This podcast highlights the updated clinical practice guideline on adult sinusitis that is published as an April 2015 supplement to Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. In the first of two podcasts for this supplement, Editor in chief John Krouse is joined by lead author Richard Rosenfeld and co-author Richard Orlandi in discussing key findings from the guideline in the diagnosis and treatment of adults with symptoms of sinusitis.

Sinusitis affects about 1 in 8 adults in the United States, resulting in more than 30 million annual diagnoses. The direct cost of managing acute and chronic sinusitis exceeds $11 billion per year, with additional expense from lost productivity, reduced job effectiveness, and impaired quality of life. More than 1 in 5 antibiotics prescribed in adults are for sinusitis, making it the fifth-most common diagnosis responsible for antibiotic therapy.  Rhinosinusitis may be classified by duration as acute rhinosinusitis (ARS) if less than 4 weeks’ duration or as chronic rhinosinusitis (CRS) if lasting more than 12 weeks, with or without acute exacerbations. ARS may be classified further by presumed etiology, based on symptoms and time course, into acute bacterial rhinosinusitis (ABRS) or viral rhinosinusitis (VRS).  Symptoms include purulent nasal discharge accompanied by nasal obstruction, facial pain/pressure/fullness, or both. Acute bacterial rhinosinusitis can be differentiated from acute viral rhinosinusitis if symptoms persist for at least 10 days without improvement or if symptoms worsen within 10 days after initial improvement.  In addition, clinicians should not obtain radiographic imaging for uncomplicated acute rhinosinusitis.  Furthermore, clinicians can consider watchful waiting without antibiotic treatment for uncomplicated acute sinusitis.  Primary antibiotic therapy should include 5 to 10 days of amoxicillin with or without clavulate for most adults with sinusitis.  These guidelines discuss additional recommendations and options for clinicians treating these adult patients with sinusitis.

Click here to read the full article. 

This podcast highlights original research published in the April 2015 issue of Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief John Krouse is joined by lead author Travis Lewis and associate editor Cristina Baldassari in discussing the issue of weight gain among patients who have undergone adenotonsillectomy.

Adenotonsillectomy remains a commonly performed operative procedure for both obstructive sleep apnea and recurrent infection. Change in weight following surgery has been discussed for many years, with recent evidence suggesting that some patients gain weight following removal of the tonsils. The current paper further investigates this clinical issue to try to determine the effective of adenotonsillar surgery on weight, height, and BMI. In this study, the authors utilized a case control methodology in which 154 patients undergoing adenotonsillectomy were compared with 182 demographically matched children enrolled in primary care practices over a two-year period. The authors noted that at each 6-month assessment, children who underwent adenotonsillectomy gained more weight than matched nonsurgical controls. In addition, obese children gained significantly greater amounts of weight following surgery than did nonobese children at 12-, 18-, and 24-months. The authors discuss the implications of their findings, especially the observation of significant weight gain among obese children after adenotonsillectomy, for clinical practice, patient counseling and further research.

Click here to read the full article.

This podcast highlights original research published in the April 2015 issue of Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief John Krouse is joined by lead author Travis Lewis and associate editor Cristina Baldassari in discussing the issue of weight gain among patients who have undergone adenotonsillectomy.

Adenotonsillectomy remains a commonly performed operative procedure for both obstructive sleep apnea and recurrent infection.  Change in weight following surgery has been discussed for many years, with recent evidence suggesting that some patients gain weight following removal of the tonsils.  The current paper further investigates this clinical issue to try to determine the effective of adenotonsillar surgery on weight, height, and BMI.  In this study, the authors utilized a case control methodology in which 154 patients undergoing adenotonsillectomy were compared with 182 demographically matched children enrolled in primary care practices over a two-year period.  The authors noted that at each 6-month assessment, children who underwent adenotonsillectomy gained more weight than matched nonsurgical controls.  In addition, obese children gained significantly greater amounts of weight following surgery than did nonobese children at 12-, 18-, and 24-months.  The authors discuss the implications of their findings, especially the observation of significant weight gain among obese children after adenotonsillectomy, for clinical practice, patient counseling and further research.

Click here to read the full article. 

The highlighted articles for March 2015 are “Analysis of an online match discussion board: improving the otolaryngology-head and neck surgery match,” “The decline of tracheotomy amongst otolaryngologists: a 14-year review,” “Characteristics and intraoperative treatments associated with head and neck free tissue transfer complications and failures,” “TORP ossiculoplasty outcomes with and without a stapes footplate prosthesis.”

Click here to read the full article.

This podcast highlights original research published in the March 2015 issue of Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief John Krouse is joined by lead author Kyle Stansifer and associate editor Daniel Deschler in discussing the topic of modifiable risk factors in patients with thyroid cancers.

While it is well known that the risk of thyroid cancer can be increased by factors that may be outside of the patient’s control, such as exposure to ionizing radiation, the risks of common patient characteristics such as smoking, drinking, and BMI are not well appreciated. In the present study, the authors examined 467 patients with thyroid cancer from a single institutional database and compared them with a control group of 255 patients without thyroid cancer. Their analyses demonstrated that none of these modifiable factors were associated with an increased risk of thyroid cancer among their sample of patients. Interestingly, while there was no relationship with obesity, there appeared to be a small, although statistically significant, reduction in risk among current alcohol users and smokers. While not recommending the use of these substances in an attempt to reduce thyroid cancer risk, the authors do point out some potential theoretical mechanisms that might explain these observations. The authors discuss the implications of their findings for clinical practice and further research.

Click here to read the full article.

The highlighted articles for March 2015 are “Analysis of an online match discussion board: improving the otolaryngology-head and neck surgery match,” “The decline of tracheotomy amongst otolaryngologists: a 14-year review,” “Characteristics and intraoperative treatments associated with head and neck free tissue transfer complications and failures,” “TORP ossiculoplasty outcomes with and without a stapes footplate prosthesis.”

Click here to read the full article. 

This podcast highlights original research published in the March 2015 issue of Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief John Krouse is joined by lead author Kyle Stansifer and associate editor Daniel Deschler in discussing the topic of modifiable risk factors in patients with thyroid cancers.

While it is well known that the risk of thyroid cancer can be increased by factors that may be outside of the patient’s control, such as exposure to ionizing radiation, the risks of common patient characteristics such as smoking, drinking, and BMI are not well appreciated.  In the present study, the authors examined 467 patients with thyroid cancer from a single institutional database and compared them with a control group of 255 patients without thyroid cancer.  Their analyses demonstrated that none of these modifiable factors were associated with an increased risk of thyroid cancer among their sample of patients.  Interestingly, while there was no relationship with obesity, there appeared to be a small, although statistically significant, reduction in risk among current alcohol users and smokers.  While not recommending the use of these substances in an attempt to reduce thyroid cancer risk, the authors do point out some potential theoretical mechanisms that might explain these observations.  The authors discuss the implications of their findings for clinical practice and further research.

Click here to read the full article. 

This podcast highlights a clinical practice guideline on allergic rhinitis that is published as a February 2015 supplement to Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. In the first of two podcasts for this supplement, Editor in chief John Krouse is joined by lead author Michael Seidman and co-author Sandra Lin in discussing key findings from the guideline in the diagnosis and treatment of patients with allergic rhinitis.

Allergic rhinitis is a common condition affecting both children and adults. It affects about 1 in 6 Americans and is responsible for $2 billion to $5 billion in direct healthcare expenditures annually. It is defined as an IgE-mediated inflammatory response of the nasal mucosa after exposure to inhaled antigens. Symptoms include sneezing, nasal itching, anterior or posterior nasal discharge, and nasal congestion. Allergic rhinitis can occur seasonally or can be present throughout the year. In the guideline, several key recommendations and options were offered. Clinicians should make a diagnosis of allergic rhinitis on the basis of history and physical examination, and utilize allergy testing when the diagnosis is uncertain or when patients do not respond to empiric therapy. Clinicians should not routinely perform imaging studies in patients whose symptoms correspond to a diagnosis of allergic rhinitis. In addition, clinicians should primarily use intranasal corticosteroid medications or oral antihistamines for the primary treatment of allergic rhinitis, rather than leukotriene receptor antagonists. The guidelines discuss additional recommendations and options for clinicians treating these patients with allergic rhinitis.

This podcast highlights a clinical practice guideline on allergic rhinitis that is published as a February 2015 supplement to Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. In the second of two podcasts for this supplement, Editor in chief John Krouse is joined by co-authors Jesse Hackell and Mark Dykewicz in discussing implications of the guidelines for primary care physicians and pediatricians.

Allergic rhinitis is the most common chronic condition affecting children in the United States today. It is responsible for impaired quality of life and is associated with decreased work and school attendance and decreased productivity and efficiency. It is important for primary care clinicians to consider a diagnosis of allergic rhinitis in all children who present with the classic symptoms of sneezing, nasal itching, anterior and posterior discharge, and nasal congestion. The authors also discuss the role for allergy testing and immunotherapy in patients with allergic rhinitis, and look at issues such as prevention and environmental control measures in this podcast.

This podcast highlights a systematic review and meta-analysis published in the February 2015 issue of Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief John Krouse is joined by authors Carrie Liu and Joseph Dort and associate editor Jennifer Shin in discussing the issue of early vs. late tracheostomies and its impact on clinical indicators such as length of stay in intensive care units (ICUs).

One question that is often debated is whether it is preferential to perform tracheostomies early in the course of an illness among intubated ICU patients, or whether it is preferential to delay these procedures to avoid the potential complications that might occur following tracheostomy. In this paper, the authors performed a systemic review of the literature and selected 11 papers for inclusion. In a meta-analysis of these studies, the authors noted that there was a significant decrease in length of ICU stay among patients receiving an early tracheostomy. There was no difference noted in overall mortality between the two groups. The currently available data were considered insufficient to discuss differences in indices such as incidence of pneumonia or occurrence of laryngotracheal injury. The authors discuss the important implications of their findings and offer discussion about the need for further research in this important area.

Click here to read the full article.