Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by Associate Editor Jacob Hunter, MD, and senior author Jay F. Piccirillo, MD, for a discussion of the article “Identifying Predictors of Treatment Response in Meniere's Disease: A Clinical Severity Staging System,” which published in the January 2024 issue of Otolaryngology–Head and Neck Surgery. Their conversation highlights how decreased vertigo severity, reduced comorbidity burden, and absence of hearing loss are associated with conservative treatment response in Meniere's disease. Click here to read the article.

Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by Associate Editor Jacob Hunter, MD, and co-author Anil K. Lalwani MD, for a discussion of the article “The Association of Hearing Loss With Active Music Enjoyment in Hearing Aid Users,” which published in the December 2023 issue of Otolaryngology–Head and Neck Surgery. Their conversation highlights the effect of hearing aids on active music enjoyment in individuals with varying levels of hearing loss. Article: https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ohn.473

Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by Associate Editor Babak Givi, MD, and lead author Leila J. Mady MD, PhD, MPH, to discuss “Gender Differences Among Head and Neck Microvascular Reconstructive Surgeons,” which published in the November 2023 issue of Otolaryngology–Head and Neck Surgery.  The research used a survey that was sent to facial plastic and maxillofacial surgeons, in addition to microvascular surgeons, to gain a comprehensive understanding of what causes gender differences in the subspecialty. One takeaway of note was that there were no gender differences when it came to training and practice patterns. Another revealed gender differences when explaining changes in practice—for men, the reasons related to career advancement; for women, the reasons related to burnout, usually related to work-life balance and especially if they have children.

Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by Associate Editor Raymond L. Chai, MD, and lead author Julia E. Noel, MD, to discuss “Time-Driven Activity-Based Cost Comparison of Thyroid Lobectomy and Radiofrequency Ablation,” which published in the October 2023 issue of Otolaryngology–Head and Neck Surgery.  Dr. Noel and her coauthors used time-driven activity-based cost methodology to drill down the details that reveal radiofrequency ablation (RFA) is a more cost-effective treatment modality. They looked at the entire treatment cycle for both lobectomy and RFA— from initial visit in clinic through the procedure and postoperative visit—to determine cost data for the hospital.

Editor in Chief Cecelia E. Schmalbach, MD, MSc, hosts Associate Editor Michael J. Brenner, MD, and lead author Ryan N. Heffelfinger, MD, for a conversation about the article “Recovery Benefit With Total Intravenous Anesthesia in Patients Receiving Rhinoplasty,” which published in the September 2023 issue of Otolaryngology–Head and Neck Surgery. This wide-ranging discussion covers outcomes of less nausea and vomiting for patients receiving TIVA, cost of TIVA, and data related to the environmental impact of TIVA vs. inhalational agents. Click here to read the article.

Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by Associate Editor Thomas Q. Gallagher, DO, and lead author Sarah Nuss, BS, for a discussion of the article “Developing Consensus on Priority Pediatric Otolaryngology-Head and Neck Surgery Conditions and Procedures,” which published in the August 2023 issue of Otolaryngology–Head and Neck Surgery. This study was done in collaboration with the Global OHNS Initiative and used the Delphi method to capture consensus lists through survey participants representative of the seven World Bank regions. Click here to read the article.

Editor in Chief Cecelia E. Schmalbach, MD, MSc, Associate Editor James “Whit” Mims, MD, and lead author Ameen Amanian, MD, MSE, discuss “The Evolution and Application of Artificial Intelligence in Rhinology: A State of the Art Review.” The article, published in the July 2023 issue of Otolaryngology-Head and Neck Surgery, provides a good introduction to what AI can do within the context of rhinology. One podcast highlight fleshes out the AI nomenclature and provides examples within rhinology of machine learning and deep learning, both of which fall under the AI domain. AI for diagnosis and AI for treatment outcomes are explained as are the limits of AI within the high stakes of patient care, including how AI will never replace the personal touch only clinicians can provide. Click here to read the article.

Join Editor in Chief Cecelia E. Schmalbach, MD, MSc, for a compelling discussion of “Individuals Experiencing Homelessness: A Systematic Review of Otolaryngology-Related Health Needs and Community-Based Interventions,” which published in the June 2023 issue of Otolaryngology-Head and Neck Surgery. Associate Editor Michael J. Brenner, MD; senior author Antoine Eskander MD, ScM, FRCSC; and lead author and recent graduate Dorsa Mavedatnia, MD, take part in the discussion of this literature review on otolaryngology health needs and interventions for populations, both adult and pediatric, experiencing homelessness.

Editor in Chief Cecelia E. Schmalbach, MD, MSc, hosts a rich discussion of “Current Management of Subcondylar Fractures: A Systematic Review,” which published in the May 2023 issue of Otolaryngology-Head and Neck Surgery. Lead author Kalpesh Vakharia, MD, and Associate Editor Babak Givi, MD, join Dr. Schmalbach in a conversation that delves into the approaches used for subcondylar fractures when treating facial trauma. This systematic review provides a resource for surgeons and demonstrates a need for more research in this area. Click here to read the article.

Editor in Chief Cecelia E. Schmalbach, MD, MSc, hosts a discussion on “Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients,” which published in the April 2023 issue of Otolaryngology–Head and Neck Surgery. Joining the conversation are authors Maggie A. Kuhn MD, MAS, and M. Boyd Gillespie MD, MSc, and Associate Editor Lee M. Akst, MD. This ECS is the result of a multidisciplinary team comprising experts who reached consensus on recommendations that fill existing clinical practice knowledge gaps. Also discussed are the statements that did not reach consensus, particularly those around the use of reactive and prophylactic feeding tubes. Click here to read the article.

Editor in Chief Cecelia E. Schmalbach, MD, MSc, hosts this podcast on the article “Sponsorship and Negotiation for Women Otolaryngologists at Midcareer: A Content Analysis,” which published in the March 2023 issue of Otolaryngology–Head and Neck Surgery. Coauthors Janice L. Farlow, MD, PhD, and Sonya Malekzadeh, MD, along with Associate Editor Chau T. Nguyen, MD, join Dr. Schmalbach for a compelling discussion around the need for midcareer women otolaryngologists to gain knowledge about sponsorship and negotiation.  Click here to read the full article.

Editor in Chief Cecelia E. Schmalbach, MD, MSc, hosts this podcast on “Expert Consensus Statement: Management of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy,” which published in the February 2023 issue of Otolaryngology–Head and Neck Surgery. Joining Dr. Schmalbach in conversation are lead author and chair of the expert panel, Stacey L. Ishman, MD, MPH, and coauthor Stephen C. Maturo, MD. This ECS focuses on pediatric patients (between ages 2 and 18) with persistent OSA and on those with recurrent OSA who underwent previous tonsillectomy or adenotonsillectomy, but OSA came back. Rich discussion occurs around how consensus statements concentrate on quality opportunities that exist and areas on which experts agree to put forth best practices. Click here to read the full article.

Join Otolaryngology–Head and Neck Surgery’s Editor in Chief Cecelia E. Schmalbach, MD, MSc, as she discusses the article “Reimbursement Trends in Pediatric Otolaryngology From 2000 to 2020: A CMS Physician Fee Schedule Analysis” with senior author Jay R. Shah, MD, and Associate Editor Thomas Q. Gallagher, DO. This engaging conversation touches on Common Procedural Terminology (CPT) codes, relative value units, reevaluation of CPT codes, and trends in reimbursements. Click here to read the full article.

This podcast highlights a systematic review to determine safety of cochlear implantation in pediatric patients 12 months and younger. This research was published in the December 2022 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) The results of this systematic review and meta-analysis involving 269 studies suggest that cochlear implantation in patients 12 months and younger is safe with similar rates of complications to older cohorts. Click here to read the full article

This podcast highlights original research published in the November official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objectives were to offer pragmatic, evidence-informed advice on administering corticosteroids in otolaryngology during the coronavirus disease 2019 (COVID-19) pandemic, considering therapeutic efficacy, potential adverse effects, susceptibility to COVID-19, and potential effects on efficacy of vaccination against SARS-CoV-2, which causes COVID-19.   In conclusion, systemic corticosteroids (SCSs) reduce long-term morbidity in individuals with SSNHL and Bell’s palsy, reduce acute laryngotracheal edema, and have benefit in perioperative management for some procedures. Topical or locally injected corticosteroids are preferable for most other otolaryngologic indications. SCSs have not shown long-term benefit for sinonasal disorders. SCSs are not a contraindication to vaccination with COVID-19 vaccines approved by the US Food and Drug Administration. The Centers for Disease Control and Prevention noted that these vaccines are safe for immunocompromised patients.   Click here to read the full article.

This podcast highlights original research published in the October official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objectives were to identify anatomic contributions to chronic rhinosinusitis (CRS) necessitating revision endoscopic sinus surgery (RESS), and to create a clinical acronym to guide imaging review prior to RESS that addresses pertinent sites of disease and potential sites of surgical morbidity.   In conclusion, the REVISIONS acronym was developed as a tool to distill the unique anatomic contributions of primary endoscopic sinus surgery failure into a format that can be easily incorporated in preoperative radiologic review and surgical planning to optimize outcomes and minimize complications.   Click here to read the full article.

This podcast concludes the remarkable tenure of John H. Krouse, MD, PhD, MBA, editor in chief of Otolaryngology–Head and Neck Surgery and OTO Open, the official journals of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF), and welcomes the incoming leadership of Cecelia E. Schmalbach, MD, MSc, as the new editor in chief. In his final podcast, Dr. Krouse ushers in a new era as he discusses with Dr. Schmalbach her plans for the future of both AAO-HNSF journals.   Click here to read the article.

This podcast highlights original research published in the August official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective was to evaluate nodule height-to-width ratio as a continuous variable predicting likelihood of thyroid malignancy. In conclusion, our results support the association between greater height-to-width ratio and malignancy but suggest that a multilevel rather than binary variable improves prediction. The likelihood ratios at different intervals give a more nuanced view of how height-to-width ratio predicts malignancy. With continuing review of guidelines for thyroid nodule biopsy, it is important to consider these data for any point total attributed to shape.   Click here to read the article.

This podcast highlights original research published in the July official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective was to determine the range of incidental mucosal changes in a general sinonasally asymptomatic population on radiology. In conclusion, the prevalence of incidental mucosal changes in a general asymptomatic population on radiology needs to be considered when making a diagnosis of chronic rhinosinusitis.   Click here to read the article.

This podcast highlights original research published in the June official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. There has never been a time in our society when we have been as willing and open in our discussions around issues of racial and ethnic inequalities, discrimination, systemic racism, and socioeconomic disparities. Within this dialogue on health inequalities, one soon comes to realize the strong interplay of bioethics, social justice, and systemic racism on health care and outcomes. Ethical questions pertaining to the rights of individual participants in research, criteria for inclusion and recruitment into studies, and the development of trusting relationships among communities, health systems, and governmental agencies continue to challenge us in achieving our goals of reducing health disparities and improving health care outcomes for our patients.   Click here to read the full issue.

This podcast highlights original research published in the May official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Infants with posterior tongue-tie (PTT) can have substantial difficulty with breastfeeding and bottle-feeding. This study aimed to address the dearth in investigational objective data surrounding PTT release to better quantify the postoperative impacts of frenotomy for ankyloglossia. In conclusion, when measured 10 days after frenotomy for PTT, infants improve feeding parameters using an objective bottle-feeding system. Similar improvements are seen with patient-reported outcomes when PTT is released. Posterior tongue-tie is a valid clinical concern, and surgical release can improve infant and maternal symptoms.   Click here to read the full article.

This podcast highlights original research published in the April official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. There is little research on the rate and risk factors for revision tonsillectomy after primary intracapsular tonsillectomy. Our study aimed to determine the revision rate following intracapsular tonsillectomy, identify patient characteristics that may increase the probability of revision surgery, and report the tonsillar hemorrhage rate after revision. In conclusion, patients below age 4 years and patients with gastroesophageal reflux disease may be at increased risk of undergoing revision tonsillectomy after primary intracapsular tonsillectomy. These factors should be considered when selecting an intracapsular technique for primary tonsillectomy in pediatric patients.   Click here to read the full article.

This podcast highlights original research published in the March 2022 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The aim of this study was to evaluate the hearing outcome of cochlear implantation in patients deafened by Ménière’s disease. In conclusion, cochlear implant in patients deafened by Ménière’s disease significantly improves word recognition scores regardless of whether medical or surgical treatment is used prior to implantation. The potential improvement in word recognition scores decreases after age 70 years.   Click here to read the full article.

This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations", published as a supplement to the February 2022 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The purpose of this clinical practice guideline update is to reassess and update recommendations in the prior guideline from 2013 and to provide clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children.   Click here to read the Guideline.

This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations", published as a supplement to the February 2022 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The purpose of this clinical practice guideline update is to reassess and update recommendations in the prior guideline from 2013 and to provide clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children.   Click here to read the Guideline.

This podcast highlights original research published in the January 2022 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The aging US population requires an increasing volume of otolaryngology–head and neck surgery services, yet the otolaryngologist physician workforce remains static. Advanced practice providers (APPs), including physician assistants and nurse practitioners, improve access across the continuum of primary and subspecialty health care. In conclusion, the demand for health care services in otolaryngology care will increasingly exceed otolaryngologist surgeon workforce capacity. APPs are valuable partners in meeting growing needs of the population. While further data are needed to determine the optimal models of high-quality care, it is clear that APPs will be play an ever-greater role in shaping the specialty. Successful growth in otolaryngology–head and neck surgery requires a culture that supports effective integration of APPs across diverse practice settings. Progress also requires open-mindedness on the part of both providers and patients in embracing evolving models of care.   Click here to read the full article.

This podcast highlights original research published in the December 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Subglottic stenosis (SGS) is a known complication of granulomatosis with polyangiitis (GPA). We investigated the impact of medical and surgical interventions on the surgical dilation interval and characterized patients with glottic involvement. In conclusion, although GPA is classically thought to affect the subglottis, it also involves the glottis in a subset of patients. These patients have greater complaints of dysphonia and require more frequent surgery. Systemic therapy may increase dilation intervals. In this preliminary study, patients taking leflunomide demonstrated an improvement, highlighting the need for further study of immunosuppression regimens in the treatment of GPA-associated SGS.   Click here to read the full article.

This podcast highlights original research published in the November 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective was to review long-term clinical and quality-of-life outcomes following free flap reconstruction for osteonecrosis. In conclusion, the majority of patients maintained or had advancement in diet following reconstruction, with low rates of osteonecrosis or cancer recurrence and above-average scores on UW-QOL survey suggesting good return of function and quality of life.   Click here to read the full article.

This podcast highlights original research published in the October 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Pathologic extranodal extension (ENE) is an important adverse feature for human papillomavirus (HPV)–negative head and neck squamous cell carcinoma (HNSCC), but the prognostic significance of microscopic ENE (ENEmi) and role of adjuvant concurrent chemoradiation (CRT) for ENEmi remain unclear. This study evaluates (1) the prognostic significance of ENEmi in HPV-negative HNSCC and (2) whether adjuvant CRT is associated with improved overall survival (OS) for these patients. In conclusion, for patients with HPV-negative HNSCC, pN+ with ENEmi is associated with worse OS than pN+ without ENE. However, for patients with ENEmi, concurrent CRT is not associated with improved OS relative to RT. The optimal adjuvant paradigm for ENEmi requires additional investigation.   Click here to read the full article.

This podcast highlights original research published in the September 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Traumatic brain injury (TBI) is the leading cause of acquired long-term disability during childhood, and it may result in wide range of negative developmental consequences. Auditory dysfunction is generally recognized to be a possible sequela of pediatric TBI. Unfortunately, few contemporary studies have quantified the association between head injury and hearing loss in the pediatric population. In conclusion, findings suggest a notable association between TBI and hearing loss. Children with a history of TBI are 2.67 times more likely to have concurrent hearing complaints.   Click here to read the full article.

This podcast highlights original research published in the August 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective was to evaluate the presence of bitter taste receptors (T2Rs) in the middle ear and to examine their relationship with chronic ear infections. In conclusion, T2Rs were found within the middle ear of every patient sampled; the rs1376251 allele of TAS2R50 appears to be related to chronic ear infections. These receptors are an intriguing target for future research and possible drug targeting.   Click here to read the full article.

This podcast highlights original research published in the July 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Nurse practitioners and physician assistants form a growing advanced practice provider (APP) group. We aim to analyze the trends and types of services provided by APPs in otolaryngology. In conclusion, due to increasing numbers, APPs are accounting for more patient visits and procedures over time. The physician workforce and the numbers of procedures performed per physician have remained relatively stable from 2012 to 2017. Increasing complexity of patients seen and a broader range of procedures offered by work-experienced or postgraduate-trained APPs may further improve access to health care in the face of possible physician shortages.   Click here to read the full article.

This podcast highlights original research published in the June 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective was to characterize the relationship between objective tympanogram values and patient-reported symptoms and associations with common comorbid conditions. In conclusion, patients with symptoms of ETD may have a TPP within a range typically considered normal per conventional standards. This suggests that the currently accepted interpretation of tympanometry findings may be insensitive for the diagnosis of less severe cases of ETD.   Click here to read the full article.

This podcast highlights original research published in the May 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Part 1 objective: To assess the prevalence of distress and burnout in otolaryngology trainees, including associations with relevant sociodemographic and professional factors, and to compare these results with those of attending otolaryngologists. Part 2 objective: To ascertain the prevalence of and associations with distress and professional burnout among academic otolaryngology attending physicians. Part 1 conclusion: Otolaryngology trainees experience significant work-place distress (49%) and burnout (35%). Gender, HW, and NOC had the strongest associations with distress and burnout. Part 2 conclusion: Distress or professional burnout occurs in more than a quarter of academic otolaryngology attending physicians, whereas the prevalence of depression or anxiety is approximately 10%. The number of hours worked per week had the strongest association with distress and burnout. These findings may be used to develop and implement programs to promote physician well-being and mitigate professional burnout.   Click here to read the full part 1 article. Click here to read the full part 2 article.

This podcast highlights original research published in the April 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The first pediatric tracheostomy tube change often occurs within 7 days after placement; however, the optimal timing is not known. The primary objective was to determine the rate of adverse events of an early tube change. Secondary objectives compared rates of significant peristomal wounds, sedation requirements, and expedited intensive care discharges. In conclusion, the first tracheostomy tube change in children can occur without adverse events on day 4, resulting in fewer significant peristomal wounds and earlier intensive care discharge.   Click here to read the full article.

This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations", published as a supplement to the April 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The purpose of this specialty-specific guideline is to identify quality improvement opportunities in postoperative pain management of common otolaryngologic surgical procedures. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation.   Click here to read the Guideline.

This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations", published as a supplement to the April 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The purpose of this specialty-specific guideline is to identify quality improvement opportunities in postoperative pain management of common otolaryngologic surgical procedures. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation.   Click here to read the Guideline.

This podcast highlights original research published in the March 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective was to evaluate the association between race/ethnicity and insurance status on the access to early cochlear implantation. In conclusion, racial/ethnic and insurance disparities in pediatric cochlear implantation can be observed at the population level. To address these racial and insurance inequalities, a multidisciplinary care team is needed and priorities should be given to research endeavors and policy interventions that target these disparities.   Click here to read the full article.

This podcast highlights original research published in the February 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Building a diverse otolaryngology workforce—one that mirrors society—is critical. In conclusion, structural inequities are woven into the fabric of society and medicine, and these effects are often invisible to those who do not bear the brunt of them.   Click here to read the full article.

This podcast highlights original research published in the January 2021 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective was to investigate differences in epidemiology of oropharyngeal squamous cell carcinoma (OPSCC) with regards to human papillomavirus (HPV), race, and socioeconomic status (SES) using the National Cancer Database (NCDB). In conclusion, significant differences in HPV status exist between socioeconomic and racial groups, with HPV-negative disease more common among blacks and lower SES. When controlling for HPV status, race and SES still influence outcomes in oropharyngeal cancers.   Click here to read the full article.

This podcast highlights original research published in the December 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Auditory complaints are commonly reported following traumatic brain injury (TBI). However, few studies have examined patient-reported auditory symptomatology and quality-of-life metrics in individuals with TBI. We hypothesize that following TBI, individuals can experience auditory symptoms even with hearing thresholds in the normal range. In conclusion, despite hearing thresholds in the normal range, some individuals with TBI experience decrements in auditory quality of life, even in the absence of TBF.   Click here to read the full article.

This podcast highlights original research published in the November 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Eustachian tube dysfunction (ETD) is a common diagnosis among adults presenting for outpatient care. We sought to determine national utilization and the associated cost of invasive procedures for adult ETD. In conclusion, several nasal and otologic procedures are associated with a diagnosis of adult ETD at substantial cost. Development of therapeutic alternatives should be sought to mitigate the need for invasive procedures to treat this condition.   Click here to read the full article.

This podcast highlights original research published in the October 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this review was to evaluate clinicians’ adherence to these guidelines’ recommendations as measured in the literature. In conclusion, adherence to recommendations in the AAO-HNSF guidelines varies widely. These findings highlight areas for further guideline dissemination, research about guideline adoption, and quality improvement   Click here to read the full article.

This podcast highlights original research published in the September 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective was to investigate the outcomes of pediatric tracheostomy as influenced by demographics and comorbidities. In conclusion, pediatric tracheostomy requires substantial health care resources with length of stay escalating over recent years. Age, race, region, discharge destination, and comorbidities were associated with differences in length of stay.   Click here to read the full article.

This podcast highlights original research published in the August 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Human papillomavirus (HPV)–positive oropharynx squamous cell carcinoma (OPSCC) is known to have improved survival over HPV-negative disease. However, it is largely unknown whether HPV status similarly affects survival in patients presenting with distant metastatic disease. We queried the National Cancer Database for OPSCC with distant metastasis. In conclusion, HPV-positive OPSCC has improved survival in the setting of distant metastatic presentation as compared with HPV-negative disease and shows greater responsiveness to treatment.   Click here to read the full article.

This podcast highlights original research published in the June 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Surgical care is increasingly shifting to freestanding ambulatory surgical centers (ASCs). The extent to which otolaryngologists use ASCs has implications for patient safety and health care spending. This study characterizes trends in utilization and resultant financial implications for common otolaryngologic procedures performed at ASC and hospital outpatient departments (HOPDs). In conclusion, otolaryngologists shifted outpatient surgical care from HOPDs to ASCs between 2010 and 2017, with resultant reductions in Medicare expenditures. Further research is necessary to examine the impact of this shift on patient safety.   Click here to read the full article.

This podcast highlights two original research papers published in the July 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The first paper is: "Olfactory Dysfunction: A Highly Prevalent Symptom of COVID-19 With Public Health Significance". The objective of this study was to review the scientific evidence about anosmia in COVID-19. In conclusion, current evidence shows that OD is highly prevalent in COVID-19, with up to 80% of patients reporting subjective OD and objective olfactory testing potentially showing even higher prevalence. OD is frequently accompanied by taste dysfunction. Up to 25% of COVID-19 patients may experience sudden-onset OD as the first symptom. A large proportion of COVID-19 OD cases may resolve over the period of a few weeks. Click here to read the full article. The second paper is: "The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis". The objective was to determine the pooled global prevalence of olfactory and gustatory dysfunction in patients with the 2019 novel coronavirus (COVID-19). In conclusion, olfactory and gustatory dysfunction are common symptoms in patients with COVID-19 and may represent early symptoms in the clinical course of infection. Increased awareness of this fact may encourage earlier diagnosis and treatment, as well as heighten vigilance for viral transmission. To our knowledge, this is the first meta-analysis to report on the prevalence of these symptoms in COVID-19 patients. Click here to read the full article.

This podcast highlights original research published in the May 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective was to identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology–Head and Neck Surgery clinical consensus statements. In conclusion, this expert panel reached consensus on several statements that clarify the diagnosis, management, and treatment of ankyloglossia in children 0 to 18 years of age. Lack of consensus on other statements likely reflects knowledge gaps and lack of evidence regarding the diagnosis, management, and treatment of ankyloglossia. Expert panel consensus may provide helpful information for otolaryngologists treating patients with ankyloglossia.   Click here to read the full article.

This podcast highlights original research published in the April 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this study was to demonstrate whether race, education, income, or insurance status influences where patients seek medical care and the cost of care for a broad range of otolaryngologic diseases in the United States. In this study, significant racial and socioeconomic discrepancies exist in the utilization and cost of health care for otolaryngologic conditions in the United States.   Click here to read the full article.

This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Ménière’s Disease", published as a supplement to the April 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of Ménière’s disease. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.   Click here to read the Guideline.

This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Ménière’s Disease", published as a supplement to the April 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of Ménière’s disease. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.   Click here to read the Guideline.

This podcast highlights original research published in the March 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this study was to characterize the temporal trajectory of body image disturbance (BID) in patients with surgically treated head and neck cancer (HNC). In conclusion, in this cohort of patients surgically treated for HNC, BID worsens posttreatment before returning to pretreatment (baseline) levels at 9 months posttreatment. However, 4 in 10 patients will experience a protracted course with persistent posttreatment body image concerns, and half will experience a significant increase in BIS scores relative to pretreatment levels.   Click here to read the full article.

This podcast highlights original research published in the February 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Hospital-acquired aspiration pneumonia remains a rare but potentially devastating problem. The best means by which to prevent aspiration in a cancer hospital population has not been evaluated. The aim of this study was to evaluate the impact of dysphagia screening on aspiration pneumonia rates in an acute care oncology hospital. In conclusion, nursing-initiated dysphagia screening did not decrease aspiration pneumonia rates. The causes of aspiration-associated pneumonia were heterogeneous. Aspiration of intestinal contents is a more common source of hospital-acquired pneumonia than oropharyngeal dysphagia.   Click here to read the full article.

This podcast highlights original research published in the January 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Although neck impairment has been described following surgical resection, limited studies have investigated its prevalence in nonsurgical treatment. The purpose of this study is to determine the prevalence and predictors of neck disability following head and neck cancer (HNC) treatment and to explore its association with quality of life (QOL). In conclusion, this study revealed a high prevalence of neck disability following nonsurgical treatment. While neck disability is an established sequela of surgical resection, the impact of nonsurgical treatment has gone unrecognized. Early identification and intervention to prevent progression of neck disability are crucial to optimize QOL.   Click here to read the full article.

This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Nosebleed (Epistaxis)", published as a supplement to the January 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. For the purposes of this guideline, we define the target patient with a nosebleed as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient’s quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hospitalization for aggressive treatment of severe nosebleeds has been reported in 0.2% of patients with nosebleeds.   Click here to read the Guideline.

This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Nosebleed (Epistaxis)", published as a supplement to the January 2020 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. For the purposes of this guideline, we define the target patient with a nosebleed as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient’s quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hospitalization for aggressive treatment of severe nosebleeds has been reported in 0.2% of patients with nosebleeds.   Click here to read the Guideline.

This podcast highlights original research published in the December 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Despite increased concern with the opioid epidemic, literature remains scant regarding narcotic prescription and use following tonsillectomy. In conclusion, patient-reported narcotic use is significantly lower than the amount prescribed after tonsillectomy for benign disease. Providers can use these data to adjust narcotic-prescribing patterns while maintaining appropriate pain management for patients undergoing tonsillectomy.   Click here to read the full article.

This podcast highlights original research published in the November 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this study was to better quantify the risk of ibuprofen-associated posttonsillectomy hemorrhage (PTH). In conclusion, our meta-analysis of available cohort studies and randomized controlled trials (RCTs) shows possible increased tendency to PTH with the use of ibuprofen. This has not been demonstrated in other studies and systematic reviews because their analyses were limited by use of multiple nonsteroidal anti-inflammatory drugs and inclusion of studies limited to the perioperative period and low sample size. However, the current analysis is limited due to inclusion of many retrospective cohort studies with unclear follow-up and no blinding. Further RCTs will be required to investigate this trend toward increased PTH.   Click here to read the full article.

This podcast highlights original research published in the October 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Balloon sinuplasty (BS) is a surgical management option in the treatment of chronic rhinosinusitis. The purpose of this study was to examine BS utilization among children with a national database. In conclusion, rates of BS performance in the pediatric population have not increased over time. Results showed no difference in readmission rates between BS and ESS. BS was associated with higher costs as compared with ESS. The role of BS in the pediatric chronic rhinosinusitis population remains unclear.   Click here to read the full article.

This podcast highlights original research published in the September 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this study was to recognize that thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; Bethesda III) have different risks of malignancy based on genetic mutation and to consider molecular testing of nodules with AUS/FLUS to help avoid unnecessary morbidity or cost. In conclusion, not all molecular mutations in thyroid nodules with AUS/FLUS have a high risk of malignancy. Of note, patients with BRAF and RET mutations in our population had a 100% risk of malignancy. Patients with PAX, HRAS, or NRAS mutations had a high risk of malignancy, while patients with KRAS mutations had a lower risk of malignancy. Further studies are needed to determine if the presence of certain molecular mutations can help personalize care and aid in the decision for thyroid surgery.   Click here to read the full article.

This podcast highlights original research published in the August 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Although the literature adequately identifies the current gender inequality that exists in academic otolaryngology and describes the barriers to advancement of women in academic medicine, there is little information regarding the daily details of how successful women in academic otolaryngology achieve work-life balance. This study was designed to better understand how women in academic otolaryngology achieve work-life balance while negotiating family and childrearing commitments, clinical workload, and scholarly activity, as well as to highlight coping strategies and behaviors that women have used to achieve these successes. The conflicting demands between home and professional life are one of the barriers to recruiting, promoting, and retaining women in academic otolaryngology. Fostering a better environment for work-life balance is critical to promote the advancement of women in otolaryngology and otolaryngology leadership.   Click here to read the full article.

This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Sudden Hearing Loss (Update)", published as a supplement to the August 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This guideline update provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with sudden hearing loss. It focuses on sudden sensorineural hearing loss in adult patients aged ≥18 years and primarily on those with idiopathic sudden sensorineural hearing loss. Prompt recognition and management of sudden sensorineural hearing loss may improve hearing recovery and patient quality of life. The guideline update is intended for all clinicians who diagnose or manage adult patients who present with sudden hearing loss.   Click here to read the Guideline.

This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Sudden Hearing Loss (Update)", published as a supplement to the August 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This guideline update provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with sudden hearing loss. It focuses on sudden sensorineural hearing loss in adult patients aged ≥18 years and primarily on those with idiopathic sudden sensorineural hearing loss. Prompt recognition and management of sudden sensorineural hearing loss may improve hearing recovery and patient quality of life. The guideline update is intended for all clinicians who diagnose or manage adult patients who present with sudden hearing loss.   Click here to read the Guideline.

This podcast highlights original research published in the July 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this study was to compare outcomes for patients undergoing a transmastoid approach versus a middle fossa craniotomy approach with plugging and/or resurfacing for repair of superior semicircular canal dehiscence. Outcome measures include symptom resolution, hearing, operative time, hospital stay, complications, and revision rates. In conclusion, both the transmastoid approach and the middle fossa craniotomy approach for repair of superior canal dehiscence offer symptom resolution with minimal risk. The transmastoid approach was associated with shorter hospital stays and lower recurrence rate as compared with the middle fossa craniotomy approach.   Click here to read the full article.

This podcast highlights original research published in the June 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this study was to determine the role of cognitive testing in predicting age-appropriate audiometric responses among children aged 30 to 42 months. In conclusion, the DAYC-2 is a useful screen to identify children likely to complete an age-appropriate audiogram.   Click here to read the full article.

This podcast highlights original research published in the May 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objectives of this study were to (1) analyze unsolicited patient complaints (UPCs) among otolaryngologists, (2) identify risk factors for UPCs, and (3) determine the impact of physician feedback on subsequent UPCs. In conclusion, systematic monitoring and respectful sharing of peer-comparative patient complaint data offers an intervention associated with UPCs and concomitant malpractice risk reduction. Collegial feedback over time increases the response rate, but a small proportion of physicians will require directive interventions.   Click here to read the full article.

This podcast highlights original research published in the April 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Obstructive eustachian tube dysfunction (OETD) affects up to 5% of adults; however, available treatment strategies have limitations. It was previously reported that balloon dilation of the eustachian tube (BDET) with the eustachian tube balloon catheter + medical management (MM) results in a significantly higher proportion of subjects with normalized tympanograms versus MM alone at 6- and 24-week follow-up. The current analysis extends these initial findings by investigating the durability of BDET + MM treatment outcomes through 52 weeks. In conclusion, the present study suggests that the beneficial effects of BDET + MM on tympanogram normalization and symptoms of subjects with refractory OETD demonstrate significant durability that is clinically relevant through 52 weeks.   Click here to read the full article.

This podcast highlights original research published in the March 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objectives of this study were (1) to determine the short-term effectiveness of oral steroids in women with benign vocal fold lesions and (2) to determine the effectiveness of adjuvant oral steroids in women undergoing voice therapy for benign vocal fold lesions. In conclusion, a short course of oral steroids did not benefit women with phonotraumatic vocal fold lesions. In addition, steroids had little beneficial effect when used adjunctively with voice therapy in this patient cohort.   Click here to read the full article.  

This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Tonsillectomy in Children (Update)", published as a supplement to the February 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This update of a 2011 guideline developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children 1 to 18 years of age under consideration for tonsillectomy. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil, including its capsule, by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Tonsillectomy is one of the most common surgical procedures in the United States, with 289,000 ambulatory procedures performed annually in children   Click here to read the Guideline.  

This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Tonsillectomy in Children (Update)", published as a supplement to the February 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This update of a 2011 guideline developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children 1 to 18 years of age under consideration for tonsillectomy. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil, including its capsule, by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Tonsillectomy is one of the most common surgical procedures in the United States, with 289,000 ambulatory procedures performed annually in children   Click here to read the Guideline.  

This podcast highlights original research published in February 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this study was to understand the effects of positron emission tomography/computed tomography (PET/CT) evaluation on patients with previously untreated head and neck squamous cell carcinoma (HNSCC) with clinical evidence of regional lymph node involvement. In conclusion, when added to more conventional patient evaluation, PET/CT results in changes to the TNM categories, but overall staging and treatment were less frequently affected. Whether PET/CT should be used routinely for patients with stage III and IV HNSCC is still subjective and merits further study.   Click here to read the full article.  

This podcast highlights original research published in the January 2019 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Vestibular symptoms such as dizziness and vertigo are common after head injury and may be due to trauma to the peripheral vestibular system. The pathophysiology of peripheral vestibular symptoms following head injury without temporal bone (TB) fracture, however, is not well understood. Herein, this study investigates the histopathology of the peripheral vestibular system of patients who sustained head injury without a TB fracture. In conclusion, otopathologic analysis of patients with a history of head injury without TB fracture demonstrated peripheral vestibular otopathology. Future studies are necessary to determine if otopathology findings are directly attributable to head injury.   Click here to read the full article.  

This podcast highlights original research published in the December 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This retrospective study uses a large national claims-based database to analyze recent practice patterns related to balloon catheter dilation (BCD) of the sinuses. In conclusion, BCD, especially in the office, has risen in popularity since the introduction of Current Procedural Terminologycodes in 2011. This study reveals significant differences in demographics and comorbidities between patients undergoing BCD and those undergoing FESS. Such disparities may highlight the need for better-defined indications for use of this technology.   Click here to read the full article.

This podcast highlights original research published in the November 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The purpose of this study was to (1) determine 1-year period prevalence of suicidal ideation, suicide attempt, and completed suicide among patients newly diagnosed with a first occurrence of head and neck cancer (HNC). (2) Characterize stability and trajectory of suicidal ideation over the year following cancer diagnosis. (3) Identify patients at risk of suicidal ideation. In conclusion, suicide prevention strategies are clearly needed as part of routine clinical care in head and neck oncology, as well as their integration into clinical practice guidelines for HNC.   Click here to read the full article.

This podcast highlights original research published in the October 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The purpose of this study was to determine the incidence of posttracheostomy tracheal stenosis and to investigate variables related to the patient, hospitalization, or operation that may affect stenosis rates. In conclusion, greater than 10 days of orotracheal intubation prior to tracheostomy and endotracheal tube cuff pressure ≥30 mm H2O were associated with greater rates of subsequent tracheal stenosis. The only patient-related factor associated with tracheal stenosis was obesity. Surgical variables associated with increased rates of subsequent stenosis included placement of a tracheostomy tube size >6, use of percutaneous technique, and failure to create a Bjork flap.   Click here to read the full article.

This podcast highlights original research published in the September 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The purpose of this study was to characterize industry payments to otolaryngologists in 2016 versus 2014 and 2015. In conclusion, industry compensation to otolaryngologists is increasing and increasingly unequal, although it is still less than that in most other specialties. In otolaryngology, the Open Payments Database has not decreased physician-industry relationships as intended.   Click here to read the full article.

This podcast highlights original research published in the August 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this study was to determine factors that influence cost variability in septoplasty with inferior turbinate reduction. For septoplasty with inferior turbinate reduction, the greatest driver of cost variation was operative time. Resident involvement correlated with increased time and cost. Supply costs had a much smaller impact. When subanalyzed by resident year, junior resident–involved cases were significantly longer than no-resident cases.   Click here to read the full article.

This podcast highlights original research published in the July 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this study was to determine if balloon catheter dilation of sinus ostia affects the severity or frequency of headache among patients who have barometric pressure–related “sinus” headache. Subjects with sinus pressure headache without evidence of mucosal thickening on computed tomography had no significant difference in outcomes between active treatment (balloon dilation of sinus ostia) and placebo (nasal dilation). Further study on the etiology and effective treatment of barometric pressure / “sinus” headache is needed.   Click here to read the full article.

This podcast highlights original research published in the June 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Professional burnout is a barrier to physician wellness. Burnout is prevalent across medicine, and otolaryngology as a specialty ranks near the mean. We review burnout levels in various subgroups of otolaryngology, including academic chairs, faculty, and residents. Risk factors of burnout are discussed, which differ by subgroup. Finally, we propose measures that could help minimize burnout and promote healthy and satisfying careers.   Click here to read the full article.

This podcast highlights original research published in the May 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The purpose of this study is to identify and clarify current evidence supporting and disputing the effectiveness of perioperative antibiotic use for common otolaryngology procedures. Evidence does not support the use of perioperative antibiotics for most otolaryngologic procedures. Antibiotic overuse and variability among providers may be due to lack of formal practice guidelines. This review can help otolaryngologists understand current evidence so they can make informed decisions about perioperative antibiotic usage.   Click here to read the full article.

This podcast highlights a state-of-the-art literature review published in the April 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The aim of this report is to present a cohesive evidence-based approach to reducing venous thromboembolism (VTE) in otolaryngology–head and neck surgery. VTE prevention includes deep venous thrombosis and pulmonary embolism. Despite national efforts in VTE prevention, guidelines do not exist for otolaryngology–head and neck surgery in the United States. Otolaryngologists should consider an individualized and risk-stratified plan for perioperative thromboprophylaxis in every patient. The risk of bleeding must be weighed against the risk of VTE when deciding on chemoprophylaxis.   Click here to read the full article.

This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)", published as a supplement to the March 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia.   Click here to read the Guideline.

This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)", published as a supplement to the March 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia.   Click here to read the Guideline.

This podcast highlights original research published in the March 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Objectives: (1) Evaluate changes in subjective symptoms in patients following transmastoid canal plugging for superior semicircular canal dehiscence (SSCD) syndrome. (2) Quantify changes in hearing in patients who have undergone transmastoid canal plugging for SSCD syndrome. In our study, patients with SSCD demonstrated excellent hearing outcomes and resolution of most otologic symptoms after surgical repair. Transmastoid canal plugging, which has been described to date only in smaller case series, is a safe and effective alternative to the traditional middle cranial fossa approach.   Click here to read the full article.

This podcast highlights original research published in the February 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This study was performed to determine whether the efficacy and safety of medical management of uncomplicated peritonsillar abscess (PTA) presenting in the emergency department is equivalent to medical plus surgical therapy. In conclusion, compared to ST, MT appears to be equally safe and efficacious, with less pain, opioid use, and days off work, especially if patients with PTA present without trismus. MT for PTAs reduces the possibility of surgical complications, as well as the cost and inconvenience associated with ST.   Click here to read the full article.

This podcast highlights original research published in the January 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Home oximetry is commonly used to screen for obstructive sleep apnea (OSA) in children; however, normal oxygen desaturation levels by disease severity are not well known. It was our objective to determine if oxygen saturation levels differed by OSA severity category in children and if these differences were similar for preteen children and adolescents. In conclusion, adolescents have longer sleep times and higher obstructive apnea-hypopnea indexes than preteens, but oxygen saturations and desaturation indices were similar. This supports current triage algorithms for children with OSA, as we found no significant age-based differences   Click here to read the full article.

This podcast highlights original research published in the December 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this study was to determine the rate of residual cholesteatoma during planned second-look procedures in pediatric patients following primary cholesteatoma resection using endoscopic and microscopic operative approaches. In conclusion, residual cholesteatoma rates during planned second-look procedures were similar between the study groups. Use of the endoscope led to a lower rate of mastoidectomy for cases with similar disease extent.   Click here to read the full article.

This podcast highlights original research published in the November 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this study was to characterize the relationship between industry payments and use of paranasal sinus balloon catheter dilations (BCDs) for chronic rhinosinusitis. Physicians with Medicare claims with Current Procedural Terminology codes 31295 to 31297 were identified and cross-referenced with industry payments. Multivariate linear regression controlling for age, race, sex, and comorbidity in a physician’s Medicare population was performed to identify associations between use of BCDs and industry payments. The final analysis included 334 physicians performing 31,506 procedures, each of whom performed at least 11 balloon dilation procedures. Payments by manufacturers of BCD devices were associated with increased use of BCD for chronic rhinosinusitis. On separate analyses, the number of payments for food and beverages as well as that for speaker and consulting fees was associated with increased BCD use. This study was cross-sectional and cannot prove causality, and several factors likely exist for the uptrend in BCD use.   Click here to read the full article.

This podcast highlights original research published in the October 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The US Food and Drug Administration (FDA) clears moderate-risk devices via the 510(k) process based on substantial equivalence to previously cleared devices; evidence of safety and effectiveness is not required. We characterized the premarket evidence supporting FDA clearance of otolaryngologic devices. The FDA cleared most moderate-risk otolaryngologic devices for marketing via the 510(k) process without clinical evidence of safety and effectiveness. Otolaryngologists should be aware of limitations in premarket evidence when considering the adoption of new devices into clinical practice.   Click here to read the full article.

This podcast discusses the implications for non-otolaryngologists of "Clinical Practice Guideline: Evaluation of the Neck Mass in Adults", published as a supplement to the September 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Neck masses are common in adults, but often the underlying etiology is not easily identifiable. While infections cause most of the neck masses in children, most persistent neck masses in adults are neoplasms. Malignant neoplasms far exceed any other etiology of adult neck mass. Importantly, an asymptomatic neck mass may be the initial or only clinically apparent manifestation of head and neck cancer, such as squamous cell carcinoma (HNSCC), lymphoma, thyroid, or salivary gland cancer. Evidence suggests that a neck mass in the adult patient should be considered malignant until proven otherwise. Timely diagnosis of a neck mass due to metastatic HNSCC is paramount because delayed diagnosis directly affects tumor stage and worsens prognosis. Unfortunately, despite substantial advances in testing modalities over the last few decades, diagnostic delays are common. Currently, there is only 1 evidence-based clinical practice guideline to assist clinicians in evaluating an adult with a neck mass. Additionally, much of the available information is fragmented, disorganized, or focused on specific etiologies. In addition, although there is literature related to the diagnostic accuracy of individual tests, there is little guidance about rational sequencing of tests in the course of clinical care. This guideline strives to bring a coherent, evidence-based, multidisciplinary perspective to the evaluation of the neck mass with the intention to facilitate prompt diagnosis and enhance patient outcomes.   Click here to read the Guideline.

This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Evaluation of the Neck Mass in Adults", published as a supplement to the September 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Neck masses are common in adults, but often the underlying etiology is not easily identifiable. While infections cause most of the neck masses in children, most persistent neck masses in adults are neoplasms. Malignant neoplasms far exceed any other etiology of adult neck mass. Importantly, an asymptomatic neck mass may be the initial or only clinically apparent manifestation of head and neck cancer, such as squamous cell carcinoma (HNSCC), lymphoma, thyroid, or salivary gland cancer. Evidence suggests that a neck mass in the adult patient should be considered malignant until proven otherwise. Timely diagnosis of a neck mass due to metastatic HNSCC is paramount because delayed diagnosis directly affects tumor stage and worsens prognosis. Unfortunately, despite substantial advances in testing modalities over the last few decades, diagnostic delays are common. Currently, there is only 1 evidence-based clinical practice guideline to assist clinicians in evaluating an adult with a neck mass. Additionally, much of the available information is fragmented, disorganized, or focused on specific etiologies. In addition, although there is literature related to the diagnostic accuracy of individual tests, there is little guidance about rational sequencing of tests in the course of clinical care. This guideline strives to bring a coherent, evidence-based, multidisciplinary perspective to the evaluation of the neck mass with the intention to facilitate prompt diagnosis and enhance patient outcomes.   Click here to read the Guideline.

This podcast highlights original research published in the September 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective for this study was to describe the cost, length of stay, and incidence of postoperative hemorrhage associated with Down syndrome (DS) patients undergoing tonsillectomy in a national sample of inpatient children. Across the United States, children with DS hospitalized for tonsillectomy have an increased length of stay and cost of care. These data also suggest an increased risk of postoperative hemorrhage during the initial admission without an increased risk of respiratory complications.   Click here to read the full article.

This podcast highlights original research published in the August 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Our objectives were (1) to assess patterns of intranasal steroid administration when otitis media with effusion (OME) has been diagnosed in children, (2) to investigate whether usage varies according to visit setting, and (3) to determine if practice gaps are such that quality improvement could be tracked. Despite randomized controlled trials showing a lack of efficacy for isolated OME, nasal steroids continue to be used in treating children with OME in the United States. Related quality improvement opportunities to prevent usage of an ineffective treatment exist.   Click here to read the full article.

This podcast highlights original research published in the July 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. A pilot study of an anonymous, voluntary, event reporting system made available to all members of the American Academy of Otolaryngology—Head and Neck Surgery was performed. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index was used to classify error types. Descriptive statistics were used to summarize submissions to the database. This preliminary descriptive analysis of a novel otolaryngology patient safety event reporting tool shows that this platform brings unique value to the identification of errors and adverse events in our specialty. Most reported events were classified as errors resulting in harm. The most common type of reported event was a technical error, most often resulting in a nerve injury.   Click here to read the full article.

This podcast highlights original research published in the June 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This State of the Art Review aims (1) to define recent qualifications of otolaryngology resident applicants by focusing on United States Medical Licensing Examination (USMLE) scores, Alpha Omega Alpha (AOA) status, and research/publications and (2) to summarize the current literature regarding the relationship between these measures and performance in residency. The consistent decline in applications for otolaryngology residency is concerning and reflects a need for change in the current stereotype of the “ideal” otolaryngology applicant. This includes consideration of additional selection measures focusing on noncognitive and holistic qualities. Furthermore, otolaryngology faculty should counsel medical students that applying in otolaryngology is not “impossible” but rather a feasible and worthwhile endeavor.   Click here to read the full article.

This podcast highlights original research published in the May 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This study evaluates oncologic results and safety of neural monitored, staged thyroid cancer surgery for management of advanced thyroid cancer. In conclusion, a neural monitored, staged surgical approach was conducted without significant adverse events in this small sample and represents and effective alternative strategy option to simultaneous bilateral surgery in the management of thyroid cancer with extensive neck metastases.   Click here to read the full article.

This podcast highlights original research published in the April 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective for this study was to evaluate changes in distribution of reported thyroid nodule fine-needle aspiration (FNA) cytopathology results since implementation of the Bethesda classification and revised 2015 American Thyroid Association (ATA) guidelines for selecting nodules for biopsy. We observed a significantly increased proportion of indeterminate cytology and corresponding decrease in benign nodules compared with an earlier sample, predominately from an increase in AUS/FLUS. Multiple factors are likely involved, including selection of sonographically suspicious nodules for biopsy based upon 2015 ATA guidelines coupled with cytopathological interpretation by a new generation of cytopathologists trained in the era of Bethesda reporting; further study is required to make a definitive conclusion.   Click here to read the full article.

This podcast discusses the implications for primary care providers and patients of "Clinical Practice Guideline (Update): Benign Paroxysmal Positional Vertigo", published as a supplement to the March 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This update of a 2008 guideline from the American Academy of Otolaryngology—Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV. The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed.   Click here to read the Guideline.

This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline (Update): Benign Paroxysmal Positional Vertigo", published as a supplement to the March 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This update of a 2008 guideline from the American Academy of Otolaryngology—Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV. The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed.   Click here to read the Guideline.

This podcast highlights original research published in the March 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective for this study was to determine which complications, as defined by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, correlate with 30-day mortality in surgery for malignancies of the head and neck. NSQIP data from 2005 to 2014 were queried for ICD-9 codes head and neck malignancies. Multivariate logistic regression was used to examine the correlation of individual complications with 30-day mortality. The NSQIP database has been extensively validated and used to examine surgical complications, yet there is little analysis on which complications are associated with death. This study identified complications associated with increased risk of 30-day mortality following head and neck cancer surgery. These associations may be used as a measure of complication severity and should be considered when using the NSQIP database to evaluate outcomes in head and neck surgery.   Click here to read the full article.

This podcast discusses the implications for primary care providers and patients of "Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty", published as a supplement to the February 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is   Click here to read the Guideline.

This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty", published as a supplement to the February 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is   Click here to read the Guideline.  

This podcast highlights original research published in the February 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Complementary and alternative medicine, or integrative medicine, has become increasingly popular among patients with head and neck cancer. Despite its increasing prevalence, many patients feel uncomfortable discussing such therapies with their physicians, and many physicians are unaware and underequipped to evaluate or discuss their use with patients. The aim of this article is to use recent data to outline the decision making inherent to integrative medicine utilization among patients with head and neck cancer, to discuss the ethical implications inherent to balancing integrative and conventional approaches to treatment, and to highlight available resources to enhance head and neck cancer providers’ understanding of integrative medicine. Integrative medicine is gaining popularity for the management of cancer and is most commonly used for symptom management. A number of randomized controlled trials provide data to support integrative therapies, yet physicians who treat head and neck cancer may be faced with ethical dilemmas and practical barriers surrounding incorporation of integrative medicine.   Click here to read the full article.

This podcast discusses the implications for primary care providers and patients of "Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)", published as a supplement to the January 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This update of the 2008 American Academy of Otolaryngology—Head and Neck Surgery Foundation cerumen impaction clinical practice guideline provides evidencebased recommendations on managing cerumen impaction. Cerumen impaction is defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. The primary purpose of this guideline is to help clinicians identify patients with cerumen impaction who may benefit from intervention and to promote evidence-based management. Another purpose of the guideline is to highlight needs and management options in special populations or in patients who have modifying factors. The guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction, and it applies to any setting in which cerumen impaction would be identified, monitored, or managed.   Click here to read the Guideline.

This podcast discusses the implications for otolaryngologists of "Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)", published as a supplement to the January 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. This update of the 2008 American Academy of Otolaryngology—Head and Neck Surgery Foundation cerumen impaction clinical practice guideline provides evidencebased recommendations on managing cerumen impaction. Cerumen impaction is defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. The primary purpose of this guideline is to help clinicians identify patients with cerumen impaction who may benefit from intervention and to promote evidence-based management. Another purpose of the guideline is to highlight needs and management options in special populations or in patients who have modifying factors. The guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction, and it applies to any setting in which cerumen impaction would be identified, monitored, or managed.   Click here to read the Guideline.

This podcast highlights original research published in the January 2017 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Adherence to the allergic rhinitis clinical practice guideline is being considered as a potential focus for national performance metrics. To help inform this discussion, we assessed patient- and clinician-reported medication administration among nationally representative populations of patients with allergic rhinitis. Within the National Health and Nutrition Examination Survey, an estimated 29.2 million patients were diagnosed with “hay fever,” while 92.2 million were diagnosed with “allergies.” Patients with symptoms of allergic rhinitis reported that antihistamines or nasal steroids were prescribed in 21.1% to 24.0% of cases. Leukotriene receptor antagonists were given to 1.7% of those without asthma or use of other allergy medications. Within the National Ambulatory Medical Care Survey / National Hospital Ambulatory Medical Care Survey, observations representing 149.5 million visits for allergic rhinitis demonstrated that nasal steroids were administered in 29.6% of cases, while nonsedating and sedating antihistamines were given in 22.4% and 17.2%, respectively. Despite a high prevalence of allergic rhinitis, per patient report and clinician entry, a substantial number of affected patients do not receive antihistamines and nasal steroids.   Click here to read the full article.

This podcast highlights original research published in the December 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to suppress expression of periostin, a matricellular protein that is markedly elevated in nasal polyp tissue. The purpose of this study was to determine whether use of these antihypertensive agents affects the time to revision sinus surgery in patients with polyp regrowth.  Use of ACEIs and ARBs is associated with an increased time to revision sinus surgery among patients with concurrent nasal polyps and asthma. A possible mechanism of this observed effect is suppression of periostin expression through inhibition of the angiotensin pathway.   Click here to read the full article.

This podcast highlights original research published in the November 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Persistent dysphonia from vocal fold scar remains a clinical challenge, with current therapies providing inconsistent outcomes. The objective of this study was to evaluate voice outcomes after a single office-based steroid injection. Office-based steroid injection combined with voice therapy for mild/moderate vocal fold scar is associated with improved patient-reported and functional voice measures. These findings provide preliminary support for this approach. Importantly, the procedure is low risk and can be performed in the office, thus offering a simple treatment alternative to patients with a disorder that has traditionally been difficult to manage. Prospective studies evaluating the effects of multiple injections are warranted.   Click here to read the full article.

This podcast highlights original research published in the October 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this article was to determine the prevalence and also accuracy of the laryngopharyngeal reflux (LPR) referring diagnosis and to determine the most useful clinical tool in arriving at the final diagnosis in a tertiary laryngology practice.  It concluded that LPR appears to be an overused diagnosis for laryngologic complaints. For patients who have already had transnasal flexible laryngoscopic exams prior to their referral, laryngeal stroboscopy is the key diagnostic tool in arriving at the correct diagnosis.   Click here to read the full article.

This podcast highlights original research published in the September 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this case series was to determine the effect of ibuprofen on posttonsillectomy bleeding when compared with codeine in posttonsillectomy analgesia. It concluded that age is an independent risk factor for posttonsillectomy bleeding. When age is controlled, there is no statistically significant increase in the incidence of posttonsillectomy bleeding events among patients treated with ibuprofen when compared to patients treated with codeine.   Click here to read the full article.

This podcast highlights original research published in the August 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The objective of this study was to evaluate parental recall of surgical risks and benefits in pediatric otolaryngology and to assess for factors that may influence recall. The study found that parental recall of benefits and risks associated with common pediatric otolaryngology procedures was poor. This information is important because a low rate of recall may influence parents’ perspectives of the procedure and could alter their decision-making processes or expectations. Methods to improve parental recall should be further studied.   Click here to read the full article.

This podcast highlights original research published in the July 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. Avoiding oral steroids for otitis media with effusion (OME) is endorsed as a performance measure by the National Quality Foundation, but data regarding current gaps and practice patterns are lacking. Our objectives were to evaluate oral steroid use for OME and the related diagnoses of eustachian tube dysfunction (ETD) and tympanic membrane retraction (TMR), to assess variations by visit setting, and to identify opportunities for measurable performance improvement. OME/ETD/TMR is infrequently treated with oral steroids, particularly in children. Opportunities for performance improvement are limited.   Click here to read the full article.

This podcast highlights original research published in the June 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The purpose of this study was to investigate intra- and postoperative outcomes of endoscopic stapes surgery. The present multicentered study of endoscopic stapes surgery demonstrates similar audiometric and postoperative outcomes previously published in the literature, with a median postoperative air-bone gap of 9.0 dB HL. Future prospective endoscopic stapes surgery studies, addressing the need for scutum removal, postoperative taste changes, and pain scores, are merited.   Click here to read the full article.

This podcast highlights original research published in the May 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The purpose of this study was to evaluate differences in sinus surgery rates in the US Medicaid population by ethnicities. The Medicaid database was selected for this analysis to eliminate payer and wealth as potential confounders in access to health care. Despite this approach, significant differences in surgery rates among ethnic groups were observed. Further research is critical to understand those differences and provide actionable and effective recommendations for change.   Click here to read the full article.

This podcast highlights original research published in the April 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The purpose of this study was to investigate the epidemiology of wire-bristle grill brush injury. The study found that injury from wire-bristle grill brush is uncommon but prevalent during certain seasons. Otolaryngologists play an important in the diagnosis and treatment of these injuries. Awareness among consumers and product manufacturers is necessary to promote safety.   Click here to read the full article.

This podcast highlights original research published in the March 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.  The indications for neck dissection concurrent with salvage laryngectomy in the clinically N0 setting remain unclear. The goals of this study are to determine the prevalence of occult nodal disease, analyze nodal disease distribution patterns, and identify predictors of occult nodal disease in a salvage laryngectomy cohort.  Histologically positive occult nodes are identified in 17% of cN0 patients undergoing salvage laryngectomy with neck dissection. Occult nodal disease varies in frequency and distribution based on tumor subsite. Predictors of high (>20%) occult nodal positivity include T4 tumors and supraglottic subsite. In glottic LSCC, the most frequent sites of occult nodal disease are the paratracheal nodal basins. Click here to read the full article.

This podcast discusses the implications for primary care providers and patients of ‘Clinical Practice Guideline: Otitis Media Effusion (Update),’ published as a supplement to the February 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline “Otitis Media With Effusion in Young Children,” which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children aged 1 to 3 years with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology- Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced practice nursing to revise the OME guideline.   Click here to read the Guideline.

This podcast discusses the implications for otolaryngologists of ‘Clinical Practice Guideline: Otitis Media Effusion (Update),’ published as a supplement to the February 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline “Otitis Media With Effusion in Young Children,” which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children aged 1 to 3 years with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology- Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced practice nursing to revise the OME guideline   Click here to read the Guideline.

This podcast highlights original research published in the February 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.  The objective of this retrospective review was to determine the variability of ratings given to students on the otolaryngology standardized letter of recommendation (SLOR) The review found that the explosion of applications being sent out by candidates for otolaryngology residency programs has prompted the implementation of the SLOR. The lack of variation in the ratings across the 10 domains does not allow for differentiation among student applicants. Reliance on the narrative letter of recommendation attached to the SLOR still remains the most significant way to differentiate among applicants. Refinements will need to be made in either the structure or use of the SLOR for it to be a more useful tool.   Click here to read the full article. 

This podcast highlights a systematic review published in the January 2016 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.  The objectives of this study were to analyze the sensitivity and specificity of fine-needle aspiration (FNA) in distinguishing benign from malignant parotid disease, and to determine the anticipated posttest probability of malignancy and probability of nondiagnostic and indeterminate cytology with parotid FNA. FNA has moderate sensitivity and high specificity in differentiating malignant from benign parotid lesions. Considerable heterogeneity is present among studies.   Click here to read the full article.

This podcast highlights a systematic review published in the December 2015 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation.   The objective of this study was to critically review published literature for treatment-related outcomes for bilateral inferior turbinate reduction (IFTR) via either microdebrider-assisted turbinoplasty (MAT) or radiofrequency turbinoplasty. The primary outcomes were relief of nasal obstruction according to visual analog scale and nasal airflow, volume, and resistance measures based on acoustic rhinomanometry. This review found that IFTR produces a significant subjective and objective improvement in nasal airflow in the short term. This change does not appear to be related to the technique used for IFTR. Click here to read the full article.

This podcast highlights a systematic review and meta-analysis published in the November 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 senior author Luke Rudmik and associate editor Gordon Sun in discussing geographic variation in the use of endoscopic sinus surgery. The phenomenon of geographic variation in the delivery of health care has been recognized for decades.  Variation in small areas can be a driver of health care costs and is associated with differences in the utilization of both medical and surgical services.  The importance of variation in both the cost and the quality of care has been highlighted by many, including several impactful publications by Atul Gawande.  In the present study, Dr. Rudmik and colleagues review differences in the number of endoscopic sinus surgical procedures in the province of Alberta, Canada, and demonstrate that significant differences can occur in proximate geographic areas, much as the authors have previously noted in the United States.  In this podcast, Dr. Rudmik discusses the measurement of geographic variation, the findings from his important study, and the implications for both practice and further investigation.    Drs. Rudmik and Sun then discuss the implications of these interesting observations for health care delivery and some of their potential causes, as well as examining the importance of additional research in further characterizing the nature of surgical variation in otolaryngology. Click here to read the full article.

This podcast highlights a systematic review and meta-analysis published in the October 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 senior author Nausheen Jamal and associate editor Kenneth Altman in discussing partial epiglottoplasty for specific forms of pharyngeal dysphagia.   Patients commonly experience difficulty swallowing due to structural abnormalities that impinge on their normal pharyngeal anatomy.   In these patients various pathologies, such as severe cervical osteophytes or the presence of cervical spinal hardware, can interfere with their ability to swallow smoothly and successfully.  In this study, Dr. Jamal describes a simple transoral procedure that was demonstrated to significantly improve swallowing in this select group of 12 individuals with pharyngeal dysphagia.  In this podcast, she discusses this procedure as well as the outcomes of its use to treat dysphagia.    Drs. Jamal and Altman then discuss the implications of these interesting findings and the potential complications that could arise, as well as examining the need for additional research in expanding and further demonstrating the role for this innovative procedure. Click here to read the full article.  

This podcast highlights a systematic review and meta-analysis published in the September 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 senior author Lisa Ishii and associate editor Eric Kezirian in discussing the role of nasal surgery in the treatment of obstructive sleep apnea (OSA). When considering treatment for snoring and obstructive sleep apnea (OSA), patients frequently inquire about the role of nasal obstruction in leading to the symptoms of OSA.  In addition, patients often ask if there is a role for nasal surgery in lessening these symptoms and in improving control of their OSA.  In the current paper, in examining the role of isolated nasal surgery in patients with OSA, the authors note that among patients with nasal obstruction, nasal surgery improved several sleep parameters, including scores on the Epworth Sleepiness Scale and the Respiratory Disturbance Index.  Based on their results, the authors review the role of nasal surgery in the overall multi-level treatment of patients with OSA.  Drs. Ishii and Kezirian discuss the implications of these interesting findings, as well as exploring the need for further research in examining the type and site of nasal surgery and its effect on sleepiness and OSA. Click here to read the full article.

This podcast highlights original research published in the August 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 senior author Stacey Ishman and associate editor David Darrow in discussing the association of tonsillar size in children, the severity of obstructive sleep apnea (OSA), and the response to surgical treatment for OSA in these children.   Obstructive sleep apnea (OSA) is a problem of increasing concern for children and their parents.  Many otolaryngologists may believe that OSA is worse in children with very large tonsils than it is in children with smaller tonsils.  The present paper, however, suggests that the severity of OSA is independent of tonsillar size, and that children with both small and large tonsils appear to have similar reductions in objective indicators of OSA after adenotonsillectomy.  An important message from this study is that even children with small tonsils on physical examination may have clinically significant OSA, and that surgical treatment might be of benefit even in this patient population.  In addition, the participants discuss the role of polysomnography as a diagnostic modality in these children, as well as other diagnostic considerations that may be important.  Drs. Ishman and Darrow discuss the implications of these observations for the medical and surgical management of children with obstructive sleep apnea. Click here to read the full article.

This podcast highlights a state of the art review published in the July 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 senior author Ryan Bransky and associate editor Cristina Baldassari in discussing the growing use of electronic cigarettes in the United States.  Over the past decade there has been a rapid expansion in the use of and types of electronic cigarettes, or e-cigarettes, among the US population.  In 2009 less than 1% of the American population had tried using e-cigarettes, and by 2013 over 8% of Americans had used them.  The sales of e-cigarettes are predicted to surpass $10 billion by 2017.  There has also been a rapid expansion in use among teenagers, who enter the use of oral nicotine in early life as their first cigarette experience through “vaping.”  There are establishments that are dedicated to the use of these products, and this use is currently unregulated.  Drs. Bransky and Baldassari discuss the implications of this rapid growth in electronic cigarettes, especially among children during their school-age years, and look at the range of potential concerns for both present and future use. Click here to read the full article.    

This podcast highlights original research published in the June 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 senior author Seth Dailey and associate editor Matthew Brigger in discussing the topic of office-based photoangiolytic laser therapy of Reinke’s edema. Reinke’s edema is a common, benign condition of the vocal folds characterized by edema and vascular congestion in Reinke’s space.  Multiple risk factors are associated with this condition, including tobacco use, vocal abuse, and laryngopharyngeal reflux.  In this paper, the authors discuss an office-based procedure for treating Reinke’s edema using topical anesthesia and flexible transnasal endoscopy.  They report their findings on 19 patients who completed this office-based therapy, and demonstrate improvement in both quality of life and acoustic and aerodynamic measures following the treatment.  They also discuss patient characteristics that interfere with the successful completion of the procedure.  Finally, the authors review the implications of their findings for clinical practice and further research.  Click here to read the full article. 

This podcast highlights original research published in the May 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 Lauren Roland and associate editor Meredith Adams in discussing mindfulness-based stress reduction therapy for tinnitus.   Tinnitus is a common problem that affects millions of patients on a chronic basis.  In general there have been few treatment options for patients with tinnitus, and symptoms can be frustrating and debilitating for many individuals.  In this paper, the authors utilize a therapeutic method that includes a cognitive-behavioral approach with planned meditation to reduce stress among patients.  They were able to not only facilitate reduction in bother from tinnitus among a single group of selected patients, but also demonstrated changes in neural connectivity on functional MRI that suggested some adaptation to tinnitus with treatment.  The authors discuss the implications of their interesting findings for patients bothered by tinnitus, and examine ideas for future research that would expand on the encouraging results noted in this pilot study. Click here to read the full article. 

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 authors Ashok Kumar and Maggie Kramper in discussing key findings from the guideline in the diagnosis and treatment of adults with symptoms of sinusitis and their implications for primary care health providers and patients.   Sinusitis affects about 1 in 8 adults in the United States, resulting in more than 30 million annual diagnoses. More than 1 in 5 antibiotics prescribed in adults are for sinusitis, making it the fifth-most common diagnosis responsible for antibiotic therapy.  Many symptoms of sinusitis can overlap with other common conditions such as allergic rhinitis, and can complicate the diagnosis and treatment of these individuals.  Common symptoms of acute sinusitis include purulent nasal discharge accompanied by nasal obstruction, facial pain/pressure/fullness, or both. Patients and their health providers can utilize a variety of approaches in treating these symptoms, judiciously using antibiotics and other prescription and over-the-counter medications as indicated.  These guidelines discuss recommendations and options for clinicians treating adult sinusitis and their patients. Click here to read the full article. 

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 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 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.     

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 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.  

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 December 2014 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 Matthew Carlson and associate editor Thomas Eby in discussing long-term dizziness among patients treated with varying modalities for vestibular schwannomas.    Vestibular schwannomas (VS) are benign slow-growing tumors that arise from the vestibular portion of the eighth cranial nerve. The majority of patients are diagnosed after experiencing audiovestibular symptoms including asymmetrical hearing loss, tinnitus, vertigo, or unsteadiness.  The current study surveyed 538 respondents that were managed over a 10-year period with microsurgery, stereotactic radiosurgery, or observation.  At a mean follow-up of eight (8) years, more than half of patients continued to report significant dizziness, irrespective of the treatment modality that was used.  Furthermore, there was a strong association between postoperative headaches and persistent dizziness.  The author discusses implications of the study, as well as the role of concurrent and sustained migraine as a contributor to both headache and dizziness among patients with vestibular schwannoma.  He also suggests the need for additional research to further define relationships observed in the current study.   Click here to read the full article.  

This podcast highlights original research in the November 2014 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 B. Tucker Woodson and associate editor Sonya Malekzadeh in discussing the efficacy of hypoglossal nerve stimulation in the treatment of the signs and symptoms of obstructive sleep apnea.   Obstructive sleep apnea (OSA) is a common chronic condition that has been treated with a wide range of medical and surgical methods.  The current study demonstrates that the sustained use of an implantable hypoglossal nerve stimulator results in persistent reduction in both symptoms and apnea-hypopnea index (AHI).  In addition, it demonstrates that when use of this treatment is suspended temporarily, its beneficial effects rapidly wane.  The study also suggests that additional research is necessary to define specific populations that will achieve the greatest benefit from this treatment.  The author discusses some of his thoughts about current and future applications of this new technique, and proposes additional research to further characterize the patient populations most amenable to this surgical intervention.       Click here to read the full article. 

This podcast highlights a clinical practice guideline on tinnitus that is published as an October 2014 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 Richard Rosenfeld is joined by lead author David Tunkel and co-author Carol Bauer in discussing implications of the guideline for clinicians who manage patients with tinnitus.

This podcast highlights a clinical practice guideline on tinnitus that is published as an October 2014 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 Richard Rosenfeld is joined by co-authors James Henry and Deena Hollingsworth in discussing the importance of rehabilitation and coping strategies in managing patients with tinnitus.

This podcast highlights original research in the October 2014 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 corresponding author Richard Gurgel and associate editor Matthew Ryan in discussing the impact of duty hours changes in otolaryngology residency training and their impact on case volumes in key indicator procedures.    Click here to read the full article.  

This podcast highlights original research in the September 2014 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 Richard Rosenfeld is joined by lead author Michael Benninger and associate editor Neil Bhattacharyya in discussing the impact of endoscopic sinus surgery on the health care needs of patients with chronic rhinosinusitis and respiratory comorbidities.   Click here to read the full article.  

This podcast highlights original research in the August 2014 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 Richard Rosenfeld is joined by corresponding author Judith Lieu and associate editor Mark Boston in discussing the impact of recurrent and chronic otitis media on children’s health-related quality of life.   Click here to read the full article. 

This podcast highlights original research in the July 2014 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 Richard Rosenfeld is joined by lead author Bruce Matt and associate editor David Stepnick in discussing how lean management principles can optimize ultrasound guided needle biopsy for patients with head and neck masses.   Click here to read the full article.  

This podcast highlights original research in the June 2014 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 Richard Rosenfeld is joined by author Benjamin Judson and associate editor Vicente Resto in discussing the prevalence and outcomes of transoral robotic surgery for oropharyngeal cancer.   Click here to read the full article.  

This podcast highlights original research in the May 2014 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 Richard Rosenfeld is joined by author Rahul Shah and associate editor Matthew Brigger in discussing the progress over the past decade in dealing with medical errors and adverse events.   Read the full article here.  

This podcast highlights original research in the April 2014 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 Richard Rosenfeld is joined by author Sunil Verma and associate editor Kenneth Altman in discussing the prevalence of swallowing disorders and opportunities to improve the quality of care for afflicted patients.   Click here to read the full article.  

This podcast highlights original research in the March 2014 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 Richard Rosenfeld is joined by author Edward Weaver and associate editor Eric Kezirian in discussing why functional comorbidity is essential to understanding the impact of sleep apnea on quality of life.   Click here to read the full article.  

This podcast highlights an updated Clinical Practice Guideline on Acute Otitis Externa (swimmer’s ear) appearing as a February 2014 supplement in Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief Richard Rosenfeld is joined by authors Geoffrey Simon, a pediatrician, and Kaparaboyna (Ashok) Kumar, a family physician, in discussing implications for primary care clinicians and how to optimize interaction with specialists.   Click here to read the full article.  

This podcast highlights an updated Clinical Practice Guideline on Acute Otitis Externa (swimmer’s ear) appearing as a February 2014 supplement in Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief Richard Rosenfeld is joined by authors Peter Roland, an otologist, and William Huang, a dermatologist, in discussing the key quality improvement recommendations in the guideline.   Click here to read the full article.  

This podcast highlights original research in the January 2014 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 Richard Rosenfeld is joined by author Seth Cohen and associate editor Kenneth Altman in discussing how the diagnosis for voice-disordered patients can change over time.   Click here to read the full article.  

This is the first study of overall procedure-specific post-discharge complications (PDCs) after inpatient otolaryngology surgery. The authors studied over 48.000 adults from the American College of Surgeons National Quality Improvement Program database who underwent inpatient otolaryngologic surgery from 2005 to 2011, analyzing complications, reoperation, and mortality in the first 30 days after the procedure. The highest rates of PDCs were for laryngectomy (8.0%), lip surgery (7.4%), and mouth surgery (4.1%), and consisted primarily of infections (surgical site, pneumonia, urinary tract) and less often venous thromboembolic events. Factors associated with PDCs were increasing age, prolonged operative time, hospital stay more than 1 day, and American Society of Anesthesiologists (ASA) class 3 or higher. Implications of these findings for patient counseling are discussed in the podcast.

This podcast highlights a Clinical Practice Guideline on Bell’s Palsy appearing as a November 2013 supplement in Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief Richard Rosenfeld is joined by authors John Halperin, a neurologist, and Kaparaboyna Ashok Kumar, a family physician, in discussing aspects of the guideline related to diagnosis and patient counseling.

This podcast highlights a Clinical Practice Guideline on Bell’s Palsy appearing as a November 2013 supplement in Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief Richard Rosenfeld is joined by authors Lisa Ishii, assistant chair of the guideline development group, and Richard Gurgel, a neurotologist, in discussing aspects of the guideline related to medical and surgical management.

This podcast highlights original research in the October 2013 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 Richard Rosenfeld is joined by author Emily Boss and associate editor Craig Derkay in discussing health disparities in chronic rhinosinusitis in children.

This podcast highlights a commentary in the September 2013 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 Richard Rosenfeld is joined by author David Francis and guideline expert Seth Schwartz in discussing the role of evidence and guidelines in modern health policy.

This podcast highlights a systematic review in the August 2013 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 Richard Rosenfeld is joined lead author Smriti Nayan and star reviewer Helene Krouse in discussing therapeutic interventions for smoking cessation in adults with cancer.

This podcast highlights a clinical practice guideline supplement in the July 2013 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 and lead author Richard Rosenfeld is joined by coauthors David Tunkel and Jesse Hackell in discussing novel aspects of the guideline and its implications for patient care.

This podcast highlights a systematic review in the July 2013 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 and lead author Richard Rosenfeld is joined coauthor Richard Harvey and associate editor John Krouse in discussing implications for clinicians who perform endoscopic sinus surgery.

This podcast highlights a clinical practice guideline supplement in the July 2013 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 and lead author Richard Rosenfeld is joined by coauthors Melissa Pynnonen and Denis Lafreniere in discussing novel aspects of the guideline and its implications for patient care.

This podcast highlights a clinical practice guideline supplement in the June 2013 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 Richard Rosenfeld is joined by coauthors Julie Barkmeier-Kraemer and Michael S. Benninger in discussing a proactive approach to identifying voice problems after thyroid surgery and improving voice quality. Click here to read the full article.

This podcast highlights a clinical practice guideline supplement in the June 2013 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 Richard Rosenfeld is joined in by lead author Sujana Chandrasekhar and co-author Gregory Randolph in discussing how thyroid surgery can impact voice and what can be done to achieve the best outcomes. Click here to read the full article.

This podcast highlights original research appearing in the June 2013 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 Richard Rosenfeld is joined in by author John Greinwald Jr. and associate editor Thomas Eby in discussing the latest advances in gene-sequencing technology for molecular diagnosis of hereditary hearing loss.

This podcast highlights original research appearing in the May 2013 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 Richard Rosenfeld is joined in by lead author Stephanie Shintani Smith and associate editor John H. Krouse in discussing factors related to variations in antibiotic prescribing for acute rhinosinusitis in United States ambulatory care settings.

This podcast highlights original research appearing in the April 2013 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 Richard Rosenfeld is joined in by lead author Annie Simpson and associate editor Jennifer Shin in discussing the role of cardiovascular disease markers in age-related hearing loss over time.

This podcast highlights original research appearing in the March 2013 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 Richard Rosenfeld is joined in by author Hossein Mahboubi and associate editor Thomas Eby in assessing how well commercially available earplugs prevent water entry during swimming. Click here to read the full article.

Women comprise nearly half of all US medical students but they remain underrepresented in academic practice within surgical specialties.  To see if this occurs in otolaryngology departments, the authors analyzed faculty listings from academic departments and compared academic rank and h-index by gender.  The h-index was chosen to reflect scholarly productivity, since it reflects the number of manuscripts published by the author that have been cited at least that many times (e.g., an h-index of 10 means they published 10 articles cited by others 10 or more times each).  Men had higher h-indices than women at junior academic ranks, but the productivity rates of women increased and equaled, or surpassed, those of men later in their careers.  Women academic otolaryngologists of senior rank had higher h-indices than their male counterparts.  Despite this higher productivity women are underrepresented in positions of leadership and seniority, which is likely generational since the proportion of female otolaryngology residents has only recently exceeded 20%.

As defined by the Institute of Medicine (IOM), clinical practice guidelines are "statements that include recommendations to optimize patient care that are informed by a systematic review of the evidence and an assessment of the benefits and harms of alternative care options."  In crafting their recent standards for trustworthy guidelines, the IOM repeatedly referenced the AAO-HNS manual discussed in this podcast as an example of best practice.  This third edition of the manual builds upon prior editions (from 2006 and 2009) with new material that includes standards for trustworthy guidelines, updated evidence levels, increased patient and public involvement, assessing confidence in the evidence, documenting differences of opinion, managing conflict of interest, and using computerized decision support for crafting actionable recommendations.  The participants discuss unique features of the manual, the preeminent role of action statement profiles in promoting transparency, and how guideline users and developers can best take advantage of the principles and practices described.

Although tracheostomy is one of the oldest and most common surgical procedures, management is often based on opinion and local practices because of a paucity of high level evidence to guide care.  To address this issue, the AAO-HNS convened a national expert panel representing pediatric and adult otolaryngology, laryngology, head and neck oncologic surgery, advanced nursing practice, respiratory therapy, and emergency medicine.  Using systematic review and a modified Delphi method the group achieved consensus on 77 statements that address emergencies, complications, decannulation, perioperative care, ancillary devices, and patient education.  Part one of this podcast emphasizes supportive care and patient education from the perspective of two nurses on the expert panel.  Part two offers the physician perspective from two panel participants with expertise in adult and pediatric tracheotomy care.  A common theme is the importance of engaging patients and caregivers in all aspects of decision making and supportive care to improve outcomes and reduce complications.

Although tracheostomy is one of the oldest and most common surgical procedures, management is often based on opinion and local practices because of a paucity of high level evidence to guide care.  To address this issue, the AAO-HNS convened a national expert panel representing pediatric and adult otolaryngology, laryngology, head and neck oncologic surgery, advanced nursing practice, respiratory therapy, and emergency medicine.  Using systematic review and a modified Delphi method the group achieved consensus on 77 statements that address emergencies, complications, decannulation, perioperative care, ancillary devices, and patient education.  Part one of this podcast emphasizes supportive care and patient education from the perspective of two nurses on the expert panel.  Part two offers the physician perspective from two panel participants with expertise in adult and pediatric tracheotomy care.  A common theme is the importance of engaging patients and caregivers in all aspects of decision making and supportive care to improve outcomes and reduce complications.

Using data from a national database the authors analyzed more than 8 million ambulatory health care encounters for adults with obstructive sleep apnea (OSA).  Although OSA affects up to 7% of adults in the United States, only 10% of ambulatory health care visits studied were associated with otolaryngologic care.  This presents an opportunity for increased awareness of OSA and the unique role of otolaryngologists in management.  OSA was significantly associated with commonly encountered comorbid conditions, including obesity, asthma, depression, and hypertension.  Otolaryngologists who diagnose and treat patients with OSA should be aware of increased risk for these background conditions since their presence could impact therapeutic outcomes.  Clinicians in general are likely to see more OSA patients given the rising prevalence of obesity and the aging of the population, since elderly patients are more likely to have the multiple chronic conditions associated with an increased risk for OSA.

Although computed tomography (CT imaging) is an essential diagnostic tool for patients with paranasal sinus disease the test is associated with significant costs, radiation exposure, and overuse concerns.  To help define appropriate use of CT imaging an expert panel was convened and areas of clinical consensus were identified using a 3 round modified Delphi method. Statements reaching consensus included (a) CT imaging is not indicated for clinicall diagnosed uncomplicated acute sinusitis or when sinusitis has fully responded to antibiotic therapy, (b) CT imaging is indicated for adults with chronic sinusitis, recurrent acute sinusitis, and those not responding appropriately to medical management, and (c) CT imaging is indicated for tumor surveillance, complicated sinusitis, complicated dental infections, and for facial pain following dental surgery (odontogenic sinusitis). When CT imaging is obtained for routine chronic sinusitis intravenous contrast is not indicated.  Further, plain radiographs and ultrasonography are not recommend for evaluating sinusitis.   Click here to read the full article.  

Although computed tomography (CT imaging) is an essential diagnostic tool for patients with paranasal sinus disease the test is associated with significant costs, radiation exposure, and overuse concerns.  To help define appropriate use of CT imaging an expert panel was convened and areas of clinical consensus were identified using a 3 round modified Delphi method. Statements reaching consensus included (a) CT imaging is not indicated for an uncomplicated "cold" lasting less than 10 days or for uncomplicated acute sinusitis in children under age 3 years, (b) CT imaging is indicated for chronic sinusitis in children that persists despite adenoidectomy or medical management, and (c) CT imaging is indicated for at any age for suspected tumor, complications from sinusitis, or prior to sinus surgery.  The presenters stress that the diagnosis of uncomplicated, acute bacterial sinusitis in children should be based on clinical signs and symptoms, not on CT imaging.

The Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) is a 35-item standardized tool that asks consumers and patients to report and evaluate their experiences and satisfaction with their surgical care (completion time of 15-20 minutes).  In this prospective study, 354 adult patients completed the S-CAHPS survey through and electronic data capture system 7 to 28 days after otolaryngologic surgery.  Most patients rated their surgeons very high (at least 9.5 out of 10.0), but there was more variability in communication practices: the top-box scores for were 79% for surgeon communication prior to surgery, 61% for surgeon attentiveness on day of surgery, 64% on information to guide recovery, 77% for surgeon communication after surgery, and 88% for helpful and courteous office staff.  The overall 40% survey response rate confirms the feasibility of the S-CAHPS, which may ultimately become a platform for quality improvement, financial incentives (from insurers and health plans), and assessment of surgeon interpersonal and communication skills on Part IV of the American Board of Otolaryngology Maintenance of Certification examination.

This podcast highlights original research appearing in the September 2012 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 Richard M. Rosenfeld is joined by lead author Max Pusz and associate editor Julie Wei in discussing the quality of information about common otolaryngology problems that would be encountered by consumers through Google internet searches.

This podcast highlights original research appearing in the August 2012 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 Richard M. Rosenfeld is joined by lead author Michael Brandt and associate editor David Stepnick in discussing patient concerns prior to thyroid surgery.

This podcast highlights original research appearing in the July 2012 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 Richard M. Rosenfeld is joined by corresponding author Jeffrey Spiegel and associate editor Mark K. Wax in discussing the preoperative incidence of olfactory dysfunction in nasal surgery patients.   Click here to read the full article.  

This podcast highlights a systematic review appearing in the June 2012 edition 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 Richard M. Rosenfeld, MD, MPH, is joined by Jason L. Acevedo, MD, lead author and Craig S. Derkay, associate editor for pediatric otolaryngology, in comparing the complication rates of total vs. partial (intracapsular) tonsillectomy.   Click here to read the full article.  

This podcast highlights a systematic review entitled "Esophageal reflux disease proton pump inhibitor therapy impact on sleep disturbance" in the April 2012 edition Otolaryngology-Head and Neck Surgery, the official journal of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief Richard M. Rosenfeld, MD, MPH is joined by lead author Elliot Regenbogen, MD, and associate editor Kenneth Altman, MD, in discussing how proton pump inhibitor therapy can improve sleep quality for patients with reflux disease. Click here to read the full article.

This podcast is the second in a two-part series highlighting the Clinical Practice Guideline on Sudden Hearing Loss, which is a supplement to the March 2012 edition 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 Richard M. Rosenfeld, MD, MPH is joined by guideline assistant chair Sujana S. Chandrasekhar, MD, and co-author Seth R. Schwartz, in discussing the how the guideline was developed and what steps were taken to ensure it is trustworthy. Click here to read the full article.

This podcast is the first in a two-part series highlighting the Clinical Practice Guideline on Sudden Hearing Loss, which is a supplement to the March 2012 edition 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 Richard M. Rosenfeld, MD, MPH is joined by lead author Robert J. Stachler, MD, and co-author Seth R. Schwartz, in discussing the how the guideline was developed and what steps were taken to ensure it is trustworthy. Click here to read the full article.

This podcast highlights a commentary appearing in the May 2012 edition 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 Richard M. Rosenfeld, MD, MPH, is joined by Gordon H. Sun, MD, lead author and David Nielsen, EVP and CEO of the AAO-HNS, in a timely discussion of health care reform its impact on otolaryngology practice and research.   Click here to read the full article.

This podcast highlights original research appearing in the March 2012 edition 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 Richard M. Rosenfeld, MD, MPH is joined by corresponding author Cecelia E. Schmalbach, MD, and associate editor Mark K. Wax, MD, in discussing practice patterns and perceptions of junior otolaryngologists in treatment of maxillofacial and neck trauma. Click here to read the full article.

This podcast highlights original research appearing in the February 2012 edition 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 Richard M. Rosenfeld, MD, MPH is joined by lead author Aaron M. Fletcher, MD, and associate editor Cristina Baldassari, MD, in discussing which demographic and practice characteristics predict professional burnout in otolaryngologists. Click here to read the full article.

This podcast highlights original research appearing in the January 2012 edition 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 Richard M. Rosenfeld, MD, MPH is joined by lead author Reena Dhanda Patil, MD, and associate editor Eric A. Mair, MD, in discussing a survey of Veterans Affairs Health Care Providers on preoperative screening and postoperative care of patients with obstructive sleep apnea. Click here to read the full article.

This podcast highlights original research appearing in the December 2011 edition 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 Richard M. Rosenfeld, MD, MPH, is joined by lead author Inessa Fishman, MD, and associate editor Peter Roland, MD, for an informative and clinically relevant discussion of managing tympanostomy tube otorrhea that is refractory to oral or topical antibiotics. Click here to read the full article.

This podcast highlights a commentary appearing in the October 2011 edition 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 Richard M. Rosenfeld, MD, MPH, is joined by Gordon Hughes, MD, corresponding author and Director of Clinical Trials at the National Institute on Deafness and Other Communicative Disorders (NIDCD), and David Nielsen, EVP and CEO of the AAO-HNS, in a lively discussion of health care reform and the role of evidence-based medicine. Click here to read the full article.

This podcast highlights a systematic review appearing in the September 2011 edition of Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery Foundation. Editor in chief Richard M. Rosenfeld, MD, MPH, is joined by corresponding author Walter T. Lee, MD, in discussing the benefits, and limitations, of sentinel node biopsy for melanoma in the head and neck region. Click here to read the full article.

This podcast highlights an original research article appearing in the August 2011 edition of Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery Foundation. Editor in chief, Richard M. Rosenfeld, MD, MPH, is joined by lead author, Mia E. Miller, MD, and associate editor, Daniel G. Deschler, MD, in discussing the reasons behind increased disease-specific survival for tonsillar squamous cell carcinoma in recent years. Click here to read the full article.

This podcast features expert commentary on a Clinical Practice Guideline entitled "Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children," which is published as a supplement to the July 2011 issue of Otolaryngology - Head and Neck Surgery Journal. Richard Rosenfeld, editor in chief, is joined by two co-authors of the guideline, Ron Mitchell, a pediatric otolaryngologist, and Norman Friedman, a sleep medicine specialist and pediatric otolaryngologist. Click here to read the full article.

This podcast highlights an article published in the July 2011 issue of Otolaryngology - Head and Neck Surgery Journal entitled "The challenge of protocols for reflux disease: systematic review and development of a critical pathway." Discussants include Richard Rosenfeld, editor in chief, Kenneth Altman, lead author, and Julie Wei, associate editor.   Click here to read the full article. 

In this podcast editor in chief, Richard Rosenfeld, and first author, Lara Abdul-Sater, discuss an article from the May 2011 edition of Otolaryngology - Head and Neck Surgery Journal entitled What are thyroidectomy patients really concerned about? Listeners may be surprised to learn what is really on patients minds as they contemplate thyroid surgery. Click here to read the full article.

This podcast from the American Academy of Otolaryngology – Head and Neck Surgery features expert commentary on an article published in the June 2011 issue of Otolaryngology – Head and Neck Surgery Journal entitled “Robotic-assisted parathyroidectomy: a feasibility study. Participants include Richard Rosenfeld, editor in chief, Neil Tolley, lead author, and Gregory Randolph, associate editor.   Click here to read the full article.  

This podcast features commentary on an article published in the April 2011 issue of Otolaryngology – Head and Neck Surgery Journal, entitled “The value of otolaryngologists’ services in America: a national survey.”  Joining the discussion are Richard M. Rosenfeld, MD, MPH, editor in chief, Paul C. Frake, MD, lead author, and Julie Wei, MD, associate editor. Click here to read the full article.

Richard M. Rosenfeld, editor in chief of Otolaryngology – Head and Neck Surgery Journal is joined by associate editor John H. Krouse and lead author Neil Bhattacharyya in discussing an article from the March 2011 issue, entitled "Cost burden of chronic rhinosinusitis: a claims-based study." Click here to read the full article.

In this podcast AAO-HNS Journal Editor, Richard Rosenfeld, is joined by M. Boyd Gillespie and Eric Mair in discussing "Effect of Palatal Implants on Continuous Positive Airway Pressure (CPAP) and Compliance," published in the February 2011 issue of Otolaryngology Head and Neck Surgery.  This randomized clinical trial shows no significant impact of palatal implants on CPAP pressure or compliance compared to sham controls. Click here to read the full article.

PART 3: In this podcast AAO-HNS Journal Editor, Richard Rosenfeld, is joined by Reginald Baugh, Sanford Archer, and Ron Mitchell in discussing the Clinical Practice Guideline, Tonsillectomy in Children. An overview of the guideline is presented followed by recommendations on selecting the best candidates or surgery or watchful waiting. Click here to read the full article.

PART 1: In this podcast AAO-HNS Journal Editor, Richard Rosenfeld, is joined by Reginald Baugh, Sanford Archer, and Ron Mitchell in discussing the Clinical Practice Guideline, Tonsillectomy in Children. An overview of the guideline is presented followed by recommendations on selecting the best candidates or surgery or watchful waiting. Click here to read the full article.

PART 2: In this podcast AAO-HNS Journal Editor, Richard Rosenfeld, is joined by Reginald Baugh, Sanford Archer, and Ron Mitchell in discussing the Clinical Practice Guideline, Tonsillectomy in Children. An overview of the guideline is presented followed by recommendations on selecting the best candidates or surgery or watchful waiting. Click here to read the full article.