Τρίτη, 16 Απριλίου 2019

Otolaryngologic Clinics

Office-based Procedures in Otolaryngology
University of Michigan Health System, West Ann Arbor Health Center, 380 Parkland Plaza, Ann Arbor, MI 48103-6021, USA
Department of Otolaryngology-HNS, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA

Otolaryngologic Clinics of North America

Publication stage: In Press Corrected Proof
Contemporary otolaryngology clinical practice entails a wide array of office-based surgical procedures. Recent advances in anesthesia, medical technology, and surgical technique have resulted in a shift of procedures from the operating room to the office. Today, 70% of all operations are performed outside the hospital operating room. In fact, it is estimated that up to 15% of procedural interventions occur in an office-based setting.1
Article in Press
Coding for Otolaryngology Office Procedures

Otolaryngologic Clinics of North America

Publication stage: In Press Corrected Proof

This review article provides a summary of current correct coding for in-office surgical procedures. The relevant Current Procedural Terminology codes are covered and tips and guidance provided for their correct use. Also, where applicable, facility versus nonfacility reimbursement policy and the associated implications for physicians practicing in hospital-based clinics are discussed.

This review article provides a summary of current correct coding for in-office surgical procedures. The relevant Current Procedural Terminology codes are covered and tips and guidance provided for their correct use. Also, where applicable, facility versus nonfacility reimbursement policy and the associated implications for physicians practicing in hospital-based clinics are discussed.

Article in Press
Minimally Invasive Facial Cosmetic Procedures

Otolaryngologic Clinics of North America

Publication stage: In Press Corrected Proof

Minimally invasive procedures including neurotoxins, dermal fillers, deoxycholic acid, lasers, peels, and microneedling offer powerful, less permanent adjuncts to surgery that are highly effective in select patients. Injectables and skin resurfacing techniques target facial irregularities including wrinkles and fine lines, decrease in volume and contour, and unwanted fat. Determining the best approach for a given patient involves careful consideration of the patient's health conditions, unique anatomic characteristics, tissue quality, and desired results. A detailed understanding of facial anatomy, aesthetics, and techniques is necessary to master these approaches. This article addresses the spectrum of nonsurgical cosmetic procedures to rejuvenate and optimize the face.

Minimally invasive procedures including neurotoxins, dermal fillers, deoxycholic acid, lasers, peels, and microneedling offer powerful, less permanent adjuncts to surgery that are highly effective in select patients. Injectables and skin resurfacing techniques target facial irregularities including wrinkles and fine lines, decrease in volume and contour, and unwanted fat. Determining the best approach for a given patient involves careful consideration of the patient's health conditions, unique anatomic characteristics, tissue quality, and desired results. A detailed understanding of facial anatomy, aesthetics, and techniques is necessary to master these approaches. This article addresses the spectrum of nonsurgical cosmetic procedures to rejuvenate and optimize the face.

Article in Press
In-Office Ultrasonographic Evaluation of Neck Masses/Thyroid Nodules

Otolaryngologic Clinics of North America

Publication stage: In Press Corrected Proof

Office-based ultrasonography is increasingly becoming an integral part of an otolaryngology-head and neck surgery practice. A thorough knowledge of the ultrasonic appearance of normal and abnormal pathology are key for performing/interpreting office-based head and neck ultrasonography. A focused but systematic approach allows for efficient and effective office-based head and neck ultrasonography. Office-based ultrasonography also allows for imaging procedures expanding the otolaryngologist's armamentarium. Ultrasound-guided fine needle aspiration (USgFNA) is an integral part of clinician-performed ultrasonography because it allows cytologic diagnosis of suspicious lesions. Understanding the successful techniques and pitfalls in this procedure are critical for the otolaryngologist performing USgFNA.

Office-based ultrasonography is increasingly becoming an integral part of an otolaryngology-head and neck surgery practice. A thorough knowledge of the ultrasonic appearance of normal and abnormal pathology are key for performing/interpreting office-based head and neck ultrasonography. A focused but systematic approach allows for efficient and effective office-based head and neck ultrasonography. Office-based ultrasonography also allows for imaging procedures expanding the otolaryngologist's armamentarium. Ultrasound-guided fine needle aspiration (USgFNA) is an integral part of clinician-performed ultrasonography because it allows cytologic diagnosis of suspicious lesions. Understanding the successful techniques and pitfalls in this procedure are critical for the otolaryngologist performing USgFNA.

Article in Press
Surgical Cosmetic Procedures of the Face

Otolaryngologic Clinics of North America

Publication stage: In Press Corrected Proof

Surgical techniques for cosmetic facial rejuvenation, antiaging concerns, and the optimization of facial beauty can be nuanced and complex. Generally speaking, surgical interventions, including facelift, necklift, blepharoplasty, and rhinoplasty, are the gold standard approaches for the enhancement of facial features. A detailed understanding of facial anatomy, aesthetics, and techniques is necessary to master these approaches.

Surgical techniques for cosmetic facial rejuvenation, antiaging concerns, and the optimization of facial beauty can be nuanced and complex. Generally speaking, surgical interventions, including facelift, necklift, blepharoplasty, and rhinoplasty, are the gold standard approaches for the enhancement of facial features. A detailed understanding of facial anatomy, aesthetics, and techniques is necessary to master these approaches.

Article in Press
Office-Based 532-Nanometer Pulsed Potassium-Titanyl-Phosphate Laser Procedures in Laryngology

Otolaryngologic Clinics of North America

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.

Article in Press
In-office Functional Nasal Surgery

Otolaryngologic Clinics of North America

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.

Article in Press
Reprocessing Flexible Endoscopes in the Otolaryngology Clinic

Otolaryngologic Clinics of North America

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.

Article in Press
In-Office Evaluation and Management of Dysphagia
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

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.

Article in Press
In-Office Laryngology Injections
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

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.

Article in Press
Office-Based Otology Procedures
Department of Otolaryngology, University of Minnesota, Minneapolis, MN, USA

Otolaryngologic Clinics of North America

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.

Article in Press
Office-Based Sinus Surgery

Otolaryngologic Clinics of North America

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.

Article in Press
Mohs Reconstruction and Scar Revision

Otolaryngologic Clinics of North America

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.

Article in Press
Patient Safety and Anesthesia Considerations for Office-Based Otolaryngology Procedures
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

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.

Article in Press
In-Office Balloon Dilation of the Eustachian Tube under Local Anesthesia

Otolaryngologic Clinics of North America

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.

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