Pub Date : 2024-09-18DOI: 10.1177/00034894241280537
Zuhaib A. Khokhar, John F. Mills, Shaun A. Nguyen, David R. White, Wayne K. Robbins, Ted A. Meyer
Objective:This review sought to answer the following research question: What are the characteristics of pediatric necrotizing otitis externa (NOE)? Moreover, we wanted to highlight the clinical importance of the current limitations in the literature.Methods:A scoping review was performed to determine what is known about NOE in the pediatric population. Four databases (COCHRANE Library, CINAHL, PubMed, and Scopus) were queried for articles published in English between 1976 to 2022. Variables extracted included comorbidities, demographics, outcomes, and treatment.Results:A total of 20 studies (N = 439) reported sufficient measures to be included in the review. Patients with NOE had a mean age of 10.0 years (range 2 months to 14 years) with a male-to-female gender ratio of 1.1:1. Mean length of hospital stay was 2.9 days (95%CI: 2.7-3.0). Demographics included 45.4% Caucasian, 6.0% African American, and 2.7% Asian/Pacific Islander. Less than 5% of patients had diabetes, while other reported comorbidities included neutropenia (n = 6), anemia (n = 5), dehydration/malnutrition (n = 4), Stevens Johnson Syndrome (n = 2), some form of immunosuppression/organ transplantation (n = 2), thrombocytopenia (n = 2), and leukopenia (n = 2). There have been no reported deaths from NOE in children.Conclusions:In the adult population NOE most commonly affects patients with diabetes, but our review reveals that diabetes does not appear to play as big a role in children. The disease seems to commonly affect patients with immunosuppression or severe health conditions. Complications such as cranial nerve palsies appear to be more common in the pediatric population. Specifically, the role of biopsy and culture in the treatment of pediatric NOE is stressed as they are important in treatment decisions.
{"title":"Pediatric Necrotizing Otitis Externa: A Scoping Review","authors":"Zuhaib A. Khokhar, John F. Mills, Shaun A. Nguyen, David R. White, Wayne K. Robbins, Ted A. Meyer","doi":"10.1177/00034894241280537","DOIUrl":"https://doi.org/10.1177/00034894241280537","url":null,"abstract":"Objective:This review sought to answer the following research question: What are the characteristics of pediatric necrotizing otitis externa (NOE)? Moreover, we wanted to highlight the clinical importance of the current limitations in the literature.Methods:A scoping review was performed to determine what is known about NOE in the pediatric population. Four databases (COCHRANE Library, CINAHL, PubMed, and Scopus) were queried for articles published in English between 1976 to 2022. Variables extracted included comorbidities, demographics, outcomes, and treatment.Results:A total of 20 studies (N = 439) reported sufficient measures to be included in the review. Patients with NOE had a mean age of 10.0 years (range 2 months to 14 years) with a male-to-female gender ratio of 1.1:1. Mean length of hospital stay was 2.9 days (95%CI: 2.7-3.0). Demographics included 45.4% Caucasian, 6.0% African American, and 2.7% Asian/Pacific Islander. Less than 5% of patients had diabetes, while other reported comorbidities included neutropenia (n = 6), anemia (n = 5), dehydration/malnutrition (n = 4), Stevens Johnson Syndrome (n = 2), some form of immunosuppression/organ transplantation (n = 2), thrombocytopenia (n = 2), and leukopenia (n = 2). There have been no reported deaths from NOE in children.Conclusions:In the adult population NOE most commonly affects patients with diabetes, but our review reveals that diabetes does not appear to play as big a role in children. The disease seems to commonly affect patients with immunosuppression or severe health conditions. Complications such as cranial nerve palsies appear to be more common in the pediatric population. Specifically, the role of biopsy and culture in the treatment of pediatric NOE is stressed as they are important in treatment decisions.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"18 1","pages":"34894241280537"},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263918","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}
Pub Date : 2024-04-29DOI: 10.1177/00034894241249611
Azmi Marouf, Samuel Doty, Humzah A. Quereshy, Benjamin R. Johnson, Claudia I. Cabrera, Sarah Mowry, Akina Tamaki
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.
{"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}
Pub Date : 2024-04-27DOI: 10.1177/00034894241249621
Jonathan M. Carnino, William R. Pellegrini, Megan Willis, Michael B. Cohen, Marianella Paz-Lansberg, Elizabeth M. Davis, Gregory A. Grillone, Jessica R. Levi
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.
{"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}
Pub Date : 2024-04-27DOI: 10.1177/00034894241250177
Dylan B. McBee, Michael J. DiLeo, Caroline C. Keehn, Andrew T. Huang, Angela D. Haskins, David J. Hernandez
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.
目的：本研究旨在评估下颌骨切除术后微血管游离组织转移（MVFTT）与早期和晚期并发症最相关的因素。方法：对一家学术机构在2016年9月至2021年2月期间接受下颌骨节段切除术后MVFTT的患者进行了回顾性研究。收集的手术变量包括下颌骨缺损的位置（前部与后部）和皮瓣类型（骨性或非骨性）。主要结果变量包括术后并发症（早期，90 天；晚期，90 天）和患者的功能状态（恢复口腔摄入）。我们采用了描述性统计、卡方检验、费舍尔精确检验和双样本 t 检验来分析变量之间的差异。98%的前部缺损采用带硬件的骨性游离皮瓣重建，而58%的后部缺损采用带硬件的骨性游离皮瓣重建（P <.001）。所有软组织皮瓣在重建过程中均未使用任何硬件。前部缺损需要进行额外手术的晚期并发症较多（30% vs 9%，P = .04）。对下颌骨后部重建的二次分析比较了纯软组织皮瓣和带硬件的骨性游离皮瓣，结果显示需要额外手术的早期（12% vs 13%，P = .99）和晚期（9% vs 8%，P = .99）并发症发生率相当，同时显示完全口腔能力的恢复率（55% vs 46%，P = .52）和100%口腔饮食的恢复率（67% vs 54%，P = .53）相似。结论：骨性游离组织转移治疗下颌骨节段性缺损仍是重建的金标准。在我们的患者队列中，下颌骨前部缺损的后期（90 天）并发症较多，需要进行额外手术。下颌后部缺损的软组织重建与骨性游离皮瓣重建可获得相似的效果。
{"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}
Pub Date : 2024-04-27DOI: 10.1177/00034894241250253
Terral A. Patel, Abhinav Ettyreddy, Tracy Cheng, Kenneth Smith, Shaum S. Sridharan, Andrew A. McCall
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.
{"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}
Pub Date : 2022-11-22DOI: 10.1177/00034894221136333
Antoinette R. Esce, N. Boyd
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
{"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}
Pub Date : 2022-01-04DOI: 10.1177/00034894211068608
Rafael Ospino, A. Berges, Lena W Chen, Ioan A. Lina, A. Hillel
Objective: To report a case of a patient with idiopathic subglottic stenosis (iSGS) who no longer required surgical intervention for her disease following a chemotherapy regimen of carboplatin and doxorubicin for ovarian cancer. A brief review of the literature and discussion on the possible mechanism of action of chemotherapy agents affecting fibrosis is included. Methods: Case report and review of literature. Results: A 71-year-old Caucasian woman with iSGS was managed with serial endoscopic excision and dilation (n = 5) from 2013 to 2017 with an average dilation interval of 12.3 months. After a course of doxorubicin and carboplatin to treat her ovarian cancer, we observed that her airway stenosis surprisingly stabilized, and has no longer required a surgical dilation for 45 months, which signifies an increase of 33 months when compared to her averaged dilation interval (12.3 months) prior to her second course of chemotherapy. Conclusion: We present an iSGS patient whose fibrosis was arrested following carboplatin/doxorubicin treatment. While a single case, a possible mechanism is carboplatin/doxorubicin’s inhibition of pathologic CD4 lymphocytes that propagate laryngotracheal fibrosis. Further investigation of like mechanisms may allow for translation of local agents with inhibitory effects on CD4+ cells and/or fibroblasts as a novel therapy for airway fibrosis.
{"title":"Prolonged Surgical Interval Following Chemotherapy in a Patient With Idiopathic Subglottic Stenosis (iSGS): Case Report and Brief Review of Literature","authors":"Rafael Ospino, A. Berges, Lena W Chen, Ioan A. Lina, A. Hillel","doi":"10.1177/00034894211068608","DOIUrl":"https://doi.org/10.1177/00034894211068608","url":null,"abstract":"Objective: To report a case of a patient with idiopathic subglottic stenosis (iSGS) who no longer required surgical intervention for her disease following a chemotherapy regimen of carboplatin and doxorubicin for ovarian cancer. A brief review of the literature and discussion on the possible mechanism of action of chemotherapy agents affecting fibrosis is included. Methods: Case report and review of literature. Results: A 71-year-old Caucasian woman with iSGS was managed with serial endoscopic excision and dilation (n = 5) from 2013 to 2017 with an average dilation interval of 12.3 months. After a course of doxorubicin and carboplatin to treat her ovarian cancer, we observed that her airway stenosis surprisingly stabilized, and has no longer required a surgical dilation for 45 months, which signifies an increase of 33 months when compared to her averaged dilation interval (12.3 months) prior to her second course of chemotherapy. Conclusion: We present an iSGS patient whose fibrosis was arrested following carboplatin/doxorubicin treatment. While a single case, a possible mechanism is carboplatin/doxorubicin’s inhibition of pathologic CD4 lymphocytes that propagate laryngotracheal fibrosis. Further investigation of like mechanisms may allow for translation of local agents with inhibitory effects on CD4+ cells and/or fibroblasts as a novel therapy for airway fibrosis.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"23 1","pages":"1293 - 1296"},"PeriodicalIF":0.0,"publicationDate":"2022-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78703391","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}
Pub Date : 2021-03-01DOI: 10.1177/0003489420939080
Viraj M. Patel
Endoscopic Transsphenoidal Surgery: A Practical Guide provides a step-by-step approach for the novice ENT and neurosurgeon who are training to be endoscopic skull base surgeons. The text is written in simple language and breaks down the anatomy, pre-operative preparation, as well intraoperative decision making in endoscopic skull base surgery. There are 250 high resolution intraoperative images, a chapter dedicated to surgical instruments, and a series of case reports that summarize the key concepts of radiological findings, surgical management, and postoperative care. The writing of this book is based on the author’s anecdotal experience making it readable and easy to understand as intended for its audience. The authors use their own experience as justification for their recommended methods rather than a stringent literature review of all methods and the indications for variations. However, the author’s approach is discussed and broken down into simple steps providing a strong foundation that can easily translate to an understanding of variations in approach. A strength of this book is its high resolution intraoperative images as well as its radiographical images, which provide an invaluable reference not only for surgical anatomy and various pathologies of the anterior skull base, but also as a step-by-step guide to the operation. This book will be very useful for both otolaryngologists and neurosurgeons in training to grasp the fundamentals of endoscopic skull base surgery. 939080 AORXXX10.1177/0003489420939080Annals of Otology, Rhinology & LaryngologyBook Review book-review2020
{"title":"Book Review: Endoscopic Transsphenoidal Surgery: A Practical Guide","authors":"Viraj M. Patel","doi":"10.1177/0003489420939080","DOIUrl":"https://doi.org/10.1177/0003489420939080","url":null,"abstract":"Endoscopic Transsphenoidal Surgery: A Practical Guide provides a step-by-step approach for the novice ENT and neurosurgeon who are training to be endoscopic skull base surgeons. The text is written in simple language and breaks down the anatomy, pre-operative preparation, as well intraoperative decision making in endoscopic skull base surgery. There are 250 high resolution intraoperative images, a chapter dedicated to surgical instruments, and a series of case reports that summarize the key concepts of radiological findings, surgical management, and postoperative care. The writing of this book is based on the author’s anecdotal experience making it readable and easy to understand as intended for its audience. The authors use their own experience as justification for their recommended methods rather than a stringent literature review of all methods and the indications for variations. However, the author’s approach is discussed and broken down into simple steps providing a strong foundation that can easily translate to an understanding of variations in approach. A strength of this book is its high resolution intraoperative images as well as its radiographical images, which provide an invaluable reference not only for surgical anatomy and various pathologies of the anterior skull base, but also as a step-by-step guide to the operation. This book will be very useful for both otolaryngologists and neurosurgeons in training to grasp the fundamentals of endoscopic skull base surgery. 939080 AORXXX10.1177/0003489420939080Annals of Otology, Rhinology & LaryngologyBook Review book-review2020","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"41 1","pages":"326 - 326"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79308466","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}
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