首页 > 最新文献

Otolaryngology- Head and Neck Surgery最新文献

英文 中文
Quantitative Assessment of Collagen Architecture to Determine Role of Tumor Stroma During Vestibular Schwannoma Progression. 定量评估胶原结构以确定肿瘤基质在前庭神经丛瘤发展过程中的作用
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-07 DOI: 10.1002/ohn.1018
Melanie Fisher, Bailey H Duhon, Han T N Nguyen, Jeffrey R Tonniges, Kyle C Wu, Yin Ren

Objective: The primary objective was to characterize the abundance and architecture of collagen in the extracellular matrix in vestibular schwannoma (VS). The secondary objective was to investigate the association between collagen architecture and tumor size.

Study design: Retrospective cohort study.

Setting: Academic referral center.

Methods: Tumor samples were obtained from patients with sporadic VS undergoing microsurgical resection. Histological analyses were performed including picrosirius red (PSR) staining under polarized light. Collagen architecture was quantified using an automated fiber detection software. Second Harmonic Generation (SHG) microscopy and immunofluorescence (IF) were utilized to characterize collagen architecture.

Results: Eleven tumor specimens were included (mean tumor diameter = 2.80 cm, range 1.5-4.0 cm), and were divided into large (mean diameter = 3.5 ± 0.4 cm) and small (mean tumor diameter = 2.0 ± 0.4 cm) cohorts based on size. The large VS cohort showed significantly higher collagen density (27.65% vs 12.73%, P = .0043), with more thick fibers (mature Type I, 24.54% vs 12.97%, P = .0022) and thin fibers (immature Type I or mature Type III, 23.55% vs 12.27%, P = .026). Tumor volume correlated with greater degree of collagen fiber disorganization (P = .0413, r2 = 0.298). Specifically, collagen type I intensity was significantly higher in large VS compared to small tumors (P < .001) and peripheral nerve (P = .028).

Conclusion: Larger VS exhibit increased collagen abundance in the tumor stroma, and a more disorganized collagen architecture compared to smaller VS and normal peripheral nerve tissue. This finding indicates that collagen organization may play a significant role in extracellular matrix remodeling and the progression of VS.

目的:主要目的是描述前庭裂隙瘤(VS)细胞外基质中胶原蛋白的丰度和结构。研究设计:回顾性队列研究:研究设计:回顾性队列研究:地点:学术转诊中心:肿瘤样本来自接受显微外科切除术的散发性 VS 患者。进行组织学分析,包括偏振光下的皮色红(PSR)染色。使用自动纤维检测软件对胶原结构进行量化。利用二次谐波发生(SHG)显微镜和免疫荧光(IF)来描述胶原结构:共纳入 11 例肿瘤标本(平均肿瘤直径 = 2.80 厘米,范围为 1.5-4.0 厘米),并根据大小分为大肿瘤(平均直径 = 3.5 ± 0.4 厘米)和小肿瘤(平均肿瘤直径 = 2.0 ± 0.4 厘米)。大型 VS 队列的胶原蛋白密度明显更高(27.65% vs 12.73%,P = .0043),有更多的粗纤维(成熟 I 型,24.54% vs 12.97%,P = .0022)和细纤维(未成熟 I 型或成熟 III 型,23.55% vs 12.27%,P = .026)。肿瘤体积与胶原纤维紊乱程度相关(P = .0413,r2 = 0.298)。具体来说,与小型肿瘤相比,大型 VS 的 I 型胶原蛋白强度明显更高(P 结论:大型 VS 的 I 型胶原蛋白强度明显高于小型肿瘤:与较小的 VS 和正常周围神经组织相比,较大的 VS 表现出肿瘤基质中胶原丰度增加,胶原结构更紊乱。这一发现表明,胶原组织可能在细胞外基质重塑和 VS 进展中发挥重要作用。
{"title":"Quantitative Assessment of Collagen Architecture to Determine Role of Tumor Stroma During Vestibular Schwannoma Progression.","authors":"Melanie Fisher, Bailey H Duhon, Han T N Nguyen, Jeffrey R Tonniges, Kyle C Wu, Yin Ren","doi":"10.1002/ohn.1018","DOIUrl":"10.1002/ohn.1018","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective was to characterize the abundance and architecture of collagen in the extracellular matrix in vestibular schwannoma (VS). The secondary objective was to investigate the association between collagen architecture and tumor size.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Academic referral center.</p><p><strong>Methods: </strong>Tumor samples were obtained from patients with sporadic VS undergoing microsurgical resection. Histological analyses were performed including picrosirius red (PSR) staining under polarized light. Collagen architecture was quantified using an automated fiber detection software. Second Harmonic Generation (SHG) microscopy and immunofluorescence (IF) were utilized to characterize collagen architecture.</p><p><strong>Results: </strong>Eleven tumor specimens were included (mean tumor diameter = 2.80 cm, range 1.5-4.0 cm), and were divided into large (mean diameter = 3.5 ± 0.4 cm) and small (mean tumor diameter = 2.0 ± 0.4 cm) cohorts based on size. The large VS cohort showed significantly higher collagen density (27.65% vs 12.73%, P = .0043), with more thick fibers (mature Type I, 24.54% vs 12.97%, P = .0022) and thin fibers (immature Type I or mature Type III, 23.55% vs 12.27%, P = .026). Tumor volume correlated with greater degree of collagen fiber disorganization (P = .0413, r<sup>2</sup> = 0.298). Specifically, collagen type I intensity was significantly higher in large VS compared to small tumors (P < .001) and peripheral nerve (P = .028).</p><p><strong>Conclusion: </strong>Larger VS exhibit increased collagen abundance in the tumor stroma, and a more disorganized collagen architecture compared to smaller VS and normal peripheral nerve tissue. This finding indicates that collagen organization may play a significant role in extracellular matrix remodeling and the progression of VS.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Factors Associated With Psychological Distress Among Thyroid Cancer Patients. 甲状腺癌患者心理压力的相关因素
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-05 DOI: 10.1002/ohn.1051
Matthew E Lin, Eric X Wei, Andrey Finegersh, Lisa A Orloff, Julia E Noel, Michelle M Chen

Objective: To assess the prevalence of psychological distress (PD) among thyroid cancer patients (TCPs) and identify clinical, demographic, and socioeconomic factors associated with PD.

Study design: Retrospective population-based cohort study.

Setting: 2016 to 2018 National Health Interview Survey.

Methods: Adults with cancer were included. The primary outcome measure was moderate-to-severe psychological distress (MSPD), defined as a respondent score ≥5 on the validated K6 Psychological Distress Scale. χ2 tests were used to assess differences in MSPD by cancer type. Weighted multivariable logistic regression was used to elucidate factors associated with MSPD among TCPs.

Results: The majority of TCPs (n = 684,674) were white (75.4%), female (78.5%), and on average 55.65 years old (SD = 13.2). 28.4% reported MSPD. On weighted analysis, TCPs were more likely to have MSPD than prostate (14.9%, P < .001), bladder (16.4%, P = .011), and nonmelanoma skin cancer (16.3%, P < .001) patients but less likely than pancreatic cancer (30.0%, P = .030) patients. TCPs who were older when surveyed (odds ratio [OR], 0.93; 95% confidence interval [CI, 0.88-0.98), previously drank alcohol (OR, 0.23; 95% CI, 0.06-0.91), and saw a general physician (GP) in the past year (OR, 0.14; 95% CI, 0.03-0.56) were less likely to have MSPD. Female sex (OR, 8.12; 95% CI, 1.61-40.89), increased number of medical comorbidities (OR, 1.46; 95% CI, 1.00-2.14), and functional limitations (OR, 4.55; 95% CI, 1.33-15.74) were associated with increased likelihood of MSPD.

Conclusion: Nearly 30% of TCPs have MSPD, especially younger patients who do not regularly see GPs. Future work to identify the most at-risk patients is needed to improve prevention and develop meaningful psychosocial interventions.

研究目的评估甲状腺癌患者(TCPs)中心理困扰(PD)的发生率,并识别与PD相关的临床、人口统计学和社会经济因素:基于人群的回顾性队列研究.地点:2016年至2018年全国健康访谈调查.方法:纳入癌症成人:纳入患有癌症的成年人。主要结果指标为中重度心理压力(MSPD),定义为受访者在有效的 K6 心理压力量表中得分≥5。χ2检验用于评估不同癌症类型的MSPD差异。采用加权多变量逻辑回归法来阐明TCPs中与MSPD相关的因素:大多数 TCPs(n = 684 674)为白人(75.4%)、女性(78.5%),平均年龄为 55.65 岁(SD = 13.2)。28.4%的人报告了 MSPD。经过加权分析,TCPs 比前列腺更有可能患有 MSPD(14.9%,P 结论):近30%的TCPs患有MSPD,尤其是不经常看全科医生的年轻患者。今后需要开展工作,确定风险最高的患者,以改善预防并制定有意义的社会心理干预措施。
{"title":"Factors Associated With Psychological Distress Among Thyroid Cancer Patients.","authors":"Matthew E Lin, Eric X Wei, Andrey Finegersh, Lisa A Orloff, Julia E Noel, Michelle M Chen","doi":"10.1002/ohn.1051","DOIUrl":"https://doi.org/10.1002/ohn.1051","url":null,"abstract":"<p><strong>Objective: </strong>To assess the prevalence of psychological distress (PD) among thyroid cancer patients (TCPs) and identify clinical, demographic, and socioeconomic factors associated with PD.</p><p><strong>Study design: </strong>Retrospective population-based cohort study.</p><p><strong>Setting: </strong>2016 to 2018 National Health Interview Survey.</p><p><strong>Methods: </strong>Adults with cancer were included. The primary outcome measure was moderate-to-severe psychological distress (MSPD), defined as a respondent score ≥5 on the validated K6 Psychological Distress Scale. χ<sup>2</sup> tests were used to assess differences in MSPD by cancer type. Weighted multivariable logistic regression was used to elucidate factors associated with MSPD among TCPs.</p><p><strong>Results: </strong>The majority of TCPs (n = 684,674) were white (75.4%), female (78.5%), and on average 55.65 years old (SD = 13.2). 28.4% reported MSPD. On weighted analysis, TCPs were more likely to have MSPD than prostate (14.9%, P < .001), bladder (16.4%, P = .011), and nonmelanoma skin cancer (16.3%, P < .001) patients but less likely than pancreatic cancer (30.0%, P = .030) patients. TCPs who were older when surveyed (odds ratio [OR], 0.93; 95% confidence interval [CI, 0.88-0.98), previously drank alcohol (OR, 0.23; 95% CI, 0.06-0.91), and saw a general physician (GP) in the past year (OR, 0.14; 95% CI, 0.03-0.56) were less likely to have MSPD. Female sex (OR, 8.12; 95% CI, 1.61-40.89), increased number of medical comorbidities (OR, 1.46; 95% CI, 1.00-2.14), and functional limitations (OR, 4.55; 95% CI, 1.33-15.74) were associated with increased likelihood of MSPD.</p><p><strong>Conclusion: </strong>Nearly 30% of TCPs have MSPD, especially younger patients who do not regularly see GPs. Future work to identify the most at-risk patients is needed to improve prevention and develop meaningful psychosocial interventions.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Age in Single-Level Versus Multilevel Airway Compromise: A Multi-Institutional Review. 年龄对单层与多层气道损伤的影响:多机构综述。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-05 DOI: 10.1002/ohn.1026
Chanticha Laohakittikul, Inderpreet Kaur Khalsa, Shambavi J Rao, Steven D Stockton, Lyndsay L Madden, Daniel J Cates, VyVy N Young

Objective: Examine the association between age and treatment outcomes in conditions causing single- versus multilevel airway restriction.

Study design: Multi-institutional retrospective cohort study.

Setting: Tertiary laryngology centers.

Methods: Participants included younger (18-64 years) and geriatric (≥65 years) adults with posterior glottic stenosis (PGS), multilevel airway stenosis (MLAS), and bilateral vocal fold paralysis (BVFP). Subgroup demographics, comorbidities, type, and etiology of airway compromise were described. Associations between age and primary outcome variables (i.e., tracheostomy and decannulation rates, number of surgeries performed, time between surgeries, and change in quality-of-life patient-reported outcome measures [PROMs]) were evaluated. Statistical analyses included independent t tests, χ2, Fisher's exact, or Mann-Whitney tests.

Results: In 158 patients [96 younger (30 PGS, 29 MLAS, 37 BVFP) and 62 geriatric (24 PGS, 9 MLAS, 29 BVFP)], age differences were not significant for gender (P = .990), tracheostomy placement (70% vs 66%, P = .629), or decannulation success (40% vs 24%, P = .091) in younger versus geriatric groups, respectively. In younger patients, MLAS was more common (30.2% vs 14.5%, P = .024), and BVFP patients were more likely to decannulate (50% vs 12%, P = .017). Geriatric patients were more likely to have a history of prior radiation (26% vs 10%, P = .016), stenosis due to malignancy (23% vs 9%, P = .022), and fewer overall surgeries (median 1 vs 3, P = .003). Median PROMs were comparable between age subgroups (P > .05).

Conclusion: Younger adults underwent more surgeries, but overall comorbidities, tracheostomy decannulation rates, and PROMs were comparable between groups. Age does not negatively impact treatment outcomes and should not be a deterrent in treatment decision-making.

目的:研究单层气道受限和多层气道受限情况下年龄与治疗效果之间的关系:研究设计: 多机构回顾性队列研究:多机构回顾性队列研究:地点:三级喉科中心:参与者包括患有声门后狭窄(PGS)、多层次气道狭窄(MLAS)和双侧声带麻痹(BVFP)的年轻人(18-64 岁)和老年人(≥65 岁)。研究人员还描述了亚组的人口统计学特征、合并症、气道损伤的类型和病因。评估了年龄与主要结果变量(即气管造口术和气管切开率、手术次数、手术间隔时间以及患者报告的生活质量结果指标 [PROMs] 的变化)之间的相关性。统计分析包括独立 t 检验、χ2 检验、费雪精确检验或曼-惠尼检验:在 158 名患者中[96 名年轻患者(30 名 PGS、29 名 MLAS、37 名 BVFP)和 62 名老年患者(24 名 PGS、9 名 MLAS、29 名 BVFP)],年轻组与老年组在性别(P = .990)、气管造口置入率(70% vs 66%,P = .629)或拔管成功率(40% vs 24%,P = .091)方面的年龄差异不显著。在年轻患者中,MLAS 更常见(30.2% 对 14.5%,P = .024),而 BVFP 患者更有可能解除封管(50% 对 12%,P = .017)。老年患者更可能有放射治疗史(26% vs 10%,P = .016)、恶性肿瘤导致的狭窄(23% vs 9%,P = .022)和较少的总体手术次数(中位数 1 vs 3,P = .003)。各年龄亚组的PROMs中位数相当(P > .05):结论:年轻成人接受的手术次数较多,但各组间的总体合并症、气管切开取栓率和PROMs相当。年龄不会对治疗结果产生负面影响,也不应成为治疗决策的阻碍因素。
{"title":"Impact of Age in Single-Level Versus Multilevel Airway Compromise: A Multi-Institutional Review.","authors":"Chanticha Laohakittikul, Inderpreet Kaur Khalsa, Shambavi J Rao, Steven D Stockton, Lyndsay L Madden, Daniel J Cates, VyVy N Young","doi":"10.1002/ohn.1026","DOIUrl":"https://doi.org/10.1002/ohn.1026","url":null,"abstract":"<p><strong>Objective: </strong>Examine the association between age and treatment outcomes in conditions causing single- versus multilevel airway restriction.</p><p><strong>Study design: </strong>Multi-institutional retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary laryngology centers.</p><p><strong>Methods: </strong>Participants included younger (18-64 years) and geriatric (≥65 years) adults with posterior glottic stenosis (PGS), multilevel airway stenosis (MLAS), and bilateral vocal fold paralysis (BVFP). Subgroup demographics, comorbidities, type, and etiology of airway compromise were described. Associations between age and primary outcome variables (i.e., tracheostomy and decannulation rates, number of surgeries performed, time between surgeries, and change in quality-of-life patient-reported outcome measures [PROMs]) were evaluated. Statistical analyses included independent t tests, χ<sup>2</sup>, Fisher's exact, or Mann-Whitney tests.</p><p><strong>Results: </strong>In 158 patients [96 younger (30 PGS, 29 MLAS, 37 BVFP) and 62 geriatric (24 PGS, 9 MLAS, 29 BVFP)], age differences were not significant for gender (P = .990), tracheostomy placement (70% vs 66%, P = .629), or decannulation success (40% vs 24%, P = .091) in younger versus geriatric groups, respectively. In younger patients, MLAS was more common (30.2% vs 14.5%, P = .024), and BVFP patients were more likely to decannulate (50% vs 12%, P = .017). Geriatric patients were more likely to have a history of prior radiation (26% vs 10%, P = .016), stenosis due to malignancy (23% vs 9%, P = .022), and fewer overall surgeries (median 1 vs 3, P = .003). Median PROMs were comparable between age subgroups (P > .05).</p><p><strong>Conclusion: </strong>Younger adults underwent more surgeries, but overall comorbidities, tracheostomy decannulation rates, and PROMs were comparable between groups. Age does not negatively impact treatment outcomes and should not be a deterrent in treatment decision-making.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Analysis of Adherence to AAO-HNSF Clinical Practice Guidelines for Sudden Hearing Loss. 对遵守《AAO-HNSF 突发性听力损失临床实践指南》情况的分析。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-05 DOI: 10.1002/ohn.1050
Bao Y Sciscent, F Jeffrey Lorenz, Hänel W Eberly, Andrew J Rothka, Mark E Whitaker, Neerav Goyal

Objective: To assess adherence to the 2019 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) guidelines for the diagnosis and management of sudden hearing loss (SHL) and sudden sensorineural hearing loss (SSNHL).

Study design: Retrospective cohort.

Setting: TriNetX, a de-identified healthcare database.

Methods: Evaluation focused on the percentage of patients undergoing proper guideline-adherent workup and treatment for SHL. Key measures include audiogram testing within 2 weeks for distinguishing SSNHL from CHL. For SSNHL patients, MRI or auditory brainstem response (ABR) testing should be obtained, and steroids and/or hyperbaric oxygen may be offered within 2 weeks.

Results: There were 24,203 SHL patients, 59.1% (n = 14,309) of whom underwent recommended audiogram testing, with 35.8% (n = 8,674) completing it within 2 weeks. Overall, 3,107 were diagnosed with unilateral SSNHL, 104 with unilateral conductive hearing loss (CHL), 121 with mixed hearing loss, and 10,977 were lost to follow-up. Among 3,107 SSNHL cases, just 25.5% (n = 791) obtained MRI/ABR within 1 month, and vestibular schwannoma was diagnosed in 3.5% (n = 28). Additionally, steroids were prescribed to 54.5% (n = 1,692), and <0.3% (n ≤ 10) received hyperbaric oxygen. In accordance with strong recommendations against or insufficient evidence to support the following diagnostics and treatments, 2.0% (n = 63) underwent a CT scan, less than 0.3% (n ≤ 10) were prescribed vasodilators or thrombolytics, and 3.5% (n = 108) were on antivirals.

Conclusion: There is a significant opportunity for improvement in evaluating patients with SHL, specifically SSNHL. Proper adherence to guidelines may improve screening, detection, and management of neurotologic pathologies, including vestibular schwannoma.

目的评估2019年美国耳鼻咽喉头颈外科学会(AAO-HNSF)突发性听力损失(SHL)和突发性感音神经性听力损失(SSNHL)诊断和管理指南的遵守情况:研究设计:回顾性队列:环境:TriNetX,一个去标识化的医疗数据库:评估重点是对 SHL 患者进行符合指南要求的检查和治疗的比例。主要措施包括在 2 周内进行听力图测试,以区分 SSNHL 和 CHL。对于SSNHL患者,应进行核磁共振成像或听性脑干反应(ABR)测试,并在2周内提供类固醇和/或高压氧:共有 24,203 名 SHL 患者,其中 59.1%(n=14,309)的患者接受了建议的听力图测试,35.8%(n=8,674)的患者在 2 周内完成了测试。总体而言,3107 人被诊断为单侧 SSNHL,104 人被诊断为单侧传导性听力损失 (CHL),121 人被诊断为混合性听力损失,10977 人失去了随访机会。在 3107 例 SSNHL 患者中,仅有 25.5%(n = 791)的患者在 1 个月内进行了 MRI/ABR,3.5%(n = 28)的患者被诊断为前庭分裂瘤。此外,54.5%(n = 1,692)的患者被处方类固醇药物,结论是:对 SHL(尤其是 SSNHL)患者的评估工作大有改进的余地。正确遵循指南可改善包括前庭分裂瘤在内的神经病理学病变的筛查、检测和管理。
{"title":"Analysis of Adherence to AAO-HNSF Clinical Practice Guidelines for Sudden Hearing Loss.","authors":"Bao Y Sciscent, F Jeffrey Lorenz, Hänel W Eberly, Andrew J Rothka, Mark E Whitaker, Neerav Goyal","doi":"10.1002/ohn.1050","DOIUrl":"https://doi.org/10.1002/ohn.1050","url":null,"abstract":"<p><strong>Objective: </strong>To assess adherence to the 2019 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) guidelines for the diagnosis and management of sudden hearing loss (SHL) and sudden sensorineural hearing loss (SSNHL).</p><p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>TriNetX, a de-identified healthcare database.</p><p><strong>Methods: </strong>Evaluation focused on the percentage of patients undergoing proper guideline-adherent workup and treatment for SHL. Key measures include audiogram testing within 2 weeks for distinguishing SSNHL from CHL. For SSNHL patients, MRI or auditory brainstem response (ABR) testing should be obtained, and steroids and/or hyperbaric oxygen may be offered within 2 weeks.</p><p><strong>Results: </strong>There were 24,203 SHL patients, 59.1% (n = 14,309) of whom underwent recommended audiogram testing, with 35.8% (n = 8,674) completing it within 2 weeks. Overall, 3,107 were diagnosed with unilateral SSNHL, 104 with unilateral conductive hearing loss (CHL), 121 with mixed hearing loss, and 10,977 were lost to follow-up. Among 3,107 SSNHL cases, just 25.5% (n = 791) obtained MRI/ABR within 1 month, and vestibular schwannoma was diagnosed in 3.5% (n = 28). Additionally, steroids were prescribed to 54.5% (n = 1,692), and <0.3% (n ≤ 10) received hyperbaric oxygen. In accordance with strong recommendations against or insufficient evidence to support the following diagnostics and treatments, 2.0% (n = 63) underwent a CT scan, less than 0.3% (n ≤ 10) were prescribed vasodilators or thrombolytics, and 3.5% (n = 108) were on antivirals.</p><p><strong>Conclusion: </strong>There is a significant opportunity for improvement in evaluating patients with SHL, specifically SSNHL. Proper adherence to guidelines may improve screening, detection, and management of neurotologic pathologies, including vestibular schwannoma.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Temporal Trends in Knowledge of Human Papillomavirus and Associated Oropharyngeal Cancer Following Expanded Vaccination Eligibility. 扩大疫苗接种资格后对人类乳头瘤病毒及相关口咽癌知识的时间趋势。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-04 DOI: 10.1002/ohn.1041
Oluwatobiloba O Ayo-Ajibola, Michelle Koh, Catherine Julien, Ryan J Davis, Matthew E Lin, James Kim, Wendy J Mack, Daniel I Kwon

Objective: Human papillomavirus (HPV) is a significant driver of elevated risk for oropharyngeal squamous cell carcinoma (OPSCC). In 2018, HPV vaccination eligibility was expanded to men and women aged 27 to 45. We evaluated changes in awareness of HPV, its association with OPSCC, and HPV vaccination among all US adults between 2018 and 2020, focusing on those aged 27 to 45.

Study design: Cross-sectional survey cycles.

Setting: The Health Information National Trends Survey (HINTS).

Methods: The HINTS, a nationally representative survey of US adults, was queried. A total of 3504 adults in 2018 and 3865 adults in 2020 were assessed for knowledge of HPV, its vaccine, its association with OPSCC, and changes in awareness between 2018 and 2020. Statistical significance was set at P < .05.

Results: Most respondents were aware of HPV (2018: 60.8%; 2020: 64.8%) and its vaccine (2018: 60.8%; 2020: 61.6%). A significant decrease in awareness of the association between HPV and cervical cancer was seen between 2018 and 2020 (75.0% vs 70.2%, P = .028). Knowledge of HPV+ OPSCC was poor and did not change over time (2018: 27.0%, 2020: 29.5%). Statistically significant increases in HPV awareness between 2018 and 2020 were found for individuals who reported completing high school as their highest level of education (P = .009), Caucasians (P = .013), males (P = .024), and those making more than $200,000 annually (P = .022).

Conclusion: Knowledge of the association between HPV and OPSCC remained poor despite expanded vaccine eligibility. Public health education on the association may increase awareness for groups likely to benefit from vaccination.

目的:人类乳头瘤病毒(HPV)是口咽鳞状细胞癌(OPSCC)风险升高的重要驱动因素。2018 年,HPV 疫苗接种资格扩大到 27 至 45 岁的男性和女性。我们评估了 2018 年至 2020 年间所有美国成年人对 HPV 的认识、其与口咽鳞状细胞癌的关系以及 HPV 疫苗接种情况的变化,重点关注 27 岁至 45 岁的人群:横断面调查周期:健康信息全国趋势调查(HINTS):HINTS是一项针对美国成年人的全国性代表性调查。共对 2018 年的 3504 名成人和 2020 年的 3865 名成人进行了评估,以了解他们对 HPV、HPV 疫苗、HPV 与 OPSCC 的关联以及 2018 年至 2020 年间认知度的变化。统计显著性设定为 P 结果:大多数受访者了解 HPV(2018 年:60.8%;2020 年:64.8%)及其疫苗(2018 年:60.8%;2020 年:61.6%)。在 2018 年和 2020 年之间,受访者对 HPV 与宫颈癌之间关系的了解程度明显下降(75.0% vs 70.2%,P = .028)。对 HPV+ OPSCC 的认知度较低,且未随着时间的推移而发生变化(2018 年:27.0%,2020 年:29.5%)。在2018年和2020年之间,HPV认知度在以下人群中出现了统计学意义上的显着增长:将高中毕业作为最高教育水平的人群(P = .009)、白种人(P = .013)、男性(P = .024)以及年收入超过20万美元的人群(P = .022):结论:尽管扩大了疫苗接种资格,但人们对人类乳头瘤病毒与卵巢扁桃体癌之间的关系仍然知之甚少。对可能从疫苗接种中获益的人群开展有关这种关联的公共卫生教育可能会提高他们的认识。
{"title":"Temporal Trends in Knowledge of Human Papillomavirus and Associated Oropharyngeal Cancer Following Expanded Vaccination Eligibility.","authors":"Oluwatobiloba O Ayo-Ajibola, Michelle Koh, Catherine Julien, Ryan J Davis, Matthew E Lin, James Kim, Wendy J Mack, Daniel I Kwon","doi":"10.1002/ohn.1041","DOIUrl":"https://doi.org/10.1002/ohn.1041","url":null,"abstract":"<p><strong>Objective: </strong>Human papillomavirus (HPV) is a significant driver of elevated risk for oropharyngeal squamous cell carcinoma (OPSCC). In 2018, HPV vaccination eligibility was expanded to men and women aged 27 to 45. We evaluated changes in awareness of HPV, its association with OPSCC, and HPV vaccination among all US adults between 2018 and 2020, focusing on those aged 27 to 45.</p><p><strong>Study design: </strong>Cross-sectional survey cycles.</p><p><strong>Setting: </strong>The Health Information National Trends Survey (HINTS).</p><p><strong>Methods: </strong>The HINTS, a nationally representative survey of US adults, was queried. A total of 3504 adults in 2018 and 3865 adults in 2020 were assessed for knowledge of HPV, its vaccine, its association with OPSCC, and changes in awareness between 2018 and 2020. Statistical significance was set at P < .05.</p><p><strong>Results: </strong>Most respondents were aware of HPV (2018: 60.8%; 2020: 64.8%) and its vaccine (2018: 60.8%; 2020: 61.6%). A significant decrease in awareness of the association between HPV and cervical cancer was seen between 2018 and 2020 (75.0% vs 70.2%, P = .028). Knowledge of HPV+ OPSCC was poor and did not change over time (2018: 27.0%, 2020: 29.5%). Statistically significant increases in HPV awareness between 2018 and 2020 were found for individuals who reported completing high school as their highest level of education (P = .009), Caucasians (P = .013), males (P = .024), and those making more than $200,000 annually (P = .022).</p><p><strong>Conclusion: </strong>Knowledge of the association between HPV and OPSCC remained poor despite expanded vaccine eligibility. Public health education on the association may increase awareness for groups likely to benefit from vaccination.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pediatric Adenotonsillectomy Opioid Prescriptions Before and After Practice Guidelines and American Academy of Pediatrics Challenge. 小儿腺扁桃体切除术阿片类药物处方前后的实践指南和美国儿科学会的挑战。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-04 DOI: 10.1002/ohn.1048
Najm S Khan, David Z Allen, Yin Yiu, Omar G Ahmed, Masayoshi Takashima, Zi Y Jiang

The opioid epidemic continues to concern the CDC and public health officials but recent trends in opioid prescribing rates following common pediatric otolaryngology surgeries are unexplored. This retrospective cohort study queried the TriNetX Research database from January 1, 2010, through December 31, 2023, for pediatric patients who underwent tonsillectomy and/or adenoidectomy and received oral opioids within 5 days of surgery. Prescription trends from 2010 to 2017 were compared to 2022 to 2023, after the publication of multiple clinical practice guidelines (CPGs). Of 286,572 surgeries, 29% of patients received postoperative opioids. Comparing the 2 time periods, a significant decrease was observed in the risk of postoperative opioid prescriptions following 2022 (RR 0.87, CI95% 0.86-0.88). Prescribing rates decreased between 2018 and 2023 from 34% to 24%. Publication of CPGs were associated with a decrease in opioid prescribing rates and may have contributed to an encouraging trend in opioid stewardship.

阿片类药物的流行继续引起美国疾病预防控制中心和公共卫生官员的关注,但常见儿科耳鼻喉科手术后阿片类药物处方率的最新趋势尚未得到探讨。这项回顾性队列研究查询了 TriNetX Research 数据库中 2010 年 1 月 1 日至 2023 年 12 月 31 日期间接受扁桃体切除术和/或腺样体切除术并在术后 5 天内口服阿片类药物的儿科患者。将 2010 年至 2017 年的处方趋势与 2022 年至 2023 年的趋势进行了比较,后者是多项临床实践指南 (CPG) 发布之后的趋势。在 286,572 例手术中,29% 的患者在术后接受了阿片类药物治疗。比较两个时间段,发现2022年之后术后阿片类药物处方风险显著下降(RR 0.87,CI95% 0.86-0.88)。2018年至2023年期间,处方率从34%降至24%。CPG的发布与阿片类药物处方率的下降有关,可能有助于阿片类药物管理方面令人鼓舞的趋势。
{"title":"Pediatric Adenotonsillectomy Opioid Prescriptions Before and After Practice Guidelines and American Academy of Pediatrics Challenge.","authors":"Najm S Khan, David Z Allen, Yin Yiu, Omar G Ahmed, Masayoshi Takashima, Zi Y Jiang","doi":"10.1002/ohn.1048","DOIUrl":"https://doi.org/10.1002/ohn.1048","url":null,"abstract":"<p><p>The opioid epidemic continues to concern the CDC and public health officials but recent trends in opioid prescribing rates following common pediatric otolaryngology surgeries are unexplored. This retrospective cohort study queried the TriNetX Research database from January 1, 2010, through December 31, 2023, for pediatric patients who underwent tonsillectomy and/or adenoidectomy and received oral opioids within 5 days of surgery. Prescription trends from 2010 to 2017 were compared to 2022 to 2023, after the publication of multiple clinical practice guidelines (CPGs). Of 286,572 surgeries, 29% of patients received postoperative opioids. Comparing the 2 time periods, a significant decrease was observed in the risk of postoperative opioid prescriptions following 2022 (RR 0.87, CI<sub>95%</sub> 0.86-0.88). Prescribing rates decreased between 2018 and 2023 from 34% to 24%. Publication of CPGs were associated with a decrease in opioid prescribing rates and may have contributed to an encouraging trend in opioid stewardship.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mechanisms Responsible for Postsurgical Transition From Positional to Nonpositional Obstructive Sleep Apnea Remain Elusive. 手术后从体位性阻塞性睡眠呼吸暂停向非体位性阻塞性睡眠呼吸暂停转变的机制仍然不明。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-04 DOI: 10.1002/ohn.1045
G Dave Singh
{"title":"Mechanisms Responsible for Postsurgical Transition From Positional to Nonpositional Obstructive Sleep Apnea Remain Elusive.","authors":"G Dave Singh","doi":"10.1002/ohn.1045","DOIUrl":"https://doi.org/10.1002/ohn.1045","url":null,"abstract":"","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sleep Disturbance in Vestibular Migraine and Meniere's Disease: A Comparative Analysis. 前庭性偏头痛和梅尼埃病的睡眠障碍:对比分析
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-04 DOI: 10.1002/ohn.1049
Chao-Hui Yang, Ming-Hsien Tsai, Chung-Feng Hwang, Ming-Yu Yang

Objective: To investigate the differences in the prevalence of sleep disturbance between vestibular migraine (VM) and Meniere's disease (MD), and to determine whether poor sleep quality is correlated with dizziness handicap.

Study design: Observational prospective study.

Setting: Tertiary Academic Medical Center.

Methods: Patients diagnosed with VM, MD, and healthy controls completed the Mini Sleep Questionnaire (MSQ), which comprises 10 items assessing sleep quality. The MSQ total score was calculated by summing the scores of each item. The Dizziness Handicap Inventory (DHI) was used to evaluate the physical, emotional, and functional impacts of dizziness on daily life.

Results: A total of 87 participants (35 with VM, 39 with MD, and 13 healthy controls) were enrolled. Both the VM and MD groups had significantly higher MSQ total scores than the control group (P < .001). The VM group exhibited a higher prevalence of "difficulty falling asleep" (P = .015) and "headaches on awakening" (P = .012) than the MD group. Additionally, the MSQ total score was significantly correlated with the DHI total score in VM patients (P = .001, r = .518). VM patients with severe dizziness handicap had significantly higher MSQ total scores than those with mild handicap (P = .005).

Conclusion: This study highlights the high prevalence of sleep disturbance in both VM and MD patients. The severity of sleep disturbance is correlated with dizziness handicap in VM patients, emphasizing the importance of assessing sleep quality and promoting good sleep habits in the management of VM.

研究目的调查前庭性偏头痛(VM)和梅尼埃病(MD)之间睡眠障碍发生率的差异,并确定睡眠质量差是否与头晕障碍相关:研究设计:前瞻性观察研究:研究设计:观察性前瞻性研究:方法:被诊断为 VM、MD 和健康对照组的患者填写迷你睡眠问卷(MSQ),该问卷由 10 个评估睡眠质量的项目组成。MSQ 总分由每个项目的得分相加计算得出。头晕障碍量表(DHI)用于评估头晕对日常生活造成的身体、情绪和功能影响:共有 87 名参与者(35 名眩晕症患者、39 名头晕症患者和 13 名健康对照组)参加了研究。眩晕症组和多发性眩晕症组的 MSQ 总分均明显高于对照组(P 结论:眩晕症组和多发性眩晕症组的 MSQ 总分均明显高于对照组:这项研究强调了睡眠障碍在脑损伤和脑血管疾病患者中的高发病率。睡眠障碍的严重程度与 VM 患者的头晕障碍相关,强调了评估睡眠质量和促进良好睡眠习惯在 VM 治疗中的重要性。
{"title":"Sleep Disturbance in Vestibular Migraine and Meniere's Disease: A Comparative Analysis.","authors":"Chao-Hui Yang, Ming-Hsien Tsai, Chung-Feng Hwang, Ming-Yu Yang","doi":"10.1002/ohn.1049","DOIUrl":"https://doi.org/10.1002/ohn.1049","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the differences in the prevalence of sleep disturbance between vestibular migraine (VM) and Meniere's disease (MD), and to determine whether poor sleep quality is correlated with dizziness handicap.</p><p><strong>Study design: </strong>Observational prospective study.</p><p><strong>Setting: </strong>Tertiary Academic Medical Center.</p><p><strong>Methods: </strong>Patients diagnosed with VM, MD, and healthy controls completed the Mini Sleep Questionnaire (MSQ), which comprises 10 items assessing sleep quality. The MSQ total score was calculated by summing the scores of each item. The Dizziness Handicap Inventory (DHI) was used to evaluate the physical, emotional, and functional impacts of dizziness on daily life.</p><p><strong>Results: </strong>A total of 87 participants (35 with VM, 39 with MD, and 13 healthy controls) were enrolled. Both the VM and MD groups had significantly higher MSQ total scores than the control group (P < .001). The VM group exhibited a higher prevalence of \"difficulty falling asleep\" (P = .015) and \"headaches on awakening\" (P = .012) than the MD group. Additionally, the MSQ total score was significantly correlated with the DHI total score in VM patients (P = .001, r = .518). VM patients with severe dizziness handicap had significantly higher MSQ total scores than those with mild handicap (P = .005).</p><p><strong>Conclusion: </strong>This study highlights the high prevalence of sleep disturbance in both VM and MD patients. The severity of sleep disturbance is correlated with dizziness handicap in VM patients, emphasizing the importance of assessing sleep quality and promoting good sleep habits in the management of VM.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trends in Medicare Utilization and Reimbursement of Tracheostomy From 2000 to 2022. 2000 年至 2022 年医疗保险气管切开术的使用和报销趋势。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-04 DOI: 10.1002/ohn.1044
Rahul A Patel, Sina J Torabi, Said Izreig, R Peter Manes

Objective: To analyze the utilization and reimbursement for tracheostomy.

Study design: Retrospective Cross-Sectional Study.

Setting: Centers for Medicare & Medicaid Services (CMS) Medicare Provider Utilization and Payment Data (2013 and 2021) and Part B Medicare Fee-For-Service National Summary Data (2000-2022).

Methods: Utilization, payment, and specialty breakdown were analyzed for planned tracheostomy (Current Procedural Terminology [CPT] codes 31600, 31601, 31610) and emergency tracheostomy (CPT codes 31603, 31605).

Results: From 2000 to 2022, there was a 48.9% decrease (40,754-20,812) in number of planned tracheostomies and a 75.3% decrease (3277-811) in number of emergency tracheostomies, leading to an overall decrease of 51%. Similarly, there was a 59.3% inflation-adjusted decrease ($13.4-$5.5 million) in total reimbursement for planned tracheostomies and an 82.1% inflation-adjusted decrease ($1.1 million-$205 thousand) in total reimbursement for emergency tracheostomies. There was a 20.3% inflation-adjusted decrease ($329-$262) in reimbursement per planned tracheostomy and a 27.7% inflation-adjusted decrease ($349-$252) in reimbursement per emergency tracheostomy. In our sample of 280 high-volume tracheostomy providers in 2021 (28.2% otolaryngology, 28.2% general surgery, 14.6% thoracic surgery, 14.3% pulmonary disease, 6.4% critical care), the average provider performed 15.8 tracheostomies and was reimbursed $5362.

Conclusion: Despite significant declines in tracheostomy utilization and reimbursement, understanding trends for these lifesaving procedures are critical for otolaryngologists and other providers in delivering high-quality care, and can be used by surgeons, hospital systems, and policymakers to guide future health care legislation.

研究目的分析气管切开术的使用和报销情况:回顾性横断面研究:美国医疗保险和医疗补助服务中心(CMS)的医疗保险提供者使用和支付数据(2013 年和 2021 年)以及 B 部分医疗保险收费服务全国汇总数据(2000-2022 年):方法: 对计划气管切开术(Current Procedural Terminology [CPT] codes 31600, 31601, 31610)和急诊气管切开术(CPT codes 31603, 31605)的使用、支付和专业分类进行分析:从 2000 年到 2022 年,计划气管造口术的数量减少了 48.9%(40754-20812 例),急诊气管造口术的数量减少了 75.3%(3277-811 例),总体减少了 51%。同样,经通货膨胀调整后,计划气管造口术的报销总额减少了 59.3%(1340 万-550 万美元),经通货膨胀调整后,急诊气管造口术的报销总额减少了 82.1%(110 万-20.5 万美元)。经通货膨胀调整后,每次计划气管切开术的报销额下降了 20.3%(329 美元-262 美元),经通货膨胀调整后,每次紧急气管切开术的报销额下降了 27.7%(349 美元-252 美元)。在我们对 2021 年 280 家高额气管造口术医疗机构(28.2% 耳鼻喉科、28.2% 普外科、14.6% 胸外科、14.3% 肺病科、6.4% 重症监护科)的抽样调查中,医疗机构平均实施了 15.8 例气管造口术,报销金额为 5362 美元:尽管气管造口术的使用率和报销额度大幅下降,但了解这些救命手术的趋势对于耳鼻喉科医生和其他医疗服务提供者提供高质量的医疗服务至关重要,外科医生、医院系统和政策制定者可以利用这些趋势来指导未来的医疗立法。
{"title":"Trends in Medicare Utilization and Reimbursement of Tracheostomy From 2000 to 2022.","authors":"Rahul A Patel, Sina J Torabi, Said Izreig, R Peter Manes","doi":"10.1002/ohn.1044","DOIUrl":"https://doi.org/10.1002/ohn.1044","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the utilization and reimbursement for tracheostomy.</p><p><strong>Study design: </strong>Retrospective Cross-Sectional Study.</p><p><strong>Setting: </strong>Centers for Medicare & Medicaid Services (CMS) Medicare Provider Utilization and Payment Data (2013 and 2021) and Part B Medicare Fee-For-Service National Summary Data (2000-2022).</p><p><strong>Methods: </strong>Utilization, payment, and specialty breakdown were analyzed for planned tracheostomy (Current Procedural Terminology [CPT] codes 31600, 31601, 31610) and emergency tracheostomy (CPT codes 31603, 31605).</p><p><strong>Results: </strong>From 2000 to 2022, there was a 48.9% decrease (40,754-20,812) in number of planned tracheostomies and a 75.3% decrease (3277-811) in number of emergency tracheostomies, leading to an overall decrease of 51%. Similarly, there was a 59.3% inflation-adjusted decrease ($13.4-$5.5 million) in total reimbursement for planned tracheostomies and an 82.1% inflation-adjusted decrease ($1.1 million-$205 thousand) in total reimbursement for emergency tracheostomies. There was a 20.3% inflation-adjusted decrease ($329-$262) in reimbursement per planned tracheostomy and a 27.7% inflation-adjusted decrease ($349-$252) in reimbursement per emergency tracheostomy. In our sample of 280 high-volume tracheostomy providers in 2021 (28.2% otolaryngology, 28.2% general surgery, 14.6% thoracic surgery, 14.3% pulmonary disease, 6.4% critical care), the average provider performed 15.8 tracheostomies and was reimbursed $5362.</p><p><strong>Conclusion: </strong>Despite significant declines in tracheostomy utilization and reimbursement, understanding trends for these lifesaving procedures are critical for otolaryngologists and other providers in delivering high-quality care, and can be used by surgeons, hospital systems, and policymakers to guide future health care legislation.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outcomes and Predictors of Success Following Multilevel Surgery in Positional and Nonpositional Obstructive Sleep Apnea. 位置性和非位置性阻塞性睡眠呼吸暂停多层次手术的疗效和成功预测因素。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-21 DOI: 10.1002/ohn.912
Hae E Noh, Min-Seok Rha, Yeonsu Jeong, Chang-Hoon Kim, Hyung-Ju Cho

Objective: To assess the surgical outcomes and identify predictors of surgical success in patients with positional and non-positional obstructive sleep apnea following multilevel airway surgery.

Study design: Retrospective cohort study.

Setting: Singe-tertiary medical center.

Methods: This study included 158 patients with obstructive sleep apnea who underwent multilevel airway surgery. Patients were divided into 2 groups according to position dependency: "positional patients" group (n = 100), and "nonpositional patients" group (n = 58). The characteristics and surgical outcomes of the 2 groups were compared.

Results: The nonpositional group included younger and more obese patients in comparison to the positional group. Moreover, the nonpositional group had more severe disease than the positional group. Both groups showed overall improvement after surgery, and the surgical success rate did not differ significantly between the 2 groups (nonpositional, 41.4% vs positional, 48.0%; P = .424). Notably, 69.0% of patients belonging to the non-positional group converted to positional group postoperatively. Logistic regression analysis revealed that larger tonsil size, female sex, and higher mean O2 saturation were associated with higher success rate in the positional group, whereas larger tonsil size was associated with surgical success in the nonpositional group.

Conclusion: Both nonpositional and positional groups showed improvements following multilevel airway surgery, and surgery induced a transition from nonpositional to positional group. Given that the factors related to surgical success differed between the two groups, surgeons should consider position dependency and these distinct factors during decision-making.

研究目的评估体位性和非体位性阻塞性睡眠呼吸暂停患者接受多水平气道手术后的手术效果,并确定手术成功的预测因素:研究设计:回顾性队列研究:研究设计:回顾性队列研究:本研究纳入了158名接受多水平气道手术的阻塞性睡眠呼吸暂停患者。根据体位依赖性将患者分为两组:"体位依赖患者 "组(100 人)和 "非体位依赖患者 "组(58 人)。比较了两组患者的特征和手术结果:结果:与体位性组相比,非体位性组的患者更年轻、更肥胖。此外,非体位组的病情比体位组严重。两组患者术后的整体情况都有所改善,手术成功率在两组之间没有明显差异(非体位性,41.4%;体位性,48.0%;P = .424)。值得注意的是,69.0% 的非体位组患者术后转为体位组。逻辑回归分析显示,扁桃体较大、女性和平均氧饱和度较高与体位组的成功率有关,而扁桃体较大与非体位组的手术成功率有关:结论:多水平气道手术后,非体位组和体位组都有所改善,手术促使非体位组向体位组过渡。鉴于两组手术成功的相关因素不同,外科医生在决策时应考虑体位依赖性和这些不同的因素。
{"title":"Outcomes and Predictors of Success Following Multilevel Surgery in Positional and Nonpositional Obstructive Sleep Apnea.","authors":"Hae E Noh, Min-Seok Rha, Yeonsu Jeong, Chang-Hoon Kim, Hyung-Ju Cho","doi":"10.1002/ohn.912","DOIUrl":"10.1002/ohn.912","url":null,"abstract":"<p><strong>Objective: </strong>To assess the surgical outcomes and identify predictors of surgical success in patients with positional and non-positional obstructive sleep apnea following multilevel airway surgery.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Singe-tertiary medical center.</p><p><strong>Methods: </strong>This study included 158 patients with obstructive sleep apnea who underwent multilevel airway surgery. Patients were divided into 2 groups according to position dependency: \"positional patients\" group (n = 100), and \"nonpositional patients\" group (n = 58). The characteristics and surgical outcomes of the 2 groups were compared.</p><p><strong>Results: </strong>The nonpositional group included younger and more obese patients in comparison to the positional group. Moreover, the nonpositional group had more severe disease than the positional group. Both groups showed overall improvement after surgery, and the surgical success rate did not differ significantly between the 2 groups (nonpositional, 41.4% vs positional, 48.0%; P = .424). Notably, 69.0% of patients belonging to the non-positional group converted to positional group postoperatively. Logistic regression analysis revealed that larger tonsil size, female sex, and higher mean O<sub>2</sub> saturation were associated with higher success rate in the positional group, whereas larger tonsil size was associated with surgical success in the nonpositional group.</p><p><strong>Conclusion: </strong>Both nonpositional and positional groups showed improvements following multilevel airway surgery, and surgery induced a transition from nonpositional to positional group. Given that the factors related to surgical success differed between the two groups, surgeons should consider position dependency and these distinct factors during decision-making.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1562-1571"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Otolaryngology- Head and Neck Surgery
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1