The COVID-19 pandemic has quickly and radically altered how Otolaryngologists provide patient care in the outpatient setting. Continuity of care with established patients as well as establishment of ...a professional relationship with new patients is challenging during this Public Health Emergency (PHE). Many geographic areas are under “stay at home” or “shelter in place” directives from state and local governments to avoid COVID-19 exposure risks. Medicare has recently allowed “broad flexibilities to furnish services using remote communications technology to avoid exposure risks to health care providers, patients, and the community.” 1 The implementation of telemedicine, or virtual, services, will help the Otolaryngologists provide needed care to patients while mitigating the clinical and financial impact of the pandemic. The significant coding and billing issues related to implementing telemedicine services are discussed to promote acceptance of this technology by the practicing Otolaryngologist. Of particular importance, outpatient visit Current Procedural Terminology® codes (99201-99215) may be used for telehealth visits performed in real-time audio and video.
COVID-19 and rhinology: A look at the future Setzen, Michael; Svider, Peter F.; Pollock, Kim
American journal of otolaryngology,
05/2020, Letnik:
41, Številka:
3
Journal Article
Recenzirano
Odprti dostop
The novel Coronavirus (COVID-19) has created a deadly pandemic that is now significantly impacting the United States. Otolaryngologists are considered high risk for contracting disease, as the virus ...resides in the nasal cavity, nasopharynx, and oropharynx. While valuable work has been publicized regarding several topics in Rhinology, we discuss other aspects of our specialty in further detail. There are several issues regarding Rhinologic practice that need to be clarified both for the current epidemic as well as for future expected “waves.” In addition, as the pandemic dies down, guidelines are needed to optimize safe practices as we start seeing more patients again. These include protocols pertinent to safety, in-office Rhinologic procedures, the substitution of imaging for endoscopy, and understanding the appropriate role of telemedicine. We discuss these aspects of Rhinology as well as practical concerns relating to telemedicine and billing, as these issues take on increasing importance for Rhinologists both in the present and the future.
Objectives/Hypothesis
Sinonasal malignancies vary in behavior according to histology and anatomical location. Incidence, survival, and optimal treatment for these lesions are thus uncertain in ...various cases. Our objective was to utilize a national population‐based registry to identify the most common sinonasal histopathologies by anatomical site, and subsequently analyze the data by incidence trends, survival rates, patient demographics, and treatment modalities.
Study Design
Retrospective analysis of the United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry.
Methods
The SEER database was examined for patients diagnosed with sinonasal malignancies between 1973 and 2011. Data were stratified according to anatomical site, incidence, survival, histology, staging, and patient demographics. Therapy‐based outcomes were analyzed for cases from 1983 to 2011.
Results
A total of 13,295 patients were identified, with an incidence of 0.83 per 100,000 people. Males comprised 58.6% of cases. Whites represented 81.5% of cases, while blacks comprised 8.7%. Squamous cell carcinoma was the most common histology (41.9%) across all sites of the sinonasal tract. The most common anatomical site of malignancy was the nasal cavity (45.7%), and least common was the frontal sinus (1.2%). For single sites, 5‐year disease‐specific survival (DSS) was highest for nasal cavity tumors (67.1%) and lowest for overlapping sinus malignancies (37.6%). The overall 5‐year DSS for all sinonasal malignancies was 53.7%.
Conclusion
Sinonasal malignancies are rare entities with poor overall prognosis. By anatomical site, prognosis is best for nasal cavity cancers and worst for overlapping lesions.
Level of Evidence
4. Laryngoscope, 125:2491–2497, 2015
Objectives/Hypothesis
The number of women in medicine has increased considerably over the past 3 decades, and they now comprise approximately half of medical school matriculants. We examine whether ...gender disparities in research productivity are present throughout various specialties and compare these findings to those previously described among otolaryngologists.
Study Design
Bibliometric analysis.
Methods
Research productivity, measured by the h‐index, was calculated for 9,952 academic physicians representing 34 medical specialties. Additionally, trends in how rate of research productivity changed throughout different career stages were compared.
Results
Women were underrepresented at the level of professor and in positions of departmental leadership relative to their representation among assistant and associate professors. Male faculty had statistically higher research productivity both overall (H = 10.3 ±0.14 vs. 5.6 ± 0.14) and at all academic ranks. For the overall sample, men and women appeared to have equivalent rates of research productivity. In internal medicine, men had higher early‐career productivity, while female faculty had productivity equaling and even surpassing that of their male colleagues beyond 20 to 25 years. Men and women had equivalent productivity in surgical specialties throughout their careers, and similar rates in pediatrics until 25 to 30 years.
Conclusions
Female academic physicians have decreased research productivity relative to men, which may be one factor contributing to their underrepresentation at the level of professor and departmental leader relative to their proportions in junior academic ranks. Potential explanations may include fewer woman physicians in the age groups during which higher academic ranks are attained, greater family responsibilities, and greater involvement in clinical service and educational contributions.
Level of Evidence
N/A. Laryngoscope, 123:1865–1875, 2013
Objectives/Hypothesis
There has been growing recognition of the roles prescription drug misuse and diversion play in facilitating the ongoing opioid epidemic. Our objective was to evaluate opioid ...prescription patterns among practicing otolaryngologists.
Study Design
Retrospective review of a CMS database.
Methods
Medicare Part D beneficiary data (2015) were accessed for a list of otolaryngologists. Opioid prescription rates, amount, and supply were calculated. Factors including board certification, experience, gender, and location were obtained for the 9,068 unique otolaryngologists represented in this dataset.
Results
In 2015, otolaryngologists wrote 133,779 opioid prescriptions for 922,806 days (6.9 days/per prescription). The majority was for hydrocodone‐acetaminophen (64.0%). Most otolaryngologists (51.2%) prescribed ≤ 10 opioids; 6.1% offered > 50 opioid prescriptions. Men wrote more prescriptions on average. Opioid prescription rates were greatest in the Midwest (4.6%) and least in the Northeast (1.8%), and the highest/lowest rates were in Delaware (8.6%) and New York (1.3%). Midcareer (11 –20 years) otolaryngologists were most likely to write >50 prescriptions. The opioid prescription rate declined with greater experience.
Conclusions
Opioid prescriptions written by otolaryngologists may play a significant role in the availability of these agents, as otolaryngologists wrote nearly 1 million days worth of opioids to Medicare beneficiaries in 2015. Although the majority of otolaryngologists write fewer than 11 prescriptions annually, those writing more prescriptions also write lengthier courses. There is significant geographic variation in prescribing patterns, highlighting a lack of consensus, and midcareer otolaryngologists are more aggressive in offering opioids. These findings highlight an urgent need for strengthening educational resources aimed at minimizing unnecessary prescriptions.
Level of Evidence
NA. Laryngoscope, 128:1576–1581, 2018
Objectives/Hypothesis
The h‐index, a bibliometric indicator that objectively characterizes the impact of an author's scholarship, is an effective tool that may be considered by academic departments ...for decisions related to hiring and faculty advancement. Our objective was to characterize the scholarly productivity of academic surgeons from different specialties relative to otolaryngologists.
Study Design
Analysis of a bibliometric database.
Methods
The h‐indices of 2,429 faculty members within surgical specialties at 20 randomly selected academic institutions were calculated using the Scopus database and were examined to determine relationship with academic rank and comparison among surgical subspecialties.
Results
The h‐index statistically increased with academic rank. Mean h‐indices were as follows: assistant professor, 4.37 (range, 2.73–6.69); associate professor, 8.70 (6.53–11.02); professor, 16.44 (13.39–20.45); and chairperson, 20.79 (14.81–27.89). Mean increase between academic rank was 5.47, with the largest increase between the levels of associate professor and professor. Further examination demonstrated statistically significant increases through all academic ranks for most, but not all, individual specialties. Urologists, general surgeons, and neurosurgeons had the highest mean h‐indices.
Conclusions
h‐indices among the different surgical specialties vary and are potentially impacted by the number of practitioners as well as research emphasis within a field. The mean h‐index of academic otolaryngologists falls in the lower values for academic surgeons. Because this metric varies among different fields, it is most relevant for comparison when examining values within a field. H‐indices reliably increase with increasing academic rank through professor and offer a quantifiable and objective alternative to other metrics when evaluating faculty members for academic advancement.
Objective
Determine the effect of patient demographics and surgical approach on patient outcomes after tracheal resection in the management of thyroid cancer.
Study Design
Systematic review and ...meta‐analysis.
Methods
Systematic review of literature was performed using PubMed, Embase, and Cochrane Library to identify patients with thyroid carcinoma who underwent tracheal resection. Pooled estimates for patient demographics, presenting findings, complications, and outcomes are determined using random‐effects meta‐analyses.
Results
Ninety‐six relevant studies encompassing 1,179 patients met inclusion criteria. Meta‐analysis pooled rates of complications: 1.7% (confidence interval CI 0.8–2.5; P < .001; I2 = 1.85%) airway complications, 2.8% (CI 1.6–3.9; P < .001; I2 = 13.34%) bilateral recurrent laryngeal nerve paralysis, 2.2% (CI 1.2–3.1; P < .001; I2 = 6.72%) anastomotic dehiscence. Circumferential resection pooled estimates major complications, locoregional recurrence, distal recurrence, overall survival: 14.1% (CI 8.3–19.9; P < .001; I2 = 35.26%), 15% (CI 9.6–20.3; P < .001; I2 = 38.2%), 19.7% (CI 13.7–25.8; P < .001; I2 = 28.83%), 74.5% (CI 64.4–84.6; P < .001; I2 = 85.07%). Window resection estimates: 19.8% (CI 6.9–32.8; P < .001; I2 = 18.83%) major complications, 25.6% (CI 5.1–46.1; P < .014; I2 = 84.68%) locoregional recurrence, 15.6% (CI 9.7–21.5; P < .001; I2 = 0%) distal recurrence, 77.1% (CI 58–96.2; P < .001; I2 = 78.77%) overall survival.
Conclusion
Management of invasive thyroid carcinoma may require tracheal resection to achieve locoregional control. Nevertheless, postoperative complications are not insignificant, and therefore this risk cannot be overlooked when counseling patients perioperatively. Laryngoscope, 131:932–946, 2021
To examine whether there is an association between scholarly impact, as measured by the h-index, academic rank, and National Institutes of Health (NIH) awards in academic ophthalmology.
Retrospective ...analysis of NIH RePORTER and Scopus databases.
Not applicable.
Five hundred seventy-three NIH awards to 391 primary investigators (PIs) in ophthalmology departments were examined. Grant recipients were organized by academic rank, obtained from online listings, and h-index, calculated using the Scopus database. Non-NIH-funded faculty from 20 randomly chosen academic ophthalmology departments also were organized by rank and h-index for comparison with their NIH-funded colleagues.
Scholarly impact, as measured by the h-index, and NIH funding.
The h-index increased with successive academic rank among non-NIH-funded and NIH-funded faculty, as did NIH funding among the latter group. The NIH-funded faculty had higher scholarly impact, as measured by the h-index, than their non-NIH-funded PIs (h = 18.3 vs. 7.8; P <0.0001), even when considering publications only in the prior 5 years; h-index increased with increasing NIH funding ranges. The h-indices of those holding an MD degree (21.4±1.6 standard error of mean) were not statistically higher than those of PhD holders (17.9±0.6) and those with both an MD and PhD degree (18.1±1.7; P = 0.14).
The h-index increases with increasing academic rank among NIH-funded and non-NIH-funded faculty in ophthalmology departments. This bibliometric is associated strongly with NIH funding because NIH-funded PIs had higher scholarly impact than their non-NIH-funded colleagues, and increasing impact was noted with higher funding. The h-index is an objective and easily calculable measure that may be valuable as an adjunct in assessing research productivity, a significant factor for academic promotion in academic ophthalmology.
Although studies demonstrate 4 to 20% of patients with pulsatile tinnitus (PT) have associated sigmoid sinus anomalies, no consensus exists regarding optimal management. Our objective was to perform ...a systematic review exploring surgical and endovascular intervention of PT caused by sigmoid sinus anomalies.
A systematic review was performed using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis guidelines for reporting of results, with a target population encompassing patients with PT and either sigmoid sinus diverticulum or sigmoid wall dehiscence. From an initial search yielding 74 articles, 21 manuscripts met inclusion criteria.
Of 139 patients, 90.4% were female. Mean age was 39.0 years. Diagnosis was sigmoid sinus diverticulum/aneurysm in 47.5% of patients, sigmoid sinus dehiscence in 35.3% of patients, and both in 17.3%. Sigmoid sinus wall reconstruction/resurfacing (SSW R/R) was used in 91.4% and endovascular procedures in 7.9% of patients. Postoperative recurrence was 3.5% (mean follow-up 21.1 m). Although there was no association between resolution rate and age or sex, right-sided PT resolved at a higher rate. For every increase in body mass index by 1 kg/m, the odds of PT resolution increased 9.2%.
PT as a result of sigmoid sinus diverticula, aneurysms, and dehiscence is a rare, but largely treatable condition. Available interventions include SSW R/R, endovascular intervention, and cardiac U-clip techniques. In SSW R/R, bone pate, unspecified soft-tissue graft, and bone cement had the highest rates of PT resolution. While temporalis fascia and autologous bone chips were the materials most commonly used, they had significantly lower rates of PT resolution compared with the other materials, with the exception of auricular cartilage and bone cement. Most episodes of recurrence are resolved with medical management or a revision procedure. This study serves to summarize the current state of knowledge on the treatment of pulsatile tinnitus across disciplines.
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