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Ménière’s Disease, Tongue Tie, Nosebleed

Explore updates on three critical otolaryngologic diseases and conditions. Three separate sessions will put the spotlight on recent research and future published clinical practice guidelines for Ménière’s disease and epistaxis as well as a clinical consensus statement for ankyloglossia.

These are preview sessions on the following AAO-HNSF quality knowledge products. The materials presented are embargoed until published in Otolaryngology-Head and Neck Surgery. 

AAO-HNSF Clinical Consensus Statement: Ankyloglossia (Tongue-Tie) in Children
10:00 am, Today
Room 392

When it comes to tongue-tie in children, Anna H. Messner, MD, of the Baylor College of Medicine and Texas Children’s Hospital, said it has taken a lot of effort to come up with a clinical consensus statement.

“The consensus group looked at several different topics related to tongue-tie,” she said. “The first issue we tackled was, what is the definition of tongue-tie? The definition that people use has really changed over time, and it is very controversial.”

The group, she said, was able to come to consensus on the definition of interior tongue-tie but was left stumped by what it means to have a posterior tongue-tie. Some in the group don’t even use that term.

“The reason the definition is important is because we don’t even know the incidence,” said Dr. Messner. “The original studies that look at the incidence of tongue-tie looked at the old definition, which would be the equivalent of interior (tongue-tie).”

The consensus group explored the relationship between tongue-tie and breastfeeding. Frenotomies are being performed on babies with tongue-tie, but the group questioned if that was to a reasonable extent. They also asked if infants are being put through unnecessary procedures.

The consensus statement will summarize frenotomies and breastfeeding results as well as address the relationship of tongue-tie to speech and other oral mechanical issues.

“The whole subject of tongue-tie has exploded over the last 10 years,” said Dr. Messner. “The number of children being diagnosed with ankyloglossia and being treated for ankyloglossia has greatly increased in the U.S., and the consensus group agreed that in some communities, many children are being overdiagnosed and overtreated for ankyloglossia.”

AAO-HNSF Clinical Practice Guideline: Ménière’s Disease
1:15 pm, Today
New Orleans Theater A

“There has been 24 years of lag time since the last guideline came out, basically discussing and recommending how clinicians diagnose and manage cases,” said Gregory J. Basura, MD, with the University of Michigan Medical Center and the Taubman Health Center, who is moderating the session.

“The guideline key action statements are only as strong as the literature. If you’ve got really good studies that are done, then we can create powerful statements.”

The 16 key action statements include a wealth of information about Ménière’s disease, including its basic history, physical exams, diagnosis, criteria, surgical and medical management, patient education, counseling, and documenting the outcomes.

“It really covers the whole gamut of the disease process,” said Dr. Basura.

AAO-HNSF Clinical Practice Guideline: Nosebleed (Epistaxis)
3:45 pm, Today
Room 288/289

The guideline for nosebleeds targets patients over three years of age who need medical treatment. This accounts for about six percent of people who experience them. Epistaxis (acute nosebleeds) accounts for an estimated 0.5 percent of all emergency room visits and as much as one-third of emergency room visits related to otolaryngology.

David E. Tunkel, MD, is the director of pediatric otolaryngology at The Johns Hopkins Hospital and the moderator of the nosebleed session.

“Nosebleeds are common, and they can be simple nuisances or life-threatening when severe and recurrent,” said Dr. Tunkel. “[This] is the first multidisciplinary evidence-based guideline aimed at improving quality of care for patients with nosebleed as well as reducing variations in care.”

The session will cover recommendations for improving nosebleed treatments and the quality of care as well as highlighting the current variations in practice across otolaryngology.