American Academy of Otolaryngology, Sept. 29 Oct. 2, 2013
The annual meeting of the American Academy of Otolaryngology (AAO) - Head and Neck Surgery was held from Sept. 29 to Oct. 2 in Vancouver, Canada, and attracted more than 8,000 participants from around the world, including otolaryngologists, medical experts, allied health professionals, and administrators. Presentations focused on the latest advances in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck.
In one study, Amanda Stapleton, M.D., of the University of Pittsburgh, and colleagues found that functional nasal surgery (septoplasty and functional septorhinoplasty) to correct nasal airway obstruction leads to a statistically significant improvement in a patient's sleep quality as assessed by validated outcome measurements.
"The degree of improvement in sleep quality with nasal airway surgery correlated with the severity of the patient's nasal obstruction preoperatively. The degree of improvement in sleep quality also correlated with the degree of improvement in their nasal obstruction after surgery," said Stapleton. "This study provides additional scientific evidence that by correcting a patient's nasal airway obstruction surgically we can positively impact a patient's quality of sleep. This gives the ENT surgeon additional tools to positively impact a patient's quality of life and quality of sleep."
In an effort to evaluate the safety of minimally invasive video-assisted thyroidectomies (MIVATs), Jennifer White, of the Medical College of Georgia in Augusta, and colleagues compared the outcomes of MIVAT patients directly to the outcomes of patients undergoing conventional thyroid procedures.
"What we found was that, by and large, the majority of the MIVAT patients were younger, more likely to be female, more likely to be managed on an outpatient basis, and more likely to undergo unilateral surgery. The rate of malignancy was equivalent in the two surgical groups," said White. "The overall complication rate for MIVAT was significantly lower at 6.5 percent, versus 18.5 percent in the conventional group. Both the rate of temporary hypocalcemia and recurrent laryngeal nerve dysfunction were lower in the MIVAT group. There was no significant difference in the incidence of cellulitis between the two surgical groups."
The investigators were not able to evaluate the influence of surgical approach on hematoma in this population due to the low rate of occurrence in the conventional thyroidectomy group and the absence of any occurrences in the MIVAT group. In addition, the investigators found no cases of permanent recurrent laryngeal nerve dysfunction or permanent hypocalcemia in the MIVAT group. According to White, given the small incision length (with the mean being 2.3 cm), good cosmetic results can be anticipated with the MIVAT approach.
"We demonstrated the safety of MIVAT in the largest series of North American outpatients. In these carefully selected patients, the rates of postoperative hypocalcemia and recurrent laryngeal nerve dysfunction are as good as or better than those of conventional thyroidectomy," White added.
In another study, R. June Lin, M.B.B.Ch., and colleagues found that the use of intraoperative peritonsillar local anesthetic infiltration or topical local anesthetic application to the tonsillar fossa improves postoperative pain control.
"The effect was more consistent in patients who underwent tonsillectomy alone. Bupivacaine, a type of long-acting local anesthetic, as the agent of choice produced more consistent pain control up to 24 hours after surgery. Peritonsillar local anesthetic infiltration was a relatively safe procedure with no major morbidity or mortality reported," said Lin. "Routine intraoperative use of local anesthetics, whether infiltrative or topical, is effective in reducing pain following tonsillectomy."
According to Lin, the current AAO guideline on tonsillectomy recommends one single intraoperative dose of dexamethasone to reduce postoperative nausea and vomiting. The evidence supporting this was based on randomized controlled trials and a systemic review.
"We feel that the data included in our review are comparable to the evidence supporting the use of dexamethasone," Lin added. "Thus routine intraoperative use of local anesthetics should be considered to be included in future tonsillectomy guidelines."
Paul Mick, M.D., of the University of Toronto, and colleagues conducted a cross sectional analysis of data from the National Health and Nutrition Examination Survey to determine whether hearing impairment was associated with social isolation in persons aged 60 to 84 years. The investigators also sought to determine if the effect was modified by age and sex. A participant was considered "isolated" if they met at least two of the following criteria: no romantic partner or spouse, no close friends, no one to provide emotional support, and no one to provide financial support.
"For women in their sixties, for every 25-decibel reduction in hearing, the odds of social isolation increased 3.5 times. Sexagenarian women had fewer sources of emotional and financial support. Hearing loss was not associated with social isolation in other age and sex groups," said Mick. "We conclude that for women in their sixties, hearing loss strongly predicts social isolation. Odds ratios in other age and sex groups did not reach statistical significance and further research is needed to explain the age and sex interaction."
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