OTO Journal

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.

The highlighted articles for February 2015 are “A Population-Based Study on the Association

Between Statin Use and Sudden Sensorineural Hearing Loss,” “Clinical Characteristics of Keratosis Obturans and External Auditory Canal Cholesteatoma,” “Correlating Regional Aeroallergen Effects on Internet Search Activity,” “Lymphedema Outcomes in Patients with Head and Neck Cancer,” and “Readability Assessment of Online Tracheostomy Care Resources.”

Click here to read the full article.

The highlighted articles for February 2015 are “A Population-Based Study on the Association

Between Statin Use and Sudden Sensorineural Hearing Loss,” “Clinical Characteristics of Keratosis Obturans and External Auditory Canal Cholesteatoma,” “Correlating Regional Aeroallergen Effects on Internet Search Activity,” “Lymphedema Outcomes in Patients with Head and Neck Cancer,” and “Readability Assessment of Online Tracheostomy Care Resources.”

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.  

The highlighted articles for this month are “Ubiquitous Aspirin: A Systematic Review of Its Impact on Sensorineural Hearing Loss,” “Treatment of Aspirin Exacerbated Respiratory Disease with a Low Salicylate Diet: A Pilot Crossover Study,” “Current Trends in Perioperative Antibiotic Use: A Survey of Otolaryngologists,” “Surgical Fires in Laser Laryngeal Surgery: Are We Safe Enough?,” and “Endolymphatic Duct Blockage: Randomized Controlled Trial of a Novel Surgical Technique for Ménière's Disease Treatment.”

Click here to read the full article.

The highlighted articles for this month are “Ubiquitous Aspirin: A Systematic Review of Its Impact on Sensorineural Hearing Loss,” “Treatment of Aspirin Exacerbated Respiratory Disease with a Low Salicylate Diet: A Pilot Crossover Study,” “Current Trends in Perioperative Antibiotic Use: A Survey of Otolaryngologists,” “Surgical Fires in Laser Laryngeal Surgery: Are We Safe Enough?,” and “Endolymphatic Duct Blockage: Randomized Controlled Trial of a Novel Surgical Technique for Ménière's Disease Treatment.”

Click here to read the full article.  

This podcast highlights original research in the January 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 Soham Roy and Lee Smith and associate editor Kenneth Altman in discussing the issue of airway fires in the operating room during laser laryngeal surgery.

Airway fires continue to be a dreaded complication of laser laryngeal surgery. Prior work by the authors has demonstrated that endoscopic airway surgery remains the most frequent cause of operating room fires. In the current study, Roy and Smith employ a simulated laser surgical environment in which they utilize a mannequin model to vary the parameters of inspired oxygen concentration and examine various maneuvers designed to decrease the incidence and morbidity of airway fires. Their study demonstrates that sustained airway fires occur at 40% FiO2 and above, while O2 concentrations of 29% or lower demonstrate flaming briefly, if at all. In addition, the authors note that cuffs strikes are a significant risk for fires, and that wet pledgets are not an absolutely protection from these events. The authors discuss the important implications of their paper and provide guidance for decreasing the risk of airway fires during laser laryngeal surgery.

This podcast highlights original research in the January 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 Soham Roy and Lee Smith and associate editor Kenneth Altman in discussing the issue of airway fires in the operating room during laser laryngeal surgery.

Airway fires continue to be a dreaded complication of laser laryngeal surgery.  Prior work by the authors has demonstrated that endoscopic airway surgery remains the most frequent cause of operating room fires.  In the current study, Roy and Smith employ a simulated laser surgical environment in which they utilize a mannequin model to vary the parameters of inspired oxygen concentration and examine various maneuvers designed to decrease the incidence and morbidity of airway fires.  Their study demonstrates that sustained airway fires occur at 40% FiO2 and above, while O2 concentrations of 29% or lower demonstrate flaming briefly, if at all.  In addition, the authors note that cuffs strikes are a significant risk for fires, and that wet pledgets are not an absolutely protection from these events.  The authors discuss the important implications of their paper and provide guidance for decreasing the risk of airway fires during laser laryngeal surgery.