bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Pacific Island Health Care Project: Utilization of Otolaryngology and Impact on Graduate Medical Education
Authors: Groom Kelly , Ramsey Mitchell J. 
Published: September 2014

Objectives:(1) Assess otolaryngology–head and neck subspecialist utilization within a large telemedicine program. (2) Examine the impact of that program on graduate medical education.Methods:A retrospective review of the Pacific Island Health Care Project records from 1998 to 2012 was performed to identify the number and type of telehealth consultations for patients with disorders of the head and neck. Consultations were categorized into diagnostic groups to evaluate referral patterns. Medical records from patients referred through the program were reviewed to determine the number and types of surgical procedures performed.Results:Four thousand telehealth consultations were sent to a single medical center with consultants representing all major medical and surgical subspecialties. A total of 730 teleconsultations were submitted for primary disorders of the head/neck, representing 18.3% of all consultations. The 3 most common reasons for teleconsultation included: benign or malignant head/neck mass (nonthyroid); thyroid mass; and cleft lip/palate. A total of 242 patients were referred for definitive surgical management. Seven hundred fifty‐eight coded procedures were performed on those patients resulting in 383 key index procedures.Conclusions:Otolaryngology as a specialty is well suited for telemedicine applications. This study demonstrates a high utilization of otolaryngology indicating a high degree of referral feasibility and a high requirement for head and neck specialist consultation. This program had a large impact on graduate medical education, not only in terms of increased experience with complex patient care and operative case numbers, but also less tangible benefits relating to opportunities for residents to develop key competencies required for successful graduate medical training.
Pediatric Head and Neck Gunshot Wounds in the United States: A Cohort Study
Authors: Johnson Romaine F. , Shah Gopi 
Published: September 2014

Objectives:Study head and neck gunshot wounds (GSW) involving pediatric patients in the United States.Methods:Study Design: Retrospective cohort study. Setting: The KIDS Inpatient Database (KID) years 2003, 2006, and 2009. The subpopulation of pediatric patients 21 years and younger admitted with head and neck trauma due to gunshot wounds were compared with all patients admitted with head and neck traumatic injuries. Univariate and multivariate analysis was completed to evaluate demographics, morbidity, and mortality associated with gunshot wounds to the head and neck. Age, sex, and ethnic disparities were also examined.Results:An estimated 1342 (SE, 100.7) pediatric patients suffered gun shot wounds to the head and neck, 3.2% (SE, 0.19) of all head and neck traumatic wounds. The mean age was 17.1 years (SE 0.12). The population was 88.1 % male (SE, 1.1), 48.2% (SE, 2.9) black, and 10.2% (SE, 1.1) died during their hospitalization. Mean total charges were $70,312 (SE, $4216). When compared with the larger population of pediatric head and neck trauma patients, GSW patients were statistically significantly older, male, black, and living in the lowest income quartile (all P <. 01). Additionally, GSW patients had longer hospital stays, higher total charges, and higher mortality rates. These findings held constant when controlling for age, sex, and injury severity/mortality risk.Conclusions:Gunshot wounds to the head and neck are an uncommon but serious injury in pediatric patients. Continued research regarding treatment and prevention is warranted.
Postoperative Pain Scores in Thermal Welding and Conventional Tonsillectomy Techniques: A Randomized Controlled Study
Authors: Fida Abdulkareem R. , Sendi Khalil S. 
Published: September 2014

Objectives:Assess postoperative pain of the thermal welding system tonsillectomy compared to conventional tonsillectomy.Methods:A total of 342 patients aged from 8 through 39 years were enrolled in a randomized prospective controlled study. Extracapsular tonsillectomy with thermal welding and conventional system was performed randomly in each patient. Patients with chronic tonsillitis were included. Patients undergoing adenoidectomy, with suspected or confirmed tonsillar malignancy, or undergoing another procedure together with tonsillectomy were excluded from the study. Postoperative pain was measured by means of Face Pain Scale and Numerical Pain Score for each patient on 3 occasions (6‐8 hours postoperative, 24 hours postoperative, and 6 days later during the first postoperative visit) for each side.Results:There was a statistically significant difference between the pain scores of both procedures on all 3 occasions (P >. 001). Patients treated with thermal welding had the lowest postoperative pain score regardless of the occasion. Patients treated with the conventional technique had a significantly higher postoperative pain score on all 3 occasions.Conclusions:Thermal welding tonsillectomy is superior to the conventional technique, with less postoperative pain.
Predictors of Initial Technical Skill Acquisition in Otorhinolaryngology Residency Applicants
Authors: Gomez Ernest D. , Bur Andres , Eliades Steven J. , Lee Jonathan M. , Kearney James J. , Ruckenstein Michael J. 
Published: September 2014

Objectives:(1) Investigate the utility of residency applicant characteristics as predictors of technical skill. (2) Demonstrate the feasibility of technical skill assessment in the residency interview setting.Methods:A cross‐sectional study was performed in December of 2013 to identify residency applicant characteristics that may predict technical skill. During 2 residency interview days, 39 medical students performed up to 5 trials each of 2 box trainer tasks: myringotomy and endoscopic grasping. Subject performance was assessed by an attending surgeon using a global rating scale (GRS). Completion time and error counts were recorded. Applicant factors studied were United States Medical Licensing Examination Step 1 score, Alpha Omega Alpha status, medical school grades, and extracurricular activities. Pearson coefficients and Wilcoxon rank‐sum tests were used to evaluate each applicant characteristic.Results:A total of 117 endoscopic grasping trials and 179 myringotomy trials were assessed. Thirty‐eight of 39 subjects completed both tasks at least 3 times. Participation in competitive sports was associated with more errors during the first endoscopic grasping trial (W = 110.5, P =. 0036) with no difference found in subsequent trials. Step 1 scores and honors grades in core clerkships did not correlate with performance metrics for either task during any trial. Participation in competitive sports did not correlate significantly with task performance for myringotomy.Conclusions:Common methods of residency applicant assessment do not predict performance on otolaryngology‐specific task trainers. It is feasible to measure initial technical skill acquisition in the residency interview setting. It is unknown whether initial technical skill acquisition will correlate with technical skill during residency.
Predictors of Outcome in Angiotensin Converting‐Enzyme Inhibitor‐Induced Angioedema
Authors: Kieu Monica C. Q. , Rajasakher Arun , Bangiyev John N. , Thottam Prasad J. , Wilburn John , Stern Noah , Levy Phillip 
Published: September 2014

Objectives:(1) Identify high‐risk symptoms and anatomical regions involved in Angiotensin Converting‐Enzyme Inhibitor‐Induced Angioedema (AIIA) that may affect admission and placement, hospital length of stay, need for airway intervention, and clinical improvement versus deterioration. (2) Describe a clinical algorithm for the management and treatment of AIIA that would dictate placement of patients (ICU, general medical floor, observation unit, or discharge home), medical therapy, and the need for airway intervention (intubation or tracheostomy).Methods:A retrospective chart review of adult patients presenting to the emergency department (ED) at Detroit Medical Center diagnosed with AIIA from July 2010 to July 2013. Patients were followed from initial presentation until discharge. Descriptive statistics (frequency, means, and standard deviations) were calculated for all predictor, outcome, and control variables.Results:A total of 302 patients who were diagnosed with AIIA in the ED were evaluated with flexible laryngoscopy by an otolaryngologist. A total of 94% of patients were African American, with a slight female predominance of 63%. The most frequent presenting sign was lip swelling (62%). Angioedema confined to the lips was a negative predictor for airway intervention (P <. 01). Also, patients with isolated lip swelling were less likely to have progression of symptoms (P <. 05), and were less likely to require ICU monitoring (P <. 05).Conclusion:This is the largest patient series to date of AIIA. Using the information from this study, a clinical algorithm was developed that details management of AIIA based on presenting signs and anatomic location, with otolaryngologists playing a vital role in the decision making process.
Pediatric Anesthesiologists Increase Operating Room Efficiency for Pediatric Adenotonsillectomies
Authors: Dewyer Nicholas A. , Russell Marika D. 
Published: September 2014

Objectives:(1) Determine whether Accreditation Council for Graduate Medical Education fellowship‐trained pediatric anesthesiologists improve the efficiency of pediatric operations at hospitals that do not have dedicated pediatric operating rooms (ORs). (2) Determine what anesthesia practices may account for a difference in efficiency between general and pediatric anesthesiologists.Methods:This retrospective chart review study compared the anesthesia‐controlled time (ACT) between pediatric and general anesthesiologists for pediatric adenotonsillectomies performed at an academic county hospital without dedicated pediatric operating rooms (ORs). All patients age 12 years and under who underwent tonsillectomy or adenotonsillectomy from January 2008 to July 2013 at San Francisco General Hospital were included. Patient demographics, surgical time, ACT, and anesthesia techniques were compared between pediatric and general anesthesiologists.Results:Pediatric anesthesiologists had significantly shorter ACT than general anesthesiologists (33 ± 12 vs 47 ± 15 minutes; P <. 0001). Surgical time was also shorter for cases staffed by pediatric anesthesiologists (44 ± 14 vs 54 ± 23 minutes; P <. 05).Conclusions:These findings suggest that, at hospitals without dedicated pediatric ORs, staffing pediatric operations with fellowship‐trained pediatric anesthesiologists may be an effective strategy for increasing OR efficiency and reducing costs without compromising patient care.
A Standardized Lingual Tonsil Grading System: Interexaminer Agreement
Authors: Friedman Michael , Yalamanchali Sreeya , Kaye Kathryn , Joseph Ninos J. 
Published: September 2014

Objectives:Comparisons between studies involving the tongue base are limited by the lack of a universal system for grading lingual tonsils. The authors propose a new standardized grading system for lingual tonsil hypertrophy (LTH). Validation was assessed via an interexaminer agreement study.Methods:Video assessment: The proposed grading system consists of a 0 to 4 scale with: 0 = complete absence of lymphoid tissue, 1 = lymphoid tissue scattered over tongue base, 2 = lymphoid tissue covering entirety of the tongue base with limited vertical thickness, 3 = lymphoid tissue 5 to 10 mm in thickness, 4 = lymphoid tissue >1 cm in thickness (above tip of the epiglottis). A teaching video was created to demonstrate identification of this grading system. After viewing the teaching video, 8 trained otolaryngologists graded 25 video clips of the tongue base, recorded during flexible laryngoscopy. Live assessment: A second study was performed by 2 examiners directly examining the tongue base of 23 patients using flexible laryngoscopy during a routine clinic visit. Each examiner viewed and recorded the grade of the lingual tonsils independently.Results:Video assessment: The overall Fleiss kappa statistic was found to be κ = 0.449 (P <. 0001). This value denotes moderate agreement. Live assessment: The overall kappa for nominal data were found to be κ = 0.8665 (P <. 0001). This value denotes perfect agreement.Conclusions:The moderate interexaminer correlation demonstrated during video‐assessment, and perfect interexaminer correlation demonstrated during live assessment, indicate that this proposed grading system may be a valuable and useful tool in creating a common language to describe lingual tonsils.
Substantial Delay in Discharge of Elderly with Tracheotomies: Our 10‐Year Experience
Authors: Bergeron Mathieu , Audet Nathalie 
Published: September 2014

Objectives:Comparing management of tracheotomies in older (>75 years old) versus younger patients ≤75 years old) for duration of hospitalization secondary to tracheotomy and finding associated risk factors.Methods:Retrospective chart review (2003‐2013) for all patients >75 years old who had tracheotomy compared to patients ≤75 years old.Results:Mean age is 79.3 versus 53.1 years, respectively (P <. 0001). Main reason for tracheotomy is prolonged endotracheal intubation (59/112‐52.7% vs 65/99‐65.7%, P =. 181). There is a statistically significant difference between time performing tracheotomy and its weaning for older versus younger patients: 33.14 (24.41‐41.87 confidence interval [CI] 95%) versus 22.90 days (19.22‐26.59 CI 95%, <. 0285). Older patients stayed 4.73 days longer at hospital specifically for tracheotomy management (1.97‐41.87, CI 95%) versus 0.58 days for younger patients (0.00‐1.42 CI 95%, P <. 0001). When leaving hospital with a tracheotomy, discharge is delayed by 14.39 days in older (5.80‐22.98 CI 95%) versus 3.17 days in younger patients (0.00‐8.02 CI 95%, P =. 0299). Elderly patients are discharged to a nursing home more frequently (36.5% vs 20.7%, P =. 0255). Spearman correlation revealed that time between tracheotomy and the first change of cannula, time to wean tracheotomy and postoperative Eastern Cooperative Oncology Group status were all predictive factors of prolonged hospitalization (all P <. 0001).Conclusion:Elderly patients need special management secondary to a tracheotomy to prevent prolonged hospitalization. Improving doctor awareness and knowledge of patient risk factors may improve tracheotomy management.
Tonsillotomy or Tonsillectomy: What Do Parents Prefer?
Authors: Stasio Sally D. , Brietzke Scott E. , Shah Rahul K. 
Published: September 2014

Objectives:Tonsillotomy has been presented as a less‐invasive alternative to the traditional tonsillectomy. The decreased pain and recovery time after tonsillotomy have been well established, but questions regarding tonsil regrowth remain. It has been assumed that parents would prefer tonsillotomy because of its recovery advantages. The objective of this study is to (1) directly sample the opinion of typical parents who would be considering tonsillotomy versus tonsillectomy. (2) Assess the role of age, educational level, and risk aversion in this parental choice.Methods:Parents in a busy pediatric otolaryngology waiting room were approached and asked to hypothetically choose either tonsillectomy or tonsillotomy for their child via a written survey. Each procedure was described in basic terms listing basic risks and benefits including pain, recovery, regrowth, and incidence of complications. Parents were also asked simple questions regarding age range, educational level, and risk tolerance. Data analysis included simple descriptive statistics and contingency table analysis.Results:Two hundred thirty parents completed the survey. Parents overwhelmingly (85.8%) preferred tonsillectomy over tonsillotomy. An increasing risk aversion score was associated with a preference for tonsillectomy (P =. 001, Fisher's exact test). Education and age range were not significantly related to procedural preference or risk tolerance. As might be expected, most parents (72%) were generally risk averse.Conclusions:Despite prevailing opinion that presumes parents generally prefer tonsillotomy over tonsillectomy because of its recovery advantages, an overwhelming majority of parents surveyed actually prefer tonsillectomy. The basis of this decision appears to be in part risk aversion of tonsil regrowth.
Triune Tube Outcomes
Authors: Schramm Jordan C. , Person Austin , Burt Alexandra J. , Yonkers Anthony J. 
Published: September 2014

Objectives:(1) Determine complication rates of Triune tubes. (2) Compare complication rates of the Triune tubes with rates cited previously in the literature. (3) Compare complication rates of Triune tubes with T‐tubes and grommet tubes.Methods:A retrospective chart review was conducted on myringotomy tubes placed from 2002 to 2011 by a single surgeon in a university hospital setting. Medical records were reviewed for the following data: type of myringotomy tube placed, duration of time the tube remained situated in the tympanic membrane, complications related to the tube placement (persistent tympanic membrane perforation, tube obstruction, granuloma formation, or reoperation), and procedures performed to remediate any encountered complications.Results:A total of 1216 tubes were placed in 565 patients (250 female). Average patient age was 6.8 years (range, 3.7 months to 95.6 years). The primary indication for myringotomy with tube placement was chronic serous otitis media (n = 1062, 87.2%). Other indications included recurrent acute otitis media (n = 12, 1.0%), removal and replacement of nonfunctioning tubes (n = 132, 10.8%), and barotrauma (n = 11, 0.9%). The indication was not specified for 1 tube (0.1%). During the study period, 459 (37.7%) of the tubes placed were Triune, 650 (53.5%) were T‐tubes, 88 (7.2%) were grommets, and 19 (1.6%) were not specified. Overall, complications occurred in 96 (20.9%) Triune tubes, 134 (20.6%) T‐tubes, and 9 (10.2%) grommet tubes. However, these differences were not statistically significant (chi‐square 4.797; P =. 187).Conclusions:Triune tubes are safe when myringotomy tube placement is indicated. Complication rates with Triune tubes are comparable with both grommet tubes and T‐tubes.
Validation Study on Intraoperative Video Recording as an Objective Assessment Tool in ENT Surgery
Authors: Bowles Philippe F. , Das Prodip , Young John P. F. , Saunders Nicholas , Harries Meredydd L. , Fleming Jason 
Published: September 2014

Objectives:(1) Determine the construct validity and the reliability of video assessment scoring of myringotomy and grommet insertion. (2) Measure the performance (by rating) of participants compared to operative time.Methods:Study design was a single blinded (raters) video assessment, conducted in a tertiary care university hospital August to October 2013. Participants were consultant and trainee (Specialty Registrar [StR] and Core Trainee [CT]) ear, nose, and throat (ENT) surgeons performing a total of 30 consecutive index procedures. Two raters at ENT Consultant level with a subspecialty interest in otology who did not take part in the study were invited to score results.Results:A strong correlation between scores by the 2 blinded raters was demonstrated (rho = 0.748; P <. 001). Median scores (/45) for each group were: CT 25.5 (interquartile range [IQR] 21.13‐31.25), SpR 33 (IQR 24.88‐35), and consultant 40 (IQR 35.38‐42.63). Kruskal‐Wallis test analysis showed statistically significant mean rank scores between the 3 different levels of experience (H = 12.77, P =. 002). Multiple group comparisons indicated a significant difference between CT and consultant groups (P <. 001) and StR and consultant groups (P =. 007). Analysis of the time taken between the experience groups demonstrated a difference (H = 8.689, P =. 013), although individual intergroup comparisons indicated this was only significant between CT and consultant groups (P =. 004). There was a significant negative correlation (rho = –0.842; P <. 001) between time taken for procedure and score achieved.Conclusions:Video assessment of this procedure may represent a valid, feasible tool for use in summative and formative assessments of trainee ENT surgeons. Remote scoring of assessment procedures minimizes bias and enables blinding of raters.
Awareness of Human Papillomavirus and Its Association with Oropharyngeal Cancer
Authors: Goldenberg David , Williams Michael U. , Carr Michele M. 
Published: September 2014

Objectives:Assess public awareness of human papillomavirus (HPV) as a cause of oropharyngeal cancer.Methods:A total of 477 participants were randomly chosen to participate in a 23‐item survey at various shopping malls and Maxwell Air Force Base in 2012. The Chi‐square test was used in statistical analysis.Results:Three hundred nineteen participants were civilians and 158 were military officer trainees (MOT). All MOT had a bachelor's degree or higher, while 37% of civilian participants had a bachelor's degree or higher. Eighty‐two percent of MOT knew of oropharyngeal cancer, but 53% of civilians had not heard of oropharyngeal cancer (P <. 0001). Most participants (75% civilian and 94% military) were aware of the connection between HPV and cervical cancer. Conversely, 75% of civilian population and 49% of MOT had no knowledge of the association between HPV and oropharyngeal cancer (P <. 0001). The majority of participants (61% military and 81% civilian) did not know that both sexes were eligible for HPV vaccine (P <. 0001). A total of 75% of MOT and 63% of civilians would agree to be vaccinated for HPV if it were free and they were eligible.Conclusions:Most people were aware that HPV is a causative agent of cervical cancer. However, the majority were not aware of the association between oropharyngeal cancer and HPV. Furthermore, many participants were not aware that HPV equally affects men and women and that the vaccine is available for both sexes. This underscores the need to educate the public on the availability of HPV vaccine and the association between HPV and oropharyngeal cancer.