Objectives/Hypothesis:Obstructive sleep apnea (OSA) has been associated with upregulation of prothrombotic factors. We hypothesize that diagnosis of OSA may be protective against postoperative hemorrhage. This study investigates the relationships between preoperative clinical diagnosis and postoperative hemorrhage.Study Design:Seven‐year retrospective case–control study.Methods:Medical records of tonsillectomy subjects with and without hemorrhage were reviewed for demographics, clinical diagnosis, and treatment. Clinical diagnoses included OSA confirmed by polysomnogram, sleep‐disordered breathing (SDB), chronic tonsillitis, and a mixed group.Results:A total of 9,023 tonsillectomy patients were identified (52.0% male, 48.0% female; mean age, 6.9 years). Of these, 2.4% (n = 212) presented with hemorrhage. There were 48 (22.6%) primary and 164 (77.4%) secondary hemorrhages. The control group consisted of 1,488 nonhemorrhage patients. A multivariate logistic regression analysis compared the two groups controlling for age, sex, and clinical diagnosis. OSA patients were half as likely to hemorrhage compared to chronic tonsillitis patients (P = .04). SDB patients also had a lower chance of hemorrhage compared to chronic tonsillitis patients; this result was not significant (P = .09). Patients older than 6 years had a higher hemorrhage rate (P < .001).Conclusions:This study demonstrates that patients with OSA may be less likely to have postoperative hemorrhage than patients with chronic tonsillitis. Younger age was associated with fewer hemorrhages. Laryngoscope, 2012

Objectives/Hypothesis Develop a standardized letter of recommendation (SLOR) for otolaryngology residency application that investigates the qualities desired in residents and letter writer’s experience. Compare this SLOR to narrative letters of recommendation (NLOR). Study Design Prospective SLOR/NLOR Comparison. Methods The SLOR was sent to a NLOR writer for each applicant. The applicant’s NLOR/SLOR pair was blinded and ranked in seven categories by three reviewers. Inter-rater reliability and NLOR/SLOR rankings were compared. Means of cumulative NLOR and SLOR scores were compared to our departmental rank list. Results Thirty-one SLORs (66%) were collected. The SLORs had higher inter-rater reliability for applicant’s qualifications for otolaryngology, global assessment, summary statement, and overall letter ranking. Writer’s background, comparison to contemporaries/predecessors, and letter review ease had higher inter-rater reliability on the NLORs. Mean SLOR rankings were higher for writer’s background (p=0.0007), comparison of applicant to contemporaries/predecessors (p=0.0031), and letter review ease (p<0.0001). Mean SLOR writing time was 4.17±2.18 minutes. Mean ranking time was significantly lower (p<0.0001) for the SLORs (39.24±23.45 seconds) compared to the NLORs (70.95±40.14 seconds). Means of cumulative SLOR scores correlated with our rank list (p=0.004), whereas means of cumulative NLOR scores did not (p=0.18). Means of cumulative NLOR and SLOR scores did not correlate (p=0.26). Conclusions SLORs require little writing time, save reviewing time, and are easier to review compared to NLORs. Our SLOR had higher inter-rater reliability in 4 of 7 categories and was correlated with our rank list. This tool conveys standardized information in an efficient manner.

Pediatric otolaryngologists are noncompliant with the 2002 American Academy of Pediatrics and the 2011 American Academy of Otolaryngology-Head and Neck Surgery guidelines. Despite noncompliance, they fortunately have a lower threshold to monitor high-risk children overnight following surgery. The recommended Center for Disease Control measures to diagnose childhood obesity occasionally are being utilized. An educational campaign is necessary to update clinicians who take care of children on the new evidence-based guidelines.

Objectives/Hypothesis: To develop a pediatric otolaryngology fellowship selection standardized letter of recommendation (SLOR). Study Design: SLOR and narrative letter of recommendation (NLOR) comparison study. Methods: An SLOR was created to investigate qualities desired in fellows using five content‐based categories: writer background, comparison of the applicant to contemporaries and predecessors, applicant's qualifications for pediatric otolaryngology, a global assessment of the applicant, and a summary statement about the applicant. In phase I, the SLORs were completed, including writing time, by the applicant's pediatric otolaryngology chief. In phase II, letters were ranked on Likert‐type scales for the content‐based categories, reviewer's overall ranking, and ease of review by six otolaryngologists. Reviewers recorded time needed to review each letter. Results: Nineteen SLORs (73%) were collected. Mean writing time was 8.84 ± 3.87 minutes. Interrater reliability was higher on the SLORs in the content‐based sections and the overall ranking. Ranking times were lower on the SLORs. Mean and median rankings were higher on the SLORs for writer background, comparison of the applicant to contemporaries and predecessors, applicant's qualifications for pediatric otolaryngology, and ease of review; mean global assessment of the applicant, summary statement about the applicant, and overall rankings were lower on the SLORs. Conclusions: To our knowledge, this is the first inquiry using an SLOR developed for otolaryngology. SLORs are an alternative to NLORs for fellowship selection that offers improved reliability and efficiency. Further investigation using SLORs in otolaryngology residency selection is merited.