Practice Focus

A New Direction for Sleep: New OSA guidelines fuel another evidence-based medicine debate

Recent publication of practice parameters for surgery in adults with obstructive sleep apnea (OSA) by the American Academy of Sleep Medicine (AASM) has set off another round of debate on the need for otolaryngologists to get involved in generating their own guidelines. Although otolaryngologists have yet to agree on whether or not the time is right for guidelines on surgical treatment for sleep apnea, consensus can be claimed regarding the need perceived by the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) to get on the evidence-based bandwagon.

A Coping Mechanism: Child life specialists can ease hospital stays for pediatric patients

Seven-year-old Michael is scheduled to have a hemangioma removed from his face at the Arkansas Children’s Hospital (ACH) Ambulatory Surgery Center in Little Rock. The morning of surgery, he and his mother meet with child life specialists Cassandra C. James, MS, CCLS, and Camille Dante, MS, CCLS, who show him pictures of the operating room. They let him play with an anesthesia mask and a pulse oximeter, and talk about what to expect when he goes to sleep.

Lingering Issues: Challenges remain in repairing CSF leaks

Once the province of neurosurgeons, cerebrospinal fluid (CSF) leak repair is now handled mostly by otolaryngologists. This change has occurred over the past couple of decades, during which time the evolution of endoscopic tools and techniques has made possible extracranial rather than intracranial repair. The success rate for repairing these leaks from below has reached about 90 percent, particularly for small leaks.

Old Problem, New Focus: Otolaryngologists tailor allergy treatments to geriatric patients

Allergic rhinitis among the elderly poses a particularly difficult diagnostic challenge for the otolaryngologist. As people age, they undergo immunosenescence. The thymus, which produces T cells against new invaders, atrophies markedly after adolescence, and this decline results in a less robust immune response to bacteria, viruses and presumably allergens (J Pathol. 2007;211(2):144-156). Consequently, physicians have assumed that allergies should decline as people age.