Sonopalpation: a novel application of ultrasound for detection of submandibular calculi.

OBJECTIVE: To study the sensitivity and specificity of physical examination, ultrasound (US) alone, and sonopalpation (concurrent US and transoral palpation) for identification of submandibular gland (SMG) calculi. STUDY DESIGN: Case series with prospective data collection. SETTING: Tertiary-level academic center. SUBJECT AND METHODS: Patients with suspected SMG swelling were examined by physical examination, US alone, and sonopalpation. The presence or absence and location of sialolithiasis was noted in each group. Sialendoscopy, open sialolithotomy, or sialadenectomy was performed as the gold standard for definitive diagnosis. Sensitivity and specificity for each technique was then determined. RESULTS: Sixty-nine patients were identified with SMG swelling. Physical examination, US, and sonopalpation positively identified sialoliths in 49, 54, and 57 patients, respectively. Fifty-nine patients eventually demonstrated calculi. Sensitivity of physical examination, US alone, and sonopalpation for SMG calculi was 83%, 91%, and 96.6%, respectively. Specificity for physical examination was 60%, 80% for US alone, and 90% for sonopalpation. Of 59 patients with stones, 17 patients underwent purely endoscopic procedures, 36 patients underwent combined or purely transoral approaches, and 6 underwent sialadenectomy. Of the 3 modalities, only sonopalpation was able to both identify and localize pathology and guide treatment management. CONCLUSION: US is effective in the diagnosis and management of SMG stones during sialendoscopy or sialolithotomy. Sonopalpation has increased sensitivity and specificity over US alone or physical examination not only for the detection of SMG calculi but also for localization of pathology in the ductal system.

Resident physicians' perspectives on health care reform.

OBJECTIVE: To investigate the perspectives of resident physicians, in otolaryngology and other specialties, with respect to various health care reform proposals. Also, to determine if these opinions vary between residents training to become general medical doctors versus surgeons and specialists and between those with various levels of educational debt. STUDY DESIGN AND PARTICIPANTS: Survey of resident physicians across the United States. METHODS: Opinions of participants were measured on a 5-point Likert scale. RESULTS: Of the 1576 respondents, the majority agreed that tort reform and electronic medical records would improve quality of care and help contain health care costs. However, few residents agreed that bundling of services (BOS), hospital-acquired conditions penalties (HACP), and quality-based reimbursement (QBR) would improve the quality of care. Specialists and surgeons, in comparison to generalists, were (1) less likely to agree that BOS, HACP, or QBR would improve the quality of care; (2) more likely to agree that tort reform would help contain health care costs; and (3) more likely to believe that BOS, HACP, or QBR would decrease physician compensation. Higher educational debt burden was also an independent predictor of increased skepticism about health care reforms effects on physician compensation. CONCLUSIONS: Residents in general medicine and surgery/specialty training programs agreed that tort reform and electronic medical records would help improve the quality of health care and help contain costs. However, both groups expressed strong concern that certain elements of the Patient Protection and Affordable Care Act would not achieve these goals.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an indication for tonsillectomy.

Children with obsessive compulsive disorder or tic disorders that are associated with streptococcal infections (Group A beta-hemolytic) in the oro-pharyngeal region are given the diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Tonsillectomy has been reported to resolve the neuro-psychiatric symptoms in these children. We have a case of a 9-year-old boy who was seen in our clinic with multiple recurrent streptococcal infections of the oro-pharyngeal cavity. He also exhibited neuro-psychiatric symptoms including agitation, hyperactivity, and tics. These symptoms followed his recurrent infections. Tonsillectomy was performed and in one year follow-up the patient did not have any recurrent streptococcal infections, and his neuro-psychiatric symptoms resolved completely. Guidelines for medical and surgical management of recurrent strep infections in the face of PANDAS are reviewed.

Professional perceptions of plastic and reconstructive surgery: what primary care physicians think.

BACKGROUND: The great breadth of the specialty of plastic surgery is often misunderstood by practitioners in other specialties and by the public at large. The authors investigate the perceptions of primary care physicians in training toward the practice of different areas of plastic and reconstructive surgery. METHODS: A short, anonymous, Web-based survey was administered to residents of internal medicine, family medicine, and pediatrics training programs in the United States. Respondents were asked to choose the specialist they perceived to be an expert for six specific clinical areas, including eyelid surgery, cleft lip and palate surgery, facial fractures, hand surgery, rhinoplasty, and skin cancer of the face. Specialists for selection included the following choices: dermatologist, general surgeon, ophthalmologist, oral and maxillofacial surgeon, orthopedic surgeon, otolaryngologist, and plastic surgeon. RESULTS: A total of 1020 usable survey responses were collected. Respondents believed the following specialists were experts for eyelid surgery (plastic surgeon, 70 percent; ophthalmologist, 59 percent; oral and maxillofacial surgeon, 15 percent; dermatologist, 5 percent; and otolaryngologist, 5 percent); cleft lip and palate surgery (oral and maxillofacial surgeon, 78 percent; plastic surgeon, 57 percent; and otolaryngologist, 36 percent); facial fractures (oral and maxillofacial surgeon, 88 percent; plastic surgeon, 36 percent; otolaryngologist, 30 percent; orthopedic surgeon, 11 percent; general surgeon, 3 percent; and ophthalmologist, 2 percent); hand surgery (orthopedic surgeon, 76 percent; plastic surgeon, 52 percent; and general surgeon, 7 percent); rhinoplasty (plastic surgeon, 76 percent; otolaryngologist, 45 percent; and oral and maxillofacial surgeon, 18 percent); and skin cancer of the face (dermatologist, 89 percent; plastic surgeon, 35 percent; oral and maxillofacial surgeon, 9 percent; otolaryngologist, 8 percent; and general surgeon, 7 percent). CONCLUSION: As the field of plastic surgery and other areas of medicine continue to evolve, additional education of internal medicine, pediatrics, and family practice physicians and trainees in the scope of plastic surgery practice will be critical.