OTO Open最新文献

Objective: Women have been underrepresented in academic medicine and surgical fields. This study aimed to describe the gender distribution in academic rhinology and investigate otolaryngology departmental factors associated with female rhinologists representation.

Study design: Cross-sectional study.

Setting: American Medical Association (AMA) FREIDA database, American Rhinologic Society database, and online search.

Methods: We identified fellowship-trained rhinologists from institutional searches of residency programs identified from the AMA FREIDA database. Demographic and academic data of each rhinologist were extracted from online search. Departmental characteristics were obtained from the FREIDA database and institutional websites. The associations between female rhinologists representation and departmental factors were assessed using logistic regression analyses.

Results: Among 224 fellowship-trained rhinologists, female comprised 26.8%. There were more female assistant professors (55.0% vs 39.6%) and fewer full professors (10.0% vs. 24.4%) than their male counterparts (P = .046). The mean H index was lower for female than male rhinologists among those over 5 years in practice (20.5 vs 33.0, P = .029). In the multivariate analysis, female rhinologists were more likely to be found in departments with greater proportions of female faculty (adjusted odds ratio 1.08 [95% confidence interval 1.04-1.12], P < .001).

Conclusion: The proportion of female rhinologists decreased significantly as they advanced through academic rank. The main driver for female rhinologists representation is the increased number of female faculty in the department. There should be increased efforts to promote female mentorship and women in leadership positions.

Objective: Primary ciliary dyskinesia (PCD) is characterized by upper and lower airway disease. Multiple studies have demonstrated the progression of pulmonary disease; however, longitudinal changes in the otologic and nasal symptoms have not been well described in patients. This study defines age-related prevalence, age of onset, and age-related trends in self-reported otologic and sinonasal comorbidities in individuals with PCD.

Study design: A prospective, longitudinal, multicenter, observational study spanning up to 12 years.

Setting: Six PCD centers in North America.

Methods: Inclusion criteria were <19 years of age and a confirmed diagnosis of PCD based on electron microscopy and/or genetics. A standardized medical history questionnaire and physical exam were completed during each study visit. Descriptive statistics were performed for the entire cohort as well as for subgroups based on ciliary ultrastructure.

Results: A total of 147 participants were followed for an average of 7.6 ± 3.2 years. Pressure equalization tubes (PETs) were placed in 80%, transient hearing loss was reported in 68%, and persistent hearing loss was reported in 30%. Hearing aids and speech therapy were utilized by 8% and 27%, respectively. PETs were placed earlier in those with inner dynein arm/microtubular disorganization defects than those with outer dynein arm defects. Participants reported chronic nasal congestion in 97%, sinusitis in 87%, and 35% underwent >1 sinus surgery.

Conclusion: There is a high prevalence of reported otologic and sinonasal morbidity among people with PCD that begins during early childhood and persists. Further analysis is indicated to evaluate differences over time among participants with varying ultrastructural defects.

Level of evidence: Level 2.

Objective: Given the recent dramatic changes in medical therapy for cystic fibrosis (CF), this study aims to describe temporal changes in chronic rhinosinusitis (CRS) and endoscopic sinus surgery (ESS) rates.

Methods: National Inpatient Sample (2004-2019; weighted estimates for 119,067 pediatric and 202,407 adult patients) was used to analyze adult (age ≥18 years) and pediatric patients with CF with pulmonary manifestations. Comorbid CRS, ESS rates, and extended length of stay (LOS, ≥75th percentile) were analyzed.

Results: The rate of CRS in both pediatric (14.1% vs 21.1%, P < .001) and adult (16.5% vs 40.9%, P < .001) patients increased. Rate of ESS in pediatric patients with CRS decreased from 25.3% to 3.4% (P < .001). A similar decline occurred in adults with CRS (12.3% vs 3.6%, P < .001). In multivariate analysis from 2015 to 2019, ESS and extended LOS were associated with admission in the Western United States (P < .001). CRS (OR 1.14, P = .002) and ESS (OR 1.78, P = .002) were independent predictors of extended LOS. Elective admission, primary insurance, race, and hospital teaching/location were significantly associated with ESS and extended LOS (P < .05).

Conclusion: Despite the increased prevalence of CRS in adults and pediatric patients with CF, rates of inpatient ESS have declined from 2004 to 2019. Patient and hospital factors affect undergoing ESS in 2015 to 2019. CRS and ESS are associated with extended LOS in recent years.

Objective: We aimed to establish normative data on the bony partition between the facial canal (FC) and the lateral semicircular canal (LSCC) and present our initial series of cases in which an FC-LSCC dehiscence was identified based on these anatomic criteria, with or without other third window pathologies.

Study design: Normative data: Analysis of archival otopathological human temporal bone specimens and computed tomography (CT) scans. Clinical data: Case studies.

Setting: An otopathology laboratory and a specialized otolaryngology, head and neck surgery outpatient clinic.

Methods: We measured the bony partition thickness between the FC-LSCC in human temporal bone otopathological specimens and CT scans. The clinical study involved a series of reviews of patients with FC-LSCC, presenting clinical data and CT images.

Results: The average thickness of the bony partition measured via CT was 0.6 mm ± 0.2 mm, whereas in otopathological specimens it was 0.56 mm ± 0.17 mm. We identified 34 patients with FC-LSCC dehiscence. The most frequently reported symptoms were hearing loss (44%), dizziness/vertigo (44%), and tinnitus (41%). Of the patients, 15 (44%) had more than 1 site of bone dehiscence and 21 (62%) had bilateral FC-LSCC dehiscence. We then identified 36 patients in whom only FC-LSCC dehiscences were found and provided characteristics for this population.

Conclusion: Our study provides normative characteristics on the bony partition between the FC-LSCC and the signs and symptoms of this third window abnormality. FC-LSCC should be included in differential diagnoses of patients presenting with third window syndrome symptoms.

Objective: Chronic otitis media (COM) is a common middle ear disease in children and young adults. Dysfunction of the Eustachian tube and bacterial infection are the main causes. This pilot study aimed to describe and compare bacteriomes of the middle ear in children and young adults with serious forms of COM, such as cholesteatoma and retraction pocket (RP) of the tympanic membrane, with bacteriomes in healthy middle ears.

Study design: Observational study.

Setting: Clinical practice in a tertiary center. From January 1, 2021 to August 31, 2022. Patients aged 0 to 20 years.

Methods: In this case-control study, middle ears were swabbed during surgery on children with cholesteatoma (N = 23) or RP (N = 26) and on children indicated for cochlear implant (N = 15, controls). Genomic DNA extraction was followed by creation of a 16S ribosomal DNA gene library and sequencing on a MiSeq instrument. Samples with relative abundance of at least one bacterial genus >20% were considered positive for the specific genus.

Results: Bacterial diversity was generally low in the middle ear samples from patients with COM, with DNA content from 1 or 2 bacteria usually dominating in the sample. A significant difference in positivity for one or more bacterial genera was observed between patients with cholesteatoma or RP (38.8%) versus patients indicated for cochlear implants (6.7%).

Conclusion: While middle ear bacteriomes in cases of cholesteatoma and RP differed from those of controls, findings in the 2 pathological conditions were similar. These results support the statement that the RP could be a precholesteatoma stage.

Objective: To compare hearing thresholds at 250 and 500 Hz in pediatric patients with tympanic membrane perforations (TMP) using RadioEar IP30 insert earphones and RadioEar TDH50s 3045 supra-aural headphones.

Study design: Prospective clinical pilot study.

Setting: Primary Children's Hospital, Utah.

Methods: Children (<18 years of age) were prospectively enrolled into 2 groups based on the presence of TMPs (no TMP, TMP). Hearing thresholds were measured at 250 and 500 Hz using RadioEar IP30 insert earphones and RadioEar TDH50s 3045 supra-aural headphones for all participants.

Results: At 250 and 500 Hz, hearing thresholds were significantly higher when recorded with insert earphones than with supra-aural headphones in pediatric participants with TMPs. At 250 Hz, thresholds obtained with inserts were 14.7 ± 7.2 dB (P < .001) higher than thresholds obtained with supra-aural headphones and 8.0 ± 7.5 dB higher (P < .01) at 500 Hz.

Conclusion: Low-frequency hearing thresholds were significantly higher when measured with insert earphones in patients with TMPsbut not in patients without TMPs. A diagnosis of low-frequency hearing loss must be interpreted with caution when using insert earphones in participants with TMPs.

This study compares delays in otolaryngologic care between patients in Mekelle, Ethiopia and Harare, Zimbabwe using the Three Delays model. Patient surveys conducted among 46 patients in Zimbabwe during October 2022 and 105 patients in Ethiopia during June 2023 revealed a significantly higher prevalence of delays in seeking and reaching care in Ethiopia. This was in the aftermath of the Tigray War, which damaged the region's health care infrastructure and diminished the trust of patients. In Zimbabwe, there was poor awareness among patients and nonotolaryngologist providers of otolaryngology disease and care capacity leading to delays in seeking and reaching care. Patients in both countries faced delays in receiving appropriate care due to resource limitations, with Ethiopia's constraints worsened by the recent war and Zimbabwe's by consistent health care underfunding. The longest delays were observed in head and neck oncology care. These findings provide a foundation for understanding otolaryngologic care delays in these low- and middle-income countries.