ENTtoday: October 2011

Resident Tips: Private and academic practitioners offer career advice

For residents embarking on their professional careers or physicians changing a career, navigating the many issues involved in making a decision that will significantly affect both their professional and personal lives can be daunting and challenging. To provide some guidance, practicing physicians with many years of experience in their respective careers discussed these issues during a session held here Sept. 13 at the 2011 American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) Annual Meeting.

Corticosteroid Confusion: Evidence lacking for most conditions, panelists say

Although steroids are widely used to treat a variety of otolaryngologic conditions, the short- and long-term side effects remain a concern and fuel the need to better understand their proper role. Contributing to the ongoing controversy over their use are gaps in the evidence, panelists said here Sept. 12 at the American Academy of Otolaryngology-Head and Neck Surgery Annual Meeting.

Biofilms in Otolaryngology: Relation to clinical disease needs more study, experts say

It is now well recognized that pathogens found in biofilms play a role in many mucosal-based otolaryngologic-related infections, but what that role is and how to prevent or treat biofilms remain unknown, concluded a panel of experts convened here on Sept. 17 at the 2011 American Academy of Otolaryngology-Head and Neck Surgery Annual Meeting.

Geriatric Challenges: Age shouldn’t determine treatment, experts say

One of William Dale’s healthiest patients was working out three times a week, regularly walking two miles, lifting weights, maintaining a stable body weight of 120 pounds and not on any medications when she was diagnosed with a stage IV ovarian cancer. Dale, MD, PhD, section chief of geriatrics and palliative medicine at the University of Chicago, said the patient did fine with both surgery and chemotherapy. The fact that she was 89 years old, he said, shouldn’t necessarily come as a surprise.

Get Ready for Quality Improvement: Panelists outline helpful metrics and more

Close on the heels of the evidence-based medicine movement comes increasing pressure for physicians and health care institutions to develop and implement quality improvement measures that will not only improve quality of care, but also reduce medical costs and provide a way to measure performance by physicians and institutions. Integral to this process is the development of appropriate metrics by which to measure outcomes and physician performance that accurately reflect otolaryngology and its subspecialties. Two sessions at the recent 2011 American Academy of Otolaryngology–Head and Neck Surgery Annual Meeting held here Sept. 13 highlighted issues that are important for otolaryngologists striving to meet the growing demand for quality improvement.

Reducing Patient Wait Times: Examine your operations to boost efficiency

Here’s a telling statistic: The average time patients wait in an office to see an otolaryngologist is 24 minutes, according to Press Ganey Associates, Inc., a South Bend, Ind., health care performance measurement and improvement firm. If that doesn’t sound bad, or if you think your practice exceeds that benchmark, consider that otolaryngology ranked 19th in overall satisfaction among 25 medical specialties measured in Press Ganey’s 2010 Medical Practice Pulse Report.

Face Time: Ask the right questions when meeting with EMR vendors

In my last column (ENT Today, August 2011), I explained some of the broader issues regarding electronic medical records/electronic health records (EMR/EHR) selection, centered around the understanding that an EMR is a record that is more practice centered while an EHR is a health record intended to follow the patient through multiple providers. This article is directed toward practices with a large degree of autonomy in selecting their products; therefore, we will be discussing EMRs. If you’re part of a multidisciplinary practice or a university, you likely had little to no input regarding the EHR chosen. This is because larger numbers like primary care drive EHR selection. Don’t stop reading, however; assessment of disease-specific pathways is still applicable for the EHR you have.

Payment Shifts: Expect reimbursement structure changes ahead, policy experts say

Although the new U.S. health care law does not specifically alter the current fee-for-service payment structure, changes to how physicians and hospitals will be reimbursed for services are under construction. These changes are reflected by the growing focus on the development and implementation of quality improvement and physician and institutional performance measures on which reimbursement will increasingly be made, panelists said here on Sept. 11 at the 2011 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Annual Meeting.

The Role of Balloon Catheter Sinuplasty in Pediatric Sinus Disease

What is the role of balloon catheter sinuplasty (BCS) in the surgical management of pediatric sinus disease? Background: Adenoidectomy and functional endoscopic sinus surgery have traditionally comprised the surgical management of chronic recurrent sinusitis (CRS) recalcitrant to medical therapy in the pediatric population. First introduced in 2006, BCS does not involve tissue removal and is, theoretically, […]

Optimal Timing of Surgical Intervention Following Laryngeal Trauma

What is the optimal timing of surgical intervention following adult laryngeal trauma? Background: Airway management is paramount in cases of adult laryngeal trauma. Even with a secured airway, however, laryngeal lacerations and fractures require further therapeutic interventions. While some propose immediate surgical intervention, others suggest a three- to five-day waiting period prior to operative intervention. Study […]

Both Endoscopic and External Approaches Needed for ZD

Is the transcervical approach indicated in the treatment of Zenker’s diverticulum (ZD) and, if so, to what extent? Background: According to the literature, the only existing curative approach to ZD is surgical treatment. While the endoscopic-microscopic method is now established as the treatment of choice, studies have not shown if and to what extent traditional external […]

Behavioral and Environmental Factors Play Role in Spasmodic Dysphonia

Are specific triggers associated with the onset of spasmodic dysphonia? Background: Spasmodic dysphonia (SD) is an idiopathic voice disorder characterized by a strained, strangled voice quality or a breathy voice with aphonic segments of connected speech. Knowledge regarding causes and predisposing factors remains extremely limited. Study design: Retrospective chart review. Setting: New York Head and Neck Institute, Center […]

More Research Needed on Gamma Knife Surgery

Is quality of life (QOL) better after surgical removal of vestibular schwannoma or after gamma knife surgery? Background: Gamma knife surgery is becoming an increasingly popular method to manage vestibular schwannoma. As a less invasive modality, gamma knife surgery should improve QOL over surgical intervention. Study design: Prospective study. Setting: Gamma Knife Center, Michigan. Synopsis: Researchers relied on QOL […]

The Case for Second Look Procedures

Are there any intraoperative findings that could determine whether a second look procedure should be performed in pediatric cholesteatoma surgery? Background: There is no clear consensus regarding the surgical management of pediatric cholesteatoma. Canal wall up surgery is a popular approach, but the indications and timing of a second look procedure remain vague. Study design: Retrospective chart […]