scholarly journals Evaluation of Compliance for Treatment of Sudden Hearing Loss

2016 ◽  
Vol 155 (1) ◽  
pp. 48-55 ◽  
Author(s):  
David L. Witsell ◽  
Tawfiq Khoury ◽  
Kristine A. Schulz ◽  
Robert Stachler ◽  
Debara L. Tucci ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Clinical Practice ◽  
American Academy ◽  
Head And Neck ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Neck Surgery ◽  
Sudden Hearing Loss ◽  
Head And Neck Surgery ◽  
Community Based

Objective The objective of this study is to describe the presentation and management of sudden sensorineural hearing loss for patients seen in academic and community-based practices within the context of the American Academy of Otolaryngology—Head and Neck Surgery Foundation’s “Clinical Practice Guideline: Sudden Hearing Loss.” The intention is to use these findings to guide implementation strategies and quality improvement initiatives and as pilot data for the development of clinical research initiatives. Study Design A cross-sectional study of patients with sudden hearing loss. Setting Patients were recruited from practices within the Creating Healthcare Excellence through Education and Research (CHEER) network. The CHEER network is an National Institutes of Health–funded network of 30 otolaryngology sites across the country, half of which are community based and half of which are academic practices. Subjects and Methods A total of 173 patients were recruited. Data were gathered via custom questionnaires collected by study site coordinators and entered into a secure online platform. Descriptive analyses and correlation statistics were run with SAS 9.3.1. Results Of the 13 guideline statements in the American Academy of Otolaryngology—Head and Neck Surgery Foundation’s clinical practice guideline on sudden hearing loss, 11 statements were evaluable through this study. Compliance for otolaryngologists was >95% for key action statements (KASs) 1, 3, and 6; 90% to 95% for KASs 5 and 10; and <90% for KASs 7 and 13. Compliance was <45% for nonotolaryngologists for KASs 3 and 5-7. Conclusions There is opportunity for nonotolaryngologists to improve for statements 3 and 5-7. Otolaryngologists are compliant with many of the KASs overall, but there is significant room for improvement.

Clinical Practice Guideline: Hoarseness (Dysphonia)

2009 ◽  
Vol 141 (1_suppl) ◽  
pp. 1-31 ◽  
Author(s):  
Seth R. Schwartz ◽  
Seth M. Cohen ◽  
Seth H. Dailey ◽  
Richard M. Rosenfeld ◽  
Ellen S. Deutsch ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Head And Neck ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Voice Therapy ◽  
Evidence Based ◽  
Inappropriate Use ◽  
Vocal Effort

Objective: This guideline provides evidence-based recommendations on managing hoarseness (dysphonia), defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL). Hoarseness affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness. Purpose: The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti-reflux medications, reduce inappropriate use of radiographic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. In creating this guideline the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of neurology, speech-language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology–head and neck surgery, pediatrics, and consumers. Results The panel made strong recommendations that 1) the clinician should not routinely prescribe antibiotics to treat hoarseness and 2) the clinician should advocate voice therapy for patients diagnosed with hoarseness that reduces voice-related QOL. The panel made recommendations that 1) the clinician should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related QOL; 2) the clinician should assess the patient with hoarseness by history and/or physical examination for factors that modify management, such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer; 3) the clinician should visualize the patient's larynx, or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected; 4) the clinician should not obtain computed tomography or magnetic resonance imaging of the patient with a primary complaint of hoarseness prior to visualizing the larynx; 5) the clinician should not prescribe anti-reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease; 6) the clinician should not routinely prescribe oral corticosteroids to treat hoarseness; 7) the clinician should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist; and 8) the clinician should prescribe, or refer the patient to a clinician who can prescribe, botulinum toxin injections for the treatment of hoarseness caused by adductor spasmodic dysphonia. The panel offered as options that 1) the clinician may perform laryngoscopy at any time in a patient with hoarseness, or may refer the patient to a clinician who can visualize the larynx; 2) the clinician may prescribe anti-reflux medication for patients with hoarseness and signs of chronic laryngitis; and 3) the clinician may educate/counsel patients with hoarseness about control/preventive measures. Disclaimer: This clinical practice guideline is not intended as a sole source of guidance in managing hoarseness (dysphonia). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.

Hypertension and Epistaxis: Why Is There Limited Guidance in the Nosebleed Clinical Practice Guidelines?

2020 ◽  
Vol 162 (1) ◽  
pp. 33-34 ◽  
Author(s):  
Spencer C. Payne ◽  
David Feldstein ◽  
Samantha Anne ◽  
David E. Tunkel
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Head And Neck ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Multivariate Analyses ◽  
Relevant Literature ◽  
Neck Surgery

Hypertension has long been thought to influence the risk and severity of epistaxis. However, evaluation of the relevant literature reveals articles with methodologic concerns or limited quality. In many instances, these studies are not adequately controlled, and lack of multivariate analyses calls into question any noted association between epistaxis and hypertension. The goal of this commentary is to explain why there is limited guidance about the management of hypertension and the possible association with nosebleed in the 2020 American Academy of Otolaryngology–Head and Neck Surgery Foundation clinical practice guideline for nosebleeds. Background on the literature that describes the association between hypertension and nosebleeds is provided.

scholarly journals Time to Laryngoscopy for Hoarseness in Canada: Are the American Academy of Otolaryngology Guidelines Feasible?

OTO Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 2473974X2093250
Author(s):  
Joel Howlett ◽  
Joel Singer ◽  
Terry Lee ◽  
Amanda Hu
Keyword(s):  
Clinical Practice ◽  
American Academy ◽  
Head And Neck ◽  
Outcome Measures ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Odds Ratio ◽  
Neck Surgery ◽  
Secondary Outcome ◽  
Chart Audit

Objectives To determine if a Canadian voice center is meeting the recommended time to laryngoscopy for hoarseness per the clinical practice guideline of the American Academy of Otolaryngology–Head and Neck Surgery. Study Design Retrospective chart audit. Setting Tertiary referral Canadian voice center. Participants and Methods A total of 149 adult patients presenting with hoarseness over 6 months were included. Primary outcome measures were the time from onset of symptoms to laryngoscopy and the time from referral to laryngoscopy. Secondary outcome measures included patient- and disease-modifying factors, diagnosis, and clinical management. Analysis was performed to determine what factors were associated with meeting the guideline. Results Patients were evaluated by the laryngologist after 21.9 ± 37.6 months (mean ± SD) of symptoms. One-third (34.2%) of patients were seen within 3 months; 10.7% were seen within 4 weeks. Logistic regression showed that patients with neurologic symptoms (odds ratio, 4.04; 95% CI, 1.31-12.43; P = .015) and endotracheal intubation (odds ratio, 5.94; 95% CI, 2.21-15.95; P < .001) were associated with being seen within 3 months. Patients who had recent intubation (odds ratio, 6.04; 95% CI, 1.99-18.34; P = .002) were associated with being seen within 4 weeks. Conclusion It is an ongoing challenge for our Canadian voice center to meet the American Academy of Otolaryngology–Head and Neck Surgery’s clinical practice guideline for recommended time to laryngoscopy. Patients with more severe pathologies were consistently triaged more urgently. It is debatable whether this 4-week time recommendation is generalizable to a socialized health care system.

scholarly journals Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary

2017 ◽  
Vol 156 (3) ◽  
pp. 403-416 ◽  
Author(s):  
Neil Bhattacharyya ◽  
Samuel P. Gubbels ◽  
Seth R. Schwartz ◽  
Jonathan A. Edlow ◽  
Hussam El-Kashlan ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Head And Neck ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Benign Paroxysmal Positional Vertigo ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Inappropriate Use ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

The American Academy of Otolaryngology—Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology–Head and Neck Surgery featuring the “Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update).” To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 recommendations developed emphasize diagnostic accuracy and efficiency, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing, and increasing the appropriate therapeutic repositioning maneuvers. An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.

Quality Improvement in Otolaryngology–Head and Neck Surgery: Age-Related Hearing Loss Measures

2021 ◽  
pp. 019459982110004
Author(s):  
Richard K. Gurgel ◽  
Selena E. Briggs ◽  
Nui Dhepyasuwan ◽  
Richard M. Rosenfeld
Keyword(s):  
Hearing Loss ◽  
Clinical Practice ◽  
Head And Neck ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Neck Surgery ◽  
Diagnosis And Treatment ◽  
Evidence Based ◽  
Age Related ◽  
Age Related Hearing Loss

Background and Significance There is a high and growing prevalence of age-related hearing loss (ARHL), defined as presbycusis or bilateral, symmetric sensorineural hearing loss in older adults. Due to the increasing prevalence of ARHL, the potential delays in its diagnosis and treatment, and the significant disability associated with ARHL, the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) convened a Measures Development Group (MDG) to develop quality measures (QMs) of clinical practice that could be incorporated into the AAO-HNSF’s data registry Reg-ent. Although the AAO-HNSF has been engaged in robust clinical practice guideline development since 2006, the development of quality and performance measures is more recent. Methods We report the process, experience, and outcomes in developing a de novo QM set for ARHL in the absence of a preexisting clinical practice guideline on this topic. Steps include the MDG review of evidentiary literature on ARHL, followed by stakeholder discussions to develop measure specifications. Key considerations included discussion on the relative importance, usability, and feasibility of each measure within the Reg-ent or similar databases. Results The MDG created 4 QMs for the diagnosis and treatment of AHRL. These measures represent the AAO-HNSF’s quality initiatives to develop evidence-based QMs and improve patient care and outcomes, and they are intended to assist providers in enhancing quality of care. Conclusion Development of the ARHL measures is intended for clinicians to evaluate the patient perception, structure, process, and outcomes of care. This process represents a new stage in the AAO-HNSF’s measure development efforts to facilitate future efforts in evidence-based QM.

Clinical practice guideline: Acute otitis externa

2006 ◽  
Vol 134 (4_suppl) ◽  
pp. S4-S23 ◽  
Author(s):  
Richard M. Rosenfeld ◽  
Lance Brown ◽  
C. Ron Cannon ◽  
Rowena J. Dolor ◽  
Theodore G. Ganiats ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Head And Neck ◽  
Tympanic Membrane ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Otitis Externa ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Evidence Based ◽  
Ear Canal

OBJECTIVE: This guideline provides evidence-based recommendations to manage diffuse acute otitis externa (AOE), defined as generalized inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The primary purpose is to promote appropriate use of oral and topical antimicrobials and to highlight the need for adequate pain relief. STUDY DESIGN: In creating this guideline, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) selected a development group representing the fields of otolaryngology-head and neck surgery, pediatrics, family medicine, infectious disease, internal medicine, emergency medicine, and medical informatics. The guideline was created with the use of an explicit, a priori, evidence-based protocol. RESULTS: The group made a strong recommendation that management of AOE should include an assessment of pain, and the clinician should recommend analgesic treatment based on the severity of pain. The group made recommendations that clinicians should: 1) distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the ear canal; 2) assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, prior radiotherapy); and 3) use topical preparations for initial therapy of diffuse, uncomplicated AOE; systemic antimicrobial therapy should not be used unless there is extension outside of the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. The group made additional recommendations that: 4) the choice of topical antimicrobial therapy of diffuse AOE should be based on efficacy, low incidence of adverse events, likelihood of adherence to therapy, and cost; 5) clinicians should inform patients how to administer topical drops, and when the ear canal is obstructed, delivery of topical preparations should be enhanced by aural toilet, placing a wick, or both; 6) when the patient has a tympanostomy tube or known perforation of the tympanic membrane, the clinician should prescribe a nonototoxic topical preparation; and 7) if the patient fails to respond to the initial therapeutic option within 48 to 72 hours, the clinician should reassess the patient to confirm the diagnosis of diffuse AOE and to exclude other causes of illness. And finally, the panel compiled a list of research needs based on limitations of the evidence reviewed. CONCLUSION: This clinical practice guideline is not intended as a sole source of guidance in evaluating patients with AOE. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all individuals with this condition and may not provide the only appropriate approach to the diagnosis and management of this problem. SIGNIFICANCE: This is the first, explicit, evidence-based clinical practice guideline on acute otitis externa, and the first clinical practice guideline produced independently by the AAO-HNSF. © 2006 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. All rights reserved.

scholarly journals Clinical Practice Guideline (Update): Earwax (Cerumen Impaction) Executive Summary

2017 ◽  
Vol 156 (1) ◽  
pp. 14-29 ◽  
Author(s):  
Seth R. Schwartz ◽  
Anthony E. Magit ◽  
Richard M. Rosenfeld ◽  
Bopanna B. Ballachanda ◽  
Jesse M. Hackell ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Head And Neck ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Coordination Of Care ◽  
Executive Summary ◽  
Randomized Controlled ◽  
New Evidence

The American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue of Otolaryngology–Head and Neck Surgery featuring the updated Clinical Practice Guideline: Earwax (Cerumen Impaction). To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations emphasize proper ear hygiene, diagnosis of cerumen impaction, factors that modify management, evaluating the need for intervention, and proper treatment. An updated guideline is needed due to new evidence (3 guidelines, 5 systematic reviews, and 6 randomized controlled trials) and the need to add statements on managing cerumen impaction that focus on primary prevention, contraindicated intervention, and referral and coordination of care.

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