ALEXANDRIA, VA — The American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) released a list of specific tests and treatments that are commonly ordered, but not always necessary in the care of disorders of the ear, nose, throat and related structures of the head and neck. As part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation, the list identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is most appropriate.
AAO-HNSF’s list identified the following recommendations:
- Don’t order computed tomography (CT) scan of the head/brain for sudden hearing loss.
Computed tomography scanning is expensive, exposes the patient to radiation and offers no useful information that would improve initial management. CT scanning may be appropriate in patients with focal neurologic findings, a history of trauma or chronic ear disease. - Don’t prescribe oral antibiotics for uncomplicated acute tympanostomy tube otorrhea.
Oral antibiotics have significant adverse effects and do not provide adequate coverage of the bacteria that cause most episodes; in contrast, topically administered products do provide coverage for these organisms. Avoidance of oral antibiotics can reduce the spread of antibiotic resistance and the risk of opportunistic infections. - Don’t prescribe oral antibiotics for uncomplicated acute external otitis.
Oral antibiotics have significant adverse effects and do not provide adequate coverage of the bacteria that cause most episodes; in contrast, topically administered products do provide coverage for these organisms. Avoidance of oral antibiotics can reduce the spread of antibiotic resistance and the risk of opportunistic infections. - Don’t routinely obtain radiographic imaging for patients who meet diagnostic criteria for uncomplicated acute rhinosinusitis.
Imaging of the paranasal sinuses, including plain film radiography, computed tomography (CT) and magnetic resonance imaging (MRI) is unnecessary in patients who meet the clinical diagnostic criteria for uncomplicated acute rhinosinusitis. Acute rhinosinusitis is defined as up to four weeks of purulent nasal drainage (anterior, posterior or both) accompanied by nasal obstruction, facial pain-pressure-fullness or both. Imaging is costly and exposes patients to radiation. Imaging may be appropriate in patients with a complication of acute rhinosinusitis, patients with comorbidities that predispose them to complications and patients in whom an alternative diagnosis is suspected. - Don’t obtain computed tomography (CT) or magnetic resonance imaging (MRI) in patients with a primary complaint of hoarseness prior to examining the larynx.
Examination of the larynx with mirror or fiberoptic scope is the primary method for evaluating patients with hoarseness. Imaging is unnecessary in most patients and is both costly and has potential for radiation exposure. After laryngoscopy, evidence supports the use of imaging to further evaluate 1) vocal fold paralysis, or 2) a mass or lesion of the larynx.
We must be thinking simply about what every otolaryngologist could do to improve care in his or her practice and to make better use of resources. That means that physicians with their patients are choosing the best care that is supported by evidence, showing patients that treatments work and that they are not duplicative of other tests or procedures and are truly necessary.
David R. Nielsen, MD, Executive Vice President and CEO
The AAO-HNSF list, approved by the board of directors, was developed over a six-month period with considerable input from physician members. The list is evidence-based and reflects current frequency/use of the test or treatment.
Releasing lists along with AAO-HNSF today are 16 other organizations representing more than 350,000 physicians, nurses, pathologists, radiologists and other healthcare professionals. They are:
- American Academy of Family Physicians*
- American Academy of Hospice and Palliative Medicine
- American Academy of Neurology
- American Academy of Ophthalmology
- American Academy of Pediatrics
- American College of Obstetricians and Gynecologists
- American College of Rheumatology
- American Geriatrics Society
- American Society for Clinical Pathology
- American Society of Echocardiography
- American Urological Association
- Society for Vascular Medicine
- Society of Cardiovascular Computed Tomography
- Society of Hospital Medicine
- Society of Nuclear Medicine and Molecular Imaging
*Releasing a second list
To date more than 130 tests and procedures to question have been released as part of the campaign, and the specialty societies are now undertaking considerable efforts to share the recommendations with their collective membership of more than 725,000 physicians.
The campaign is also reaching millions of consumers nationwide through consumer partners, led by Consumer Reports—the world’s largest independent product-testing organization—which has worked with the ABIM Foundation to distribute patient-friendly resources for consumers and physicians to engage in these important conversations. Choosing Wisely consumer partners include:
- AARP
- Alliance Health Networks
- The Leapfrog Group
- Midwest Business Group on Health
- Minnesota Health Action Group
- National Business Coalition on Health
- National Business Group on Health
- National Center for Farmworker Health
- National Hospice and Palliative Care Organization
- National Partnership for Women & Families
- Pacific Business Group on Health
- SEIU
- Union Plus
- Wikipedia
AAO-HNSF, the first surgical society to join the Choosing Wisely campaign, will continue to participate in the ongoing campaign and plans to develop additional lists.
Learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them.
