Malcolm B. Taw

Clinical Practice Guideline Tinnitus

Objective Tinnitus is the perception of sound without an external source. More than 50 million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. Despite the high prevalence of tinnitus and its potential significant effect on quality of life, there are no evidence-based, multidisciplinary clinical practice guidelines to assist clinicians with management. The focus of this guideline is on tinnitus that is both bothersome and persistent (lasting 6 months or longer), which often negatively affects the patient’s quality of life. The target audience for the guideline is any clinician, including nonphysicians, involved in managing patients with tinnitus. The target patient population is limited to adults (18 years and older) with primary tinnitus that is persistent and bothersome. Purpose The purpose of this guideline is to provide evidence-based recommendations for clinicians managing patients with tinnitus. This guideline provides clinicians with a logical framework to improve patient care and mitigate the personal and social effects of persistent, bothersome tinnitus. It will discuss the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the effect of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers. Action Statements The development group made a strong recommendation that clinicians distinguish patients with bothersome tinnitus from patients with nonbothersome tinnitus. The development group made a strong recommendation against obtaining imaging studies of the head and neck in patients with tinnitus, specifically to evaluate tinnitus that does not localize to 1 ear, is nonpulsatile, and is not associated with focal neurologic abnormalities or an asymmetric hearing loss. The panel made the following recommendations: Clinicians should (a) perform a targeted history and physical examination at the initial evaluation of a patient with presumed primary tinnitus to identify conditions that if promptly identified and managed may relieve tinnitus; (b) obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, persistent (≥ 6 months), or associated with hearing difficulties; (c) distinguish patients with bothersome tinnitus of recent onset from those with persistent symptoms (≥ 6 months) to prioritize intervention and facilitate discussions about natural history and follow-up care; (d) educate patients with persistent, bothersome tinnitus about management strategies; (e) recommend a hearing aid evaluation for patients who have persistent, bothersome tinnitus associated with documented hearing loss; and (f) recommend cognitive behavioral therapy to patients with persistent, bothersome tinnitus. The panel recommended against (a) antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for the routine treatment of patients with persistent, bothersome tinnitus; (b) Ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent, bothersome tinnitus; and (c) transcranial magnetic stimulation for the routine treatment of patients with persistent, bothersome tinnitus. The development group provided the following options: Clinicians may (a) obtain an initial comprehensive audiologic examination in patients who present with tinnitus (regardless of laterality, duration, or perceived hearing status); and (b) recommend sound therapy to patients with persistent, bothersome tinnitus. The development group provided no recommendation regarding the effect of acupuncture in patients with persistent, bothersome tinnitus.

Clinical practice guideline: tinnitus executive summary.

The American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Tinnitus. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 13 recommendations developed address the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the impact of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers.

Acupuncture for treating polycystic ovary syndrome: guidance for future randomized controlled trials

ObjectiveTo provide guidance for future randomized controlled trials (RCTs) based on a review concerning acupuncture for treating polycystic ovary syndrome (PCOS).MethodsA comprehensive literature search was conducted in October 2015 using MEDLINE, EMBASE, SCISEARCH, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Menstrual Disorders and Subfertility Group trials register, Allied and Complementary Medicine (AMED), China National Knowledge Infrastructure (CNKI), and the Wanfang databases. RCTs comparing either acupuncture with no/sham/pharmacological intervention or a combination of acupuncture and conventional therapy with conventional therapy in the treatment of PCOS were included in this review. A quality evaluation was performed for each of the included studies.ResultsThirty-one RCTs were included in the review and were divided into four categories according to the type of intervention used in the comparator or control group. Menstrual frequency, hormones, anthropometrics, insulin sensitivity, blood lipids, and fertility were used as the main measurements to assess the effects of acupuncture on the patients with PCOS. Thirty trials, except for one, showed an improvement in at least one of the indicators of PCOS after acupuncture treatment. However, normalizing the methodological and reporting format remains an issue.ConclusionsBased upon this review of current clinical trials concerning acupuncture for treating PCOS, we provide guidelines for better clinical trial design in the future.中文概要目 的基于对针刺治疗多囊卵巢综合征随机对照临床试验现状的系统总结和分析,提出对未来相关临床研究的建议。创新点首次对目前针刺治疗多囊卵巢综合征随机对照临床试验进行了全面的总结和分析,从研究设计和报告规范等方面提出了一系列改进的建议。方 法对MEDLINE、EMBASE、万方和知网等八个数据库进行了针刺治疗多囊卵巢综合征相关文献的全面检索,按照纳入标准将文章进行分类和总结,并对每项研究进行了详细的质量评估。根据当前的研究情况对未来针刺治疗多囊卵巢综合征的随机对照临床试验提出了一系列建议。结 论从如何完善实验设计,提高研究质量,加强报告规范等方面提出了一系列改进的建议,对未来针刺治疗多囊卵巢综合征随机对照试验的设计和实施提供了指导和帮助。

Acupuncture and allergic rhinitis.

Purpose of review Allergic rhinitis has a high prevalence and negatively impacts quality of life. Patients commonly use complementary and integrative modalities to help alleviate their symptoms of allergic rhinitis, with approximately one in five receiving acupuncture. This article reviews the evidence base on the efficacy/effectiveness, safety and cost-effectiveness of acupuncture for allergic rhinitis. Recent findings Our review of the medical literature from January 2013 through December 2014 revealed that there is research demonstrating efficacy and effectiveness for acupuncture in the treatment of allergic rhinitis, as well as improvement of quality of life and quality-adjusted life-years. Summary There are high-quality randomized controlled trials that demonstrate efficacy and effectiveness for acupuncture in the treatment of both seasonal and perennial allergic rhinitis. Smaller head-to-head studies also show some preliminary benefit of acupuncture when compared with antihistamines, but these had a variety of methodological limitations. Further studies of higher quality are needed, particularly with a focus on comparative effectiveness research.

Complementary and integrative treatments: rhinosinusitis.

Rhinosinusitis is characterized by inflammation of the mucosa involving the paranasal sinuses and the nasal cavity and is one of the most common health care problems, with significant impairment of quality of life. There is a growing amount of interest in the use of complementary and integrative medicine for the treatment of rhinosinusitis. This article focuses on an integrative approach to rhinosinusitis.

Integrative medicine, or not integrative medicine: that is the question

On September 26-27, 2015, the 8th European Congress for Integrative Medicine convened the Global Summit on Integrative Medicine and Healthcare in Greater Copenhagen and Helsingør, Denmark at the Culture Yard just across from Kronborg Castle, which is home to William Shakespeares Hamlet. This article is a summary of the authors presentation about integrative medicine within the Nordic region, driving factors that determine value in healthcare, key tenets of integrative medicine that lead to healthcare cost savings and the potential for a Nordic healthcare renaissance.

Complementary and Integrative Treatments: Balance Disorders

This article presents an overview of balance disorders for the practicing otolaryngologist. The demographics of balance disorders, anatomy and physiology of human balance, clinical features, differential diagnosis, and treatment, within the framework of an holistic approach, are discussed.

Integrative care of the patient with head and neck cancer: Integrative Care for Head and Neck Cancer

To review the literature on integrative care of the patient with head and neck cancer.

Integrative Approach to Atypical Facial Pain and Headache

Program Description: The otolaryngologist may frequently deal with patients who present with atypical facial pain and headache, with no obvious anatomic, infectious, or inflammatory etiology. Such patients are challenging and require a multidisciplinary approach for diagnosis and treatment. In this miniseminar, we will review the definition, differential diagnosis, workup, and treatment recommendations for patients with atypical facial pain and headache. An integrative approach to the management of atypical facial pain will be outlined, including role for surgery, pharmacotherapy, complementary/alternative methods, mind-body approaches, and lifestyle changes. Challenging cases will be presented to the panel of experts for discussion. Educational Objectives: 1) Define atypical facial pain based on the International Headache Society’s classification. Other diagnoses, including cranial neuralgias, optic neuritis, and temporomandibular joint must be ruled out. 2) Recognize the etiology of rhinogenic headache and discuss the workup, controversies, and recommended treatment options. 3) Apply integrative approaches to treatment of atypical facial pain, including pharmacotherapy, role for surgery, complementary/alternative methods, mind-body approaches, and lifestyle changes.