Postoperative pain with or without nasal splints after septoplasty and inferior turbinate reduction.

PURPOSE: To determine the effect of intranasal Doyle splints on postoperative pain following septoplasty and inferior turbinate reduction (ITR). Changes in Nasal Obstruction Symptom Evaluation (NOSE) scores were also evaluated. MATERIALS AND METHODS: A prospective cohort study conducted from January 2017 to January 2019. Patients were recruited if they experienced nasal obstruction due to septal deviation and inferior turbinate hypertrophy, and failed a one-month trial of intranasal corticosteroids. All patients underwent septoplasty with ITR, and either had Doyle splints or no splints placed. Patients were prescribed hydrocodone-acetaminophen 5-325 mg and asked to keep a daily log of pain medication use and visual analog scale (VAS) scores. Pain logs and NOSE scores were compared between patients who had splints versus patients who had no splints placed after septoplasty and ITR over the first postoperative week. NOSE scores were also collected at every postoperative visit (1 week, 1 month, and 6 months). RESULTS: Fifty-seven patients were enrolled (37 splints, 20 no-splints). The median postoperative pain VAS score was 3.0 (interquartile range [IQR] 2.0-5.0) for the splint group and 4.0 (IQR 2.0-5.0) for the no-splint group (P = 0.906). The median postoperative pain medication requirement in morphine equivalents at the first postoperative visit was 5.4 mg/day (IQR 2.0-13.3) for the splint group and 8.4 mg/day (IQR 1.8-15.3) for the no-splint group (P = 0.833). CONCLUSIONS: There were no statistically significant differences in postoperative pain VAS scores or pain medication use between the two groups. All patients experienced significant reductions in NOSE scores postoperatively.

Recognizing odontogenic sinusitis: A national survey of otolaryngology chief residents.

PURPOSE: Odontogenic sinusitis is underrepresented in sinusitis literature as well as in the otolaryngology teaching curriculum sponsored by the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngologists and residents in training may therefore have a decreased awareness of the condition. The objective of this study was to survey otolaryngology chief residents toward the ends of their training to determine how often they considered odontogenic sinusitis as a cause of unilateral sinus disease. MATERIALS AND METHODS: An online REDCap survey was conducted from December 2018 to January 2019. Online surveys were emailed to 119 Otolaryngology residency program directors in the United States of America, which were then forwarded to their chief residents. Surveys included 3 demographic and 4 clinical questions. Clinical questions included 3 computed tomography-based questions requiring either differential diagnoses or most likely diagnosis, and 1 question on residents' perceived prevalence of odontogenic sinusitis as a cause of unilateral sinus opacification. Answer choices were tabulated and compared based on geographic region and post-residency career plans. RESULTS: Of 293 chief residents emailed, 94 completed the survey (32.1%). While answer choices on imaging-based questions varied, odontogenic sinusitis was generally underrecognized. Approximately 70% of residents felt odontogenic sinusitis represented 0%-40% of unilateral sinus opacification. There were no statistically significant differences in answers based on geographic distribution or post-residency career plans. CONCLUSIONS: Otolaryngology chief residents recognized odontogenic sinusitis with variable accuracy on imaging, and generally underestimated its prevalence as a cause of unilateral sinus opacification. Efforts should be made to teach otolaryngology residents about odontogenic sinusitis.

Grit: A predictor of medical student performance.

Background: Several predictors of medical school performance have been identified, yet more research is needed to select applicants who will perform well. Grit is a personality trait that is described as persevering through difficult tasks. Although it is hypothesized that this type of trait would be high in a medical student population, this has not been studied. The purpose of this study was to examine grit among medical students and to explore whether grit-predicted performance in medical school. Methods: There were 131 graduating medical students who completed a questionnaire in May 2014 on grit as well as demographic questions and involvement in other activities in medical school. Data on test scores, years in medical school, and class ranking were obtained from the medical school. Results: The average grit score among 130 medical students was high (mean = 4.01, standard deviation = 0.42). Those who completed the program in 4 years had higher grit scores than those who completed in 5 years (P = 0.01). Grit was related to medical school performance including clinical knowledge scores (P = 0.02). There was also a difference between the highest and lowest class rank (P = 0.03). Discussion: Medical students have high levels of trait-like perseverance and it appears that those with higher levels of grit are more likely to perform better in medical school.

A study of otolaryngology resident quality of life and sleepiness.

OBJECTIVES: This study aimed to determine otolaryngology residents' quality of life and sleepiness. METHODS: An electronic survey was distributed to otolaryngology residents in the United States in October 2014 and May 2015. The survey included questions from the Physician Well-Being Index (PWBI) and Epworth Sleepiness Scale (ESS). Data were analyzed using standard descriptive and frequency analyses, Spearman correlations, and Student's t-test. RESULTS: The 196 respondents (13% response rate) had a mean age of 29.9 years and worked an average of 70.88 hours/week. Higher PWBI score (lower quality of life) correlated with higher ESS (more sleepiness) for all respondents regardless of rotation (Spearman coefficient of .45; p = .001). PWBI scores were higher for head/neck oncology. Both PWBI and ESS scores were highest for postgraduate year two. PWBI showed a significant positive correlation with hours worked (correlation coefficient .35; p = .001) as well as a significant negative correlation with exercise time (correlation coefficient -.18; p = .010). There was a positive correlation between hours worked and ESS (correlation coefficient .48; p = .001). CONCLUSION: For the otolaryngology survey respondents, sleepiness and overall well-being were better during the first year with a dramatic worsening during junior years followed by an improvement in the senior years. More work hours and poor quality of life was associated with less physically active residents. Focused interventions during these rotations may reduce distress, improve quality of life, and enhance learning. LEVEL OF EVIDENCE: NA.

Predictors of repeated "no-showing" to clinic appointments.

OBJECTIVE: To determine the variables that contribute to repeated patient non-compliance with showing up to clinic appointments. STUDY DESIGN: Retrospective chart review. SETTING: Single tertiary care academic institution. SUBJECTS AND METHODS: Patients who did not show up to 3 or more clinic appointments in the otolaryngology department in the Henry Ford Health System in metro Detroit, Michigan between July 1, 2011 to June 30, 2012 area were compared to control patients randomly chosen from those who had appointments on the same day with the same provider as the no-show patients. RESULTS: 105 patients were identified who no-showed to 3 or more clinic appointments. Younger age, black race, and lower income were all found to be significant factors for patients missing appointments in a multiple variate model. On logistic regression, Medicaid insurance, closer distance from home to appointment, less bus transfers, and less time by bus travel were also found to correlate with no-showing. CONCLUSION: Age, race, and income are significantly related to patient non-compliance with clinic appointments. Paradoxically, proximity to the clinical appointment location is also significantly related - we hypothesize this may be the result of significant income inequality in the metro Detroit population distribution. Follow up studies include analyzing factors that precluded patient access and interventions to improve compliance and decrease cost.

Lack of financial barriers to pediatric cochlear implantation: impact of socioeconomic status on access and outcomes.

OBJECTIVES: (1) To analyze if socioeconomic status influences access to cochlear implantation in an environment with adequate Medicaid reimbursement. (2) To determine the impact of socioeconomic status on outcomes after unilateral cochlear implantation. DESIGN: Retrospective cohort study. SETTING: University Hospitals Case Medical Center and Rainbow Babies and Children's Hospital (tertiary referral center), Cleveland, Ohio. PARTICIPANTS: Pediatric patients (age range, newborn to 18 years) who received unilateral cochlear implantation during the period 1996 to 2008. MAIN OUTCOME MEASURES: Access to cochlear implantation after referral to a cochlear implant center, postoperative complications, compliance with follow-up appointments, and access to sequential bilateral cochlear implantation. RESULTS: A total of 133 pediatric patients were included in this study; 64 were Medicaid-insured patients and 69 were privately insured patients. There was no statistical difference in the odds of initial cochlear implantation, age at referral, or age at implantation between the 2 groups. The odds of prelingual Medicaid-insured patients receiving sequential bilateral cochlear implantation was less than half that of the privately insured group (odds ratio [OR], 0.43; P = .03). The odds of complications in Medicaid-insured children were almost 5-fold greater than the odds for privately insured children (OR, 4.6; P = .03). There were 10 complications in 51 Medicaid-insured patients (19.6%) as opposed to 3 in 61 privately insured patients (4.9%). Medicaid-insured patients missed substantially more follow-up appointments overall (35% vs 23%) and more consecutive visits (1.9 vs 1.1) compared with privately insured patients. CONCLUSIONS: In an environment with adequate Medicaid reimbursement, eligible children have equal access to cochlear implantation, regardless of socioeconomic background. However, lower socioeconomic background is associated with higher rates of postoperative complications, worse follow-up compliance, and lower rates of sequential bilateral implantation, observed herein in Medicaid-insured patients. These findings present opportunities for cochlear implant centers to create programs to address such downstream disparities.

Double bilobed radial forearm free flap for anterior tongue and floor-of-mouth reconstruction.

We describe what is, to the best of our knowledge, the first use of a double bilobed radial forearm free flap in reconstructive surgery of the tongue and floor of the mouth following bilateral tumor resection. Our patient was a 78-year-old man who had experienced tumor recurrence in the anterior floor of the mouth after previous resection and radiotherapy. Eleven weeks postoperatively, the patient could extend his tongue to his hard palate and past his mandibular alveolus anteriorly. Within 6 months, he was able to tolerate an oral diet of soft food and exhibited understandable speech quality. Although the use of a single bilobed radial forearm flap is widely used after hemiglossectomy, our double bilobed modification extends this technique to anterior tongue and floor-of-mouth defects. This technique provides adequate bulk while allowing for depth of a ventral sulcus that will minimize tethering of the tongue and reduce oral incompetence. We recommend that this technique be included in the armamentarium of any reconstructive head and neck cancer surgeon.

Introduction of visually oriented information handouts in an academic pediatric otolaryngology practice.

OBJECTIVES: To characterize after-hours postoperative caregiver telephone calls received by on-call otolaryngology residents and to determine the feasibility of using visually oriented handouts to affect postoperative telephone call volume. STUDY DESIGN AND SETTING: We conducted a prospective, before-after feasibility study at a tertiary-care children's hospital. Visually oriented handouts describing expected postoperative courses were distributed preoperatively to the parents of all adenotonsillectomy and tympanostomy tube patients. Postoperative caregiver telephone call volume and content were recorded before and after handout introduction. RESULTS: The handouts were well accepted and viewed favorably by caregivers, and they led to some changes in the nature of postoperative telephone call content, but call log compliance was not adequate to fully assess the impact on call volume and content. CONCLUSIONS: We demonstrated the feasibility of implementing visually oriented informational handouts and characterized the nature of postoperative caregiver telephone calls received by on-call residents in an academic pediatric otolaryngology practice. SIGNIFICANCE: Visually oriented instructional handouts may have benefits that deserve further study. Data from this study can help plan a definitive clinical trial.

Branchial cleftlike cysts of the thyroid.

Branchial cleftlike cysts of the thyroid gland are rare lesions. Although initially described in patients with chronic lymphocytic thyroiditis, these cysts have been reported in a variety of histologic settings. We present 2 case studies, 1 in a 30-year-old woman and 1 in a 50-year-old man. The mode of presentation and management of these cases, along with a literature review, is discussed in brief.