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Outcomes, Research and Evidence-Based Medicine Committee

Committee Charge: The Outcomes Research and Evidence-Based Medicine Committee is charged to serve as a repository of expertise on health services research and evidence-based medicine, including outcomes and effectiveness research generally and specifically in otolaryngology-head and neck surgery; to advise and support other Academy and Foundation committees on outcomes and clinical effectiveness; to liaison with the Quality Improvement Committee on research aspects of the development of clinical practice guidelines; to develop and maintain educational materials; instructional courses; and Annual Meeting miniseminars in these areas, including an Outcomes Primer; and to develop and maintain a prioritized list of project areas suitable for research on outcomes and clinical effectiveness.

CHAIR:  Scott Brietzke, MD, MPH
STAFF LIAISON:  Heather M. Hussey, MPH

With the above charge in mind, the OREBM aims to:

1) Highlight relevant, current research data that can assist the Otolaryngologist with patient decision-making and
2) Guide research efforts into clinical areas that will most benefit our specialty based on identified gaps in evidence and emerging clinical importance.

SURVEYS & DATABASE STUDIES

Study Principal Investigator
Goal and Updates
Parent Response to Ear Disease in Children with and without Tubes (PREDICT) Quality of Life Research Study
Judith E. C. Lieu, MD
Washington University
SOM
St. Louis, MO
As of Feb 2011, the study is 64% to our goal of 1000 complete (physician and patient) records. 1,896 sets of forms have been sent out to our 23 participating sites. Of those, 1,138 physician forms (60%0 and 696 patient forms (37%) have been returned to the AAO-HNSF for data entry.
TALC (Treatment of Advanced Laryngeal Cancer) Study
Bevan Yueh, MD, MPH
University of Minnesota
Minneapolis, MN
As of Feb 2011, the study is 22% (48 patients) to our goal of enrolling 220 patients.
  • Mean age = 60.5
  • Gender = 39 Male and 9 Female
  • Treatment Group = 30 Laryngectomy and 18 Chemoradiation
Assessing Practice Patterns and Outcomes in the Evaluation and Management of Hoarseness/Dysphonia Seth M. Cohen, MD, MPH
Duke University Medical Center
The objective of Assessing Practice Patterns and Outcomes in the Evaluation and Management of Hoarseness/Dysphonia study is to evaluate the practice patterns and associated outcomes of dysphonia management.  4 out of the 10 proposed aims have been addressed to some degree to date.

Results:

  • Poster entitled Prevalence and Causes of Dysphonia in a Large-Treatment Seeking Population presented at the 132nd Annual Meeting of the American Laryngological Association (ALA), April 27-28, 2011, Chicago, IL.
  • First publication submitted to Laryngoscope May 2011
  • Second manuscript Direct Economic Impact of Dysphonia in preparation for submission
Hypopharyngeal Surgery in OSA: Practice Patterns, Perceptions, and Attitudes Eric J. Kezirian, MD, MPH, University of CA, San Francisco The survey-based study considers factors that may be relevant to the surgical treatment of obstructive sleep apnea, with a specific focus on procedures that treat hypopharyngeal or retrolingual obstruction.

Results:
  • 100 respondents
  • Goal, 70% of sleep (200 responses) and perhaps half that response rates for the controls (also 200).
Studying Life Effects and Effectiveness of Palatopharyngoplasty (SLEEP) Edward M. Weaver, MD, MPH
University of Washington
Seattle, WA
Results Published:

Studying Life Effects & Effectiveness of Palatopharyngoplasty (SLEEP) Study: Subjective Outcomes of Isolated Uvulopalatopharyngoplasty. Weaver EM, Woodson BT, Yueh B, Smith T, Stewart MG, Hannley M, Schulz K, Patel MM, Witsell D; the SLEEP Study Investigators. Otolaryngol Head Neck Surg. 2011 Apr;144(4):623-631. Epub 2011 Feb 10.

SYSTEMATIC REVIEWS AND META-ANALYSIS
In addition to pondering evidence gaps, the OREBM committee has been considering and attempting to identify clinical areas that may benefit from compiling and critically analyzing the currently available data in the form of a systematic review or meta-analysis. These efforts may lead to future studies and/or help sharply develop clinical areas where true "evidence gap" lie. The completion of a high-quality meta-analysis is not a simple task. Committee members Seth Cohen, MD, MPH and Melissa M. Pynnonen, MD were selected, after an academy-wide competitive search, for sponsorship to attend the International Cochrane Colloquium Meeting in October 2011 that will include training in advanced meta-analysis techniques. The expectation of receiving this support is a resulting submission of a completed meta-analysis for publication in the Otolaryngology–Head and Neck Surgery journal. Thus, academy members can expect to see more and more high-quality meta-analyses in our journal in the future.

IDENTIFIED EVIDENCE GAPS

Subspecialty Evidence Gap
Pediatric Otolaryngology
 1. Diagnosis and management of residual obstructive sleep apnea after adenotonsillectomy to include use of sleep endoscopy and cine MRI
2. Management of otitis media with effusion diagnosed in neonates within neonatal hearing screening programs
3. Use of imaging in evaluation of hearing loss in children – MRI versus CT
4. Benefits of proton pump inhibitor therapy in neonates with laryngomalacia/stridor
5. Use of balloon dilation in the management of pediatric subglottic stenosis
Rhinology 1. Standardization of maximal medical therapy for chronic rhinosinusitis
2. Accuracy of diagnosis of chronic rhinosinusitis in the primary care setting, e.g., Family practice, internal medicine
3. Development of a chronic rhinosinusitis treatment data registry
4. Role of bioflims in chronic rhinosinusitis
Laryngology 1. Long-term compliance and benefits of voice therapy
2. Effectiveness of antibiotic therapy in the setting of acute laryngitis
3. Determination which hoarse patients benefit the most from proton pump inhibitor therapy
4. Efficacy of neurontin, elavil, and/or lyrica in treating chronic cough
5. Utility of voice rest of after vocal surgery
Sleep Surgery
1. Outcomes for nasal (and pharyngeal) surgery in improving long-term CPAP compliance
2. Benefit of turbinoplasty in addition to adenotonsillectomy for management of pediatric obstructive sleep apnea
3. Use of home sleep testing in a sleep surgical practice
4. Outcomes for medical and surgical treatments for treatment of socially bothersome primary snoring
5. Development of a sleep surgery data registry

OREBM LEADERSHIP
Research Advisory Board (RAB)
The creation of the RAB was approved at the May 5, 2008 AAO-HNSF Board of Directors (BOD) Meeting. The relationship between the RAB and the Foundation BOD have been modeled after the articles and relationship between the Board of Governors and the AAO-HNS Board. The RAB fills a much needed paucity of opportunities to cultivate leaders from the AAO-HNS membership. The RAB is composed of 12 officers, including both AAO-HNS members and nonmember stakeholders active in otolaryngology research.  The RAB is made of up of representatives from the American Board of Otolaryngology, an At-Large ARO representative, an At-Large Clinical/Translational representative, an At-Large Basic Science Representative, a Residency Training Representative, an AAO-HNS Board of Governors Liaison, an Industry Liaison, and an Ex-officio Federal, NIDCD, NIH Representative. The RAB is currently chaired by Steven D. Rauch, MD. The OREBM reports up to the RAB.