Michael R. Holtel

Corticosteroid treatment for idiopathic facial nerve paralysis: a meta-analysis.

Objective A meta‐analysis was designed to evaluate facial recovery in patients with complete idiopathic facial nerve paralysis (IFNP) by comparing outcomes of those treated with corticosteroid therapy with outcomes of those treated with placebo or no treatment.

An Analysis of 3599 Midfacial and 1141 Orbital Blowout Fractures Among 4426 United States Army Soldiers, 1980–2000

OBJECTIVE: We sought to present the epidemiology associated with 3599 midfacial and 1141 orbital blowout fractures. STUDY DESIGN AND SETTING: We conducted a multicenter, 20-year retrospective analysis of hospitalization data on U.S. Army active duty soldiers. RESULTS: Men composed 96% of the patients, with men aged 20 to 29 years the most affected. Of midfacial and blowout fractures, 54.8% and 70.2% occurred with concomitant injury, with 36.2% and 50.9% sustaining other facial fractures, respectively. Three hundred forty orbital blowout fractures (29.8%) had an associated eye injury. Common mechanisms included fighting and motor vehicle accidents. CONCLUSIONS: Young men comprised the most susceptible population, and assault was the predominant mechanism. A high incidence of concomitant injury in midfacial and orbital blowout fractures, particularly ocular and intracranial injury, emphasizes the importance of a thorough physical examination. SIGNIFICANCE: We report the results from one of the largest series of midfacial and orbital floor blowout fractures from a population that crosses urban, rural, and foreign boundaries.

Overview of Telemedicine Applications for Otolaryngology

Objective/Hypothesis: As we evolve into the managed care era, telemedicine technologies can help to provide efficiencies for the entire health care system. Our practice is centered around a residency training program in a federal facility. Our goal was to lay the groundwork for an entire service being on‐line.

Radiofrequency excision versus monopolar electrosurgical excision for tonsillectomy.

OBJECTIVE: We previously compared radiofrequency (Evac) tonsillotomy with monopolar electrosurgical (Bovie) tonsillectomy and showed significantly less pain with the Evac. Tonsillotomy leaves a cuff of tonsil behind, the significance of which is unknown. We hypothesize that Evac tonsillectomy also is less painful than Bovie tonsillectomy. STUDY DESIGN AND SETTING: We compared Evac (ENTec Evac 70; ArthroCare, Sunnyvale, CA) and Bovie tonsillectomy in a prospective, blinded fashion. Each participant had 1 tonsil removed by each device. We recorded, by side, the surgical time, blood loss, operative difficulty, pain (postoperative days 1, 3, 5, 7, 10, and 14), and the side that each patient preferred. RESULTS: Data were analyzed for 17 patients. They reported significantly less pain with the Evac (P < 0.036, F = 5.87). The Evac was preferred by 12 of 14 patients. CONCLUSION: Evac tonsillectomy is significantly less painful than Bovie tonsillectomy. Patients blinded to treatment preferred the Evac technique. SIGNIFICANCE: The Evac device decreases postoperative pain.

Rare tumors of the thyroid gland

Although the vast majority of thyroid cancers are well-differentiated and carry an excellent prognosis, several rare tumors occasionally involve the thyroid gland and require unique treatment paradigms. Anaplastic carcinoma of the thyroid is an extremely aggressive neoplasm that is generally best managed with surgery followed by a multimodality regimen of radiotherapy and chemotherapy. Squamous cell carcinoma of the thyroid often mimics the clinical course of anaplastic carcinoma and is best treated with aggressive surgery followed by postoperative radiotherapy. Treatment and prognosis of lymphoma of the thyroid varies depending upon the specific pathological subtype, with combination chemotherapy and radiation therapy used primarily. Sarcomas of the thyroid are primarily managed with surgery, although radiation and chemotherapy are indicated in some cases.

Saline Irrigation in the Prevention of Otorrhea After Tympanostomy Tube Placement

Objectives: Comparison of intraoperative saline irrigation to otic drops in the prevention of postoperative otorrhea in children with middle ear effusion undergoing bilateral myringotomy with ventilation tubes.

Cell Phones in Telehealth and Otolaryngology

The worldwide prevalence of mobile phones makes them a powerful platform for providing individualized health care delivered at the patients convenience. They have the potential to extend the health care interaction from a brief office visit to a continuous monitoring via body sensors of either a specific healthcare parameter or with multiple sensors in wireless body area networks. Remote data collection by way of mobile phones in underserved areas allows for better management of public health and provides the opportunity for timely intervention. Published data showing benefits specific to otolaryngology are primarily in remote consultation, body sensors specific to balance, and appointment compliance.

A Toy Story

While advocates see Telehealth as an essential fundamental change that will improve the way health care is delivered, others view Telehealth as a nice-to-have-tool or an intriguing array of high-tech gadgets, which may make us feel “cutting edge” but ultimately have little effect on the delivery of care. Some of its harshest critics see it as an expensive and time-consuming operation that is unlikely to enhance the existing health care system. While not a challenge for the average adolescent, there are clearly challenges in the transition to new or different communication modalities in the adult population. While we all watch television and often enjoy the various interactive programs as passive observers, when a group of professionals convene and are asked to communicate with a similar remote group using analogous television techniques, an interesting spectrum of avoidance and hesitant attitudes appears that frequently hinders successful encounter, regardless if it is a ContinuingMedical Education event, active consultation, or telesurgery. More passive, less interactive applications, such as electronic medical records, are understandably more acceptable, although we all share the frustrations, sometimes anger, that exist around their implementation and inefficiencies. Our profession is many times a solo venture encompassing long hours, either in the clinic or in the operating room. Unidirectional encounters, such as patient education or even e-prescriptions, are often more intuitively comfortable, while electronic interactive exchange tends to meet with more resistance, often reflected as skepticism.

Telepresence: teleproctored surgery

Teleproctoring provides guidance and support to distant colleagues while performing operative techniques. We present a study to assess the reliability of teleproctored surgery and to develop standards and guidelines for future teleproctored procedures. Endoscopic sinus surgery is performed with conventional proctoring and teleproctoring in a residency program, and the results are compared. The severity of diseases is controlled and usability issues and clinical outcomes are compared between groups. Our preliminary results indicate equal operative times and no increase in complications.