Leaderboard Ad

Getting Up-to-Date on a Range of Topics

Tonsillectomy, e-cigarettes, and citrus headlined Monday’s Panel Presentation “Are You Up-to-Date? Key Otolaryngology Systematic Reviews” that provided attendees current, evidence-based otolaryngology research. Attendees heard the latest randomized trials and systematic reviews in the fields of pediatric otolaryngology, facial plastic and reconstructive surgery, head and neck surgery, otology, laryngology, and rhinology.

Tonsillectomy: Children undergoing tonsillectomy had fewer sore throats and strep infections after surgery, but there was no difference one year post-op when compared with children in a “watchful waiting” group. However, the tonsillectomy children and teens did miss fewer days of school and had fewer doctor visits.

The pediatric tonsillectomy review covered 241 studies over 36 years.

“As many of us know, there is no gold standard for tonsillitis,” said Carrie Francis, MD, associate professor in the Pediatric Otolaryngology Division of the Department of Otolaryngology-Head and Neck Surgery at Kansas University Medical Center. The review authors said using the frequency of infections as a measure of severity to determine tonsillectomy is fraught with complexity related to diagnostic variability and inconsistent medical documentation.

“This confirms prior thinking that the decision-making needs to balance the benefits of reducing illness-related outcomes with the risks associated with surgery,” Dr. Francis said.

E-cigarettes: E-cigarettes are not an effective option for people trying to quit smoking, according to a review of 38 research papers.

“E-cigarettes are a growing issue; we hear more and more about them, and they have become a multibillion dollar industry very quickly,” said Samir Khariwala, MD, MS, associate professor and chief of the Division of Head and Neck Surgery at the University of Minnesota.

While the carcinogen dose is lower in e-cigarettes, it is not zero.

“And there are other things in these products that we just don’t know about. Propylene glycol is the main solvent, and we don’t know what the long-term impact of inhaling proplylene glycol is,” he said.

The studies revealed e-cigarette users were actually less likely to quit smoking. Clinicians should encourage patients to use other, proven options, such as nicotine replacement therapy or behavioral therapy, Dr. Khariwala said.

Citrus for oral cancer: A review of 17 studies showed high levels of citrus can reduce the risk of oral cancer. Other studies have shown that citrus may reduce a person’s risk of bladder, breast, and esophageal cancers. The citrus review compared highest versus lowest citrus amount, but it stopped short of defining the optimal amounts.

“I don’t know if that’s 10 oranges or two oranges, so it’s hard to put this into practice,” Dr. Khariwala said.

Overall, the studies showed a significant reduced risk of oral cancer in those with high intakes of citrus, which probably relates to vitamin C, he said.

“In practice, I would consider this for patients who are at high risk of recurrence or who have multiple oral cancers,” he said. “It clearly does have a benefit, so that’s something useful we can tell our patients.”