Lawrence M. Simon

Impact of Incision and Drainage of Infected Thyroglossal Duct Cyst on Recurrence After Sistrunk Procedure

OBJECTIVE To determine whether incision and drainage of infected thyroglossal duct cysts (TGDCs) is associated with increased risk of recurrence after Sistrunk procedure when compared with antibiotic treatment alone. DESIGN Retrospective case review. SETTING Tertiary referral practice. PATIENTS Patients treated for thyroglossal duct remnants in a tertiary care pediatric center from January 1, 2002, through December 31, 2008. Study subjects were identified using the diagnosis code for TGDC or the procedure code for excision of thyroglossal duct cyst or sinus. MAIN OUTCOME MEASURES The presence of infection, treatment of infected TGDCs, and relationship between infection, treatment of infection, and recurrence. RESULTS We identified 120 patients from 2002 through 2008 who met the search criteria. The mean age at the time of presentation was 5.1 years; at the time of surgery, 5.4 years. More than half the patients (58.2%) were male, and the most common presentation was an asymptomatic midline neck mass. Forty-nine of our patients (40.8%) had a history of infection and 6 of these (12%) required incision and drainage. The overall recurrence rate was 10.8%. Ten of the patients with preoperative infection (20%) had a recurrence compared with 3 of the 71 patients (4%) without preoperative infection (P = .002). Of all patients with recurrences, only 1 had undergone incision and drainage. CONCLUSIONS This case series suggests that preoperative infection is associated with an increased recurrence rate. Incision and drainage of an infected TGDC may not increase the risk of postoperative recurrence. The results of this case series may assist in preoperative counseling and management of infected TGDC prior to definitive surgery.

Survey of Ménière's disease in a subspecialty referral practice.

OBJECTIVES: To define the prevalence of definite Ménières disease (MD) among patients presenting with characteristic symptoms and examine the utility of published diagnostic guidelines. STUDY DESIGN AND SETTING: Retrospective review in an academic referral practice. RESULTS: The prevalence of definite MD in these 295 individuals was 64%. The next-largest group (23%) consisted of patients with only cochlear symptoms. Those initially classified as probable are usually reclassified as definite with extended follow-up. Of those with definite MD, the mean duration of disease at last follow-up was 7.6 years, 56% were female, 19% had bilateral disease, and 34% required surgical management for vertigo. CONCLUSIONS: The 1995 AAO-HNS guidelines are useful for classification of MD according to certainty of diagnosis and severity of disease, though some modifications could be considered. SIGNIFICANCE: Application of consistent diagnostic criteria is essential for epidemiological, genetic, or outcomes studies of Ménières disease.

Using Social Media in Medicine

Program Description: Social media has moved from an emerging technology to a mainstay of our patients’ lives. The panelists consist of speakers at the forefront of the social media field in otolaryngology in both academic and private arenas. This talk will demonstrate how social media has already been incorporated in the medical marketplace and future applications. We will discuss strategies for how physicians can incorporate this into their academic/private practices. Common pitfalls encountered in assimilating social media into your practice will be described. Additionally, we will discuss the inherent medico-legal risk and ethical considerations associated with these endeavors. Educational Objectives: 1) Discuss how social media affects medicine today. 2) Describe methods to use social media to help build/maintain your practice in an academic and private arena. 3) Apply the best uses of social media to interact with and educate your patients while being aware of the medico-legal implications.

Clinical predictors for hearing loss in children with bacterial meningitis

OBJECTIVES To identify clinical risk factors that predict a higher incidence of hearing loss in children with bacterial meningitis, to determine the overall incidence of hearing loss in a large group of children proven by culture findings to have bacterial meningitis, and to compare clinical characteristics among patients with Streptococcus pneumoniae meningitis and Neisseria meningitidis meningitis. DESIGN Retrospective review SETTING Tertiary pediatric hospital. PATIENTS A total of 171 children identified with bacterial meningitis who met inclusion criteria over a consecutive 10-year period. MAIN OUTCOME MEASURE Presence of sensorineural hearing loss. RESULTS Of 134 patients who underwent audiologic testing during their initial hospitalization, 41 (30.6%) were found to have at least a unilateral mild sensorineural hearing loss. The incidence of hearing loss was greater in patients with S pneumoniae meningitis than in patients with N meningitidis meningitis (35.9% and 23.9%, respectively). Length of hospitalization, development of seizures, elevated cerebrospinal fluid protein, and decreased cerebrospinal fluid glucose were significant predictors for hearing loss in children with bacterial meningitis. These factors were not found to be as strong a predictor for hearing loss in patients with N meningitidis meningitis. Stability of hearing was demonstrated with limited follow-up audiometry. CONCLUSIONS Sensorineural hearing loss is a common sequela in children with bacterial meningitis. Identification of hearing loss in children with bacterial meningitis and early rehabilitation will lessen the long-term educational and social difficulties these children may experience.