Trends in the management of pediatric chronic sinusitis: survey of the American Society of Pediatric Otolaryngology

BACKGROUND: The management of chronic sinusitis (CS) in children has yet to be fully elucidated. The objective of this study is to assess practice trends within the pediatric otolaryngology community for the management of children with CS. METHODS: A multiple choice survey of the members of the American Society of Pediatric Otolaryngology (ASPO) was performed to assess for various factors related to the management of CS in children. RESULTS: A total of 175 ASPO members responded to the survey. The majority of respondents initially treat patients medically with oral antibiotics (95%), topical steroids (90%), and nasal saline sprays (68%). Fifty-five percent performed adenoidectomy as part of the treatment of CS, with 81% performing the operation before endoscopic sinus surgery (ESS). Compared with 3 years before the survey, 47% of respondents performed approximately the same number of ESS cases, whereas 35% reported doing fewer cases annually. Seventy-two percent of practitioners do not routinely perform a second-look surgery. CONCLUSIONS: The majority of pediatric otolaryngologists use oral antibiotics, nasal steroids, and saline lavage, and will perform adenoidectomy when managing patients with CS. More than a third of pediatric otolaryngologists are using more stringent criteria for surgery and performing less extensive surgery than 3 years before the survey. Surgical outcomes for CS do not appear to have changed over the past 3 years.     

Management of lymphatic malformations and macroglossia: Results of a national treatment survey

Objective

To determine current trends among American Society of Pediatric Otolaryngology members on the treatment of various stages of lymphatic malformation (LM) with an emphasis on tongue management.

Methods

We queried the members on practice demographics, number of LMs and LM-Mac treated, preferred treatment of different stages of LM and Lm-Mac, indications for LM-Mac tongue treatment, preferred method of surgical tongue reduction, and medical management of acutely enlarging LMs and LM-Mac.

Results

39/329 (12%) American Society of Pediatric Otolaryngology members responded to the survey. Airway obstruction or obstructive sleep apnea (27/39, 69%) followed by recurrent tongue trauma with bleeding, pain or mucosal changes (11/39, 28%) were the most common indications for tongue management. 16/37 (43%) of respondents preferred staged tongue reduction followed by neck dissection (cervical approach to the LM), 8/37 (22%) preferred staged neck dissection followed by tongue reduction, and 13/37 (35%) preferred simultaneous treatment of the tongue and neck. The preferred methods of tongue reduction were superficial laser ablation (17/38, 45%) and surgical excision (14/39, 36%). The preferred methods of surgical tongue reduction were anterior wedge (18/38, 47%) and midline keyhole reduction (13/38, 34%). For rapidly enlarging lymphatic malformations involving the tongue, the majority of respondents indicated that they would admit and observe (34/38, 89%), give steroids (34/37, 92%) and administer antibiotics (35/38, 92%).

Conclusions

While providing insight into treatment patterns, this survey also helps to elucidate the need for multicenter trials for treatment of LM to develop a standard of care that can be recommended based on evidence based medicine rather.     

Recent advances in the use of lasers in otolaryngology

The laser (Light Amplification by Stimulated Emission of Radiation) has been used in Otolaryngology for over 20 years and is by now an accepted part of the armamentarium. A tremendous amount of work is being done in refining existing techniques and developing new ones, and this review discusses some of the recent advances.     

基于大数据分析的鼻科学临床教学改革初探

如何针对不同基础、不同层次的医师进行针对性的临床教学,从而更有效率的使用教学资源,提高学生临床应用技能,是鼻科学教学的重点和难点。本教学团队通过网络问卷调查600名临床医师,了解一线医师的临床需求。发现临床医师在继续教育过程中最感兴趣的是了解规范的诊疗方案、手术方案的指导和经典病例的分享。在疾病的种类上,发现无论省、市、县三级医院,医师最关注的前四类疾病均为鼻窦炎/鼻息肉、鼻内翻乳头状瘤、过敏性鼻炎、鼻腔良性肿瘤。而在市、县级医院普遍关注度不高的颅底疾病、鼻腔鼻窦恶性肿瘤,省级医院的医师却很感兴趣。上述结果表明,鼻科学临床教学应针对于不同层次医师的需求和执业环境,从“千篇一律”到“量体裁衣”,采取差异化、个体化的培训方式,使每个医师获得适合自身的临床技能进步。     

耳鼻咽喉科住院总医师1062例会诊病例分析

目的:分析耳鼻咽喉科住院总医师会诊患者的构成特点,从一个侧面反映住院总医师的工作情况。方法:统计第四军医大学西京医院耳鼻咽喉科1名住院总医师在2005年6月1日~2006年3月15日会诊的患者。结果:会诊患者共计1 062例,平均每周新会诊28例。其中急症会诊467例(43.97%),常规会诊595例(56.03%)。急症会诊的患者构成:鼻出血最多,共279例,占急症会诊总数的59.72%,病因主要为凝血机制障碍、高血压、肝肾功能衰竭、外伤等,少数为医源性诱发。喉阻塞及气管切开术113例,占急症会诊的24.19%,位于第2位。气管和支气管异物43例,病情均较危重。内科请常规会诊以炎症性疾病最多,慢性鼻炎及鼻窦炎169例,慢性咽炎及急慢性扁桃体炎162例,注意检查与诊断的全面性。外科因术前准备请耳鼻咽喉科常规会诊67例,目的是围手术期耳鼻咽喉科疾病风险评价和预防。结论:会诊工作具有特殊性和挑战性,住院总医师应该了解会诊患者特点,在会诊中学习和积累经验。     

《中国耳鼻咽喉头颈外科》论文临床随访资料评价

目的 评价《中国耳鼻咽喉头颈外科》临床随访资料的质量,为提高临床论文的水平提供依据.方法 对1 994年1月～2005年12月〈中国耳鼻咽喉头颈外科〉进行人工检索和机检,对临床随访资料进行分析和评价.结果 查阅该期刊更名前后12卷76期,文章2462篇,检索出提及随访的相关文章199篇.分别就其全文中的临床随访资料从随访时间及频度、随访评价标准、随访的方法、失访率、随访资料生存分析、随访结果的完整报道等指标进行了分析与比较.结论 虽然《中国耳鼻咽喉头颈外科》临床随访资料存在一些问题,但杂志更名后论文的临床随访资料在数量和质量等方面都有显著提高.     

老年良性阵发性位置性眩晕诊断与治疗

 良性阵发性位置性眩晕（benign paroxysmal positional vertigo, BPPV）是常见的外周性前庭疾病,尤其在老年人群中具有较高发病率。本文系统地回顾了国内外在BPPV领域的相关文献,并总结分析老年BPPV患者的病因、发病机制及临床特点,详细描述了老年BPPV患者诊断与治疗情况,以期提高临床对老年BPPV的认识及诊治水平。     

How informed is consent in a modern ENT department

The Department of Health issued a model consent form for use throughout the NHS from the 1st April 2002. Details of benefits and serious or frequent risks should be included on the form. We undertook a study to identify what proportion of complications from otolaryngology procedures were being recorded. Local morbidity and mortality records and case notes were examined from March to November 2004. Complications were identified and recorded. The consent forms for these operations were examined to identify if these complications had been recorded on the form prior to surgery. Complications were classified as “serious”, causing significant morbidity or increasing length of hospital stay or “frequent”, occurring in 1% or more of cases. A total of 2,978 operations were performed between March and November 2004. Seventy complications were identified in 60 patients (2% of operated patients). Twenty-three complications were not recorded on the consent forms in 20 (33%) patients. A total of 67% of all the complications were documented on the form as potential problems resulting from planned operations. Seven (74%) of complications that occurred but were not recorded on the consent forms were judged as “serious” or “frequent”. A significant proportion of serious or frequent complications are not being documented on the national consent forms before otolaryngological procedures and may not have been discussed. This may reflect a lack of openness during the consent process. In the current medical climate, this has serious ethical and medico-legal ramifications. It may also reflect a problem with the form and a need for a re-think of its design.     

结缔组织病在耳鼻咽喉科表现特点探讨

本文着重阐述了结缔组织病在耳鼻咽喉科的表坎特点，并就10例首诊我科的白塞氏病及Wegener’s肉芽肿等逐一分析，总结其特点，以利提高对这类疾病的诊断水平。     

联黎维和中国二级医院595例耳鼻咽喉疾病谱分析

自2007年2月,我国向黎巴嫩维和任务区派遣60人的医疗分队组建联合国驻黎巴嫩临时部队中国二级医院。根据中华人民共和国与联合国签署的《谅解备忘录》,该医院为自我维持医院,由中国分遣队配备人员、提供装备和物资,每一批维和人员在到达任务区之前必需充分考虑人员安排,准备好维和期间所需药品耗材。笔者对自2009年11月-2013年3月5个任务期内该院耳鼻咽喉科接诊的595例患者疾病进行总结分析,为今后维和医院专科医师的配备、专科药品及器材的准备提供参考。     

A national audit of paediatric service provision in otolaryngology in England and Wales

INTRODUCTION: Otolaryngology is the surgical speciality with the highest paediatric workload, accounting for 29% of the total. Children are not miniature adults and require specially trained staff, equipment, facilities and an environment appropriate to their needs. Documents from the Department of Health and the Royal Colleges of Surgeons and Anaesthetists have been published outlining national standards and recommendations for paediatric surgical service provision. We undertook an audit to assess the current state of paediatric services in ENT in England and Wales and how they conform to these guidelines. METHOD: A database of ENT departments in England and Wales was constructed and a postal questionnaire sent to a named consultant in each unit. The questionnaire encompassed the areas of recommendation outlined in the aforementioned reports. Respondents were also asked to state the kind of hospital in which they worked so a further breakdown of the results could be made. RESULTS: One hundred and eighty-nine units were included in the audit with a response rate of 56%. Structurally the documents recommend that each unit has a dedicated named paediatric ENT consultant and a designated clinical lead for children's surgery. This is being met in 54.7% and 56.6%, respectively. Omitting the specialist stand alone group the paediatric facilities in theatre were of a lower standard and overall only 30% met the requirements set by the reports. This theme continues when analysing the data of the provision of anaesthetic services with only 50% of the small district general hospitals having the appropriate level of supervision and expertise. One of the worst met targets is that of acute pain service being provided in only 26% of the hospitals that responded. Overall there is a common theme with the specialist stand alone units scoring the highest and the small district general hospitals scoring the lowest. CONCLUSION: This audit reveals that we are not meeting the guidelines in nearly 50% of the targeted areas. Paediatric care should be "child centred" and if we are not able to provide this specialised care then paediatric surgical services could be forced into centralisation.     

Otolaryngology sleep medicine curriculum objectives as determined by sleep experts

Purpose

(1) Ascertain the most important concepts and topics for otolaryngology resident education in sleep medicine and surgery, as determined by faculty who teach sleep medicine to otolaryngology residents. (2) Create learning objectives within the area of otolaryngologic sleep medicine in order to design a sleep medicine curriculum for otolaryngology residents.

任务驱动式费曼学习法在耳鼻咽喉科教学中的探索与应用

目的 分析费曼学习法教学模式在耳鼻咽喉科学理论教学中的应用实践,为耳鼻咽喉头颈外科学本科教学改革提供参考。方法 选择某院2016级临床医学八年制学生52人为研究对象,采用随机数字法分为实验组与对照组,每组26名学生,全体学生首先接受教师的传统理论教学授课,随后实验组学生根据费曼学习法对对照组学生进行模拟教学。理论教学结束后均有一次课堂测验,其中实验组学生模拟教学前后的测验分数分别记为A1、A2组,对照组分数记为B组。通过A1、A2和B组分数和问卷调查评估研究结果。结果 A2组测验成绩(80.92±2.76)分高于A1组(76.23±3.29)分、B组(76.38±3.38)分,差异均具有统计学意义(P均＜0.05),A1组与B组分数比较,差异无统计学意义(P＞0.05)。实验组教学整体满意度优于对照组,问卷调查条目2、3、4、6、7差异均具有统计学意义(P均＜0.05)。结论 费曼学习法应用于耳鼻咽喉科学理论教学中可提高教学质量与效果,教学模式得到学生的认可。     

Vagal nerve stimulator implantation: the otolaryngologist’s perspective

Vagal nerve stimulation (VNS) is a recognised and effective measure in treating refractory epilepsy and depression. VNS implantation is a widely accepted surgical procedure, most commonly performed by neurosurgeons. Otolaryngologists, in particular those with an interest in head and neck surgery, are very familiar with the surgical anatomy and dissection of the vagus nerve in the carotid sheath. We present a retrospective analysis of the first 12 patients to be implanted in our department. Our series suggests that otolaryngologists can safely and effectively perform VNS implantation. Otolaryngologists can assess and treat the most common post-operative complication of dysphonia and help the neurologist set the correct level of stimulation in such a way as to minimise laryngeal complications.     

Auditory symptoms and autistic spectrum disorder: A scoping review and recommendations for future research

IntroductionAuditory symptoms in individuals with Autistic Spectrum Disorder (ASD) are well described within the neurodevelopmental literature, yet there is minimal mention of ASD in Otolaryngology literature. This is surprising considering the potential clinical and diagnostic implications of this link, and the potential for ASD to present to Otolaryngologists in the form of unexplained auditory symptoms. The aims of this literature review were to explore the intersection of auditory symptoms and ASD from the perspective of clinical Otolaryngology, and to outline a clinically focused research agenda based on emerging themes relevant to Otolaryngology.MethodsWe searched Pubmed, Embase, Ovid and Cochrane library for studies until November 2021. Four authors independently reviewed 227 publications identified. 39 were filtered into the final analysis. The PRISMA 2020 guidelines were followed. The heterogeneity of literature meant that a Systematic Review was not feasible. Included studies were therefore classified thematically, forming the basis of the scoping review.ResultsDiagnostic theories for auditory symptoms in ASD include the entire auditory pathway and brain. There is a growing body of literature on auditory symptoms in ASD, suggesting that a primary diagnosis of ASD should be considered in patients presenting with otherwise unexplained auditory symptoms, and indicating a learning need for Otolaryngologists and audiologists, to whom these patients may present.ConclusionWe recommend a research agenda focusing on multidisciplinary collaboration, stakeholder engagement, responsible clinical screening, and clarification of pathophysiological mechanisms and terminology.