Chen, Philip G

AbstractObjectiveDoctors can influence the development of sound healthcare policy through financial contributions to political campaigns and candidates. Our objective was to characterize the political contributions of otolaryngologists in the United States, both individually and through the ENT Political Action Committee (ENTPAC) between the years 2003 and 2020.Study DesignRetrospective observational study.SettingPublicly available information on the internet: fec.gov.MethodsThe Federal Election Commission's website, fec.gov, was used to identify the political contributions of individual otolaryngologists and the ENTPAC between 2003 and 2020. Each contribution is associated with a political group or candidate, designated as a Republican, Democratic, or Independent entity.ResultsA total of 1407 distinct political contributions were made by individuals identifying as otolaryngologists between 2003 and 2020, totaling $432,201. Overall, Republicans received more individual donations than Democrats (711 vs 540), while Democrats received more money ($231,139 vs $183,427). Donations peaked during election years, with the total amount overall increasing each election year ($9664 in 2004 vs $75,102 in 2020). The predominant political party receiving donations between 2003 and 2020 in each US state matched each state's predominant party of the governors and senators 48.6% of the time. The ENTPAC donated $3,027,383 between 2003 and 2020 to a variety of political candidates and entities.ConclusionOtolaryngologists are making increased political contributions over time and interest in political advocacy may be at an all‐time high. Increased time and attention should be devoted to educating otolaryngologists to best politically advocate for interests which are of the most importance to themselves and the profession.

Objectives: Topical vasoconstrictors and intravenous tranexamic acid (IV TXA) are safe and efficacious to decrease bleeding and improve the surgical field during endoscopic sinus surgery (ESS). The purpose of this study was to investigate practice patterns, awareness of clinical evidence, and comfort levels among anesthesia providers regarding these hemostatic agents for ESS. Methods: A total of 767 attending anesthesiologists, residents, and certified registered nurse anesthetists (CRNAs) at 5 United States academic centers were invited to participate in a survey regarding their experience with IV TXA and 3 topical vasoconstrictor medications (oxymetazoline, epinephrine, and cocaine) during ESS. Results: 330 (47%) anesthesia providers responded to the electronic survey. 113 (97%) residents, 92 (83%) CRNAs, and 52 (68%) attendings managed 5 or fewer ESS cases per month. Two-thirds of providers had not reviewed efficacy or safety literature for these hemostatic agents. Oxymetazoline was perceived safest, followed by epinephrine, IV TXA, and cocaine. Respondents considered potential side effects over surgical field visibility when selecting agents. The majority of providers had no formal training on these agents for ESS, but indicated interest in educational opportunities. Conclusion: Many anesthesia providers are unfamiliar with safety and efficacy literature regarding agents used to improve hemostasis for ESS, highlighting a need for development of relevant educational resources. Rhinologic surgeons have an opportunity to communicate with anesthesia colleagues on the use of hemostatic agents to improve the surgical field during ESS.

BackgroundBalloon sinus dilation (BSD) is a commonly performed sinus procedure in the United States. Several cadaveric studies have evaluated BSD accuracy and the maxillary sinus has consistently been shown to be the most challenging to cannulate. We designed an independent study to evaluate the intraoperative accuracy of maxillary sinus BSD.MethodsA prospective, single‐blinded trial evaluating the accuracy of maxillary sinus BSD was performed using 2 commercially available BSD systems (guidewire‐ and probe‐based systems) randomly assigned to patients undergoing endoscopic surgery for chronic rhinosinusitus without nasal polyps (CRSsNP) or a skullbase approach in patients without sinus disease. All patients underwent maxillary BSD followed by uncinectomy to reveal dilation of the natural maxillary sinus ostia. The recorded procedures were reviewed by 3 fellowship‐trained rhinologists from different institutions blinded to the BSD system utilized. The primary endpoint compared accuracy of maxillary BSD attempts. The secondary endpoint compared accuracy between the 2 systems.ResultsTwenty‐nine maxillary BSD procedures were performed in 18 patients (age range, 20‐79 years; mean, 51 years) without nasal polyposis undergoing maxillary antrostomy as part of a more extensive procedure. BSD was successful in 18 of 29 (62%) attempts and unsuccessful in 9 of 29 (31%) attempts, with statistically “almost perfect” interrater agreement (kappa = 0.86). There was no statistical difference between the 2 BSD systems (p = 0.81).ConclusionMaxillary BSD appeared to be less accurate in living patients when compared with findings from previously published cadaver studies. There were no differences in accuracy between the probe‐ and guidewire‐based systems. This is the first non‒industry‐sponsored study evaluating maxillary sinus BSD in living patients. Further studies are needed to investigate the clinical implications of our findings.