Ten Smart Sound Bites We Caught at SCSOHNS 2023 in Myrtle Beach
We were all ears at the North Carolina and South Carolina Societies of Otolaryngology-Head and Neck Surgery Annual Meeting last month. Here are just a few of the ah-has we picked up during three days of insightful presentations from clinicians throughout the Carolinas.
1. “Not everything needs a free flap.”
“Having multiple tools in your reconstructive toolbox is important,” said presenter Peter M. Horwich, Bsc.H, M.Ed, MD, FRCSC. Sometimes an optimal donor site is unavailable. And, even when a free flap is an option, a submental island regional flap is often a better option.
Submental island tissue is thin, pliable, and well-vascularized. Deploying this tissue for regional flap facial reconstructions can mean the patient spends less time on the OR table, which can boost surgical outcomes–especially for patients with comorbidities. Lately, Dr. Horwich has been doing D-shaped submental island cuts because he observes they close more easily than other options.
2. Glad Press’n Seal: It’s not just for leftovers anymore.
Facial reanimation expert Michele Hwang, MD sometimes recommends this affordable, easily-available solution to patients managing the dry eye symptoms that often accompany immediate onset Bell’s Palsy. For a patient taping an eye at home, Glad Press’n Seal is easier to manage than other tapes.
3. Total thyroidectomy or hemithyroidectomy? When will molecular testing help surgeons make that call?
Molecular testing is the “latest and greatest” technique for guiding the appropriate extent of surgery for well-differentiated thyroid cancer, said presenter W. Greer Albergotti III, MD.
For surgeons grappling with the TT vs. HT decision, molecular testing will be a solid ally in the future, but it’s “not quite ready for prime time,” Dr. Albergotti noted.
4. “Treating OSA with surgery can lessen overall health care utilization compared to no treatment and CPAP.”
Continuous positive airway pressure (CPAP) alone isn’t a silver bullet for treating obstructive sleep apnea (OSA), observed presenter Mohamed Abdelwahab, MD, MS, PhD, first author on a retrospective study recently published in Otolaryngology–Head and Neck Surgery.
Researchers compared data for 18,050 OSA patients who underwent surgery, 1,054,578 who were untreated, and 799,370 who received CPAP. The population-based study tracked clinical utilization and expenditures across outpatient, and inpatient services, and medication prescriptions over two years. Researchers excluded surgery and CPAP costs from their analysis of expenditures.
The group that had surgery for OSA needed far less inpatient, outpatient, and pharmaceutical care over the two-year period than patients in the untreated and CPAP groups. Virtual surgical planning (VSP) should improve surgical outcomes even more strikingly as VSP technology takes hold, Dr. Abdelwahab observed.
5. Before he discovered PCR, Kary Mullis grew up in Columbia, SC … and synthesized hallucinogenic drugs.
Ameer Ghodke, MD (UNC) briefly alluded to this mind-expanding detail when he talked about spatial analysis of benign and malignant faucial tonsil.
When it came to LSD trips, Nobel Prize winning scientist Mullis was a frequent flier. “If you hire this guy Mullis, he’s an excellent synthetic chemist,” classmate Tom White told prospective employers who were skeptical about Mullis because he’d just barely squeaked by his PhD requirements. “I knew he was a good chemist because he’d been synthesizing hallucinogenic drugs at Berkeley,” White recalls.
“Sometimes a good idea comes to you when you are not looking for it,” Mullis wrote in a 1990 Scientific American article. “Through an improbable combination of coincidences, naiveté and lucky mistakes, such a revelation came to me one Friday night in April, 1983, as I gripped the steering wheel of my car and snaked along a moonlit mountain road into northern California’s redwood country. That was how I stumbled across a process that could make unlimited numbers of copies of genes, a process now known as the polymerase chain reaction (PCR).”
Where are we now on this long and winding road? Spatially Resolved Transcriptomics (SRT) is the most recent stop on a continuum that includes genomics and single-cell sequencing, Dr. Ghodke told SCSOHNS participants. SRT will change how otolaryngologists practice by 2030, he predicted.
6. Taking a patient into the OR for functional nasal surgery? Do this first.
Presenter Krishna Patel, MD, PhD said she asks patients to do forced and normal breathing immediately before she takes them into the OR. The exercise reminds her of insights she gained during early examination and assessments like SCHNOS. Once the patient is under anesthesia, nasal structures become flaccid,
Pro tip: During assessments, Dr. Patel performs and documents the Cottle Maneuver. She finds that most payers require it and that documenting Cottle can help prevent claims denials.
7. SLPs and MDs are perfect partners for treating globus sensation.
A patient who feels a “lump in the throat” but lacks a physical lump can be challenging for a physician alone to treat. A speech and language therapy (SLP) referral can help.
While physician time is notoriously limited, an SLP visit contains 60 minutes, pointed out presenter Kathryn W. Ruckart, MS, CCC-SCP. This visit length gives an SLP time to dig into life habits the physician may not have had time to explore, such as hydration. SLPs palpate and do quality-of-life assessments like the LUMP questionnaire. And, SLPs are trained to detect voice disorders that may be contributing to the globus sensation.
SLPs can help the patient manage globus sensation with techniques like systemic hydration, changes in posture, and ditching medicated cough drops. Sometimes, psychoeducational counseling can help.
8. When a patient says, “I hear my heartbeat in my ear,” don’t forget to consider IIH.
Several conditions can cause pulsatile tinnitus–including middle ear tumors and sinus wall abnormalities (SWAA), said peaker Calhoun D. Cunningham III, MD.
Idiopathic intracranial hypertension (IIH) is one etiology, said Dr. Cunningham. About 60 percent of patients with IIH report pulsatile tinnitus, perhaps because IIH narrows sinuses. IIH is becoming more common as obesity grows more common–especially among obese women aged 15-45.
9. Blame the Neanderthals for HPV 16.
During her talk on “Current Updates in the Work-up & Treatment of HPV & Oropharyngeal Squamous Cell Carcinoma,” Alexandra E. Kejner, MD reminded conference attendees about the evolutionary origins of human papillomavirus.
Evidence published in 2016 suggests that our human ancestors may have gotten HPV when they hooked up with Neanderthals. Sex with Denisovans (another extinct near-human species) also could have been part of the STD’s origin story.
10. PROMs trump speech recognition testing for evaluating cochlear implantation outcomes.
The number of cochlear implants (CI) worldwide is one million and counting, noted speaker Teddy McRackan, MD. Also, CI has become more common in the US since the FDA approved cochlear implantation for people with SSD and AHL, as well as bilateral hearing loss.
Currently, speech recognition testing is the standard for measuring CI outcomes, but speech recognition doesn’t affect real-world hearing that much, Dr. McRackan noted. Patient-reported outcome measures (PROM) are more meaningful.
Clinicians at MUSC have developed a post-CI PROM called CIQOL, complete with a user manual.
