ENTtoday: September 2010


Practice Management, Tech Talk

Is There Still a Place for the Head Mirror?

It’s no surprise that head mirrors are second only to the stethoscope as one of the most recognizable symbols used in artists’ renderings and Hollywood depictions of a physician. Or that, in most cases, head mirrors are incorrectly shown situated squarely in the middle of the “doctor’s” forehead, much like a shiny, silver bull’s eye instead of flipped down over one eye.

Everyday Ethics, Practice Management, Viewpoint

More of the Same: Why isn’t otolaryngology becoming more diverse?

As America grows and evolves, its face necessarily changes. Our country rests solidly on the idea that life, liberty and the pursuit of happiness should be available to all. Our collective understanding that access to health care and healthy living are essential to that ideal happiness continues to mature. But while the population becomes more diverse and blended, cultural disparities in health care not only persist, they do not appear to be diminishing. Collectively, African-Americans, Hispanic Americans and Native Americans comprise over one-quarter of our population. Yet, in the year 2000, they made up less than 10 percent of the physician workforce. These numbers dwindle even more when we consider surgical subspecialties.

Career Development, Practice Management

Generation Gap: Combating “fogeyphobia” in the workplace

In an address to the 2009 Combined Otolaryngological Spring Meetings in Las Vegas, neurosurgeon Harry Van Loveren, MD, chair of the department of neurosurgery at the University of South Florida, coined the term “fogeyphobia” to describe a tendency among older doctors to become reluctant to speak out against new surgical tools and techniques, out of fear of being viewed as old-fashioned.

Health Policy, Practice Management

The Opt-Outs: Otolaryngologists extol the benefits of third-party independence

When describing to the curious the benefits of opting out of both Medicare and private insurance, Gerard J. Gianoli, MD, president of The Ear and Balance Institute in Baton Rouge, La., often recalls one particular example: During one 90-day global period about five years ago, after an eight-hour resection of a skull-based glomus tumor, post-operative ICU care and several days of inpatient care and the usual post-operative office visits, he received a total reimbursement of $500.


Literature Reviews

Is Comprehensive ASNHL Screening Always Needed?

What are the costs and diagnostic yield of screening patients presenting with asymmetrical sensorineural hearing loss (ASNHL)? Background: The magnitude of workup on a patient with ASNHL of an uncertain onset or chronic nature is a problem commonly encountered by otolaryngologists. The typical comprehensive workup includes a number of expensive tests, including a battery of serologic […]

Literature Reviews

The Application of Posterior Hyoid Space to the Sistrunk Procedure

If the recurrence of thyroglossal duct cysts (TGDC) occurs as a consequence of incomplete resection, will the application of the posterior hyoid space (PHS) to the Sistrunk procedure minimize the risk of recurrent TGDC? Background: TGDCs are the most common congenital abnormality in the neck, with surgical extirpation recommended because of the likelihood of recurrent […]

Literature Reviews

Robotic Surgery Offers Advantages for Infratemporal Fossa

Does robotic surgery provide better access to the infratemporal fossa (ITF), and is suprahyoid port placement an option?  Background: Recent experimentation with robotic-assisted surgery has shown applications in head and neck surgery and advantages such as excellent three-dimensional microscopic visualization and two-handed, tremor-free operating. These advantages make robotic surgery particularly attractive in areas in which open […]

Literature Reviews

Fractal Analysis of OSAS Provides Some Information

Does fractal quantitative endoscopic evaluation of the upper airway in patients with obstructive sleep apnea syndrome (OSAS) provide objectivity in the interpretation of these studies?  Study Design: Diagnostic test assessment Setting: Tertiary care private hospital sleep laboratory in Athens, Greece Background: Fiberoptic nasopharyngolaryngeal endoscopic examination with Müller’s Maneuver (FNPMM) has been used over the years for the evaluation […]

Literature Reviews

A Contemporary Review of Papillomavirus and Oropharynx Cancer

What is the evidence for the role of human papillomavirus (HPV) in the etiology of oropharyngeal cancers, methods of viral detection and the resulting clinical implications? Background: The incidence of head and neck squamous cell carcinoma (HNSCC) has remained stable over the last 15 years, while the incidence of oropharyngeal squamous cell carcinoma (OPSCC), linked both […]

Literature Reviews

Children with OSAS Have Diminished Mucosal Sensation

Do children with obstructive sleep apnea syndrome (OSAS) have diminished upper airway sensation compared with controls? Background: Studies have shown that attenuation of the upper airway mucosal sensation by topical anesthesia increases the tendency of upper airway collapse. These findings suggest that impairment of upper airway mucosal sensation may contribute to upper airway collapse in sleep […]