Health Literacy and Web-Based Audiovisual Multimedia in Pituitary and Endoscopic Skull Base Surgery.

Introduction The internet presents a rich milieu of multimedia options relating to pituitary and endoscopic skull base surgery (ESBS). Misinformation can create discordance between patient and provider expectations. The purpose of this study is to analyze the understandability and actionability of available ESBS and pituitary surgery audiovisual information on YouTube and Google. Methods The top 50 videos generated by searching "pituitary surgery/transsphenoidal surgery" and "endoscopic skull base surgery" in both YouTube and Google were sorted by relevance. Two independent reviewers evaluated each for understandability and actionability based on the Patient Education Materials Assessment Tool for audiovisual material (PEMAT-A/V). Source, authorship, audience, and education/advertisement variables were collected. Chi-square test followed by univariate and multivariate regression analyses assessed the association between these variables and quality. Results A total of 85 videos (52 YouTube and 33 Google) met inclusion criteria for analysis. There was no significant difference in the presence of the aforementioned variables between YouTube and Google ( p < 0.05). Also, 72% of videos targeted patients and 28% targeted surgeons. Academic institutions uploaded 58% of videos. Surgeon-targeted videos were more educational ( p = 0.01) and patient-targeted videos involved more advertisement ( p = 0.01). Understandability and actionability scores were below the 70% threshold for both YouTube (65 ± 15, 38 ± 33, p = 0.65) and Google (66 ± 12, 38 ± 26, p = 0.94). Patient-targeted videos ( p = 0.002) were more understandable, while surgeon- ( p < 0.001) and education-focused videos ( p < 0.001) were more actionable. Conclusion Understandability and actionability of YouTube and Google audiovisual patient information on ESBS and pituitary surgery is poor. Consideration should be given to the formation of a standardized patient information resource.

Pathologic analysis of routine tonsillectomy and adenoidectomy specimens.

OBJECTIVES: Recent literature has suggested that histopathologic analysis of routine tonsillectomy and adenoidectomy (T&A) specimens may be unnecessary. This study investigates T&A specimen handling practices in the United States between 1989 and 1999. METHODS: Surveys were sent to 4715 members of the American Academy of Otolaryngology. Surveys assessed practice type, pathologic processing practices (full, gross, no pathology), and reasons for change. The authors also performed a retrospective analysis of 1583 pediatric T&A specimens for evidence of occult malignancy. RESULTS: Practice types were 80% private, 12% academic, 6% salaried, and 2% military. Chi squared analysis revealed a significant increase (P < 0.001) in respondents ordering "gross only" and "no pathology." The retrospective analysis found no occult malignancies. CONCLUSIONS: There is a statistically significant increase in the number of otolaryngologists sending routine T&A specimens for "gross only" and "no pathology." There was no correlation between the type of practice and changes in pathologic analysis performed.

Management of the cleft palate.

Oral clefts are among the most common of all birth defects. The exact etiology of palatal clefting is unclear, however, it is believed to be a multifactorial disruption of embryologic morphogenesis. Evaluation of these patients is complex and requires a thorough understanding of palatal anatomy and embryology. A team approach is used to addresses the varied anatomic, genetic, and psychosocial issues that surround these patients and their families. This article reviews the anatomy, embryology, epidemiology, diagnosis, and treatment of children with cleft palate.

Calvarial bone graft harvest: a new technique.

OBJECTIVE: This study evaluates the use of a new calvarial bone graft-harvesting device (BHD). STUDY DESIGN: A total of 18 calvarial bone grafts (CBGs) were harvested from 9 cadavers with the BHD. The recorded parameters included drilling time, graft harvest time, graft size, graft integrity, and violation of the calvarial inner table. Five CBGs were subsequently harvested in vivo and used for 2 nasal reconstructions and 3 orbital reconstructions. RESULTS: The CBG dimensions ranged from 1.25 to 2.5 cm in width and 3.0 to 16.0 cm in length. Graft harvest time ranged from 5 minutes, 55 seconds to 25 minutes, 30 seconds (mean 13 minutes, 7 seconds). There were no fractured grafts. The cadaveric inner table was violated twice with a cutting burr, and 1 dural exposure occurred in the clinical study. CONCLUSION: Although caution must be used with all CBGs, the BHD appears to be safe and more efficient than osteotomes or oscillating saws.

Management of nasal fractures.

The nasal bones are the most commonly fractured bones in the body. Accurate diagnosis and appropriate surgical intervention are key in the management of nasal fractures. While these injuries are not life-threatening, mismanagement of nasal fractures can lead to both aesthetic and functional deformities. A thorough history and careful physical examination are adequate for the diagnosis of nasal fractures. Literature in the field does not support the use of x-ray films to aid in the diagnosis. The majority of injuries are seen after significant edema becomes present and cannot be accurately reduced at that time. Therefore, with the exception of grossly displaced fractures, open fractures, and septal hematomas, most nasal fractures should be definitively treated after 3 to 10 days once swelling has resolved. This article will review pertinent nasal anatomic structure, pathophysiological characteristics of nasal fractures, diagnostic techniques, treatment modalities, and common controversies associated with nasal fractures.

Zygoma complex fractures.

The zygomaticomaxillary complex (ZMC) has integral structure and function in the bony skeleton of the face. The prominent convex shape of the ZMC makes it particularly vulnerable to injury. Facial trauma can result in fractures limited to a single buttress of the ZMC but more commonly results in a tetrapod fracture involving all four buttresses. Accurate clinical diagnosis is based on a thorough head and neck examination with ophthalmologic consultation when indicated. Computed tomography is the gold standard for confirmation of the clinical diagnosis and for surgical planning. Multiple surgical approaches to the ZMC are discussed, including the hemicoronal approach to the zygomatic arch, the transconjunctival and subciliary approaches to the orbital rim, and the sublabial approach to the zygomaticomaxillary suture line. The topics of one-, two-, or three-point fixation, as well as plate versus wire fixation, are discussed. Finally, the diagnosis and management of complications such as diplopia and ectropion are discussed.

Intractable epistaxis: transantral ligation vs. embolization: efficacy review and cost analysis.

After posterior nasal packing, the two most common therapies for intractable epistaxis are transantral ligation of the internal maxillary artery and percutaneous embolization of the distal internal maxillary artery. However, optimal management of intractable posterior epistaxis remains controversial. We retrospectively reviewed the charts of 21 patients treated for intractable epistaxis and obtained data on presentation, risk factors, treatment, success rates, complications, and cost. Twelve patients received percutaneous embolization, five underwent transantral ligation, and four required both. The success rates for transantral ligation and percutaneous embolization were 89% and 94%, respectively. No mortality or serious morbidity occurred with either technique. A cost comparison revealed that transantral ligation was moderately less expensive than percutaneous embolization ($5941 vs. $6783). Although some authors advocate transantral ligation or percutaneous embolization as the procedure of choice for intractable epistaxis, a direct comparison of efficacy and cost reveals that they are comparable procedures with specific strengths and weaknesses. We present our experience and a review of the literature, highlighting the indications and advantages of each technique. We conclude that the choice of treatment modality should be based on the benefits of each procedure as it pertains to the specific needs of the individual patient.

Intraoral ultrasound evaluation of peritonsillar abscess.

Peritonsillar cellulitis and peritonsillar abscess are similar clinical entities with markedly different methods of treatment. Therefore, accurate diagnosis is paramount to appropriate treatment. This pilot study was designed to evaluate the sensitivity and specificity of intraoral ultrasound as a noninvasive method of differentiating abscess from cellulitis. Sixteen consecutive patients suspected of having peritonsillar abscess were prospectively evaluated with intraoral ultrasound. The results were confirmed with imaging or surgical drainage. Correct diagnoses were made in 9 (90%) of 10 abscesses and in 5 (83%) of 6 cases of cellulitis. Our results suggest that, while there is a learning curve for intraoral ultrasound, it is an accurate, noninvasive, and inexpensive tool to differentiate abscess from cellulitis. We believe that this will be a clinically useful technique in the future.

Multireceptor activation of the pulmonary chemoreflex.

Schertel et al. (J. Appl. Physiol. 61: 1237-1240, 1984) reported that pulmonary C fibers initiate the prompt apnea followed by rapid shallow breathing evoked by pulmonary arterial injections of capsaicin. However, doubt has remained as to whether these changes in breathing pattern are induced exclusively by direct stimulation of pulmonary C fibers or whether secondary stimulation of slowly adapting pulmonary stretch receptors by capsaicin-induced reflex bronchoconstriction also contributes to the response. To determine the contribution of this secondary mechanism to changes in breathing pattern, we evoked the pulmonary chemoreflex in spontaneously breathing dogs before and after blockade of muscarinic receptors with atropine. Right atrial injections of capsaicin before the administration of atropine induced a classical pulmonary chemoreflex, i.e., apnea, hypotension, and bradycardia followed by rapid shallow breathing and bronchoconstriction. After atropine, all components of the pulmonary chemoreflex induced by right atrial injections of capsaicin remained intact except bronchoconstriction. However, the absolute magnitude of the change in each component of the reflex except apnea was significantly attenuated. We conclude that the classic pulmonary chemoreflex is a complex phenomenon initiated primarily by stimulation of pulmonary C fibers but significantly influenced by secondary stimulation of slowly adapting pulmonary stretch receptors.

Respiratory reflexes in the anesthetized miniature swine.

To assess the suitability of the miniature swine for studies of the control of breathing we evaluated the response of these animals to commonly used respiratory stimuli. Hanford miniature pigs were anesthetized with alpha chloralose and allowed to breathe spontaneously. Rapid lung inflations induced a prolonged expiratory pause proportional to load. Mechanical stimulation of the upper airways induced coughing. Central venous injections of C-fiber stimulants produced bradycardia, hypotension with apnea and/or rapid shallow breathing. CO2 rebreathing increased ventilation primarily through an increase in tidal volume; inspiratory time was not changed. Bilateral vagotomy caused a slower, deeper pattern of breathing, and significantly attenuated the ventilatory response to CO2; all other reflexes were abolished by vagotomy. Cooling the vagus nerves caused reversible blockade of the cough, inflation and C-fiber mediated reflexes in that order. We conclude that the pig can serve as a useful animal in which to study the control of breathing.