ENTtoday: April 2010


Medical Education

Treating Allergic Rhinitis: A Patient Experiment

Berrylin J. Ferguson, MD, FACS, FAAOA, associate professor of otolaryngology and director of the Division of Sino-Nasal Disorders and Allergy at the University of Pittsburgh School of Medicine in Pittsburgh, Pa., uses the following form to help determine which allergy treatments will work best for each patient.

Career Development, Medical Education, Viewpoint

Mission Possible: Humanitarian work allows otolaryngologists to enact change

Performing international surgical outreach missions to help the world’s most disadvantaged patients overcome the disability imposed by disease is an extremely rewarding experience. Missions are challenging, varying in their length, level of working and living conditions and the surgery performed. Despite the rigors of mission work, there has not been a mission where members of the medical team did not find the experience to be life changing.

Medical Education

Alternative Remedies for Chronic Rhinosinusitis: Are complementary and alternative treatments harmful or advisable?

Laurie McCombs, 53, has dealt with sinus problems nearly all of her adult life. Clogged sino-nasal passages made it difficult for her to breathe at night, and the congestion caused morning pressure headaches. Over-the-counter and prescription antihistamines muted her symptoms but did not address their cause. At the age of 40, she decided to take the advice of friends who had experienced relief with acupuncture. Now McCombs follows the advice of the acupuncturist, who diagnosed her with allergies to dairy products and yeast, by limiting her intake of breads and milk products. She also continues to take loratadine and has found saline irrigation with the neti pot helpful in clearing her sinuses.

Health Policy, Legal Matters, Practice Management

Avoid the Hot Seat: How to prepare for a CMS audit

In February, the Centers for Medicare and Medicaid Services (CMS) began rolling out its national Recovery Audit Contractor (RAC) program, aimed at ferreting out improper payments and preventing fraud, waste and abuse in the Medicare system. If you bill for Medicare fee-for-service, you are fair game for a RAC audit. A three-year demonstration of the RAC program, which ended in March 2008, heavily targeted bronchoscopy, injectable drugs and IV hydration therapy. But auditors are rapidly expanding the list, and the permanent program will include adenoidectomies, tonsillectomies, thyroidectomies and other otolaryngology-related procedures.

Practice Management, Tech Talk

Scarless Surgery: The benefits and drawbacks of robotic thryroidectomy

Using robotic arms, surgeons can now remove the thyroid gland through an incision in the axilla, or armpit, thereby avoiding the large scar on the front of the neck caused by traditional thyroid surgery. The procedure offers no other benefits over the traditional approach developed a century ago by Emil Theodor Kocher, MD, according to head and neck surgeons who perform the robotic surgery. In fact, it takes longer to recover from the robotic surgery, they say, with some patients complaining of chest numbness for months afterwards.


Literature Reviews

Videolaryngostroboscopy Valuable in Pediatric Patients

What is the diagnostic value of laryngeal videostroboscopy in pediatric patients with dysphonia? Background: Laryngeal videostroboscopy has been proven to be a valuable tool in the evaluation of adult voice disorders. It allows for detailed assessment of glottal closure, mucosal pliability and subtle vocal fold lesions. Pediatric dysphonia is found in six percent to nine percent […]

Literature Reviews

Prevalence of Dysplasia with Recurrent Respiratory Papillomatosis Is High

What is the prevalence of dysplasia in recurrent respiratory papillomatosis? Background: Recurrent respiratory papillomatosis (RRP) is a debilitating disease caused by the human papilloma virus (HPV). Between two percent and four percent of cases are reported to undergo malignant degeneration. Epithelial dysplasia is implicated in the progression towards malignancy. Study design: Retrospective case series review Setting: Two academic […]

Literature Reviews

System Automatically Monitors Apnea-Hypopnea Index

Does a new, full-night automatic system for the detection of snoring provide information on the acoustic characteristics of snores that differ in relation to the apnea-hypopnea index (AHI)? Background: The probability of obstructive sleep apnea syndrome (OSAS) is 3.2 times higher in snorers than in non-snorers. Although several studies have shown differences in acoustic snoring characteristics […]

Literature Reviews

Cidofovir Therapy Does Not Correlate with Worsening Dysplasia

What is the association between an increasing degree of papilloma dysplasia and the use of cidofovir in the context of the natural progression of dysplasia in recurrent respiratory papillomatosis (RRP)? Background: RRP is a benign disease characterized by recurrent lesions in the airway. The prevalence and degree of dysplasia present in the natural course of RRP […]

Literature Reviews

PET-CT Adds to Management of Salivary Gland Malignancies

What is the efficacy of combined positron emission tomography-computed tomography (PET-CT) in identifying salivary gland malignancies, and what is its role in the management of these patients? Background: In early studies, PET information improved the sensitivity of CT in detecting primary salivary tumors, cervical metastases and distant metastases, but the small number of patients and the […]

Literature Reviews

Fibula and Osteocutaneous Radial Forearm Free Flap Are Comparable

Does the osteocutaneous radial forearm free flap (OCRFFF) provide equivalent functional outcomes and improved morbidity compared to the fibular free flap (FFF) in mandibular reconstruction? Background: Although widely used due to length and quality of bone, FFF routinely results in up to three months of antalgic gait and can cripple the elderly population. Recently there has […]