Maya G. Sardesai

A multi-institutional analysis of tracheotomy complications.

To define the prevalence of tracheotomy tube complications and evaluate risk factors (RFs) associated with their occurrence.

Quantitative and qualitative dermal change with microfat grafting of facial scars

Objective To evaluate changes in dermal characteristics with subdermal fat grafting of cutaneous scars. DESIGN Prospective cohort. METHODS Fourteen patients with various scar types were treated with subdermal fat grafting over 30 months. Dermal elasticity, vascularity, pigmentation, patient perception and satisfaction, and observer assessment of scar characteristics were evaluated preoperatively and 1 year after treatment with validated objective and subjective measures. RESULTS Significant improvements were observed in dermal elasticity, patient and observer perception of scar thickness, patient perception of stiffness, and observer perception of relief and pliability (P < 0.05). A trend toward significance was seen in observer assessment of height as evaluated by the Vancouver Scar Scale (P < 0.1). No significant differences were seen in quantitatively and qualitatively measured vascularity and pigmentation (P > 0.1). No significant difference in pain, pruritis, and irregularity were reported (P > 0.1). CONCLUSION Although fat grafting represents a subdermal process, it appears to improve certain quantitative and qualitative dermal characteristics. Fat grafting does not appear to affect skin color, vascularity, or patient symptoms.

Prospective study of voice outcomes and patient tolerance of in‐office percutaneous injection laryngoplasty

In‐office percutaneous injection laryngoplasty is a common treatment for glottal insufficiency. Our objective was to prospectively study voice outcomes and patient tolerance of the procedure.

A need for otolaryngology education among primary care providers

Objective : Otolaryngic disorders are very common in primary care, comprising 20–50% of presenting complaints to a primary care provider. There is limited otolaryngology training in undergraduate and postgraduate medical education for primary care. Presented at the American Academy of Otolaryngology – Head & Neck Surgery 2011 Annual Meeting, San Francisco, USA, on Tuesday, September 13, 2011. Continuing medical education may be the next opportunity to train our primary care providers (PCPs). The objective of this study was to assess the otolaryngology knowledge of a group of PCPs attending an otolaryngology update course. Methods : PCPs enrolled in an otolaryngology update course completed a web-based anonymous survey on demographics and a pre-course knowledge test. This test was composed of 12 multiple choice questions with five options each. At the end of the course, they were asked to evaluate the usefulness of the course for their clinical practice. Results : Thirty seven (74%) PCPs completed the survey. Mean knowledge test score out of a maximum score of 12 was 4.0±1.7 (33.3±14.0%). Sorted by area of specialty, the mean scores out of a maximum score of 12 were: family medicine 4.6±2.1 (38.3±17.3%), pediatric medicine 4.2±0.8 (35.0±7.0%), other (e.g., dentistry, emergency medicine) 4.2±2.0 (34.6±17.0%), and adult medicine 3.9±2.1 (32.3±17.5%). Ninety one percent of respondents would attend the course again. Conclusion : There is a low level of otolaryngology knowledge among PCPs attending an otolaryngology update course. There is a need for otolaryngology education among PCPs.

Transorbital Neuroendoscopic Management of Sinogenic Complications Involving the Frontal Sinus, Orbit, and Anterior Cranial Fossa

Transnasal endoscopic surgery has remained at the forefront of surgical management of sinogenic complications involving the frontal sinus, orbit, and anterior skull base. However, the difficulty in accessing certain areas of these anatomical regions can potentially limit its use. Transorbital neuroendoscopic surgery (TONES) was recently introduced to transgress the limits of transnasal endoscopic surgery; the access that it provides could add additional surgical pathways for treating sinogenic complications involving the frontal sinus, orbit, and anterior cranial fossa. We describe a prospective series of 13 patients who underwent TONES for the management of various sinogenic complications, including epidural abscess, orbital abscess, and fronto-orbital mucocele or mucopyocele, as well as subperiosteal abscess presenting with orbital apex syndrome. The primary outcome measurement was the efficacy of TONES in treating these pathologies. TONES provided effective access to the frontal sinus, orbit, and the anterior cranial fossa. All patients demonstrated postoperative resolution of initial clinical symptoms with well-hidden surgical scars. There were no ophthalmologic complications or recurrence of pathology. Based on our experience, TONES appears to provide a valuable addition to the current surgical armamentarium for treating selected complications of sinusitis.

Influence of age and gender on dose and effectiveness of botulinum toxin for laryngeal dystonia

To evaluate the influence of age and gender on the required dose and resulting efficacy of botulinum toxin injection for adductor laryngeal dystonia.

Impact of patient-related factors on the outcomes of office-based injection laryngoplasty

In‐office percutaneous injection laryngoplasty (IL) is a common treatment for glottal insufficiency. The objective of this prospective study was to determine if voice outcomes from IL are affected by age, gender, or initial disease severity.

Face, content, and construct validation of a low-cost, non-biologic, sinus surgery task trainer and knowledge-based curriculum.

The purpose of this study was to evaluate face and content validity of a low‐cost, low‐technology, non‐biologic endoscopic sinus surgery (ESS) task trainer and knowledge‐based curriculum followed by construct validation of the task trainer.

Recent progress in facial paralysis: advances and obstacles.

Purpose of reviewFacial paralysis is a devastating and debilitating condition for which a range of management options exists; all of them continue to have limitations. We review the recent scientific literature and highlight key developments and opportunities for further exploration with the goal that this may help direct clinical practice and research endeavor. Recent findingsWe reviewed recent findings in the evaluation of facial paralysis, pharmacological management, nerve injury prevention and treatment. This includes review of novel techniques using photography and videography. Review of surgical and adjunctive techniques identifies several refinements of existing techniques, some novel techniques, and the value of adjunctive materials and therapies. SummaryManagement of facial paralysis remains an area of active investigation and innovation. The challenge to researchers and care providers will be to continue to explore and refine management strategies while maintaining rigorous and standardized means of evaluation and follow-up, such that outcomes may be determined and reported accurately and in a way that they can be transferred to other clinical practices. Further study of the role of growth factors and stem cells in facial nerve regeneration is critical, and is the most likely means of surmounting the remaining barriers to successful outcomes in alleviating the ravages of this devastating malady.

Trainee perceptions of laryngology in otolaryngology residency programs.

OBJECTIVES There is no standardized curriculum for laryngology within otolaryngology residency programs despite the fact that laryngology is a significant portion of the Royal College of Physicians and Surgeons of Canada examination. Our objective was to evaluate trainee perceptions of laryngology within otolaryngology residency programs. DESIGN Cross-sectional survey. SETTING Canadian otolaryngology residency programs. METHODS A Web-based, anonymous survey was conducted among otolaryngology residents. The survey was based on Royal College learning objectives for laryngology. The survey was administered using Dillmans Total Design Method and distributed in English and French. RESULTS Sixty-four of 150 (42.6%) residents responded to the survey (55.6% male; mean age 29.3 years). About half of the respondents agreed or strongly agreed that the amount of didactic and clinical laryngology instruction was adequate. About 41.0% agreed or strongly agreed that the amount of operative laryngology instruction was adequate. Cited areas for improvement included injection laryngoplasty, botulinum toxin injection, medialization thyroplasty, care of the professional voice, phonosurgery, and videostroboscopy. Areas of strength included flexible nasopharyngoscopy, laryngeal anatomy, hoarseness, stridor, laryngopharyngeal reflux disease, and vocal cord paralysis. Overall, 40.7% felt somewhat comfortable providing laryngology care. The presence of a laryngology fellowship at the training program, respondent interest in pursuing a fellowship, completion of a laryngology elective, and previous laryngology research did not affect the residency experience. Senior residents are more comfortable with providing laryngology care than juniors. CONCLUSIONS Several areas of strengths and areas for improvement in laryngology appear to exist within otolaryngology residency programs as perceived by current trainees.