Otolaryngology- Head and Neck Surgery最新文献

Objective: To investigate the predictive value of tubomanometry (TMM) in predicting subjective outcome of Balloon Eustachian Tuboplasty (BET) in patients with long-lasting Eustachian tube dysfunction (ETD).

Study design: Retrospective case series.

Setting: Single tertiary referral center.

Methods: A total of 111 ETD patients undergoing 194 BET procedures were included. Demographics, TMM measurements, and tympanograms were registered before and 3 to 6 months after BET. The time ratio between the pressure increase in the nasopharynx and the outer ear canal was labelled R value.

Results: At follow-up, 58.8% of the patients were satisfied with BET outcomes. The prevalence of normal R values increased significantly at 30 mbar (12%, P = .024), 40 mbar (14%, P = .0082), and 50 mbar (13%, P = .011). The prevalence of R = 0 decreased at all three pressure levels (-20%, P = .0001; -15%, P = .0013, and -16%, P = .0005, respectively). Type A tympanograms increased from 37% to 56% (P = .0002), while type B tympanograms decreased from 44% to 25% (P = .0006). Stratifying TMM measurements (R ≤ 1, R > 1, and R = 0) showed that preoperative R values were not prognostic of subjective outcome. Preoperative type B tympanogram indicated a risk of poor subjective outcome.

Conclusion: BET appeared to improve Eustachian tube function with reduced prevalence of pathologic R values and tympanograms. Although preoperative R values were not prognostic, TMM remains promising for assessing Eustachian tube function. Further studies are needed to refine TMM's role in predicting BET efficacy.

Objective: Explore the experiences of stakeholders within hearing care pathways using a human-centered design process to design a patient navigator (PN) to improve hearing health equity for deaf or hard-of-hearing children.

Study design: A qualitative, prospective, observational study utilizing the Empathize, Define, and Ideate phases of Human-Centered Design.

Setting: Academic tertiary children's hospital with interviews over Zoom.

Methods: We interviewed 12 hearing care providers, diverse in role and education across the United States, and 10 parents of deaf or hard-of-hearing children, diverse in preferred language and delays in care (mean age at diagnosis of 4.7 months, mean age at intervention of 10.5 months). The main outcomes were themes and subsequent insights that arose from the thematic analysis of interviews, which were used within a design synthesis session.

Results: Qualitative analysis revealed 3 themes: Intrinsic Barriers, Extrinsic Barriers, and Areas of Opportunity. Within Intrinsic Barriers, a majority of providers and parents described a grieving process that led to delays. Within Extrinsic Barriers, interviewees expressed challenges navigating multiple deaf or hard-of-hearing care pathways. Within Areas of Opportunity, providers and parents agreed on connecting parents of new hearing loss diagnoses with mentor families to improve the care-seeking experience. Intercoder reliability was achieved (Cohen's κ = 0.73). Findings from the qualitative analysis were incorporated in a synthesis session with diverse stakeholders to design a PN role.

Conclusion: Providers and parents agree that the deaf or hard-of-hearing care pathway is difficult to navigate at baseline with delays in accessing care further exacerbated by barriers intrinsic to the family unit.

Objective: The objective of this study is to examine the risk of hypocalcemia after thyroidectomy in patients taking histamine-2 receptor antagonists.

Study design: Retrospective cohort study.

Setting: Multicenter, single database.

Methods: Thirty-four thousand two hundred eighteen patients treated with total thyroidectomy from 2011 to 2022 were identified via the TriNetX Research Network. We compared the incidence of transient (0-1 month and 1-6 months following thyroidectomy) and permanent (6-12 months following thyroidectomy) postthyroidectomy hypocalcemia in patients with and without H2 receptor antagonists. Propensity score matching and sensitivity analysis were done to control for additional risk factors.

Results: Patients were divided into 2 cohorts: those with an H2 receptor antagonist prescription before surgery (n = 5108) and those without (n = 29,110). 44.9% and 11.6% of thyroidectomy patients taking H2 receptor antagonists had hypocalcemia compared to 38.3% and 8.2% of patients without H2 receptor antagonists at 0 to 1 month and 6 to 12 months, respectively. Patients taking H2 receptor antagonists had a significantly increased risk of experiencing hypocalcemia at 0 to 1 month, 1 to 6 months, and 6 to 12 months. Patients taking H2 receptor antagonists were also at increased risk for visiting the emergency department and receiving intravenous calcium replenishment at 1 and 6 months following surgery. Sensitivity analysis continued to yield significant results at all time points.

Conclusion: Patients taking H2 receptor antagonists may be at increased risk of short and long-term hypocalcemia after thyroid surgery. This is the first retrospective cohort study examining the risk of hypocalcemia after thyroidectomy in patients taking H2 receptor antagonists.

Objective: Cystic fibrosis (CF) is a clinical entity defined by aberrant chloride (Cl^-) ion transport causing downstream effects on mucociliary clearance (MCC) in sinonasal epithelia. Inducible deficiencies in transepithelial Cl^- transport via CF transmembrane conductance regulator (CFTR) has been theorized to be a driving process in recalcitrant chronic rhinosinusitis (CRS) in patients without CF. We have previously identified that brief exposures to bacterial lipopolysaccharide (LPS) in mammalian cells induces an acquired dysfunction of CFTR in vitro and in vivo. The objective of the current study is to evaluate whether LPS generates a model of acquired CFTR dysfunction murine nasal airways.

Study design: Basic science.

Setting: Laboratory.

Methods: CFTR^+/+ murine nasal airways were irrigated with 2 µg/mL LPS or control vehicle twice daily for 1 week and transepithelial Cl^- transport assessed with the nasal potential difference (NPD) assay. Histopathologic evaluation included the number of lymphoid aggregates, as well as the epithelial and subepithelial heights.

Results: Transepithelial Cl^- secretion by NPD was markedly reduced in mice exposed to LPS (in mV, -0.14 ± 7.7 vs control, -6.98 ± 7.15, P < .05), while amiloride-sensitive voltage was preserved (6.38 ± 5.09 vs control, 7.36 ± 2.87, P = .99). Histopathology demonstrated significantly higher lymphoid aggregates per high-power field (2.3 ± 0.9 vs 1.1 ± 0.7, control, P < .01) and increased epithelial height (in µm, 40.88 ± 13.9 vs control, 25.32 ± 6.26, P < .05).

Conclusion: Twice daily irrigation with LPS in murine nasal airways over 1 week led to acquired defects in transepithelial Cl^- transport. This animal model provides an excellent means to test the contributions of acquired CFTR dysfunction to CRS and test CFTR correctors and potentiators that might improve MCC.

This article explores the life of Dr. Margaret F. Butler and her many contributions to the field of otolaryngology. Dr. Butler not only served as the first female chair of an otolaryngology department at the Woman's Medical College of Pennsylvania but her mentorship of other physicians also helped support early efforts to promote gender diversity in the specialty of otolaryngology. Using autobiographical material including Dr. Butler's writings and speeches, many housed in The Legacy Center Archives and Special Collections at Drexel University College of Medicine, we explore the legacy of Margaret F. Butler to provide a perspective on women in otolaryngology.

The Centers for Medicare & Medicaid Services (CMS) recently increased payment for evaluation and management (E/M) visits, but did not apply these updates to post-operative global period visits. We investigated the resulting Medicare fee-for-service revenue loss for otolaryngologists. Using publicly available Medicare spending/utilization data, we estimated how much additional payment otolaryngologists would have received in 2023 if CMS had reimbursed global period visits at the same rates as other E/M visits. Our analysis included 291 procedures with 10- or 90-day global periods. The total estimated global period revenue loss was $7.0 M and concentrated among facial plastic/reconstructive ($3.3 M; 47.1%), head and neck ($1.5 M; 21.4%), and otologic ($1.2 M; 17.1%) procedures. Total estimated losses were greatest for nasal septoplasty (CPT 30520; $1.2 M), tympanostomy with ventilating tube placement (CPT 69433; $0.6 M), and cervical lymphadenectomy (CPT 38724; $0.5 M). Payment reforms based on robust and empirically-derived measures of physician work are necessary to promote fair procedural compensation.

Objective: Hearing loss (HL) is associated with depression, but existing datasets are limited by the type of data available for both hearing and mental health conditions. The purpose of this study is to determine if there is an association between HL and depressive disorders within a large bi-institutional electronic health record (EHR) system containing more granular diagnostic information.

Study design: Cross-sectional epidemiologic study.

Setting: Two academic medical centers.

Methods: Audiometric data was collected from patients ≥18 years old between 2020 to mid-2023 (n = 29,772). The exposure was HL defined as the 4-frequency pure-tone average (PTA), speech reception threshold (SRT), and word recognition score (WRS). The outcomes were depression, categorized as either: (1) major depressive disorder, defined by International Classification of Diseases, 10th Revision (ICD-10) code; (2) persistent mood disorder, defined by ICD-10 code; or (3) antidepressant medication use, defined by medication lists. Odds ratios were computed from logistic regressions between HL and each of the outcome variables, controlling for age, sex, cardiovascular risks, and site.

Results: The mean age (standard deviation) was 60.5 (18.2) years, and 17,736 participants (59.6%) were female. Controlling for covariates, for every 10-dB worsening in hearing by PTA, the odds of major depressive disorder increased by 1.04 times (95% confidence interval [CI] = 1.01-1.07, P = .015). Similarly, for every 10 dB worsening in hearing by PTA or SRT, the odds of antidepressant medication use increased by 1.04 times (95% CI = 1.01-1.06, P = .004). Odds ratios for persistent mood disorder were nonsignificant.

Conclusion: In a large academic EHR, HL is associated with major depressive disorder and antidepressant medication use.

Objective: Evaluate inpatient audiometry on clinical decision-making. Assess stakeholder perspectives on the practice of inpatient audiometry and financial impact.

Study design: This is a mixed methods study utilizing retrospective chart review, a focus group, and financial analyses.

Setting: Academic tertiary referral center.

Methods: Included subjects were adults (18+) admitted from 2015 to 2022 who received an inpatient audiogram (n = 302). A binary assessment of whether audiograms impacted inpatient clinical management was determined. Financial analyses estimated the cost of audiograms. An audiology focus group was conducted.

Results: The average age was 51 years. Thirty-nine percent were female. Seventy percent of inpatient audiograms were associated with Otolaryngology consultation. Inpatient audiograms were performed an average of 3.6 days after request (0-47 days, 90th percentile 8.2 days). Forty-nine percent were performed within 1 day. Twenty-three percent were performed for acute hearing loss. Ototoxic monitoring was the most frequent indication (15%). Sixty-two percent of audiograms did not impact the initiation or withholding of treatment. Inpatient testing results in a 63% increase in cost over outpatient. Audiologists endorsed challenges with equipment, patient-level factors, and system-level challenges.

Conclusion: Inpatient audiometry is resource-intensive without significant data examining the impact and clinical utility. In most cases, inpatient audiometry is not used in the decision to withhold or deliver treatment and may cost 63% more than outpatient audiograms. While inpatient audiometry has a critical role in appropriate settings, system optimization and guidelines are necessary. Outpatient audiograms may suffice for the majority of otologic consults in combination with a thorough history and physical exam. Additional study across institutions with variable practice would be beneficial to establish broader recommendations.

Objective: Determine objectively noticeable features of pediatric facial scars using eye-tracking software and explore how skin tone impacts scar perception.

Study design: Cross-sectional analysis.

Setting: Tertiary care pediatric hospital.

Methods: Ninety-seven naïve adult participants viewed 12 randomized photos using an eye-tracking device. Photos of 4 children with different Fitzpatrick (FP) tones were used to digitally create 3 images each: a scarless control, a hypertrophic scar, and a dyspigmented scar. Scar size and location were consistent. Gaze metrics were compared between skin tones and scar types.

Results: Hypertrophic and dyspigmented scars had greater total fixation duration and fixation count than controls across all skin tones (P < .01). The dyspigmented scar of the FP2 child had greater total fixation duration (P = .01) and fixation count (P = .04) than the hypertrophic scar. The dyspigmented scar of the FP2 child had greater total fixation duration and fixation count than the dyspigmented scars of the FP6 and FP4 children (P < .01). The hypertrophic scar of the FP1 child had a longer total fixation duration than the hypertrophic scar of the FP6 child (P = .04). There were lower times to first fixation for both hypertrophic and dyspigmented scars in the FP1, FP4, and FP6 children (P < .04), and the dyspigmented scar in the FP2 child (P = .049).

Conclusion: Dyspigmented and hyperpigmented scars were viewed differently on children's faces with various skin tones. This highlights the importance of evaluating and accounting for both scar type and skin tone when counseling patients and families who experience facial scarring.

Objective: To compare the incidence of motor vehicle accidents (MVAs) among patients with obstructive sleep apnea (OSA) undergoing continuous positive airway pressure (CPAP) therapy and sleep surgery.

Study design: Retrospective cohort study using the TriNetX national clinical database.

Setting: Analysis of a nationwide patient cohort.

Methods: The database was queried for patients with OSA (International Classification of Diseases, 10th Revision: G47.33) treated with CPAP (Current Procedural Terminology [CPT]: 94660), sleep surgery (CPT: 42145, 64568, 64582), or no treatment. Sleep surgeries included uvulopalatopharyngoplasty and hypoglossal nerve stimulation. 1:1 Propensity score matching (PSM) ensured cohort comparability by age, sex, and race. MVA incidence rates were analyzed, along with a subanalysis of OSA-related comorbidities as a surrogate of OSA severity.

Results: A total of 2,832,437 patients with OSA were identified. Patients with OSA undergoing sleep surgery demonstrated a significantly lower incidence of MVAs (3.403%) compared to the OSA + CPAP cohort (6.072%) and the no-treatment group (4.662%). The odds ratio (OR) for MVA incidence in the no-treatment group compared to the OSA + sleep surgery cohort was 1.214 (95% confidence interval [CI]: 1.060-1.391, P = .0051). The OR in the OSA + sleep surgery cohort compared to the CPAP cohort was 0.545 (95% CI: 0.480-0.618, P < .0001). Patients with OSA who experienced MVAs were more likely to have comorbidities such as hypertension, diabetes, and heart failure following the accident.

Conclusion: Sleep surgery significantly reduces the risk of MVAs in patients with OSA compared to CPAP and no treatment. In appropriate candidates, surgery should be considered to mitigate personal and public health risks associated with OSA.