Objective Peritonsillar abscess (PTA) after surgical tonsil removal is an infrequent complication. Residual lymphoid tissue after tonsillotomy may increase this risk compared to tonsillectomy. This study aimed to identify cases of PTA following tonsillotomy or tonsillectomy in a pediatric population and compare the incidence and case details.Study Design Retrospective comparative case series.Setting Tertiary pediatric hospital.Methods A review was conducted of patients <= 18 years of age who underwent tonsillotomy or tonsillectomy from January 2010 to January 2025 and later presented with PTA. Among 5576 tonsillotomies and 19,834 tonsillectomies performed, 10 patients were identified in whom PTA occurred after tonsil surgery at the study institution, and for whom complete medical records were available.Results Nine cases of PTA occurred after tonsillotomy (0.16%) and one after tonsillectomy (0.005%). The mean interval (+/- SD) from tonsil surgery to PTA diagnosis was 8.2 +/- 3.0 years (range, 1-12 years). Mean age at PTA diagnosis was 13.7 +/- 2.3 years (range, 10-18 years). Residual tonsillar tissue was confirmed in seven of ten patients; five underwent revision tonsillectomy.Conclusion The benefits of tonsillotomy over tonsillectomy with respect to short-term postoperative morbidity are well established. Although the long-term risk of PTA secondary to residual lymphoid tissue is low, otolaryngologists should be aware of this possible outcome when counseling patients preoperatively as to intracapsular tonsillotomy versus extracapsular tonsillectomy, and when treating patients with pharyngeal symptoms with a history of prior intracapsular tonsillotomy.Level of Evidence 4 (Case series).
Objective To evaluate temporal and geographic trends in outpatient otolaryngology services billed by nurse practitioners (NPs) and physician associates (PAs).Study Design Serial cross-sectional analysis. Setting National commercial claims database. Methods We queried Merative MarketScan for adults aged 18 to 64 who received 25 common outpatient otolaryngology procedures or services from 2009 to 2023. Professional claims were categorized by provider type (NP/PA vs physician). We assessed trends in the proportion of claims billed by NPs/PAs and compared characteristics between NP/PA and physician claims. Results There were 12,099,097 otolaryngology-specific claims, among which 423,635 (3.5%) were billed by NPs/PAs, and 14,130,340 otolaryngology-relevant claims, among which 3,800,352 (26.9%) were billed by NPs/PAs. The proportion of otolaryngology-specific claims attributable to NPs/PAs increased more than tenfold, from 1.1% in 2009 to 12.9% in 2023 (P < .001), and these claims were more likely to be in rural areas compared to physicians (18.4% vs 9.0%; P < .001). North Dakota, South Dakota, and Vermont were among the top states by percentage of claims attributable to NPs/PAs, while Georgia and South Carolina were among the bottom states for both otolaryngology-specific and otolaryngology-relevant claims. Claims billed by NPs/PAs were more likely to be for younger, male, and actively employed patients, and those with high-deductible health plans and in-network insurance plans (P < .001 for all). Conclusion Outpatient otolaryngology procedures billed by NPs/PAs have increased substantially over the past decade and account for a greater share of claims in rural areas.
OBJECTIVE: High-fidelity simulation may improve surgical training in head and neck surgery, yet validated perfused cadaveric models remain scarce. We evaluated the face, content, and construct validity of a perfused cadaveric model using isolated cephalic perfusion for cervicofacial surgical simulation. STUDY DESIGN: Prospective validation study of a reperfused cadaveric model using SIMLIFE® technology. SETTING: Institute of Anatomy and Surgical Simulation, Toulouse University Hospital. METHODS: Twenty unilateral levels I to IV neck dissections were performed on 11 body donors using a perfused SIMLIFE® model with isolated cephalic perfusion. Seven experts and 5 residents participated. Face and content validity were assessed using Likert-scale questionnaires, whereas construct validity was evaluated using the Onco-Neck-Score through blinded video assessment. RESULTS: High face validity was demonstrated across most assessed domains, particularly venous wall consistency, venous coloration, nerve appearance, and bleeding flow following vascular injury. Experts rated the model as highly relevant for resident training and surgical skills acquisition. Construct validity was supported by significantly higher Onco-Neck-Score values among experts compared with residents (70.8 [interquartile range 68.8-71.0] vs 58.2 [interquartile range 53.8-61.9], P < .001). CONCLUSION: This study supports the face, content, and construct validity of a cadaveric model using isolated cephalic perfusion for cervicofacial surgical training. It provides a realistic environment for neck dissection simulation and may represent a promising tool for surgical education and competency assessment.
OBJECTIVE: To evaluate the impact of the paradigm shift toward opioid-sparing analgesia following the 2019 AAO-HNS clinical practice guideline on postoperative complications and healthcare costs after pediatric adenotonsillectomy (AT). STUDY DESIGN: Retrospective cohort study. SETTING: TriNetX, a multi-institutional federated electronic health record database. METHODS: Patients < 18 years old undergoing AT were stratified by surgical year: pre-2019 (Jan 2014-Dec 2017) or post-2019 (Jan 2021-Dec 2025). Opioid prescription data was recorded. Using 1:1 propensity score matching (PSM), the incidence of postoperative dehydration, hemorrhage, throat pain, intravenous (IV) fluid administration, and emergency department (ED) visits were compared. A number needed to treat (NNT) analysis was performed based on inflation-adjusted costs per ED visit to estimate economic cost savings. RESULTS: Following 1:1 PSM (n = 66,844 per cohort), the pre-2019 cohort demonstrated significantly higher risk ratios (RR) of dehydration (1.27; 95% CI 1.17-1.38), IV fluid needs (1.27; 95% CI 1.17-1.37), ED visits (1.21; 95% CI 1.16-1.27), and nausea/vomiting (1.24; 95% CI 1.12-1.39) compared to the post-2019 cohort (P < .0001). Postoperative hemorrhage rates were statistically stable (P = .145). Post-2019 opioid prescriptions decreased significantly (RR 1.47; 95% CI 1.44-1.50; P < .0001), notably with a 25-fold reduction in codeine prescriptions. The NNT to prevent one ED visit was 101.7, resulting in an estimated cost avoidance of $3.2 million within the studied cohort. CONCLUSION: The incidence of post-tonsillectomy dehydration, pain, and ED utilization has decreased over time, concomitant with decreased opioid prescribing, suggesting that opioid-sparing protocols have been consistent with broadly improved patient outcomes.
Abstract Objective Simulation training provides a controlled environment for the development of surgical skills. The high case complexity of functional endoscopic sinus surgery makes simulation training particularly appropriate and important. This scoping review aims to synthesize the current literature regarding endoscopic sinus surgery simulation to determine best practices. Data Sources PubMed, Embase, and Cochrane. Review Methods Databases were systematically searched for studies published between November 1998 and May 2025 that pertained to simulation training for endoscopic sinus surgery. Articles included in the final review were selected using the PRISMA protocol. Inclusion criteria included: English language, description of a simulation model used for training, and description of a training model for functional endoscopic sinus surgery. Results In the initial search, 298 studies were identified. A total of 45 studies met the inclusion criteria and were included in the review. The most popular simulation type was a task trainer, with the majority of those being 3D‐printed models. Outcome measures varied substantially across studies, with speed and global technical performance most frequently reported, but fewer than half of the studies employed validated assessment tools. Conclusion Based on cost, scalability, and demonstrated construct validity, 3D‐printed task trainers currently represent the most widely adoptable platform for standardization in endoscopic sinus surgery simulation. Standardization of simulation training could lead to more comparable outcome data and the development of more appropriate goals and expectations for trainees at specific training levels. Improved simulation training could result in quicker, more efficient learning that benefits both educators and trainees.
