The Development of Head and Neck Cancer in Patients with the Isolated Complaint of Globus Pharyngeus.

Objectives: Globus pharyngeus (GP) is a perplexing problem that accounts for 4% of referrals to otolaryngologists. Workup can be extensive and may not be definitive in terms of etiology. The concern that lingers is that of a subtle cancer, which can prolong anxiety and increase testing cost.

A Medicare Physician Fee Schedule Analysis of Reimbursement Trends in Laryngology from 2000 to 2021.

Objective: The purpose of this study is to characterize Medicare reimbursement trends for laryngology procedures over the last two decades.

Methods: This analysis used CMS' Physician Fee Schedule (PFS) Look-Up Tool to determine the reimbursement rate of 48 common laryngology procedures, which were divided into four groups based on their practice setting and clinical use: office-based, airway, voice disorders, and dysphagia. The PFS reports the physician service reimbursement for "facilities" and global reimbursement for "non-facilities".

Transmission risk of COVID-19 infection with office-based flexible laryngoscopy.

Unlabelled: Since the beginning of the Coronavirus pandemic, recommendations to ensure safety in clinical practice have fluctuated. Within the Otolaryngology community, a variety of protocols have emerged to assure safety for both patients and healthcare workers while maintaining standard of care practices, especially surrounding aerosolizing in-office procedures.

Objectives: This study aims to describe our Otolaryngology Department's Personal Protective Equipment protocol for both patients and providers during office laryngoscopy and to identify the risk of contracting COVID-19 after implementation of the protocol.

Practice Consolidation in Otolaryngology: The Decline of the Single-Provider Practice.

Objective: To observe trends in practice consolidation within otolaryngology by analyzing changes in size and geographic distribution of practices within the United States from 2014 to 2021.

Study Design: Retrospective analysis based on the Physician Compare National Database from the US Centers for Medicare and Medicaid Services.

Setting: United States.

The Utility of Comorbidity Indices in Assessing Head and Neck Surgery Outcomes: A Systematic Review.

Objective: To evaluate the utility of comorbidity index (CI) scores in predicting outcomes in head and neck surgery (HNS). The CIs evaluated were the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Kaplan-Feinstein Index (KFI), American Society of Anesthesiologists Physical Status (ASA-PS), Adult Comorbidity Evaluation-27 (ACE-27), National Cancer Institute Comorbidity Index (NCI-CI), and the Washington University Head and Neck Comorbidity Index (WUHNCI).

Methods: We report a systematic review according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Initiation of a Night Float System in an Otolaryngology Residency: Resident Perception and Impact on Operative Volume.

Objectives: Evaluate resident perception on implementation of a night float (NF) system to an otolaryngology residency program. We compared these perceptions to Accreditation Council for Graduate Medical Education (ACGME) case log data.

Methods: A retrospective anonymous survey was sent to residents and alumni graduating between 2015 and 2023.

The power of a checklist: Decrease in emergency department epistaxis transfers after clinical care pathway implementation.

Background: Annually, epistaxis costs US hospitals over $100 million dollars. Many patients visit emergency departments (ED) with variable treatment, thus providing opportunity for improvement.

Objective: To implement an epistaxis clinical care pathway (CCP) in the ED, and analyze its effects on treatment and ED transfers.

Dysphagia Evaluation: The Added Value of Concurrent MBS and Esophagram.

Objectives/hypothesis: Dysphagia is associated with increased mortality and healthcare costs. The modified barium swallow study (MBS) is the gold standard in assessing oropharyngeal dysphagia, but does not evaluate the esophagus. A barium esophagram can visualize the esophagus but does not evaluate the oropharyngeal swallow, nor does it utilize the expertise of speech and language pathologists.

"Hot Zones" for Otolaryngologists: Assessing the geographic distribution of aerosol-generating procedures amidst the COVID-19 pandemic.

Objective: Given high COVID-19 viral load and aerosolization in the head and neck, otolaryngologists are subject to uniquely elevated viral exposure in most of their inpatient and outpatient procedures and interventions. While elective activity has halted across the board nationally, the slow plateau of COVID-19 case rates prompts the question of timing of resumption of clinical activity. We sought to prospectively predict geographical "hot zones" for otolaryngological exposure to COVID-19 based on procedural volumes data from 2013 to 2017.

Geospatial analysis of COVID-19 and otolaryngologists above age 60.

Objective: The 2019 novel coronavirus (COVID-19) is disproportionately impacting older individuals and healthcare workers. Otolaryngologists are especially susceptible with the elevated risk of aerosolization and corresponding high viral loads. This study utilizes a geospatial analysis to illustrate the comparative risks of older otolaryngologists across the United States during the COVID-19 pandemic.

Discharge by Noon: A Checklist Initiative by the Otolaryngology Service.

Objectives/hypothesis: Hospital length of stay (LOS) and throughput are critical issues for hospitals. Late hospital discharges contribute to bottlenecks in the emergency department, overcrowd surgical and procedural areas, and limit patient tertiary-care center transfers. Our goal was to increase discharge by noon (DCBN) percentage from 8% to over 50% in a sustainable manner.

Outcomes of tracheoesophageal puncture in twice-radiated patients.

Objective: Previous research has demonstrated the safety of tracheoesophageal puncture voice prosthesis (TEP) placement in radiated patients; however, there is a growing population of twice-radiated patients with limited research on the outcomes of TEP-placement in this cohort.

Methods: After Institutional Review Board approval, a retrospective review of 80 patients that underwent TEP from 2006 to 2017 at a single institution was conducted, of which 16 patients underwent two courses of radiation. Outcome measures include TEP removal, complication and duration of usage.

The prefabricated supraclavicular artery flap in high-risk tracheal stenosis patients.

Objectives/hypothesis: Primary tracheal resection in appropriately selected patients with tracheal stenosis achieves >90% success rate. Risk factors for complications have been identified, making some patients high risk for this procedure. Herein is a review and discussion of a novel treatment method for tracheal stenosis utilizing a prefabricated composite auricular cartilage graft embedded in a supraclavicular artery island flap (pSCAIF) for tracheal reconstruction in high-risk patients.

Improving efficiency in epistaxis transfers in a large health system: Analyzing emergency department treatment variability as pretext for a clinical care pathway.

Introduction: Epistaxis is a common condition with an estimated $100 million in health care costs annually. A significant portion of this stems from Emergency Department (ED) management and hospital transfers. Currently there is no data in the literature clearly depicting the differences in treatment of epistaxis between Emergency Medicine (EM) physicians and Otolaryngologists.

Multi-specialty knowledge on surgical a management: Implementation of an educational initiative.

Purpose: Deficiencies in airway management knowledge can result in harm, especially in tracheostomy patients. Our objective is to assess the degree of knowledge in different medical specialties, before and after targeted airway education.

Materials And Methods: A lecture on tracheostomy management was prepared for Otolaryngology, Anesthesia, Emergency Medicine, General Surgery, Oral and Maxillofacial Surgery (OMFS), Internal Medicine (IM), and Family Medicine (FM).

A targeted initiative to discharge surgical patients earlier in the day is associated with decreased length of stay and improved hospital throughput.

Background: The timing of inpatient discharges can impact hospital throughput with later discharges leading to decreased patient satisfaction, increased length of stay (LOS), and longer boarding times.

Methods: A 12-month targeted intervention that included both pre-operative and inpatient components was implemented across all surgical inpatient services to increase the proportion of patients discharged by noon.

Results: Discharge by noon rates increased from 14.

Airway Management in a Patient With Tracheal Disruption due to Penetrating Neck Trauma With Hollow Point Ammunition: A Case Report.

Rapid sequence induction and intubation was performed for a patient in respiratory distress after a gunshot wound to the neck. Resistance was noted distal to vocal cords. With a bronchoscope unavailable, the endotracheal tube was advanced with a corkscrew maneuver.

Consensus statement: Using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis.

Introduction: The purpose of this study was to develop an evidence-based consensus statement regarding use of laryngeal electromyography (LEMG) for diagnosis and treatment of vocal fold paralysis after recurrent laryngeal neuropathy (RLN).

Methods: Two questions regarding LEMG were analyzed: (1) Does LEMG predict recovery in patients with acute unilateral or bilateral vocal fold paralysis? (2) Do LEMG findings change clinical management in these individuals? A systematic review was performed using American Academy of Neurology criteria for rating of diagnostic accuracy.

Results: Active voluntary motor unit potential recruitment and presence of polyphasic motor unit potentials within the first 6 months after lesion onset predicted recovery.

Hunsaker Mon-Jet tube ventilation: a 15-year experience.

Objective/hypothesis: The Hunsaker Mon-Jet tube (HMJT) (Xomed, Jacksonville, FL) has been used effectively for subglottic ventilation. We previously reported a series of 552 patients over a 10-year period with no major complications. This is a continuation of that series with an additional 5 years of cases.

A multi-institutional analysis of tracheotomy complications.

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

Study Design: Multi-institution historical cohort.

Methods: Data regarding tracheotomy tube complications from consecutive surgeries performed across eight participating institutions between January 1, 2008 and December 31, 2009 were retrospectively collected.

The Hunsaker Mon-Jet tube with jet ventilation is effective for microlaryngeal surgery.

Purpose: Microlaryngeal surgery involves a delicate balance between airway control and appropriate visualization of laryngeal anatomy. When the self-centering, laser-safe Hunsaker Mon-Jet tube (Xomed, Jacksonville, FL) was introduced in 1994, to provide subglottic ventilation, the needs of both anesthesiologist and surgeon appeared to have been adequately met. However, limited data exists regarding the efficacy of this device in a large patient series.

Dosage changes in patients with long-term botulinum toxin use for laryngeal dystonia.

Objective: To investigate the dosage consistency of botulinum toxin injections in patients with long-term treatment for laryngeal dystonia.

Study Design: Chart review.

Subjects And Methods: Patients with laryngeal dystonia who had received at least 20 injections to the thyroarytenoid muscle were selected.