Annals of Otology, Rhinology & Laryngology最新文献

{"title":"A Reproducible Peritonsillar Abscess Incision and Drainage Model for Junior Trainees","authors":"Azmi Marouf, Samuel Doty, Humzah A. Quereshy, Benjamin R. Johnson, Claudia I. Cabrera, Sarah Mowry, Akina Tamaki","doi":"10.1177/00034894241249611","DOIUrl":"https://doi.org/10.1177/00034894241249611","url":null,"abstract":"Objectives:To describe the design and construction of a reproducible, low-cost, peritonsillar abscess (PTA) incision and drainage simulator and assess its impact on trainees’ confidence.Methods:The 2-part simulator we developed consisted of a manikin head with a fixed, partially open mouth and a modular PTA mold. The mold is created by injecting a lotion and water mixture into plastic bubbles, followed by silicone solidification. Neodymium magnets secure the silicone-abscess packet to the manikin’s palate. The simulator was utilized during an academic otolaryngology residency training program Annual Otolaryngology Boot Camp. A self-assessment Likert scale questionnaire was used to evaluate participants’ confidence before and after simulator training. Fourth-year medical students and junior (first and second year) residents who participated in the boot camp and agreed to complete the evaluation were included.Results:Three medical students, 17 PGY-1, and 10 PGY-2 residents agreed to complete the evaluation. All trainees agreed the model was useful for learning skills. The overall post-training confidence Likert scores of participants, and PGY-1 residents in particular, significantly improved compared to their pre-training scores ( P < .001).Conclusions:Our model offers an affordable and efficient training opportunity for residents to enhance their competence in managing PTAs. This approach, with its simple yet effective design and low production cost, shows potential for scalability on a broader scale.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140839467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing ChatGPT’s Responses to Otolaryngology Patient Questions","authors":"Jonathan M. Carnino, William R. Pellegrini, Megan Willis, Michael B. Cohen, Marianella Paz-Lansberg, Elizabeth M. Davis, Gregory A. Grillone, Jessica R. Levi","doi":"10.1177/00034894241249621","DOIUrl":"https://doi.org/10.1177/00034894241249621","url":null,"abstract":"Objective:This study aims to evaluate ChatGPT’s performance in addressing real-world otolaryngology patient questions, focusing on accuracy, comprehensiveness, and patient safety, to assess its suitability for integration into healthcare.Methods:A cross-sectional study was conducted using patient questions from the public online forum Reddit’s r/AskDocs, where medical advice is sought from healthcare professionals. Patient questions were input into ChatGPT (GPT-3.5), and responses were reviewed by 5 board-certified otolaryngologists. The evaluation criteria included difficulty, accuracy, comprehensiveness, and bedside manner/empathy. Statistical analysis explored the relationship between patient question characteristics and ChatGPT response scores. Potentially dangerous responses were also identified.Results:Patient questions averaged 224.93 words, while ChatGPT responses were longer at 414.93 words. The accuracy scores for ChatGPT responses were 3.76/5, comprehensiveness scores were 3.59/5, and bedside manner/empathy scores were 4.28/5. Longer patient questions did not correlate with higher response ratings. However, longer ChatGPT responses scored higher in bedside manner/empathy. Higher question difficulty correlated with lower comprehensiveness. Five responses were flagged as potentially dangerous.Conclusion:While ChatGPT exhibits promise in addressing otolaryngology patient questions, this study demonstrates its limitations, particularly in accuracy and comprehensiveness. The identification of potentially dangerous responses underscores the need for a cautious approach to AI in medical advice. Responsible integration of AI into healthcare necessitates thorough assessments of model performance and ethical considerations for patient safety.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140812502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and Late Complications of Mandibulectomy Free Flap Reconstruction: Does the Selective Use of Soft Tissue Only Flaps Reduce Complications?","authors":"Dylan B. McBee, Michael J. DiLeo, Caroline C. Keehn, Andrew T. Huang, Angela D. Haskins, David J. Hernandez","doi":"10.1177/00034894241250177","DOIUrl":"https://doi.org/10.1177/00034894241250177","url":null,"abstract":"Purpose:This study aims to evaluate the factors most associated with early and late complications following microvascular free tissue transfer (MVFTT) after mandibulectomy.Methods:A retrospective review of patients undergoing MVFTT after segmental mandibulectomy from September 2016 to February 2021 was performed across a single academic institution. Surgical variables were collected, including the location of the resultant mandibular defect (anterior vs posterior) and flap type (osseous or non-osseous). The primary outcome variables included postoperative complications (early, <90 days; and late, >90 days) and the patients’ functional status (return to oral intake). Descriptive statistics, chi-square test, Fischer’s exact test, and 2-sample t tests were used to analyze differences among variables.Results:We analyzed a cohort of 114 consecutive patients with mandibular defects, comprising 57 anterior and 57 posterior defects. Bony free flaps with hardware were used to reconstruct 98% of anterior defects compared to 58% of posterior defects ( P < .001). All soft tissue only flaps did not utilize any hardware during the reconstruction. Anterior defects demonstrated more late complications requiring additional surgery (30% vs 9%, P = .04). A secondary analysis of posterior mandibular reconstructions compared soft tissue only flaps and bony free flaps with hardware and showed equivalent rates of early (12% vs 13%, P > .99) and late (9% vs 8%, P > .99) complications requiring additional surgery while demonstrating a similar return to full oral competence (55% vs 46%, P = .52) and recovery of a 100% oral diet (67% vs 54%, P = .53).Conclusion:Osseous free tissue transfer for segmental mandibular defects remains the gold standard in reconstruction. In our patient cohort, anterior mandibular defects are associated with greater late (>90 day) complications requiring additional surgery. Comparable outcomes may be achieved with soft tissue only versus osseous free flap reconstruction of posterior mandibular defects.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140812920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Diffusion Weighted MRI Versus Planned Second-Look Surgery for Cholesteatoma","authors":"Terral A. Patel, Abhinav Ettyreddy, Tracy Cheng, Kenneth Smith, Shaum S. Sridharan, Andrew A. McCall","doi":"10.1177/00034894241250253","DOIUrl":"https://doi.org/10.1177/00034894241250253","url":null,"abstract":"Objective:To compare the cost-effectiveness of serial non-echo planar diffusion weighted MRI (non-EP DW MRI) versus planned second look surgery following initial canal wall up tympanomastoidectomy for the treatment of cholesteatoma.Methods:A decision-analytic model was developed. Model inputs including residual cholesteatoma rates, rates of non-EP DW MRI positivity after surgery, and health utility scores were abstracted from published literature. Cost data were derived from the 2022 Centers for Medicare and Medicaid Services fee rates. Efficacy was defined as increase in quality-adjusted life year (QALY). One- and 2-way sensitivity analyses were performed on variables of interest to probe the model. Total time horizon was 50 years with a willingness to pay (WTP) threshold set at $50 000/QALY.Results:Base case analysis revealed that planned second-look surgery ($11 537, 17.30 QALY) and imaging surveillance with non-EP DWMRI ($10 439, 17.26 QALY) were both cost effective options. Incremental cost effectiveness ratio was $27 298/QALY, which is below the WTP threhshold. One-way sensitivity analyses showed that non-EP DW MRI was more cost effective than planned second-look surgery if the rate of residual disease after surgery increased to 48.3% or if the rate of positive MRI was below 45.9%. A probabilistic sensitivity analysis at WTP of $50 000/QALY found that second-look surgery was more cost-effective in 56.7% of iterations.Conclusion:Non-EP DW MRI surveillance is a cost-effect alternative to planned second-look surgery following primary canal wall up tympanomastoidectomy for cholesteatoma. Cholesteatoma surveillance decisions after initial canal wall up tympanomastoidectomy should be individualized.Level of Evidence:V.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"124 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140812309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Book Review: Balancing Care: A Review of “Head and Neck Cancer Care in a Pandemic: Prioritizing Safe Care”","authors":"Antoinette R. Esce, N. Boyd","doi":"10.1177/00034894221136333","DOIUrl":"https://doi.org/10.1177/00034894221136333","url":null,"abstract":"It is already easy to forget the sense of fear and anxiety that permeated our field in the early part of the COVID-19 pandemic. What has now become a slow grind of rippling surges and annoying unknowns was once a time of universal uncertainty and widespread panic. Reading this textbook feels like opening a time capsule, remembering our makeshift intensive care beds in our operating rooms, recalling lengthy debates over the safety and necessity of once simple procedures, and reliving the struggle to balance the safety of our community and the care of our head and neck patients. Head and Neck Cancer Care in a Pandemic aims to provide a sweeping overview of how the care of our complex and vulnerable patients was changed by this global pandemic and the ways to mitigate harm—for the patients in our clinic and the communities we all returned home to at night. This book was written at a time when we all still hoped that the world would someday go back to normal. Now that a new normal has started to reveal itself, and with the possibility of future pandemic scenarios, the book feels particularly prescient. While some of the information is now out of date with the advent of vaccines, which have drastically altered our protocols and institutional responses to the pandemic, this textbook serves as a useful reference for head and neck cancer providers in a still unsettled global health emergency. The book reads more like a collection of essays than a cohesive textbook. Many concepts, themes, and critical points arise in multiple chapters. For example, numerous chapters address the importance of not delaying necessary care, how and when to use personal protective equipment, the utility of testing, conserving resources, and the need for interdisciplinary teams to help make decisions in these complex situations. This redundancy is a strength of the book, given its likely use as a reference text. Another repeated theme is the need for protocols and clear procedures in times of uncertainty. Leaving it up to every individual physician to ration care, choose alternative treatments, or forgo standard treatments can lead to disparities in outcome, an inability to collect meaningful data and adjust processes, and lead to provider and healthcare team burnout and mental health issues, as detailed in the last section of the book. Many chapters provide excellent summaries of existing references, from expedited journal articles or society guidelines. They also note the importance of incorporating geographic and institution specific variation in local protocols and procedures. To this end, there are several useful summary tables and treatment algorithms that providers can reference, including a particularly helpful flowchart about the management of salivary neoplasms during a pandemic. One aspect of the book that surprised us was the assumption, reflected in several places throughout the work, that surgical treatment of disease is always the most resource intensive strategy","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"29 3 1","pages":"1275 - 1276"},"PeriodicalIF":0.0,"publicationDate":"2022-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90871580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Book Review: Pediatric Audiology Casebook","authors":"Mahindra A. Ramdhanie","doi":"10.1177/0003489420939086","DOIUrl":"https://doi.org/10.1177/0003489420939086","url":null,"abstract":"","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"50 1","pages":"327 - 327"},"PeriodicalIF":0.0,"publicationDate":"2020-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77578923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Book Review: Head and Neck Cancer: Management and Reconstruction","authors":"V. Mehta","doi":"10.1177/0003489420912420","DOIUrl":"https://doi.org/10.1177/0003489420912420","url":null,"abstract":"Head and Neck Cancer: Management and Reconstruction represents the 2nd edition of Eric Genden’s textbook on the subject, and is a combination of two prior prior texts: Reconstruction of the Head and Neck: A Defect-Oriented Approach and Head and Neck Cancer: An Evidence-Based Team Approach. He has collaborated with 46 different contributors from internationally renowned academic institutions to produce this contemporary and pragmatic reference. The chapters are organized anatomically, and are followed by a corresponding chapter on the principles of reconstruction and functional rehabilitation for that particular head and neck cancer site. This enables the reader to get full exposure to, and appreciation for, all the facets of head and neck cancer surgery. Many of the chapters conclude with corresponding case studies, and there is also available online, high-quality video content demonstrating surgical techniques for several of the topics. The structure of the book allows the text to be a comprehensive and concise review of head and neck cancer surgical techniques and reconstruction, thereby functioning as a single reference source for physicians and other providers involved in the care of these patients. The chapters contain essential and practical information, rather than functioning as an encyclopedic reference. This approach makes the book more attractive to physicians earlier in their career or those that are still in training. However, combined with the welldesigned figures and tables, the text allows the reader to efficiently and expeditiously get the vital information needed to manage complex head and neck cancer cases, and thoroughly understand and explore options for functional reconstruction of oncologic defects. Overall, this is an excellent reference source for those looking for a single textbook that contains complete and practical knowledge on the subject. 912420 AORXXX10.1177/0003489420912420Annals of Otology, Rhinology & LaryngologyBook Review book-review2020","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"4 4 1","pages":"840 - 840"},"PeriodicalIF":0.0,"publicationDate":"2020-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88359090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Book Review: Patient and Family-Centered Speech-Language Pathology and Audiology","authors":"Gina L. Palma","doi":"10.1177/0003489419888637","DOIUrl":"https://doi.org/10.1177/0003489419888637","url":null,"abstract":"","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"1 1","pages":"413 - 413"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84486322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“In-Office Balloon Sinus Ostial Dilation with Concurrent Antiplatelet and Anticoagulant Therapy for Chronic Rhinosinusitis without Nasal Polyps”","authors":"T. Higgins, B. Öcal, Ridwan Adams, Arthur W. Wu","doi":"10.1177/0003489419887195","DOIUrl":"https://doi.org/10.1177/0003489419887195","url":null,"abstract":"Objective: Functional endoscopic sinus surgery (FESS) and balloon sinus ostial dilation (BSD) are well-recognized minimally invasive surgical treatments for chronic rhinosinusitis without nasal polyps (CRSsNP) refractory symptoms to medical therapy. Patients on antiplatelet and anticoagulant therapies (AAT) usually are recommended to discontinue their medications around the period of endoscopic sinus surgery. The goal of this study is to assess the clinical experience of BSD in CRSsNP patients with concurrent anticoagulant or antiplatelet therapy. Methods: A review of prospectively-collected clinical data from October 2012 to March 2017 were used to perform a cohort study of subjects with CRSsNP who met criteria for surgical intervention while on antiplatelet and anticoagulant therapy. Data were collected on demographics, details of the procedures, type of AAT used, pre- and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores, and complications. Results: Thirty-five patients underwent in-office BSD while on antiplatelet and/or anticoagulant therapy. The mean difference in pre- and postoperative SNOT-22 scores of 9.9 (SD 14.4, P < .001) was both statistically significant and exceeded the minimal clinically important difference of 8.9. Absorbable nasal packing was used for persistent bleeding immediately post-procedure in two patients. Intraoperative bleeding was associated with aspirin 325 mg and warfarin. FESS was required for further management of chronic sinusitis in four patients after anticoagulant/antiplatelet therapy could be discontinued. There were no systemic complications. None of the patients experienced significant bleeding events postoperatively after leaving the office. Conclusion: In-office BSD appears to be a safe alternative to endoscopic sinus surgery in select patients who cannot discontinue antiplatelet and anticoagulant therapy. Levels of Evidence: IV","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"109 3","pages":"280 - 286"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91477825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Book Review: Key Topics in Otolaryngology","authors":"S. Nawaz","doi":"10.1177/0003489419884553","DOIUrl":"https://doi.org/10.1177/0003489419884553","url":null,"abstract":"","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"5 1","pages":"306 - 306"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83989089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}