Harold S. Pine

Allergy testing and immunotherapy in an academic otolaryngology practice: A 20-year review☆☆☆

OBJECTIVE: Allergic disease plays a central role in the clinical practice of otolaryngology. The purpose of this study was to review the 20-year experience of an allergy clinic integrated within an otolaryngology practice at a major academic institution. STUDY DESIGN: We performed a retrospective database review of over 3300 otolaryngology patients referred for allergy skin testing between 1979 and 1999. RESULTS: Approximately 80% of patients referred for allergy testing in our clinic had positive test results, of which 75.7% went on to undergo desensitization. The most common allergen was house dust, with allergies to mites, ragweed, and grass also prevalent. Among current allergy immunotherapy patients, 30.8% have undergone nasal septal, turbinate, and/or endoscopic sinus procedures in addition to allergy management. Nasal obstruction was the symptom most frequently persistent despite immunotherapy and the one most frequently reported to be improved by surgery. CONCLUSIONS: The otolaryngologist-head and neck surgeon is uniquely qualified to perform comprehensive medical and surgical management for patients with complex disease processes involving a component of allergy. We believe that an integrated approach to allergy within an otolaryngology practice optimizes the treatment of such patients. (Otolaryngol Head Neck Surg 2001;124:9-15.)

Tonsillectomy and adenoidectomy.

Adenotonsillectomy (AT) is one of the most common pediatric surgical procedures performed in the United States; more than 530,000 are performed annually in children younger than 15 years of age. AT was traditionally performed for recurrent tonsillitis and its sequelae but in recent times, sleep-disordered breathing/obstructive sleep apnea in children has emerged as the primary indication for surgical removal of adenoids and tonsils. The new guidelines used by clinicians to identify children who are appropriate candidates for AT address indications based primarily on obstructive and infectious causes.

Pediatric cochlear implantation: expanding applications and outcomes.

Cochlear implantation is a revolutionary yet time-sensitive treatment for deaf children that must be performed within a critical window of time, in early life, for a congenitally deafened child to receive maximum benefit. Potential candidates should therefore be referred for evaluation early. Primary reasons for delay of cochlear implantation include slow referrals for care, parental delays, and payer delays. It is vital that all newborn children undergo hearing screening to identify deaf children at birth, and for parents, health care providers, and health care payers to be educated about the indications, important benefits, and reasonable risks of cochlear implantation for deaf children.

Laryngopharyngeal reflux disease in children.

Extraesophageal reflux disease, commonly called laryngopharyngeal reflux disease (LPRD), continues to be an entity with more questions than answers. Although the role of LPRD has been implicated in various pediatric diseases, it has been inadequately studied in others. LPRD is believed to contribute to failure to thrive, laryngomalacia, recurrent respiratory papillomatosis, chronic cough, hoarseness, esophagitis, and aspiration among other pathologies. Thus, LPRD should be considered as a chronic disease with a variety of presentations. High clinical suspicion along with consultation with an otolaryngologist, who can evaluate for laryngeal findings, is necessary to accurately diagnose LPRD.

The Otolaryngologist's Approach to the Patient with Down Syndrome

As more patients with Down syndrome are living into adulthood, attention has focused on health factors that affect the quality of the patients life and their ability to reach full potential. Patients with Down syndrome have several morphologic abnormalities that predispose them to problems with the ear, nose, and throat, and appropriate treatment can have a significant impact on the quality of life of these patients. Otolaryngologists are likely to see many patients with Down syndrome throughout their careers. This article reviews the literature to provide information and recommendations regarding management of Down syndrome.

Chronic Cough in Children

The management of chronic cough, a common complaint in children, is challenging for most health care professionals. Millions of dollars are spent every year on unnecessary testing and treatment. A rational approach based on a detailed interview and a thorough physical examination guides further intervention and management. Inexpensive and simple homemade syrups based on dark honey have proved to be an effective measure when dealing with cough in children.

Discharge after tonsillectomy in pediatric sleep apnea patients

OBJECTIVESnOutpatient tonsillectomy has gained favor in recent years, however patients with obstructive sleep apnea/hypopnea syndrome have been excluded from outpatient surgery criteria. It is the practice of the senior author to discharge patients after tonsillectomy with a respiratory disturbance or apnea hypopnea index of 5 or less. The purpose of this study is to examine the respiratory complication rate based on respiratory disturbance or apnea hypopnea index, and co-morbidities in order to determine which pediatric patients with obstructive sleep apnea/hypopnea syndrome can be safely discharged after tonsillectomy.nnnMETHODSnAll patients undergoing tonsillectomy with the diagnosis of obstructive sleep apnea made by polysomnography by a single surgeon from 2008 to 2011 were included. Decision to admit was based on respiratory disturbance or apnea hypopnea index, body mass index, and comorbidities. All inpatient notes, phone calls, and follow up visit documentation were monitored and reviewed for post operative complications.nnnRESULTSn104 patients were included, 74 patients were admitted post operatively, and 30 were discharged home. There were no complications in the group that was discharged home. In the group that was admitted, there was two minor and two intermediate complications, including desaturations to 92% and 83% requiring oxygen, and wheezing requiring breathing treatment. All complications occurred in patients with respiratory disturbance or apnea hypopnea index of 11 or greater.nnnCONCLUSIONnOur data suggest there is a correlation between higher respiratory disturbance or apnea hypopnea index and post operative complications. Patients with an RDI of <5.0, and minimal co-morbidities can be safely discharged home following tonsillectomy for OSAHS. Complications related to sleep apnea were not seen in patients with RDI <11.0, suggesting that patients with an RDI between 5 and 10, who are not obese and have no significant comorbidities may also be sent home after surgery.

Short-lasting unilateral neuralgiform headache attacks with conjunctiva injection and tearing presenting as sphenoiditis ☆

Headaches secondary to paranasal sinus disease are a common problem in otolaryngology practice. However, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCTs) are an extremely rare presentation of sinusitis. We report for the first time an unusual case of acute sinusitis presenting with SUNCTs-like symptoms with radiographically-proven isolated ipsilateral sphenoiditis, without any other intracranial pathologies. This case demonstrates an additional spectrum of acute sinusitis, which should be familiar to the otolaryngologist population.

Role of Google Glass in improving patient satisfaction for otolaryngology residents: A pilot study

To demonstrate the feasibility and efficacy of the Google Glass as a tool to improve patient satisfaction and patient–physician communication for otolaryngology residents in the outpatient clinic setting. The primary outcome of the study was to improve patient satisfaction scores based on physician communication‐related questions from Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.

Tube Education Device (TED) Simulator for Myringotomy with Tube Insertion for Resident Training Purposes

Objectives: 1) Implement a training device to train otolaryngology residents to perform myringotomy with tube insertion. 2) Analyze data on the performance of medical students with this device. Methods: After approval by University of Texas Medical Branch Institutional Review Board, medical students were recruited to partake in the study from June 2012 to present. An instructional video on this procedure was shown to each subject before each trial. In the operating room, the subjects performed the procedure 5 consecutive times while being recorded through the ear microscope. An otolaryngology resident performed the duties of a surgical tech. The videos were then all randomized and reviewed by 3 attending otolaryngologists with the following criteria: average time, number of errors, and subjective numerical grading of each attempt. Results: To date, 7 subjects have participated. From the first attempt to the fifth attempt, the average time for procedure decreased from 160 seconds to 80 seconds. The average times the myringotomy knife touched the sides of the simulated ear canal dropped from over 2.6 to 0.7 times. The average percentage of instances the grader would allow the subject to perform procedure on a real patient increased from 38% to 91%. The success of the procedure determined by the grader increased from 52% to 95%. Conclusions: No standardized training is available for myringotomy with tube insertion. Training with this device can decrease procedure time by 50%, reduce errors, and increase the confidence of attending otolaryngologists of trainees. These results show potential benefits to translate to real patients.