Maria K. Brake

Work environment discomfort and injury: an ergonomic survey study of the American Society of Pediatric Otolaryngology members☆☆☆

BACKGROUND Workplace-related musculoskeletal pain has been studied in various occupations, but it is rarely reported in the surgical literature. OBJECTIVE The aim of this study was to examine work-related discomfort and injury among pediatric otolaryngologists and to assess their knowledge of workplace ergonomic principles. METHODS We surveyed current North American members of the American Society of Pediatric Otolaryngology. Our main outcomes were whether the physician had ever experienced discomfort or physical symptoms that they attributed to their surgical practice. RESULTS Response rate of 43.7% was attained, and 62.0% of respondents reported experiencing pain or discomfort that they attributed to their surgical practice. Women were significantly more likely to report experiencing pain or discomfort that they associated with their surgical practice (P = .033). There were no significant differences found among length of time in practice, academic vs community setting, or number of surgeries completed by the surgeon. Some of the surgeons (31.0%) were aware of ergonomic principles, and of those who were aware, 83.9% had implemented ergonomic principles into their surgical practice. CONCLUSION Almost two thirds of surgeons who responded to the survey reported experiencing pain or discomfort that they attributed to their surgical practice. Only a minority of respondents were aware of ergonomic principles. These findings may confirm that most physicians believe that their physical health is affected by their operative environment. Increased knowledge of surgical ergonomics may lead to strategies that improve workplace health and safety.

Feeding and mandibular distraction osteogenesis in children with Pierre Robin sequence: A case series of functional outcomes

INTRODUCTION In addition to upper airway obstruction, many patients with micrognathia and Pierre Robin sequence also have swallowing abnormalities and reflux. Many studies have demonstrated the effectiveness in alleviating the airway symptoms with mandibular distraction osteogenesis, but very few studies have focused on feeding and reflux outcomes. METHODS A retrospective chart review was performed to identify patients with Pierre Robin sequence who underwent mandibular distraction osteogenesis with completed pre- and post-operative upper gastroesophageal series and videofluoroscopic swallow assessments. RESULTS All six children in our series demonstrated significant improvements in both airway obstructive symptoms and feeding abnormalities. More specifically, all patients showed clinical and objective improvements in reflux and swallowing function after distraction surgery. CONCLUSION Objective and symptomatic improvements in swallowing function and reflux disease can be seen after mandibular distraction osteogenesis in children with Pierre Robin sequence.

Complementary and alternative medicine use in the thyroid patients of a head and neck practice.

Objective. To investigate the prevalence of complementary and alternative medicine (CAM) use among patients being investigated for thyroid nodules in a head and neck oncology practice. Subsequently, to determine whether the common therapies used were likely to interfere with the planned patient’s care and whether the predominance was significant to warrant inclusion in routine history assessments. Study Design. Cross-sectional survey. Setting. Dalhousie University, Halifax, Nova Scotia, Canada. Subjects and Methods. A survey regarding CAM use was completed by 100 patients being investigated for thyroid nodules upon their initial presentation to a head and neck oncology practice. Results. Preliminary results showed that 79% of participants have a history of CAM use and 51% of participants were actively using oral supplements. Thirty-one percent of participants reported using supplements known to have hemostasis-affecting properties. Conclusion. Medical professionals should incorporate CAM questioning in any thyroid patient assessment to reduce patient risk and optimize medical and surgical outcomes.

Laryngeal reconstruction following CO2 laser surgery for glottic cancer.

CO2 laser has become a common surgical technique in the management of glottic cancer. The patients treated with this modality may benefit from additional phonosurgical techniques used to improve postoperative vocal outcome.

Liposuction for Submental Lymphedema Improves Appearance and Self-Perception in the Head and Neck Cancer Patient

Objective Patients who have undergone treatment for head and neck cancer are at risk for neck lymphedema, which can severely affect quality of life. Liposuction has been used successfully for cancer patients who suffer from posttreatment limb lymphedema. The purpose of our study was to review the outcomes of head and neck cancer patients at our center who have undergone submental liposuction for posttreatment lymphedema. Study Design Prospective cohort study. Setting Oncology center in tertiary hospital setting. Subjects and Methods Head and neck cancer patients who underwent submental liposuction for posttreatment lymphedema were included. Nine patients met the study criteria. Patients completed 2 surveys (Modified Blepharoplasty Outcome Evaluation and the validated Derriford Appearance Scale) pre- and postoperatively to assess satisfaction. Patients’ pre- and postoperative photos were graded by independent observers to assess outcomes objectively. Results Our study demonstrated a statistically significant improvement in patients’ self-perception of appearance and statistically significant objective scoring of appearance following submental liposuction. Conclusion Submental liposuction improves the appearance and quality of life for head and neck cancer patients suffering from posttreatment lymphedema by way of improving their self-perception and self-confidence.

Expectantly waiting: a survey of thyroid surgery wait times among Canadian Otolaryngologists

BackgroundOur objective is to highlight discrepancies between actual wait times and perceived appropriate wait times for various thyroid pathologies among Otolaryngology- Head and Neck Surgeons in Canada; and to identify specific diagnoses/pathologies where wait times could be improved.MethodsA questionnaire was distributed to all practicing CSO-HNS members. Questions focused on actual wait times for initial consults and surgery within individual practices, in the setting of various thyroid pathologies. Respondents were also asked to state wait times that they felt were appropriate for each scenario. Wilcoxon signed-rank tests were performed to determine statistically significant differences between actual and appropriate wait times.ResultsFor most scenarios, the actual wait times were significantly longer than most physicians felt were appropriate; these scenarios included time to initial consult for undiagnosed nodules, time to surgery for confirmed malignancies, and time to completion thyroidectomy for surgically confirmed malignancies.ConclusionsWait times for thyroid consults and surgeries in Canada are longer than physicians feel are appropriate. The authors hope that this survey may spur a move towards a national consensus on appropriate wait times for the treatment of thyroid pathology.

Complementary and alternative medicine use among patients presenting to a pediatric otolaryngology clinic

OBJECTIVES This study sought to quantify and characterize complementary and alternative medicine (CAM) use among patients presenting to a pediatric otolaryngology clinic with the aim of increasing CAM use awareness for the practicing pediatric otolaryngologist. METHODS Four hundred thirty-four caregivers of patients presenting to a pediatric otolaryngology clinic were surveyed regarding their childs use of CAMs. Demographic information, perceived benefits, and sources of information regarding CAM was collected. Spearman correlation coefficient was used to assess strength of associations. RESULTS Three-hundred and sixty-four caregivers completed the survey (83.9% response rate). The children of 69% of respondents had utilized CAM, and 46% were using CAM at the time of the survey. Higher income and chronic illness in the child were significant predictors of CAM use. The children of older and married parents were more likely to have utilized CAM (non-significant). The most common agents were multivitamins (43%) and vitamin D (32%). Parents whose children used more CAMs were more likely to perceive a benefit. CONCLUSIONS A significant proportion of pediatric otolaryngology patients utilized CAM in our study population. The most commonly used agents are mostly benign, but others may have more unknown consequences. It is crucial that otolaryngologists ask specifically about these agents, as they potentially interact with prescription medications and some may lead to surgical complications.

Subglottic Stenosis Secondary to Lymphoplasmacytic Lymphoma

Subglottic stenosis often presents a challenging problem for the otolaryngologist because its causes are many and varied, and its management is often difficult. The causes of adult-onset subglottic stenosis have been well documented and include trauma, collagen vascular diseases, benign and malignant neoplasms, and chronic inflammatory conditions.To our knowledge, we present the first successfully medically managed case of subglottic stenosis secondary to lymphoplasmacytic lymphoma (LPL), a malignant, infiltrative lymphoproliferative disorder of IgM producing monoclonal B lymphocytes. The clinical findings of LPL are commonly called Waldenstrom macroglobulinemia (WM).