The COVID-19 pandemic has created a situation unparalleled in our lifetime. As the medical community has attempted to navigate a sea of ever-changing information and policies, this uncertainty has instead bred creativity, community, and evolution. Necessity is the mother of invention, and one of the by-products of our rapidly changing environment is the increased reliance on telemedicine. Here, we discuss our experience with incorporating telemedicine into an urban academic pediatric otolaryngology practice, the challenges that we have encountered, and the principles unique to this population.
The outbreak of COVID-19 has affected the globe in previously unimaginable ways, with far-reaching economic and social implications. It has also led to an outpouring of daily, ever-changing information. To assess the amount of data that were emerging, a PubMed search related to COVID-19 was performed. Nearly 8000 articles have been published since the virus was defined 4 months ago. This number has grown exponentially every month, potentially hindering our ability to discern what is scientifically important. Unlike previous global pandemics, we exist in a world of instantaneous access. Information, accurate or otherwise, is flowing from one side of the world to the other via word of mouth, social media, news, and medical journals. Changes in practice guidelines should be based on high-quality, well-powered research. Our job as health care providers is to mitigate misinformation and provide reassurance to prevent a second pandemic of misinformation.
Objective To determine whether a smartphone adaptor can record laryngoscopic videos of adequate quality for clinical diagnosis and communication among otolaryngologists and assess the impact of recorded exams on patient satisfaction. Methods Twenty adult inpatients undergoing flexible laryngoscopy in a tertiary care medical center were prospectively enrolled. Each subject's larynx was visualized with the standard laryngoscope eyepiece and with an attached mobile phone adaptor with video recording capabilities. A 5‐point Likert scale was used by the resident performing the scope to grade the adaptor and eyepiece exams. The same scale was used by an offsite otolaryngology attending to grade the adaptor video. Patients were shown the video, and a satisfaction survey was administered. Results In all patients, the adaptor was easy to use and required minimal setup. Ninety percent of patients reported an increase in satisfaction after watching the video of their exam. The eyepiece was superior to the adaptor in resolution, focus, color fidelity, brightness, and optical fluidity (P < 0.05). The video recording was deemed sufficient for clinical assessment in 90% of cases. The offsite reviewer determined that there would be “little” (15%) or “no value” (65%) in repeating the scope exam in the majority of patients. The laryngeal subsites were equally visible with the eyepiece and the adaptor (“full view,” 85%–100%). Conclusion Laryngoscopy videos recorded by a portable smartphone adaptor are sufficient for clinical evaluation in the majority of cases. This technology may improve patient satisfaction and communication among clinicians. Level of Evidence 4 Laryngoscope, 129:2147–2152, 2019
Background The purpose of this study was to evaluate the efficacy of sleep endoscopy-directed simultaneous lingual tonsillectomy and epiglottopexy in patients with sleep disordered breathing (SDB), including polysomnography (PSG) and swallowing outcomes. Methods A retrospective review was performed of all patients undergoing simultaneous lingual tonsillectomy and epiglottopexy over the study period. PSG objective measures were recorded pre- and postoperatively, along with demographic data, comorbidities, and descriptive data of swallowing dysfunction in the postoperative setting. Results A total of 24 patients met inclusion criteria for consideration, with 13 having valid pre- and postoperative PSG data. Successful surgery was achieved in 84.6% of patients, with no difference based on presence of medical comorbidities including Trisomy 21. Median reduction in obstructive apnea–hypopnea index (oAHI) with the procedure was 69.9%. Four patients (16.7%) had postoperative concern for dysphagia, but all objective swallowing evaluations were normal and no dietary modifications were necessary. Conclusion Combination lingual tonsillectomy and epiglottopexy in indicated patients has a high rate of success in this single-institutional study without new dysphagia in this population. These procedures are amenable to a combination surgery in appropriately selected patients determined by sleep state endoscopy in the setting of SDB evaluated with drug-induced sleep endoscopy. Graphical abstract
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