Odontogenic sinusitis: a case series studying diagnosis and management.

BACKGROUND: Odontogenic sinusitis is a well-recognized, but understudied form of sinusitis. Odontogenic sinusitis requires unique diagnostic criteria and a treatment regimen that differs from non-odontogenic sinusitis. The purpose of this article is to present a case series of patients with odontogenic sinusitis in order to clarify key disease characteristics and management techniques. METHODS: Retrospective case series of 55 patients with odontogenic sinusitis. Each patient underwent chart and imaging review to analyze demographic factors, diagnostic criteria, clinical course, and management. RESULTS: Fifty-five patients were identified retrospectively. Forty-four were diagnosed at initial visit. Twenty-eight (64%) of these patients were diagnosed by computed tomography (CT) scan showing dental pathology, 11 (25%) by known temporal relationship to a dental procedure, and 5 (11%) by presentation with oral-antral fistula. Only 65% of radiology reports for all patients mentioned dental pathology. Overall, 21 (38%) patients had disease resolution. Of these, 7 (33%) resolved with endoscopic sinus surgery (ESS) alone, 7 (33%) resolved with concurrent ESS and dental surgery, 2 (10%) resolved with dental surgery alone, 2 (10%) resolved with ESS after failing dental surgery, 2 (10%) resolved with medical management alone, and 1 (5%) resolved with medical management after failing dental surgery. Forty-six (84%) patients had unilateral odontogenic sinusitis. The Lund-Mackay score for all patients was (mean ± standard deviation [SD]) 4.0 ± 3.2. CONCLUSION: Odontogenic sinusitis is often misdiagnosed. Radiology reports commonly do not mention dental pathology. Management of odontogenic sinusitis needs to be tailored to each individual patient and involves varying combinations of medical management, dental surgery, and ESS.

Attitudes toward professionalism education in Otolaryngology-Head and Neck Surgery residency programs.

OBJECTIVES/HYPOTHESIS: Resident professionalism development is important for physician training and patient care. Meaningful professionalism curriculum requires collaboration between learners and educators. We aimed to better understand attitudes of Otolaryngology-Head and Neck Surgery (OHNS) program directors (PDs) and residents toward professionalism education. STUDY DESIGN: Prospective survey. METHODS: We identified contemporary methods of professionalism evaluation and education and formulated questions to assess attitudes toward professionalism education. Surveys were electronically distributed to 104 PDs who were asked to forward a separate survey to residents. RESULTS: The resident survey was completed by 110 OHNS residents, and the PD survey was completed by 33 OHNS PDs. The majority of residents (78%) and faculty (84%) believed professionalism could be taught. Role modeling (93%) and morbidity and mortality conference (90%) were the most common methods of education. Faculty questionnaires (100%) and nursing/ancillary staff questionnaires (93%) were the most common methods of resident evaluation. The majority of residents considered faculty mentoring (66%) and small group discussions (56%) to be useful methods for teaching professionalism, whereas only 14% considered formal lectures useful. Residents valued questionnaires by faculty (98%), medical staff (97%), and patients (94%) for professionalism evaluation. CONCLUSION: We are the first to study OHNS residents and PDs attitudes toward professionalism evaluation and education. Residents value mentoring programs and small group sessions rather than formal didactics and value evaluation from multiple sources. Programs should consider incorporating these specific educational and evaluative methods into their professionalism curricula. LEVEL OF EVIDENCE: N/A.

Subdural hematoma--a rare complication of removal of osseointegrated auricular prosthesis retention system.

Periauricular osseointegrated prosthesis retention systems have been proven safe and effective in the management of microtia. Intracranial hemorrhage has been previously reported with implantation but is rare. We report a case of subdural hemorrhage following removal of an auricular prosthesis implant system. This case highlights the role of imaging, surgical technique, and neurosurgical support in prevention and management of intracranial hemorrhage associated with osseointegrated device removal.

Recovery of vocal fold immobility following isolated patent ductus arteriosus ligation.

OBJECTIVE: Identify laryngoscopic and functional outcomes of infants with vocal fold immobility (VFI) following patent ductus arteriosus (PDA) ligation and identify predictors of recovery. METHODS: Retrospective review of patients with VFI following PDA ligation from 2001 to 2012 at a single institution. Inclusion criteria were: (1) PDA ligation as only cardiac surgical procedure; (2) left VFI documented by laryngoscopy; (3) minimum follow up 120 days, with at least 2 laryngoscopies performed. Resolution of VFI was determined at follow-up laryngoscopy. Univariate logistic regression models were used to identify variables associated with VFI recovery. RESULTS: 66 subjects were included with median follow up of 3.0 (± 2.1) years. The mean gestational age was 24.5 ± 1.4 weeks, mean birth weight 673 ± 167 g, and mean age at procedure was 18.6 ± 14.3 days. Patients presented with respiratory symptoms (39%), dysphonia (78%) and dysphagia (55%). Resolution of VFI was observed in 2/66 (3%) patients. Recovery was documented at 20 days and 11 months respectively. Respiratory symptoms, dysphagia, and dysphonia persisted at last follow up in 11%, 47%, and 20% of patients. CONCLUSIONS: VFI associated with ligation of the ductus arteriosus has a low rate of recovery. Clinical symptoms frequently persist, and as such regular follow-up by otolaryngologists to mitigate morbidity is indicated.

Operationalizing professionalism: a meaningful and practical integration for resident education.

OBJECTIVES/HYPOTHESIS: Review contemporary definitions of professionalism and apply them to resident evaluation and education. DATA SOURCES: Review of PubMed, Medline, and Google Scholar. REVIEW METHODS: Review of articles and bibliographies from 1980 to 2012 for professionalism definitions, evaluation, and education in resident training was performed. RESULTS: Our initial search returned 291 articles. Sixty-seven articles were included in the final review. Definitions of professionalism often focused on attitudes and traits such as honesty, altruism, self-reflection, reliability, and respect for others. The operationalization of such abstract definitions is challenging as they are subject to variable interpretations when translated into measurable behaviors. Despite the challenges, specific behavioral benchmarks can be developed and utilized for evaluation with available methods including patient/nurse surveys, faculty observation, objective structured clinical exams (OSCE), ethical reasoning tests, and completion of administrative tasks. Curriculums have often been lecture-based, limiting the ability to transmit professional values and behaviors. Professionalism is taught most effectively through multiple modalities including mentorship, faculty role modeling, self-reflection, and resident professionalism portfolios. For professionalism evaluation and education to be effective, the curriculum should be developed as a collaborative effort between residents and faculty. CONCLUSIONS: Professionalism training requires practical, behavior-based definitions of professional conduct. Once professional expectations are defined, multiple methods should be used to comprehensively evaluate the learner. Professionalism curriculums must be interactive and promote development through a variety of methods with the goal to improve resident performance in this critical core competency.

Pediatric exposure to choking hazards is associated with parental knowledge of choking hazards.

OBJECTIVE: To evaluate parental knowledge regarding household food and non-food choking hazards. DESIGN: Cross Sectional Survey. SETTING: Tertiary Care Children's Hospital. PARTICIPANTS: Parents presenting to a Pediatric Otolaryngology Clinic with a child <4 years old. METHODS: Parental survey asking which choking hazard foods (CHF) they allow their child to eat, previous instruction of CHF, knowledge of non-food choking hazards, and their knowledge sources. STATISTICS: adjusted odds ratios (AOR) and logistic regressions. RESULTS: 492 respondents. Adjusted for significant covariates associations between correct knowledge of CHF and correct parents actions of disallowing CHF: fruit chunks (prior instruction=42%; correct action=25%; AOR=3.51; P<0.0001), hot dogs (59%; 28%; 1.75; 0.0178), raw vegetables (41%; 47%; 1.28; 0.198) popcorn (67%; 49% 2.64; <0.0001), whole grapes (68%; 51%; 2.2; <0.0001), nuts (73%; 66%; 2.47; <0.0001), chunks of peanut butter (45%; 79%; 2.55; 0.0003), sticky candy (79%; 80%; 2.16; <0.0033), gum (72%; 84%; 1.75; 0.028), seeds (65%; 87%; 1.4; 0.247), 76% always supervise meals, 57% always cut food, 62% know CPR. KNOWLEDGE OF NON-FOOD HAZARDS: Coins (97%), marbles (94%), small batteries (93%), small toy parts (93%), dice (92%), pen caps (92%), safety pins (85%), balloons (84%), syringes (40%). Sources of choking hazard knowledge: physicians (67%), family/friends (52%), books/magazines (40%), and the Internet (25%). CONCLUSIONS: Parental knowledge of CHF is incomplete. The consumption of CHF in children under 4 is significantly associated with decreased parental knowledge. Therefore, more parental education is needed.