ENTtoday: November 2011

Tough Situations: Residents discuss ethics-fraught cases

Residents in the general surgery program at Washington University in St. Louis, Mo., participate in monthly “pizza grand rounds,” in which they discuss ethics-fraught situations they encounter. Some of the situations are the subjects of papers published in Surgery. Here are summaries of a few of those published situations. The papers intentionally do not mention the actions ultimately taken, so that the attention remains on the principles and questions involved.

Behind the Red Tape: A brief history of common health care regulations

Have you ever wondered about the reasoning behind hospital discharge paperwork or the requirement that every patient sign a HIPAA form?Here are explanations for some of the health care policies you come across on a daily basis.

Conflicting Curriculums: Ethics education for residents inconsistent across programs

A man with moderate dementia who is living in a nursing home is diagnosed with laryngeal cancer. The man is still able to talk and interact with other people. But he doesn’t know what year it is and is unable to make decisions on his own.

Practice Alternatives: Three otolaryngologists discuss what it’s like to work under evolving care models

Certain well-established care delivery models for otolaryngologists have long defined the specialty. But, like pharmacology, surgical techniques and treatment therapies, practice models evolve. And while traditional models continue to dominate the scope of most otolaryngology practices, the field is seeing a gradual shift to new constructs. Among them…

Balloon Sinuplasty Use Continues to Evolve: Procedure may complement traditional sinus surgery

Six years after balloon sinuplasty was introduced to the otolaryngology community, it remains an evolving technology. “In my opinion, balloon dilatation has great potential, but it’s still trying to find its proper place in the ENT arena,” said Ralph Metson, MD, clinical professor of otology and laryngology at Harvard Medical School and Massachusetts Eye and Ear Infirmary in Boston.

Interested in a Policy Career? Four programs to get you into the Beltway and beyond

Otolaryngologists with a desire to broaden their careers beyond traditional medical practice have several options. Programs exist that can open doors into medical leadership, health policy work, clinical and outcomes research and public office. Opportunities are available at all stages of a physician’s career. Here’s a look at a handful of programs that aim to provide physicians with the tools they need to take their careers in a new direction.

New Ventures, New Risks: Review all possibilities before affiliating with a hospital

In my January 2011 column (“A Seller’s Market: How to prepare your practice for sale to a hospital”), I described the growing trend of physicians selling their practices to hospitals and large health systems and then working for the hospital or health system. This trend is expected to continue in full force through 2012. As I noted in my January article, the physician’s post-sale arrangement is the driver for the growth of the physician’s practice within the hospital or health system.

Novel Method Overcomes Nasal Discomfort in Office-Based Laser Surgery

What can be done to help patients with narrow nasal passages and/or nasal discomfort during office-based laser laryngeal surgery? Background: Although channeled flexible laryngoscopes have permitted a transnasal approach for biopsies, vocal fold augmentation and unsedated laser laryngeal surgery, some patients with nasal anatomic restrictions experience significant nasal discomfort and cannot tolerate these procedures. Study design: Description […]

Swallowing Function After TLM + Adjuvant Therapy

For patients with advanced-stage oropharyngeal cancer, how does transoral laser microsurgery (TLM) + adjuvant therapy impact swallowing function? Background: For survival reasons, patients with advanced oropharyngeal cancer have elected adjuvant therapy, which introduces treatment interventions known to acutely and chronically decrease swallowing ability. In recent years, minimally invasive surgical approaches, including transoral laser microsurgery (TLM), have […]

What’s the Best Way to Use Outpatient Physician Extenders?

Are physician extenders a valuable asset to an outpatient otolaryngology practice? Background: Use of physician extenders, nurse practitioners and physician assistants is increasing in specialty and subspecialty medicine. The field of otolaryngology, however, is currently underrepresented. Study design: Contemporary review. Setting: Department of Otolaryngology and Communicative Sciences, University of Mississippi, Jackson. Synopsis: The authors proposed a framework of five […]

Cochlear Implants Improve Performance and Net Savings in Infants

Do the costs and benefits of cochlear implantation differ between infants and older children? Background: While many studies show more rapid auditory and cognitive development in early cochlear implantation, other studies report little difference in outcomes in a small sample of children, some implanted before 12 months of age and others implanted later. Additionally, the development […]

Medical Management for CRS Improves QOL

In patients who have failed medical management for chronic rhinosinusitis (CRS), are there greater quality of life (QOL) outcome improvements with further medical therapy or endoscopic sinus surgery (ESS)? Background: Although it is widely believed that QOL measures are improved with ESS, there is insufficient evidence in the literature comparing various treatments for CRS. This study […]

Middle Turbinate Variations Don’t Justify Sinus Surgery

Are anatomic variations of the middle turbinate (MT), such as concha bullosa and paradoxical MT, associated with nasal septal deviation or chronic rhinosinusitis (CRS)? Background: CRS has multiple underlying causes. Although anatomic variations of nasal and sinus structures have been implicated as a possible risk factor for CRS, there is no agreement in the literature. Study […]