Cost Analysis of Channeled, Distal Chip Laryngoscope for In-office Laryngopharyngeal Biopsies.

OBJECTIVE: Given that financial considerations play an increasingly prominent role in clinical decision-making, we sought (1) to determine the cost-effectiveness of in-office biopsy for the patient, the provider, and the health-care system, and (2) to determine the diagnostic accuracy of in-office biopsy. STUDY DESIGN: Retrospective, financial analyses were performed. METHODS: Patients who underwent in-office (Current Procedural Terminology Code 31576) or operative biopsy (CPT Code 31535) for laryngopharyngeal lesions were included. Two financial analyses were performed: (1) the average cost of operating room (OR) versus in-office biopsy was calculated, and (2) a break-even analysis was calculated to determine the cost-effectiveness of in-office biopsy for the provider. In addition, the diagnostic accuracy of in-office biopsies and need for additional biopsies or procedures was recorded. RESULTS: Of the 48 patients included in the current study, 28 underwent in-office biopsy. A pathologic sample was obtained in 26 of 28 (92.9%) biopsies performed in the office. Of these patients, 16 avoided subsequent OR procedures. The average per patient cost was $7000 and $11,000 for in-office and OR biopsy, respectively. Break-even analysis demonstrated that the provider could achieve a profit 2 years after purchase of the necessary equipment. CONCLUSION: In-office laryngopharyngeal biopsies are accurate and, overall, more cost-effective than OR biopsies. Purchase of the channeled, distal chip laryngoscope and biopsy forceps to perform in-office biopsies can be profitable for a provider with a videolaryngoscopy tower. In-office biopsy should be considered the initial diagnostic tool for suspected laryngopharyngeal malignancies noted on videolaryngoscopy.

[Radio-induced oral and pharyngeal mucositis: management updates]. / Mucites radio-induites buccopharyngées : actualités sur la prise en charge.

Mucositis is a major side effect induced by radiotherapy and/or chemotherapy of head and neck cancer. This toxicity impacts patient's quality of life and may compromise optimal treatments. Pathophysiology, risk factors, incidence and consequences of mucositis will be discussed in this review. Its management remains principally supportive (pain medication and nutritional support); however, in recent years several studies have revealed that the use of low level energy laser is particularly useful in the prevention and treatment of chemo- and radio-induced mucositis.

[The management of pharyngocutaneous fistulas after total laryngectomy and the factors affecting their incidence]. / Total larenjektomi sonrasi farengokutanöz fistül gelisimini etkileyen faktörler ve fistül tedavisine yaklasimimiz.

OBJECTIVES: This study sought to determine the incidence and etiologic factors of pharyngocutaneous fistulas occurring after total laryngectomy. PATIENTS AND METHODS: A total of 138 patients (136 males, 2 females; mean age 59.5 years; range 36 to 83 years) underwent total laryngectomy for squamous cell carcinoma. Risk factors and the management of pharyngocutaneous fistulas were assessed together with durations in relation to fistula occurrence, oral feeding, hospitalization, and healing. RESULTS: Pharyngocutaneous fistulas were seen in 37 patients (26.8%). Significantly high rates of fistula occurrence were detected in patients with alcohol consumption (p=0.032), and in those who underwent partial pharyngectomy (p=0.058) or bilateral neck dissection (p=0.049) along with total laryngectomy. The occurrence of fistulas was significantly associated with prolonged lengths of time for oral feeding and hospital stay (p<0.001). Fistulas were repaired surgically in 24.3% of patients, in whom the time to oral feeding was significantly shorter than that of patients who received local wound care (p=0.03). CONCLUSION: Our data show that early surgical intervention is more beneficial in preventing further morbidity associated with pharyngocutaneous fistulas.

The validity and reliability of the reflux finding score (RFS).

BACKGROUND: The evaluation of medical and surgical outcomes relies on methods of accurately quantifying treatment results. Currently, there is no validated instrument whose purpose is to document the physical findings and severity of laryngopharyngeal reflux (LPR). OBJECTIVE: To evaluate the validity and reliability of the reflux finding score (RFS). METHODS: Forty patients with LPR confirmed by double-probe pH monitoring were evaluated pretreatment and 2, 4, and 6 months after treatment. The RFS was documented for each patient at each visit. For test-retest intraobserver reliability assessment, a blinded laryngologist determined the RFS on two separate occasions. To evaluate interobserver reliability, the RFS was determined by two different blinded laryngologists. RESULTS: The mean age of the cohort was 50 years (+/- 12 standard deviation [SD]). Seventy-three percent were women. The RFS at entry was 11.5 (+/- 5.2 SD). This score improved to 9.3 (+/- 4.7 SD) at 2 months, 7.3 (+/- 5.5 SD) at 4 months, and 6.1 (+/- 5.2 SD) at 6 months of treatment (P <.001 with trend). The mean RFS for laryngologist no. 1 was 10.8 (+/- 4.1 SD) at the initial screening and 10.8 (+/- 4.0 SD) at the repeat evaluation (r = 0.95, P <.001). The mean RFS for laryngologist no. 2 was 11.1 (+/- 3.8 SD) at the initial screening and 10.9 (+/- 3.7 SD) at the repeat evaluation (r = 0.95, P <.001). The correlation coefficient for interobserver variability was 0.90 (P <.001). CONCLUSIONS: The RFS accurately documents treatment efficacy in patients with LPR. It demonstrates excellent inter- and intraobserver reproducibility.

Reducing demand for physician visits through public education: a look at the pilot cold-and-flu campaign in London, Ontario.

OBJECTIVE: To estimate the effect of the Ontario Ministry of Health's pilot public-education campaign launched in London, Ont., on Jan. 15, 1994, to reduce the number of visits to physicians' offices because of cold and flu symptoms. DESIGN: Before-after comparison of claims to the Ontario Health Insurance Plan. OUTCOME MEASURES: Physician billings for visits because of cold and flu symptoms and total billings for all types of visits during the 2 months before and after the start of the campaign, and during the same two periods in the previous year, in London and in the rest of Ontario. RESULTS: By the time the campaign was started, much of the cold and flu season was already over for that winter. Still, the decrease in billings for visits because of cold and flu symptoms in the 2 months after the campaign was introduced was 6% greater in London than in the rest of Ontario. There was virtually no difference in total billings between London and the rest of the province during the same period. CONCLUSION: The modest relative reduction in physician billings for visits because of cold or flu symptoms in London following the introduction of the public-education campaign may have been due to the intervention as well as to other factors.

Modern assessment of tonsils and adenoids.

Modern assessment of the tonsils and adenoids is based on an appreciation of new concepts pertaining to the pathogenesis of tonsil and adenoid disease. Recognition of the emergence of beta-lactamase-producing and encapsulated anaerobic bacteria in the tonsils and adenoids should lead to a reconsideration of present therapeutic recommendations for antibiotic therapy in infectious tonsil and adenoid disease. The performance of a precise history, use of a standardized physical examination, and judicious use of laboratory evaluation are all necessary for appropriate patient management and improved communication between the pediatrician and otolaryngologist. Thus, appropriate recommendation for tonsillectomy and adenoidectomy will enhance their benefits, and the result will be happier and healthier children.

Twenty-four-hour monitoring of esophagopharyngeal pH in outpatients. Use of four-channel pH probe and computerized system.

A 24 hour computerized four-channel esophagopharyngeal pH system is described. Using a 1.5 mm diameter esophageal probe containing four separate antimony-tipped electrodes and a small patient-worn digital recording computer, inpatient and outpatient studies are performed in the physiologic environment of the patient's workplace or home. Stored pH data in the computer are teletransmitted from satellite esophageal pH laboratories to a central esophageal pH laboratory for analysis, scoring, printout, and storage. Satellite laboratories located in hospitals, clinics, and physicians' offices use a minimum of equipment and obtain a quality computer-based printout. This preserves patient-physician relationships in the home environment and is cost-effective. Four case reports are presented identifying the advantages derived from the four-channel system localizing and quantifying the extent of cephalad transport of refluxed upper gastrointestinal content. The system has unique clinical and research potential in all age groups in such disparate problems as sleep apnea, laryngitis, bradycardia and cardiac irregularities, and aspiration pneumonia and pulmonary abscess.