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Guidelines for Guidance

Richard Rosenfeld, MD, MPH, former chair of the AAO-HNS Guideline Development Task Force and chair of otolaryngology at SUNY Downstate Medical Center in Brooklyn, N.Y., said that he needs to look no further than his own practice to know that these guidelines—recommendations meant to optimize patient care resulting from systematic reviews of the evidence—can change care.

He said he used to give peri-operative antibiotics as a matter of course for tonsillectomy but no longer does so after his participation in reviewing evidence and issuing guidelines that recommend against doing so unless there are overriding reasons for antibiotics. “They don’t make a significant difference,” he said. “That, I thought, was an insight that was very helpful to me in practice.”

Another guideline involved pain control after tonsillectomy. The rule of thumb was that using nonsteroidal antiinflammatory drugs was too risky. After a review, the clinical practice guideline suggested using NSAIDS, Dr. Rosenfeld said.

Another found almost no value in home sleep studies for children, which he used to rely on.

Dr. Rosenfeld said, “I thought I was really practicing great medicine, and I learned very quickly in this guideline that only overnight sleep studies are truly accurate.”

He also said he’s learned—and implemented—the concept of using water to dissolve earwax and discovered that adenoidectomy doesn’t have an effect on otitis media with effusion for patients younger than four years old. “So I’d encourage you to look at the guidelines,” he said, adding, with some understatement, “Occasionally, there’s some useful information in there.”

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Thomas Collins is a freelance medical writer based in Florida.