Evaluation of Acupuncture's Efficacy Within Otolaryngology

OBJECTIVES

Acupuncture is a form of Traditional Chinese Medicine that has minimal side effects, is cost-effective, can be easily administered, and may serve as a useful non-pharmaceutical therapy for certain conditions. However, studies and clinical practice guidelines are inconsistent in conclusions and recommendations about acupuncture. This qualitative review addresses the evidence available for acupuncture use in otolaryngology.

METHODS

A literature review was completed using EMBASE, PubMed, and The Cochrane Collection for conditions within otolaryngology that have used and studied the comparative effects of acupuncture. Thirty studies ultimately fit the inclusion criteria and were used for this qualitative review.

RESULTS

Studies included in this review contained a variety of conditions within otolaryngology, including allergic rhinitis, chronic rhinitis, tinnitus, sudden sensorineural hearing loss, post-viral olfactory dysfunction, dysphonia, and tonsillectomies.

CONCLUSION

Given its safety profile, cost, and perceived benefit, recommendations and guidelines supporting acupuncture as an alternative or adjunctive therapy are surfacing for certain conditions such as allergic rhinitis. However, stronger conclusions with specific recommendations are limited by varied methodology between majority of the studies. Additional high-quality randomized control studies with low risk of bias are required to continue to assess the effects of acupuncture in the field of otolaryngology before stronger recommendations can be made on other conditions.

Alternatives to Acid Suppression Treatment for Laryngopharyngeal Reflux

OBJECTIVE

Laryngopharyngeal reflux (LPR) and associated symptoms can be refractory to treatment with acid suppressing medication. We investigated the role and evidence for complementary and alternative medicine (CAM) for LPR in this systematic review.

REVIEW METHODS

Complementary and alternative treatment was defined in this systematic review as any non-acid suppressing medication, treatment, or therapy. A literature search was performed by two authors in consultation with a medical librarian using controlled vocabulary for "complementary and alternative medicine" and "laryngopharyngeal reflux" in the databases PubMed and EMBASE, with supplemental searches with Google Scholar.

RESULTS

Twenty articles were included in this review for the modalities: alginate, diet modification, prokinetics, respiratory retraining, voice therapy, rikkunshito (RKT), hypnotherapy, and sleep positioning. The studies were analyzed for bias based on the Cochrane criteria for RCTs and Methodological Index for non-RCT (MINORS) criteria for all other studies. For each modality a level of evidence was assigned to the current body of evidence using the GRADE approach.

CONCLUSION

There is mixed evidence with a high degree of bias and heterogeneity between studies for the modalities presented in the paper. Based on this review, an anti-reflux diet is recommended for all patients and there is some low-quality evidence to support alkaline water. For patients with predominant vocal symptoms there is evidence that supports voice therapy. There is insufficient evidence to recommend prokinetics at this time. For patients with predominant globus symptoms, alginate, RKT, and relaxation strategies may be used in conjunction with acid suppressing medications for symptom relief.

Facebook Group Use among Parents of Children with Tracheostomy

Tracheotomy in the pediatric population creates unique challenges for parents. Parents often feel underprepared to provide adequate tracheostomy care. Social media is used as a resource for many medical conditions. We looked at Facebook use among parents of children with a tracheostomy to determine how this resource is used as support and to assess common concerns that require improved education prior to discharge. We joined 8 Facebook groups focused on children with a tracheostomy, analyzed the posts for how the groups were used, and identified recurring content. The primary focus of the groups was parental support and general information about tracheostomy care. A common theme identified was patients not receiving medical supplies on time, and groups provided a forum to obtain supplies. Groups also provided general advice about how to travel with a tracheostomy and medical advice, such as when to worry about blood in the tracheostomy tube.

Assessing the Educational Quality of Facebook Videos as an Informative Resource on Otitis Media

OBJECTIVE

This study analyzes the quality and reliability of otitis media (OM) videos on Facebook and investigates whether the videos shared within the Facebook community are considered to be a valuable educational tool. The results of this study are important for providing clinicians with the necessary understanding about the video content that their patients may be exposed to.

STUDY DESIGN

Cross-sectional analysis of video content.

SETTING

A new Facebook account was created to carry out a search for videos on OM.

METHODS

Inclusion criteria were as follows: videos intended for educating patients or guardians on OM, videos in the English language, and videos with at least 1 share.

RESULTS

A total of 364 videos were screened, and 62 fit our inclusion criteria for analysis. The majority (56%) of OM videos on Facebook focused on complementary and alternative medication without mentioning any current guidelines. A limited amount of videos (29%) made any mention to surgical treatment options for OM. There was a strong positive correlation (rho = 0.8419, P < .001) between a video's content and its reliability. There was no correlation seen between a video's content and its shares (rho = -0.142, P = .1359).

CONCLUSIONS

The majority of OM videos on Facebook are inadequate for educational value. Clinicians should know about the existence of videos on OM and the quality of information that parents are exposed to.

Factors associated with retained tympanostomy tubes a case-controlled study

OBJECTIVE

To determine factors associated with retained tympanostomy tubes in order to improve parent counseling on procedure risks and outcomes.

METHODS

This is a case-control study; we conducted a retrospective chart review from 2012 to 2019 of cases of retained tympanostomy tubes compared to controls with confirmed tympanostomy tube extrusion. The study was conducted at a single tertiary care center, Boston Medical Center. A retained tympanostomy tube was defined as in place for more than two years requiring removal in the operating room. Cases were matched to two controls and assessed for the following factors: indication for tympanostomy tube insertion, frequency of otitis media and otorrhea after tympanostomy tube insertion, duration tympanostomy tubes were in place, numbered set of tympanostomy tubes, sinopulmonary conditions, and adenoidectomy status prior to tympanostomy tube removal or extrusion.

RESULTS

46 cases were identified and matched to 92 controls. Cases had a significantly longer tympanostomy tube duration (3.273, IQR 1.099 vs 1.611, IQR 0.894 years, p < 0.001). The indication for tympanostomy tube placement for cases compared to controls was significantly more likely to be recurrent otitis media only (odds ratio 2.36, CI 1.121 to 5.003). A multiple logistic regression model was performed with the indication for tympanostomy tube placement (chronic or recurrent otitis media) and a history of more than two sets of tympanostomy tubes. The model had a low sensitivity, 9.09%, and high specificity, 98.91%.

CONCLUSION

Patients whose only indication for surgery is recurrent otitis media are possibly at higher risk for retained tympanostomy tubes that require removal in the operating room.