Pub Date : 2019-11-20DOI: 10.1177/0003489419889066
M. R. Hoffman, D. Francis, Johnny P. Mai, S. Dailey
Objective: Office-based steroid injection has shown promise for idiopathic subglottic stenosis (iSGS). It is important to understand safety and patient-lived experience. We report patient experience related to airway restriction, voice, and side effects. Methods: Sixteen patients (51 ± 14 years) with mild-moderate (20-50%) stenosis undergoing office-based transnasal steroid injections were included; fourteen had prior operations. Patients typically underwent three injections, 1 month apart, followed by transnasal tracheoscopy 1 month later to evaluate outcome; number of injections can vary based on disease severity and response. Outcomes were Dyspnea Index (DI), Modified Medical Research Council (MMRC) dyspnea scale, voice handicap index-10 (VHI-10), and degree of stenosis (estimated from procedural video). At each visit, patients were queried about post-injection airway restriction and side effects. Paired t-tests compared values at baseline versus follow-up tracheoscopy. Results: DI decreased (t = 3.938, P = 0.0013), as did MMRC (t = 2.179, P = 0.0457). There was no change in VHI-10 (t = 1.354; P = 0.1957) scores. Airway stenosis decreased (t = 4.331; P = 0.0006); this was not correlated with change in DI (r = 0.267, P = 0.318). Side effects included airway restriction lasting <48 hours (n = 5), cough (n = 3), and nasal pain (n = 2). Conclusion: Steroid injections improved upper airway symptoms. Side effects were mild and transient. Improvement in DI did not correlate with percent stenosis.
{"title":"Office-Based Steroid Injections for Idiopathic Subglottic Stenosis: Patient-Reported Outcomes, Effect on Stenosis, and Side Effects","authors":"M. R. Hoffman, D. Francis, Johnny P. Mai, S. Dailey","doi":"10.1177/0003489419889066","DOIUrl":"https://doi.org/10.1177/0003489419889066","url":null,"abstract":"Objective: Office-based steroid injection has shown promise for idiopathic subglottic stenosis (iSGS). It is important to understand safety and patient-lived experience. We report patient experience related to airway restriction, voice, and side effects. Methods: Sixteen patients (51 ± 14 years) with mild-moderate (20-50%) stenosis undergoing office-based transnasal steroid injections were included; fourteen had prior operations. Patients typically underwent three injections, 1 month apart, followed by transnasal tracheoscopy 1 month later to evaluate outcome; number of injections can vary based on disease severity and response. Outcomes were Dyspnea Index (DI), Modified Medical Research Council (MMRC) dyspnea scale, voice handicap index-10 (VHI-10), and degree of stenosis (estimated from procedural video). At each visit, patients were queried about post-injection airway restriction and side effects. Paired t-tests compared values at baseline versus follow-up tracheoscopy. Results: DI decreased (t = 3.938, P = 0.0013), as did MMRC (t = 2.179, P = 0.0457). There was no change in VHI-10 (t = 1.354; P = 0.1957) scores. Airway stenosis decreased (t = 4.331; P = 0.0006); this was not correlated with change in DI (r = 0.267, P = 0.318). Side effects included airway restriction lasting <48 hours (n = 5), cough (n = 3), and nasal pain (n = 2). Conclusion: Steroid injections improved upper airway symptoms. Side effects were mild and transient. Improvement in DI did not correlate with percent stenosis.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"86 1","pages":"361 - 368"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76353832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-18DOI: 10.1177/0003489419888232
Anthony M. Tolisano, Natalie Schauwecker, Bethany Baumgart, Johanna Whitson, J. Kutz, B. Isaacson, Jacob B. Hunter
Objective: To identify demographic predictors of patients undergoing cochlear implantation evaluation and surgery. Methods: Consecutive adult patients between 2009 and 2018 who underwent cochlear implantation evaluation at a university cochlear implantation program were retrospectively identified to determine (1) cochlear implantation qualification rate and (2) pursuit of surgery rate with respect to age, gender, race, primary spoken language, marital status, insurance type, and distance to the cochlear implantation center. Results: A total of 823 cochlear implantation evaluations were analyzed. Overall, 76.3% of patients qualified for cochlear implantation and 61.5% of these patients pursued surgery. Age was the only independent predictor for cochlear implantation qualification, such that, for each year younger, the odds of qualifying for cochlear implantation increased by 2.5% (OR 0.98; 95% CI: 0.96-0.99). Age, race, marital status, and insurance type were each independent predictors of the decision to pursue surgery. The odds of pursuing surgery increased by 2.8% for each year younger (OR 1.03; 95% CI: 1.01-1.05). Compared to White patients, non-Whites were half as likely to pursue surgery (OR 0.47; 95% CI: 0.25-0.88). Single (OR 0.49; 95% CI: 0.26-0.94) and widowed patients (OR 0.46; 95% CI: 0.23-0.95) were about half as likely to pursue surgery as compared to married patients. Patients with military insurance were 13 times more likely to pursue surgery as compared to patients with Medicare (OR 13.0; 95% CI: 1.67-101.4). Conclusion: Younger age is an independent predictor for a higher cochlear implantation qualification rate, suggesting the possibility for delayed candidacy referral. Rate of surgical pursuit in qualified cochlear implantation candidates is lower for racial minorities, single and widowed patients, and older patients.
{"title":"Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program","authors":"Anthony M. Tolisano, Natalie Schauwecker, Bethany Baumgart, Johanna Whitson, J. Kutz, B. Isaacson, Jacob B. Hunter","doi":"10.1177/0003489419888232","DOIUrl":"https://doi.org/10.1177/0003489419888232","url":null,"abstract":"Objective: To identify demographic predictors of patients undergoing cochlear implantation evaluation and surgery. Methods: Consecutive adult patients between 2009 and 2018 who underwent cochlear implantation evaluation at a university cochlear implantation program were retrospectively identified to determine (1) cochlear implantation qualification rate and (2) pursuit of surgery rate with respect to age, gender, race, primary spoken language, marital status, insurance type, and distance to the cochlear implantation center. Results: A total of 823 cochlear implantation evaluations were analyzed. Overall, 76.3% of patients qualified for cochlear implantation and 61.5% of these patients pursued surgery. Age was the only independent predictor for cochlear implantation qualification, such that, for each year younger, the odds of qualifying for cochlear implantation increased by 2.5% (OR 0.98; 95% CI: 0.96-0.99). Age, race, marital status, and insurance type were each independent predictors of the decision to pursue surgery. The odds of pursuing surgery increased by 2.8% for each year younger (OR 1.03; 95% CI: 1.01-1.05). Compared to White patients, non-Whites were half as likely to pursue surgery (OR 0.47; 95% CI: 0.25-0.88). Single (OR 0.49; 95% CI: 0.26-0.94) and widowed patients (OR 0.46; 95% CI: 0.23-0.95) were about half as likely to pursue surgery as compared to married patients. Patients with military insurance were 13 times more likely to pursue surgery as compared to patients with Medicare (OR 13.0; 95% CI: 1.67-101.4). Conclusion: Younger age is an independent predictor for a higher cochlear implantation qualification rate, suggesting the possibility for delayed candidacy referral. Rate of surgical pursuit in qualified cochlear implantation candidates is lower for racial minorities, single and widowed patients, and older patients.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"128 1","pages":"347 - 354"},"PeriodicalIF":0.0,"publicationDate":"2019-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85739019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-18DOI: 10.1177/0003489419888956
M. E. Graham, Marshall E. Smith
Objectives: Recurrent laryngeal nerve (RLN) injury may be a consequence of surgical procedures of the skull base, neck, and chest, with adverse consequences to function and quality of life. Laryngeal reinnervation offers a potentially stable improvement in vocal fold position and tone. The classic donor nerve is the ansa cervicalis, but is not always available due to damage or sacrifice during previous neck surgeries. Our objective was to introduce the nerve to the thyrohyoid (TH) muscle as an alternate donor nerve for reinnervation, which has not previously been described. Methods: Case series of two patients using the TH nerve for laryngeal reinnervation after RLN injury, with description of surgical harvest. Results: Follow-up results are available for 10 months (one patient) and 3 years (one patient) demonstrating both subjective and objective improvement in function. GRBAS scores were reduced. Maximal phonation time was improved. Patient rating of voice was stable or improved postoperatively. One patient described significant preoperative dyspnea which was significantly improved postoperatively, from a score of 24 to 10 out of 40 on the dyspnea handicap index. VHI was improved in one patient, but scores elevated in the other, despite a change from “moderately severe impairment” to “normal voice” subjectively. Neither patient experienced significant complications from the procedure. Conclusion: Laryngeal reinnervation procedures provide good outcomes in pediatric patients. When ansa cervicalis is not available as a donor nerve, the nerve to TH provides a reasonable alternative.
{"title":"The Nerve to Thyrohyoid Muscle as a Novel Donor Nerve for Laryngeal Reinnervation","authors":"M. E. Graham, Marshall E. Smith","doi":"10.1177/0003489419888956","DOIUrl":"https://doi.org/10.1177/0003489419888956","url":null,"abstract":"Objectives: Recurrent laryngeal nerve (RLN) injury may be a consequence of surgical procedures of the skull base, neck, and chest, with adverse consequences to function and quality of life. Laryngeal reinnervation offers a potentially stable improvement in vocal fold position and tone. The classic donor nerve is the ansa cervicalis, but is not always available due to damage or sacrifice during previous neck surgeries. Our objective was to introduce the nerve to the thyrohyoid (TH) muscle as an alternate donor nerve for reinnervation, which has not previously been described. Methods: Case series of two patients using the TH nerve for laryngeal reinnervation after RLN injury, with description of surgical harvest. Results: Follow-up results are available for 10 months (one patient) and 3 years (one patient) demonstrating both subjective and objective improvement in function. GRBAS scores were reduced. Maximal phonation time was improved. Patient rating of voice was stable or improved postoperatively. One patient described significant preoperative dyspnea which was significantly improved postoperatively, from a score of 24 to 10 out of 40 on the dyspnea handicap index. VHI was improved in one patient, but scores elevated in the other, despite a change from “moderately severe impairment” to “normal voice” subjectively. Neither patient experienced significant complications from the procedure. Conclusion: Laryngeal reinnervation procedures provide good outcomes in pediatric patients. When ansa cervicalis is not available as a donor nerve, the nerve to TH provides a reasonable alternative.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"286 1","pages":"355 - 360"},"PeriodicalIF":0.0,"publicationDate":"2019-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89952493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.1177/0003489419888947
J. Lechien, A. Rodriguez Ruiz, D. Dequanter, F. Bobin, F. Mouawad, V. Muls, K. Huet, B. Harmegnies, Sarah Remacle, C. Finck, S. Saussez
Objective: To develop and validate the Reflux Sign Assessment (RSA), a clinical instrument evaluating the physical findings of laryngopharyngeal reflux (LPR). Methods: A total of 106 patients completed a 3-month treatment based on the association of diet, pantoprazole, alginate, or magaldrate with the LPR characteristics (acid, nonacid, mixed). Forty-two asymptomatic individuals completed the study (control group). The RSA results and reflux finding score (RFS) were documented for the LPR patients at baseline and after treatment. Intrarater reliability was assessed through a test-retest blinded evaluation of signs (7-day intervals). Interrater reliability was assessed by comparing the RSA evaluations of three blinded otolaryngologists through Kendall’s W. Responsiveness to change was evaluated through a comparison of the baseline and 3-month posttreatment findings. The RSA cutoffs for determining the presence and absence of LPR were examined by receiver operating characteristic (ROC) analysis. Results: A total of 102 LPR patients completed the study (68 females). The mean age was 53 years. The mean RSA at baseline was 25.95 ± 9.58; it significantly improved to 18.96 ± 7.58 after 3 months of therapy (P < .001). RSA exhibited good intra- (r = 0.813) and interrater (Kendall’s W = 0.663) reliabilities (N = 56). There was no significant association between the RSA, gastrointestinal endoscopy findings, and the types of reflux (acid, nonacid, or mixed) according to impedance-pH monitoring. An RSA >14 may be suggestive of LPR. Conclusion: The RSA is a complete clinical instrument evaluating both laryngeal and extralaryngeal findings associated with LPR. The RSA demonstrated high intra- and interrater reliabilities and responsiveness to change.
{"title":"Validity and Reliability of the Reflux Sign Assessment","authors":"J. Lechien, A. Rodriguez Ruiz, D. Dequanter, F. Bobin, F. Mouawad, V. Muls, K. Huet, B. Harmegnies, Sarah Remacle, C. Finck, S. Saussez","doi":"10.1177/0003489419888947","DOIUrl":"https://doi.org/10.1177/0003489419888947","url":null,"abstract":"Objective: To develop and validate the Reflux Sign Assessment (RSA), a clinical instrument evaluating the physical findings of laryngopharyngeal reflux (LPR). Methods: A total of 106 patients completed a 3-month treatment based on the association of diet, pantoprazole, alginate, or magaldrate with the LPR characteristics (acid, nonacid, mixed). Forty-two asymptomatic individuals completed the study (control group). The RSA results and reflux finding score (RFS) were documented for the LPR patients at baseline and after treatment. Intrarater reliability was assessed through a test-retest blinded evaluation of signs (7-day intervals). Interrater reliability was assessed by comparing the RSA evaluations of three blinded otolaryngologists through Kendall’s W. Responsiveness to change was evaluated through a comparison of the baseline and 3-month posttreatment findings. The RSA cutoffs for determining the presence and absence of LPR were examined by receiver operating characteristic (ROC) analysis. Results: A total of 102 LPR patients completed the study (68 females). The mean age was 53 years. The mean RSA at baseline was 25.95 ± 9.58; it significantly improved to 18.96 ± 7.58 after 3 months of therapy (P < .001). RSA exhibited good intra- (r = 0.813) and interrater (Kendall’s W = 0.663) reliabilities (N = 56). There was no significant association between the RSA, gastrointestinal endoscopy findings, and the types of reflux (acid, nonacid, or mixed) according to impedance-pH monitoring. An RSA >14 may be suggestive of LPR. Conclusion: The RSA is a complete clinical instrument evaluating both laryngeal and extralaryngeal findings associated with LPR. The RSA demonstrated high intra- and interrater reliabilities and responsiveness to change.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"114 1","pages":"313 - 325"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74825894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.1177/0003489419889373
Justin Ross, William L. Valentino, A. Calder, David Bigly, S. Othman, B. McKinnon, R. Sataloff
Objectives: Hearing loss has been implicated in dysphonia secondary to voice misuse, although the data supporting this claim are scant. Determining the prevalence of hearing loss in patients with dysphonia and correlating it with self-perception of vocal handicap may help clarify the value of audiometry in evaluation of patients with dysphonia. Methods: This is a retrospective chart review of all new voice patients (n = 405) presenting with dysphonia to the primary investigator between 2015 and 2018. Each new patient routinely undergoes audiometric and voice objective analyses. Main outcomes measured include prevalence, severity of hearing loss, and voice handicap index-10 (VHI-10). Results: Of the 405 subjects reviewed, mean age was 49.0 years (SD = 17.4). 60.7% of subjects were female and 39.3% male. Patients with hearing loss defined as >25 dB in worse ear with pure tone average (PTA) thresholds at 0.5, 1, 2, and 3 kHz (PTA-S) accounted for 18% of the total cohort. The prevalence of previously undiagnosed hearing loss in this cohort was 13.1% (53 of 405 subjects). Of these subjects, 62.3% (33 subjects) reported no perception of hearing loss while 37.7% (20 subjects) suspected they had some hearing loss, yet never sought evaluation. Only increased PTA-S, speech discrimination, Reflux Symptom Index, and female gender demonstrated a significant relationship with VHI-10 when analyzed with multivariate linear regression analysis. Conclusions: The prevalence of hearing loss in patients presenting with dysphonia in this cohort is similar to normative population data. This study has also demonstrated that the majority of these patients did not perceive any hearing loss. The reasons behind this may be a result of or associated with the patients’ dysphonia. Furthermore, clinicians should consider performing audiometric evaluation in patients with abnormal VHI-10 scores in the appropriate clinical context.
{"title":"Utility of Audiometry in the Evaluation of Patients Presenting with Dysphonia","authors":"Justin Ross, William L. Valentino, A. Calder, David Bigly, S. Othman, B. McKinnon, R. Sataloff","doi":"10.1177/0003489419889373","DOIUrl":"https://doi.org/10.1177/0003489419889373","url":null,"abstract":"Objectives: Hearing loss has been implicated in dysphonia secondary to voice misuse, although the data supporting this claim are scant. Determining the prevalence of hearing loss in patients with dysphonia and correlating it with self-perception of vocal handicap may help clarify the value of audiometry in evaluation of patients with dysphonia. Methods: This is a retrospective chart review of all new voice patients (n = 405) presenting with dysphonia to the primary investigator between 2015 and 2018. Each new patient routinely undergoes audiometric and voice objective analyses. Main outcomes measured include prevalence, severity of hearing loss, and voice handicap index-10 (VHI-10). Results: Of the 405 subjects reviewed, mean age was 49.0 years (SD = 17.4). 60.7% of subjects were female and 39.3% male. Patients with hearing loss defined as >25 dB in worse ear with pure tone average (PTA) thresholds at 0.5, 1, 2, and 3 kHz (PTA-S) accounted for 18% of the total cohort. The prevalence of previously undiagnosed hearing loss in this cohort was 13.1% (53 of 405 subjects). Of these subjects, 62.3% (33 subjects) reported no perception of hearing loss while 37.7% (20 subjects) suspected they had some hearing loss, yet never sought evaluation. Only increased PTA-S, speech discrimination, Reflux Symptom Index, and female gender demonstrated a significant relationship with VHI-10 when analyzed with multivariate linear regression analysis. Conclusions: The prevalence of hearing loss in patients presenting with dysphonia in this cohort is similar to normative population data. This study has also demonstrated that the majority of these patients did not perceive any hearing loss. The reasons behind this may be a result of or associated with the patients’ dysphonia. Furthermore, clinicians should consider performing audiometric evaluation in patients with abnormal VHI-10 scores in the appropriate clinical context.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"103 1","pages":"333 - 339"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77159996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.1177/0003489419889069
V. Patel, A. Khaku, M. Carr
Background: This study identifies risk factors and 30-day adverse outcomes of pediatric patients undergoing thyroidectomy. Methods: Retrospective analysis utilizing the American College of Surgeons National Surgical Quality Improvement–Pediatric Database (2015-2016). Study population includes pediatric patients (≤18 years) who underwent hemithyroidectomy (HT), total thyroidectomy (TT), and total thyroidectomy with central neck dissection (TT+ND). Results: A total of 720 cases were identified; mean age at time of surgery was 14.1 years, with a female-to-male ratio of 3.4:1. Following hospital discharge, there were 10 related readmissions, with 1 patient requiring reoperation for neck hematoma evacuation. Regression analysis revealed anesthesia time had a significant impact on total length of stay (P = .0020). Conclusion: Contemporary pediatric thyroidectomy has a low incidence of 30-day general surgical postoperative complications. Future research efforts are necessary once thyroidectomy specific variables are incorporated into ACS-NSQIP-P, which will provide further insights into managing this unique patient population.
{"title":"Pediatric Thyroidectomy: NSQIP-P Analysis of Adverse Perioperative Outcomes","authors":"V. Patel, A. Khaku, M. Carr","doi":"10.1177/0003489419889069","DOIUrl":"https://doi.org/10.1177/0003489419889069","url":null,"abstract":"Background: This study identifies risk factors and 30-day adverse outcomes of pediatric patients undergoing thyroidectomy. Methods: Retrospective analysis utilizing the American College of Surgeons National Surgical Quality Improvement–Pediatric Database (2015-2016). Study population includes pediatric patients (≤18 years) who underwent hemithyroidectomy (HT), total thyroidectomy (TT), and total thyroidectomy with central neck dissection (TT+ND). Results: A total of 720 cases were identified; mean age at time of surgery was 14.1 years, with a female-to-male ratio of 3.4:1. Following hospital discharge, there were 10 related readmissions, with 1 patient requiring reoperation for neck hematoma evacuation. Regression analysis revealed anesthesia time had a significant impact on total length of stay (P = .0020). Conclusion: Contemporary pediatric thyroidectomy has a low incidence of 30-day general surgical postoperative complications. Future research efforts are necessary once thyroidectomy specific variables are incorporated into ACS-NSQIP-P, which will provide further insights into managing this unique patient population.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"44 1","pages":"326 - 332"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80783032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.1177/0003489419889376
T. Kerwin, G. Wiet, Bradley Hittle, D. Stredney, P. De Boeck, A. Moberly, S. Andersen
Objective: Competency-based surgical training involves progressive autonomy given to the trainee. This requires systematic and evidence-based assessment with well-defined standards of proficiency. The objective of this study is to develop standards for the cross-institutional mastoidectomy assessment tool to inform decisions regarding whether a resident demonstrates sufficient skill to perform a mastoidectomy with or without supervision. Methods: A panel of fellowship-trained content experts in mastoidectomy was surveyed in relation to the 16 items of the assessment tool to determine the skills needed for supervised and unsupervised surgery. We examined the consensus score to investigate the degree of agreement among respondents for each survey item as well as additional analyses to determine whether the reported skill level required for each survey item was significantly different for the supervised versus unsupervised level. Results: Ten panelists representing different US training programs responded. There was considerable consensus on cut-off scores for each item and trainee level between panelists, with moderate (0.62) to very high (0.95) consensus scores depending on assessment item. Further analyses demonstrated that the difference between supervised and unsupervised skill levels was significantly meaningful for all items. Finally, minimum-passing scores for each item was established. Conclusion: We defined performance standards for the cross-institutional mastoidectomy assessment tool using the Angoff method. These cut-off scores that can be used to determine when trainees can progress from performance under supervision to performance without supervision. This can be used to guide training in a competency-based training curriculum.
{"title":"Standard Setting of Competency in Mastoidectomy for the Cross-Institutional Mastoidectomy Assessment Tool","authors":"T. Kerwin, G. Wiet, Bradley Hittle, D. Stredney, P. De Boeck, A. Moberly, S. Andersen","doi":"10.1177/0003489419889376","DOIUrl":"https://doi.org/10.1177/0003489419889376","url":null,"abstract":"Objective: Competency-based surgical training involves progressive autonomy given to the trainee. This requires systematic and evidence-based assessment with well-defined standards of proficiency. The objective of this study is to develop standards for the cross-institutional mastoidectomy assessment tool to inform decisions regarding whether a resident demonstrates sufficient skill to perform a mastoidectomy with or without supervision. Methods: A panel of fellowship-trained content experts in mastoidectomy was surveyed in relation to the 16 items of the assessment tool to determine the skills needed for supervised and unsupervised surgery. We examined the consensus score to investigate the degree of agreement among respondents for each survey item as well as additional analyses to determine whether the reported skill level required for each survey item was significantly different for the supervised versus unsupervised level. Results: Ten panelists representing different US training programs responded. There was considerable consensus on cut-off scores for each item and trainee level between panelists, with moderate (0.62) to very high (0.95) consensus scores depending on assessment item. Further analyses demonstrated that the difference between supervised and unsupervised skill levels was significantly meaningful for all items. Finally, minimum-passing scores for each item was established. Conclusion: We defined performance standards for the cross-institutional mastoidectomy assessment tool using the Angoff method. These cut-off scores that can be used to determine when trainees can progress from performance under supervision to performance without supervision. This can be used to guide training in a competency-based training curriculum.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"59 1","pages":"340 - 346"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79570390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-09DOI: 10.1177/0003489419887403
Narmien Haddad, Pratima Agarwal, Jessica R. Levi, J. Tracy, L. Tracy
Objective: To examine the clinical presentation, diagnostic evaluation, and management of Killian–Jamieson diverticula (KJD) through literature review. Methods: A comprehensive literature review was conducted through December 2018 using keywords Killian–Jamieson diverticula/diverticulum. Data extracted included clinical presentation, imaging characteristics, surgical management, and postoperative care. Sources: PubMed and Google Scholar. Results: Sixty-eight cases of KJD in 59 reports (29M:39F; median 58 years old) were identified for review. The most common presentation was dysphagia (n = 39), suspected thyroid nodule (n = 24) and globus (n = 14). The majority of KJD (n = 51) occur on the left, with rare reports of right side (n = 11) and bilateral (n = 5) presentation. Thirty-two cases describe surgical management: 22 utilizing a transcervical approach, with (n = 13) or without (n = 9) cricopharyngeal myotomy; and 10 reported endoscopic surgery. Diverticula managed transcervically averaged 3.8 cm in size in comparison to average 2.8 cm in the endoscopic group. Time to diet initiation after transcervical surgery averaged 4 days versus 2 days after endoscopic surgery. Complications were reported in 2/68 cases; both were diverticula recurrence after endoscopic surgery. Conclusion: Killian–Jamieson diverticula is a rare diagnosis that should be considered in the evaluation of dysphagia, globus, and also suspected thyroid nodule. When patient symptoms warrant intervention, a transcervical approach, with or without cricopharyngeal myotomy, is most commonly utilized. In recent years, an endoscopic approach has been presented as an alternative for smaller diverticula. Further understanding of the optimal treatment and postoperative management for KJD requires larger cohorts. Level of Evidence: 4
{"title":"Presentation and Management of Killian Jamieson Diverticulum: A Comprehensive Literature Review","authors":"Narmien Haddad, Pratima Agarwal, Jessica R. Levi, J. Tracy, L. Tracy","doi":"10.1177/0003489419887403","DOIUrl":"https://doi.org/10.1177/0003489419887403","url":null,"abstract":"Objective: To examine the clinical presentation, diagnostic evaluation, and management of Killian–Jamieson diverticula (KJD) through literature review. Methods: A comprehensive literature review was conducted through December 2018 using keywords Killian–Jamieson diverticula/diverticulum. Data extracted included clinical presentation, imaging characteristics, surgical management, and postoperative care. Sources: PubMed and Google Scholar. Results: Sixty-eight cases of KJD in 59 reports (29M:39F; median 58 years old) were identified for review. The most common presentation was dysphagia (n = 39), suspected thyroid nodule (n = 24) and globus (n = 14). The majority of KJD (n = 51) occur on the left, with rare reports of right side (n = 11) and bilateral (n = 5) presentation. Thirty-two cases describe surgical management: 22 utilizing a transcervical approach, with (n = 13) or without (n = 9) cricopharyngeal myotomy; and 10 reported endoscopic surgery. Diverticula managed transcervically averaged 3.8 cm in size in comparison to average 2.8 cm in the endoscopic group. Time to diet initiation after transcervical surgery averaged 4 days versus 2 days after endoscopic surgery. Complications were reported in 2/68 cases; both were diverticula recurrence after endoscopic surgery. Conclusion: Killian–Jamieson diverticula is a rare diagnosis that should be considered in the evaluation of dysphagia, globus, and also suspected thyroid nodule. When patient symptoms warrant intervention, a transcervical approach, with or without cricopharyngeal myotomy, is most commonly utilized. In recent years, an endoscopic approach has been presented as an alternative for smaller diverticula. Further understanding of the optimal treatment and postoperative management for KJD requires larger cohorts. Level of Evidence: 4","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"16 1","pages":"394 - 400"},"PeriodicalIF":0.0,"publicationDate":"2019-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85689369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-08DOI: 10.1177/0003489419887406
Grace S. Yi, A. Hu
Objectives: Vocal fold injection augmentations are increasingly being performed in the office setting on awake patients, as opposed to the operating room. These procedures thus require patient cooperation and education. As the Internet is a widely-used resource for patients, our aim was to assess the quality and readability of online resources on in-office awake vocal fold injections. Methods: An online Google search using the terms “office vocal fold injection medialization” and “awake vocal fold injection” was conducted. The first 50 English-language websites were categorized into professional- and patient-targeted, and major and minor sources. They were analyzed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL) test, and DISCERN quality score. Results: Fifty websites were evaluated, and the overall DISCERN score was 2.60 ± 1.01, the mean FRES was 32.16 ± 19.10, and the mean FKGL was 13.76 ± 4.12. Between the 25 professional-targeted and 25 patient-targeted websites, professional-targeted sites had significantly higher DISCERN (P < .05) and FKGL (P < .05) scores, and lower FRES (P < .05) scores. Between the 30 major and 20 minor websites, major websites had significantly lower FRES (P < .05) and higher FKGL (P < .05) scores, and there was a trend toward significance for higher DISCERN scores (P = .052). Conclusions: Our study shows that half of the top Google results for our topic were not written for patient education, but rather for health care professionals. The reading level of this information exceeds the recommended grade level for patient education materials, and may be less comprehensible than intended. While patient-targeted materials are easier to read than professional-targeted sites, they are of lower quality. The quality of the available online information on this topic is suboptimal for both patients and health care providers. This research highlights the need for more appropriate patient education materials given low health literacy rates.
{"title":"Quality and Readability of Online Information on In-Office Vocal Fold Injections","authors":"Grace S. Yi, A. Hu","doi":"10.1177/0003489419887406","DOIUrl":"https://doi.org/10.1177/0003489419887406","url":null,"abstract":"Objectives: Vocal fold injection augmentations are increasingly being performed in the office setting on awake patients, as opposed to the operating room. These procedures thus require patient cooperation and education. As the Internet is a widely-used resource for patients, our aim was to assess the quality and readability of online resources on in-office awake vocal fold injections. Methods: An online Google search using the terms “office vocal fold injection medialization” and “awake vocal fold injection” was conducted. The first 50 English-language websites were categorized into professional- and patient-targeted, and major and minor sources. They were analyzed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL) test, and DISCERN quality score. Results: Fifty websites were evaluated, and the overall DISCERN score was 2.60 ± 1.01, the mean FRES was 32.16 ± 19.10, and the mean FKGL was 13.76 ± 4.12. Between the 25 professional-targeted and 25 patient-targeted websites, professional-targeted sites had significantly higher DISCERN (P < .05) and FKGL (P < .05) scores, and lower FRES (P < .05) scores. Between the 30 major and 20 minor websites, major websites had significantly lower FRES (P < .05) and higher FKGL (P < .05) scores, and there was a trend toward significance for higher DISCERN scores (P = .052). Conclusions: Our study shows that half of the top Google results for our topic were not written for patient education, but rather for health care professionals. The reading level of this information exceeds the recommended grade level for patient education materials, and may be less comprehensible than intended. While patient-targeted materials are easier to read than professional-targeted sites, they are of lower quality. The quality of the available online information on this topic is suboptimal for both patients and health care providers. This research highlights the need for more appropriate patient education materials given low health literacy rates.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"426 1","pages":"294 - 300"},"PeriodicalIF":0.0,"publicationDate":"2019-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76753205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-08DOI: 10.1177/0003489419887410
E. Wong, Y. Liew, S. Loong, N. Prepageran
Aim: Endoscopic endonasal nasopharyngectomy (EEN) for recurrent nasopharyngeal carcinoma (rNPC) is being increasingly used due to the added high magnification, reduced morbidities associated with open procedures and good survival outcomes. Most studies looked at usage of EEN in patients with lower recurrent staging (rT1 and rT2) although more and more surgeons are studying the outcome of EEN in advanced rNPC (rT3 and rT4). The aims of this study were to report the long-term 5-year survival outcome of EEN performed in patients with advanced rNPC, and to determine any prognostic factors for patients’ survival. Methods: All patients who underwent EEN for advanced rNPC between January 2003 and December 2015 inclusive were analyzed. All surgeries were performed in University Malaya Medical Centre in Kuala Lumpur and Queen Elizabeth Hospital in Sabah. We reported the 5-year overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) and any related complications and significant prognostic factors. Results: Twelve patients with rNPC (2 rT3 and 10 rT4) were followed-up over a mean duration of 44.8 months (range, 40-440 weeks). The 5-year OS was 50.0% (mean 44.75 months), DFS was 25.0% (mean 35.25 months) and the DSS was 58.3% (mean 43.33 months). No severe operative complications were encountered and no independent prognostic factors for survival outcome were identified. Conclusion: This is the first report in English that exclusively described the long-term 5-year survival data in patients with both rT3 and rT4 recurrent NPC after EEN. The data suggest that EEN is a feasible treatment to improve survival with minimal morbidities in patients with rT3 and rT4 recurrent NPC. However, more studies with larger patient size is recommended.
{"title":"Five-year Survival Data on the Role of Endoscopic Endonasal Nasopharyngectomy in Advanced Recurrent rT3 and rT4 Nasopharyngeal Carcinoma","authors":"E. Wong, Y. Liew, S. Loong, N. Prepageran","doi":"10.1177/0003489419887410","DOIUrl":"https://doi.org/10.1177/0003489419887410","url":null,"abstract":"Aim: Endoscopic endonasal nasopharyngectomy (EEN) for recurrent nasopharyngeal carcinoma (rNPC) is being increasingly used due to the added high magnification, reduced morbidities associated with open procedures and good survival outcomes. Most studies looked at usage of EEN in patients with lower recurrent staging (rT1 and rT2) although more and more surgeons are studying the outcome of EEN in advanced rNPC (rT3 and rT4). The aims of this study were to report the long-term 5-year survival outcome of EEN performed in patients with advanced rNPC, and to determine any prognostic factors for patients’ survival. Methods: All patients who underwent EEN for advanced rNPC between January 2003 and December 2015 inclusive were analyzed. All surgeries were performed in University Malaya Medical Centre in Kuala Lumpur and Queen Elizabeth Hospital in Sabah. We reported the 5-year overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) and any related complications and significant prognostic factors. Results: Twelve patients with rNPC (2 rT3 and 10 rT4) were followed-up over a mean duration of 44.8 months (range, 40-440 weeks). The 5-year OS was 50.0% (mean 44.75 months), DFS was 25.0% (mean 35.25 months) and the DSS was 58.3% (mean 43.33 months). No severe operative complications were encountered and no independent prognostic factors for survival outcome were identified. Conclusion: This is the first report in English that exclusively described the long-term 5-year survival data in patients with both rT3 and rT4 recurrent NPC after EEN. The data suggest that EEN is a feasible treatment to improve survival with minimal morbidities in patients with rT3 and rT4 recurrent NPC. However, more studies with larger patient size is recommended.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"28 1","pages":"287 - 293"},"PeriodicalIF":0.0,"publicationDate":"2019-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85017441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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