Chronic Pain Management in Head and Neck Oncology
Pain is epidemic in patients with head and neck cancer. Providers involved in the care of patients with head and neck cancer should be able to describe the common pain syndromes experienced by these patients, identify patients at risk of pain, and provide multimodal treatment of chronic pain. Treatment of chronic pain encompasses analgesic medications; adjuvant pharmacotherapy, including antidepressants and anticonvulsants; interventional techniques; as well as integrative medicine. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - July 16, 2020 Category: ENT & OMF Authors: Michael A. Blasco, Joehassin Cordero, Yusuf Dundar Source Type: research

Controlled Substance Agreements and Other Best Opioid Prescription Practices
Controlled substance agreements between providers and patients represent important strategies for setting expectations for chronic opioid therapy. These agreements generally summarize best opioid prescription practices and destigmatize practice policies such as regular toxicology screenings. These controlled substance agreements also set expectations for discontinuation of therapy if appropriate. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - July 16, 2020 Category: ENT & OMF Authors: Melissa Straub, Anna Pashkova Source Type: research

Quality Improvement in Pain Medicine
This article discusses the rising overprescription of opioids, influenced by legislation and governmental agencies, and the steps taken to correct and reform policies to decrease the amount of opioids prescribed. Lastly, specific institutional examples of quality improvement protocols implemented to help decrease opioid consumption and prescription are discussed. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - July 16, 2020 Category: ENT & OMF Authors: Jordyn P. Lucas, John D. Cramer Source Type: research

Pain Management for the Otolaryngologist
Nearly 50,000 US adults experience opioid-overdose deaths annually and 1.7 million experience a substance use disorder from prescription opioids. Hence, understanding analgesia strategies is of utmost importance. A pre-operative analgesic plan can consist of a brief conversation between the surgeon, patient, and anesthesiologist in an uncomplicated case or range all the way to an involved, multidisciplinary plan for a chronic pain patient. Over the past several decades, there have been myriad studies examining perioperative analgesic regimens for otolaryngologic procedures, many of which have demonstrated the efficacy of n...
Source: Otolaryngologic clinics of North America - July 15, 2020 Category: ENT & OMF Authors: Peter F. Svider, Anna A. Pashkova, Jean Anderson Eloy Source Type: research

Preoperative Optimization for Perioperative Analgesia
The perioperative analgesic plan begins with preoperative planning. The surgeon should be versed in practical approaches for managing analgesia in patients with chronic pain. The first step includes evaluating the patient and conducting a focused pain history. Confirming, documenting, and understanding current outpatient prescriptions is critical. Patients should be screened for medical conditions that preclude the use of certain analgesics, or place them at higher risk of respiratory depression. Providers should coordinate with the patient ’s outpatient prescribers and pain specialists to ensure a safe and effective...
Source: Otolaryngologic clinics of North America - July 15, 2020 Category: ENT & OMF Authors: Nicole Matar, Anna Pashkova Source Type: research

Introduction: Opioid Analgesia
Many individuals believe that physicians can be difficult when they become patients, as having “just enough” knowledge or attempting to direct one’s personal medical care presents problems particularly when dealing with a dynamic issue such as analgesia. Physicians are used to being advocates for their patients, and when they are the patients themselves, there is a certain degree of tra nsition that changes one’s perspective and affects how complex medical issues are addressed. There has been an evolution in management of pain concerns in recent decades with growing recognition of the toll of the op...
Source: Otolaryngologic clinics of North America - July 15, 2020 Category: ENT & OMF Authors: Peter F. Svider Source Type: research

Local Blocks and Regional Anesthesia in the Head and Neck
Local anesthesia is commonly used for head and neck procedures. Many anesthetic agents are available, with differing properties that can alter their durations of action and lengths of time to onset. These agents can be used acutely for laceration repair or as adjuncts to intravenous sedation. Local and regional anesthetic agents can also be used for chronic conditions. Several local anesthetic blocks are available. Local anesthesia has the potential for complications, ranging from issues with injection process, such as a broken needle, to reactions of the anesthetic agent. Some populations are more at risk for certain reac...
Source: Otolaryngologic clinics of North America - July 15, 2020 Category: ENT & OMF Authors: Andrew P. Johnson, Elizabeth Boscoe, Cristina Cabrera-Muffly Source Type: research

Acute Pain Management Following Head and Neck Surgery
Acute pain management following major head and neck (HN) surgery is complex. Multimodal analgesia (MMA) regimens including acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids, and locoregional anesthetics are safe and effective in this population (including patients undergoing HN free flap surgery). Special considerations for patients undergoing HN free flap surgery include judicious use of steroids and attention to donor site pain. Evidence for specific analgesic regimens following transoral robotic surgery is limited but should include MMA and perioperative dexamethasone. Further study is required to opti...
Source: Otolaryngologic clinics of North America - July 15, 2020 Category: ENT & OMF Authors: Michael Bobian, Annika Gupta, Evan M. Graboyes Source Type: research

Perioperative Pain Management Following Otologic Surgery
Otologic surgery involves a broad range of procedures. In general, postoperative pain from most otologic surgeries can be managed with little to no opioids, and surgeons should make a concerted effort to minimize narcotic prescriptions in the midst of the opioid crisis. Many procedures, including transcanal surgeries and even postauricular surgeries, may performed with local anesthetic in selected patients. Multimodal pain regimens, local anesthesia, and alternative approaches have shown promise in minimizing narcotic use, and should be considered. Preoperative counseling to appropriately manage expectations and goals is i...
Source: Otolaryngologic clinics of North America - July 15, 2020 Category: ENT & OMF Authors: Daniel R. Morrison, Lindsay S. Moore, Erika M. Walsh Source Type: research

Nonopioid Adjuncts and Alternatives
Multimodality nonopioid analgesia can be effective for pain control. Balancing risks and benefits of treatment should guide the appropriateness of opioid versus nonopioid pain control. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - July 15, 2020 Category: ENT & OMF Authors: Qasim Husain, Catherine Banks, Stacey T. Gray Source Type: research

The Current State of the Otolaryngology Workforce
This article discusses what is known about factors of the current otolaryngology workforce, including trends in residency and fellowship training, diversity of the specialty, its geographic distribution, and the challenges of caring for an aging population. Predicting the shortage and possible solutions through modeling is complex and prone to errors caused by incomplete data and assumptions about otolaryngology ’s similarity to other specialties of medicine at large. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - July 15, 2020 Category: ENT & OMF Authors: Lauren M. Cass, Joshua B. Smith Source Type: research

Perioperative Analgesia for Thyroid and Parathyroid Surgery
This article discusses the algorithms and published practice patterns on perioperative analgesia for thyroid and parathyroid surgery. This includes medications and techniques used for general anesthesia, local anesthesia including nerve block methods, and oral medication used for postoperative pain control. The authors also discuss multimodality pain control and the increased trend to reduce opioid analgesics without inadequate pain control or patient satisfaction. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - July 1, 2020 Category: ENT & OMF Authors: Vaninder K. Dhillon, Babak Jahan-Parwar, David S. Cohen Source Type: research

Perioperative Analgesia in Pediatric Patients Undergoing Otolaryngologic Surgery
This article reviews the evidence regarding current perioperative pain management strategies in pediatric patients undergoing otolaryngologic surgery. Pediatric otolaryngology is a broad field with a wide variety of surgical procedures that each requires careful consideration for optimal perioperative pain management. Adequate pain control is vital to ensuring patient safety and achieving successful postoperative care, but many young children are limited in their capacity to communicate their pain experience. Current literature holds a disproportionate amount of focus on pain management for certain procedures, whereas ther...
Source: Otolaryngologic clinics of North America - July 1, 2020 Category: ENT & OMF Authors: Andrew J. Maroda, Kimberly K. Coca, Jennifer D. McLevy-Bazzanella, Joshua W. Wood, Erica C. Grissom, Anthony M. Sheyn Source Type: research

Strengthening Our Societies with Diversity and Inclusion
In 2018, the Joint Councils of the American Otological Society and the American Neurotology Society adopted a statement on diversity and inclusion for programs henceforth. That statement stands as a landmark touch point in our societies that heralds the engagement of all our members as we all work to advance knowledge and skills in otology and neurotology. I was asked to write this piece for Otology& Neurotology, and re-publication in this Clinics series establishes a baseline understanding of the historical limitations in organized otolaryngology and the willingness of societies to adapt and lead in shaping our profes...
Source: Otolaryngologic clinics of North America - June 27, 2020 Category: ENT & OMF Authors: Sujana S. Chandrasekhar Source Type: research

Special Article Series: Intentionally Shaping the Future of Otolaryngology
OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - June 27, 2020 Category: ENT & OMF Authors: Jennifer A. Villwock Source Type: research

Copyright
Elsevier (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - June 27, 2020 Category: ENT & OMF Source Type: research

Contributors
SUJANA S. CHANDRASEKHAR, MD, FACS, FAAOHNS (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - June 27, 2020 Category: ENT & OMF Source Type: research

Contents
Sujana S. Chandrasekhar (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - June 27, 2020 Category: ENT & OMF Source Type: research

Otolaryngologic Clinics of North America
Pain Management for the Otolaryngologist (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - June 27, 2020 Category: ENT & OMF Source Type: research

Acute Pain Management Following Facial Plastic Surgery
This article discusses the available evidence in these procedures and discusses the authors ’ recommendations for the treatment of postoperative pain, with a focus on decreasing the reliance on opioid pain medication. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - June 24, 2020 Category: ENT & OMF Authors: Taha S. Meraj, Amishav Bresler, Giancarlo F. Zuliani Source Type: research

Assessment and Management of Postoperative Pain Associated with Sleep Apnea Surgery
A literature review was conducted regarding the assessment and treatment of postoperative pain following surgery for obstructive sleep apnea (OSA). Given the risks of opioid use by patients with OSA, special attention to opioid risk reduction and avoidance is warranted in this population. The results of this review demonstrate the existence of a body of evidence that supports the use of nonopioid analgesics and nonpharmacologic approaches pain management. Strategies for managing postoperative pain should emphasize the use of local anesthetic infiltration, nonsteroidal antiinflammatory drugs, acetaminophen, topical analgesi...
Source: Otolaryngologic clinics of North America - June 18, 2020 Category: ENT & OMF Authors: Jonathan A. Waxman, Kerolos G. Shenouda, Ho-Sheng Lin Source Type: research

Spreading Our Wings: Leadership and Personal Growth in Otolaryngology
Although disorders and treatments of the ears, nose, and throat (ENT) were described in ancient Indian, Chinese, and Greek texts, otolaryngology –head and neck surgery as a specialty began in the Western world in the nineteenth century, when doctors figured out that the ears, the nose, and the throat are closely connected by a system of tubes and passages. An important new medical specialty was thus born. ENT problems are the most common r easons for physician visits around the world, both in developing and developed countries and in rural and urban communities. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - June 3, 2020 Category: ENT & OMF Authors: Sujana S. Chandrasekhar Tags: Foreword Source Type: research

Preface
Multigenerational, multicultural, multiethnic. These words describe our increasingly global society as well as many of our organizations, colleagues, communities, and patients. “Intentionally Shaping the Future of Otolaryngology” seeks to provide evidence and insight and to provoke critical thought and conversations regarding issues facing the future of our field. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - June 2, 2020 Category: ENT & OMF Authors: Jennifer A. Villwock Source Type: research

Tinnitus Neuroimaging
This article reviews the use of human neuroimaging for chronic subjective tinnitus. Evidence-based guidance on the clinical use of imaging to identify relevant auditory lesions when evaluating tinnitus patients is given. After introducing the anatomy and imaging modalities most pertinent to the neuroscience of tinnitus, the article reviews tinnitus-associated alterations in key auditory and nonauditory networks in the central nervous system. Emphasis is placed on how these findings support proposed models of tinnitus and how this line of investigation is relevant to practicing clinicians. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - May 26, 2020 Category: ENT & OMF Authors: Meredith E. Adams, Tina C. Huang, Srikantan Nagarajan, Steven W. Cheung Source Type: research

Tinnitus: Clinical, Basic Science, Audiologic and Industry Updates
Tinnitus, the perception of sound without an external source, is a phenomenon that interests people from many backgrounds and disciplines. In the United States, it is estimated that 30 million adults experience tinnitus on a daily basis, and for upward of 5% of them, the experience is severely disruptive and negatively impacts quality of life. Therefore, there are many individuals with tinnitus who may benefit from this issue by learning what is currently known about tinnitus cause and treatments. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - May 21, 2020 Category: ENT & OMF Authors: Carol A. Bauer, Ronna Hertzano, Didier Depireux Tags: Preface Source Type: research

Tinnitus: Current Understanding of an Age-Old Problem
Tinnitus, the perception of sound where there is no external sound stimulus, has long been part of the human experience. Because of our current noisy society, this condition affects 1 in 10 adults.1 However, it did not begin with the Industrial Age. There are references to it in Hindu ayurvedic medicine, where it is considered an imbalance of vata dosha, or the wind element, and in classical China, where it was thought to be caused by an imbalance of yin and yang. Mesopotamian remedies included exorcism and chants dedicated to the god of water. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - May 15, 2020 Category: ENT & OMF Authors: Sujana S. Chandrasekhar Tags: Foreword Source Type: research

Sleep Apnea
OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - May 11, 2020 Category: ENT & OMF Authors: Maria V. Suurna, Ofer Jacobowitz Source Type: research

Copyright
Elsevier (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - May 11, 2020 Category: ENT & OMF Source Type: research

Contributors
SUJANA S. CHANDRASEKHAR, MD, FACS, FAAOHNS (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - May 11, 2020 Category: ENT & OMF Source Type: research

Contents
Sujana S. Chandrasekhar (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - May 11, 2020 Category: ENT & OMF Source Type: research

Otolaryngologic Clinics of North America
Tinnitus (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - May 11, 2020 Category: ENT & OMF Source Type: research

Avenue for Future Tinnitus Treatments
This article outlines existing efforts and develops ideas on how research for improved tinnitus therapy might look in the future. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - May 4, 2020 Category: ENT & OMF Authors: Tobias Kleinjung, Berthold Langguth Source Type: research

Otolaryngologist as a Political Leader?
Otolaryngologists are in a good position to advocate for our patients and our specialty. We can do it as a volunteer or as a full-time job running for political office at the state or federal level. To be taken seriously, we need to offer solutions besides citing the problems. We encourage otolaryngologists to work with our Academy and its ENT-PAC (Ear, Nose, Throat Political Action Committee). Medicine is a great profession and Otolaryngology –Head and Neck Surgery is an even better specialty. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - May 4, 2020 Category: ENT & OMF Authors: K.J. Lee, Mark E. Lee Source Type: research

Classification of Tinnitus
This article reviews a broad range of approaches to understand and demarcate different tinnitus subtypes, which will be critical for exploring and finding cures for different subtypes. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - May 4, 2020 Category: ENT & OMF Authors: Claudia Barros Coelho, Roberto Santos, Kadja Ferraz Campara, Richard Tyler Source Type: research

Tinnitus
This report suggests terminology and definitions to promote standardization, with a brief overview of findings from selected population-based epidemiologic studies. Tinnitus-specific data are presented from the Noise Outcomes in Servicemembers Epidemiology study. Further epidemiologic studies are needed to develop tinnitus treatment and a cure for this chronic condition. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 30, 2020 Category: ENT & OMF Authors: James A. Henry, Kelly M. Reavis, Susan E. Griest, Emily J. Thielman, Sarah M. Theodoroff, Leslie D. Grush, Kathleen F. Carlson Source Type: research

Noise
Cochlear damage is often thought to result in hearing thresholds shift, whether permanent or temporary. The report of tinnitus in the absence of any clear deficit in cochlear function was believed to indicate that hearing loss and tinnitus, while comorbid, could arise independently from each other. In all likelihood, tinnitus that is not of central nervous system origin is associated with hearing loss. As a correlate, although a treatment of most forms of tinnitus will likely emerge in the years to come, curing tinnitus will first require curing hearing loss. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 30, 2020 Category: ENT & OMF Authors: Ronna Hertzano, Erika L. Lipford, Didier Depireux Source Type: research

Alternative Treatments of Tinnitus
“Because Western medicine has remained largely unsuccessful at treating tinnitus symptoms, many physicians as well as patients have turned to alternative treatment options to decrease patients’ suffering and improve their quality of life. Although research in complementary/integrative medicine c ontinues to be scarce and inconclusive, studies are pointing toward the positive effects of acupuncture, herbal remedies, dietary supplements, antioxidants, melatonin, and hypnosis on tinnitus. Although the efficacies of these treatments are inconsistent and may depend on a patient’s unique circum stances, studies...
Source: Otolaryngologic clinics of North America - April 30, 2020 Category: ENT & OMF Authors: Friederike S. Luetzenberg, Seilesh Babu, Michael D. Seidman Source Type: research

Why and When to Treat Snoring
This article discusses the many aspects of snoring, including impacts on bed partners, the individual who snores, and when and how to appropriately evaluate, diagnose, and treat the perpetrator. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of the phenomenon of snoring.It is estimated that half of the adult population over the age of 60 years of age snores. This chapter discusses snoring, including the impact on bed partners, the individual that snores and when and how to treat the snorer. The goal is for clinicians to expand their knowl edge regarding diagnosis and treatment of pat...
Source: Otolaryngologic clinics of North America - April 24, 2020 Category: ENT & OMF Authors: Kathleen Yaremchuk Source Type: research

Surgical and Nonsurgical Weight Loss for Patients with Obstructive Sleep Apnea
A strong association exists between excess weight and obstructive sleep apnea (OSA), and most patients with OSA have elevated body mass index. Weight loss is an essential part of treatment for patients with OSA and overweight or obesity. Lifestyle interventions are cornerstones of weight management. However, most patients have difficulty achieving and maintaining clinically significant weight loss with lifestyle interventions alone. Health care providers who treat patients with OSA should be familiar with advanced treatment options for overweight and obesity including antiobesity medications, bariatric surgery, and devices...
Source: Otolaryngologic clinics of North America - April 22, 2020 Category: ENT & OMF Authors: Katherine H. Saunders, Leon I. Igel, Beverly G. Tchang Source Type: research

Palatopharyngoplasty and Palatal Anatomy and Phenotypes for Treatment of Sleep Apnea in the Twenty-first Century
Successful palatopharyngoplasty is critical for successful sleep apnea surgery. Traditional uvulopalatopharyngoplasty was primarily excisional, whereas newer techniques, such as expansion sphincterpharyngoplasty, are more reconstructive. Studies of flow dynamics even demonstrate that the effectiveness of maxillofacial surgery is significantly mediated through stiffening and enlargement of the lateral retropalatal and pharyngeal airway. The current modified technique of uvulopalatopharyngoplasty/expansion sphincteroplasty aims to maximize relocation and tension on the palatopharyngeus muscle, opening the retropalatal airway...
Source: Otolaryngologic clinics of North America - April 22, 2020 Category: ENT & OMF Authors: Ryan Puccia, Beverly Tucker Woodson Source Type: research

Base of Tongue Surgery for Obstructive Sleep Apnea in the Era of Neurostimulation
Retroglossal collapse is commonly seen in patients with obstructive sleep apnea. The role of upper airway stimulation surgery for these patients continues to evolve. However, base of tongue reduction surgery continues to have usefulness for appropriately selected patients with obstructive sleep apnea. Specific tongue base approaches may vary in response to patient and surgeon preferences and be used in multilevel surgery where appropriate. Key factors include patient age, willingness to undergo device implantation, and preferences for outpatient versus inpatient procedure, single procedure versus multiple, and tolerance fo...
Source: Otolaryngologic clinics of North America - April 22, 2020 Category: ENT & OMF Authors: Ravi R. Shah, Erica R. Thaler Source Type: research

Implantable Neurostimulation for Treatment of Sleep Apnea
Hypoglossal nerve stimulation (HNS) therapy represents a novel approach and a paradigm shift in the evolution of obstructive sleep apnea (OSA) treatment as a hybrid surgically implanted, medically titratable device. Unlike traditional sleep apnea surgical procedures, HNS augments the neuromuscular activity of the pharynx, preserves upper airway structure and function, and has the potential to provide multilevel upper airway improvement with one procedure. The early success of HNS sets the stage for new technology development, further investigation into optimal patient selection and therapy titration, and application to oth...
Source: Otolaryngologic clinics of North America - April 22, 2020 Category: ENT & OMF Authors: Rachel Whelan, Ryan J. Soose Source Type: research

Skeletal Surgery for Obstructive Sleep Apnea
This article focuses on the role of skeletal surgery within the modified Stanford protocol with particular attention focused on the evolved role of MMA. First, surgery in patients presenting with congenital dentofacial deformity or characteristic drug-induced sleep endoscopy findings, then the growing role of maxillary expansion in a newly identified patient phenotype, and finally genioglossus advancement, are discussed. Less commonly used and validated techniques, such as isolated mandibular advancement and maxillomandibular expansion are not discussed in this article. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 22, 2020 Category: ENT & OMF Authors: Michael Awad, Robson Capasso Source Type: research

The Goals of Treating Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) syndrome is a destructive and insidious entity mostly underdiagnosed and undertreated. It affects not only individuals but the society as a whole. The costs to the populations can be measured not only in morbidity and mortality but also in the financial wellbeing of a society. Financial burden of this disease is staggering. The social fabric of society is also greatly impacted. Physiologic effects of OSA are far reaching. It has been shown that early intervention with treatment of OSA can often prevent and/or reverse many of the negative outcomes associated with this condition. (Source: Otolar...
Source: Otolaryngologic clinics of North America - April 22, 2020 Category: ENT & OMF Authors: Ebone C. Evans, Omotara Sulyman, Oleg Froymovich Source Type: research

Phenotypes of Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is a multisystem breathing disorder associated with increased morbidity and mortality. Clinical and operative assessment tools improve surgical approaches to treat airway obstruction. The primary sites of anatomic obstruction are at the levels of the nasal, palatal, and hypopharyngeal airway. The literature suggests a relationship between reduced neuromuscular tone and the age-related increase in OSA prevalence for normal-weight adults. Pharyngeal soft tissue collapse due to reduced airway pressure is defined as the critical closing pressure. Respiratory biochemistry homeostasis is an addition...
Source: Otolaryngologic clinics of North America - April 22, 2020 Category: ENT & OMF Authors: Kevin Coughlin, George M. Davies, Marion Boyd Gillespie Source Type: research

Sleep Studies Interpretation and Application
Obstructive sleep apnea is a common, but under-recognized, condition. Polysomnography remains the gold standard for diagnosing obstructive sleep apnea and determining whether treatment is appropriate. The development of home sleep apnea testing has allowed for a faster and more convenient method of diagnosis. Continuous positive airway pressure is the therapy of choice for most patients with obstructive sleep apnea, but otorhinolaryngologists can expect to see more and more patients looking for alternative treatments. This review highlights salient points relevant to sleep study application and interpretation for otorhinol...
Source: Otolaryngologic clinics of North America - April 22, 2020 Category: ENT & OMF Authors: Robert Hiensch, David M. Rapoport Source Type: research

Heritability and Genetics Contribution to Tinnitus
Tinnitus is the perception of sound in the absence of an external source. Genetic studies on families, twins, and adoptees cohorts have been conducted supporting tinnitus heritability, with higher heritability in men with bilateral tinnitus at any age, and young women with bilateral tinnitus, but not in unilateral tinnitus. The condition is associated with several comorbidities such as hearing loss, Meniere disease, sleep disorders, depression, and migraine and may lead toward suicidal attempts in extreme cases. Several studies have reported few regulatory allelic variants in candidate genes and pathways associated with ti...
Source: Otolaryngologic clinics of North America - April 22, 2020 Category: ENT & OMF Authors: Jose A. Lopez-Escamez, Sana Amanat Source Type: research

Noise
Tinnitus is commonly experienced by military Service Members and Veterans, especially by the newest generation who served in Iraq and Afghanistan. When patients seek health care for tinnitus, it is important to determine its type, check for comorbid conditions that might be triggering or exacerbating the condition, and to address its functional and psychosocial effects. Otolaryngologists are usually the first health care professional to evaluate a patient with tinnitus, and it is essential to provide appropriate referrals for this high-burden condition. Noise-induced tinnitus is multifaceted; by performing a thorough asses...
Source: Otolaryngologic clinics of North America - April 22, 2020 Category: ENT & OMF Authors: Sarah M. Theodoroff, Dawn Konrad-Martin Source Type: research

Perception of, and Reaction to, Tinnitus
This article discusses one element of the reaction: depression. Epidemiologic studies have noted high comorbidity of tinnitus and depression. Findings from recent brain imaging studies have noted shared neural networks in depression and severe tinnitus. As further evidence of this overlaps, antidepressants, counseling, and psychology-based approaches have been used to treat tinnitus. Multifaceted treatment strategies, using both sound-based therapies (not discussed in this paper) and psychology-based approaches, are a necessary part of the treatment options, with the aim of enhancing self-efficacy in patients with tinnitus...
Source: Otolaryngologic clinics of North America - April 22, 2020 Category: ENT & OMF Authors: Fatima T. Husain Source Type: research

Does Tinnitus Fill in the Gap Using Electrophysiology? A Scoping Review
The results showed a trend of increased post-gap amplitudes and reduced gap salience; however, the small number of articles yield and limited consensus prohibit any conclusions for clinical use. Nevertheless, gap-induced EPs may be further explored as a potential tool for tinnitus detection. (Source: Otolaryngologic clinics of North America)
Source: Otolaryngologic clinics of North America - April 22, 2020 Category: ENT & OMF Authors: Victoria Duda, Olivia Scully, Marie-Sarah Baillargeon, Sylvie H ├ębert Source Type: research