Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
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Otolaryngol Head Neck Surg · Feb 2016
Causes for 30-Day Readmission following Transsphenoidal Surgery.
The Affordable Care Act Readmissions Reduction Program introduced reimbursement policy changes resulting in penalties for hospitals with higher-than-average readmission rates among several categories, including elective surgical cases. We examined the rate of complications resulting in 30-day readmission following endoscopic transsphenoidal surgery. ⋯ Overall, the rate of 30-day readmission following endoscopic pituitary surgery is low. However, common causes of readmission do add significant cost to the overall care of this patient population. Special attention to surgical technique to prevent epistaxis and cerebrospinal fluid rhinorrhea, as well as multidisciplinary team management to avoid postoperative endocrine dysfunction, is critical to minimize these complications.
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Otolaryngol Head Neck Surg · Feb 2016
Multicenter StudyThe Vicious Cycle: Pediatric Facial Trauma from Bicycling.
Although prevention of head injuries through helmet use is widespread, there has been a paucity of inquiry and publicity regarding the potential for facial injury stemming from cycling. Our objectives included estimating the incidence of emergency department (ED) visits for bicycle-related facial trauma among the pediatric population and detailing injury patterns. ⋯ Bicycle-related facial trauma is prevalent among the pediatric population, with nearly 180,000 visits to EDs between 2010 and 2014. Soft tissue injuries predominated among all age groups, although fractures increased significantly with age. Knowledge of injury patterns described may be a useful adjunct assisting history, examination, and decision making regarding the use of medical imaging. There is a clear void in inquiry regarding the use of facial protection, reinforcing the need for further study into prevention and efforts to raise public awareness among youth.
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Otolaryngol Head Neck Surg · Feb 2016
Clinical Practice Guideline: Otitis Media with Effusion (Update).
This update of a 2004 guideline codeveloped by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, provides evidence-based recommendations to manage otitis media with effusion (OME), defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection. Changes from the prior guideline include consumer advocates added to the update group, evidence from 4 new clinical practice guidelines, 20 new systematic reviews, and 49 randomized control 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 OME. ⋯ The update group made strong recommendations that clinicians (1) should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child; (2) should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both; (3) should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy; (4) should manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown); (5) should recommend against using intranasal or systemic steroids for treating OME; (6) should recommend against using systemic antibiotics for treating OME; and (7) should recommend against using antihistamines, decongestants, or both for treating OME.The update group made recommendations that clinicians (1) should document in the medical record counseling of parents of infants with OME who fail a newborn screening regarding the importance of follow-up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss; (2) should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors; (3) should evaluate at-risk children for OME at the time of diagnosis of an at-risk condition and at 12 to 18 months of age (if diagnosed as being at risk prior to this time); (4) should not routinely screen children for OME who are not at risk and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort; (5) should educate children with OME and their families regarding the natural history of OME, need for follow-up, and the possible sequelae; (6) should obtain an age-appropriate hearing test if OME persists for 3 months or longer OR for OME of any duration in an at-risk child; (7) should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development; (8) should reevaluate, at 3- to 6-month intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; (9) should recommend tympanostomy tubes when surgery is performed for OME in a child <4 years old; adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); (10) should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child ≥4 years old; and (11) should document resolution of OME, improved hearing, or improved quality of life when managing a child with OME.
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Otolaryngol Head Neck Surg · Feb 2016
ReviewGrant-Writing Pearls and Pitfalls: Maximizing Funding Opportunities.
This invited article reviews the grant process to include the following objectives: (1) to provide an understanding of otolaryngology funding mechanisms in the context of career progression; (2) to outline key components of a well-written grant; (3) to highlight vital members of a successful research team, with emphasis on the mentor-mentee relationship; and (4) to clarify grant scoring with emphasis on common pitfalls to avoid. Current otolaryngology funding mechanisms and up-to-date resources are provided. The review is aimed to assist otolaryngology residents, faculty new to the grant process, as well as experienced researchers striving to improve their grant review scores.
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Otolaryngol Head Neck Surg · Feb 2016
Variability of Ratings in the Otolaryngology Standardized Letter of Recommendation.
To determine the variability of ratings given to students on the otolaryngology standardized letter of recommendation (SLOR). ⋯ 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.