Highlights from the June Otolaryngology--Head and Neck Surgery

Newswise — Some 23 original articles are featured in the June 2005 edition of Otolaryngology—Head and Neck Surgery, the peer-reviewed scientific journal of the American Academy of Otolaryngology—Head and Neck Surgery Foundation. This issue can be accessed at http://www.mosby.com/oto; abstracts of the articles can be viewed online. Among the new research studies are:

1. Implementation of Duty Hour Standards in Otolaryngology-Head and Neck Surgery Residency Training:A survey of program directors of otolaryngology-head and neck residency training programs in the United States has been conducted to determine what impact the recently implemented duty hour standards have had on otolaryngology-head and neck surgery residency programs. According to the majority of program directors who responded to the survey, the limitations on resident duty hours imposed by the Accreditation Council for Graduate Medical Education are not an improvement in residency training, do not improve patient care, and have decreased the training experience of residents.

2. Satisfaction and Gender Issues in Otolaryngology Residency:Results of survey of 261 otolaryngology residents (24 percent female) shows significant differences exist regarding residency operative experience, career guidance, and gender. Post-graduate year level correlated with confidence that surgical skills were appropriate, establishment of solid career network, and confidence that surgical abilities are adequate for practice. However, female residents reported less confidence surgical skills were appropriate and surgical abilities were adequate for postresidency practice. Women were encouraged to enter private practice more often, were less likely to have a solid career network, and were less confident about being able to run their own practice.

3. Successful Outpatient Treatment of Sinusitis Exacerbations Caused by Community-Acquired Methicillin-Resistant Staphylococcus Aureus:The rapid proliferation of methicillin-resistant Staphylococcus aureus (MRSA) outside of the hospital setting has led inquiry into community-acquired forms of MRSA infections. The significance of MRSA's presence is uncertain because there are data to support asymptomatic MRSA colonization in the community. A retrospective review of all cases of community-acquired Methicillin-Resistant Staphylococcus Aureus (MRSA) sinusitis encountered by the study author over a 36-month period found that community-acquired MRSA sinusitis can be very adequately treated on an outpatient basis with culture-directed oral and topical antibiotics.

4. Tissue Model and Preliminary Analysis of Microdebriders Used in Functional Endoscopic Sinus Surgery:Microdebriders, a surgical device designed to help surgeons to remove tissue with minimal damage to the surrounding mucsal tissue, have been gaining acceptance and use since its introduction in 1993. Researchers in Florida set out to develop a standardized in vitro tissue model for microdebrider comparison. The study compared two microdebriders using a soft-tissue and a firm-tissue model. They evaluated each microdebrider to determine what tissue type, blade type, and suction strength is most efficient. The researchers found their tissue model to represent a reliable and reproducible means of microdebrider comparison. A secondary analysis with a larger sample size is necessary to further validate the tissue model and to better define the trends that were observed in the study.

5. Papillary and Follicular Variant of Papillary Carcinoma of the Thyroid: Initial Presentation and Response to Therapy:There are numerous variants of papillary thyroid carcinoma; the two most common are pure papillary thyroid carcinoma (PTC) and follicular variant of papillary thyroid carcinoma (FVPTC). The clinical behavior of FVPTC is similar to that of PTC. There have been reports that the rates of pulmonary metastasis are higher in FVPTC, however, this has not been the case in other reports. Recent studies have suggested that there is no difference in survival, and even a trend toward lower rates of metastatic disease and better survival for FVPTC. A retrospective chart review of patients treated for PTC and FVPTC between 1996 and 1999 was conducted by scientists at Georgetown University to compare the clinical presentation and initial response to therapy in patients presenting with PTC and FVPTC.

6. Prognostic Significance of Stromal Eosinophilic Infiltration in Cancer of the Larynx:There are no exact parameters to determine the prognosis in laryngeal carcinoma. There are many studies investigating the relationship between tumor-associated tissue eosinophilia (TATE) and the prognosis of epithelial cancers however the findings are not uniform, but high-grade TATE tends to be associated with a good prognosis. In laryngeal cancer, reports of possible role of TATE on prognosis are controversial. Turkish researchers conducted a prospective case series to investigate prevalence and possible role of TATE as a prognostic factor in laryngeal squamous cell cancer.

7. Evaluation of Botulinum Toxin A in Treatment of Tinnitus:Botulinum toxin A is a known toxin whose full range of therapeutic benefits is still being discovered. With botulinum toxin A having proven benefit in disease processes via blockage of autonomic pathways, and a significant aspect of tinnitus believed to be effected via the autonomic pathway, the question arises whether botulinum toxin A could possibly impact the perception of tinnitus. California researchers developed a Double-blinded, prospective clinical study to explore the potential benefits of botulinum toxin A in improving subjective tinnitus.

8. Etiologic Diagnosis of Sensorineural Hearing Loss in Adults:Adult-onset hearing loss is likely the result of acquired or genetic causes or of the combination of genetic and acquired factors. The main objective of a prospective cohort study conducted at the University if Miami was to determine the etiology of sensorineural hearing loss in a group of patients with adult-onset hearing loss when there is no obvious cause determined by the patient's medical history and physical examination.

9. Preoperative Antibiotic and Steroid Therapy and Hearing Loss Caused by Semicircular Canal Transection in Pseudomonas Otitis Media:The transmission of infectious agents due to medical interference of a semicircular canal is one of the most feared complications of temporal bone surgery, primarily because of its attendant deafness and dizziness. Surgeons commonly administer antibiotics or steroids to patients found to have a semicircular canal fistula during mastoidectomy for chronic pus forming otitis media. Scientists in Florida conducted an experiment to determine whether preoperative administration of antibiotics and corticosteroids can decrease the severity of hearing loss with semicircular canal transection in a guinea pig model of Pseudomonas aeruginosa otitis media.

10. Deep Neck Infection in Diabetic Patients: Comparison of Clinical Picture and Outcomes with Nondiabetic Patients:Diabetes mellitus, or type 2 diabetes, is recognized as the most common associated systemic disease in deep neck infections. Patients with deep neck infection who have this disorder usually display a unique clinical picture in comparison with those without diabetes mellitus and therefore, should be treated in a different way. In order to determine appropriate treatment methods when dealing with such cases in the future, researchers in Taiwan compared the difference in the clinical picture and outcomes between diabetic and nondiabetic patients with deep neck infections. Patients with diabetes mellitus were compared with patients without diabetes mellitus in demography, etiology, bacteriology, treatment, duration of hospital stay, complications, and outcome.

These, and 13 other research findings are available in the June 2005 edition of Otolaryngology—Head and Neck Surgery.