The Importance of Female Mentors and Safety in the Workplace to Female Otolaryngology Applicants When Creating Rank Lists.

OBJECTIVES: The aim of this research is to understand the importance of female career mentors, research mentors, co-residents, and program directors/chairs to current female otolaryngology residents when applying to residency. The importance of safety in the workplace was also investigated. METHODS: Surveys were sent via electronic mail to 119 programs, and program directors were asked to distribute them to female residents. Using the Likert scale, participants ranked the importance of various factors when creating a rank list, in particular, importance of safety in the workplace and importance of female mentors in various leadership positions. Demographic information, geographic location, LGBTQ identification, and fellowship plans were also collected. RESULTS: There were 62 participants nationally. Eighty-seven percent (n = 54) of participants stated that having at least 1 female attending and having female co-residents was "very important" or "important" when ranking programs. A number of respondents replied that having a female career development mentor (38.7% [n = 24] and 43.5% [n = 27]), female program director or chair (4.8% [n = 3] and 16.1% [n = 10]), and female research mentor (12.9% [n = 8] and 29% [n = 18]) was "very important" or "important," respectively. Ninety-three percent (n = 58) replied that feeling safe in their training environment was "very important" or "important." CONCLUSION: Having female mentors as well as safety in the workplace in residency is important to a vast majority of residents and applicants when creating a rank list. Programs with women in these roles may gain a disproportionate number of female residents because they may be more desirable places than those without women in these roles.

The Impact of Marital Status and Race in Obstructive Sleep Apnea.

OBJECTIVES: To examine the difference in survival of obstructive sleep apnea (OSA) based on marital status and race. METHODS: A single academic institution with data collection from 2005 to 2015. Patients with a diagnosis of OSA based on polysomnogram were abstracted from electronic medical records. Patients were classified as "married" or "unmarried." Race was self-reported as White, Black, Asian American, Hispanic/Latinx, Middle Eastern descent, or unrecorded and gathered from the electronic medical record. RESULTS: There were 6200 adults included. Of these, married patients composed 62.7% (n = 3890) of the patients. Patients were 51.3% White (n = 3182), 39.8% (n = 2467) were Black, and 8.9% (n = 551) were other/unrecorded. Married patients had better survival probabilities (p < .0001). Unmarried patients had 2.72 times the risk of death than those who were married (95% CI 1.78-4.20) when examining OSA survival. When examining survival of those on continuous positive airway pressure (CPAP) between married and unmarried patients, those who were unmarried had 2.00 (95% CI 1.58-2.54) times the risk of death than those who were married. Married Black patients demonstrated the best survival probabilities, followed by married White patients (p < .0001). Married patients had lower mean sleep efficiency than those that were unmarried (76.2% and 77.2%, respectively; p = .019). CONCLUSION: Married patients with OSA had increased survival compared to their single counterparts. Married Black patients had the highest survival.

Impact of a specialty trained billing team on an academic otolaryngology practice.

PURPOSE: To determine how the incorporation of specialty specific training for coders within a focused billing team affected revenue, efficiency, time to reimbursement, and physician satisfaction in an academic otolaryngology practice. MATERIALS AND METHODS: Our academic otolaryngology department recently implemented a new billing system, which incorporated additional training in otolaryngology surgical procedures for medical coders. A mixed model analysis of variance was used to compare billing outcomes for the 6 months before and 6 months after this new approach was initiated. The following metrics were analyzed: Current Procedural Terminology codes, total charges, time between services rendered and billing submission, and time to reimbursement. A survey of department physicians assessing satisfaction with the system was reviewed. RESULTS: There were 4087 Current Procedural Terminology codes included in the analysis. In comparing the periods before and after implementation of the new system, statistically significant decreases were found in the mean number of days to coding completion (19.3 to 12.0, respectively, p < 0.001), days to posting of charges (27.0 to 15.2, p < 0.001), days to final reimbursement (54.5 to 27.2, p < 0.001), and days to closure of form (179.2 to 76.6, p < 0.001). Physician satisfaction with communication and coder feedback increased from 36% to 64% after initiation of the new program. CONCLUSIONS: The implementation of additional specialty training for medical coders in the otolaryngology department of a large medical system was associated with improved revenue cycle efficiency. Additionally, this model appears to improve physician satisfaction and confidence with the coding system.

Study design considerations for sleep-disordered breathing devices.

None: In recent years, sleep-disordered breathing (SDB) has been recognized as a prevalent but under-diagnosed condition in adults and has prompted the need for new and better diagnostic and therapeutic options. To facilitate the development and availability of innovative, safe and effective SDB medical device technologies for patients in the United States, the US Food and Drug Administration collaborated with six SDB-related professional societies and a consumer advocacy organization to convene a public workshop focused on clinical investigations of SDB devices. Sleep medicine experts discussed appropriate definitions of terms used in the diagnosis and treatment of SDB, the use of home sleep testing versus polysomnography, clinical trial design issues in studying SDB devices, and current and future trends in digital health technologies for diagnosis and monitoring SDB. The panel's breadth of clinical expertise and experience across medical specialties provided useful and important insights regarding clinical trial designs for SDB devices.

Analysis of patient factors associated with 30-day mortality after tracheostomy.

OBJECTIVE: Mortality has been reported to be 22% to 45% in patients with a tracheostomy. To better counsel patients and families, we aimed to determine the effect of body mass index (BMI), socioeconomic status (SES), and the 17 conditions of the Charlson comorbidity index (CCI) on 30-day survival posttracheostomy. METHODS: This retrospective cohort study identified adult patients enrolled from our institution in the Global Tracheostomy Collaborative database from March 2014 to June 2015. Data collected included age, BMI, residential zip code, and comorbidities. Cox proportionate univariate and multivariate analyses were used to measure the impact of BMI, SES, and CCI variables with 30-day posttracheostomy survival. We used geocoding as a surrogate for patients' SES. We used Deyo's modification of the CCI, which utilized International Classification of Diseases, 9th Revision, codes to identify comorbidities. RESULTS: Of 326 tracheostomies identified, the 30-day mortality rate was 15.6%. No significant differences were noted in BMI or in any of the SES categories between survivors and nonsurvivors. CCI was significantly higher in the 30-day mortality group. Congestive heart failure (hazard ratio [HR] = 2.39), severe liver disease (HR = 3.15), and peripheral vascular disease (HR = 2.62) were found to significantly impact 30-day survival. CONCLUSION: Higher CCI and specifically severe liver disease, congestive heart failure, and peripheral vascular disease were associated with increased 30-day mortality posttracheostomy. No association was found between BMI or SES and 30-day survival. This study identified three comorbidities that independently affect mortality in tracheostomy patients, which should be discussed with patients and families before tracheostomy. LEVEL OF EVIDENCE: 3 Laryngoscope, 129:847-851, 2019.

Drug-Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study.

OBJECTIVE: To evaluate the association between findings of blinded reviews of preoperative drug-induced sleep endoscopy (DISE) examinations using the VOTE Classification and obstructive sleep apnea (OSA) surgical outcomes in a large multicenter, international cohort. METHODS: Retrospective, multi-center cohort study of adults without tonsillar hypertrophy who underwent pharyngeal surgery for OSA. The study included only participants without enlarged tonsils. Four independent reviewers performed blinded review of preoperative DISE videos using the VOTE Classification system and scoring of a primary structure contributing to airway obstruction. DISE findings were examined for an association with surgical outcomes with univariate analyses and multiple regression. RESULTS: Two hundred seventy-five study participants were included from 14 centers. Mean age was 51.4 ± 11.8 years, and body mass index was 30.1 ± 5.2 kg/m2 . There was moderate interrater reliability (kappa = 0.40-0.60) for DISE findings. Oropharyngeal lateral wall-related obstruction was associated with poorer surgical outcomes (adjusted odds ratio (AOR) 0.51; 95% CI 0.27, 0.93). Complete tongue-related obstruction was associated with a lower odds of surgical response in moderate to severe OSA (AOR 0.52; 95% CI 0.28, 0.98), with findings that were similar but not statistically significant in other analyses. Surgical outcomes were not clearly associated with the degree and configuration of velum-related obstruction or the degree of epiglottis-related obstruction. Surgical response was associated with tonsil size and body mass index (inversely). CONCLUSION: DISE findings concerning the oropharyngeal lateral walls and tongue may be the most important findings of this evaluation technique. LEVEL OF EVIDENCE: 2B Laryngoscope, 129:761-770, 2019.

A study of otolaryngology resident quality of life and sleepiness.

OBJECTIVES: This study aimed to determine otolaryngology residents' quality of life and sleepiness. METHODS: An electronic survey was distributed to otolaryngology residents in the United States in October 2014 and May 2015. The survey included questions from the Physician Well-Being Index (PWBI) and Epworth Sleepiness Scale (ESS). Data were analyzed using standard descriptive and frequency analyses, Spearman correlations, and Student's t-test. RESULTS: The 196 respondents (13% response rate) had a mean age of 29.9 years and worked an average of 70.88 hours/week. Higher PWBI score (lower quality of life) correlated with higher ESS (more sleepiness) for all respondents regardless of rotation (Spearman coefficient of .45; p = .001). PWBI scores were higher for head/neck oncology. Both PWBI and ESS scores were highest for postgraduate year two. PWBI showed a significant positive correlation with hours worked (correlation coefficient .35; p = .001) as well as a significant negative correlation with exercise time (correlation coefficient -.18; p = .010). There was a positive correlation between hours worked and ESS (correlation coefficient .48; p = .001). CONCLUSION: For the otolaryngology survey respondents, sleepiness and overall well-being were better during the first year with a dramatic worsening during junior years followed by an improvement in the senior years. More work hours and poor quality of life was associated with less physically active residents. Focused interventions during these rotations may reduce distress, improve quality of life, and enhance learning. LEVEL OF EVIDENCE: NA.

The Role of Tonsillectomy in Adults with Tonsillar Hypertrophy and Obstructive Sleep Apnea.

Objective To determine if tonsillectomy alone is an effective treatment in improving obstructive sleep apnea in adult subjects with tonsillar hypertrophy and to evaluate the effect of tonsillectomy on patient-reported quality-of-life indices. Study Design Case series with planned data collection. Setting Academic hospital. Subjects and Methods Thirty-four subjects completed enrollment and intervention from January 2011 to January 2016. Subjects completed pre- and postoperative quality-of-life questionnaires, including the Insomnia Severity Index, Epworth Sleepiness Scale, and the Functional Outcomes of Sleep Questionnaire-10. Surgical response to treatment was defined by a >50% decrease in the Apnea-Hypopnea Index and a decrease in the overall Apnea-Hypopnea Index to <20. Wilcoxon matched-pairs signed-rank tests were used to test each variable to assess for a change from pre- to postintervention. Subjects were then split into 3 BMI subgroups, with results also evaluated by Wilcoxon matched-pairs signed-rank tests. Results There was a significant difference discovered between the mean preoperative Apnea-Hypopnea Index of 31.57 and the mean postoperative value of 8.12 ( P < .001). All patient-reported outcomes improved significantly following tonsillectomy. After stratifying all outcome variables (Apnea-Hypopnea Index, Epworth Sleepiness Scale, Insomnia Severity Index, and Functional Outcomes of Sleep Questionnaire-10) by sex, race, and tonsil size, no statistically significant difference was noted among any of these subgroups. There was a 78% surgical response to treatment. Conclusion Tonsillectomy appears to be an effective treatment for obstructive sleep apnea in a select population of adults with tonsillar hypertrophy.

Robotics in otolaryngology and head and neck surgery: Recommendations for training and credentialing: A report of the 2015 AHNS education committee, AAO-HNS robotic task force and AAO-HNS sleep disorders committee.

Training and credentialing for robotic surgery in otolaryngology - head and neck surgery is currently not standardized, but rather relies heavily on industry guidance. This manuscript represents a comprehensive review of this increasingly important topic and outlines clear recommendations to better standardize the practice. The recommendations provided can be used as a reference by individuals and institutions alike, and are expected to evolve over time. © 2016 Wiley Periodicals, Inc. Head Neck 38: E151-E158.

Cost of care for subjective tinnitus in relation to patient satisfaction.

OBJECTIVE: A consistent management algorithm for subjective tinnitus remains to be elucidated. Chronic tinnitus yields approximately US$2110 in annual health care costs per patient. However, it is unclear whether spending more in the management of tinnitus equates with greater patient satisfaction. Thus, the aim of this study is to correlate patient satisfaction with patient demographics, provider recommendations, and total health care-related expenditures. STUDY DESIGN: A retrospective chart review and a patient satisfaction questionnaire. SETTING: All data were collected from a large Midwestern hospital. SUBJECTS AND METHODS: Patients were included who presented to the tinnitus clinic during the year 2011 and were between the ages of 18 and 89 years. They were excluded with diagnoses of Ménière's disease, pulsatile tinnitus, acoustic neuromas, or autoimmune inner ear diseases. The retrospective data and satisfaction surveys were entered by 3 of the authors. Responses were based on Likert scales. RESULTS: Of the 692 patients included, 230 completed and returned the satisfaction questionnaire (33.2% response rate), yielding an overall mean of $662.60 charges. The frequency of intervention recommendations per patients ranged from 0 to 13, with a median of 4. Spearman's correlations did not result in significant correlations between patient satisfaction and number of clinic visits (P=.499) or associated charges (P=.453). CONCLUSION: Given that the variability among provider recommendations, the high overall mean of tinnitus-related charges, and patient satisfaction was not related to costs, further research is needed examining patient preference in the treatment of tinnitus.

The uncertain fate of otolaryngology in sleep medicine.

Since 2011, otolaryngologists have been required to complete a 1-year fellowship in sleep medicine in order to be eligible for the ABOto Sleep Medicine Certification Examination (ASMCE). Resultantly, the number of sleep medicine board-certified otolaryngologists has plunged since that time. This push toward extinction comes at a time when otolaryngologists have been cast into the spotlight for the diagnosis and treatment of obstructive sleep apnea, the prevailing disorder in sleep medicine. To reverse the trajectory of this subspecialty, 2 changes need to occur: increase the exposure to sleep medicine/surgery during residency and improve access to sleep medicine fellowships featuring a strong otolaryngology presence.

PROMIS evaluation for head and neck cancer patients: a comprehensive quality-of-life outcomes assessment tool.

OBJECTIVES/HYPOTHESIS: The objective of this study was to evaluate the Patient-Reported Outcomes Measure Information System (PROMIS) in a head and neck cancer patient cohort by assessing the associations of the PROMIS instruments with the responses to the European Oncology Research and Treatment of Cancer (EORTC) general measures, EORTC head and neck (H&N) measures, and Voice Handicap Index (VHI-10). We hypothesized that PROMIS scores are related to the other measures and may be used as assessment tools to help determine quality-of-life outcomes in head and neck cancer patients. STUDY DESIGN: Prospective baseline assessment of quality-of-life outcomes. METHODS: Thirty-nine head and neck cancer patients were included in the study. PROMIS (domains of fatigue, physical functioning, sleep disturbance, sleep-related impairment, and negative perceived cognitive function, EORTC (general), EORTC H&N, and the VHI-10 were given to all patients at the onset of their cancer diagnosis. Spearman correlation coefficients were computed to assess relationships between the measures. Correlations with corresponding P values <.0083 (Bonferroni adjustment) were considered statistically significant. Descriptive statistics of means, standard deviations, medians, and ranges were computed for all the instruments and measures. RESULTS: Significant correlations between the PROMIS instruments and EORTC functional scales were observed. The PROMIS instruments were also associated with some of the EORTC symptom scales, as well as some of the EORTC H&N symptoms measures. PROMIS fatigue instrument was significantly correlated with the VHI-10 measure. CONCLUSIONS: PROMIS instruments are reasonable measures to determine quality-of-life outcomes in head and neck cancer patients. Computerized adaptive testing devices can be effectively utilized in this patient population. LEVEL OF EVIDENCE: 2c.

Clinical practice guideline: sudden hearing loss.

OBJECTIVE: Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SHL. The guideline primarily focuses on sudden sensorineural hearing loss (SSNHL) in adult patients (aged 18 and older). Prompt recognition and management of SSNHL may improve hearing recovery and patient quality of life (QOL). Sudden sensorineural hearing loss affects 5 to 20 per 100,000 population, with about 4000 new cases per year in the United States. This guideline is intended for all clinicians who diagnose or manage adult patients who present with SHL. PURPOSE: The purpose of this guideline is to provide clinicians with evidence-based recommendations in evaluating patients with SHL, with particular emphasis on managing SSNHL. The panel recognized that patients enter the health care system with SHL as a nonspecific, primary complaint. Therefore, the initial recommendations of the guideline deal with efficiently distinguishing SSNHL from other causes of SHL at the time of presentation. By focusing on opportunities for quality improvement, the guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients. RESULTS: The panel made strong recommendations that clinicians should (1) distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL; (2) educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures. The panel made recommendations that clinicians should (1) assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings; (2) diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination; (3) evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up; (4) offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and (5) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL. The panel offered as options that clinicians may offer (1) corticosteroids as initial therapy to patients with ISSNHL and (2) hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL. The panel made a recommendation against clinicians routinely prescribing antivirals, thrombolytics, vasodilators, vasoactive substances, or antioxidants to patients with ISSNHL. The panel made strong recommendations against clinicians (1) ordering computerized tomography of the head/brain in the initial evaluation of a patient with presumptive SSNHL and (2) obtaining routine laboratory tests in patients with ISSNHL.

Commentary on "Otolaryngology-head and neck surgery physician workforce issues an analysis for future specialty planning" by Kim, Cooper, and Kennedy.

An impending physician shortage has been projected. The article by Kim, Cooper, and Kennedy, titled "Otolaryngology-Head and Neck Surgery Physician Workforce Issues: An Analysis for Future Specialty Planning," is an attempt to evaluate and address this potential shortage as it applies to otolaryngology. The authors of this comment have concerns about the article's assumptions, design, and recommendations. Kim et al attempt to extrapolate data from other specialties and other countries to the US otolaryngology workforce, use that data in modeling methods without demonstrated validity, and based on their analysis, they recommend drastic changes to otolaryngologic training and practice in the United States. Particularly troublesome are (1) the emphasis placed on gender and part-time work and (2) the measurement of productivity defined as hours worked per week. Before redefining our specialty, more thorough and systematic data acquisition and review are necessary to meet the needs of our patients now and in the future.

Management of angiotensin-converting enzyme inhibitor-induced angioedema.

OBJECTIVES/HYPOTHESIS: To develop and validate a clinical algorithm for management of patients with angiotensin-converting enzyme inhibitor-induced angioedema (AIIA). STUDY DESIGN: Prospective cohort observational study. METHODS: Over 1 year, 40 patients with AIIA were evaluated by otolaryngology, underwent laryngoscopy, and were followed until disease resolution. The need for airway intervention, disposition for appropriate level of care, and other parameters were analyzed. RESULTS: Treatment started within 61.5 minutes of presentation to the emergency department (ED). Mean duration until resolution of edema was 29 hours. Twenty (50%) patients required intensive care unit (ICU) admission, and six (15%) required intubation. Seventeen (42.5%) were monitored and discharged from the ED. Floor-of-mouth edema was present in 19 (47.5%), and massive tongue edema was found in four (10%) patients. The aryepiglottic fold was involved in 20 (50%) patients on laryngoscopy. Older patients (P = .048) with subjective dyspnea (P = .003) and dysphonia (P = .001) were most likely to require ICU admission. Upper lip swelling had a negative correlation with airway edema identifiable on laryngoscopy alone (P = .008). Dysphonia (n = 16) predicted airway edema upon laryngoscopy (P = .001). All 40 patients were triaged successfully without the need for readmission or escalation of level of care. CONCLUSIONS: The management protocol was successful in 40 consecutive patients to the appropriate level of care. History and physical examination may predict airway findings identified on laryngoscopy and help guide management when treatment by otolaryngology is not immediately available. A subset of patients will require acute airway intervention and can be identified at initial presentation.

Communication outcomes in audiologic reporting.

BACKGROUND: Audiologists often work collaboratively with other health professionals-particularly otolaryngology providers. Some form of written reporting of audiologic outcomes is typically the vehicle by which communication among providers occurs. Quality patient care is dependent on both accurate interpretation of outcomes and effectiveness of communication between providers. Audiologic reporting protocols tend to vary among clinics and providers, with most methods being based on preference rather than standardized definitions. PURPOSE: As part of an ongoing quality-improvement program, audiologic communication was reviewed by comparing written audiometric reports to descriptions of the audiometric results dictated by otolaryngology providers to evaluate the agreement of communication between provider groups. RESEARCH DESIGN: Retrospective chart review. STUDY SAMPLE: The study sample consisted of 6000 randomly selected charts from a total of 15,625 for the years 2004 and 2008 in the electronic medical record system of a large academic health-care system. DATA COLLECTION AND ANALYSIS: Audiogram reports and associated otolaryngology reports were reviewed by an audiologist and two audiology doctoral students. Communication occurred among 37 audiology providers and 39 otolaryngology providers. Data collected included rating of congruence or incongruence between reports, normal versus abnormal audiologic outcomes, and the nature of communication disparities. Data also included provider type (audiologist, audiology doctoral student, or trainee in clinical fellowship year [CFY]; otolaryngologist, otolaryngology resident, physician assistant, or nurse practitioner). RESULTS: Incongruent results were higher among the sample of audiologic evaluations with abnormal outcomes (29.2%) compared with normal outcomes (9.5%). Of those cases rated as incongruent, differences in reporting audiometric results stemmed largely from variance in reporting of numerical values from the audiogram (20%), apparent dictation errors (10.1%), and communication of the ear tested (8.6%). Of those cases in which the interpretations of audiology providers differed from those of otolaryngology providers, incongruent results occurred in the interpretation of degree (29.4%), tympanometric results (28.2%), type of hearing loss (12.8%), acoustic reflex results (4.0%), symmetry (3.3%), and other domains (4.2%). Rates of incongruent results were similar regardless of experience level of the audiology provider (audiologist or audiology doctoral student/CFY) but differed depending on the educational background and experience of the otolaryngology provider. The highest incongruent interpretations were found among residents (32.5%), followed by otolaryngologists (25.2%) and physician assistants and nurse practitioners (21%). CONCLUSIONS: This study highlights the need for audiologists to critically evaluate the effectiveness of their communication with other health-care providers and demonstrates the need for evidence-based approaches for interpreting audiologic information and reporting audiologic information to others.

Acute airway obstruction in cervical spinal procedures with bone morphogenetic proteins.

OBJECTIVES: Bone morphogenetic proteins (BMP) used in anterior cervical spinal procedures causes an inflammatory response resulting in upper-airway obstruction between postoperative days 2 to 7. The purpose of this study is to determine the incidence and severity of complications associated with use of BMP. STUDY DESIGN: Retrospective cohort study. METHODS: This is a retrospective study of 260 patients who underwent cervical spinal procedures with BMP from 2004 to 2009 and a control group of 515 patients who underwent cervical spinal procedures without BMP during the same period at a tertiary care institution. The two groups were compared on hospital length of stay (LOS), hospital charges, incidence of airway obstruction, unplanned intubations after surgery, tracheotomies, intensive care unit (ICU) admissions, hoarseness, dyspnea, respiratory failure, dysphasia, dysphagia, readmissions, and need for percutaneous endoscopic gastrostomy (PEG) tubes. RESULTS: Patients who underwent cervical spine procedures with BMP were noted to have significantly longer hospital stays (P = .001) and higher hospital charges (P = .001) than the control group. Tracheotomies (P = .024), unplanned intubations after surgery (P = .003), dysphagia (P = .001), dyspnea (P = .001), respiratory failure (P = .001), hospital readmissions (P = .040), ICU admissions (P = .001), and 90-day mortality rates (P = .047) were increased for the BMP group. CONCLUSIONS: The use of BMP in anterior cervical spinal procedures results in acute airway obstruction due to an extensive soft-tissue inflammatory reaction that is most likely to occur 2 to 7 days after surgery. The increased incidence of unplanned intubations and tracheotomies demonstrates the risk associated with BMP in cervical spinal procedures.

Evaluation of culture and antibiotic use in patients with pharyngitis.

OBJECTIVES: The objectives of this study were to evaluate practice patterns for treatment of patients with pharyngitis with regard to testing for group A beta hemolytic streptococcal (GABHS) infection, frequency of antibiotic use, and appropriate choice of antibiotics. STUDY DESIGN: The authors conducted a retrospective review of billing data for 10,482 office visits for pharyngitis. METHODS: The 2004 billing database for a tertiary institution was queried for outpatient visits for pharyngitis or tonsillitis, group A Streptococcus tests (GAST), and antibiotic prescriptions filled after the visit. Patients were separated by age group and analyzed for the proportion of patients that received a GAST and proportion prescribed an antibiotic. Antibiotic prescriptions were also analyzed to determine whether they were appropriate for treatment of GABHS. RESULTS: A total of 68.7% of all patients and 82.2% of pediatric patients were tested for GAST. A total of 47.1% of adult patients and 44.9% of pediatric patients received an antibiotic. For adult patients for whom GAST was obtained, 48.6% were prescribed an antibiotic versus 53.6% of those not tested. Streptococcus testing was a significant predictor of antibiotic use (P < .0001), whereas age was not (P = .22). A total of 82.1% of all antibiotics prescribed were recommended for treatment of GABHS. CONCLUSIONS: Most patients seen for pharyngitis were tested for GABHS, but pediatric patients were tested more frequently than adults. Patients who received a GAST were less likely to receive antibiotics. The rates experienced in our tertiary academic institution are higher than previously quoted for community practice. When antibiotics were prescribed, they were usually appropriate for the treatment of GABHS based on current recommendations.