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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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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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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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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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Burnout and well-being in otolaryngology trainees:A systematic review

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World Journal of Otorhinolaryngology-head and neck surgery 2022年第2期8卷 118-125页

作者： Skye K.Lawlor Christopher M.Low Matthew L.Carlson Karthik Rajasekaran Garret Choby department of otolaryngology-head and neck surgery Mayo ClinicRochesterMinnesotaUSA department of Neurologic surgery Mayo ClinicRochesterMinnesotaUSA department of otolaryngology-head and neck surgery University of PennsylvaniaPennsylvaniaUSA

Objective:To comprehensively review the recent published literature to characterize current trends of burnout and well-being among otolaryngology trainees.Methods:Study design:systematic review and meta-analysis.A comprehensive literature review from 2000 to 2021 of studies related to otolaryngology resident burnout and well-being,as well as the general topic of well-being among surgical residents was completed.All included studies were summarized qualitatively.For the quantitative analysis,only articles reporting a Maslach burnout inventory(MBI),modified MBI or Mini-Z-Burnout assessment were included.Results:Twenty-five articles were included in the qualitative summary and nine articles in the quantitative analysis.In the qualitative summary,trainees were reported to have increased levels of distress and emotional hardening compared to attending otolaryngologists.Total hours worked per week and female gender were associated with worsened well-being.Residency program strategies to improve trainee well-being include program-sponsored wellness activities,dedicated wellness champions,and assistance with clerical burden.Implementation of protected nonclinical time has been shown to decrease burnout and increase well-being among trainees.Moreover,formal trainee mentorship programs have also been shown to reduce trainee burnout and stress.In the quantitative analysis,rates of trainee burnout ranged from 29.7%to 86%with an overall trend towards reduced rates of burnout from 2006 to 2021.Utilizing a weighted average,the overall burnout among otolaryngology residents was 58.6%.Conclusions:Rates of burnout remain high among otolaryngology trainees.Implementing formal mentorship programs and providing protected time during regular work hours appear to be effective tools to improve resident well-being.

关键词： burnout ENT otolaryngology residents wellness

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The use of Montgomery salivary bypass tubes and pharyngocutaneous fistula following salvage laryngectomy

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World Journal of Otorhinolaryngology-head and neck surgery 2024年第1期10卷 43-48页

作者： Courtney B.Shires Mackenzie Latour Merry Sebelik Karuna Dewan West Cancer Center GermantownTennesseeUSA department of otolaryngology-head and neck surgery Louisiana State University Health ShreveportShreveportLouisianaUSA department of otolaryngology-head and neck surgery Emory UniversityAtlantaGeorgiaUSA

Objectives:Pharyngocutaneous fistula(PCF)is the most common complication to follow total laryngectomy(TL)and is associated with increases in length of hospital stay and with a need for revision surgery or readmission,as well as with delays in return to oral diet.Patients who require salvageTL(STL)or primary(chemo)radiation therapy are at higher risk for developing PCF.Due to the quality‐of‐life burden of PCF on patients,limiting this occurrence is crucial.Methods:We conducted a retrospective cohort study of patients undergoing STL with placement of Montgomery salivary bypass tube(MSBT)^(TM)for at least 2 weeks duration between 2013 and 2017 at a single institution.Our patients all underwent free flap reconstruction.Our primary outcome of interest was development of PCF.Secondary outcomes included demographics,previous treatment,base of tongue(BOT)involvement,extent of defect,concurrent neck dissection(ND),and margin status.Univariateχ^(2) analysis was used to evaluate factors associated with PCF.Results:Forty‐four patients underwent STL with Montgomery tube placement and free flap reconstruction.Eight developed PCF(18.2%).The average age was 61.6 years;36 patients were male(81.8%),whereas eight patients were female(18.2%).There was no association between PCF and previous chemoradiation versus radiation(15.8%vs.33.3%,P<0.30),BOT involvement versus not(11.1 vs.22.2%,P<0.38),circumferential versus partial defect(18.8%vs.17.9%,P<0.94),ND versus none(10%vs.25%,P<0.20),or margin status.Conclusion:PCF complicated 18.2%of STL cases at our institution and was not associated with differences in primary treatment modality,presence of concomitant ND,extent of pharyngeal defect,BOT involvement,or positive frozen or permanent surgical margin.

关键词： free flap reconstruction Montgomery pharyngocutaneous fistula salivary bypass tube salvage total laryngectomy total laryngectomy

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Anesthesia for office-based facial plastic surgery procedures

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世界耳鼻咽喉头颈外科杂志(英文) 2023年第3期9卷 200-205页

作者： Suhas Bharadwaj William Dougherty department of otolaryngology-head and neck surgery Eastern Virginia Medical SchoolNorfolkVirginiaUSA

Objective:The objective of this study is to provide a state-of-the-art review on the use of anesthetics for in-office facial plastic procedures.Methods:A search was performed on PubMed,Embase,Web of Science,and Cochrane Review using the keywords"anesthesia,""office-based procedures,""local anesthesia,""facial plastics,""oral sedation,""moderate sedation,"and"deep sedation."Results and Conclusions:Over the past few decades,the shift toward in-office invasive procedures has increased patient convenience and decreased hospital resource utilization.Many tools exist to reduce patient anxiety and discomfort in an office-based setting.With proper patient selection and technique,facial plastic surgeons can adequately anesthetize patients to perform Mohs reconstruction,cutaneous excisions,blepharoplasty,face-lifts,and other in-office procedures.

关键词： anesthesia facial plastic surgery office-based procedures

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Autoinflammatory characteristics and short-term effects of delivering high-dose steroids to the surface of the intact endolymphatic sac and incus in refractory Ménière’s disease

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Journal of Otology 2019年第2期14卷 40-50页

作者： Jing Zou department of otolaryngology-head and neck surgery Center for Otolaryngology-Head & Neck Surgery of Chinese PLA Changhai Hospital Second Military Medical University

Objective:To investigate immune-related genetic background in intractable Meniere’s disease(MD)and the immediate results of a novel therapy by delivering steroids to the surface of the intact endolymphatic sac(ES)and incus in a sustainable manner.Case report and methods:Candidate genes involved in immune regulation were sequenced using a nextgeneration sequencing method in a patient with intractable MD.Mutations were confirmed using the Sanger sequencing method.The ES was exposed,and gelatin sponge particles were immersed in highdose methylprednisolone solution and placed onto the surface of ES.“L”-shaped gelatin sponge strips were immersed in dexamethasone solution and served as a guiding device for the steroids by touching the incus and gelatin sponge particles on the surface of the ES.Gelatin sponge particles immersed in dexamethasone solution were placed around the gelatin sponge strips and sealed using fibrin glue.Results:Autoinflammation in the refractory MD case was indicated by genotype,including novel heterozygous mutations of PRF1,UNC13D,SLC29A3,ITCH,and JAK3,as well as phenotype.The vertigo was fully relieved immediately after operation.Tinnitus and aural fullness were resolved 3 weeks after operation,whereas hearing improved in 2 mon postoperation.No recurrence was noted during the 5-monfollow-up,and the final MRI supported the novel therapeutic hypothesis.Conclusion:Autoinflammation was involved in a refractory MD.This novel therapy,which involves the delivery of steroids to the surface of the intact ES and incus,is effective in relieving vertigo and tinnitus and improves hearing function of refractory MD.

关键词： Vestibular function Tinnitus Genetic disorders Hearing

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Survival differences of low-grade versus high-grade head and neck pleomorphic dermal sarcomas and a review of a scalp case

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World Journal of Otorhinolaryngology-head and neck surgery 2023年第1期9卷 74-78页

作者： Tyler A.Janz Barry D.Long Rohan R.Joshi Orly M.Coblens department of otolaryngology-head and neck surgery University of Texas Medical BranchGalvestonTexasUSA

Objective:To examine survival by tumor grade of pleomorphic dermal sarcomas(PDS)of the head and neck(H&N)and review a scalp PDS case.Methods:Patients in the Surveillance,Epidemiology,and End Results(SEER)database were included from 1980 to 2016 based on a diagnosis of H&N PDS.Survival estimates were performed using Kaplan–Meier analysis.Additionally,a case of a grade III H&N PDS is presented.Results:Two hundred-seventy cases of PDS were identified.The mean age at diagnosis was 75.1 years(SD:13.5).Two hundred-thirty-four(86.7%)patients were male.Eighty-seven percent of patients received surgery as a part of their care.The 5-year overall survival rates for grades I,II,III,and IV PDSs were 69%,60%,50%,and 42%,respectively(P=0.03).Conclusions:H&N PDS occurs most commonly in older-age males.Surgical management is frequently a part of H&N PDS care.Survival rates significantly decline based on tumor grade.

关键词： head and neck cancer pleomorphic dermal sarcoma

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