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Normal microbial colonization of the human larynx
Otolaryngology H e a d a n d N e c k Surgery V o l u m e 113
Scientific Posters
Number 2
with some but not all of the symptoms of chronic sinusitis, and (3) symptoms of allergic rhinitis are similar to some of the symptoms of chronic sinusitis but are not reflected in CT scan findings. 16
Total Quality Management for the Otolaryngologist RICHARD RAJARATNAM, MD, FRCS, FACS, Riverside, Calif.
Since the time of Edward Demming in the 1950s, the industrial environmenthas endeavored to focus on quality. These techniques are now being transposed into the medical care fields. Otolaryngology is not exempt from these methods. Total quality management (TQM) is a process for meeting and exceeding customer requirements. Our patients are our external customers. The traditional components of TQM are as follows: (1) patient-focused, continuous improvement, (2) analytic implementation, and (3) interpersonal strategies. These principles are encompassed in the following: (1) process recognition, (2) data collation, (3) root cause assessment, (4) options for continuous improvement, (5) implement of change, (6) measure of change, and (7) future planning. The poster will depict how the industrial model is applied to otolaryngologic patients. I will illustrate this as otitis media in children, which is undergoing changes in its management in recent times. This will be illustrated in the form of a quality road map as shown in the following summary: 1. Process recognition: Problems of otitis media in children 2. Data collation: History, physicial examination, and diagnostic tests 3. Root cause assessment; Treatment plans 4. Options: Medical/surgical therapy selection 5. Implement change: Implementation of selected therapy 6. Measure change: Follow-up 7. Future plans: Prevention of any complications The purpose of the poster is to help otolaryngologists use the TQM tools in the practices and to have this as template for other TQM projects in improving the care of their patients.
P 167
We report a case of fatal malignant degeneration of juvenile onset recurrent laryngotracheobronchial papillomatosis in a non-smoking, nonirradiated, 26-year-old patient. HPV type 6 was found within the patient's bronchial papillomas and a metastatic mediastinal lymph node. Prior reported cases of spontaneous malignant degeneration of recurrent respiratory papillomas are reviewed. Potential risk factors for the development of invasive carcinoma are assessed. The implications of currently available viral studies are discussed.
18 Normal Microbial Colonization of the Human Larynx MICHAEL G. MENDELSOHN, MD, HENRY D. ISENBERG, PHD, ALLAN L. ABRAMSON, MD, and BETTIEM. STEINBERG, PHD, New Hyde Park, N.Y.
The normal microbial flora has been documented in various body sites, including skin, conjunctive, oral cavity, pharynx, intestinal, and genitourinary tract. A few reports describe the presence of microbes in the larynges of laboratory animals but no similar human studies. Many have assumed that the larynx is either sterile or harbors very few organisms. Using a specially designed sheathed Culture swab (3.8 mm Accu Culshure Swab, Medical Laboratory Automation, Inc.), cultures were obtained from the larynges of 29 patients undergoing direct laryngoscopy. In 20 of these patients, cultures were also obtained from the pharynx using the same technique. Diagnoses included laryngeal papillomatosis, vocal cord polyps/nodules, squamous carcinoma, verrucous carcinoma, and structural abnormalities. Larynx cultures revealed the presence of microbes in 86% of patients. There were a surprisingly large number of species (26), including gram-positive aerobes, gram-negative fecal organisms, and yeasts. Streptococcus and Staphylococcus species predominated. Although pharynx cultures showed similar organisms, there was a discordance of 80% (16/20) when comparing pharynx versus larynx for the same patient. We conclude that there is a well-established microbial flora in the larynx that may be independent of the microorganisms in the pharynx.
17
Spontaneous Malignant Degeneration of Recurrent Respiratory PapiUomatosis 9LAURA A. GOGUEN, MD, SEEMA BYAHATTI, MD, and GREGORY GRILLONE, MD, Boston, Mass.
Recurrent respiratory papillomas are the most common benign laryngeal lesions in children. The lesions are now known to result from human papilloma virus infection, usually types 6 and 11. Progression to invasive carcinoma is a rare phenomenom and is most commonly associated with radiation therapy, tobacco use, or the two in combination. Less often malignant degeneration occurs without obvious 9inciting factors.
19
The Use of Laser-Assisted Uvulopalatoplasty for the Treatment of Snoring: Comparing Risk Factors to Results JOSEPH J. DONZELLI, MD, REGINA PALOYAN WALKER, MD, and ABHAY M. VAIDYA, MD, M a y w o o d , III.
An estimated 40 million people in the United States snore. Laser- assisted uvulopalatoplasty (LAUP) is increasingly being performed for the treatment of snoring. There is, however, relatively little reported data on the success of LAUP with respect to snoring. We have evaluated 541 patients for LAUP, 170 of whom have completed treatment. Of these 170 patiemts, 65 were
09 rv LLI I-r
O n
Scientific Posters
Number 2
with some but not all of the symptoms of chronic sinusitis, and (3) symptoms of allergic rhinitis are similar to some of the symptoms of chronic sinusitis but are not reflected in CT scan findings. 16
Total Quality Management for the Otolaryngologist RICHARD RAJARATNAM, MD, FRCS, FACS, Riverside, Calif.
Since the time of Edward Demming in the 1950s, the industrial environmenthas endeavored to focus on quality. These techniques are now being transposed into the medical care fields. Otolaryngology is not exempt from these methods. Total quality management (TQM) is a process for meeting and exceeding customer requirements. Our patients are our external customers. The traditional components of TQM are as follows: (1) patient-focused, continuous improvement, (2) analytic implementation, and (3) interpersonal strategies. These principles are encompassed in the following: (1) process recognition, (2) data collation, (3) root cause assessment, (4) options for continuous improvement, (5) implement of change, (6) measure of change, and (7) future planning. The poster will depict how the industrial model is applied to otolaryngologic patients. I will illustrate this as otitis media in children, which is undergoing changes in its management in recent times. This will be illustrated in the form of a quality road map as shown in the following summary: 1. Process recognition: Problems of otitis media in children 2. Data collation: History, physicial examination, and diagnostic tests 3. Root cause assessment; Treatment plans 4. Options: Medical/surgical therapy selection 5. Implement change: Implementation of selected therapy 6. Measure change: Follow-up 7. Future plans: Prevention of any complications The purpose of the poster is to help otolaryngologists use the TQM tools in the practices and to have this as template for other TQM projects in improving the care of their patients.
P 167
We report a case of fatal malignant degeneration of juvenile onset recurrent laryngotracheobronchial papillomatosis in a non-smoking, nonirradiated, 26-year-old patient. HPV type 6 was found within the patient's bronchial papillomas and a metastatic mediastinal lymph node. Prior reported cases of spontaneous malignant degeneration of recurrent respiratory papillomas are reviewed. Potential risk factors for the development of invasive carcinoma are assessed. The implications of currently available viral studies are discussed.
18 Normal Microbial Colonization of the Human Larynx MICHAEL G. MENDELSOHN, MD, HENRY D. ISENBERG, PHD, ALLAN L. ABRAMSON, MD, and BETTIEM. STEINBERG, PHD, New Hyde Park, N.Y.
The normal microbial flora has been documented in various body sites, including skin, conjunctive, oral cavity, pharynx, intestinal, and genitourinary tract. A few reports describe the presence of microbes in the larynges of laboratory animals but no similar human studies. Many have assumed that the larynx is either sterile or harbors very few organisms. Using a specially designed sheathed Culture swab (3.8 mm Accu Culshure Swab, Medical Laboratory Automation, Inc.), cultures were obtained from the larynges of 29 patients undergoing direct laryngoscopy. In 20 of these patients, cultures were also obtained from the pharynx using the same technique. Diagnoses included laryngeal papillomatosis, vocal cord polyps/nodules, squamous carcinoma, verrucous carcinoma, and structural abnormalities. Larynx cultures revealed the presence of microbes in 86% of patients. There were a surprisingly large number of species (26), including gram-positive aerobes, gram-negative fecal organisms, and yeasts. Streptococcus and Staphylococcus species predominated. Although pharynx cultures showed similar organisms, there was a discordance of 80% (16/20) when comparing pharynx versus larynx for the same patient. We conclude that there is a well-established microbial flora in the larynx that may be independent of the microorganisms in the pharynx.
17
Spontaneous Malignant Degeneration of Recurrent Respiratory PapiUomatosis 9LAURA A. GOGUEN, MD, SEEMA BYAHATTI, MD, and GREGORY GRILLONE, MD, Boston, Mass.
Recurrent respiratory papillomas are the most common benign laryngeal lesions in children. The lesions are now known to result from human papilloma virus infection, usually types 6 and 11. Progression to invasive carcinoma is a rare phenomenom and is most commonly associated with radiation therapy, tobacco use, or the two in combination. Less often malignant degeneration occurs without obvious 9inciting factors.
19
The Use of Laser-Assisted Uvulopalatoplasty for the Treatment of Snoring: Comparing Risk Factors to Results JOSEPH J. DONZELLI, MD, REGINA PALOYAN WALKER, MD, and ABHAY M. VAIDYA, MD, M a y w o o d , III.
An estimated 40 million people in the United States snore. Laser- assisted uvulopalatoplasty (LAUP) is increasingly being performed for the treatment of snoring. There is, however, relatively little reported data on the success of LAUP with respect to snoring. We have evaluated 541 patients for LAUP, 170 of whom have completed treatment. Of these 170 patiemts, 65 were
09 rv LLI I-r
O n