Study design: Literature review.
Explore This IssueJune 2013
Setting: English-language literature published in the PubMed database between January 1990 and July 2012 that discussed the role of ESS in children with CRS.
Synopsis: Eleven articles from PubMed were used after inclusion and exclusion criteria were applied; two Cochrane Library articles were excluded. In one study, both ESS ± adenoidectomy and adenoidectomy alone showed equal quality-of-life improvements. In another study, the ESS/adenoidectomy group had a better success rate than adenoidectomy alone (87 percent vs. 52 percent). In a third study, 75 percent of those who failed with medical treatment received benefit from adenoidectomy, and 100 percent of those who failed with medical treatment and adenoidectomy received benefit from ESS. Other studies showed a success rate of between 82 percent and 97 percent. Only one study added objective outcome data, with a success rate of 87.7 percent and a mean post-operative CT scan score of 2.36 at a four-month follow up. Only one retrospective study compared ESS to BCS in children: 62.5 percent of ESS patients and 80 percent of BCS patients showed improvement in overall sinus symptoms postoperatively. Six complications were reported out of 440 cases in all studies combined. Limitations included a lack of uniformity in the articles and a wide variation in follow-up periods.
Bottom line: Pediatric ESS is a surgical alternative for children suffering from refractory CRS who have failed with other medical intervention. However, there are still questions regarding when ESS is indicated for children.
Citation: Makary CA, Ramadan HH. The role of sinus surgery in children. Laryngoscope. 2013;123:1348-1352.
—Reviewed by Amy Eckner
Otolaryngology Hospitalist Model Can Work for Inpatient Practices
How viable is a clinical otolaryngology hospitalist, and is there a valid paradigm for the practice?
Background: The hospitalist model has been adopted recently by many specialty fields due to a need to treat acutely ill patients in an inpatient setting. This study details a consortium-based model. Each week, a single faculty member was solely responsible for covering inpatient, emergency room and acute care otolaryngology consultations; the on-call faculty member would suspend his or her primary practice and would not see new patients or perform elective surgeries during that time.
Study design: Retrospective administrative database review for the years 2009 to 2011.
Setting: University of California, San Francisco—Parnassus Heights Campus tertiary referral hospital.
Synopsis: Data were collected for 375 unique patients and 951 billable encounters and procedures. The most common diagnoses were respiratory failure, sinusitis, stridor, dysphonia/vocal fold paralysis, tonsillitis/pharyngitis, epistaxis, facial cellulitis, swelling of the head and neck, and otitis. Procedural services were often provided by the hospitalist team; flexible indirect nasolaryngoscopy was the most common. Common upper airway endoscopic interventions included direct laryngoscopy with biopsy, bronchoscopy, injection laryngoplasty and esophagoscopy. General and pediatric otolaryngology were the most common encounters for the first two years (39 percent in year one; 46 percent in year two), followed by laryngology encounters (29 percent in year one; 23 percent in year two) and rhinology consultations (19 percent in year one; 14 percent in year two). Adult and pediatric airway-related cases accounted for 47 percent of consultations. Several complex surgical cases were performed, including maxillectomy with orbital exenteration. The authors speculated on value equations for this position but noted that calculations would require a methodical approach to more rigorous detail. Limitations include the fact that data for emergency room and acute care consultation encounters were not available for analysis and that age data were not always available.