ALEXANDRIA, VA — The American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) today released its second list of specific tests and treatments that are commonly ordered but not always necessary when treating disorders of the ear, nose, throat and related structures of the head and neck. The released list is part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation to promote candid conversations between patients and physicians about what care is appropriate and truly needed.
AAO-HNSF’s second list identifies the following recommendations:
- Don’t place ear tubes in otherwise healthy children who have had a single episode of ear fluid lasting less than 3 months.
Ear fluid of short duration is likely to resolve spontaneously. The child should be monitored to ensure resolution of the fluid. In children with comorbid conditions or speech delay, earlier tube placement may be appropriate. - Don’t order imaging studies in patients with non-pulsatile bilateral tinnitus, symmetric hearing loss and an otherwise normal history and physical examination.
The utility of imaging procedures in primary tinnitus is undocumented; imaging is costly, has potential for radiation exposure and does not change management. - Don’t order more than one computerized tomography (CT) scan of the paranasal sinuses within 90 days to evaluate uncomplicated chronic rhinosinusitis patients when the paranasal sinus CT obtained is of adequate quality and resolution to be interpreted by the clinician and used for clinical decision-making and/or surgical planning.
Computerized tomography scanning is expensive, exposes the patient to ionizing radiation and offers no additional information that would improve initial management. Multiple CT scans within 90 days may be appropriate in patients with complicated sinusitis or where an alternative diagnosis is suspected. - Don’t routinely use perioperative antibiotics for elective tonsillectomy in children.
Oral antibiotics may have significant adverse effects and do not provide demonstrable benefit after tonsillectomy. Avoidance of oral antibiotics can reduce the spread of antibiotic resistance and the risk of opportunistic infections. - Don’t routinely perform sinonasal imaging in patients with symptoms limited to a primary diagnosis of allergic rhinitis alone.
History, physical examination and allergy testing are the cornerstones of diagnosis of allergic rhinitis. The utility of imaging for allergic rhinitis is unproven.
As physicians it is our responsibility to initiate conversations with patients about what is the most appropriate care for the individual. If patients are receiving care that they don’t need or care that is duplicative, it can cause harm and expend resources that could be more effectively used within the health care system. The ultimate goal is to prompt physician-patient conversations.
James C. Denneny III, MD, Executive Vice President and CEO
The AAO-HNSF’s newest Choosing Wisely® recommendations are supported by key action statements from AAO-HNSF’s evidence-based clinical practice guidelines on tympanostomy tubes in children, tinnitus, adult sinusitis, tonsillectomy in children, and allergic rhinitis. The list was developed after months of careful consideration and review, using the most current evidence about management and treatment options. The AAO-HNSF’s Patient Safety and Quality Improvement Committee spearheaded the list development with insight from the Specialty Society Advisory Council, Academy and Foundation Committees, the Guideline Task Force, and approval from the Foundation Board of Directors.
The AAO-HNSF first participated in the Choosing Wisely® campaign two years ago. To date, nearly 100 national, regional and state medical specialty societies, health collaboratives and consumer groups have joined the campaign, releasing more than 60 lists of tests and procedures that physicians and patients should discuss.
Learn more about AAO-HNSF’s involvement in Choosing Wisely® and the evidence supporting these recommendations.
