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Article in Press
Office-Based 532-Nanometer Pulsed Potassium-Titanyl-Phosphate Laser Procedures in Laryngology
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Kathleen M. Tibbetts, MDa,∗,'Correspondence information about the author MD Kathleen M. TibbettsEmail the author MD Kathleen M. Tibbetts, Charles Blakely Simpson, MDb
Otolaryngologic Clinics of North America
Published online: March 26, 2019
Publication stage: In Press Corrected Proof
With fiber-based lasers that may be passed via the working channel of a flexible laryngoscope, in-office laser laryngeal surgery has become possible. The potassium-titanyl-phosphate laser has several features that make it ideal for laryngeal surgery, and it is now the laser of choice for in-office management of a variety of laryngeal lesions. Its applications have expanded significantly since its introduction, with reports of new indications continuing to appear in the literature. This article provides a comprehensive review of the indications and technical details of in-office potassium-titanyl-phosphate laser laryngeal surgery, and a summary of the existing literature regarding outcomes of these procedures.
With fiber-based lasers that may be passed via the working channel of a flexible laryngoscope, in-office laser laryngeal surgery has become possible. The potassium-titanyl-phosphate laser has several features that make it ideal for laryngeal surgery, and it is now the laser of choice for in-office management of a variety of laryngeal lesions. Its applications have expanded significantly since its introduction, with reports of new indications continuing to appear in the literature. This article provides a comprehensive review of the indications and technical details of in-office potassium-titanyl-phosphate laser laryngeal surgery, and a summary of the existing literature regarding outcomes of these procedures.
© 2019 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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In-office Functional Nasal Surgery
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Richard Kao, MDa, Cyrus C. Rabbani, MDa, Jonathan Y. Ting, MDb, Taha Z. Shipchandler, MDc,∗,'Correspondence information about the author MD Taha Z. ShipchandlerEmail the author MD Taha Z. Shipchandler
Otolaryngologic Clinics of North America
Published online: March 22, 2019
Publication stage: In Press Corrected Proof
Nasal airway obstruction is a common complaint encountered by the otolaryngologist. In-office nasal procedures are becoming increasingly popular and should be considered for patients desiring immediate treatment without the adverse effects of general anesthesia, operating room costs, or scheduling delays. This article discusses the factors in patient selection, room setup, and other considerations. The options available for in-office treatment of nasal valve repair are discussed, including turbinoplasty, septoplasty, and nasal valve repair/functional rhinoplasty–type techniques described in the literature.
Nasal airway obstruction is a common complaint encountered by the otolaryngologist. In-office nasal procedures are becoming increasingly popular and should be considered for patients desiring immediate treatment without the adverse effects of general anesthesia, operating room costs, or scheduling delays. This article discusses the factors in patient selection, room setup, and other considerations. The options available for in-office treatment of nasal valve repair are discussed, including turbinoplasty, septoplasty, and nasal valve repair/functional rhinoplasty–type techniques described in the literature.
© 2019 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
Article in Press
Reprocessing Flexible Endoscopes in the Otolaryngology Clinic
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Melissa Pynnonen, MD, MSca,∗,'Correspondence information about the author MD, MSc Melissa PynnonenEmail the author MD, MSc Melissa Pynnonen, John Whelan, BSN, RNb
Otolaryngologic Clinics of North America
Published online: March 22, 2019
Publication stage: In Press Corrected Proof
Reprocessing a flexible endoscope is a complex multistep process. Attention to detail is essential for patient safety. Physicians need to empower their staff to function as guardians and advocates for best practices in endoscope reprocessing. Current best practice standards and guidelines for flexible endoscope reprocessing in the United States have been led by the Society of Gastroenterology Nurses and Associates, the Association for the Advancement of Medical Instrumentation, the Association of periOperative Registered Nurses, American Society for Gastrointestinal Endoscopy, and Multisociety Guideline. This article focuses on important aspects and current best practices for flexible endoscope cleaning and high-level disinfection.
Reprocessing a flexible endoscope is a complex multistep process. Attention to detail is essential for patient safety. Physicians need to empower their staff to function as guardians and advocates for best practices in endoscope reprocessing. Current best practice standards and guidelines for flexible endoscope reprocessing in the United States have been led by the Society of Gastroenterology Nurses and Associates, the Association for the Advancement of Medical Instrumentation, the Association of periOperative Registered Nurses, American Society for Gastrointestinal Endoscopy, and Multisociety Guideline. This article focuses on important aspects and current best practices for flexible endoscope cleaning and high-level disinfection.
© 2019 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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In-Office Evaluation and Management of Dysphagia
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Abdulmalik S. Alsaied, MD∗,'Correspondence information about the author MD Abdulmalik S. AlsaiedEmail the author MD Abdulmalik S. Alsaied, Gregory N. Postma, MD
Department of Otolaryngology, Voice, Airway and Swallowing Center, Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
Otolaryngologic Clinics of North America
Published online: March 22, 2019
Publication stage: In Press Corrected Proof
Dysphagia is a common complaint encountered in otolaryngology clinics. Approaching the patient with dysphagia starts with a comprehensive symptomatic analysis and thorough physical examination. The recent rapid revolution in office-based procedures has a great impact in the evaluation and management of dysphagia. Currently, diagnostic and therapeutic procedures can be performed safely and effectively in the office setting with the advantage of avoidance of sedation or general anesthesia.
Dysphagia is a common complaint encountered in otolaryngology clinics. Approaching the patient with dysphagia starts with a comprehensive symptomatic analysis and thorough physical examination. The recent rapid revolution in office-based procedures has a great impact in the evaluation and management of dysphagia. Currently, diagnostic and therapeutic procedures can be performed safely and effectively in the office setting with the advantage of avoidance of sedation or general anesthesia.
© 2019 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
Article in Press
In-Office Laryngology Injections
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Gregory R. Dion, MD, MS∗,'Correspondence information about the author MD, MS Gregory R. DionEmail the author MD, MS Gregory R. Dion, Skyler W. Nielsen, DO
Department of Otolaryngology–Head and Neck Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam, Houston, TX 78234, USA
Otolaryngologic Clinics of North America
Published online: March 22, 2019
Publication stage: In Press Corrected Proof
The ability to perform in-office vocal fold injections has been greatly enhanced by advances in videolaryngoscopy technology. With improved optics and thin, channeled flexible laryngoscopes, in-office laryngeal injections have expanded from vocal fold augmentation for glottic insufficiency, vocal cold immobility, and botulinum toxin injections for spasmodic dysphonia, to vocal fold steroid injections for benign vocal fold lesions and scars and various injections for neurogenic cough. Efficacy, approaches, post-procedure management, and common complications of in-office laryngeal injections are outlined and supporting evidence discussed.
The ability to perform in-office vocal fold injections has been greatly enhanced by advances in videolaryngoscopy technology. With improved optics and thin, channeled flexible laryngoscopes, in-office laryngeal injections have expanded from vocal fold augmentation for glottic insufficiency, vocal cold immobility, and botulinum toxin injections for spasmodic dysphonia, to vocal fold steroid injections for benign vocal fold lesions and scars and various injections for neurogenic cough. Efficacy, approaches, post-procedure management, and common complications of in-office laryngeal injections are outlined and supporting evidence discussed.
Published by Elsevier Inc.
Article in Press
Office-Based Otology Procedures
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Manuela Fina, MD∗,'Correspondence information about the author MD Manuela FinaEmail the author MD Manuela Fina, Douglas Chieffe, MD
Department of Otolaryngology, University of Minnesota, Minneapolis, MN, USA
Otolaryngologic Clinics of North America
Published online: March 22, 2019
Publication stage: In Press Corrected Proof
Endoscopy has changed the practice of otology in both operative and clinic settings. Endoscopes increase the visibility of anterior tympanic perforations expanding the criteria for in-office repair. Endoscopic myringoplasty techniques using tissue-engineered grafts and porcine-based extracellular grafts are described. Endoscopic inspection of deep retraction pockets is a new important tool for pre-operative surgical assessment. This section also discusses the use and potential benefits of intratympanic injections for sudden sensorineural hearing loss and Meniere's disease.
Endoscopy has changed the practice of otology in both operative and clinic settings. Endoscopes increase the visibility of anterior tympanic perforations expanding the criteria for in-office repair. Endoscopic myringoplasty techniques using tissue-engineered grafts and porcine-based extracellular grafts are described. Endoscopic inspection of deep retraction pockets is a new important tool for pre-operative surgical assessment. This section also discusses the use and potential benefits of intratympanic injections for sudden sensorineural hearing loss and Meniere's disease.
© 2019 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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Office-Based Sinus Surgery
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Alok T. Saini, MDa, Martin J. Citardi, MDb, William C. Yao, MDb, Amber U. Luong, MD, PhDb,∗,'Correspondence information about the author MD, PhD Amber U. LuongEmail the author MD, PhD Amber U. Luong
Otolaryngologic Clinics of North America
Published online: March 22, 2019
Publication stage: In Press Corrected Proof
Office-based rhinologic procedures have seen a dramatic rise in incidence over the last decade. It is crucial to select appropriate patients and understand which pathologies may be amenable to in-office procedures. It behooves the otolaryngologist to be familiar with the array of technologic advances that are expanding the limits of office-based rhinology and to have a solid understanding of the technical nuances of using these technologies in the clinic. This article highlights the issues associated with some of the more common office-based sinus procedures, and provides practical information on set-up and reimbursement.
Office-based rhinologic procedures have seen a dramatic rise in incidence over the last decade. It is crucial to select appropriate patients and understand which pathologies may be amenable to in-office procedures. It behooves the otolaryngologist to be familiar with the array of technologic advances that are expanding the limits of office-based rhinology and to have a solid understanding of the technical nuances of using these technologies in the clinic. This article highlights the issues associated with some of the more common office-based sinus procedures, and provides practical information on set-up and reimbursement.
© 2019 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
Article in Press
Mohs Reconstruction and Scar Revision
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Andrew W. Joseph, MD, MPHa,∗,'Correspondence information about the author MD, MPH Andrew W. JosephEmail the author MD, MPH Andrew W. Joseph, Shannon S. Joseph, MDb
Otolaryngologic Clinics of North America
Published online: March 22, 2019
Publication stage: In Press Corrected Proof
Facial reconstruction may be effectively performed in an office setting using a variety of techniques. Careful patient selection is paramount for achieving successful outcomes in this setting. The most common reconstructive techniques used in the office setting include local flaps and skin grafts. Scar management is complementary to all facial reconstructive procedures, and the reconstructive surgeon has a large variety of scar management techniques available. Scar management should be individualized based on clinical setting and available resources.
Facial reconstruction may be effectively performed in an office setting using a variety of techniques. Careful patient selection is paramount for achieving successful outcomes in this setting. The most common reconstructive techniques used in the office setting include local flaps and skin grafts. Scar management is complementary to all facial reconstructive procedures, and the reconstructive surgeon has a large variety of scar management techniques available. Scar management should be individualized based on clinical setting and available resources.
© 2019 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
Article in Press
Patient Safety and Anesthesia Considerations for Office-Based Otolaryngology Procedures
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Cecelia E. Schmalbach, MD, MScEmail the author MD, MSc Cecelia E. Schmalbach
Otolaryngology–Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, 3440 N, Broad Street, Kresge West, 3rd Floor, Room 309, Philadelphia, PA 19140, USA
Otolaryngologic Clinics of North America
Published online: March 22, 2019
Publication stage: In Press Corrected Proof
Office-based otolaryngology procedures provide a safe and efficient alternative to the traditional operating room. Physicians are responsible for knowing their state regulations and subspecialty guidelines. Although the clinic setting has fewer regulations than hospitals and ambulatory surgery centers, the clinic has the same standards as a hospital with respect to emergency equipment, trained personnel, protocols, and safety measures. Sedation occurs along a continuum; it is impossible to predict a patient's response to sedation. Otolaryngologists performing office-based sedation must be prepared to rescue with airway and advanced life support in the event that the sedation level encountered is deeper than expected.
Office-based otolaryngology procedures provide a safe and efficient alternative to the traditional operating room. Physicians are responsible for knowing their state regulations and subspecialty guidelines. Although the clinic setting has fewer regulations than hospitals and ambulatory surgery centers, the clinic has the same standards as a hospital with respect to emergency equipment, trained personnel, protocols, and safety measures. Sedation occurs along a continuum; it is impossible to predict a patient's response to sedation. Otolaryngologists performing office-based sedation must be prepared to rescue with airway and advanced life support in the event that the sedation level encountered is deeper than expected.
© 2019 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
Article in Press
In-Office Balloon Dilation of the Eustachian Tube under Local Anesthesia
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Marc Dean, MDa,∗,'Correspondence information about the author MD Marc DeanEmail the author MD Marc Dean, Melissa Pynnonen, MD, MScb
Otolaryngologic Clinics of North America
Published online: March 22, 2019
Publication stage: In Press Corrected Proof
Balloon dilation of the Eustachian tube (BDET) is an effective treatment of Eustachian tube dysfunction. This procedure can be performed under local anesthesia in the office. This article outlines the evolution of BDET under local anesthesia, describes the techniques of in-office BDET and provides an algorithm to identify suitable patients for this procedure.
Balloon dilation of the Eustachian tube (BDET) is an effective treatment of Eustachian tube dysfunction. This procedure can be performed under local anesthesia in the office. This article outlines the evolution of BDET under local anesthesia, describes the techniques of in-office BDET and provides an algorithm to identify suitable patients for this procedure.
© 2019 The Authors. Published by Elsevier Inc.
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