ENTtoday: August 2011

The Lost Art of Medicine: Patient care is paramount in practice

The science of medicine continues to expand rapidly, and this is obviously good for humanity. The art of medicine, on the other hand, has been largely forgotten. This skill is the basis of the time-honored physician-patient relationship and is an important aspect of good patient care. So why have so many physicians forgotten this basic skill? Why would a caring physician disregard any expertise that would benefit his patient?

Update Your Practice: Follow these tips to select the right EMR for your group

I have been working with electronic medical records (EMR) for many years, having first become interested in 1996, when I was looking for a tool to collect data for pediatric sinusitis. As we designed a product to collect this data, our scope expanded into developing a subspecialty-specific EMR. I have since learned a great deal about developing and codifying information and am currently participating in my third and largest implementation of an EMR at Boys Town National Research Hospital in Omaha, Neb. In this column, I would like to discuss what to look for in an EMR and give some initial thoughts on implementation.

Work Overload: Sense of achievement key to combating professional burnout

Most microvascular and reconstructive free-flap head and neck surgeons experience at least moderate professional burnout, according to a study published in October 2010 in the Archives of Otolaryngology and Head and Neck Surgery.

Structural Support: Surgeons extol the cartilage stability provided by a new nasal implant

For patients who undergo septoplasty to repair a crooked septum, reconnecting pieces of cartilage and stabilizing the cartilage during the healing process is critical to achieving straight alignment of the nasal septum. Stabilizing cartilage is particularly challenging for patients who require correction of severe septal deviations or severe post-traumatic deformities that are often both functional and cosmetic.

Sleep Studies Clarified: New guidelines amplify the role of PSG for children with sleep-disordered breathing

For otolaryngologists seeing increasing numbers of children with sleep-disordered breathing, whether or not to refer children for a polysomnography (PSG) prior to surgery is not a decision easily made. Currently, only about 10 percent of otolaryngologists request a sleep study in children with sleep-disordered breathing prior to surgery.

A New Way to Learn: Residency programs use medical simulation to fill training gaps

In May, Marcelo Antunes, MD, chief resident of otorhinolaryngology-head and neck surgery at the University of Pennsylvania, was able to practice bilobed flaps on pig’s feet at an ORL Rising Chief Boot Camp held at Penn Medicine Clinical Simulation Center in Philadelphia. While he had previously experienced medical simulation during his otolaryngology residency, the boot camp put the methodology in proper context for Dr. Antunes, who is particularly interested in facial plastics.

Ultrasound-Guided Needle Dye Injection by Surgeon Localizes Tumor

What is the effect of ultrasound-guided needle dye injection in localization of intraoperative tumors? Background: Locating and surgically excising non-palpable neck tumors in an accurate, efficient and safe manner, particularly in previously operated areas, can be a challenge. Preoperative imaging with computed tomography, magnetic resonance, positron emission tomography, or ultrasound-guided fine-needle aspiration biopsy are tools typically […]

Preservation of Residual Hearing after Cochlear Implant Using SMA

Is residual hearing preserved after cochlear implantation with the suprameatal approach (SMA) technique? And, is there an alternative analysis to document the conservation of hearing more accurately? Background: The SMA is the most frequently used implantation technique for cochlear implantation. The SMA has received both criticism and praise since its introduction in 1999, but the question […]

A Meta-Analysis of Minimally Invasive Video-Assisted Thyroidectomy

How does minimally invasive video-assisted thyroidectomy (MIVAT) compare with conventional thyroidectomy? Background: The advantages of minimally invasive thyroid surgery include shorter hospital stays, reduced postoperative pain, and improved cosmetic results. Studies have also demonstrated functional advantages over conventional surgery with regard to voice and swallowing. MIVAT is one type of these procedures, with two others being […]

Best Practice in Tympanoplasty

Does concomitant mastoidectomy improve outcomes for patients undergoing repair of tympanic membrane perforations? Background: Controversy currently exists regarding the appropriate treatment of tympanic membrane perforations resulting from chronic suppurative otitis media (CSOM) without cholesteatoma. Proponents for mastoidectomy contend that surgical opening of the mastoid pneumatic system buffers pressure changes in the middle ear and allows for […]

Single-Staged Modified UPPP with Nasal Surgery Safe for OSAS Patients

Can an anatomy-based staging system effectively predict the efficacy of uvulopalatopharyngoplasty (UPPP) performed along with nasal surgery? Background: While the overall efficacy of UPPP is estimated at 40 percent, Friedman and colleagues published a series of 134 patients who were staged based upon oral cavity exam and body mass index (BMI) (Otolaryngol Head Neck Surg. 2002;127:13-21). […]

Mild OSA Linked to Nasal Obstruction

What impact does nasal obstruction have on obstructive sleep apnea (OSA) as measured by polysomnography (PSG)? Background: While nasal obstruction is often identified and treated in patients with OSA, its role in the pathogenesis or exacerbation of sleep-disordered breathing (SDB) has not been clearly shown. Several previous studies have used nasal packing or complete nasal obstruction […]