Highlights
Highlights from the Current Issue: January 2015
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eginning with the current issue of Otolaryngology– Head and Neck Surgery, I am going to highlight selected articles from manuscripts published this month that might be of particular interest to our readers. These articles are also listed on the front cover of the journal. In this January 2015 issue, I would like to feature 5 papers that span a broad range of topics in our specialty and draw the attention of our readers to their interesting outcomes. First, Valdez and colleagues1 report that a majority of otolaryngologists who responded to a survey inquiring about their perioperative antibiotic use continue to routinely prescribe antibiotics around the time of surgery, despite their recognition that for many of the procedures, insufficient evidence exists to support this use. The authors specifically comment on antibiotic use with tonsillectomy, which continues to be common practice, despite the recommendations of the recent AAO-HNSF Clinical Practice Guidelines recommending against their use.2 Valdez et al1 conclude that additional research is necessary to further characterize the appropriate perioperative use of antibiotics in procedures of the head and neck especially since there does not appear to be a uniform application in surgery. In a second paper, Kyle and colleagues3 present a systematic review of the effect of aspirin on hearing loss, which is clinically relevant given the common use of daily aspirin therapy for its potential cardioprotective effects. Using selective search criteria, the authors identified 37 criterion-meeting studies examining the effects of various doses of aspirin on the change in hearing thresholds. Results of the review demonstrate that doses of aspirin in excess of 1.95 g daily are associated with worse audiometric results and that these effects appear to be both dose dependent and reversible. The authors also report that there have been no long-term trials of lower doses, including doses as low as 81 mg daily, which can confirm aspirin’s safety in hearing levels over time. Based on the demonstration of aspirin’s adverse effect at higher doses, as well as its frequent long-term use in many patients, Kyle et al3 caution that the potential risks for hearing loss with the sustained use of aspirin remain a concern. They also recommend additional research to better estimate its safety. Saliba and colleagues4 next examine the effectiveness of endolymphatic duct blockage (EDB) as a surgical procedure to treat and control the symptoms of Me´nie`re’s disease. The authors present data from a study in which EDB is compared with endolymphatic sac decompression (ESD) on the outcome measures of vertigo, tinnitus, and audiometric findings. They report that when compared with ESD, EDB
Otolaryngology– Head and Neck Surgery 2015, Vol. 152(1) 3–4 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599814558829 http://otojournal.org
results in better control of vertigo and tinnitus with equivalent results in hearing preservation, with no significant complications reported in 35 patients. Saliba et al4 discuss this procedure as a surgical option in the treatment of patients with refractory Me´nie`re’s disease. In the next paper, Sommer and associates5 examine the role of a low salicylate diet in the treatment of patients with aspirinexacerbated respiratory disease (AERD). They performed a crossover study in which patients with documented AERD were randomized to receive either a normal diet or one that was low in salicylate-containing foods. Results of this pilot study demonstrate that patients experienced fewer sinus-related symptoms and had improved appearance of their sinonasal mucosa with a low salicylate diet. Sommer et al5 discuss the implications of their study for future research and clinical practice. Finally, Roy and Smith6 discuss the important issue of surgical fires in laser laryngeal surgery. This area is of great concern to otolaryngologists since airway fires represent a significant potential hazard. Roy and Smith6 performed a surgical simulation in which an intubation mannequin was used to test different conditions of oxygen delivery (FiO2) and endotracheal tube cuff protection. Their findings demonstrate that at both 100% FiO2 and 40% FiO2, an immediate and sustained flame was created by a cuff strike with the laser, while at 29% FiO2, only a small, nonsustained flame was noted, and at room air, there was no fire. They also report that the use of wet pledgets alone does not provide absolute protection. Roy and Smith6 caution that endotracheal tube cuffs should be placed away from areas where inadvertent laser strikes can occur and that oxygen supplementation be kept to the minimum necessary. Please read these highlighted papers in their entirety to further explore the findings and discussion from the authors. 1
Temple University, Philadelphia, Pennsylvania, USA
Corresponding Author: John H. Krouse, MD, PhD, Temple University, 3440 North Broad Street, Kresge West #300, Philadelphia, PA 19140, USA. Email: [email protected]
A podcast for this article is available at http://otojournal.org. Scan this code with your phone to hear the podcast instantly.
4
Otolaryngology–Head and Neck Surgery 152(1)
In addition, I invite you to examine the other papers published in this January issue. John H. Krouse, MD, PhD Editor in Chief Temple University, Philadelphia, Pennsylvania, USA
References 1. Valdez TA, Marvin K, Bennett NJ, et al. Current trends in perioperative antibiotic use: a survey of otolaryngologists. Otolaryngol Head Neck Surg. 2015;152:63-66. 2. Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;144:S1-S30.
3. Kyle MG, Wang J, Shin JJ.Ubiquitous aspirin: a systematic review of its impact on sensorineural hearing loss. Otolaryngol Head Neck Surg. 2015;152:23-41. 4. Saliba I, Gabra N, Alzahrani M, et al. Endolymphatic duct blockage: randomized controlled trial of a novel surgical technique for Meniere’s disease treatment. Otolaryngol Head Neck Surg. 2015;152:122-129. 5. Sommer DD, Hoffbauer S, Au M, et al. Treatment of aspirin exacerbated respiratory disease with a low-salicylate diet: a pilot cross-over study. Otolaryngol Head Neck Surg. 2015;152: 42-47. 6. Roy S, Smith L.Surgical fires in laser laryngeal surgery: are we safe enough. Otolaryngol Head Neck Surg. 2015;152:67-72.
Highlights from the Current Issue: January 2015
B
eginning with the current issue of Otolaryngology– Head and Neck Surgery, I am going to highlight selected articles from manuscripts published this month that might be of particular interest to our readers. These articles are also listed on the front cover of the journal. In this January 2015 issue, I would like to feature 5 papers that span a broad range of topics in our specialty and draw the attention of our readers to their interesting outcomes. First, Valdez and colleagues1 report that a majority of otolaryngologists who responded to a survey inquiring about their perioperative antibiotic use continue to routinely prescribe antibiotics around the time of surgery, despite their recognition that for many of the procedures, insufficient evidence exists to support this use. The authors specifically comment on antibiotic use with tonsillectomy, which continues to be common practice, despite the recommendations of the recent AAO-HNSF Clinical Practice Guidelines recommending against their use.2 Valdez et al1 conclude that additional research is necessary to further characterize the appropriate perioperative use of antibiotics in procedures of the head and neck especially since there does not appear to be a uniform application in surgery. In a second paper, Kyle and colleagues3 present a systematic review of the effect of aspirin on hearing loss, which is clinically relevant given the common use of daily aspirin therapy for its potential cardioprotective effects. Using selective search criteria, the authors identified 37 criterion-meeting studies examining the effects of various doses of aspirin on the change in hearing thresholds. Results of the review demonstrate that doses of aspirin in excess of 1.95 g daily are associated with worse audiometric results and that these effects appear to be both dose dependent and reversible. The authors also report that there have been no long-term trials of lower doses, including doses as low as 81 mg daily, which can confirm aspirin’s safety in hearing levels over time. Based on the demonstration of aspirin’s adverse effect at higher doses, as well as its frequent long-term use in many patients, Kyle et al3 caution that the potential risks for hearing loss with the sustained use of aspirin remain a concern. They also recommend additional research to better estimate its safety. Saliba and colleagues4 next examine the effectiveness of endolymphatic duct blockage (EDB) as a surgical procedure to treat and control the symptoms of Me´nie`re’s disease. The authors present data from a study in which EDB is compared with endolymphatic sac decompression (ESD) on the outcome measures of vertigo, tinnitus, and audiometric findings. They report that when compared with ESD, EDB
Otolaryngology– Head and Neck Surgery 2015, Vol. 152(1) 3–4 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599814558829 http://otojournal.org
results in better control of vertigo and tinnitus with equivalent results in hearing preservation, with no significant complications reported in 35 patients. Saliba et al4 discuss this procedure as a surgical option in the treatment of patients with refractory Me´nie`re’s disease. In the next paper, Sommer and associates5 examine the role of a low salicylate diet in the treatment of patients with aspirinexacerbated respiratory disease (AERD). They performed a crossover study in which patients with documented AERD were randomized to receive either a normal diet or one that was low in salicylate-containing foods. Results of this pilot study demonstrate that patients experienced fewer sinus-related symptoms and had improved appearance of their sinonasal mucosa with a low salicylate diet. Sommer et al5 discuss the implications of their study for future research and clinical practice. Finally, Roy and Smith6 discuss the important issue of surgical fires in laser laryngeal surgery. This area is of great concern to otolaryngologists since airway fires represent a significant potential hazard. Roy and Smith6 performed a surgical simulation in which an intubation mannequin was used to test different conditions of oxygen delivery (FiO2) and endotracheal tube cuff protection. Their findings demonstrate that at both 100% FiO2 and 40% FiO2, an immediate and sustained flame was created by a cuff strike with the laser, while at 29% FiO2, only a small, nonsustained flame was noted, and at room air, there was no fire. They also report that the use of wet pledgets alone does not provide absolute protection. Roy and Smith6 caution that endotracheal tube cuffs should be placed away from areas where inadvertent laser strikes can occur and that oxygen supplementation be kept to the minimum necessary. Please read these highlighted papers in their entirety to further explore the findings and discussion from the authors. 1
Temple University, Philadelphia, Pennsylvania, USA
Corresponding Author: John H. Krouse, MD, PhD, Temple University, 3440 North Broad Street, Kresge West #300, Philadelphia, PA 19140, USA. Email: [email protected]
A podcast for this article is available at http://otojournal.org. Scan this code with your phone to hear the podcast instantly.
4
Otolaryngology–Head and Neck Surgery 152(1)
In addition, I invite you to examine the other papers published in this January issue. John H. Krouse, MD, PhD Editor in Chief Temple University, Philadelphia, Pennsylvania, USA
References 1. Valdez TA, Marvin K, Bennett NJ, et al. Current trends in perioperative antibiotic use: a survey of otolaryngologists. Otolaryngol Head Neck Surg. 2015;152:63-66. 2. Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;144:S1-S30.
3. Kyle MG, Wang J, Shin JJ.Ubiquitous aspirin: a systematic review of its impact on sensorineural hearing loss. Otolaryngol Head Neck Surg. 2015;152:23-41. 4. Saliba I, Gabra N, Alzahrani M, et al. Endolymphatic duct blockage: randomized controlled trial of a novel surgical technique for Meniere’s disease treatment. Otolaryngol Head Neck Surg. 2015;152:122-129. 5. Sommer DD, Hoffbauer S, Au M, et al. Treatment of aspirin exacerbated respiratory disease with a low-salicylate diet: a pilot cross-over study. Otolaryngol Head Neck Surg. 2015;152: 42-47. 6. Roy S, Smith L.Surgical fires in laser laryngeal surgery: are we safe enough. Otolaryngol Head Neck Surg. 2015;152:67-72.
