Experts gave guidance on how to tackle four areas important to otolaryngologists and head and neck surgeons during a “controversies” session held during the Triological Society Combined Sections Meeting.
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March 2018Congenital Aural Atresia
Bradley Kesser, MD, professor of otolaryngology-head and neck surgery at the University of Virginia in Charlottesville, discussed a controversial clinical question: whether bone conduction hearing devices (BCHDs) should be used in all children with unilateral congenital aural atresia (CAA). While these devices are crucial to support speech and language development in children with bilateral CAA, he said that the literature suggests they might not be necessary for all children with unilateral CAA.
A study in which Dr. Kesser was involved found that none of the 40 children with unilateral CAA repeated a grade in school, but families did seek out resources to help their children, including amplification, speech therapy, and independent education plans arranged with their school districts (Laryngoscope. 2013;123:2270-2275).
Dr. Kesser said his approach is never to discourage families from trying a BCHD, but they certainly shouldn’t be made to feel guilty for not having their children use one. “I tell parents: ‘We have enough battles to fight with our children—making your 5-year-old wear a bone conductor for eight hours a day doesn’t necessarily need to be one of [them],’” he said. But, he emphasized, it’s crucial to monitor academic progress, speech and language development, and hearing, and to put in place resources to support a child’s academic success.
Middle Turbinate and Headache
Ashutosh Kacker, MD, professor of clinical otolaryngology at Weill Cornell Medical College in New York, said that one of the most difficult issues involving the middle turbinate is whether or not surgical treatment can improve headache. “Not everyone believes in it, (and) there’s a lack of good quality studies,” he said.
There is some suggestion in the literature that surgical treatment of the concha bullosa yields better results than medical care (Eur Rev Med Pharmacol Sci. 2015;19:2327-2330).
In a study with the highest-quality evidence Dr. Kacker could find, researchers reported that surgical resection of contact points, including resection of the middle turbinate concha bullosa, had the best results for patients with Type 3 migraine (Plast Reconstr Surg. 2017;13:184-189). Unfortunately, he said, no predictors have been identified to help predict surgical success with regard to Type 3 migraine.
As a specialty, we must be proactive in preserving our relevance in a health system that would increasingly value our contributions to the health of an increasingly diverse population. The selection process should reflect the kind of resident we’re trying to attract. —Howard Francis, MD, MBA
Neck Dissection vs. Parotidectomy for Positive Sentinel Lymph Node
Carol Bradford, MD, executive vice dean for academic affairs at the University of Michigan Medical School in Ann Arbor, said that conversations with melanoma patients about neck dissection used to be simple: Neck dissection, parotidectomy, or both should be performed when a patient has a positive sentinel node; if not, the patient should be watched closely.