Vocal Cord Paresis After Posterior Spinal Fusion to Treat Adolescent Idiopathic Scoliosis: A Case Report.

CASE: A 15-year-old girl with adolescent idiopathic scoliosis with a 50° curve underwent posterior spinal fusion from T3 to T11. After discharge from the hospital, the patient reported dysphonia and dysphagia. Flexible nasendoscopy confirmed left vocal cord paresis. Stretch injury to the recurrent laryngeal nerve from the left T5 pedicle screw or intubation may have caused the vocal cord paresis. The pedicle screw was removed during revision surgery. Postsurgically, the patient demonstrated immediate and ultimately full recovery and no longer had any symptoms. CONCLUSION: To our knowledge, this is the first case report of vocal cord paresis most likely caused by pedicle screw position after posterior spinal fusion.

Implementation of ethics grand rounds in an otolaryngology department.

OBJECTIVES/HYPOTHESIS: To create a case-based curriculum designed to teach and discuss the tenets of clinical medical ethics within an otolaryngology department. STUDY DESIGN: Survey-based study in a single-institution, academic otolaryngology department. METHODS: Case-based departmental ethics grand rounds were implemented on a quarterly basis within an academic department of otolaryngology. One-hour sessions were designed to use challenging cases volunteered by clinicians within the department to create a forum for discussion and education about clinical medical ethics. A four-question satisfaction survey was administered to participating clinicians to measure the impact of the program. RESULTS: Five grand rounds were held over 16 months from 2009 to 2011, with four to six cases presented per session. Sessions were well attended and received, with broad coverage of topics and lively discussions. The mean survey score was 18 (median, 19; standard deviation, 2) out of a maximum possible score of 20. When asked if the sessions helped to advance their skills and comfort within the field of medical ethics, 100% of respondents agreed or strongly agreed. A total of 86% of respondents agreed or strongly agreed that the sessions would change how they practiced medicine in a way that would benefit their patients. CONCLUSIONS: It is feasible to successfully implement case-based ethics grand rounds within an otolaryngology department. Participants demonstrated a gratifying level of approval, and a stated desire to implement the principles learned within their clinical practice.