Children with OSA and mild CSA on preoperative PSG showed significant improvement in CAI following adenotonsillectomy. Future studies are needed to determine the clinical significance of CSA in children with OSA and to identify treatment strategies.

To date, there is minimal literature discussing quality improvement curricula in otolaryngology. Herein, we present our program, including didactic, web-based, and experiential learning, developed in the setting of a preexisting institutional quality and safety policy. Nine otolaryngology residents were evaluated with assessments focused on learner satisfaction, learner attitudes, and knowledge acquisition according to the Kirkpatrick framework. Wilcoxon signed-rank test was used to compare results. While the total score increased across all assessments, it was significant for only the Quality Improvement Knowledge Application Tool Revised (P < .05). We find our initial learning outcomes encouraging and hope that our comprehensive curriculum can serve as a resource to other programs, which can be adapted to fit within the context of variable training environments. Furthermore, it is imperative to consider continuous assessment and refinement of any educational program, using the same quality improvement principles that we endeavor to teach.

IntroductionHypocalcemia after thyroidectomy results in prolongation of hospitalization and patient discomfort but can be predicted by PTH assays. However, there is considerable variation in their use.MethodsThis study was undertaken to document current US and European practice patterns regarding the use of this assay. Anonymous surveys were collected in 2009–2011 from members of the American Academies of Otolaryngology-Head and Neck Surgery and Endocrine Surgery and the European, Italian, French, Spanish and British Societies of Endocrine Surgery.ResultsThere were 356 American (3% response) and 61 European (10% response) respondents. 105 (29.8%) American and 25 (41%) European respondents reported routine PTH assay use. Fellowship trained surgeons reported increased use of the PTH assay (P = 0.004). Shorter reported average post-operative hospital stay was associated with American physicians (P = 0.0001), community practice location (P = 0.0002) and routine calcium supplementation (P = 0.0015).ConclusionsSurgical training was associated with routine use of the PTH assay. Average reported hospital stay was lower for American and community practice physicians and correlated with post-operative oral calcium use.

Apathetic hyperthyroidism is an uncommon presentation of thyrotoxicosis that is most commonly observed in elderly individuals. A small number of cases, however, have been observed in young adults-all of whom were female. We describe a case of apathetic hyperthyroidism due to painless thyroiditis in a 23-year-old active duty male, who presented with a 1-month history of change in behavior characterized by poverty of speech and disinterest in his surrounding environment. Initial evaluation for neuropsychological disorders was negative. Thyroid function tests showed a thyrotoxic state. Results of thyroid antibody testing and a thyroid uptake and scan supported the diagnosis of painless thyroiditis. The patient's presenting symptoms were attributed to apathetic thyrotoxicosis and he was treated supportively. His speech and social involvement slowly improved. Although uncommon in young adults, we recommend that apathetic hyperthyroidism be considered in the differential diagnosis of withdrawn social behavior and subsequently investigated with thyroid function tests.

POSTERSdetecting early superficial pharyngeal cancers, which are difficult to detect with a standard endoscopy. In this study, we investigated the usefulness of submucosal dissection for such superficial lesions of pharyngeal cancer retrospectively.Method: Fifty patients with superficial pharyngeal cancer were treated since September 2007. Under general anesthesia, a curved laryngoscope was inserted trans-orally, the extent of the lesion was determined by the NBI endoscope, and the lesion was dissected with an orally inserted curved electric knife.Results: Tracheostomy was performed in 5 cases, which had synchronous multiple lesions in the hypopharynx. Regarding adverse effects, postoperative bleeding occurred in one case, which needed emergency tracheostomy. With a median follow-up period of 20 months, metachronous multiple laryngo-pharyngeal cancer occurred in 4 cases and recurrence occurred in 2 cases. All the metachronous cancer cases and the recurrent case were controlled with additional endoscopic submucosal dissection. The cause-specific survival rates at 2 years were 100%. All the patients retained their pharynx and their speaking, breathing, and swallowing functions.Conclusion: Endoscopic submucosal dissection for early pharyngeal cancer allows excellent survival and preservation of swallowing and voice functions. Early detection of superficial pharyngeal cancer with narrow band imaging technology and treatment with endoscopic submucosal dissection can be a new treatment strategy for head and neck cancer.Objective: 1) Identify differences in PTH assay usage by European vs American physicians. 2) Analyze factors that correlate with these differences.Method: Anonymous surveys of physicians regarding their use of post-thyroidectomy PTH assay were collected in 2009 from members of the American Academies of Otolaryngology and Endocrine Surgery and compared with 2010 survey data from members of the European, Italian, French, Spanish, and British Societies of Endocrine Surgery.Results: European respondents returned 61 surveys that were compared with 356 received from American physicians (11% vs 3% response rate). A total of 40.1% of the European physicians used the PTH assay vs 29.8% of the American physicians (chi-square P = .083). A total of 63% of US respondents were otolaryngologists, compared with 7% of the Europeans, but usage among US physicians was not significantly correlated with specialty. Fewer American physicians were fellowship trained (26.6% vs 44.3% (chi-square P = .003)). Using Mann-Whitney testing, estimates of the rate of temporary hypocalcemia were similar, median 10% to 20% (P = .708), but American respondents provided a lower estimated rate of permanent hypocalcemia (P = .007). Conclusion:We found a trend suggesting that more European physicians obtain PTH levels than US physicians and report higher rates of permanent hypocalcemia among thyroidectomy patients, perhaps accounting for their more frequent use of PTH assays.Objective: American Indians and Alaska Natives (AI/AN) experience poor...