bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical Malpractice and the Liability of the Loss of Airway: The Otolaryngology Perspective
Authors: Hong Steven S. , Yheulon Christopher , Rieth Katherine , Cable Benjamin B. 
Published: August 2013

Objectives:Analyze malpractice litigation trends to better understand the causes and outcomes of suits involving loss of airway to prevent future litigation and improve physician education.Methods:Jury verdict reviews involving otolaryngologists and loss of airway were obtained from a computerized legal database, WESTLAW from 2001‐2011. Data were compiled on the demographics of the defendant, plaintiff, nature of injury, legal allegations, verdicts, and judgments.Results:Fourteen cases were identified and selected for review. Ten cases resulted in mortality, three cases in anoxic brain injury, and one case involved subglottic stenosis. Four cases were found in favor of the defendant, while ten cases resulted in plaintiff verdicts or settlements with an average award of $1,580,172. Seven cases involved loss of airway due to failed intubations. The most common procedures involved in the loss of airway were oropharyngeal procedures (29%). There were no cases involving a planned surgical airway. The most common legal allegation was delay in procedures (64%). No cases involved failure of informed consent.Conclusions:In cases of loss of airway, there is significant liability consigned to otolaryngologists. They are held accountable for recognizing an emergent airway, promptly and successfully securing the airway, and ensuring a protected airway throughout the patient's disposition. Thus, close oversight, prompt action, and unequivocal communication in emergent airways is imperative.
Volume Expansion of Tissue Engineered Human Nasal Septal Cartilage
Authors: Reuther Marsha S. , Briggs Kristen K. , Wong Van , Neuman Monica K. , Masuda Koichi , Sah Robert , Watson Deborah 
Published: August 2013

Objectives:1) Produce autologous human septal neocartilage constructs substantially larger in size than previously produced constructs. 2) Demonstrate that volume expanded neocartilage constructs possess comparable histologic and biochemical properties to standard size constructs. 3) Show that volume expanded neocartilage constructs retain similar biomechanical properties to standard size constructs.Methods:Human septal chondrocytes from 8 donors were used to create 12mm and 24mm neocartilage constructs. These were cultured for a total of 10 weeks. Photo documentation, histologic, biochemical, and biomechanical properties were measured and compared.Results:The 24mm diameter constructs were qualitatively similar to the 12mm constructs. They possessed adequate strength and durability to be manually manipulated. Histologic analysis of the constructs demonstrated similar staining patterns in standard and volume expanded constructs. Proliferation, as measured by DNA content, was similar in 24mm and 12mm constructs. Additionally, GAG and total collagen content did not significantly differ between the two construct sizes. Biomechanical analysis of the 24mm and 12mm constructs demonstrated comparable compressive and tensile properties.Conclusions:Volume expanded human septal neocartilage constructs are qualitatively and histologically similar to standard 12mm constructs. Biochemical and biomechanical analysis of the constructs demonstrated equivalent properties. This study shows that modification of existing protocols is not required to successfully produce neocartilage constructs in larger sizes for reconstruction of more substantial craniofacial defects.
Angioedema of the Upper Aerodigestive Tract: Risk Factors for Intubation and Review of Management Algorithm
Authors: Brook Christopher , Devaiah Anand K. , Mahoney Elizabeth 
Published: August 2013

Objectives:To define the risks associated with angioedema related airway obstruction and intervention, and to delineate the treatment algorithm used at our institution for airway management in patients with angioedema.Methods:Retrospective chart review of consecutive otolaryngology consultations for angioedema in the emergency department (ED) from 1999‐2003. All patients were evaluated by an otolaryngologist and underwent fiberoptic laryngoscopy.Results:177 patients were included in our study. 32 (18%) patients required intubation, 25 (14%) on initial presentation and 7 (4%) patients progressed from an initially stable airway to requiring intervention after reevaluation. ANOVA analysis demonstrated a statistically significant variance between location of edema and rate of intubation, with higher rates in the pharynx and larynx versus the lip and face. There was no difference between pharyngeal and laryngeal edema in rate of intubation, and there was no difference between oral cavity edema and other subsite in rate of airway intervention. Patients who required intubation after progression between serial evaluations were more statistically more likely to have edema that involved deeper portions of the aerodigestive tract. Patients who required intubation were statistically more likely to be older (average age 61.8 vs 55.1, P=0.03).Conclusions:In this large series of patients managed for aerodigestive angioedema we demonstrate risk factors associated with airway intervention and risk factors associated with clinical progression on serial examination to airway intervention. In addition, we demonstrate a successful management algorithm for patients with aerodigestive angioedema.
Deep Venous Thrombosis and Pulmonary Embolism in Otolaryngology Surgery Patients: An Analysis Using NSQIP
Authors: Zapanta Philip E. , Park Joseph 
Published: August 2013

Objectives:1) Compare rates of post‐operative deep venous thrombosis (DVT) and pulmonary embolism (PE) in otolaryngology surgery (OTO‐HNS) to other surgical fields. 2) Determine if otolaryngology and cancer are significantly associated with differing proportion of DVT and PE.Methods:Using the American College of Surgeons National Surgery Quality Improvement Program (NSQIP) database, 1,300,956 cases (2006‐2010) were analyzed for DVT and PE complications. Otolaryngology DVT and PE complication rates were compared to other specialties using Pearson's Chi‐Square test. These data were analyzed using a logistic regression analysis (Logit binomial model) to determine the association of OTO‐HNS and cancer with proportion of DVT or PE occurrence. Seventy‐three variables from NSQIP were identified as controls for patient demographics, pre‐operative, and intra‐operative factors.Results:OTO‐HNS has decreased prevalence of DVT (OR=0.37; p<0.001) and PE (OR=0.43; p=0.001) compared to other surgeries specialties. Odds ratios for DVT and PE in OTO‐HNS patients with cancer were 4.35 (p<0.001) and 3.86 (p<0.001) respectively. However, OTO‐HNS was associated with significantly increased proportion of DVT (p<0.001) and PE (p=0.008) while cancer was associated with decreased DVT and PE (both p<0.001).Conclusions:Otolaryngology patients experience post‐operative DVT and PE less frequently than patients undergoing other types of surgery. However, when controlling for other potential risk factors, OTO‐HNS has increased risk for DVT and PE. Given the nature of the specialty, otolaryngologists may not be as aggressive in preventing DVT and PE as their peers. This may prompt otolaryngologists to revisit their standards of practice.
Do Obese Patients Need Larger Endotracheal Tubes?
Authors: D'Anza Brian , Knight Jesse , Greene J. Scott 
Published: August 2013

Objectives:1) Correlate tracheal airway size with Body Mass Index (BMI) and other height and weight measurements. 2) Discuss implications for choosing endotracheal tube sizes in adult patients of varying body habitus.Methods:This was a radiographic (computed tomography [CT]) study of 123 consecutive hospitalized patients undergoing tracheotomy over a 4‐year period (2007‐2011). Personal observation of the senior author was that obese patients do not have larger tracheas. In morbidly obese patients, the tracheal dimensions appeared to be even smaller. We expected BMI to not be a good predictor of airway size. We measured airway dimensions in axial CT imaging and made comparisons with their height, weight, BMI, gender, and age. Measurements were taken at the level of the first tracheal ring including anterior‐posterior length, width, and calculated area.Results:The linear regression model showed BMI was significantly inversely related to CT width after controlling for gender and age. For every 1 kg/m2 increase in BMI the CT width decreased by 0.05 points (P = 0.0389). Among all patients there was a trend for airway area to diminish with increasing BMI.Conclusions:The results support our hypothesis that obese patients do not have larger airways. Moreover, the results indicated a trend toward smaller airways as BMI increased. Specifically, as BMI increases, tracheal width appears to decrease. This information should help medical professionals avoid the tendency to use a larger tube to intubate an obese patient. Hopefully this will result in fewer airway injuries in a society where obesity has become an epidemic.
Operative Time and Cost of Resident Surgical Experience: Effect of Instituting an Otolaryngology Residency Program
Authors: Pollei Taylor R. , Barrs David M. , Bansberg Stephen F. , Hinni Michael L. , Walter Logan 
Published: August 2013

Objectives:Describe the procedure length difference between surgeries performed by an attending surgeon alone compared to the resident surgeon supervised by the same attending surgeon.Methods:Case series with chart review. Setting: Tertiary care center and residency program. Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into two cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology—head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. Additionally, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data.Results:Five of the six procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (p= 0.0097), 11.3 minutes for a tonsillectomy (p< 0.0001), 27.4 minutes for a parotidectomy (p= 0.028), 38.3 minutes for a septoplasty (p< 0.0001), and 51 minutes for tympanomastoidectomy (p< 0.0021). Thyroidectomy showed no operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training related costs.Conclusions:Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need be acknowledged.
Interval versus Massed Training: How Do We Best Teach Surgery?
Authors: Kesser Bradley W. , Keeley Meg , Peirce‐Cottler Shayn 
Published: August 2013

Objectives:1) Compare two training paradigms, massed vs. interval training, when novice students learn to perform myringotomy with ventilation tube insertion (MVTI) on a validated simulator. 2) Determine if training paradigm affected confidence levels performing the procedure and comfort level working under a microscope.Methods:Between September 2011 and April 2012, 40 medical students were randomized to the interval group (n=19), in which they were trained to perform MVTI in five practice trials/day over 3 days, or the massed group (n=21) in which they were trained over 15 practice trials in one sitting. One week later, all students were tested in five final trials. Outcome measures included time to complete the operation and number and type of error made. Pre‐ and post‐test surveys were administered.Results:Students in both groups demonstrated a significant decrease in time between practice and final trials. There was no significant difference between the two groups in time to complete their final trials. No difference was observed in the number of errors committed per trial between practice and final trials (both groups) or between massed and interval groups in their final trials. Students in both groups showed significantly increased confidence in conducting the procedure and in using a microscope. In the final trials, participants in the interval group felt significantly more confident about their ability to perform the procedure than those in the massed group.Conclusions:Training method had little impact on proficiency in performing a simulated surgical procedure in this setting.
Intraoperative Local Anesthesia for Reducing Pain following Tonsillectomy
Authors: Lin Rui J. , Naidoo Lalenthra , Burton Martin J. , Chadha Neil K. 
Published: August 2013

Objectives:Perform a Cochrane review to systematically appraise the available evidence of pain relief through the use of intra‐operative local anaesthetic (LA) administration to the tonsillar region in adults and children undergoing tonsillectomy.Methods:The study followed the rigorous systematic review and meta‐analysis methodology as developed by the Cochrane Collaboration. A comprehensive search strategy was applied to multiple databases for published and unpublished trials up to April 2012. Randomized, double‐blind, placebo‐controlled trials were eligible. Two reviewers independently extracted data and assessed trials for quality. Data analyses were performed using the RevMan 5.1 software.Results:Sixty‐six randomized controlled trials were included in the review. Eleven trials assessing peritonsillar infiltration of LA and seven trials that investigated topical application of LA were suitable for meta‐analysis. Peritonsillar LA infiltration was associated with significant reduction in pain up to 2 hours after surgery (mean difference ‐1.34 on a scale of ‐10 to 10; 95% CI ‐1.80 to ‐0.88; P< 0.00001). Topical LA application to the tonsillar fossa was also associated with significant pain reduction in the early post‐operative period (mean difference ‐0.66 on a scale of ‐1 to 1; 95% CI ‐1.06 to ‐0.27; P = 0.001). Intra‐operative LA was associated with a longer period of time without analgesic requests post‐operatively (mean difference 12 minutes; 95% CI 2.0 to 21.8; P = 0.020).Conclusions:Based on the available evidence, we would advocate routine intra‐operative application of LA, whether infiltrative or topical, for patients undergoing tonsillectomy.
Isolated Basilar Skull Fracture: Outcomes and Predictors of Readmission
Authors: McCutcheon Brandon A. , Orosco Ryan K. , Chang David C. , Maturo Stephen C. , Magit Anthony E. 
Published: August 2013

Objectives:Outcomes in pediatric and adult patients with isolated basilar skull fracture.Methods:Cases of isolated basilar skull fracture were identified in the California Office of Statewide Health Planning and Development (OSHPD) database. In‐hospital and 90‐day rates of meningitis and cerebrospinal fluid (CSF) leak were assessed. Determinants of 30‐day readmission were evaluated using multivariate logistic regression.Results:5,223 pediatric and 7,421 adult patients met inclusion criteria. Most patients had a length of stay greater than one day (64.3% pediatric and 77.5% adult). In‐hospital rates of meningitis (0.41% and 0.55%) and CSF leak (2.24% and 1.75%) were similar among children and adults, respectively. Rates of 90‐day meningitis (0.24% and 0.37%) and CSF leak (0.43% and 0.40%) were also similar. 30‐day readmission was 3.94% for children compared to 12.4% for adults. For pediatric and adult patients, extra‐axial hematoma (odds ratio [OR] 1.73 and 1.57) and comorbidities (OR 2.18 and 1.50) were associated with significant increases in 30‐day readmission (p<0.001). Loss of consciousness of greater than one hour (OR 2.45, p<0.001), and CSF leak (OR 2.80 p=0.002) was also associated with significant increases in pediatric readmissions. No association between length of stay and the likelihood of readmission was observed.Conclusions:Meningitis and CSF leaks following isolated basilar skull fractures are rare in both children and adults. This study found no association between length of stay and likelihood of readmission. This suggests that, in the absence of CSF leak or other complication, extended inpatient monitoring may be unwarranted as a means to reduce complications and readmissions.
Regional Differences in Gender Promotion and Scholarly Productivity
Authors: Mady Leila J. , Svider Peter F. , Kalyoussef Evelyne , Setzen Michael , Baredes Soly , Chandrasekhar Sujana S. , Eloy Jean A. 
Published: August 2013

Objectives:Identify whether there are regional differences in previously described gender disparities in scholarly productivity and faculty rank among academic otolaryngologists.Methods:Online faculty listings from 95 academic otolaryngology departments were searched to identify clinical faculty and further organize them by gender, academic rank, fellowship training status, and institutional location. The Scopus database was used to assess various bibliometrics of these otolaryngologists, including the h‐index, number of publications, and publication range (in years).Results:Analysis included 1,127 otolaryngologists, 916 men (81.3%) and 211 women (18.7%). Female faculty comprised 15.4% in the Midwest, 18.8% in the Northeast, 21.3% in the South, and 19.0% in the West (p=0.44). Overall, men obtained significantly higher senior academic ranks (Associate Professor or Professor) compared to women (59.8% vs. 40.2%, p<0.0001). Regional gender differences among senior faculty were found in the South (59.8% men vs. 37.3% women, p=0.0003) and in the Northeast (56.4% men vs. 24.1% women, p<0.0001) with concomitant gender differences in scholarly impact, as measured by the h‐index (South, p=0.0003; Northeast, p=0.0001). Among geographic subdivisions, female representation at senior ranks was lowest in the Mid‐Atlantic (21.9%), New England (17.1%), and West South Central (33.3%), while highest in the Pacific (60.0%) and Mountain (71.4%) regions. No regional gender differences were found in fellowship training patterns (p‐values>0.05).Conclusions:Gender disparities in academic rank and scholarly productivity exist regionally, most notably in the Northeast where women in otolaryngology are most underrepresented relative to men at senior academic ranks and in scholarly productivity.
Risk Factors for Unplanned Hospital Readmission in Otolaryngology Patients
Authors: Graboyes Evan M. , Liou Tzyy‐Nong , Kallogjeri Dorina , Nussenbaum Brian , Diaz Jason A. 
Published: August 2013

Objectives:Describe the risk factors that predict 30‐day unplanned readmission in hospitalized otolaryngology patients.Methods:We conducted a retrospective review of all otolaryngology admissions for the one year period between January 1, 2011, and December 31, 2011, at a single academic medical center with a broad and heterogeneous otolaryngology practice. A univariate logistic regression and then a forward stepwise logistic regression model were performed to identify risk factors for unplanned readmission to the hospital within thirty days of discharge from the otolaryngology service.Results:1271 patients met inclusion criteria. The 30‐day unplanned readmission rate for patients discharged from otolaryngology was 7.3% (93/1271). There were twenty variables that were significant on univariate analysis. The risk factors for readmission after the forward stepwise logistic regression model were new total laryngectomy (Odds Ratio (OR) 5.5) (95% Confidence Interval (CI) 2.1; 14.6), prior unplanned readmission from any service at the academic center (OR 3.1) (95% CI 1.9; 5.1), current illicit drug use (OR 3.4) (95% CI 1.8, 6.4), preoperative non‐steroidal immunosuppression (OR 3.4) (95% CI 1.4; 8.4), discharge to an extended care facility or skilled nursing facility (OR 3.4) (95% CI 1.6; 7.1), and discharge to home with home healthcare (OR 2.3) (95% CI 1.2; 4,4). The c‐index for the regression model was 0.73.Conclusions:Otolaryngology patients have unique risk factors that predict unplanned readmission within 30‐days of discharge. These data identify specific patient characteristics and care processes that can be targeted with quality improvement interventions to decrease readmissions.
Three‐Dimensional, Virtual Reality Vestibular Rehabilitation for Ménière's Disease‐Induced Chronic Imbalance Problem
Authors: Yeh Shih‐Ching , Wang Pa‐Chun , Su Mu‐Chun , Chang Chia‐Huang , Fang Te‐Yung 
Published: August 2013

Objectives:Patients with Ménière's disease (MD) may suffer from chronic imbalance problem that cannot be cured by surgery or medication. For these patients, vestibular rehabilitation is another treatment option. Three‐dimensional (3D), virtual reality (VR) technology may be applied to facilitate rehabilitation exercise. In this study we report outcomes of 3D, VR rehabilitation for patients with MD‐related chronic vestibular dysfunction.Methods:A VR‐based rehabilitation system was developed. The system consists of the Kinect Xbox for full‐body interaction, 3D‐ready projector with shutter‐glasses for stereo imaging, Wii Fit pressure pad (for tracing the center of gravity sway and statokinesigrams [SKG], in cm2), and Unity game engine for leveled‐difficulty design. The modified Cawthorne‐Cooksey exercises (MCCE) was adapted into this system; the MCCE scores were compared following intervention. 50 MD patients with chronic balance were recruited for this prospective, longitudinal, uncontrolled clinical study. Patients followed the instructions of MCCE to complete at least 6 sessions of vestibular rehabilitation within a 4‐week period.Results:All patients experienced improvement of balance function performing daily activities and were overall positive about the training protocol. After intervention, the fast components of postural sway and SKG (P < 0.05) were reduced. The MCCE scores significantly improved (66.6 to 74.6, P < 0.05). We found age (Î2 = ‐0.52, P < 0.05) and number of training sessions (Î2 = 2.53X, P < 0.05) were significant predictors for clinical improvement.Conclusions:Vestibular rehabilitation can assist MD patients who cannot benefit from medication and surgery. The data support the applicability of 3D, VR technology in the field of vestibular rehabilitation.