OTO Open最新文献

Objective: This study aims to (1) develop an augmented reality (AR) navigation platform for craniomaxillofacial (CMF) and head and neck surgery; (2) apply it to a range of surgical cases; and (3) evaluate the advantages, disadvantages, and clinical opportunities for AR navigation.

Study design: A multi-center retrospective case series.

Setting: Four tertiary care academic centers.

Methods: A novel AR navigation platform was collaboratively developed with Xironetic and deployed intraoperatively using only a head-mounted display (Microsoft HoloLens 2). Virtual surgical plans were generated from computed tomography/magnetic resonance imaging data and uploaded onto the AR platform. A reference array was mounted to the patient, and the virtual plan was registered to the patient intraoperatively. A retrospective review of all AR-navigated CMF cases since September 2023 was performed.

Results: Thirty-three cases were reviewed and classified as either trauma, orthognathic, tumor, or craniofacial. The AR platform had several advantages over traditional navigation including real-time 3D visualization of the surgical plan, identification of critical structures, and real-time tracking. Furthermore, this case series presents the first-known examples of (1) AR instrument tracking for midface osteotomies, (2) AR tracking of the zygomaticomaxillary complex during fracture reduction, (3) mandibular tracking in orthognathic surgery, (4) AR fibula cutting guides for mandibular reconstruction, and (5) integration of real-time infrared visualization in an AR headset for vasculature identification.

Conclusion: While still a developing technology, AR navigation provides several advantages over traditional navigation for CMF and head and neck surgery, including heads up, interactive 3D visualization of the surgical plan, identification of critical anatomy, and real-time tracking.

Objective: To assess associations of digital inequity with oropharyngeal cancer (OPC) prognostic and care outcomes in the United States while adjusting for traditional social determinants/drivers of health (SDoH).

Study design: Retrospective cohort study.

Setting: United States.

Methods: In total, 70,604 patients from 2008 to 2017 were assessed for regression trends in long-term follow-up period, survival, prognosis, and treatment across increasing overall digital inequity, as measured by the Digital Inequity Index (DII). DII is based on 17 census-tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (ie, digital-related variables) or sociodemographic (ie, education, income, and disability status) and weighted-averaged into a composite score.

Results: With increasing DII, decreases in length of follow-up (10.22%, 32.9-29.5 months; P < .001) and survival (8.93%, 19-17.3 months; P < .001) were observed. Affordability of internet access displayed the largest influence, followed by device access and internet-service availability. Compared to OPC patients with low digital inequity, high digital inequity was associated with increased odds of diagnosing more than one malignant tumor (odds ratio [OR] 1.01, 95% CI 1.01-1.03; P = .012) and advanced staging (OR 1.01, 95% CI 1.00-1.02; P = .034), while having decreased odds of receiving indicated chemotherapy (OR 0.98, 95% CI 0.97-0.99; P < .001), radiation therapy (OR 0.98, 95% CI 0.97-0.99; P < .001), or primary surgery (OR 0.98, 95% CI 0.97-0.99; P < .001).

Conclusion: Digital inequities contribute to detrimental trends in OPC patient care and prognosis in the United States. These findings can inform strategic discourse targeted against the most pertinent disparities in the modern-day environment.

Objective: Determine relationships between pain and mental health disorders (MHDs) in patients undergoing microvascular free flap reconstruction for head and neck cancer (HNC).

Study design: Retrospective cohort.

Setting: Tertiary Care Institution in the Southeastern United States.

Methods: Clinical data were manually abstracted from digital health records to obtain demographic, MHD, clinical outcomes, and pain data for HNC patients who underwent free flap reconstruction from 2017 to 2023. Univariate and multivariable regression analyses were performed to delineate relationships between MHDs and postoperative pain.

Results: The study cohort comprised 283 patients. Ninety-four patients (33%) had preoperative MHDs, which were more common in women (42% vs 30%, P = .04) and in patients with chronic pain (53% vs 32%, P < .01). Preoperative opioid use (P = .03) and preoperative MHD (P = .03) were predictive of higher postoperative day (POD) 5 pain score. Thirty-three patients (11.7%) were diagnosed with a new MHD postoperatively, and 58 patients (20.5%) were started on a new long-term psychiatric medication postoperatively. POD1 pain score was predictive of the need for a new psychiatric medication postoperatively (odds ratio [OR] = 1.27, 95% CI: 1.05-1.56, P = .02).

Conclusion: Postoperative pain and MHDs are independently predictive of one another in patients with HNC undergoing microvascular free flap reconstruction. Higher POD5 pain is predicted by the presence of preoperative MHD, and the need for a new psychiatric medication postoperatively is predicted by higher POD1 pain. HNC surgeons should align themselves with psychiatrists, social workers, and other allied fields to meet the complex mental health needs of their patients both preoperatively and postoperatively.

Objective: This study examines the influence of sexual orientation and gender on residents' experiences in US Otolaryngology residency programs. This study assesses the prevalence of bullying, sexual harassment, discrimination, homophobic remarks and evaluates the workplace environment, well-being, and impact of LGBTQ+ residents/faculty on rank list.

Study design: A 26-question REDCap survey was distributed to all US Otolaryngology residencies.

Methods: The survey was distributed to program directors over three months. Responses were compared between groups (sexual orientation and gender) using Fisher's exact test (5% significance level).

Results: The response rate was 5.9% (104 responses), 15.5% identified as LGBTQ+. LGBTQ+ residents felt less comfortable disclosing relationships to attendings than heterosexuals (68.8% versus 85.3%, P = .005). LGBTQ+ and female respondents perceived a worse residency environment (P < .05). LGBTQ+ residents were less satisfied with their decision to pursue Otolaryngology (75% vs 95.4%, P = .044) and more likely to consider leaving their program (25% vs 6.9%; P = .047). An LGBTQ+ faculty member or resident positively impacted rank lists for LGBTQ+ residents (43.8% vs 12.6%, P = .007; 50% vs 16.1% P = .005). Women reported more discrimination and sexual harassment than men (78.4% vs 14.8%; P < .001; 31.9% vs 11.1%; P = .014, respectively).

Conclusion: LGBTQ+ and female respondents perceive a worse residency environment. LGBTQ+ residents are less comfortable disclosing relationships to attendings, less satisfied with their decision to pursue Otolaryngology, more likely to consider leaving programs, and desire representation. Women are at increased risk of sexual harassment and discrimination.

Objective: This study aims to assess a quality improvement intervention to decrease opiate prescriptions at discharge and improve patient access to multimodal analgesics (MMA) after otolaryngologic surgery.

Study design: Longitudinal quality improvement initiative with retrospective prescription trend review and prospective patient questionnaire collection.

Setting: An academic medical center.

Methods: Opioid, acetaminophen, and non-steroidal anti-inflammatory drug (NSAID) discharge prescriptions after otolaryngologic procedures were reviewed. Two annual department-wide workshops were carried out to review the literature on published MMA protocols and develop standardized post-operative pain medication instructions to reduce opioid use. Concurrently, a patient survey was distributed to evaluate discharge pain medication use and satisfaction with pain control.

Results: Discharge pain medications were reviewed for 9064 procedures between January 2021 and May 2024. After the interventions above, the percentage of patients receiving opioids at discharge decreased from 61.4% to 46.8% (P < .00001). Concurrently, acetaminophen and NSAID discharge prescriptions increased from 24.3% and 10.2% to 67.4% and 46.1%, respectively (both P < .00001). Among 100 patients surveyed, satisfaction with post-operative pain control was high before and after the implementation of standardized discharge instructions, even though fewer post-intervention patients received opioids at discharge (49.1% compared to 76.6% pre-intervention, P = .007). Notably, 27% of patients prescribed opioids reported not taking them and 23% reported saving unused opioids for future use.

Conclusion: Implementation of standardized post-operative pain medication instructions at discharge after otolaryngologic procedures led to a substantial decrease in opioids prescribed while maintaining patient satisfaction with post-operative pain management. A significant proportion of patients reported saving unused opioids for future use despite standardized safe disposal instructions.

Objective: This study investigated whether patients' perception of their hearing loss accurately reflects their measured hearing thresholds on their audiogram, specifically relating to a mild to moderate hearing loss, which is the determining candidacy for over-the-counter (OTC) hearing aids.

Study design: Retrospective review.

Setting: Audiology clinic at a tertiary care center.

Methods: This retrospective chart review included 232 ears from 116 patients older than 18 years seen for audiograms at our audiology clinic between 2022 and 2023. Data points were taken using the pure tone average (PTA) thresholds at 500 to 2000 Hz and the PTA thresholds at 2000 to 4000 Hz, as hearing sensitivity at these frequencies is most widely associated with speech comprehension and serves as a reliable measure of hearing.

Results: Overall, when using the 2000- to 4000-Hz PTA as an indicator of the degree of hearing loss, only 52% of patients correctly quantified their level of hearing. When using the 500- to 2000-Hz PTA, 61% of patients correctly quantified their degree of hearing loss.

Conclusion: This study suggested that individuals are frequently unable to assess their degree of hearing loss with sufficient accuracy to choose the most appropriate care. To ensure that consumers are making informed decisions about the use of OTC hearing aids, the Food and Drug Administration should consider offering additional guidance that directs patients to first seek out a more standardized measure of hearing provided by a hearing health professional. This additional direction can enhance the quality of care of OTC hearing aid consumers.

Objective: We evaluated an ototoxicity monitoring program (OMP) for improving audiologic follow-up in head and neck cancer (HNC) patients.

Study design: Retrospective cohort study.

Setting: Tertiary academic center.

Methods: Two hundred and forty patients were recommended for chemotherapy between January 2017 and June 2022. An OMP was implemented in March 2021; every patient received an audiology referral and was contacted to schedule a pretreatment audiogram. Patients were divided into pre-OMP and post-OMP cohorts. Main outcome measures included rates of pretreatment audiograms, posttreatment audiograms, posttreatment otologic symptoms, and hearing aid utilization.

Results: There were 131 patients evaluated pre-OMP and 109 evaluated post-OMP. The mean age for all patients was 62.8 ± 11.9 years; 76.3% were male. After the implementation of the OMP, a significantly higher proportion of patients received a pretreatment audiogram (66.1% vs 34.4%, P < .001), with enrolled patients being 3.8 times more likely to obtain 1 (95% confidence interval: 2.2-6.6), P < .001). There was a significant increase in reported otologic symptoms after implementing the program (18% vs 36%, P = .002). However, the rate of hearing aid utilization decreased after OMP implementation (pre-OMP: 33% vs post-OMP: 13%, P = .02).

Conclusion: Implementation of an OMP significantly improved the proportion of HNC patients that underwent pretreatment audiograms prior to systemic therapy; however, audiologic follow-up remained largely unchanged in the posttreatment period.

Level of evidence: Level 4.

Facial nerve dysfunction following superficial parotidectomy is one of the most well-known and dreaded complications of the procedure, leading to significant postoperative impairments in affected patients. In lesions involving the parotid tail, the marginal mandibular branch is at particular risk. In contrast, injury to the cervical branch is usually of minimal consequence. Classically, facial nerve dissection in parotidectomy is performed anterograde from the main trunk. In patients presenting with benign superficial parotid tail lesions, however, we often begin with the identification of the cervical branch and perform retrograde dissection to decrease the risk of injury to both the main trunk and the marginal mandibular branch. This technique also allows for the preservation of the great auricular nerve, a shorter incision, and a smaller elevated facial flap, yielding better cosmetic and functional results without compromising the integrity of the resection. Here we describe this technique used for 5 consecutive patients with excellent outcomes.

Objective: To evaluate the long-term safety and effectiveness of temperature-controlled radiofrequency (TCRF) treatment of nasal valve collapse (NVC) in patients with nasal airway obstruction (NAO).

Study design: This is an extended follow-up from a prospective, multicenter, single-arm study. The initial study included participants from 12 sites across the United States who were followed for 24 months and additionally agreed to participate in the extended 36-month follow-up.

Setting: Procedure was performed in-office with an in-person follow-up at 3 months and subsequent follow-up assessment remotely.

Methods: Participants received TCRF treatment of only the nasal valve and participated in the extended 36-month follow-up. The effect of TCRF treatment was determined by analyzing changes in nasal obstruction symptom evaluation (NOSE) score at each follow-up compared to the baseline.

Results: Of the 122 participants in the primary study, 66 participated in the extended 36-month follow-up. Compared to baseline, there was a 52.6% decrease in the NOSE score at 36 months (mean change -45.3 [95% CI -52.3 to -38.3]; P < .001), and 83.3% of the participants met the criteria for treatment response at 36 months, as defined by the study endpoint. Post hoc sensitivity analysis of the treatment response for all participants from the time of enrollment was 73.9%. No device or procedure-related adverse events or serious adverse events were reported in the interval between 24 and 36 months.

Conclusion: TCRF treatment of only the nasal valve resulted in significant and durable improvement in NAO symptoms through 36 months in participants with NAO due to NVC.

Gloves are the highest-volume single-use disposable product used in health care. Minimizing unnecessary glove use is relevant in the context of mitigating health care waste and greenhouse gas emissions. We sought to reduce non-sterile glove overuse in the Otolaryngology - Head and Neck Surgery and Plastic Surgery/Burn Clinics affiliated with a tertiary care safety-net teaching hospital by using evidence-based education regarding hand hygiene and appropriate glove use. Baseline use averaged 14,820 gloves/month and 10.8 gloves/patient visit. After intervention, use decreased to 10,100 gloves/month and 7.9 gloves/visit, respectively, representing a 27% reduction in gloves/visit. On an annualized basis, this corresponds to a savings of 56,628 gloves, 180 kilograms of waste, and $3,003.17 per year. Calculated projected reduction in CO₂e emissions is 1472-1767 kg annually, equivalent in impact to 3766-4519 miles driven in a standard gas-powered car. Widespread adoption would provide a significant positive impact given the scale of glove use in US health care settings.