Putting Research Findings into Clinical Practice : Feasibility of Integrated Evidence Based Care Pathways in Otorhinolaryngology Head and Neck Surgery at Sultan Qaboos University Hospital , Oman

In February 2019 American Academy of Otolaryngology-Head and Neck Surgery published clinical practice guidelines which provides evidence-based recommendations that applies to children under consideration for tonsillectomy. This update to the 2011 publication includes large amount of new, practical information about pre-, intra- and postoperative care and management, that can be useful for surgeons as well as GPs and pediatricians

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Clinical Practice Guideline: Hoarseness (Dysphonia)

Otolaryngology ◽

10.1016/j.otohns.2009.06.744 ◽

2009 ◽

Vol 141 (1_suppl) ◽

pp. 1-31 ◽

Cited By ~ 212

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.

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Clinical practice guideline: Acute otitis externa

Otolaryngology ◽

10.1016/j.otohns.2006.02.014 ◽

2006 ◽

Vol 134 (4_suppl) ◽

pp. S4-S23 ◽

Cited By ~ 87

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.

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Quality Improvement in Otolaryngology–Head and Neck Surgery: Developing Registry-Enabled Quality Measures From Guidelines for Cerumen Impaction and Allergic Rhinitis Through a Transparent and Systematic Process

Otolaryngology ◽

10.1177/01945998211011987 ◽

2021 ◽

pp. 019459982110119

Author(s):

Jeremy J. Michel ◽

Seth R. Schwartz ◽

Douglas E. Dawson ◽

James C. Denneny ◽

Eileen Erinoff ◽

...

Keyword(s):

Allergic Rhinitis ◽

Clinical Practice ◽

Head And Neck ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Clinical Care ◽

Quality Measures ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Quality Reporting

Background and Significance Quality measurement can drive improvement in clinical care and allow for easy reporting of quality care by clinicians, but creating quality measures is a time-consuming and costly process. ECRI (formerly Emergency Care Research Institute) has pioneered a process to support systematic translation of clinical practice guidelines into electronic quality measures using a transparent and reproducible pathway. This process could be used to augment or support the development of electronic quality measures of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) and others as the Centers for Medicare and Medicaid Services transitions from the Merit-Based Incentive Payment System (MIPS) to the MIPS Value Pathways for quality reporting. Methods We used a transparent and reproducible process to create electronic quality measures based on recommendations from 2 AAO-HNSF clinical practice guidelines (cerumen impaction and allergic rhinitis). Steps of this process include source material review, electronic content extraction, logic development, implementation barrier analysis, content encoding and structuring, and measure formalization. Proposed measures then go through the standard publication process for AAO-HNSF measures. Results The 2 guidelines contained 29 recommendation statements, of which 7 were translated into electronic quality measures and published. Intermediate products of the guideline conversion process facilitated development and were retained to support review, updating, and transparency. Of the 7 initially published quality measures, 6 were approved as 2018 MIPS measures, and 2 continued to demonstrate a gap in care after a year of data collection. Conclusion Developing high-quality, registry-enabled measures from guidelines via a rigorous reproducible process is feasible. The streamlined process was effective in producing quality measures for publication in a timely fashion. Efforts to better identify gaps in care and more quickly recognize recommendations that would not translate well into quality measures could further streamline this process.

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American Academy of Otolaryngology–Head and Neck Surgery/Foundation Reg-ent Registry: Purpose, Properties, and Priorities

Otolaryngology ◽

10.1177/0194599820984135 ◽

2021 ◽

pp. 019459982098413

Author(s):

Cecelia E. Schmalbach ◽

Jean Brereton ◽

Cathlin Bowman ◽

James C. Denneny

Keyword(s):

American Academy ◽

Head And Neck ◽

Best Practice ◽

Medical Center ◽

Quality Care ◽

Academic Medical Center ◽

Neck Surgery ◽

Performance Measure ◽

Head And Neck Surgery ◽

Evidence Based

Objective (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology–Head and Neck Surgery/Foundation and ultimately define “quality” for our field of otolaryngology–head and neck surgery. Methods Data analytics was performed on Reg-ent (2015-2020) Results A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and “private” was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis–unspecified and sensorineural hearing loss–bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. Discussion Reg-ent benefits are vast—from monitoring one’s practice to defining otolaryngology–head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology–head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. Implications for Practice Reg-ent provides the first ever registry that is specific to otolaryngology–head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.

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Is GRADE the Right Choice for Clinical Practice Guidelines Developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation?

Otolaryngology ◽

10.1177/0194599819846458 ◽

2019 ◽

Vol 161 (1) ◽

pp. 3-5

Author(s):

Andrés M. Bur ◽

Richard M. Rosenfeld

Keyword(s):

Clinical Practice ◽

American Academy ◽

Head And Neck ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Current Knowledge ◽

Clinical Care ◽

Neck Surgery ◽

Head And Neck Surgery ◽

The Right

Clinical practice guidelines (CPGs), developed to inform clinicians, patients, and policy makers about what constitutes optimal clinical care, are one way of increasing implementation of evidence into clinical practice. Many factors must be considered by multidisciplinary guideline panels, including strength of available evidence, limitations of current knowledge, risks/benefits of interventions, patient values, and limited resources. Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a framework for summarizing evidence that has been endorsed by many national and international organizations for developing CPGs. But is GRADE the right choice for CPGs developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF)? In this commentary, we will introduce GRADE, discuss its strengths and limitations, and address the question of what potential benefits GRADE might offer beyond existing methodology used by the AAO-HNSF in developing CPGs.

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Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo

Otolaryngology ◽

10.1016/j.otohns.2008.08.022 ◽

2008 ◽

Vol 139 (5_suppl) ◽

pp. 47-81 ◽

Cited By ~ 359

Author(s):

Neil Bhattacharyya ◽

Reginald F. Baugh ◽

Laura Orvidas ◽

David Barrs ◽

Leo J. Bronston ◽

...

Keyword(s):

Head And Neck ◽

Benign Paroxysmal Positional Vertigo ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Evidence Based ◽

Radiographic Imaging ◽

Inappropriate Use ◽

Positional Vertigo ◽

Paroxysmal Positional Vertigo

Objectives: This guideline provides evidence-based recommendations on managing benign paroxysmal positional vertigo (BPPV), which is the most common vestibular disorder in adults, with a lifetime prevalence of 2.4 percent. The guideline targets patients aged 18 years or older with a potential diagnosis of BPPV, evaluated in any setting in which an adult with BPPV would be identified, monitored, or managed. This guideline is intended for all clinicians who are likely to diagnose and manage adults with BPPV. Purpose: The primary purposes of this guideline are to improve quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary tests such as radiographic imaging and vestibular testing, and to promote the use of effective repositioning maneuvers for treatment. In creating this guideline, the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of audiology, chiropractic medicine, emergency medicine, family medicine, geriatric medicine, internal medicine, neurology, nursing, otolaryngology–head and neck surgery, physical therapy, and physical medicine and rehabilitation. Results The panel made strong recommendations that 1) clinicians should diagnose posterior semicircular canal BPPV when vertigo associated with nystagmus is provoked by the Dix-Hallpike maneuver. The panel made recommendations against 1) radiographic imaging, vestibular testing, or both in patients diagnosed with BPPV, unless the diagnosis is uncertain or there are additional symptoms or signs unrelated to BPPV that warrant testing; and 2) routinely treating BPPV with vestibular suppressant medications such as antihistamines or benzodiazepines. The panel made recommendations that 1) if the patient has a history compatible with BPPV and the Dix-Hallpike test is negative, clinicians should perform a supine roll test to assess for lateral semicircular canal BPPV; 2) clinicians should differentiate BPPV from other causes of imbalance, dizziness, and vertigo; 3) clinicians should question patients with BPPV for factors that modify management including impaired mobility or balance, CNS disorders, lack of home support, and increased risk for falling; 4) clinicians should treat patients with posterior canal BPPV with a particle repositioning maneuver (PRM); 5) clinicians should reassess patients within 1 month after an initial period of observation or treatment to confirm symptom resolution; 6) clinicians should evaluate patients with BPPV who are initial treatment failures for persistent BPPV or underlying peripheral vestibular or CNS disorders; and 7) clinicians should counsel patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. The panel offered as options that 1) clinicians may offer vestibular rehabilitation, either self-administered or with a clinician, for the initial treatment of BPPV and 2) clinicians may offer observation as initial management for patients with BPPV and with assurance of follow-up. The panel made no recommendation concerning audiometric testing in patients diagnosed with BPPV. Disclaimer: This clinical practice guideline is not intended as a sole source of guidance in managing benign paroxysmal positional vertigo. 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 judgement or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem. ® 2008 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved.

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Risk of blood splashes in otorhinolaryngology surgery: do we really require protection?

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20164840 ◽

2016 ◽

Vol 3 (1) ◽

pp. 6

Author(s):

Bikash Lal Shrestha ◽

Ram Chayya Man Amatya

Keyword(s):

Head And Neck ◽

Body Fluid ◽

Neck Surgery ◽

Head And Neck Surgery ◽

University Hospital ◽

Radical Mastoidectomy ◽

Modified Radical Mastoidectomy ◽

Needle Stick Injuries ◽

Nose And Throat ◽

Protective Mask

Background: Surgeons are particularly at risk from blood borne pathogens like hepatitis and HIV during interventions or surgeries. They do take precaution to avoid the needle stick injuries but few pay attention on blood or body fluid splashes into eye. The main aim of the study was to know the risk of blood splashes in glass, gown and mask during ENT –HNS (ear, nose and throat and head and neck surgery).Methods: The prospective study conducted in Department of ENT-HNS of Dhulikhel Hospital, Kathmandu University Hospital from 1st July 2016 to 30th September 2016. All the elective cases were included for study. Surgery was performed by the single surgeon. The surgeon wore the glass and mask during the surgery. At the end of the surgery, the glass, mask and gown was inspected by the surgeon for any blood splashes and information was recorded. Results: There were total 62 patients with male 30 and female 32. Regarding the age, most of the patients lie between 20-50 years. The amount of blood splatter in glass, mask and gown is most common in modified radical mastoidectomy surgery. Likewise, the blood splatter is most common in tonsillectomy in throat surgery and in head and neck surgery, the blood splatter is common in all head and neck surgery.Conclusions: The blood splashes is high even in various ENT surgeries. So it is important to take precaution by surgeon like protective mask and glass worn during surgeries to protect from various blood-borne infection transmissions.

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Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology – head and neck surgery during the COVID-19 pandemic

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-020-00425-6 ◽

2020 ◽

Vol 49 (1) ◽

Cited By ~ 34

Author(s):

Andrew Thamboo ◽

Jane Lea ◽

Doron D. Sommer ◽

Leigh Sowerby ◽

Arman Abdalkhani ◽

...

Keyword(s):

Head And Neck ◽

Clinical Evidence ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Evidence Based ◽

Medical Procedures

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Ent Instructions for Authors

Ear Nose & Throat Journal ◽

10.1177/014556131709600703 ◽

2017 ◽

Vol 96 (7) ◽

pp. 271-272

Keyword(s):

Clinical Practice ◽

Head And Neck ◽

Basic Science ◽

Case Reports ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Original Research ◽

Letters To The Editor

Ear, Nose & Throat Journal publishes original articles on the clinical practice and basic science of otolaryngology–head and neck surgery. Authors may submit case reports, reviews, and original research, as well as brief papers suitable for one of the regularly published ENT Clinics (departments), guest editorials, or letters to the editor.

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