Marketing Your Practice: Setting Yourself Apart in a Competitive Market, Online Reputation Building, and Managing Patient Experience/Satisfaction.

The days of making a first impression when you meet your patients in person are numbered. Rather, in today's digital age, your prospective patients have likely already formed opinions about you and your practice before they meet you. And these opinions are largely influenced by the information they discover about you online. While you cannot completely control your personal brand or reputation as a physician, you can certainly try by controlling your online narrative: communicate your expertise and your value by effectively using social media, by regularly updating your practice website, and by proactively managing patient satisfaction reflected on physician rating websites. Set yourself apart in a competitive market today by building a strong digital presence.

Coblation cryptolysis to treat tonsil stones: a retrospective case series.

We introduce a novel and potentially effective approach in the treatment of tonsil stones using Coblation technology. A retrospective pilot case series was performed demonstrating the effectiveness of a technique that we call Coblation tonsil cryptolysis. This technique is unique in that it can be performed in adult patients without sedation using only local anesthesia, much like laser tonsil cryptolysis. As with laser cryptolysis, pain is significant for only a few days and most adults can resume normal diet and activity within 1 week. In contrast, tonsillectomy entails significant morbidity for several weeks. However, Coblation avoids the significant disadvantages of laser use, including the potential for airway fire, retinal damage from reflected scatter, dealing with plume from vaporized tissues, oral/facial burns, and the high cost of purchasing and maintaining laser equipment. After a single session of Coblation tonsil cryptolysis, a significant decrease and even elimination of tonsil stones can potentially be achieved.

A survey of current practices of physicians who treat adductor spasmodic dysphonia in the U.S.

We conducted a survey to determine the current practices of a subset of physicians in the United States who treat patients with adductor spasmodic dysphonia. Surveys were sent to 169 physicians listed in the National Spasmodic Dysphonia Association database, and responses were returned by 43 (25.4%). Almost all respondents (95.4%) indicated that they use botulinum toxin type A injections, either alone or in combination with other treatments, to treat adductor spasmodic dysphonia, and most (69.8%) inject the toxin under electromyographic guidance. However, there were wide variations in the amount of sterile saline used to reconstitute the toxin, the size of the initial dose, and the use of other treatment strategies.

Relationship of botulinum dosage to duration of side effects and normal voice in adductor spasmodic dysphonia.

OBJECTIVE: Objective evaluation of botulinum toxin A (BTX-A) dosing by determination of the statistical relationship between injection amount and duration of side effects and normal voice in adductor spasmodic dysphonia (SD) patients. From this information, to provide a rational guide to determine the initial and follow-up BTX-A amounts for injection. STUDY DESIGN AND SETTING: Private laryngology clinic. Statistical analysis was performed on data obtained from 101 patients with SD. RESULTS: Significant and predictable positive correlations were found between duration of side effects and duration of normal voice after BTX-A injection in patients with SD. Dose of BTX-A injected also appeared to have a significant positive correlation with duration of side effects, but a negative correlation with duration of normal voice. A trend toward more severe side effects was seen with larger doses of BTX-A injections. CONCLUSIONS AND SIGNIFICANCE: Increased understanding of the response of the human voice over time after BTX-A injection at various doses suggests new ideas to further increase clinical efficacy with the use of lower BTX-A doses.

Bilateral pharyngoceles (branchial cleft anomalies?) and endoscopic surgical considerations.

A case report of bilateral pharyngoceles without a history of elevated intrapharyngeal pressures is used to support the hypothesis that pharyngoceles may be an adult manifestation of an internal branchial sinus anomaly. The development of a pharyngocele from a branchial sinus origin would suggest a predictable relationship to the hypoglossal, glossopharyngeal, and superior laryngeal nerves, which may influence the choice of surgical approach (open versus endoscopic) and the counseling of patients who are considering surgical correction.

Novel use of a swimming pool biocide in the treatment of a rare fungal mastoiditis.

OBJECTIVE: To describe an extremely rare fungal mastoiditis caused by Lecythophora hoffmannii, its recalcitrant behavior to therapy, and eventual successful treatment with adjunctive therapy using polyhexamethylene biguanide (a common swimming pool biocide). STUDY DESIGN: Case report and review of literature of human Lecythophora hoffmannii infections. METHODS: Medline database was searched using the keywords Lecythophora and hoffmannii. All articles that described Lecythophora hoffmannii as the cause of human infection at any site were identified. Literature and patient's records were considered for complete data review and extraction. RESULTS: We present the second known case in the literature of a human infection with Lecythophora hoffmannii. We also present the process to definitively identify and then to successfully eradicate this unusual fungal infection using polyhexamethylene biguanide as adjunctive treatment. CONCLUSIONS: Successful treatment of a chronic Lecythophora hoffmannii fungal mastoiditis involved a combination of radical surgical removal of all apparent infected tissue along with local treatments with polyhexamethylene biguanide, a common swimming pool biocide agent under the brand name Baquacil (Avecia, Manchester, United Kingdom). Given the prolonged course of treatment, this report particularly stresses the importance of concurrent surgery combined with creative local antimicrobial therapy to eliminate an unusual fungal infection in an immunocompetent host.

Malignant hyperthermia and the otolaryngologist.

Malignant hyperthermia is a rare disorder that can occur in patients who are sensitive to certain agents used in general anesthesia. The treatment of malignant hyperthermia has not changed over the years, but prevention strategies have evolved. These strategies include an increased emphasis on how patients are managed prior to a surgical procedure, on the selection of the particular anesthetic agent, and on postoperative vigilance. Susceptible patients who undergo simple excisions or a low degree of surgical stress can receive treatment safely in the office or ambulatory surgery center and be discharged the same day, provided that all known triggering agents are avoided. For more extensive procedures that cause a moderate level of surgical stress to susceptible patients, facilities for managing malignant hyperthermia should be readily available. Susceptible patients who undergo high-stress invasive procedures should be hospitalized. Routine preoperative prophylactic drug administration, even with dantrolene, is no longer considered necessary for any susceptible patients. All local anesthetics--including lidocaine, which had been previously contraindicated--are now considered to be safe for use in patients who are susceptible to malignant hyperthermia. In this article, we review the prevention, diagnosis, and management of malignant hyperthermia. We also report our experience in anesthetizing a patient who had a history of malignant hyperthermia--a case that illustrates the uncertainty that can complicate the management of such patients.

Endoscopic staple diverticulostomy for Zenker's diverticulum: review of literature and experience in 159 consecutive cases.

OBJECTIVES/HYPOTHESIS: Several reports since the early 1990s have advocated a minimally invasive technique, endoscopic staple diverticulostomy (ESD), to treat Zenker's diverticulum. However, long-term results and comparisons with the reported experience with external or other endoscopic approaches have been lacking in the literature. We present follow-up on our experience with ESD since 1995 and compare it with the results obtained by other endoscopic or external techniques for treatment of Zenker's diverticulum. STUDY DESIGN: Retrospective review of 159 consecutive ESD procedures performed on 150 unique patients with Zenker's diverticulum between March 1995 and August 2002. Telephone interviews of patients were conducted to assess long-term treatment outcome. Review of the literature was performed by Ovid MEDLINE search for all reports on the surgical treatment of Zenker's diverticulum in the English language between January 1990 and August 2002. METHODS: Data were retrospectively reviewed and information was tabulated for age, sex, size of diverticulum, symptoms, duration of symptoms, operative time, length of hospital stay, time before oral intake, complications, and relief of symptoms at first postoperative visit. Follow-up interviews of patients were conducted to assess current status of symptoms and, if any symptoms returned, how many months after the procedure they recurred. All case series in the literature in the English language since 1990 that were found in the Ovid MEDLINE database and referenced from identified articles were also tabulated for the same information. RESULTS: At the time of initial follow-up after ESD, 98% of patients reported complete or improved symptoms. Average hospital stay was 0.76 days, with a diet started on postoperative day 0.25. There was a 2.0% significant complication rate without mortality. Further follow-up (average, 32.2 mo) identified a recurrence rate of 11.8%. On review of the literature, patients who underwent ESD had shorter perioperative courses, quicker return to diet, and lower complication and mortality rates compared with external procedures. ESD had comparable operative times and mortality rates, but fewer complications and more rapid convalescent times compared with other endoscopic procedures. Recurrence rates were found to be variable. CONCLUSIONS: Overall, ESD is an outpatient procedure with few complications. The technique has a faster operative and convalescence period with fewer complication rates compared with other endoscopic or external transcervical approaches. The results in the present study and those reported in the English language literature advocate that ESD be the initial preferred treatment for Zenker's diverticulum.