ENTtoday: May 2010

A Better Way to Implement EMRs: Why one-size-fits-all won’t work

I have been a strong advocate of electronic medical records (EMRs) for almost a decade. In fact, I used the phrases “It is the silver bullet for health care reform infrastructure” and “It is the cornerstone for health care reform infrastructure” to describe EMR plans when President Obama was campaigning. However, technology, like fire, can warm your house or burn it down, cook your food or kill you. Likewise, the wrong EMR will escalate inefficiency and raise health care costs. The wrong mandates or the wrong incentives have the potential to paralyze the day-to-day practice of medicine.  

Digital Dilemma: Physicians oppose EHR requirements

The federal government’s proposed rule establishing incentive payments for physicians who “meaningfully use” electronic health records (EHRs) is too onerous and would discourage physicians from participating, some otolaryngologists say.

The Great Debate: Canal-wall-up vs. canal-wall-down surgery for pediatric cholesteatomas

During the last 50 years, the debate over the merits of canal-wall-up (CWU) versus canal-wall-down (CWD) surgery for removing pediatric cholesteatomas has shifted focus several times.

Canal Wall Up vs. Canal Wall Down: Symptom of a greater need?

This issue of ENT Today includes an article on the debate over canal-wall-up (CWU) versus canal-wall-down (CWD) tympanomastoidectomy (p. 5). I remember hearing the same arguments when I was a resident at UCLA, which was also the last time I drilled a mastoid bone; my practice focused on head and neck surgery and pediatric otolaryngology. Over the past 32 years, Drs. Bruce Gantz, Rick Chole (two of my otology colleagues on the Board of Otolaryngology), and other otologist friends have suffered through my semi-tongue-in-cheek comments on why otologists can’t agree on which procedure is better. Although the technology used in both procedures has evolved, the final product of the two procedures, a dry, safe ear, is, as best I can tell, the same as it was when I was a resident. I have been told that one of the main factors considered in the decision regarding which procedure to perform is where the otologist trained.

Health Reform to Insure 32 Million: Are you ready for them?

The new health system reform law is expected to reduce the number of uninsured Americans by 32 million people, and that means more paying patients for physician practices. Many doctors, however, worry that the law’s lack of Medicare payment reform and medical malpractice caps will exacerbate a looming physician shortage. This raises questions about how successful the law will be in increasing health care access.

A Partner in the Business: Practices see mid-level providers as valuable additions

When Winston C. Vaughan, MD, told his Stanford University patients he was leaving academia to establish a private group practice, they had one question: “Are you taking Kathleen with you?” Their concern attests to the integral role that Kathleen Low, RN, NP, fills as a patient-care provider in Dr. Vaughan’s otolaryngology practice.

A Patient Experiment

Berrylin J. Ferguson, MD, FACS, FAAOA, associate professor of otolaryngology and director of the Division of Sino-Nasal Disorders and Allergy at the University of Pittsburgh School of Medicine in Pittsburgh, Pa., uses the following form to help determine which allergy treatments will work best for each patient.

MRI Useful for Identification of Sudden Sensorineural Hearing Loss Etiology

What is the evidence for different etiologies of sudden sensorineural hearing loss (SSNHL)? Background: The incidence of SSNHL has been estimated from five to 20 per 100,000 persons per year, but the causes are speculative and probably multifactorial. While identifying the most commonly reported etiologies of SSNHL, the ultimate goal of this study was to develop […]

Caution Regarding Elective Neck Dissection During Salvage Surgery

Is elective neck dissection the optimal management of the node-negative (N0) neck during salvage surgery after initial treatment with elective nodal irradiation (ENI)? Background: When the neck is seeded at the time of squamous cell carcinoma recurrence, there is a likelihood of occult regional metastatic disease. While it is common practice to include an elective neck […]

The Internet Says I’m Attractive

Can facial attractiveness scores obtained from an Internet-based rating system correlate with and be an alternative for those accrued from the traditional focus group method? Background: Despite the extensive number of facial beauty studies, research has been unable to define facial beauty with more specific parameters. A significant limitation is the tedium and difficulty of obtaining […]

Trial Assesses Shorter Moxifloxacin Therapy

What is the efficacy and safety of a five-day moxifloxacin regimen in the treatment of acute bacterial rhinosinusitis (ABRS)? Background: There is a lack of clarity regarding the role of antimicrobials in ABRS treatment. Although current guidelines encourage the use of antimicrobials, it is difficult to identify appropriate patients. Additionally, there would be benefits to reducing […]

Secondhand Smoke Increases Chronic Rhinosinusitis Risk

Is exposure to secondhand smoke a risk factor for chronic rhinosinusitis (CRS)? Background: There are surprisingly few studies that address the association between secondhand smoke (SHS) and sinusitis, and most use fairly weak criteria for sinusitis, such as a patient’s having checked “sinusitis” on a health questionnaire. There are, however, several studies that address the effects […]

New OSA Clinical Guideline

What is the current recommended standard for evaluation and treatment of sleep-disordered breathing and obstructive sleep apnea (OSA)?  Background: There is lack of consensus about diagnostic protocols for OSA in adults. This multicenter, multispecialty clinical guideline summarizes the best evidence and makes a series of clinical recommendations, with associated strength of recommendation depending on the underlying […]