ENTtoday: September 2011

A Blessing and a Curse: Health care reform comes at a steep price

There is a Chinese proverb that is both a blessing and a curse. The blessing is, “May you live in interesting times,” and the curse is, “May you live in interesting times.” All of us would like things to stabilize into a constant, comfortable and predictable environment for us to live our lives, raise our families and care for our patients. We are entering the most complex and challenging period that medicine has experienced since the 1960s when Medicare was introduced. From now on, everything we have come to know and are comfortable with in our professional lives will change.

A Boost for Research: The Triological Society’s grants help physician-scientists launch investigative careers

It can be difficult to launch a career as a physician–scientist, especially when budget cuts are making research funding harder to find—and this is doubly true for a small specialty like otolaryngology. That challenge is the reasoning behind the Triological Society’s grant programs. The society, which has awarded more than $2.5 million in grants since 1994, promotes research into the causes and treatments of ear, nose and throat diseases.

Personalized Care: Study highlights which patients would benefit from a second round of chemoradiation

Balancing the risks and benefits of concurrent reirradiation and chemotherapy for recurrent head and neck cancers is difficult for physicians at even the most experienced centers. Research recently published in Cancer, however, suggests that selection of patients who may benefit from this therapy should be based on the patient’s previous treatment and the amount of time that has elapsed since initial treatment…

Repair Revolution: Surgeons use fat grafts to address extensive facial deformities

Fat grafts have been used to repair the aging face for about two decades, but recently, surgeons have been using grafts to repair more extensive facial deformities caused by injury, illness or congenital abnormalities. Success, they said in interviews with ENT Today, depends on proper patient selection, matching the fat graft to defects that are most amenable to repair with fat injections and an understanding of the biology of the graft and how it reacts with surrounding facial structures.

Rent the Right Way: Medical offices require unique leases

As tenants of medical office spaces, physicians often create special leasing issues. Medical tenants use hazardous materials, generate biomedical waste, demand confidentiality of patient records and require compliance with occupational safety standards—all unique aspects of the medical profession. Yet, often, physicians will sign “form” medical office lease agreements provided by the landlord without the benefit of legal counsel. Typically, the landlord provides a standard fill-in-the-blank lease form with the tenant’s name and the general business terms (including the term of lease, rental rate and commencement date). Tenants may gloss over the legal boilerplate provisions included in the lease agreement, assuming that these terms are standard to all leases and are not subject to negotiation.

New Speech-Language Pathology Rule: Supervision of videostroboscopy and nasopharyngoscopy no longer required

Medicare requirements for physician supervision of speech-language pathologists conducting videostroboscopy (CPT 31579) and nasopharyngoscopy (CPT 92511) will move from the strictest level of oversight back to no national supervision level starting in October.

Chaos Control: Plan ahead to ensure your practice survives a disaster

Ten years have passed since the U.S. was attacked on September 11, 2001 and six since Hurricane Katrina slammed into the Gulf Coast. And, while disasters of that magnitude are rare, hundreds of smaller-scale disasters occur every year, including tornadoes, blizzards, fires, earthquakes, airline crashes and chemical spills.

The Future is Small: Nanotechnology promises big changes for head and neck surgery

The biggest gains in the future for surgical and therapeutic treatments of head and neck cancer will likely include the use of imaging techniques, radio-enhancers and drug delivery vehicles that are really, really small.

Return on Investment: 2010 grant winners discuss their research spending

The otolaryngology treatments of tomorrow are the research of today, but somebody has to pay for it.

Health Care Utilization for Allergic Rhinitis

Have there been incremental increases in health care utilization and expenditures for allergic rhinitis (AR) patients? Background: AR, one of the most common and likely underdiagnosed conditions, has been studied for quality of life issues, but little has been studied regarding its economic and health care burdens. Study design: Review of data from the 2007 Medical Expenditure […]

Consideration of Race, Ethnicity and Ancestry

Should race, ethnicity and ancestry be used as universal proxies for genetic, social and socioeconomic issues related to otolaryngology conditions? Background: Historically, race, ethnicity and ancestry have been associated with otolaryngology conditions such as nasopharyngeal carcinoma, otosclerosis, acoustic neuroma, sickle cell anemia, Burkitt’s lymphoma and skin malignancies. Advances in genetics could help otolaryngologists move beyond these […]

Total or Hemithyroidectomy for Papillary Thyroid Microcarcinoma?

What is the best surgical treatment for papillary thyroid microcarcinoma (PTMC)? Background: Surgeons have debated whether to perform a total or hemithyroidectomy for PTMC, a carcinoma less than 1 cm in size. Historically, treatment was a total thyroidectomy, but the paradigm has shifted with recent guidelines from the American and British Thyroid Associations. Study design: Retrospective chart […]

Medical Therapy vs. Surgery for CRS

How does surgery perform prospectively when compared to medical therapy for chronic rhinosinusitis (CRS)? Background: Since the introduction of endoscopic diagnosis and surgery for CRS in 1985, very few prospective studies have addressed the question of when patients should be treated with medical therapy alone and when they should have endoscopic sinus surgery (ESS). Study design: Level […]

Scant Data on Oral Corticosteroid Therapy for CRS Without Polyps

How well do our non-polyp chronic rhinosinusitis patients do when treated with oral steroids as part of their medical therapy? Background: Because we now look at chronic rhinosinusitis (CRS) as an inflammatory problem, the use of topical and oral corticosteroids becomes more important. Systematic evaluation of oral steroid use in CRS without nasal polyposis (CRSsNP) has […]