bluuebunny/crossref_metadata_2025_split huggingface dataset:
Google Glass in Head and Neck Surgery
Authors: Lutch Matthew J. , Kohli Ajay , Cates Daniel , Lue Allen 
Published: September 2014

Objectives:(1) Implement the use of Google Glass in the operating room and in the office for teaching purposes and intraoperative consultations. (2) Recognize the potential for wearable technologies to maximally leverage the electronic medical record (EMR) as a platform to optimize communication between physicians and care for patients.Methods:Google Glass is a wearable camera with an optical head mounted display (OHMD) with voice control and internet connectivity via either wireless or Bluetooth‐smartphone tethering. The OHMD was used for procedures including tonsillectomy, endoscopic nasal polypectomy, office‐based vocal cord injection, and flexible transnasal laser laryngoscopy.Results:The smartphone technology was used to successfully broadcast the surgical procedures to consultant surgeons off‐site as well as mentor resident physicians during procedures. Procedures were performed without complications on patients under general anesthesia as well as patients under local anesthesia without sedation.Conclusions:We report, to our knowledge, the first uses of Google Glass in head and neck surgery. This feasibility study will review potentials for Google Glass, including resident teaching and intraoperative consultations. We will address lessons learned thus far in optimizing the view obtained from the OHMD. We will also discuss implications of wearable technology in the hospital environment from the standpoint of the future of telemedicine, the consent process, and the potential for novel user interfaces with the EMR.
Improving Patient Satisfaction in the Outpatient Otolaryngology Clinic
Authors: Orb Quinn T. , Wilson Kevin F. , Meier Jeremy D. , Error Marc E. , Johnson Steven , Ward Preston D. 
Published: September 2014

Objectives:(1) Determine patient and provider factors associated with patient dissatisfaction in an otolaryngology clinic. (2) Identify strategies to improve the patient experience.Methods:Patient satisfaction surveys were prospectively collected in an academic otolaryngology clinic from January 2011 through March 2013. Patient variables (age, insurance type, established vs new patient, diagnosis, and treatability of condition) and provider variables (years in practice, subspecialty, and clinic wait time) were retrospectively analyzed to determine factors associated with patient dissatisfaction. “Treatability” was graded on a scale of 1 to 5, with diagnoses having a clear treatment option (ie, tonsillectomy for chronic tonsillitis) = 1, and diagnoses with no therapeutic options available (ie, tinnitus) = 5.Results:The cohort included 820 patient satisfaction surveys and charts. Stepwise linear regression analysis identified no single patient or provider variable associated with poor satisfaction scores. Cluster analysis evaluating the interplay between variables identified 5 unique clusters of patients. Satisfaction scores in 4 of the clusters were in the 99th percentile, while the remaining cluster ranked in the 10th percentile. This cluster consisted of a higher proportion of new patients with difficult‐to‐treat otologic conditions who described their wait time as excessive and were more likely to be self‐pay.Conclusions:Several factors influence patient satisfaction in an otolaryngology clinic. In this study, variables associated with lower patient satisfaction scores included patients with longer clinic wait times, “difficult to treat” otologic diagnoses, and new patients. Addressing the issues common in this population to better meet their needs and expectations may improve overall patient satisfaction.
High‐Volume Tracheostomies in the Critically Ill Population: Analysis of Technique and Indications
Authors: Naseri Iman , Salem Whitney B. , Davis‐Malesevich Melinda 
Published: September 2014

Objectives:Analyze the frequency of and techniques used in performing tracheostomies. Understand the prevailing contraindications used in the decision between open versus percutaneous method. Evaluate outcomes among the 2 modes of tracheostomy procedures.Methods:Case‐series review of all patients who underwent a tracheostomy spanning 4 years within a tertiary metropolitan hospital. Clinical and demographic data were used to compare the 2 groups of patients with respect to average age, hospital stay, related emergency department (ED) visits, and other complications.Results:A total of 1333 tracheostomies were performed on 1302 patients. This included 452 (34%) open versus 881 (66%) via the percutaneous dilatational technique (PDT). There was no difference in short‐term complications between the 2 groups. The primary long‐term complication, tracheal stenosis, occurred most commonly in the PDT group. The contraindications practiced in decision for open versus PDT are not uniform among the various services performing tracheostomies. Approximately 26% of all discharged patients presented to the ED with respiratory or tracheostomy‐related complaint within 90 days of discharge.Conclusions:We present the largest tracheostomy case‐series containing a majority performed via the percutaneous technique. Tracheal stenosis is the most common long‐term complication seen primarily among PDT group, indicating that factors such technique may lead to such outcomes. Institutional adoption of absolute contraindications may be necessary to avoid long‐term complications. The development of an institutional common pathway for care and follow‐up may help avoid related ED visits.
How Much Does the Type of Tympanostomy Tube Matter? A Utility‐Based Markov Decision Analysis
Authors: Baik Grace , Brietzke Scott E. 
Published: September 2014

Objectives:Different types of tympanostomy tubes (TT) are available to the otolaryngologist with relative advantages and disadvantages. The objectives of this study are: (1) Use a utility‐based Markov Decision Analysis model to compare outcomes of short‐term grommet tubes, “intermediate” type tubes (Triune, Grace Medical, USA), and “permanent” T‐Tubes. (2) Use sensitivity analysis to determine the most important factors influencing outcomes with one type of TT versus another.Methods:A Markov cohort decision analysis model was created using computer software (Treeage Software, Inc. USA) comparing the 3 types of TT. Published data were used to determine key baseline model parameters. The model featured potential complications including eardrum perforation, early TT extrusion, and the need for possible repeat TT placement after extrusion. Outcomes were quantified using a 0.95 (one procedure, full recovery) to 0.6 (failed myringoplasty) utility scale. Utility values were discounted over time to incorporate real life inconvenience. Statistical analysis included simple descriptive statistics and contingency tables.Results:The intermediate TT accumulated superior total utility in 2‐, 4‐, and 6‐year models (2.48, 3.96, and 5.27 total utility) compared with grommets (2.32,3.82,5.18) and T‐tubes (2.42, 3.86, 5.18). Examining a hypothetical 3000 child cohort, T‐tubes resulted in an increased overall perforation rate (10.5% versus 2.0%, P <. 001 chi‐squared). Sensitivity analysis indicated that the rate of repeat TT placement and the inconvenience utility discount factor over time were the driving factors of the model.Conclusions:The intermediate TT may produce favorable outcomes as it combines a balance of a lower perforation rate than T‐tubes and a longer period of ventilation than grommet tubes.
Human Papillomavirus Infection in Benign Tonsil Swabs and Tonsillectomy Specimens
Authors: Cockerill Cara C. , Orvidas Laura J. , Moore Eric J. , Duresko Brian J. , Tombers Nicole , Cockerill Franklin R. , Pritt Bobbi S. 
Published: September 2014

Objectives:(1) Determine incidence of HPV (human papillomavirus) infection in routine tonsillectomy swabs and specimens. (2) Determine if vaccination impacts tonsillar HPV infection.Methods:This was a prospective study conducted from July 2012 to January 2014. Patients ages 1 to 100 years undergoing tonsillectomy for nonmalignant indications were enrolled. Demographic data and immunization status were collected. Specimens collected during surgery included a flocked swab and half of the left and right tonsil. All specimens were tested for HPV DNA using the polymerase chain reaction–based Roche Cobas Amplicor test and for the presence of E6/E7 mRNA using the Gen‐Probe Aptima HPV test.Results:Patients were stratified into 2 groups, pediatric (ages 1‐12 years) and adults (age 13 years and up) based on age of potential sexual maturity. In the pediatric group (n = 130) mean age was 5.2 years, 42% were female, 58% were male, and only 3 patients were fully vaccinated against HPV. In the adult group (n = 64) mean age was 24 years, 76% female, 24% male, and 47% were either fully or partially vaccinated. All specimens were negative for HPV infection via both testing methods. Internal controls confirmed the tests were functioning properly.Conclusions:This is the first study to examine fresh tonsil swabs and tonsillectomy specimens for HPV infection using a Food and Drug Administration–approved method. Interestingly, both adult and pediatric specimens were negative for HPV infection. The role of vaccination in oropharyngeal HPV infection remains unclear.
Inclusion of Otolaryngology in Medical Student Education: A National Survey
Authors: Ryan Timothy P. , Ishman Stacey L. , Stewart C. Matthew , Stewart Rosalyn W. , Stanley James , Stierer Kevin D. , Benke James R. , Kern David E. 
Published: September 2014

Objectives:Otolaryngology‐related conditions make up 25% of primary care complaints; however, US medical schools do not routinely require otolaryngology instruction, potentially negatively impacting knowledge, attitudes, and medical student career choices. This survey was intended to (1) determine the extent of clinical and pre‐clinical otolaryngology education at Accreditation Council for Graduate Medical Education institutions, and (2) focus future educational efforts.Methods:A prospective online survey was sent from the Education Steering Committee of the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO‐HNSF) to all Accreditation Council for Graduate Medical Education (ACGME) otolaryngology training programs.Results:Forty percent (42/105) of program directors responded. They reported that medical students could graduate without any clinical instruction in otolaryngology in 85% (34/40) or any formal otolaryngology instruction in 59% (24/41). An otolaryngology rotation was required in only 5% (2/41) of programs. Increased exposure to otolaryngology was noted in 44% (18/41) while decreased exposure was seen in only 22% (9/41). Otolaryngologists provided formal teaching sessions for less than 8 hours over 4 years of medical school in 90% (26/29) of programs. When asked about instruction in specific topic areas, respondents did not know if topics were covered in 19‐37% (8‐15/42), regardless of topic.Conclusions:Otolaryngology‐provided education is extremely limited in ACGME medical student education despite its importance in patient care. We suggest that the lack of otolaryngology integration in the medical student curriculum should be the focus of future educational efforts, including a national medical student curriculum.
An Innovative Smartphone‐Based Rhinoendoscope
Authors: Wu Cheng Jung , Wu Sheng Yu , Lin Yaoh Shiang 
Published: September 2014

Objectives:Traditional rhinoendoscope is widely used in the diagnosis of a variety of nose diseases, but they can only be used by one doctor at a time. With the advances of electronic health technology, the extended potential application of smartphones to support medical practice is evolving. The first phase of the study discussed how smartphones can be used for rhinoscopic photography and image management via an innovative adaptor. The second phase of the study is to evaluate the diagnostic capability of the smartphone‐based rhinoendcoscope compared with traditional video rhinoendoscope and its application in tele‐otolaryngology.Methods:We designed a unique adaptor to connect the rhinoendoscope and smartphone. The main idea is to transform the smartphone into a rhinoendoscope. The device uses the smartphone's camera to capture rhinoscopic images. With an available free web real‐time communication application platform and 3G (or WiFi) network, the smartphone‐based rhinoendoscope could also synchronize your smartphone‐based rhinoscopic image to other mobile devices.Results:Ten clinical rhinoscopic images acquired via the smartphone‐based rhinoendoscope were tested in this study. Four teleconsultants reviewed the 10 clinical rhinoscopic images and made a telediagnosis. Compared with the face‐to‐ face diagnosis, for which the diagnosis was made in person via traditional video rhinoendoscope, 4 teleconsultants obtained scores of correct primary telediagnosis of 90%, 90%, 100%, and 100%, respectively.Conclusions:The use of already available technologies, without any additional expensive devices, could significantly increase quality diagnostics while lowering extra costs. It also increases connectivity between most isolated family doctors and remote referral centers.
Maxillary Artery Embolization for the Treatment of Intractable Epistaxis
Authors: Partington Erin J. , Harrigan Mark 
Published: September 2014

Objectives:Arterial embolization has become a common treatment for intractable epistaxis. The objectives of this study are to evaluate the outcomes and optimal endovascular treatment strategy for patients undergoing embolization for intractable epistaxis.Methods:Retrospective review of patients undergoing endovascular embolization for intractable epistaxis from 2004 to 2013. Patients having tumor embolization were excluded. Vessels were embolized with polyvinyl alcohol (PVA). Data were collected concerning demographics, risk factors, management prior to embolization, vessels embolized, outcomes, and complications.Results:Forty‐three patients underwent embolization for intractable epistaxis. Risk factors included uncontrolled hypertension (n = 20), anticoagulation therapy (n = 17), facial trauma (n = 4), and recent nasal or palate surgery (n = 5). Therapy attempted prior to embolization included anterior nasal packing (86%), nasopharyngeal balloon packing (42%), chemical cauterization (9%), surgical intervention (19%), prior embolization (7%), and oropharyngeal packing (2%). Vessels embolized were bilateral maxillary arteries (MA) (81%), bilateral MA with bilateral facial arteries (5%), and unilateral MA when bilateral embolization was not possible due to vessel anatomy (14%). Successful embolization, defined as resolution of bleeding prior to discharge, occurred in 35 patients. Of the 8 cases with postembolization bleeding, 6 stopped spontaneously or with minimal intervention. The rate of successful embolization was 83% for both unilateral and bilateral MA embolization. The only major complication was nasal tip and alar necrosis that occurred in 1 patient after facial artery embolization. No neurologic complications were identified.Conclusions:Maxillary artery embolization had favorable outcomes and no significant complications in the current study.
National Trends and Associated Factors of Retropharyngeal Abscess among Adult Inpatients with Peritonsillar Abscess
Authors: Qureshi Hannan A. , Tan Bruce K. , Chandra Rakesh K. , Kern Robert C. , Smith Stephanie S. 
Published: September 2014

Objectives:(1) Describe national trends in retropharyngeal abscess (RPA) complicating peritonsillar abscess (PTA). (2) Determine factors associated with RPA in patients with PTA.Methods:Years 2003 to 2010 of the Nationwide Inpatient Sample (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality) were queried for PTA (ICD‐9 code: 475) and RPA (ICD‐9 code: 478.24) in adult patients (age ≥18 years old). The cohort was analyzed using descriptive statistics and multivariate regression modeling to identify factors associated with RPA.Results:Of the 90,941 (95% confidence interval [CI]: 86,433‐95,449) patients identified with PTA, 885 (1.0%) also had a concurrently coded RPA. The annual rate of concomitant RPA doubled (P <. 001) from 0.5% (95% CI: 0.3%‐0.8%) to 1.4% (95% CI: 1.0%‐2.0%) between 2003 and 2010. Patients with RPA were more likely to undergo tonsillectomy (23.5% vs 11.1%) and mechanical ventilation (13.2% vs 2.0%) than those without RPA (all P <. 001). RPA patients were significantly (all P <. 001) older (41 vs 34 years old), had a longer hospital stay (6.4 vs 2.5 days), and had more procedures (2.5 vs 0.9) compared with patients without RPA. Upon multivariate regression analysis, factors associated with RPA included age groups 40 to 64 years (odds ratio [OR] = 2.073, P <. 001), 65 years and older (OR = 2.148, P =. 021), and teaching hospital (OR = 1.838, P <. 001). When controlling for age, sex, and hospital characteristics, general linear modeling demonstrated that RPA accounted for $27,240 (P <. 001) in excess total charges per patient.Conclusions:The incidence of RPA among adult inpatients with PTA is increasing, and patients with RPA have higher in‐hospital resource utilization. Further studies may help validate factors predictive of RPA to enable earlier identification.
A New Trend in the Management of Esophageal Foreign Bodies: Transnasal Esophagoscopy
Authors: Shih Chun Wen , Hao Sheng‐Po 
Published: September 2014

Objectives:(1) Retrospectively review esophageal foreign body (EFB) management. (2) Analyze the outcome of patients with EFB managed by either transnasal esophagoscopy (TNE) or rigid esophagoscopy. (3) Review the value of neck lateral view x‐ray.Methods:We retrospectively reviewed the cases suspicious for EFB managed between January 2007 and December 2013. In each case, neck lateral view was used for initial screening and the cases suspected to have EFB underwent esophagoscopy, which was rigid before July 2010, and TNE after July 2010.Results:From January 2007 to June 2010, 43 patients received rigid esophagoscopy and 31(72.1%) of them were positive for EFB. From July 2010 to December 2013, 302 patients underwent TNE. EFB was noted in only 52 patients and in 36 (69.2%) patients, the EFB could be removed by TNE, while in the other 16 patients with large, or sharp EFB, or possibly perforated esophagus, the EFB could only be removed by rigid esophagoscopy. In the 302 patients that underwent TNE, the sensitivity and specificity of true EFB by neck lateral view x‐ray was 59% and 83%, respectively. There is no major complication of mediastinitis or esophageal perforation in both groups.Conclusions:The introduction of TNE changes the diagnosis and management for EFB. TNE is a quick and safe office procedure under local anesthesia. Neck lateral view X‐ray should not be a routine examination any more. TNE could replace neck lateral view X‐ray to be the first screening procedure and also a useful treatment for patients with EFB.
Incorporating Lean Six Sigma Training within an Otolaryngology Residency Program
Authors: Lobo Brian C. , Johnson Kim , Wannemuehler Todd J. , Matt Bruce H. , Woodward‐Hagg Heather K. , Shipchandler Taha Z. , Kokoska Mimi S. 
Published: September 2014

Objectives:(1) Describe the implementation of Lean Six Sigma (LSS) training within an otolaryngology residency program. (2) Illustrate the challenges and opportunities of project execution. (3) Address the institutional considerations for a successful LSS program.Methods:(1) From July 2013, LSS training and Lean Belt Certification were offered through the IUSM Department of Otolaryngology in collaboration with VA Systems Redesign. (2) The curriculum and training were designed to maximize participant learning and engagement. (3) Resident and faculty initiated LSS projects were reviewed. (4) Participant feedback survey results were collected.Results:(1) The Lean Belt curriculum and training were completed by some of the residents and faculty to date. (2) Two medical students completed Yellow Belt Certification. (3) Salivary and thyroid gland ultrasound projects and a sterile supply project translate quality improvement and cost savings to patients and the organization. (4) Participant survey results have been overwhelmingly positive. The medical students identified the added value of LSS certification in their residency application process.Conclusions:(1) Lean Belt Certification can be successfully incorporated into residency training. (2) Projects serve to improve patient care, increase value, and justify equipment and personnel retention and expansion. (3) Most academic centers have the necessary training available either internally or often from affiliated VAMC or Business Schools. (4) The Lean Belt curriculum and training program has since been used by other subspecialty departments. (5) The additional skill sets acquired by LSS trainees increase their confidence in identifying opportunities for improvement in their immediate health care environment.
Nonrandomized Prospective Study of an Upper Esophageal Sphincter (UES) Assist Device for Treating Laryngopharyngeal Reflux
Authors: Silvers Stacey L. 
Published: September 2014

Objectives:(1) Describe treatment of the heterogeneous disorder of laryngopharyngeal reflux (LPR) with a new upper esophageal sphincter (UES) assist medical device designed to eliminate the reflux of gastric contents into the laryngopharynx. (2) Analyze the reduction of symptoms pre‐therapy compared to posttherapy.Methods:Patients presenting with a reflux symptoms index (RSI) >13 and diagnosed with chronic cough, postnasal drip, globus, or throat clearing were included in the study. The UES assist device was fitted individually to apply external pressure above 20 mm Hg at the cricoid and worn when sleeping. The primary effectiveness endpoint was reduction of the RSI at 4 weeks. SF‐36 Health Survey, Functional Outcomes of Sleep Questionnaire (FOSQ), and patient and physician satisfaction scores were secondary end points. Intent to treat (ITT) analysis was performed. Safety was based on reported adverse reactions.Results:Forty‐four patients consented, with 42 (ITT) completing the study (age, 47 ± 13.1 years; body mass index, 24.8 ± 3.5; 66% female; 75% Caucasian). Most troublesome symptoms were post nasal drip, throat clearing, and annoying cough. Adverse events were mild and short in duration with no study withdrawals due to an adverse event. There was a significant (P <. 0001) reduction of the RSI at 2 weeks (13.2 ± 8.8) and 4 weeks (10.2 ± 7.6) posttherapy compared with pretherapy (24.5 ± 5.9). Ninety‐one percent of patients improved at least 25% with 33% improving at least 75%.Conclusions:The UES assist device is a safe and effective noninvasive method for the treatment of LPR and provides clinical utility within 2 weeks. This could be a potential alternative for LPR before considering medications or surgery.