Kathleen Yaremchuk

Regular Tracheostomy Tube Changes to Prevent Formation of Granulation Tissue

Objectives/Hypothesis Tracheostomy is a commonly performed operative procedure that has been described since 2000 b.c. The early indications for tracheostomy were for upper airway obstruction, usually occurring in young people as a result of an infectious process. Recently, tracheostomies are more commonly performed in the critically ill patient to assist in long‐term ventilatory support. Granulation tissue at the stoma and the trachea has been described as a late complication resulting in bleeding, drainage, and difficulty with maintaining mechanical ventilatory support.

Early Mortality Rate of Morbidly Obese Patients after Tracheotomy

Objectives: To 1) determine the early mortality rate (within 30 days) of morbidly obese patients after tracheotomy; 2) determine the difference between the mortality rate after tracheotomy of morbidly obese patients and patients who are not morbidly obese; and 3) determine the difference between the mortality rate after tracheotomy adjusted for case mix index (CMI) of morbidly obese patients and patients who are not morbidly obese.

Noise level analysis of commercially available toys

There have been several isolated reports of hearing loss due to noise levels from toys. Guidelines for noise production by toys is regulated by the Voluntary Product Standards PS 72-76: Toy Safety Act of 1969. To determine the current risk of noise induced hearing loss from toys currently on the market, 25 toys were purchased at a national toy store chain and sound levels were measured at distances approximating ear level (2.5 cm) and a childs arm length (25 cm) from the surface of the toy. Testing revealed peak sound levels ranging from 81 to 126 dBA at 2.5 cm and 80 to 115 dBA at 25 cm from the surface of the toy.

Robotics in otolaryngology and head and neck surgery: Recommendations for training and credentialing: A report of the 2015 AHNS education committee, AAO-HNS robotic task force and AAO-HNS sleep disorders committee.

Training and credentialing for robotic surgery in otolaryngology ‐ head and neck surgery is currently not standardized, but rather relies heavily on industry guidance. This manuscript represents a comprehensive review of this increasingly important topic and outlines clear recommendations to better standardize the practice. The recommendations provided can be used as a reference by individuals and institutions alike, and are expected to evolve over time.

The Effect of Insomnia on Tinnitus

Objective: The objective is to see how chronic tinnitus sufferers who are unmanageable to maximized medical therapy can benefit by decreasing their subjective complaints from a sleep evaluation and treatment. However, the proper identification of these particular patients has not been described well in the literature when attempting to correlate these 2 diagnoses. Thus, tinnitus patients with and without insomnia, based on ICD-9 diagnosis, were evaluated using the Tinnitus Reaction Questionnaire and Insomnia Severity Index to determine correlations between insomnia and tinnitus. Methods: Patients with a diagnosis of tinnitus and tinnitus along with insomnia who were treated at our institution from 2009 to 2011 were identified. Tinnitus Reaction Questionnaire and Insomnia Severity Index responses were obtained through written and telephone interviews. A Pearson product moment correlation was used to determine the effect of insomnia on tinnitus. Additional analyses identified whether Tinnitus Reaction Questionnaire scores were associated with a possible benefit from an evaluation for insomnia in tinnitus patients. Results: A total of 117 patients met inclusion criteria. A significant correlation was found between the Insomnia Severity Index score and Tinnitus Reaction Questionnaire severity (r = 0.64; P = .001). Tinnitus Reaction Questionnaire severity was shown to be a good predictor of sleep disturbance and good in predicting group association, especially the “emotional” subscore component (sensitivity 96.9% and specificity 55.3% for identifying tinnitus patients with insomnia). The greater the insomnia disability as exhibited by an elevated Insomnia Severity Index score, the more severe the patient’s complaints were regarding the tinnitus. Conclusion: Results suggest that if the emotional score on the Tinnitus Reaction Questionnaire is ≥ 15, the Insomnia Severity Index may be useful to identify patients who may benefit from further treatment and evaluation of insomnia. The robust correlation between the Tinnitus Reaction Questionnaire and Insomnia Severity Index objectively showed that patients with insomnia have an increased emotional distress associated with their tinnitus. Both questionnaires can be used together with a high degree of specificity and sensitivity in predicting tinnitus patients with an underlying sleep disturbance.

Preliminary NSQIP results: A tool for quality improvement

Objective: To utilize National Surgical Quality Improvement Program (NSQIP) data to evaluate patient outcomes in otolaryngology–head and neck surgery. Study Design: Retrospective medical chart abstraction of patients undergoing major surgical procedures in the inpatient and outpatient setting. Setting: Academic/teaching hospitals with more than 500 beds. Subjects and Methods: The American College of Surgeons NSQIP collects data on 135 variables including preoperative risk factors, intraoperative variables, and 30-day-postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures in the inpatient and outpatient setting. As of August 2008, there are currently 47 hospitals submitting data for otolaryngology–head and neck surgery. Results: Opportunities for improvement were identified in respiratory, wound, and venothromboembolic (VTE) occurrences. Implementation of a standardized VTE and perioperative protocol resulted in a decreased length of stay and observed-to-expected (O/E) morbidity and mortality for all surgical services. Conclusion: NSQIP reports form the basis for quality improvement with targeted interventions in areas of concern that result in changes in patient care processes. The reports are composed of outcomes-based, risk-adjusted data that are submitted by participating hospitals and have recently included data for otolaryngology–head and neck surgery. Actions taken based on NSQIP data demonstrate improvements in patient morbidity and mortality, decreased length of stay, and decreased hospital costs. In a time of increased scrutiny of health care costs and outcomes, NSQIP is an important tool for surgeons to improve quality and decrease costs.

Clinical analysis of drug-induced sleep endoscopy for the OSA patient

To determine if the use of drug‐induced sleep endoscopy (DISE) and transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea (OSA) is associated with improved outcomes and acceptable complication rates when compared to uvulopalatopharyngoplasty (UPPP) with or without tonsillectomy (± T).

Palatal Procedures for Obstructive Sleep Apnea.

Uvulopalatopharyngoplasty was the first surgical procedure described, other than tracheostomy, for the treatment of obstructive sleep apnea (OSA) in 1981. It was recognized then that there were responders who were cured of OSA with the procedure and others that were not. It took many years for a staging system to be described that categorized patients based on Mallampati score, tonsil size, and body mass index to better predict success rates. It was recognized that individuals with retro-palatal obstruction as the cause of the airway obstruction responded well but that the morbidity associated with the inpatient procedure was often problematic.

USPSTF Recommendation for Obstructive Sleep Apnea Screening in Adults

The US Preventive Services Task Force (USPSTF) was created in 1984 as an independent, volunteer panel of national experts in prevention and evidence-based medicine. It works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. Any USPSTF recommendation on a clinical service is based on a review of existing peer-reviewed medical evidence, and the clinical service is then assigned a grade of A through D, where A recommends for and D against the service, or an “I statement” when evidence is insufficient or of too poor quality to assess the balance of benefits and harms. USPSTF recommendations do not consider the costs of a preventive service. The USPSTF method for guideline development is an evidence-based approach (ie, a review of the literature rather than expert opinion).1 A Topic Work Group leads development of the review and recommendation, which includes members of USPSTF, staff from evidence-based practice centers, and staff from the Agency for Healthcare Research and Quality. For obstructive sleep apnea (OSA), the USPSTF recently reviewed the literature2 and published a recommendation statement concluding “that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults”3 and issued an I statement in this regard. For OSA, the evidence-based practice center had produced a draft evidence review that is 363 pages long and includes 293 references.2 The references reviewed validated screening tools for OSA in asymptomatic adults; detection, benefits, and harms of early detection and intervention or treatment; accuracy of screening and diagnostic tests; effectiveness of early detection and treatment; potential harms of screening and treatment; and, most importantly, an estimate of magnitude of net benefit.2 The USPSTF considered an intermediate outcome for OSA a decrease in the apnea-hypopnea index (AHI), improvement in the Epworth Sleepiness Scale (ESS), or a reduction in blood pressure (BP).3 Final health outcomes in OSA were considered to be decreased mortality, cardiovascular and cerebrovascular events, and an increase in quality-of-life measures.3 In making this recommendation, USPSTF follows a generic analytic framework for evaluation of screening topics that includes key questions. In this Editorial, I review the salient points of the recommendation.4 Burden of Disease The importance of evaluating for a target condition, such as OSA, is based on the prevalence in the population. Data indicate the estimated prevalence of OSA in the United States to be 10% for mild OSA and 3.8% to 6.5% for moderate to severe OSA.5-7 Prevalence may be increasing owing to increased rates of obesity. Observational studies have reported a 2-fold increased risk of all-cause mortality in patients with severe untreated OSA. The proportion of individuals with severe OSA who are asymptomatic or have unrecognized symptoms is unknown.

Seasonality of auricular amputations in rabbits

This retrospective observational analysis hypothesizes that an increase occurs in online reports and images of auricular amputations of confectionary rabbits during the spring. Using the online search engine Google, online content and visual portrayals of confectionary rabbit auricular amputations from 2012 to 2017 were identified and trended against seasonal variations. To determine incidence, commercial availability of chocolate rabbits in retail facilities were assayed. A statistically significant increase in mention of rabbit auricular amputations occurred during the spring. Mapping techniques showed the annual peak incidence for 2012 to 2017 to be near Easter for each year studied. Human adults and children appear to be wholly responsible for the reports of rabbit auricular amputations. Reconstructive techniques are dependent on the percentage of auricular defect. Laryngoscope, 127:773–775, 2017