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These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction...

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An algorithm was developed through an evolution of refinements in surgical technique with the goal to minimize risk and morbidity in otoplasty. Key principles were avoidance of cartilage incisions and transections and the use of multiple surgical techniques to distribute the "surgical load" evenly among these techniques. The present retrospective study was designed to test safety and efficacy of the concept in 100 consecutive patients and to discuss the results in light of the literature. Data detailing the surgery, preoperative, and postoperative period were extracted from the record and during patient interviews...

OBJECTIVE: To develop a clinical consensus statement on septoplasty with or without inferior turbinate reduction. METHODS: An expert panel of otolaryngologists with no relevant conflicts of interest was assembled to represent general otolaryngology and relevant subspecialty societies. A working definition of septoplasty with or without inferior turbinate reduction and the scope of pertinent otolaryngologic practice were first established. Patients 18 years and older were defined as the targeted population of interest...

BACKGROUND: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer...

IMPORTANCE: Tympanostomy tube removal is a commonly performed pediatric procedure. Few studies have evaluated whether removal technique influences the likelihood of the tympanic membrane (TM) to heal. OBJECTIVE: To determine whether the technique used for tympanostomy tube removal affects the likelihood of persistent TM perforation healing in children. DESIGN, SETTING, AND PARTICIPANTS: Retrospective case series with medical chart review in a tertiary care pediatric health system of 247 children undergoing tympanostomy tube removal (341 ears) between 2010 and 2013 by 1 of 4 different techniques: (1) tube removal only; (2) freshening TM perforation edges; (3) performing patch myringoplasty; or (4) both freshening edges and performing patch myringoplasty...

OBJECTIVES/HYPOTHESIS: To assess relevant variations in the anatomical course of the infraorbital nerve (ION). This understanding may reduce the risk of surgical injury. METHODS: A total of 100 consecutive computed-tomography sinus studies obtained in a tertiary referral center were reviewed, and measurements were made of the 200 IONs. Anatomic variants were classified into three types based on the degree to which (if any) the nerve's course descended from the maxillary roof into the sinus lumen...

OBJECTIVE: This study assesses the efficacy of alar suspension sutures in the management of nasal valve collapse causing nasal obstruction. These sutures are inserted between the vestibular skin and lateral crura and hitched to the periosteum of the medial inferior orbital margin; this is a variation of the alar (change everywhere) suspension suture technique. METHOD: A retrospective review of patients who underwent alar suspension suture insertion between January 2009 and December 2010 in the management of nasal obstruction was undertaken...

OBJECTIVES: To determine the outcomes of alternating doses of ibuprofen and acetaminophen in the treatment of post-tonsillectomy pain in children and to identify characteristics of children who had inadequate pain control. METHODS: The medical records of children who received alternating doses of ibuprofen and acetaminophen for post-tonsillectomy pain between August 2012 and November 2013 at a tertiary care children's hospital were reviewed. Incidences of postoperative bleeding and unresolved pain were determined...

STUDY OBJECTIVE: To determine which nostril is more suitable for nasotracheal intubation in patients with normal patency of both nostrils. DESIGN: Prospective, randomized clinical trial. SETTING: Operating room of a university medical center. PATIENTS: 191 ASA physical status 1 and 2 patients scheduled for elective oral surgery requiring general anesthesia with nasotracheal intubation. INTERVENTIONS: Patients were randomized to two groups to undergo nasotracheal intubation through the right nostril (Group R; n = 96) or the left nostril (n = 95)...

OBJECTIVE: To compare the impact of the PowerPoint multimedia presentation and chalkboard in teaching by assessing the knowledge based on the marks obtained. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, from December 2007 - June 2009. METHODOLOGY: Three-hundred male medical students were divided into three groups and a selected content-based lecture in physiology was delivered...

Videos can promote learning by either complementing classroom activities, or in self-paced online learning modules. Despite the wide availability of online videos in medicine, it can be a challenge for many educators to decide when videos should be used, how to best use videos, and whether to use existing videos or produce their own. We outline 12 tips based on a review of best practices in curriculum design, current research in multimedia learning and our experience in producing and using educational videos...

IMPORTANCE: More than 500,000 children undergo tonsillectomy each year in the United States. Although prior studies suggest that most patients received perioperative antibiotics, practice varies across centers. In 2011, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published a practice guideline recommending against perioperative antibiotic use for pediatric tonsillectomy. The impact of this recommendation has not been thoroughly examined. OBJECTIVE: To determine the impact of the AAO-HNS guideline on the use of perioperative antibiotics and patient outcomes for pediatric tonsillectomy...

IMPORTANCE: Postoperative edema and ecchymosis following rhinoplasty are a cause of anxiety for both patients and physicians and can affect the cosmetic results. Corticosteroids have been used to reduce these events. OBJECTIVE: To determine whether preoperative use of dexamethasone sodium phosphate alters the occurrence of edema and ecchymosis following rhinoplasty. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled clinical trial at an institutional referral center among a sample of individuals with rhinomegaly...

OBJECTIVE: This study describes the presentation of first branchial cleft anomalies and compares outcomes of first branchial cleft with other branchial cleft anomalies with attention to otologic findings. STUDY DESIGN: Case series with chart review. SETTING: Pediatric tertiary care facility. METHODS: Surgical databases were queried to identify children with branchial cleft anomalies. Descriptive analysis defined sample characteristics...