Benjamin D. Malkin

Bilateral Central Serous Chorioretinopathy Caused by Intranasal Corticosteroids: A Case Report and Review of the Literature

The relationship between systemic corticosteroids and central serous chorioretinopathy (CSCR) has been well established; however, there also appears to be an association with intranasal corticosteroids. A search of the English literature revealed only three reported cases of CSCR linked to intranasal corticosteroid use, and in each, clinical improvement was observed after cessation of the steroid agent. We present an additional case of bilateral CSCR resulting from intranasal corticosteroid use and review the literature regarding this uncommon side effect. Otolaryngologists, as frequent prescribers of these medications, should be aware of their myriad side effects, including ophthalmologic conditions such as CSCR.

Incentive Spirometry for the Tracheostomy Patient

Objective To determine the feasibility of developing and using a customized incentive spirometer device for patients who have undergone a tracheostomy procedure. Study Design The authors performed a prospective case series approved by the institutional review board. Setting Academic medical center. Subjects and Methods Patients were eligible for participation if they were older than 18 years and had a new tracheostomy. Spirometry exercises were performed using a protocol adapted from the American Academy of Respiratory Care guidelines. Patient data were recorded, including age, sex, tobacco use, surgical procedure, time under general anesthesia, length of hospital stay, and time until ambulation. The details of the spirometry exercises were also recorded along with any complications that occurred. Results An incentive spirometer was adapted for use with tracheostomy patients and received an investigational device exemption from the Food and Drug Administration. A total of 10 patients were enrolled (mean age 60 years). Sixty percent were current or former tobacco users, the mean anesthesia time was 9 hours, and 70% underwent a microvascular free flap reconstruction. Patients used the incentive spirometer for a mean of 1.6 days during the postoperative period, averaging 3.3 sessions per day and 6.8 breaths per session. The device was well tolerated by patients, and there were no complications associated with its use. Conclusion This study supports the feasibility of using a customized incentive spirometer for tracheostomy patients and establishes a safety profile for the device to be used in future studies.

Referral patterns from emergency department to otolaryngology clinic: Referrals From ED to ENT

Patients who present to the emergency department (ED) with various otolaryngologic disorders are frequently referred to an otolaryngologist for follow‐up care. Our aim was to further characterize this group as it has not been well described in the literature.

Prevalence of severe obstructive sleep apnea in pediatric adenotonsillectomy patients

To determine the prevalence of severe obstructive sleep apnea (OSA) in a pediatric population who underwent indicated surgery for sleep disordered breathing (SDB).

An Evaluation of the Program-Specific Paragraph in the Otolaryngology Residency Application: Evaluation of the Program-Specific Paragraph

The recent addition of mandatory program‐specific paragraphs within the personal statement during the otolaryngology match process has been controversial. It is unclear whether applicants customize these paragraphs for programs, or if they are largely uniform across applications. The objective of our study was to assess the degree of variability among program‐specific paragraphs.

Videoconferencing for the pre-operative interaction between patient and surgeon

We studied the use of videoconferencing for the pre-operative patient-surgeon interaction. Subjects were recruited from otolaryngology patients undergoing surgery at a tertiary hospital. They were randomised to a conventional face-to-face interaction with their surgeon or a videoconference call via tablet computer. Afterwards, subjects and surgeons completed questionnaires about the experience. Various time points in patient flow were also recorded. Thirty-one patients were enrolled and 25 completed the study; five surgeons participated. The mean overall patient satisfaction scores were similar in the face-to-face and videoconferencing groups (9.88 and 9.89, respectively), as were mean interaction times (119 and 82 s, respectively); neither difference was significant. The mean waiting times in the pre-operative holding area were not significantly different between the groups. Surgeons were satisfied with the videoconferencing and 60% indicated they were somewhat likely to incorporate the technology into their daily practice. Overall patient satisfaction with a pre-operative patient-surgeon interaction via videoconferencing did not differ significantly from that for a conventional face-to-face discussion. It is feasible to incorporate videoconferencing into a busy surgical practice and there is the potential for improved efficiency.

Adult Sleep Apnea and Related Procedures

Obstructive sleep apnea (OSA) is the most prevalent breathing disorder in sleep, affecting up to 20 % of the population, with approximately 5 % experiencing excessive daytime sleepiness [1, 2]. The total economic burden of OSA including health-care costs, lost productivity, accidents, and loss of quality of life is substantial, accounting for billions of dollars per year, and is expected to increase [3]. As such, procedures related to improvement of OSA symptoms, as well as unrelated procedures in patients with OSA will likely increase in prevalence. Anesthesiologists and otolaryngologists will therefore face the challenges inherent to this patient population and a thorough understanding of the scope of the disease state is crucial.