Clinical Currents

Clinical Currents 2017-06-09T10:41:42+00:00

Head and Neck

Neuromuscular electrical stimulation in rehabilitation following spinal accessory nerve injury.

This prospective study evaluates the effects of using both physical therapy and electrical stimulation to aid in functional recovery of muscle function following neck dissection surgery. Currently, physical therapy is being used to maintain range of motion in the shoulder to prevent freezing of the joint prior to return of muscle function. However, no treatments are being utilized to maintain strength of the paralyzed muscle. Approximately 70% of patients who have neck dissections suffer minor nerve damage as a result of the procedure. During the course of the procedure tissues of the neck need to be manipulated resulting in a stretch injury of the spinal accessory nerve leading to temporary weakness of the shoulder muscles. On average, the recovery period to regain normal function of the shoulder muscles is 9 months from the time of surgery.

Persistent tracheocutaneous fistula in head and neck cancer patients treated with chemoradiotherapy.

Frequently patients who undergo advanced protocol treatment (chemotherapy with concomitant radiotherapy) for head and neck cancers require the placement of a tracheostomy tube to maintain a patent airway as a result of tissue swelling in the neck. Once treatment has been completed and the swelling around the airway subsides the tracheostomy tube is removed. While the tracheostomy site in some patients heals normally (usually within two weeks), others develop a persistent tracheocutaneous fistula.

The problem of tracheocutaneous fistula relevant to head and neck cancer patients is not well described in the literature. The purpose of the proposed retrospective study is to determine the prevalence of patients who develop TCF and to determine whether there are patterns (treatment or otherwise) that lead to the cause of TCF.

The effect of standard head and neck cancer treatments on HIV positive patients.

It is a generally held belief in the medical community that patients infected with the HIV virus are unable to tolerate the doses of radiation therapy required to treat a squamous cell cancer of the head and neck region. It is believed that they experience increased side effects including irritation to their skin and the lining of their mouth, and faster progression of their HIV disease. Secondarily it is believed that these patients experience a decreased cure rate of their cancer when compared to non-HIV infected patients. It has been our experience that patients infected with the HIV virus suffer no increased side effects when compared to other cancer patients who receive similar treatments. A retrospective chart review will be conducted in order to determine whether HIV infection is a complicating factor during standard head and neck cancer treatment

Development of a smoking prevention/education program for presentation to grade schools, high schools and universities.

Minimal education is provided to teenagers through the early twenties regarding the consequences involved with smoking. While public service announcements state that smoking can lead to cancer and lung disease, little information is given regarding the devastating physical and emotional consequences that can occur due to the controllable act of smoking. The presentation is designed to offer students the ability to make an Informed Choiceä regarding smoking. It reinforces the fact that the choices that we make in life have consequences and that we should understand the consequences of our actions prior to acting. The presentation includes a brief history of tobacco use in the United States, information on who is most likely to start smoking and why, examines the role that emotional and neurological factors play in sustaining the act of smoking, includes photographs and video of the devastating medical effects smoking has on individuals, families, and society. The presentation concludes with a review of the economics of smoking and how choosing not to smoke can result in physical and financial richness.

Sinus

Cadaveric exploration of new endoscopic approaches and development of new instrumentation in sinus surgery.

This is an ongoing study examining the sinus regions. The study evaluates current treatment methods for sinus disease as well as exploration of new endoscopic approaches and instrumentation in sinus surgery.

The causes and costs associated with the misdiagnosis of sinusitis.

Sinus complaints are a common reason patients seek attention from a medical professional. However, many patients presenting with sinus complaints often have other etiologies as a source of their disease. Prior to seeing an Otolaryngologist who specializes in sinus concerns, the primary care physicians may offer the patient treatment with nasal steroids and antibiotics prior to having a definitive diagnosis. Misdiagnosis and treatment of these patients can result in unneeded medical costs, unresolved symptoms for the patient, and in some circumstances unnecessary procedures in an attempt to alleviate their symptoms.

This study will examine the causes for misdiagnosis of sinus disease and the effect that misdiagnosis and subsequent treatment have on patients. Information gathered from the study will be used to formulate an evaluation worksheet to be used by medical professionals to aid them in diagnosing sinus related diseases.

Treatment of chronic sinusitis with oral steroids: Evaluation of side effects throughout the course of treatment.

Currently, there is no standard of treatment of chronic rhinosinusitis. Oral corticosteroids have been used by some clinicians for the treatment of chronic rhinosinusitis. Others prefer a regimen devoid of corticosteroids. The purpose of this study is to elucidate the role and effects of oral steroid use in the treatment of chronic rhinosinusitis.

Otology

Outcomes of otologic surgery, hearing, and speech development in a population of cleft palate patients.

It is well known that cleft palate patients are at higher risk of developing otitis media and chronic ear disease. This can affect hearing as well as speech and language development. The complexities of the cleft palate patient has led to the role of a multidisciplinary approach for healthcare, which includes surgeons, dentists/orthodontists and speech pathologists. The purpose of this retrospective study is to generate information that may provide cleft palate patients with a general outline of what they might experience during the course of their treatment and the long term effects of their medical treatment on ear disease, hearing status, and speech development.

Viewing middle ear anatomy: Does otoendoscopy combined with intact canal wall mastoidectomy provide better visualizasion than canal wall down mastoidectomy.

The purpose of this study is to determine whether selective middle ear structures are better seen in the canal wall down approach with the operating microscope or in the intact canal wall approach with otoendoscopy. The ability to perform the necessary procedures using otoendoscopy would result in a less invasive procedure benefiting both the patient and the surgeon.

General Otolaryngology-HNS Resarch

Decreasing residency work hours: It’s effect on resident training and medical care.

The effect of sleep deprivation due to long work hours and its effect on patient care has long been a concern of the medical community. Recently, new rules enforcing a maximum 80 hour work week have been implemented. This long term study will evaluate the effects of the new requirements on the level of residency training, resident morale, and patient care.