OTO Open最新文献

Objective: With more than 1.57 billion people affected by hearing loss worldwide, this study investigates the association between ototoxic drug use and hearing loss, utilizing South Korean national health data. The goal is to inform clinical prevention and management guidelines by identifying ototoxic drugs and assessing their risks.

Study design: This study is a retrospective observational study using the Health Insurance Review and Assessment Service (HIRA) to analyze the association between suspected ototoxic drug use and hearing loss.

Setting: Data were obtained from the National Patient Samples (NPS) of HIRA in South Korea, covering 2009 to 2016. The study included all National Health Insurance (NHI) enrollees with at least one hospital visit.

Methods: Patients diagnosed with suspected ototoxicity hearing loss (SOHL) were identified, and ototoxic drugs were reviewed using national data. Of 491 reviewed ingredients, 151 were suspected ototoxic. Logistic regression and Cox proportional hazards models assessed associations between drug prescriptions and SOHL, analyzed with SAS 9.4.

Results: SOHL patients were older, with higher rates of underlying conditions and medication use compared to controls. The odds ratio (OR) for SOHL was significantly elevated in patients aged ≥65, increasing from 3.007 to 3.366. Proton pump inhibitors (PPIs) and antibiotics presented elevated risks, especially in older adults, with hazard ratios (HRs) for PPIs rising from 1.85 to 2.90. Notably, PPIs posed higher risks for patients <65.

Conclusion: The study confirms that factors like age, gender, underlying diseases, and specific medications increase SOHL risk, emphasizing the need for cautious medication use tailored to age.

Objective: Sialendoscopy is a diagnostic and interventional treatment for patients with salivary disease. Patients and physicians leverage website information to acquire knowledge about sialendoscopy; thus, understanding the quality of this information is essential. This study analyzes the quality and readability of online information on sialendoscopy.

Methods: "Sialendoscopy" was searched on Google, and the first 100 websites were evaluated. Each website was required to meet three criteria for inclusion: accessible when opened, content deemed relevant, and available in written format. Four validated readability and two validated reliability metrics were utilized. Additionally, a separate analysis was conducted for the top nine websites in the search engine, given most web traffic occurs on Google's first page.

Results: In assessing readability, the mean Flesch Reading Ease Score for included and the top nine websites was 36.2 and 39.5, respectively, with a P-value of .543. Both scores aligned with the "difficult to read" category. Other readability metrics aligned with high school reading levels. For reliability, the mean Discern score for the included and the top nine websites was 36.9 and 45.0, respectively, with a P-value of .030. These scores aligned with the "poor" and "fair" categories, respectively.

Discussion: The low readability and reliability scores implied that the online health information on sialendoscopy is not easily understandable at a reading level appropriate for the general public. Our findings showed that the most readable and highest quality websites were not the highest ranked in our search results. Factors such as search engine algorithms and complex medical terminology used in these informative websites contribute to the lack of readability and relability of online health education.

Implications for practice: As AI evolves, future studies should be conducted to assess its impact on readability and reliability of online health information. There is an opportunity to adjust search engine algorithms, collaborate with communications specialists, and utilize new technologies, such as artificial intelligence chatbots, for the benefit of health seekers.

Objective: To evaluate the perceptions of American Rhinologic Society (ARS) members on the compensation models of academic rhinologists and their impact on clinical practice, teaching, and academic responsibilities.

Study design: Survey study.

Setting: Academic rhinologists across the United States who are members of the ARS.

Methods: A twenty-six-question survey was distributed to 295 ARS members. The survey collected demographic information such as years of experience, geographic location, practice setting, and consultation volume. It also explored various compensation models and their impact on compensation, patient volume, case types, and the ability to support teaching and academic responsibilities.

Results: Out of 295 surveyed ARS members, 107 responded (36%), and 80 academic rhinologists were included in the final sample. Respondents varied in experience and geographic distribution. Most respondents were salaried (69%), while 63% were under relative value units (RVU)-based models, and 25% were under collections-based models. Additionally, 66% reported poor or no support for research and educational activities. Compensation models were found to influence patient volume (28%), procedure choices (14%), and academic duties, with 55% of respondents indicating reduced engagement with students.

Conclusion: Although a plurality of respondents (39%) believed that salaried models are most conducive to balancing academic and clinical responsibilities, survey findings highlight a dissonance. Respondents under collections-based models were more likely to feel adequately supported (64.71%) compared to those under salaried or RVU-based models. This suggests that although many perceive salaried models as ideal for balance, collections-based models may better address financial and structural needs, emphasizing the importance of developing flexible, tailored compensation structures that align with individual and institutional goals while fostering academic productivity.

Circulating tumor DNA (ctDNA) has been developed as a marker of tumor burden in human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). Inflammatory indices are also increasingly being used as prognostic surrogate markers in solid tumors, including head and neck cancers. The relationship between ctDNA levels and inflammatory indices has not been studied in HPV-associated OPSCC. We hypothesize that higher levels of inflammation are associated with higher ctDNA levels. Herein, we demonstrate an association between high pretreatment ctDNA levels and specific inflammatory indices, which may be lower-cost surrogate markers of high HPV ctDNA levels and may act as a surrogate marker for the body's immune response to HPV-positive OPSCC.

Objective: This study aims to report the prevalence and characteristics of underrepresented in medicine (URiM) funding for visiting medical student clerkships in Otolaryngology-Head and Neck Surgery (OHNS) residency programs in the United States.

Study design: Manual online review of Accreditation Council for Graduate Medical Education (ACGME)-accredited OHNS residency programs as of January 2024, reflective of typical medical student search methodology.

Setting: An online review.

Methods: For each program, at least 2 authors captured presence of funding, the funding amount, funding origin, and eligibility criteria. Presence and amount funding were analyzed for possible associations with program type (by FREIDA™ program description), urbanization level, cost of living, and degree of racial and ethnic diversity in the program's geographic location.

Results: Of 131 programs, 49 (37.4%) offered URiM funding, primarily through diversity, equity, and inclusion (DEI) entities (67.3%) or OHNS departments (32.7%). Mean funding per 1-month rotation was $1908. Eligibility criteria varied, with 63.2% using a non-specific URiM definition and 18.4% following the Association of American Medical Colleges definition. Funding presence did not differ by geographic region (P = .06), program type, urbanization level, or cost of living. However, funding amounts varied significantly by region (P < .01) and were significantly different between programs in diversity index 35.0% to 44.9% versus 45.0% to 54.9% and 55.0% to 64.9% (P = .007 and P = .002, respectively).

Conclusion: URiM funding is available in a minority of OHNS programs, with substantial variability in funding amount and eligibility criteria. Standardized guidance on defining URiM eligibility may benefit students and institutions. Funding may correlate with local racial and ethnic diversity, warranting further research.

Objective: Postnasal drip (PND) is a common symptom that is difficult to verify with a traditional examination. Nasal endoscopy has the potential to improve the diagnostic process by confirming the presence and location of mucus. This study sought to describe the association of specific features of PND on nasal endoscopy with other clinical features.

Study design: Cross-sectional with prospective data collection.

Setting: Outpatient rhinology practice.

Methods: Data were prospectively collected on adult (≥18 years of age) patients with PND who underwent nasal endoscopy over a 6-month period. Variables of interest included reflux-related symptoms, nasal congestion, hyposmia, rhinorrhea, pruritic symptoms, inferior turbinate (IT) hypertrophy, 22-item sinonasal outcome test (SNOT-22) scores, and diagnoses of allergic rhinitis (AR), chronic rhinosinusitis (CRS), and reflux disease. Presence of mucus was designated at the nasal cavity (NC) floor, posterior IT, middle meatus (MM), and sphenoethmoidal recess (SER), and consistency of thick or thin was assigned during nasal endoscopy.

Results: Of 118 patients, 112 (94.9%) had identifiable mucus on nasal endoscopy. MM/SER mucus was associated with SNOT-22 score ≥ 50, diagnosis of CRS, and absence of IT hypertrophy or diagnosis of AR. NC and IT mucus was associated with nasal congestion, rhinorrhea, pruritic symptoms, IT hypertrophy, AR, and absence of CRS. Thick NC/IT mucus was associated with reflux symptoms.

Conclusion: Great majority of patients who report PND have posterior nasal drainage of abnormal mucus that can be directly observed with nasal endoscopy. Clinicians should be encouraged to utilize nasal endoscopy when available to evaluate patients with PND.

Objective: To investigate the incidence of dysphagia among head and neck cancer (HNC) patients and assess disparities in utilization of speech-language pathology (SLP) services across different demographic groups.

Study design: Retrospective cohort study.

Setting: Analysis of data from the TriNetX global health network, comprising over 125 million deidentified electronic health records worldwide.

Methods: HNC patients diagnosed with oral, oropharyngeal, laryngeal, or nasopharyngeal cancer with and without dysphagia between January 1, 2004 and October 30, 2024 were identified. Patients were divided into two cohorts for comparison: those who received SLP services after dysphagia diagnosis and those who did not. The association of demographic characteristics (sex, ethnicity, and race) with SLP services were analyzed.

Results: Of 269,629 HNC patients, 28.8% (n = 77,562) were diagnosed with dysphagia. Significant disparities were found: female and non-White patients were less likely to be diagnosed with dysphagia. Once diagnosed, female, Hispanic/Latino, and non-White patients were also significantly less likely to receive SLP services compared to female, Hispanic/Latino, and non-White patients. Overall, only 38.8% of patients with dysphagia received SLP services.

Conclusion: This study highlights significant sex, ethnic, and racial disparities in dysphagia diagnosis and SLP service utilization among HNC patients. Furthermore, SLP services are underutilized. There is a need for targeted interventions to increase dysphagia prevention and surveillance and ensure equitable access to dysphagia care, improving outcomes for all HNC survivors.

Objective: Investigate how private equity (PE) acquisitions shape the otolaryngology workforce.

Study design: Cross-sectional.

Setting: Private outpatient clinics.

Methods: A comprehensive market database, Pitchbook (Seattle, WA), was queried utilizing keywords for outpatient otolaryngology practices acquired by PE firms from 2010 to 2023. Acquisitions were manually verified using practice websites. An open-source website archive service, WayBack Machine, was utilized to track workforce history of practicing otolaryngologist physicians, audiologists (AuDs), and advanced practice providers (APPs) at these outpatient practices and then subjected to linear regression and Pearson correlation test analysis.

Results: In total, 25 otolaryngology practices were determined to have been acquired by PE, all between 2018 and 2023. Acquisitions predominantly occurred in 2020 (n = 8, 32%) and 2023 (n = 7, 28%) and were mostly in the South Atlantic (n = 10, 40%) or Midwest (n = 8, 32%) regions. From 2018 to 2023, total practice locations increased by 32.0% (n = 194 to n = 256), and the total clinician pool increased by 17.9% (n = 901 to n = 1007). Although physicians (n = 500 to n = 517, r = 0.59, P = .213) and AuDs (n = 229 to n = 242, r = 0.34, P = .507) increased nonlinearly, the increase in APPs was strongly linear (n = 172 to n = 248, r = 0.95, P = .003). As a proportion of the total clinician pool, there was a relative decrease in physicians (55.5%-51.3%) and AuDs (25.4%-24.0%), offset by a relative increase in APPs (19.1%-24.6%).

Conclusion: Our findings indicate a disproportionate increase in APPs relative to physicians and AuDs, although without a comparison group we are unable to draw conclusions in relation to changes in the non-PE workforce as a whole.