ORL-head and neck nursing : official journal of the Society of Otorhinolaryngology and Head-Neck Nurses最新文献

Age-related hearing loss (ARHL) is a prevalent yet often overlooked public health challenge that requires interprofessional teamwork and advocacy to implement evidence-based interventions. ARHL impacts quality of life, cognitive function, and social well-being, yet access to hearing care remains limited due partly due to socioeconomic disparities, stigma, and gaps in interprofessional collaboration. This paper explores strategies to expand equitable access to hearing healthcare through interprofessional collaboration, policy advocacy, and community outreach. Nurses, otolaryngologists, audiologists, primary care providers, and public health professionals play keys roles in integrating hearing screenings into routine care, facilitating timely interventions, and addressing disparities. By leveraging electronic health record prompts, social determinants of health screenings, and interdisciplinary teamwork, healthcare systems can improve early detection and intervention for ARHL. Strengthening nurse-physician communication and fostering interprofessional collaboration ensures that hearing loss is recognized and addressed as a critical component of patient-centered care. Beyond conventional clinical settings, community-based initiatives and policy reforms can further enhance access to hearing services. Expanding insurance coverage for hearing aids, advocating for inclusive healthcare policies, and fostering partnerships with local organizations can bridge existing gaps in care. Additionally, educational campaigns aimed at reducing stigma and increasing public awareness are essential for promoting the adoption of hearing interventions. By emphasizing collaborative approaches to hearing health, this article highlights the importance of addressing ARHL as a clinical and public health priority. A coordinated, equity-driven framework can expand access to care and reduce the long-term consequences of untreated hearing loss in aging adults.

Age-related hearing loss (ARHL) is common in older adults and has been linked to significant health and social challenges. These challenges include cognitive decline, depression, falls, and overall decreased quality of life. Despite its high prevalence, ARHL remains underdiagnosed and undertreated, partly due to its gradual onset, stigma, and lack of standardized screening and management protocols. This article provides a comprehensive overview of evidence-based strategies for the early detection and management of ARHL, with an emphasis on recent clinical practice guidelines where nurses are instrumental in leading quality improvement efforts. The multifactorial etiology of ARHL, encompassing genetic predispositions, environmental exposures, and physiological aging, is discussed alongside the health and socioeconomic impacts of untreated hearing loss, including cognitive decline and increased healthcare utilization. Routine screening and hearing assessments can be integrated into patient care visits for individuals aged 50 and above to improve early detection and opportunities for hearing loss management. Effective patient education involves individualized, culturally sensitive counseling that addresses the implications of untreated hearing loss and the benefits of early intervention, which can mitigate stigma and encourage proactive management. Assistive technologies such as consumer devices, hearing aids, and cochlear implants play a vital role in promoting hearing health in personalized care plans developed in collaboration with audiologists. Regular monitoring and follow-up are essential to assess adherence, address challenges, and adjust interventions. By adopting these evidence-based strategies, healthcare professionals can improve identification and management of age-related hearing loss, enhancing the overall health and quality of life for the aging population.

Background: The operating room is one of the noisiest healthcare environments, creating critical challenges for patient safety, team efficiency, and surgical outcomes. Operating room nurses, essential for patient care and team coordination, face unique risks from noise exposure and impaired communication, yet their challenges remain underexplored.

Objective: To assess hearing challenges and communication barriers in operating room teams from nurses' perspectives, with implications for patient safety and interventions.

Design: Cross-sectional survey.

Methods: An electronic survey was distributed to operating room personnel, examining hearing difficulties, communication barriers, and current solutions using multiple-choice, Likert-scale, and open-ended formats. Quantitative and qualitative data were analyzed via descriptive statistics and summative thematic analysis.

Results: Among 225 participants, 51 were nurses (23%), with 25% reporting hearing loss, 63% no hearing loss, and 12% uncertain. All nurses with baseline hearing loss reported auditory challenges in the operating room, while half without hearing loss reported frequent struggles during surgery (p<.0021). Nurses with > 5 years' operating room exposure had over 5-fold risk of hearing loss (95% confidence interval: 1.3-21.2; p=0.028). Noise from suction devices, alarms, and music hindered communication. Self-accommodations included asking for repetition (62%) and modifying the environment (32%). Nearly all respondents (96%) emphasized improving communication, supporting ambient noise reduction, technology, or behavioral interventions like closed-loop communication.

Conclusions: Operating room nurses, central to surgical safety and team efficiency, are disproportionately impacted by noise-related communication challenges. Their dual role positions them to lead the implementation of targeted noise mitigation and communication strategies, driving critical improvements in the surgical environment.

Social determinants of health influence patient outcomes across all otolaryngology specialties, necessitating collaborative efforts among healthcare teams to promote health equity. Health disparities permeate healthcare, creating inequities related to race, ethnicity, socioeconomic status, environment, access to healthcare, education, gender, and sexual orientation. These disparities impact the diagnosis, management, and outcomes of conditions such as chronic otitis media, obstructive sleep apnea, sinusitis and allergies, hearing and balance disorders, head and neck cancer, and laryngeal or airway-related conditions such as subglottic stenosis, tracheostomy, and other laryngotracheal disorders. Recent updates in Centers for Medicare and Medicaid support capturing data on social determinants of health, which is the first step in linking patients to needed services and resources. Addressing these factors requires interprofessional collaboration involving nurses, providers, social workers, and other professionals, such as pharmacists, surgery schedulers, and community health workers. A holistic approach to otolaryngology considers social and economic factors alongside medical care, leading to positive outcomes in real-world settings, such as early hearing detection in underserved communities and nurse-led programs addressing sinusitis related to poor housing conditions. Other goals include improving digital health literacy, offering financial services, and identifying unmet needs. Ongoing research and the development of targeted educational programs are essential for reducing health disparities and improving care delivery in otolaryngology.

The Individuals with Disabilities Education Act has been pivotal in securing necessary accommodations, specialized instruction, and assistive technologies, thereby promoting educational equity. Despite these advances, children with hearing differences continue to face significant barriers in early identification, intervention, and inclusion, necessitating the continuous advocacy and involvement of interdisciplinary professionals in educational and healthcare settings. Nurses are instrumental in bridging healthcare and education, facilitating early detection of hearing differences through newborn screenings and routine school assessments. They have a role in coordinating medical and educational services and advocating for individualized accommodations that enhance learning experiences. However, inconsistent screening policies and lack of awareness among parents, educators, and pediatricians about early indicators of hearing differences persist represent barriers to timely intervention. This article also explores the broader social determinants affecting access to resources and interventions for children with hearing differences, such as socioeconomic disparities and insurance coverage. It advocates for stronger policies and resources to address these inequities and calls for an expanded role of nurses in promoting comprehensive educational access. As IDEA continues to evolve, there is an ongoing need for innovative approaches, including the integration of advanced technologies and interdisciplinary collaboration, to ensure that all children with hearing differences can achieve their full academic potential and quality of life.

Background: This systematic review evaluates the effectiveness of feeding interventions-early oral feeding, nasogastric tube feeding, and gastrostomy tube feeding-in supporting postoperative recovery in head and neck cancer patients. The primary objective is to identify the most effective feeding strategy based on outcomes such as wound dehiscence, infections, aspiration, pharyngo-cutaneous fistula, flap necrosis, and length of hospital stay.

Methods: Studies were selected based on specific inclusion criteria, focusing on head and neck cancer patients receiving alternate feeding methods post-surgery. Databases searched included PubMed, CINAHL, Embase, Cochrane, Web of Science, and Scopus, with the last search conducted on April 10, 2023. Risk of bias was assessed using the Cochrane Risk of Bias tools (RoB-2 for randomized studies and ROBINS-I for non-randomized studies). Data were synthesized and results presented in structured tables, comparing clinical outcomes across feeding methods.

Results: Ten studies involving 623 participants met the inclusion criteria. Early oral feeding was associated with reduced hospital stay and comparable or lower rates of complications, such as wound dehiscence and infections, relative to nasogastric and gastrostomy feeding. Among studies comparing early oral and nasogastric feeding, early oral feeding showed a potential advantage in recovery time, although gastrostomy feeding presented mixed outcomes with occasional higher infection rates.

Discussion: This review highlights the benefits of early oral feeding in enhancing recovery and minimizing complications. Limitations include heterogeneity in study designs, small sample sizes, and variability in outcome definitions, which may affect the robustness of these findings.

Diagnosis of head and neck malignancies remains challenging given the complexity and heterogeneity of the organs and involved anatomical features. Additionally, the presenting symptoms of head and neck cancer may often be vague, mimicking symptoms of less serious illnesses. The following case highlights these challenges. The patient presented to his primary care physician with right facial paralysis involving difficulty closing his eye, as well as intermittent right ear pain. The patient was referred to neurology for a workup to diagnose Lyme Disease or Ramsay Hunt Auricularis. The patient was initially diagnosed with and treated for Ramsay Hunt Auricularis. Despite the treatment, the patient suffered two falls from a loss of consciousness. The cardiologist consulted in the emergency department noted no cardiac etiology. Ultimately, a Computerized Tomography scan and additional imaging revealed a parotid lesion, and the patient was diagnosed with salivary gland carcinoma. The tumor was encircling the internal carotid artery and was subsequently deemed inoperable. No distant metastases were noted. The patient was treated with concurrent chemoradiation using carboplatin and paclitaxel, and leuprolide for androgen receptor-positive cancer. The patient completed this treatment and continues leuprolide every three months. His most recent Positron Emission Tomography scan revealed no evidence of residual disease or recurrent/metastatic disease. The patient still experiences significant long-term treatment effects, such as lymphedema, trismus, and peripheral neuropathy, for which he undergoes rehabilitation services. This unique case is a prime example of the complicated diagnosis and treatment trajectories for patients with head and neck cancer. Frequent follow-up and long-term multidisciplinary care are essential to manage symptoms associated with treatment for all individuals with head and neck cancers.

Aims: To determine the patient factors associated with tracheostomy-related pressure injury (TRPI) using a multilevel, multivariate logistic regression model and to evaluate how care during the COVID-19 pandemic affected TRPI and its predictors.

Design: Secondary data analysis of a tracheostomy patient database and electronic medical records.

Methods: This secondary data analysis study will merge and analyze data from the Global Tracheostomy Collaborative and the electronic health records of a large US healthcare system. We will employ a multilevel logistic regression model to investigate the relationships between suspected risk factors for TRPI.

Discussion: Given the impact of TRPI on patient outcomes and expenditures, it is imperative to standardize TRPI assessment, increase awareness of at-risk patient populations, and implement novel preventive modalities. This will be the first large-sample study quantifying the risk factors for TRPI and the impact of the COVID-19 pandemic.

Conclusion: This study aims to identify risk factors for TRPI, including the impact of the COVID-19 pandemic, using two large, diverse databases, thereby addressing a critical literature gap. The findings from this study will serve to direct future research in this under-researched adverse outcome of tracheostomy care.

Implications for patient care: The findings will inform the development of targeted interventions to mitigate the incidence and severity of TRPI, which will translate into improved patient outcomes and reduced healthcare expenditure.

Impact: The study protocol addresses the prevalence and risk factors of TRPI and examines the effects of the COVID-19 pandemic. The protocol details harmonizing two data sets of patients with a tracheostomy to provide a diverse global sample. This work serves as a reference for upcoming results manuscript publications and future protocol development.

Reporting method: This research protocol was reported using relevant components of the SPIRIT guidelines.

Patient or public contribution: Patients, families, and healthcare professionals comprise the learning community of the Global Tracheostomy Collaborative. Patients and family members participate on the Board and inform practices for data usage.

Aims: The Post-extubation Assessment of Laryngeal Symptoms and Severity (PALSS) study systematically evaluates patient symptoms related to endotracheal intubation with mechanical ventilation, assesses laryngeal injury and voice function after extubation, and develops a screening tool to identify patients with clinically important, post-extubation laryngeal injury.

Design: Single-center, prospective observational cohort study conducted in 6 intensive care units (ICU).

Methods: Patients ≥18 years old who are orally intubated and mechanically ventilated in an ICU and meet eligibility criteria will undergo flexible laryngoscopy, with a sample size goal of 300 completed laryngoscopies. Primary outcome measures include signs and symptoms of laryngeal injury, including voice symptoms and alterations in swallowing, measured using the Laryngeal Hypersensitivity Questionnaire-Acute and Voice Symptom Scale questionnaires respectively. Data will be collected within 72 hours post-extubation and at 7-day follow-up or hospital discharge (whichever occurs first). Data will be analyzed using descriptive statistics, regression models, and predictive modeling using machine learning.

Discussion: The findings of this study will describe the clinical signs and symptoms of laryngeal injury post-extubation.

Conclusion: The PALSS study will provide insights for future studies that explore laryngeal injuries using flexible laryngoscopy after endotracheal intubation.

Implications for patient care: Identifying signs and symptoms of laryngeal injury after endotracheal intubation will facilitate the development of a screening tool that will assist in early identification of post-extubation laryngeal injury, and aid in decreasing short- and long-term complications of endotracheal intubation.

Reporting method: SPIRIT.

Patient or public contribution: Patients were study participants; and family members provided informed consent when the patient lacked decision-making capacity.

Mass incarceration in the United States presents major healthcare challenges, and otorhinolaryngology-related needs within carceral settings are underrecognized. Public health crises, as exemplified by the COVID-19 pandemic which led to over 3,000 deaths among incarcerated individuals, can intensify disparities. Both acute otorhinolaryngology conditions, such as craniomaxillofacial trauma, impending airway compromise, and life-threatening infection, as well as more chronic conditions such as cancer, sinusitis, or ear infections can lead to impaired quality of life, disability, or preventable mortality. Incarcerated individuals experience substantial healthcare disparities, which are driven by intrinsic individual and carceral facility factors such as resource scarcity, structural barriers, limited self-advocacy, and social determinants of health, as well as extrinsic factors related to societal misconceptions, inadequate education of healthcare providers on carceral healthcare, and underdeveloped care systems. To address these issues, a comprehensive approach is needed, incorporating experiential learning, bias reduction, and trust building. Early clinical exposure, enhanced public health education, and community outreach efforts are conducive to cultivating structural competence and relevant skills. Carceral health initiatives can thus raise awareness and enhance the healthcare of incarcerated individuals. Healthcare professionals can expand their roles to advocate for equitable care, prioritize rehabilitation over punishment, and support individuals upon reentry into society. Healthcare professionals in otorhinolaryngology, play a pivotal role in addressing the needs of incarcerated individuals, with nurses, physicians, and allied health stakeholders working together. Education, advocacy, and compassionate care provide the basis for a more equitable and humane carceral healthcare system that upholds the dignity and well-being of all individuals.