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Overprescription of opioid analgesia is common following ambulatory Otolaryngology—head and neck surgery procedures: A multicenter study

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World Journal of Otorhinolaryngology-head and neck surgery 2022年第2期8卷 145-151页

作者： Amr F.Hamour Frederick Laliberte Jordan Levy Jason Xu Edward Park Vincent Lin John de Almeida Julie Strychowsky Antoine Eskander Eric Monteiro department of Otolaryngology-head and neck surgery University of TorontoTorontoOntarioCanada department of Otolaryngology-head and neck surgery London Health Sciences CentreLondonOntarioCanada department of Otolaryngology-head and neck surgery Mount Sinai HospitalTorontoOntarioCanada

Background: The rise in the use of prescription opioids for postoperative analgesia within surgery has mirrored an increased trend of opioid-related morbidity within Canada and the United States. This study prospectively studied daily pain levels and medication requirements postoperatively in patients undergoing elective Otolaryngology—head and neck surgery procedures.Methods: Patients were asked to prospectively document their pain level and medication use daily for 7 days postoperatively. A final survey was used to quantify unused medication left at home and clarify each patient's disposal plan. We included patients undergoing elective outpatient or short stay surgeries from three tertiary care centers in Toronto, Ontario from September 2016 to September 2017. Previous opioids users or patients suffering from chronic pain were excluded.Results: A final cohort of 56 eligible adult patients were included in the study. The most common procedures were thyroidectomy (n = 19), endoscopic sinus surgery (n= 10), tympanoplasty/ossiculoplasty (n= 7), and cochlear implant (n = 5). Most patients received a prescription for acetaminophen/codeine (n = 29, 51.8%) or acetaminophen/oxycodone (n = 22, 39.3%) and used on average 29% of their initial prescription. Patients most commonly opted to keep their unused narcotics at home (n = 23, 41%). A total of 710 tablets of narcotics were overprescribed in our study population, 351 of which were kept in patients'' home for future use.Conclusion: There is a clear tendency to overestimate postoperative pain resulting in significant overprescription of opioids among Otolaryngologists.

关键词： analgesia health policy opioid quality improvement quality of life

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Suggestions on the prevention of COVID-19 for health care workers in department of otorhinolaryngology head and neck surgery

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World Journal of Otorhinolaryngology-head and neck surgery 2020年第S01期6卷 S2-S5页

作者： Kai Xu Xiaoquan Lai Zheng Liu department of Otorhinolaryngology head and neck surgery Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China department of Nosocomial Infection Management Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China

The epidemic of the Coronavirus Disease 2019(COVID-19)has presented as a grim and complex situation recently.More than 77,000 cases of COVID-19 has been confirmed in China until February 25th,2020,which are causing great impact on economy and society,as well as seriously interfering with ordinary medical practice in the department of otorhinolar-yngology head and neck surgery.This article discussed medical precautions required in the clinic,inpatient ward and operation room of otorhinolaryngology head and neck department,which aims to protect health care workers from COVID-19.

关键词： Coronavirus disease 2019 SARS-CoV-2 Viral pneumonia Precautions Suggestion

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Prevention of nosocomial COVID-19 infections in otorhinolaryngology-head and neck surgery

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World Journal of Otorhinolaryngology-head and neck surgery 2020年第S01期6卷 S6-S10页

作者： Jie Ren Xilin Yang Zhen Xu Weiwei Lei Kun Yang Yonggang Kong Jining Qu Hua Liao Yi He Huidong Chen Yan Wang Feng Zeng Qingquan Hua department of Otorhinolaryngology-head and neck surgery Renmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina

Coronavirus disease 2019(COVID-19)has rapidly evolved into a pandemic,causing a global public health crisis.Many frontline healthcare workers providing ear,nose and throat services have been reported to contract COVID-19 at work.Early during the COVID-19 outbreak,several medical professionals in Otolaryngology-head and neck surgery were in-fected in Wuhan,China.A series of measures were then taken immediately,which successfully halted the spread of the disease.Here we would like to share the lessons we have learned,and our experience to protect our health care workers during the COVID-19 pandemic.

关键词： COVID-19 Nosocomial infection Prevention

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Pediatric otolaryngology-head and neck surgery in China: Present situation and future prospects

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Pediatric Investigation 2019年第3期3卷 137-140页

作者： Xin Ni Jie Zhang department of Otorhinolaryngology head and neck surgery Beijing Children’s HospitalCapital Medical UniversityNational Centerfor Children’s HealthBeijingChina Beijing Key Laboratory for Pediatric Diseases of Otolaryngology–head and neck surgery BeijingChina

Evolution Pediatric otolaryngology–head and neck surgery (OHNS) is a young discipline in the 21st century. During its development, the discipline and its sub-areas were increasingly enriched and refined, and its name evolved from 'ear, nose and throat' to 'otorhinolaryngology' and then to 'otolaryngology–head and neck surgery' In the United States, the American Laryngological Association was established in 1878, and the American Academy of Ophthalmology and Otolaryngology was founded in 1903. However, no doctors specialized in pediatric OHNS until the 1940s.

关键词： Pediatric otolaryngology–head and neck surgery (OHNS) discipline future prospects

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Salvage surgery after failure of non surgical therapy for advanced head and neck cancer

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Open Journal of Stomatology 2011年第4期1卷 189-194页

作者： Didier Dequanter N. Vercruysse M. Shahla P. Paulus Ph. Lothaire Department of Head and Neck Surgery CHU Charleroi department of Plastic surgery CHU Charleroi

Introduction: for organ and function preservation, chemoradiotherapy is gaining popularity for primary treatment of advanced head and neck cancer, re- serveing surgery for salvage. Methods: Retrospective outcome analysis to determine the results of salvage surgery after failure of primary treatment of advan- ced head and neck cancer by chemoradiotherapy. 104 patients with advanced head and cancer were initially treated by chemoradiotherapy. Follow-up was evalu- ated in 27 patients undergoing salvage surgery for re- current tumor (larynx n = 13;oral cavity n = 9;hypo- pharynx n = 5). The initial tumor is stage T3 in 11 cases and T4 in 16 cases. 10 patients had primary tumors stage III and 17 patients had tumors stage IV. Results: One postoperative death occured following surgery. The overall incidence of complications was 9/ 27 (%). Recurrent disease developed at the primary initially treated in 25 cases and in the neck in 2 cases after a mean follow-up of 11 months (3 - 136 months). After salvage surgery, loco-regional recurrence and/ or distant disease developed in 10/27 patients after a mean follow-up of 4 months. 6/10 (60%) patients died after re-recurrence despite salvage chemotherapy. Conclusion: Salvage surgery after failure of initial chemoradiotherapy is burdened with high morbi- dity and bad oncological outcome. We demonstrated that it is difficult to salvage locally recurrent head and neck cancer especially at more advanced T-stages or when tumor recur. The limited effect of surgical salvage for recurrent tumor need to be addressed when choosing the initial treatment plan.

关键词： head And neck Cancer Salvage surgery Advanced Disease

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Assessment of laryngologists'ratings on physician review websites

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World Journal of Otorhinolaryngology-head and neck surgery 2024年第1期10卷 1-6页

作者： Meleeka Akbarpour Karen Tawk Madelyn Frank Alizah S.Gomez Navid Mostaghni Mehdi Abouzari department of Otolaryngology-head and neck surgery University of CaliforniaIrvineUSA

Objective:To assess and characterize online ratings and comments on laryngologists and determine factors that correlate with higher ratings.Methods:All the American Laryngological Association(ALA)members were queried across several online platforms.Ratings were normalized for comparison on a five-point Likert scale.Ratings were categorized based on context and for positive/negative aspects.Results:Of the 331 ALA members,256(77%)were rated on at least one online platform.Across all platforms,the average overall rating was 4.39±0.61(range:1.00-5.00).Specific positive ratings including“bedside manners,”“diagnostic accuracy,”“adequate time spent with patient,”“appropriate follow-up,”and“physician timeliness”had significant positive correlations to overall ratings,by Pearson's correlation(P<0.001).Long wait times had significant negative correlations to overall ratings(P<0.001).Conclusion:Online ratings and comments for laryngologists are significantly influenced by patient perceptions of bedside manner,physician competence,and time spent with the patient.

关键词： laryngologist online rating patient rating physician review website

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Complications in head and neck surgery 2nd ed

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2009年

作者： David W. Eisele Richard V. Smith

ISBN: (纸本)9781416042204

Effectively avoiding, recognizing, and managing complications is integral to your operative success. Let a multidisciplinary team of experts in otolaryngology, plastic surgery, oral and maxillofacial surgery, and general surgery guide you through the full range of complications associated with every type of head and neck procedure . . . so you will be equipped to produce the most favorable outcomes for even the most challenging cases!

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Surgical outcomes for cutaneous squamous cell carcinoma of the auricle

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World Journal of Otorhinolaryngology-head and neck surgery 2023年第4期9卷 295-301页

作者： Constantin Manole Liam J.Skinner Martin J.Donnelly department of Otolaryngology/head and neck surgery University Hospital WaterfordWaterfordRepublic of Ireland Consultant in Otolaryngology/head and neck surgery University Hospital WaterfordWaterfordRepublic of Ireland

Background:Cutaneous squamous cell carcinoma (CSCC) on the auricle is believed to carry a higher risk of metastatic spread.The rates of lymphatic metastasis reported in the literature have varied widely.There are no established prognostic criteria to determine which of these tumors are higher risk and warrant prophylactic treatment of the associated lymphatic basins.Objective:To retrospectively evaluate outcomes after surgical treatment of auricular CSCC in our department,examining excision completeness,tumor recurrence,and lymphatic metastasis.Secondarily,to identify factors associated with lymphatic metastasis.Methods:One hundred and thirty‐eight consecutive cases of auricular SCC were excised from 126 patients in our department over a 7‐year period (January 2012–December 2018).Data were retrospectively collected on patient characteristics,tumor histology,surgical procedures,and follow‐up.Results:Incomplete initial excision occurred in 17 cases (12.32%).Six patients (4.76%) had a local recurrence.Lymphatic metastasis occurred in eight patients (6.35%),on average within 10.25 months after primary excision.Six patients with metastasis died during follow‐up,with a mean survival of 10.2 months.Older age was associated with lymphatic metastasis (P = 0.0267).Other factors,including tumor recurrence,size,grade,cartilage invasion,and positive margins,were evaluated and not significantly associated with metastasis.Conclusion:In this study,the metastatic rate of auricular SCC was 6.35%,which is within the previously reported ranges.No histological prognostic factors were identified in this study,which may be due to our limited sample size.In the absence of established prognostic criteria,decisions regarding prophylactic treatment should be made on an individual basis with multidisciplinary support.

关键词： cutaneous malignancy external ear metastasis squamous cell carcinoma

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Does reconstruction affect outcomes following exclusively endoscopic endonasal resection of benign orbital tumors: A systematic review with meta-analysis

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World Journal of Otorhinolaryngology-head and neck surgery 2022年第1期8卷 25-35页

作者： Ashton E.Lehmann Manuela von Sneidern Sarek A.Shen Ian M.Humphreys Waleed M.Abuzeid Aria Jafari department of Otolaryngology-head and neck surgery Vanderbilt University Medical CenterNashvilleTennesseeUSA department of Otolaryngology-head and neck surgery Geisinger Medical CenterDanvillePennsylvaniaUSA department of Otolaryngology-head and neck surgery New York University School of MedicineNew YorkNew YorkUSA department of Otolaryngology-head and neck surgery Johns Hopkins HospitalBaltimoreMarylandUSA Division of Rhinology and Endoscopic Skull Base surgery Department of Otolaryngology-Head and Neck SurgeryUniversity of WashingtonSeattleWashingtonUSA

Objective:As exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread,high-quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection.The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices.Methods:Data Sources:PubMed,EMBASE,Web of Science.A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted.Articles not reporting orbital reconstruction details were excluded.Patient and tumor characteristics,operative details,and outcomes were recorded.Variables were compared usingχ^(2),Fisher’s exact,and independentt tests.Results:Of 60 patients included from 24 studies,34(56.7%)underwent orbital reconstruction following resection.The most common types of reconstruction were pedicled flaps(n=15,44.1%)and free mucosal grafts(n=11,32.4%).Rigid reconstruction was uncommon(n=3,8.8%).Performance of orbital reconstruction was associated with preoperative vision compromise(P<0.01).The tendency to forego orbital reconstruction was associated with preoperative proptosis(P<0.001),larger tumor size(P=0.001),and operative exposure of orbital fat(P<0.001)and extraocular muscle(P=0.035).There were no statistically significant differences between the reconstruction and nonreconstruction groups in terms of short-or long-term outcomes when considering all patients.In patients with intraconal tumors,however,there was a higher rate of short-term postoperative diplopia when reconstruction was foregone(P=0.041).This potential benefit of reconstruction did not persist:At an average of two years postoperatively,all patients for whom reconstruction was foregone either had improved or unchanged diplopia.Conclusion:Most outcomes assessed did not appear affected by orbital reconstruction status.This general equivalence may suggest that orbital reconstruction is not a necessity in these ca

关键词： cavernous hemangioma diplopia endoscopic endonasal surgery enophthalmos meningioma orbital reconstruction orbital tumor outcomes schwannoma

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Microdebrider complications in sinus surgery:Analysis of the openFDA database

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World Journal of Otorhinolaryngology-head and neck surgery 2023年第4期9卷 328-332页

作者： Elias S.Saba Jacob Hoerter Jeremy Chang David W.Chou Chris Xiao Jacob G.Eide Rijul S.Kshirsagar James N.Palmer Nithin D.Adappa Department of Head and Neck Surgery Kaiser Permanente Oakland Medical CenterOaklandCaliforniaUSA department of Otorhinolaryngology‐headand neck surgery Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA department of Otolaryngology‐head and neck surgery Mount Sinai Medical CenterNew YorkNew YorkUSA department of Otorhinolaryngology‐head and neck surgery University of PennsylvaniaPhiladelphiaPennsylvaniaUSA

Objective:Functional endoscopic sinus surgery is a commonly performed otolaryngologic procedure that often uses the microdebrider device for tissue removal.Given the ubiquitous nature of the instrument,we sought to better define the patterns of device failure using the postmarket surveillance openFDA database.Methods:The openFDA database was queried for all microdebrider‐related adverse events from January 1,2000 to November 1,2020.Descriptive information on the nature of device failure and any associated patient injury was compiled.Reports not directly related to device failure were excluded from the analysis.Results:A total of 641 events were included in the analysis.The most common device failure was overheating(n=348,54.3%),followed by material separation(n=173,27%),and inconsistent device activation(n=52,8.1%).Of the reported events,the vast majority did not result in patient harm(n=579,90.3%).On review of the remaining cases,only 24 events(3.7%)resulted in true harm to the patient,defined as a temporary or permanent injury or>30 min of additional anesthesia time.Of these cases,the need to reschedule surgical cases(n=5,0.8%),retained foreign body(n=5,0.8%),and thermal tissue injury(n=3,0.5%)were the most common.Five patients suffered an injury due to surgeon error unrelated to device malfunction(n=5,0.8%).Conclusions:Microdebrider device failures are extremely rare.When they do occur,less than 10%result in patient harm.In cases of patient harm related to microdebrider failure,preoperative testing of the device before use could prevent many of the reported malfunctions.

关键词： device failure microdebrider openFDA outcomes sinus

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