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Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820927364. doi: 10.1177/0194599820927364. Online ahead of print.
Validation of a Novel, Multidomain Head and Neck Cancer Appearance- And Function-Distress Patient-Reported Outcome Measure
Evan M Graboyes 1 2, Brittany N Hand 3, Mark A Ellis 1, Andrew T Huang 4, Marci L Nilsen 5 6, Patrik Pipkorn 7, Courtney H Marsh 1, Stacey Maurer 8, Terry A Day 1, Katherine R Sterba 2 9
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PMID: 32482151 DOI: 10.1177/0194599820927364
Abstract
Objectives: Distress with self-perceived changes in appearance and function can result in body image disturbance (BID), which is common in head and neck cancer (HNC) survivors and a major source of psychosocial morbidity. To address the lack of psychometrically sound patient-reported outcome measures (PROMs) of HNC-related BID, we aim to create and validate the Inventory to Measure and Assess imaGe disturbancE-Head & Neck (IMAGE-HN).
Study design: Survey study.
Setting: Multiple academic centers.
Subjects and methods: Following item development, HNC survivors from 4 academic centers completed the IMAGE-HN. Item responses were psychometrically analyzed using confirmatory factor analysis (CFA) and Rasch analysis.
Results: Item development resulted in a 31-item PROM consisting of 5 individual domains and a global domain. In total, 305 HNC survivors of diverse ages, HNC subsites, and reconstructive paradigms completed the initial items. After removal of 3 items for local dependence, CFA confirmed the unidimensionality and local independence (item residual correlations <|0.20|) for each domain. Rasch analysis indicated acceptable fit (infit and outfit mean squares <2.0), monotonicity of all rating scale categories, and low person misfit (<4%). Person separation indices and person reliability were adequate for each domain except appearance concealment, which was removed (4 items). This resulted in the IMAGE-HN, a psychometrically acceptable 24-item PROM of HNC-related BID consisting of a global scale and 4 subscales measuring unique constructs and comprised independent items.
Conclusions: IMAGE-HN is a novel, psychometrically sound, multidomain PROM of HNC-related BID for use in clinical and research settings.
Keywords: PROMIS; appearance; body image; disfigurement; head and neck cancer; patient reported outcome measure; pyscho-oncology; survivorship.
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2
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820931789. doi: 10.1177/0194599820931789. Online ahead of print.
Time for a Paradigm Shift in Head and Neck Cancer Management During the COVID-19 Pandemic
Albert Y Han 1, Jessa E Miller 1, Jennifer L Long 1 2 3 4, Maie A St John 1 2 3
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PMID: 32484380 DOI: 10.1177/0194599820931789
Abstract
Objective: The coronavirus disease 2019 (COVID-19) pandemic has caused physicians and surgeons to consider restructuring traditional cancer management paradigms. We aim to review the current evidence regarding the diagnosis and management of head and neck cancer, with an emphasis on the role of the multidisciplinary team (MDT) during a pandemic.
Data sources: COVID-19 resources from PubMed, Google Scholar, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Head and Neck Society were examined.
Review methods: Studies and guidelines related to the multidisciplinary management of head and neck cancer in the COVID-19 setting were reviewed. A total of 54 studies were included. Given the continuously evolving body of literature, the sources cited include the latest statements from medical and dental societies.
Results: The unpredictable fluctuation of hospital resources and the risk of the nosocomial spread of SARS-CoV-2 have direct effects on head and neck cancer management. Using an MDT approach to help define "essential surgery" for immediately life- or function-threatening disease processes in the context of available hospital resources will help to maximize outcomes. Early enrollment in an MDT is often critical for considering nonsurgical options to protect patients and health care workers. The role of the MDT continues after cancer treatment, if delivered, and the MDT plays an essential role in surveillance and survivorship programs in these challenging times.
Conclusion: Head and neck cancer management during the COVID-19 pandemic poses a unique challenge for all specialists involved. Early MDT involvement is important to maximize patient outcomes and satisfaction in the context of public and community safety.
Keywords: COVID-19; cancer management; head and neck cancer; multidisciplinary cancer; survivorship.
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3
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820930214. doi: 10.1177/0194599820930214. Online ahead of print.
Otolaryngology in the Time of Corona: Assessing Operative Impact and Risk During the COVID-19 Crisis
Hannah N Kuhar 1, Ashley Heilingoetter 1, Maxwell Bergman 1, Noah Worobetz 2, Tendy Chiang 1 2, Laura Matrka 1
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PMID: 32482131 DOI: 10.1177/0194599820930214
Abstract
Objective: Limited research exists on the coronavirus disease 2019 (COVID-19) pandemic pertaining to otolaryngology-head and neck surgery (OHNS). The present study seeks to understand the response of OHNS workflows in the context of policy changes and to contribute to developing preparatory guidelines for perioperative management in OHNS.
Study design: Retrospective cohort study.
Setting: Pediatric and general adult academic medical centers and a Comprehensive Cancer Center (CCC).
Subjects and methods: OHNS cases from March 18 to April 8, 2020-the 3 weeks immediately following the Ohio state-mandated suspension of all elective surgery on March 18, 2020-were compared with a 2019 control data set.
Results: During this time, OHNS at the general adult and pediatric medical centers and CCC experienced 87.8%, 77.1%, and 32% decreases in surgical procedures as compared with 2019, respectively. Aerosol-generating procedures accounted for 86.8% of general adult cases, 92.4% of pediatric cases, and 62.0% of CCC cases. Preoperative COVID-19 testing occurred in 7.1% of general adult, 9% of pediatric, and 6.9% of CCC cases. The majority of procedures were tiers 3a and 3b per the Centers for Medicare & Medicaid Services. Aerosol-protective personal protective equipment (PPE) was worn in 28.6% of general adult, 90% of pediatric, and 15.5% of CCC cases.
Conclusion: For OHNS, the majority of essential surgical cases remained high-risk aerosol-generating procedures. Preoperative COVID-19 testing and intraoperative PPE usage were initially inconsistent; systemwide guidelines were developed rapidly but lagged behind recommendations of the OHNS department and its academy. OHNS best practice standards are needed for preoperative COVID-19 status screening and PPE usage as we begin national reopening.
Keywords: COVID-19; SARS-CoV-2; airway management; coronavirus disease; intubation; otolaryngology; preparatory response.
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4
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820923634. doi: 10.1177/0194599820923634. Online ahead of print.
Socioeconomic Disparities in Pediatric Single-Sided Deafness
Noga Lipschitz 1, Gavriel D Kohlberg 1 2, Michael Scott 3, Matthew M Smith 1 4, John H Greinwald Jr 1 4
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PMID: 32482130 DOI: 10.1177/0194599820923634
Abstract
Objective: To explore socioeconomic disparities in pediatric single-sided deafness (SSD) treatment.
Study design: Retrospective chart review.
Setting: Tertiary referral academic center.
Methods: The charts of 190 pediatric patients with SSD were reviewed for demographic and clinical characteristics. Socioeconomic variables included race and insurance status. ZIP codes were used to obtain additional socioeconomic data from the American Community Survey, including mean and median income, percentage of families below the poverty level, and employment status. Socioeconomic status (SES) was classified by insurance status and income. Treatment outcomes were analyzed by socioeconomic variables.
Results: There were 105 males and 85 females with a mean follow-up of 55.2 months and a mean age at diagnosis of 4.4 years. Sixty-three percent of children received treatment at last follow-up. Thirty-five percent of children had public insurance and 65% had private insurance. Treatment rates were similar in the private and public insurance groups (60.6% vs 66.7%, P = .42), but device type was different between groups (P = .02). Consistent device use was associated with private insurance (47.5% vs 38.9%, P = .003) and high SES (94.4% vs 80%, P = .04) on univariate but not on multivariate analysis. Aided audiometry results were similar between SES groups. No association was found between sex, race, income level, poverty level, or employment status and treatment outcomes.
Conclusion: Insurance type and SES were not associated with SSD treatment outcomes in children, although device use may be higher in children with private insurance and higher SES. Further research should focus on strategies to reduce barriers to treatment and improve adherence.
Keywords: hearing loss; insurance; single-sided deafness; socioeconomic.
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5
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820926105. doi: 10.1177/0194599820926105. Online ahead of print.
Consequences of Medical Hierarchy on Medical Students, Residents, and Medical Education in Otolaryngology
Parsa P Salehi 1, Daniel Jacobs 1, Timur Suhail-Sindhu 2, Benjamin L Judson 1, Babak Azizzadeh 3 4, Yan Ho Lee 1
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PMID: 32482121 DOI: 10.1177/0194599820926105
Abstract
Objective: To (1) review concepts of medical hierarchy; (2) examine the role of medical hierarchy in medical education and resident training; (3) discuss potential negative impacts of dysfunctional hierarchy in medical and surgical training programs, focusing on otolaryngology; and (4) investigate solutions to these issues.
Data sources: Ovid Medline, Embase, GoogleScholar, JSTOR, Google, and article reference lists.
Review methods: A literature search was performed to identify articles relating to the objectives of the study using the aforementioned data sources, with subsequent exclusion of articles believed to be outside the scope of the current work. The search was limited to the past 5 years.
Conclusions: Two types of hierarchies exist: "functional" and "dysfunctional." While functional medical hierarchies aim to optimize patient care through clinical instruction, dysfunctional hierarchies have been linked to negative impacts by creating learning environments that discourage the voicing of concerns, legitimize trainee mistreatment, and create moral distress through ethical dilemmas. Such an environment endangers patient safety, undermines physician empathy, hampers learning, lowers training satisfaction, and amplifies stress, fatigue, and burnout. On the other hand, functional hierarchies may improve resident education and well-being, as well as patient safety.
Implications for practice: Otolaryngology-head and neck surgery programs ought to work toward creating healthy systems of hierarchy that emphasize collaboration and improvement of workplace climate for trainees and faculty. The goal should be to identify aspects of dysfunctional hierarchy in one's own environment with the ambition of rebuilding a functional hierarchy where learning, personal health, and patient safety are optimized.
Keywords: ACGME; NRMP; burnout; depression; hierarchy; match; quality of life; residency; resident; stress; well-being; wellness.
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6
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820932128. doi: 10.1177/0194599820932128. Online ahead of print.
Predicting COVID-19 Incidence Using Anosmia and Other COVID-19 Symptomatology: Preliminary Analysis Using Google and Twitter
Bharat A Panuganti 1, Aria Jafari 2 3, Bridget MacDonald 4, Adam S DeConde 1
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PMID: 32484425 DOI: 10.1177/0194599820932128
Abstract
Objective: To determine the relative correlations of Twitter and Google Search user trends concerning smell loss with daily coronavirus disease 2019 (COVID-19) incidence in the United States, compared to other severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms. To describe the effect of mass media communications on Twitter and Google Search user trends.
Study design: Retrospective observational study.
Setting: United States.
Subjects and methods: Google Search and "tweet" frequency concerning COVID-19, smell, and nonsmell symptoms of COVID-19 generated between January 1 and April 8, 2020, were collected using Google Trends and Crimson Hexagon, respectively. Spearman coefficients linking each of these user trends to COVID-19 incidence were compared. Correlations obtained after excluding a short timeframe (March 22 to March 24) corresponding to the publication of a widely read lay media publication reporting anosmia as a symptom of infection was performed for comparative analysis.
Results: Google searches and tweets concerning all nonsmell symptoms (0.744 and 0.761, respectively) and COVID-19 (0.899 and 0.848) are more strongly correlated with disease incidence than smell loss (0.564 and 0.539). Twitter users tweeting about smell loss during the study period were more likely to be female (52%) than users tweeting about COVID-19 more generally (47%). Tweet and Google Search frequency pertaining to smell loss increased significantly (>2.5 standard deviations) following a widely read media publication linking smell loss and SARS-CoV-2 infection.
Conclusions: Google Search and tweet frequency regarding fever and shortness of breath are more robust indicators of COVID-19 incidence than anosmia. Mass media communications represent important confounders that should be considered in future analyses.
Keywords: COVID-19; Google trends; Twitter; epidemiology; infodemiology.
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7
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820933185. doi: 10.1177/0194599820933185. Online ahead of print.
Care of Patients With a Laryngectomy During the COVID-19 Pandemic
David C M Yeung 1, Ronald Lai 1, Eddy W Y Wong 1, Jason Y K Chan 1
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PMID: 32482154 DOI: 10.1177/0194599820933185
Abstract
Patients with a laryngectomy are at increased risk for droplet-transmitted diseases and, therefore, COVID-19, which has now caused a worldwide pandemic. Adaptive measures to protect patients with a laryngectomy and their families were designed and implemented in the Hong Kong SAR (HK). Driven by the fear of severe acute respiratory syndrome in 2003, hospitals in HK have since modified infection control routines to prevent a repeat public health nightmare. To face COVID-19, caused by SARS-CoV-2, we have adapted guidelines for our patients with a laryngectomy. Contact precautions, droplet precautions with physical barriers, and hand and equipment hygiene are our mainstays of prevention against COVID-19, and sharing these routines is the aim of this article. The COVID-19 pandemic is still roaring ahead. Awareness and precautions for patients with a laryngectomy who may be at higher risk are outlined here and should be maintained during the current pandemic.
Keywords: COVID-19; ENT; Hong Kong; head and neck cancer; laryngectomy; laryngectomy stoma; oncology; otolaryngology; otorhinolaryngology.
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8
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820926133. doi: 10.1177/0194599820926133. Online ahead of print.
Immediate Voice and Swallowing Complaints Following Revision Anterior Cervical Spine Surgery
Madeleine P Strohl 1, Winward Choy 2, Aaron J Clark 2, Praveen V Mummaneni 2, Sanjay S Dhall 2, Bobby K Tay 3, Patricia A Loftus 1, Ivan H El-Sayed 1, Matthew S Russell 1
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PMID: 32482158 DOI: 10.1177/0194599820926133
Abstract
Objective: To report on the incidence of dysphagia, dysphonia, and acute vocal fold motion impairment (VFMI) following revision anterior cervical spine surgery, as well as to identify risk factors associated with acute VFMI in the immediate postoperative period.
Study design: Retrospective cohort study.
Setting: Tertiary care center.
Subjects and methods: All patients who underwent 2-team reoperative anterior cervical discectomy and fusion (ACDF) were retrospectively reviewed. Incidence of dysphonia, dysphagia, and acute VFMI was noted. Patient and operative factors were evaluated for association with risk of acute VFMI.
Results: The incidence of postoperative dysphonia and dysphagia was 25% (18/72) and 52% (37/72), respectively. The incidence of immediate VFMI was 21% (15/72). Subjective postoperative dysphonia (odds ratio, [OR] 8; 95% CI, 2.2-28; P = .001) and dysphagia (OR, 22; 95% CI, 2.5-168; P = .005) were significantly associated with increased risk of VFMI. Three patients with VFMI required temporary injection medialization for voice complaints and/or aspiration. Infection (OR, 14; 95% CI, 1.4-147, P = .025) and level C7/T1 (OR, 5.5; 95% CI, 1.3-23, P = .02) were significantly associated with an increased risk of acute VFMI on multivariate logistic regression analysis. Number of prior surgeries, laterality of approach, side of approach relative to prior operations, and number of levels exposed were not significant.
Conclusion: Early involvement of an otolaryngologist in the care of a patient undergoing revision ACDF can be helpful to the patient in anticipation of voice and swallowing changes in the postoperative period. This may be particularly important in those being treated at C7/T1 or those with spinal infections.
Keywords: anterior cervical spine surgery; outcomes; recurrent laryngeal nerve injury; voice and swallowing.
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9
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820926137. doi: 10.1177/0194599820926137. Online ahead of print.
Alternations of Blood Pressure Before and After OSA Surgery
Ming-Hsien Tsai 1, Pei-Wen Lin 2 3, Hsin-Ching Lin 1 3 4, Michael Friedman 5 6, Anna M Salapatas 6, Yu-Hao Lu 1, Mao-Chang Su 3 7, Meng-Chih Lin 3 7
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PMID: 32484727 DOI: 10.1177/0194599820926137
Abstract
Objective: To investigate the changes of blood pressure (BP) on patients with obstructive sleep apnea/hypopnea syndrome (OSA) before and after upper airway surgery.
Design: Case series with chart review.
Setting: Tertiary academic medical center.
Subjects and methods: Patients with OSA who underwent upper airway surgery were enrolled. We retrospectively investigated the nighttime and daytime BP before and at least 3 months after OSA surgery. Paired t test was used to compare the changes of BP before and after surgery. Generalized estimating equation was used to examine the prognostic significance of the variables in predicting the changes of postoperative BP.
Results: In total, 176 patients with OSA (149 men, 27 women; mean age, 42.9 years; mean apnea/hypopnea index, 43.1/h) were enrolled in this study. The overall nighttime and daytime BP decreased significantly before and after OSA surgery (daytime systolic BP was reduced from 137.3 ± 14.0 mm Hg to 132.7 ± 17.0 mm Hg, P < .01; nighttime systolic BP was reduced from 138.7 ± 16.0 mm Hg to 133.7 ± 15.3 mm Hg, P < .01; daytime diastolic BP was reduced from 87.7 ± 14.7 mm Hg to 84.9 ± 10.6 mm Hg, P = .01; nighttime diastolic BP was reduced from 85.4 ± 12.9 mm Hg to 83.1 ± 11.1 mm Hg, P = .02). The changes of nighttime systolic and diastolic BP were significantly associated with the improvement of percentage of O2 saturation <90% during polysomnography.
Conclusion: Surgical modifications of the upper airways for patients with OSA could benefit blood pressure.
Keywords: OSA surgery; blood pressure; obstructive sleep apnea/hypopnea syndrome; snoring.
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10
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820921861. doi: 10.1177/0194599820921861. Online ahead of print.
Association Between Helicobacter pylori Infection and Otitis Media With Effusion Risk in Children: A Systematic Review and Meta-analysis
Xiaohui Wu 1 2, Yun Zheng 2, Xingqiang Gao 1, Gang Li 2, Qiuxue Cao 2
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PMID: 32482139 DOI: 10.1177/0194599820921861
Abstract
Objective: To investigate the potential correlation between Helicobacter pylori infection and otitis media with effusion (OME) risk in children.
Data sources: Electronic databases were searched, including Cochrane Library, PubMed, Embase, China Biology Medicine disc, China Science and Technology Journal Database, Wanfang Database, and China National Knowledge Infrastructure Database.
Review methods: A systematic review and meta-analysis were conducted with Revman 5.3 software. Combined odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate infection-disease association.
Results: In total, 11 studies from 9 articles regarding H pylori infection and OME risk were enrolled in this meta-analysis. A significant association between H pylori infection and OME was detected for both adenoid samples from the case group (OR, 2.75; 95% CI, 1.43-5.30; P = .002) and middle ear fluid samples from the case group (OR, 4.45; 95% CI, 2.52-7.88; P < .00001). Subgroup analyses suggested a stronger correlation in African and Asian populations.
Conclusion: This study indicated the correlation between H pylori infection and increased risk of OME in children, especially in African and Asian populations. Further well-designed studies regarding the white population are strongly recommended in the future.
Keywords: Helicobacter pylori; children; infection; meta-analysis; otitis media with effusion.
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11
Otolaryngol Head Neck Surg
. 2020 Jun;162(6):959-968. doi: 10.1177/0194599820915468.
Postoperative Outcomes of Branchial Cleft Cyst Excision in Children and Adults: An NSQIP Analysis
Annie E Moroco 1, Robert A Saadi 2, Vijay A Patel 2, Erik B Lehman 3, Meghan N Wilson 2
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PMID: 32484763 DOI: 10.1177/0194599820915468
Abstract
Objective: Identify risk factors and perioperative morbidity for patients undergoing branchial cleft cyst (BCC) excision.
Study design: Cross-sectional analysis.
Setting: American College of Surgeons National Surgical Quality Improvement Program adult and pediatric databases (NSQIP and NSQIP-P).
Subject and methods: Patients who underwent BCC excision (Current Procedural Terminology 42810, 42815) were queried via NSQIP (2005-2016) and NSQIP-P (2012-2016). Outcomes analyzed include patient demographics, medical comorbidities, admission type, operative characteristics, length of hospital stay, postoperative complications, and readmission.
Results: A total of 1775 children and 677 adults were identified. Mean age at time of surgery was 4.6 years for children and 38.6 years for adults. Outpatient procedures were performed in 87.1% of adults and 94.0% of children (P < .001). Postoperative complications were uncommon, occurring in <1% of adults and 3.9% of children (P < .001). Similarly, readmission occurred in 1.2% of adults and 1.1% of children. In adults, smoking status was shown to have a significant effect on postoperative complications (odds ratio, 6.25; P = .037). Age group did not have an effect on the complication rate in the pediatric population. Pediatric otolaryngologists had higher rates of postoperative complications (P = .001), prolonged operative times (P < .001), and fewer outpatient procedures (P < .001). Conversely, in adults, otolaryngologists had fewer postoperative complications.
Conclusion: Postoperative complications following BCC excision are relatively uncommon, demonstrating procedural safety when performed at any age.
Keywords: NSQIP; adult; branchial cleft cyst; complications; pediatric.
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12
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820924322. doi: 10.1177/0194599820924322. Online ahead of print.
Eustachian Tube Balloon Dilation: A Systematic Review and Meta-analysis of Treatment Outcomes
Michael H Froehlich 1, Phong T Le 1, Shaun A Nguyen 1, Theodore R McRackan 1, Habib G Rizk 1, Ted A Meyer 1
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PMID: 32482125 DOI: 10.1177/0194599820924322
Abstract
Objective: To examine the effectiveness of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction.
Data sources: PubMed, Scopus, and Google Scholar.
Review methods: A systematic review of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify randomized control trials and prospective and retrospective studies published prior to January 31, 2019. Meta-analysis of proportions evaluated 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ7) scores, tympanometry, otoscopy findings, and the ability to perform a Valsalva maneuver.
Results: The systematic review identified 35 studies. Twelve studies met inclusion for meta-analysis (448 patients). Mean ETDQ7 scores decreased by 2.13 from baseline to 6 weeks (95% CI, -3.02 to -1.24; P < .001). From baseline to 6 weeks, 53.0% of patients had improvement in tympanograms (P < .001). At the long-term point (3-12 months), 50.5% of patients had improved tympanograms from baseline (P < .001). There was no significant difference in the proportion of improved tympanograms at 6 weeks compared to long term (P = .535). Normal otoscopy exams at baseline increased by 30.0% at 6 weeks (P < .001) and 55.4% in the long term (P < .001). There was a 67.8% increase in proportion of patients able to perform a Valsalva maneuver in the long term compared to baseline (P < .001).
Conclusion: Eustachian tube balloon dilation appears to be associated with improvement in subjective and objective treatment outcome metrics. The improvement appears stable at 3 to 12 months after dilation. Patients with eustachian tube dysfunction are likely to benefit from balloon dilation, particularly those with medication-refractory disease.
Keywords: eustachian tube; eustachian tube balloon dilation; eustachian tube dysfunction; meta-analysis; systematic review.
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13
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820927328. doi: 10.1177/0194599820927328. Online ahead of print.
Medical Intervention Alone vs Surgical Drainage for Treatment of Peritonsillar Abscess: A Systematic Review and Meta-analysis
David Forner 1, Dennis E Curry 1, Kristy Hancock 2, Colin MacKay 1, S Mark Taylor 1, Martin Corsten 1, Jonathan R Trites 1, Matthew H Rigby 1
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PMID: 32482146 DOI: 10.1177/0194599820927328
Abstract
Objective: Peritonsillar abscesses (PTAs) are common emergency consultations for otolaryngologists. Medical management alone may offer satisfactory treatment without the risk associated with surgical drainage. Therefore, we performed a systematic review of medical treatment alone compared to surgical drainage for the treatment of PTA.
Data sources: MEDLINE, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov.
Review methods: Studies comparing the outcomes of medically treated to surgically treated patients were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. All screening and data extraction were completed by 2 independent reviewers. Meta-analysis was performed using a random-effects model. Subgroup and sensitivity analyses were performed.
Results: Ten cohort studies and 2 randomized studies were included (ntotal = 33,468). Study quality was low, with only 1 study providing multivariable analysis. The combined rate of treatment failure in patients initially treated with medical management alone was 5.7% compared to 5.5% in the surgical group. There was no statistically significant difference in the odds of treatment failure between interventions through random-effects meta-analysis (odds ratio [OR], 1.10; 95% CI, 0.53-2.26; I 2 = 41%; P = .13). Subgroup analysis excluding pediatric-specific studies revealed similar odds of treatment failure when initially managed with medical intervention (OR, 0.92; 95% CI, 0.56-1.50; P = .39; I 2 = 0%).
Conclusion: Meta-analysis of available studies demonstrated no difference in odds of treatment failure for patients with PTA managed through medical intervention alone compared to surgical intervention. These findings should be interpreted with caution due to high probability of bias and overall low quality of studies.
Keywords: evidence synthesis; general otolaryngology; meta-analysis; peritonsillar abscess; systematic review.
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14
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820932167. doi: 10.1177/0194599820932167. Online ahead of print.
Telemedicine and the Interdisciplinary Clinic Model: During the COVID-19 Pandemic and Beyond
Lisa A Zughni 1, Amanda I Gillespie 2, Jeanne L Hatcher 2, Adam D Rubin 3, John Paul Giliberto 1
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PMID: 32484731 DOI: 10.1177/0194599820932167
Abstract
The emergence of the novel coronavirus disease 2019 (COVID-19) and the subsequent need for physical distancing have necessitated a swift change in health care delivery. Prior to the COVID-19 outbreak, many institutions utilized an interdisciplinary clinic model including both a laryngologist and a speech-language pathologist for the evaluation of patients with voice, swallowing, and upper airway disorders. To improve access, many providers are pursuing the use of interdisciplinary telemedicine to provide individualized patient-centered care while allowing for physical distancing. The purpose of this commentary is to review the current literature regarding telemedicine in laryngology and speech-language pathology as well as the current and future states of practice for interdisciplinary tele-evaluations.
Keywords: COVID-19; interdisciplinary; laryngology; speech-language pathology; telemedicine; telepractice.
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15
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820917619. doi: 10.1177/0194599820917619. Online ahead of print.
Comparison of Frenotomy Techniques for the Treatment of Ankyloglossia in Children: A Systematic Review
Usman Khan 1, Jake MacPherson 2, Michael Bezuhly 1 3, Paul Hong 1 2 3
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PMID: 32482127 DOI: 10.1177/0194599820917619
Abstract
Objective: To compare the effectiveness of conventional (CF), laser (LF), and Z-plasty (ZF) frenotomies for the treatment of ankyloglossia in the pediatric population.
Data sources: A comprehensive search of PUBMED, EMBASE, and COCHRANE databases was performed.
Review methods: Relevant articles were independently assessed by 2 reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
Results: Thirty-five articles assessing CF (27 articles), LF (4 articles), ZF (3 articles), and/or rhomboid plasty frenotomy (1 article) were included. A high level of outcome heterogeneity prevented pooling of data. All 7 randomized controlled trials (RCTs) were of low quality. Both CF (5 articles with 589 patients) and LF (2 articles with 78 patients) were independently shown to reduce maternal nipple pain on a visual analog or numeric rating scale. There were reports of improvement with breastfeeding outcomes as assessed on validated assessment tools for 88% (7/8) of CF articles (588 patients) and 2 LF articles (78 patients). ZF improved breastfeeding outcomes on subjective maternal reports (1 article with 18 infants) only. One RCT with a high risk of bias concluded greater speech articulation improvements with ZF compared to CF. Only minor adverse events were reported for all frenotomy techniques.
Conclusions: Current literature does not demonstrate a clear advantage for one frenotomy technique when managing children with ankyloglossia. Recommendations for future research are provided to overcome the methodological shortcomings in the literature. We conclude that all frenotomy techniques are safe and effective for treating symptomatic ankyloglossia.
Keywords: ankyloglossia; frenotomy; tongue-tie.
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16
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820933168. doi: 10.1177/0194599820933168. Online ahead of print.
Effect of Implementing Simulation Education on Health Care Worker Comfort With Nasopharyngeal Swabbing for COVID-19
Michelle E Mark 1, Phillip LoSavio 1, Inna Husain 1, Peter Papagiannopoulos 1, Pete S Batra 1, Bobby A Tajudeen 1
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PMID: 32482155 DOI: 10.1177/0194599820933168
Abstract
Objective: To determine if rapid implementation of simulation training for the nasopharyngeal swab procedure can increase provider confidence regarding procedure competency.
Methods: A simulation training exercise was designed as a departmental initiative to improve competency performing nasopharyngeal swabs during the COVID-19 pandemic. Sixty-one health care workers attended teaching sessions led by the Department of Otorhinolaryngology on proper nasopharyngeal swab technique. After a brief lecture, participants practiced their swab technique using a high-fidelity airway simulation model. Pre- and postintervention self-evaluations were measured via standardized clinical competency questionnaires on a 5-point Likert scale ranging from "No knowledge, unable to perform" up to "Highly knowledgeable and confident, independent."
Results: Forty-six participants in this study submitted pre- and postintervention self-assessments. Postintervention scores improved on average 1.41 points (95% CI, 1.10-1.73) out of 5 from a mean score of 3.13 to 4.54 (P < .0001). This reflects a large effect size with a Glass's delta value of 1.3.
Discussion: Lecture coupled with simulation-based teaching can significantly improve health care workers' confidence in performing nasopharyngeal swabs. Proper training for frontline workers performing swabs for COVID-19 is essential to improving testing accuracy and can be achieved in a simple and timely manner.
Implications for practice: To meet the testing needs of the growing pandemic, many health care workers who are unfamiliar with nasopharyngeal swabs have been asked to perform this test. Simulation-based teaching sessions may improve health care workers' confidence and help prevent false-negative results. This intervention is easily reproducible in any setting where frequent nasopharyngeal swab testing occurs.
Level of evidence/study design: Prospective cohort study.
Keywords: COVID-19; PS/QI; coronavirus; education; nasopharyngeal; otolaryngology; simulation; swab; testing.
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17
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820932133. doi: 10.1177/0194599820932133. Online ahead of print.
Guidelines for Resident Participation in Otolaryngology Telehealth Clinics During the COVID-19 Pandemic
Michal J Plocienniczak 1 2, J Pieter Noordzij 1 2, Gregory Grillone 1 2, Michael Platt 1 2, Christopher Brook 1 2
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PMID: 32482138 DOI: 10.1177/0194599820932133
Abstract
The practice of otolaryngology has changed drastically since the start of the COVID-19 pandemic. To limit exposure and maintain a reserve of caregivers, residency education ceased most clinical activities and shifted to remote lecture consortiums hosted online across the country in lieu of ambulatory and operative experiences. Many practicing university otolaryngologists have transitioned their clinics to telehealth medicine to maintain access to clinical care during the pandemic. The participation of residents in telemedicine visits has not been described. Here we present guidelines and experience-based suggestions for successful resident involvement in telemedicine. While it is unclear what role telehealth medicine may play within the field of otolaryngology beyond the pandemic, our experiences suggest better patient outreach and access. Expanding residents' skill set with telehealth medicine can enhance their education and better prepare them for future practice.
Keywords: clinic; education; otolaryngology; resident; telehealth.
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18
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820933169. doi: 10.1177/0194599820933169. Online ahead of print.
Rhinologic Practice Special Considerations During COVID-19: Visit Planning, Personal Protective Equipment, Testing, and Environmental Controls
Brittany E Howard 1, Devyani Lal 1
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PMID: 32484728 DOI: 10.1177/0194599820933169
Abstract
As rhinologists return to practice amid SARS-CoV-2, special considerations are warranted given the unique features of their subspecialty. Rhinologist manipulation of nasal tissue, proximity, and frequent aerosol-generating procedures (AGPs) create high risk for infection transmission. There are 4 areas of special consideration to mitigate risk: (1) previsit planning for risk stratification/mitigation, (2) appropriate personal protective equipment, (3) preprocedural testing, and (4) environmental controls. During previsit planning, risk factors of the patient and procedures are considered. High-risk AGPs are identified by duration, proximity, manipulation of high-viral load tissue, and use of powered instrumentation. Appropriate personal protective equipment includes selection of respiratory and eye protection. COVID-19 testing can screen for asymptomatic carriers prior to high-risk procedures; however, alternative testing methods are required in rhinologic patients not eligible for nasopharyngeal testing due to nasal obstruction or skull base defects. Last, AGPs in rhinologic practices require considerations of room air handling and environmental controls.
Keywords: COVID; COVID-19; PPE; SARS-CoV-2; aerosol-generating procedure; air changes per hour; air handling; environmental control; environmental safety; eye protection; high-risk aerosol; oropharyngeal swab; otolaryngology; personal protective equipment; planning; respiratory protection; rhinologic; rhinology; testing; visit planning.
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19
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820933597. doi: 10.1177/0194599820933597. Online ahead of print.
Back to the Future: Principles on Resuming Outpatient Services in the COVID-19 Era
Taher S Valika 1 2, Kathleen R Billings 1 2
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PMID: 32482142 DOI: 10.1177/0194599820933597
Abstract
The rapidly changing health care climate related to coronavirus disease 2019 (COVID-19) has resulted in numerous changes to health care systems and in practices that protect both the public and the workers who serve in hospitals around the country. As a result, these past few months have seen a drastic reduction in outpatient visits. With phased reopening and appropriate guidance, health care systems are attempting to return to normal. The experiences and lessons learned are described, and we provide guiding principles to allow for a safe and effective return to outpatient care.
Keywords: COVID 19; communication; quality improvement; safety checklist.
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20
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820930229. doi: 10.1177/0194599820930229. Online ahead of print.
Implantable Drug Reservoir Devices for Inner Ear Delivery of Pharmacotherapeutics
Ashley Kita 1, Johnny Saldate 1, Courtney Chang 2, Nitika Chellappa 2, Jeremy Jong 2, Riley Matsuda 2, Andrew Schmidt 2, Brandon Shih 2, Iram Shafqat 1, Kari Schoettler 1, Shiv Acharya 2, Stephanie Seidlits 3 2, Larry Hoffman 1 3
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PMID: 32484378 DOI: 10.1177/0194599820930229
Abstract
Objective: Cisplatin is a platinum-based chemotherapeutic drug that secondarily induces toxicity in inner ear sensory epithelia, contributing to auditory and vestibular dysfunction. We describe the creation of a drug reservoir device (DRD) to combat this ototoxicity for the duration of chemotherapy. As ototoxic side effects of chemotherapy may limit an oncologist's ability to prescribe first-line agents such as cisplatin, mitigating such devastating effects through prolonged topical therapy would be tremendously valuable.
Study design: We investigated (1) the ability of an electrospun polylactic acid DRD to provide prolonged delivery of the posited otoprotectant metformin and (2) the development of an in vitro model utilizing Sh-Sy5y human neuroblastoma cells to assess the efficacy of metformin in reducing cisplatin-induced toxicity.
Setting: Neurophysiology laboratory.
Methods: Basic science experiments were performed to assess DRD properties and metformin's effects on cisplatin toxicity in culture.
Results: We found that DRDs with increasing polylactic acid concentrations exhibited metformin release for up to 8 weeks. In modeling elution across the round window in vitro, continued elution of metformin was observed for at least 6 weeks, as quantified by spectrophotometry. Unfortunately, metformin did not exhibit protective efficacy in this model using Sh-Sy5y cells.
Conclusion: While metformin was not found to be protective in Sh-Sy5y cells, these results suggest that an electrospun DRD can provide a tailorable drug delivery system providing medication for the duration of chemotherapy treatment. This represents a novel drug delivery system and efficacy screening assay with broad clinical applications in personalized delivery of inner ear therapies.
Keywords: cisplatin; drug delivery; electrospinning; inner ear; metformin; ototoxicity; round window.
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21
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820933253. doi: 10.1177/0194599820933253. Online ahead of print.
A Guiding Principles Checklist for Otolaryngologic Surgery in the COVID-19 Era
Taher S Valika 1 2, Sarah E Maurrasse 1 2, Dana M Thompson 1 2
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PMID: 32482124 DOI: 10.1177/0194599820933253
Abstract
The COVID-19 pandemic has had a dramatic impact on surgical workflows. There is an abundance of ever-changing information, and protocols are reflexively modified on a daily basis. As many otolaryngologic procedures are shown to have higher risk of viral transmission-so-called aerosol-generating procedures-it is imperative that multidisciplinary care teams be provided updated, timely, and consistent information. A single-page Guiding Principles surgical checklist was developed to discuss 7 key factors: patient information, staff wellness, risk minimization, prioritization, resource utilization, key society criteria, and communication. This was completed for every patient requiring otolaryngologic surgery and was distributed to the care teams involved. It provided the most information for those on the frontline and allowed for cogent pre-, intra-, and postoperative planning.
Keywords: COVID-19; communication; otolaryngology; quality improvement; safety checklist.
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22
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820932162. doi: 10.1177/0194599820932162. Online ahead of print.
SARS-CoV-2 Infection in Health Care Workers: Cross-sectional Analysis of an Otolaryngology Unit
Alberto Paderno 1, Milena Fior 1, Giulia Berretti 1, Alberto Schreiber 1, Alberto Grammatica 1, Davide Mattavelli 1, Alberto Deganello 1
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PMID: 32482123 DOI: 10.1177/0194599820932162
Abstract
The restart of routine in- and outpatient activity in the COVID-19 postepidemic peak needs to be carefully planned in light of specific patterns of viral diffusion. We evaluated SARS-CoV-2 serology in the entire personnel of a COVID-19-free otolaryngology department in a highly affected area. The aim was to determine the prevalence of SARS-CoV-2 positivity among staff to clarify the impact of different risk factors for infection. The entire staff of the otolaryngology unit was tested for SARS-CoV-2 serology. Symptomatic staff members were tested with nasal/pharyngeal swabs. All answered a survey focused on the number of in- and extrahospital positive contacts and type of activities in the unit. Five (9%) were positive for SARS-CoV-2 infection. The only variable associated with a higher risk of infection was the number of extrahospital contacts without personal protective equipment (P = .008). Our study shows that in non-COVID-19 departments, the use of adequate personal protective equipment leads to low rates of infection among health care workers. The prevalent risk of infection was related to extrahospital contact.
Keywords: COVID-19; SARS-CoV-2; coronavirus; hospital; infection; otolaryngology.
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Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820927364. doi: 10.1177/0194599820927364. Online ahead of print.
Validation of a Novel, Multidomain Head and Neck Cancer Appearance- And Function-Distress Patient-Reported Outcome Measure
Evan M Graboyes 1 2, Brittany N Hand 3, Mark A Ellis 1, Andrew T Huang 4, Marci L Nilsen 5 6, Patrik Pipkorn 7, Courtney H Marsh 1, Stacey Maurer 8, Terry A Day 1, Katherine R Sterba 2 9
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PMID: 32482151 DOI: 10.1177/0194599820927364
Abstract
Objectives: Distress with self-perceived changes in appearance and function can result in body image disturbance (BID), which is common in head and neck cancer (HNC) survivors and a major source of psychosocial morbidity. To address the lack of psychometrically sound patient-reported outcome measures (PROMs) of HNC-related BID, we aim to create and validate the Inventory to Measure and Assess imaGe disturbancE-Head & Neck (IMAGE-HN).
Study design: Survey study.
Setting: Multiple academic centers.
Subjects and methods: Following item development, HNC survivors from 4 academic centers completed the IMAGE-HN. Item responses were psychometrically analyzed using confirmatory factor analysis (CFA) and Rasch analysis.
Results: Item development resulted in a 31-item PROM consisting of 5 individual domains and a global domain. In total, 305 HNC survivors of diverse ages, HNC subsites, and reconstructive paradigms completed the initial items. After removal of 3 items for local dependence, CFA confirmed the unidimensionality and local independence (item residual correlations <|0.20|) for each domain. Rasch analysis indicated acceptable fit (infit and outfit mean squares <2.0), monotonicity of all rating scale categories, and low person misfit (<4%). Person separation indices and person reliability were adequate for each domain except appearance concealment, which was removed (4 items). This resulted in the IMAGE-HN, a psychometrically acceptable 24-item PROM of HNC-related BID consisting of a global scale and 4 subscales measuring unique constructs and comprised independent items.
Conclusions: IMAGE-HN is a novel, psychometrically sound, multidomain PROM of HNC-related BID for use in clinical and research settings.
Keywords: PROMIS; appearance; body image; disfigurement; head and neck cancer; patient reported outcome measure; pyscho-oncology; survivorship.
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2
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820931789. doi: 10.1177/0194599820931789. Online ahead of print.
Time for a Paradigm Shift in Head and Neck Cancer Management During the COVID-19 Pandemic
Albert Y Han 1, Jessa E Miller 1, Jennifer L Long 1 2 3 4, Maie A St John 1 2 3
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PMID: 32484380 DOI: 10.1177/0194599820931789
Abstract
Objective: The coronavirus disease 2019 (COVID-19) pandemic has caused physicians and surgeons to consider restructuring traditional cancer management paradigms. We aim to review the current evidence regarding the diagnosis and management of head and neck cancer, with an emphasis on the role of the multidisciplinary team (MDT) during a pandemic.
Data sources: COVID-19 resources from PubMed, Google Scholar, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Head and Neck Society were examined.
Review methods: Studies and guidelines related to the multidisciplinary management of head and neck cancer in the COVID-19 setting were reviewed. A total of 54 studies were included. Given the continuously evolving body of literature, the sources cited include the latest statements from medical and dental societies.
Results: The unpredictable fluctuation of hospital resources and the risk of the nosocomial spread of SARS-CoV-2 have direct effects on head and neck cancer management. Using an MDT approach to help define "essential surgery" for immediately life- or function-threatening disease processes in the context of available hospital resources will help to maximize outcomes. Early enrollment in an MDT is often critical for considering nonsurgical options to protect patients and health care workers. The role of the MDT continues after cancer treatment, if delivered, and the MDT plays an essential role in surveillance and survivorship programs in these challenging times.
Conclusion: Head and neck cancer management during the COVID-19 pandemic poses a unique challenge for all specialists involved. Early MDT involvement is important to maximize patient outcomes and satisfaction in the context of public and community safety.
Keywords: COVID-19; cancer management; head and neck cancer; multidisciplinary cancer; survivorship.
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3
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820930214. doi: 10.1177/0194599820930214. Online ahead of print.
Otolaryngology in the Time of Corona: Assessing Operative Impact and Risk During the COVID-19 Crisis
Hannah N Kuhar 1, Ashley Heilingoetter 1, Maxwell Bergman 1, Noah Worobetz 2, Tendy Chiang 1 2, Laura Matrka 1
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PMID: 32482131 DOI: 10.1177/0194599820930214
Abstract
Objective: Limited research exists on the coronavirus disease 2019 (COVID-19) pandemic pertaining to otolaryngology-head and neck surgery (OHNS). The present study seeks to understand the response of OHNS workflows in the context of policy changes and to contribute to developing preparatory guidelines for perioperative management in OHNS.
Study design: Retrospective cohort study.
Setting: Pediatric and general adult academic medical centers and a Comprehensive Cancer Center (CCC).
Subjects and methods: OHNS cases from March 18 to April 8, 2020-the 3 weeks immediately following the Ohio state-mandated suspension of all elective surgery on March 18, 2020-were compared with a 2019 control data set.
Results: During this time, OHNS at the general adult and pediatric medical centers and CCC experienced 87.8%, 77.1%, and 32% decreases in surgical procedures as compared with 2019, respectively. Aerosol-generating procedures accounted for 86.8% of general adult cases, 92.4% of pediatric cases, and 62.0% of CCC cases. Preoperative COVID-19 testing occurred in 7.1% of general adult, 9% of pediatric, and 6.9% of CCC cases. The majority of procedures were tiers 3a and 3b per the Centers for Medicare & Medicaid Services. Aerosol-protective personal protective equipment (PPE) was worn in 28.6% of general adult, 90% of pediatric, and 15.5% of CCC cases.
Conclusion: For OHNS, the majority of essential surgical cases remained high-risk aerosol-generating procedures. Preoperative COVID-19 testing and intraoperative PPE usage were initially inconsistent; systemwide guidelines were developed rapidly but lagged behind recommendations of the OHNS department and its academy. OHNS best practice standards are needed for preoperative COVID-19 status screening and PPE usage as we begin national reopening.
Keywords: COVID-19; SARS-CoV-2; airway management; coronavirus disease; intubation; otolaryngology; preparatory response.
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4
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820923634. doi: 10.1177/0194599820923634. Online ahead of print.
Socioeconomic Disparities in Pediatric Single-Sided Deafness
Noga Lipschitz 1, Gavriel D Kohlberg 1 2, Michael Scott 3, Matthew M Smith 1 4, John H Greinwald Jr 1 4
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PMID: 32482130 DOI: 10.1177/0194599820923634
Abstract
Objective: To explore socioeconomic disparities in pediatric single-sided deafness (SSD) treatment.
Study design: Retrospective chart review.
Setting: Tertiary referral academic center.
Methods: The charts of 190 pediatric patients with SSD were reviewed for demographic and clinical characteristics. Socioeconomic variables included race and insurance status. ZIP codes were used to obtain additional socioeconomic data from the American Community Survey, including mean and median income, percentage of families below the poverty level, and employment status. Socioeconomic status (SES) was classified by insurance status and income. Treatment outcomes were analyzed by socioeconomic variables.
Results: There were 105 males and 85 females with a mean follow-up of 55.2 months and a mean age at diagnosis of 4.4 years. Sixty-three percent of children received treatment at last follow-up. Thirty-five percent of children had public insurance and 65% had private insurance. Treatment rates were similar in the private and public insurance groups (60.6% vs 66.7%, P = .42), but device type was different between groups (P = .02). Consistent device use was associated with private insurance (47.5% vs 38.9%, P = .003) and high SES (94.4% vs 80%, P = .04) on univariate but not on multivariate analysis. Aided audiometry results were similar between SES groups. No association was found between sex, race, income level, poverty level, or employment status and treatment outcomes.
Conclusion: Insurance type and SES were not associated with SSD treatment outcomes in children, although device use may be higher in children with private insurance and higher SES. Further research should focus on strategies to reduce barriers to treatment and improve adherence.
Keywords: hearing loss; insurance; single-sided deafness; socioeconomic.
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5
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820926105. doi: 10.1177/0194599820926105. Online ahead of print.
Consequences of Medical Hierarchy on Medical Students, Residents, and Medical Education in Otolaryngology
Parsa P Salehi 1, Daniel Jacobs 1, Timur Suhail-Sindhu 2, Benjamin L Judson 1, Babak Azizzadeh 3 4, Yan Ho Lee 1
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PMID: 32482121 DOI: 10.1177/0194599820926105
Abstract
Objective: To (1) review concepts of medical hierarchy; (2) examine the role of medical hierarchy in medical education and resident training; (3) discuss potential negative impacts of dysfunctional hierarchy in medical and surgical training programs, focusing on otolaryngology; and (4) investigate solutions to these issues.
Data sources: Ovid Medline, Embase, GoogleScholar, JSTOR, Google, and article reference lists.
Review methods: A literature search was performed to identify articles relating to the objectives of the study using the aforementioned data sources, with subsequent exclusion of articles believed to be outside the scope of the current work. The search was limited to the past 5 years.
Conclusions: Two types of hierarchies exist: "functional" and "dysfunctional." While functional medical hierarchies aim to optimize patient care through clinical instruction, dysfunctional hierarchies have been linked to negative impacts by creating learning environments that discourage the voicing of concerns, legitimize trainee mistreatment, and create moral distress through ethical dilemmas. Such an environment endangers patient safety, undermines physician empathy, hampers learning, lowers training satisfaction, and amplifies stress, fatigue, and burnout. On the other hand, functional hierarchies may improve resident education and well-being, as well as patient safety.
Implications for practice: Otolaryngology-head and neck surgery programs ought to work toward creating healthy systems of hierarchy that emphasize collaboration and improvement of workplace climate for trainees and faculty. The goal should be to identify aspects of dysfunctional hierarchy in one's own environment with the ambition of rebuilding a functional hierarchy where learning, personal health, and patient safety are optimized.
Keywords: ACGME; NRMP; burnout; depression; hierarchy; match; quality of life; residency; resident; stress; well-being; wellness.
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6
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820932128. doi: 10.1177/0194599820932128. Online ahead of print.
Predicting COVID-19 Incidence Using Anosmia and Other COVID-19 Symptomatology: Preliminary Analysis Using Google and Twitter
Bharat A Panuganti 1, Aria Jafari 2 3, Bridget MacDonald 4, Adam S DeConde 1
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PMID: 32484425 DOI: 10.1177/0194599820932128
Abstract
Objective: To determine the relative correlations of Twitter and Google Search user trends concerning smell loss with daily coronavirus disease 2019 (COVID-19) incidence in the United States, compared to other severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms. To describe the effect of mass media communications on Twitter and Google Search user trends.
Study design: Retrospective observational study.
Setting: United States.
Subjects and methods: Google Search and "tweet" frequency concerning COVID-19, smell, and nonsmell symptoms of COVID-19 generated between January 1 and April 8, 2020, were collected using Google Trends and Crimson Hexagon, respectively. Spearman coefficients linking each of these user trends to COVID-19 incidence were compared. Correlations obtained after excluding a short timeframe (March 22 to March 24) corresponding to the publication of a widely read lay media publication reporting anosmia as a symptom of infection was performed for comparative analysis.
Results: Google searches and tweets concerning all nonsmell symptoms (0.744 and 0.761, respectively) and COVID-19 (0.899 and 0.848) are more strongly correlated with disease incidence than smell loss (0.564 and 0.539). Twitter users tweeting about smell loss during the study period were more likely to be female (52%) than users tweeting about COVID-19 more generally (47%). Tweet and Google Search frequency pertaining to smell loss increased significantly (>2.5 standard deviations) following a widely read media publication linking smell loss and SARS-CoV-2 infection.
Conclusions: Google Search and tweet frequency regarding fever and shortness of breath are more robust indicators of COVID-19 incidence than anosmia. Mass media communications represent important confounders that should be considered in future analyses.
Keywords: COVID-19; Google trends; Twitter; epidemiology; infodemiology.
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7
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820933185. doi: 10.1177/0194599820933185. Online ahead of print.
Care of Patients With a Laryngectomy During the COVID-19 Pandemic
David C M Yeung 1, Ronald Lai 1, Eddy W Y Wong 1, Jason Y K Chan 1
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PMID: 32482154 DOI: 10.1177/0194599820933185
Abstract
Patients with a laryngectomy are at increased risk for droplet-transmitted diseases and, therefore, COVID-19, which has now caused a worldwide pandemic. Adaptive measures to protect patients with a laryngectomy and their families were designed and implemented in the Hong Kong SAR (HK). Driven by the fear of severe acute respiratory syndrome in 2003, hospitals in HK have since modified infection control routines to prevent a repeat public health nightmare. To face COVID-19, caused by SARS-CoV-2, we have adapted guidelines for our patients with a laryngectomy. Contact precautions, droplet precautions with physical barriers, and hand and equipment hygiene are our mainstays of prevention against COVID-19, and sharing these routines is the aim of this article. The COVID-19 pandemic is still roaring ahead. Awareness and precautions for patients with a laryngectomy who may be at higher risk are outlined here and should be maintained during the current pandemic.
Keywords: COVID-19; ENT; Hong Kong; head and neck cancer; laryngectomy; laryngectomy stoma; oncology; otolaryngology; otorhinolaryngology.
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8
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820926133. doi: 10.1177/0194599820926133. Online ahead of print.
Immediate Voice and Swallowing Complaints Following Revision Anterior Cervical Spine Surgery
Madeleine P Strohl 1, Winward Choy 2, Aaron J Clark 2, Praveen V Mummaneni 2, Sanjay S Dhall 2, Bobby K Tay 3, Patricia A Loftus 1, Ivan H El-Sayed 1, Matthew S Russell 1
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PMID: 32482158 DOI: 10.1177/0194599820926133
Abstract
Objective: To report on the incidence of dysphagia, dysphonia, and acute vocal fold motion impairment (VFMI) following revision anterior cervical spine surgery, as well as to identify risk factors associated with acute VFMI in the immediate postoperative period.
Study design: Retrospective cohort study.
Setting: Tertiary care center.
Subjects and methods: All patients who underwent 2-team reoperative anterior cervical discectomy and fusion (ACDF) were retrospectively reviewed. Incidence of dysphonia, dysphagia, and acute VFMI was noted. Patient and operative factors were evaluated for association with risk of acute VFMI.
Results: The incidence of postoperative dysphonia and dysphagia was 25% (18/72) and 52% (37/72), respectively. The incidence of immediate VFMI was 21% (15/72). Subjective postoperative dysphonia (odds ratio, [OR] 8; 95% CI, 2.2-28; P = .001) and dysphagia (OR, 22; 95% CI, 2.5-168; P = .005) were significantly associated with increased risk of VFMI. Three patients with VFMI required temporary injection medialization for voice complaints and/or aspiration. Infection (OR, 14; 95% CI, 1.4-147, P = .025) and level C7/T1 (OR, 5.5; 95% CI, 1.3-23, P = .02) were significantly associated with an increased risk of acute VFMI on multivariate logistic regression analysis. Number of prior surgeries, laterality of approach, side of approach relative to prior operations, and number of levels exposed were not significant.
Conclusion: Early involvement of an otolaryngologist in the care of a patient undergoing revision ACDF can be helpful to the patient in anticipation of voice and swallowing changes in the postoperative period. This may be particularly important in those being treated at C7/T1 or those with spinal infections.
Keywords: anterior cervical spine surgery; outcomes; recurrent laryngeal nerve injury; voice and swallowing.
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9
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820926137. doi: 10.1177/0194599820926137. Online ahead of print.
Alternations of Blood Pressure Before and After OSA Surgery
Ming-Hsien Tsai 1, Pei-Wen Lin 2 3, Hsin-Ching Lin 1 3 4, Michael Friedman 5 6, Anna M Salapatas 6, Yu-Hao Lu 1, Mao-Chang Su 3 7, Meng-Chih Lin 3 7
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PMID: 32484727 DOI: 10.1177/0194599820926137
Abstract
Objective: To investigate the changes of blood pressure (BP) on patients with obstructive sleep apnea/hypopnea syndrome (OSA) before and after upper airway surgery.
Design: Case series with chart review.
Setting: Tertiary academic medical center.
Subjects and methods: Patients with OSA who underwent upper airway surgery were enrolled. We retrospectively investigated the nighttime and daytime BP before and at least 3 months after OSA surgery. Paired t test was used to compare the changes of BP before and after surgery. Generalized estimating equation was used to examine the prognostic significance of the variables in predicting the changes of postoperative BP.
Results: In total, 176 patients with OSA (149 men, 27 women; mean age, 42.9 years; mean apnea/hypopnea index, 43.1/h) were enrolled in this study. The overall nighttime and daytime BP decreased significantly before and after OSA surgery (daytime systolic BP was reduced from 137.3 ± 14.0 mm Hg to 132.7 ± 17.0 mm Hg, P < .01; nighttime systolic BP was reduced from 138.7 ± 16.0 mm Hg to 133.7 ± 15.3 mm Hg, P < .01; daytime diastolic BP was reduced from 87.7 ± 14.7 mm Hg to 84.9 ± 10.6 mm Hg, P = .01; nighttime diastolic BP was reduced from 85.4 ± 12.9 mm Hg to 83.1 ± 11.1 mm Hg, P = .02). The changes of nighttime systolic and diastolic BP were significantly associated with the improvement of percentage of O2 saturation <90% during polysomnography.
Conclusion: Surgical modifications of the upper airways for patients with OSA could benefit blood pressure.
Keywords: OSA surgery; blood pressure; obstructive sleep apnea/hypopnea syndrome; snoring.
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10
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820921861. doi: 10.1177/0194599820921861. Online ahead of print.
Association Between Helicobacter pylori Infection and Otitis Media With Effusion Risk in Children: A Systematic Review and Meta-analysis
Xiaohui Wu 1 2, Yun Zheng 2, Xingqiang Gao 1, Gang Li 2, Qiuxue Cao 2
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PMID: 32482139 DOI: 10.1177/0194599820921861
Abstract
Objective: To investigate the potential correlation between Helicobacter pylori infection and otitis media with effusion (OME) risk in children.
Data sources: Electronic databases were searched, including Cochrane Library, PubMed, Embase, China Biology Medicine disc, China Science and Technology Journal Database, Wanfang Database, and China National Knowledge Infrastructure Database.
Review methods: A systematic review and meta-analysis were conducted with Revman 5.3 software. Combined odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate infection-disease association.
Results: In total, 11 studies from 9 articles regarding H pylori infection and OME risk were enrolled in this meta-analysis. A significant association between H pylori infection and OME was detected for both adenoid samples from the case group (OR, 2.75; 95% CI, 1.43-5.30; P = .002) and middle ear fluid samples from the case group (OR, 4.45; 95% CI, 2.52-7.88; P < .00001). Subgroup analyses suggested a stronger correlation in African and Asian populations.
Conclusion: This study indicated the correlation between H pylori infection and increased risk of OME in children, especially in African and Asian populations. Further well-designed studies regarding the white population are strongly recommended in the future.
Keywords: Helicobacter pylori; children; infection; meta-analysis; otitis media with effusion.
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11
Otolaryngol Head Neck Surg
. 2020 Jun;162(6):959-968. doi: 10.1177/0194599820915468.
Postoperative Outcomes of Branchial Cleft Cyst Excision in Children and Adults: An NSQIP Analysis
Annie E Moroco 1, Robert A Saadi 2, Vijay A Patel 2, Erik B Lehman 3, Meghan N Wilson 2
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PMID: 32484763 DOI: 10.1177/0194599820915468
Abstract
Objective: Identify risk factors and perioperative morbidity for patients undergoing branchial cleft cyst (BCC) excision.
Study design: Cross-sectional analysis.
Setting: American College of Surgeons National Surgical Quality Improvement Program adult and pediatric databases (NSQIP and NSQIP-P).
Subject and methods: Patients who underwent BCC excision (Current Procedural Terminology 42810, 42815) were queried via NSQIP (2005-2016) and NSQIP-P (2012-2016). Outcomes analyzed include patient demographics, medical comorbidities, admission type, operative characteristics, length of hospital stay, postoperative complications, and readmission.
Results: A total of 1775 children and 677 adults were identified. Mean age at time of surgery was 4.6 years for children and 38.6 years for adults. Outpatient procedures were performed in 87.1% of adults and 94.0% of children (P < .001). Postoperative complications were uncommon, occurring in <1% of adults and 3.9% of children (P < .001). Similarly, readmission occurred in 1.2% of adults and 1.1% of children. In adults, smoking status was shown to have a significant effect on postoperative complications (odds ratio, 6.25; P = .037). Age group did not have an effect on the complication rate in the pediatric population. Pediatric otolaryngologists had higher rates of postoperative complications (P = .001), prolonged operative times (P < .001), and fewer outpatient procedures (P < .001). Conversely, in adults, otolaryngologists had fewer postoperative complications.
Conclusion: Postoperative complications following BCC excision are relatively uncommon, demonstrating procedural safety when performed at any age.
Keywords: NSQIP; adult; branchial cleft cyst; complications; pediatric.
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12
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820924322. doi: 10.1177/0194599820924322. Online ahead of print.
Eustachian Tube Balloon Dilation: A Systematic Review and Meta-analysis of Treatment Outcomes
Michael H Froehlich 1, Phong T Le 1, Shaun A Nguyen 1, Theodore R McRackan 1, Habib G Rizk 1, Ted A Meyer 1
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PMID: 32482125 DOI: 10.1177/0194599820924322
Abstract
Objective: To examine the effectiveness of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction.
Data sources: PubMed, Scopus, and Google Scholar.
Review methods: A systematic review of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify randomized control trials and prospective and retrospective studies published prior to January 31, 2019. Meta-analysis of proportions evaluated 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ7) scores, tympanometry, otoscopy findings, and the ability to perform a Valsalva maneuver.
Results: The systematic review identified 35 studies. Twelve studies met inclusion for meta-analysis (448 patients). Mean ETDQ7 scores decreased by 2.13 from baseline to 6 weeks (95% CI, -3.02 to -1.24; P < .001). From baseline to 6 weeks, 53.0% of patients had improvement in tympanograms (P < .001). At the long-term point (3-12 months), 50.5% of patients had improved tympanograms from baseline (P < .001). There was no significant difference in the proportion of improved tympanograms at 6 weeks compared to long term (P = .535). Normal otoscopy exams at baseline increased by 30.0% at 6 weeks (P < .001) and 55.4% in the long term (P < .001). There was a 67.8% increase in proportion of patients able to perform a Valsalva maneuver in the long term compared to baseline (P < .001).
Conclusion: Eustachian tube balloon dilation appears to be associated with improvement in subjective and objective treatment outcome metrics. The improvement appears stable at 3 to 12 months after dilation. Patients with eustachian tube dysfunction are likely to benefit from balloon dilation, particularly those with medication-refractory disease.
Keywords: eustachian tube; eustachian tube balloon dilation; eustachian tube dysfunction; meta-analysis; systematic review.
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13
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820927328. doi: 10.1177/0194599820927328. Online ahead of print.
Medical Intervention Alone vs Surgical Drainage for Treatment of Peritonsillar Abscess: A Systematic Review and Meta-analysis
David Forner 1, Dennis E Curry 1, Kristy Hancock 2, Colin MacKay 1, S Mark Taylor 1, Martin Corsten 1, Jonathan R Trites 1, Matthew H Rigby 1
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PMID: 32482146 DOI: 10.1177/0194599820927328
Abstract
Objective: Peritonsillar abscesses (PTAs) are common emergency consultations for otolaryngologists. Medical management alone may offer satisfactory treatment without the risk associated with surgical drainage. Therefore, we performed a systematic review of medical treatment alone compared to surgical drainage for the treatment of PTA.
Data sources: MEDLINE, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov.
Review methods: Studies comparing the outcomes of medically treated to surgically treated patients were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. All screening and data extraction were completed by 2 independent reviewers. Meta-analysis was performed using a random-effects model. Subgroup and sensitivity analyses were performed.
Results: Ten cohort studies and 2 randomized studies were included (ntotal = 33,468). Study quality was low, with only 1 study providing multivariable analysis. The combined rate of treatment failure in patients initially treated with medical management alone was 5.7% compared to 5.5% in the surgical group. There was no statistically significant difference in the odds of treatment failure between interventions through random-effects meta-analysis (odds ratio [OR], 1.10; 95% CI, 0.53-2.26; I 2 = 41%; P = .13). Subgroup analysis excluding pediatric-specific studies revealed similar odds of treatment failure when initially managed with medical intervention (OR, 0.92; 95% CI, 0.56-1.50; P = .39; I 2 = 0%).
Conclusion: Meta-analysis of available studies demonstrated no difference in odds of treatment failure for patients with PTA managed through medical intervention alone compared to surgical intervention. These findings should be interpreted with caution due to high probability of bias and overall low quality of studies.
Keywords: evidence synthesis; general otolaryngology; meta-analysis; peritonsillar abscess; systematic review.
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14
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820932167. doi: 10.1177/0194599820932167. Online ahead of print.
Telemedicine and the Interdisciplinary Clinic Model: During the COVID-19 Pandemic and Beyond
Lisa A Zughni 1, Amanda I Gillespie 2, Jeanne L Hatcher 2, Adam D Rubin 3, John Paul Giliberto 1
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PMID: 32484731 DOI: 10.1177/0194599820932167
Abstract
The emergence of the novel coronavirus disease 2019 (COVID-19) and the subsequent need for physical distancing have necessitated a swift change in health care delivery. Prior to the COVID-19 outbreak, many institutions utilized an interdisciplinary clinic model including both a laryngologist and a speech-language pathologist for the evaluation of patients with voice, swallowing, and upper airway disorders. To improve access, many providers are pursuing the use of interdisciplinary telemedicine to provide individualized patient-centered care while allowing for physical distancing. The purpose of this commentary is to review the current literature regarding telemedicine in laryngology and speech-language pathology as well as the current and future states of practice for interdisciplinary tele-evaluations.
Keywords: COVID-19; interdisciplinary; laryngology; speech-language pathology; telemedicine; telepractice.
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15
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820917619. doi: 10.1177/0194599820917619. Online ahead of print.
Comparison of Frenotomy Techniques for the Treatment of Ankyloglossia in Children: A Systematic Review
Usman Khan 1, Jake MacPherson 2, Michael Bezuhly 1 3, Paul Hong 1 2 3
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PMID: 32482127 DOI: 10.1177/0194599820917619
Abstract
Objective: To compare the effectiveness of conventional (CF), laser (LF), and Z-plasty (ZF) frenotomies for the treatment of ankyloglossia in the pediatric population.
Data sources: A comprehensive search of PUBMED, EMBASE, and COCHRANE databases was performed.
Review methods: Relevant articles were independently assessed by 2 reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
Results: Thirty-five articles assessing CF (27 articles), LF (4 articles), ZF (3 articles), and/or rhomboid plasty frenotomy (1 article) were included. A high level of outcome heterogeneity prevented pooling of data. All 7 randomized controlled trials (RCTs) were of low quality. Both CF (5 articles with 589 patients) and LF (2 articles with 78 patients) were independently shown to reduce maternal nipple pain on a visual analog or numeric rating scale. There were reports of improvement with breastfeeding outcomes as assessed on validated assessment tools for 88% (7/8) of CF articles (588 patients) and 2 LF articles (78 patients). ZF improved breastfeeding outcomes on subjective maternal reports (1 article with 18 infants) only. One RCT with a high risk of bias concluded greater speech articulation improvements with ZF compared to CF. Only minor adverse events were reported for all frenotomy techniques.
Conclusions: Current literature does not demonstrate a clear advantage for one frenotomy technique when managing children with ankyloglossia. Recommendations for future research are provided to overcome the methodological shortcomings in the literature. We conclude that all frenotomy techniques are safe and effective for treating symptomatic ankyloglossia.
Keywords: ankyloglossia; frenotomy; tongue-tie.
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16
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820933168. doi: 10.1177/0194599820933168. Online ahead of print.
Effect of Implementing Simulation Education on Health Care Worker Comfort With Nasopharyngeal Swabbing for COVID-19
Michelle E Mark 1, Phillip LoSavio 1, Inna Husain 1, Peter Papagiannopoulos 1, Pete S Batra 1, Bobby A Tajudeen 1
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PMID: 32482155 DOI: 10.1177/0194599820933168
Abstract
Objective: To determine if rapid implementation of simulation training for the nasopharyngeal swab procedure can increase provider confidence regarding procedure competency.
Methods: A simulation training exercise was designed as a departmental initiative to improve competency performing nasopharyngeal swabs during the COVID-19 pandemic. Sixty-one health care workers attended teaching sessions led by the Department of Otorhinolaryngology on proper nasopharyngeal swab technique. After a brief lecture, participants practiced their swab technique using a high-fidelity airway simulation model. Pre- and postintervention self-evaluations were measured via standardized clinical competency questionnaires on a 5-point Likert scale ranging from "No knowledge, unable to perform" up to "Highly knowledgeable and confident, independent."
Results: Forty-six participants in this study submitted pre- and postintervention self-assessments. Postintervention scores improved on average 1.41 points (95% CI, 1.10-1.73) out of 5 from a mean score of 3.13 to 4.54 (P < .0001). This reflects a large effect size with a Glass's delta value of 1.3.
Discussion: Lecture coupled with simulation-based teaching can significantly improve health care workers' confidence in performing nasopharyngeal swabs. Proper training for frontline workers performing swabs for COVID-19 is essential to improving testing accuracy and can be achieved in a simple and timely manner.
Implications for practice: To meet the testing needs of the growing pandemic, many health care workers who are unfamiliar with nasopharyngeal swabs have been asked to perform this test. Simulation-based teaching sessions may improve health care workers' confidence and help prevent false-negative results. This intervention is easily reproducible in any setting where frequent nasopharyngeal swab testing occurs.
Level of evidence/study design: Prospective cohort study.
Keywords: COVID-19; PS/QI; coronavirus; education; nasopharyngeal; otolaryngology; simulation; swab; testing.
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17
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820932133. doi: 10.1177/0194599820932133. Online ahead of print.
Guidelines for Resident Participation in Otolaryngology Telehealth Clinics During the COVID-19 Pandemic
Michal J Plocienniczak 1 2, J Pieter Noordzij 1 2, Gregory Grillone 1 2, Michael Platt 1 2, Christopher Brook 1 2
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PMID: 32482138 DOI: 10.1177/0194599820932133
Abstract
The practice of otolaryngology has changed drastically since the start of the COVID-19 pandemic. To limit exposure and maintain a reserve of caregivers, residency education ceased most clinical activities and shifted to remote lecture consortiums hosted online across the country in lieu of ambulatory and operative experiences. Many practicing university otolaryngologists have transitioned their clinics to telehealth medicine to maintain access to clinical care during the pandemic. The participation of residents in telemedicine visits has not been described. Here we present guidelines and experience-based suggestions for successful resident involvement in telemedicine. While it is unclear what role telehealth medicine may play within the field of otolaryngology beyond the pandemic, our experiences suggest better patient outreach and access. Expanding residents' skill set with telehealth medicine can enhance their education and better prepare them for future practice.
Keywords: clinic; education; otolaryngology; resident; telehealth.
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18
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820933169. doi: 10.1177/0194599820933169. Online ahead of print.
Rhinologic Practice Special Considerations During COVID-19: Visit Planning, Personal Protective Equipment, Testing, and Environmental Controls
Brittany E Howard 1, Devyani Lal 1
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PMID: 32484728 DOI: 10.1177/0194599820933169
Abstract
As rhinologists return to practice amid SARS-CoV-2, special considerations are warranted given the unique features of their subspecialty. Rhinologist manipulation of nasal tissue, proximity, and frequent aerosol-generating procedures (AGPs) create high risk for infection transmission. There are 4 areas of special consideration to mitigate risk: (1) previsit planning for risk stratification/mitigation, (2) appropriate personal protective equipment, (3) preprocedural testing, and (4) environmental controls. During previsit planning, risk factors of the patient and procedures are considered. High-risk AGPs are identified by duration, proximity, manipulation of high-viral load tissue, and use of powered instrumentation. Appropriate personal protective equipment includes selection of respiratory and eye protection. COVID-19 testing can screen for asymptomatic carriers prior to high-risk procedures; however, alternative testing methods are required in rhinologic patients not eligible for nasopharyngeal testing due to nasal obstruction or skull base defects. Last, AGPs in rhinologic practices require considerations of room air handling and environmental controls.
Keywords: COVID; COVID-19; PPE; SARS-CoV-2; aerosol-generating procedure; air changes per hour; air handling; environmental control; environmental safety; eye protection; high-risk aerosol; oropharyngeal swab; otolaryngology; personal protective equipment; planning; respiratory protection; rhinologic; rhinology; testing; visit planning.
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19
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820933597. doi: 10.1177/0194599820933597. Online ahead of print.
Back to the Future: Principles on Resuming Outpatient Services in the COVID-19 Era
Taher S Valika 1 2, Kathleen R Billings 1 2
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PMID: 32482142 DOI: 10.1177/0194599820933597
Abstract
The rapidly changing health care climate related to coronavirus disease 2019 (COVID-19) has resulted in numerous changes to health care systems and in practices that protect both the public and the workers who serve in hospitals around the country. As a result, these past few months have seen a drastic reduction in outpatient visits. With phased reopening and appropriate guidance, health care systems are attempting to return to normal. The experiences and lessons learned are described, and we provide guiding principles to allow for a safe and effective return to outpatient care.
Keywords: COVID 19; communication; quality improvement; safety checklist.
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20
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820930229. doi: 10.1177/0194599820930229. Online ahead of print.
Implantable Drug Reservoir Devices for Inner Ear Delivery of Pharmacotherapeutics
Ashley Kita 1, Johnny Saldate 1, Courtney Chang 2, Nitika Chellappa 2, Jeremy Jong 2, Riley Matsuda 2, Andrew Schmidt 2, Brandon Shih 2, Iram Shafqat 1, Kari Schoettler 1, Shiv Acharya 2, Stephanie Seidlits 3 2, Larry Hoffman 1 3
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PMID: 32484378 DOI: 10.1177/0194599820930229
Abstract
Objective: Cisplatin is a platinum-based chemotherapeutic drug that secondarily induces toxicity in inner ear sensory epithelia, contributing to auditory and vestibular dysfunction. We describe the creation of a drug reservoir device (DRD) to combat this ototoxicity for the duration of chemotherapy. As ototoxic side effects of chemotherapy may limit an oncologist's ability to prescribe first-line agents such as cisplatin, mitigating such devastating effects through prolonged topical therapy would be tremendously valuable.
Study design: We investigated (1) the ability of an electrospun polylactic acid DRD to provide prolonged delivery of the posited otoprotectant metformin and (2) the development of an in vitro model utilizing Sh-Sy5y human neuroblastoma cells to assess the efficacy of metformin in reducing cisplatin-induced toxicity.
Setting: Neurophysiology laboratory.
Methods: Basic science experiments were performed to assess DRD properties and metformin's effects on cisplatin toxicity in culture.
Results: We found that DRDs with increasing polylactic acid concentrations exhibited metformin release for up to 8 weeks. In modeling elution across the round window in vitro, continued elution of metformin was observed for at least 6 weeks, as quantified by spectrophotometry. Unfortunately, metformin did not exhibit protective efficacy in this model using Sh-Sy5y cells.
Conclusion: While metformin was not found to be protective in Sh-Sy5y cells, these results suggest that an electrospun DRD can provide a tailorable drug delivery system providing medication for the duration of chemotherapy treatment. This represents a novel drug delivery system and efficacy screening assay with broad clinical applications in personalized delivery of inner ear therapies.
Keywords: cisplatin; drug delivery; electrospinning; inner ear; metformin; ototoxicity; round window.
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21
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820933253. doi: 10.1177/0194599820933253. Online ahead of print.
A Guiding Principles Checklist for Otolaryngologic Surgery in the COVID-19 Era
Taher S Valika 1 2, Sarah E Maurrasse 1 2, Dana M Thompson 1 2
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PMID: 32482124 DOI: 10.1177/0194599820933253
Abstract
The COVID-19 pandemic has had a dramatic impact on surgical workflows. There is an abundance of ever-changing information, and protocols are reflexively modified on a daily basis. As many otolaryngologic procedures are shown to have higher risk of viral transmission-so-called aerosol-generating procedures-it is imperative that multidisciplinary care teams be provided updated, timely, and consistent information. A single-page Guiding Principles surgical checklist was developed to discuss 7 key factors: patient information, staff wellness, risk minimization, prioritization, resource utilization, key society criteria, and communication. This was completed for every patient requiring otolaryngologic surgery and was distributed to the care teams involved. It provided the most information for those on the frontline and allowed for cogent pre-, intra-, and postoperative planning.
Keywords: COVID-19; communication; otolaryngology; quality improvement; safety checklist.
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22
Otolaryngol Head Neck Surg
. 2020 Jun 2;194599820932162. doi: 10.1177/0194599820932162. Online ahead of print.
SARS-CoV-2 Infection in Health Care Workers: Cross-sectional Analysis of an Otolaryngology Unit
Alberto Paderno 1, Milena Fior 1, Giulia Berretti 1, Alberto Schreiber 1, Alberto Grammatica 1, Davide Mattavelli 1, Alberto Deganello 1
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PMID: 32482123 DOI: 10.1177/0194599820932162
Abstract
The restart of routine in- and outpatient activity in the COVID-19 postepidemic peak needs to be carefully planned in light of specific patterns of viral diffusion. We evaluated SARS-CoV-2 serology in the entire personnel of a COVID-19-free otolaryngology department in a highly affected area. The aim was to determine the prevalence of SARS-CoV-2 positivity among staff to clarify the impact of different risk factors for infection. The entire staff of the otolaryngology unit was tested for SARS-CoV-2 serology. Symptomatic staff members were tested with nasal/pharyngeal swabs. All answered a survey focused on the number of in- and extrahospital positive contacts and type of activities in the unit. Five (9%) were positive for SARS-CoV-2 infection. The only variable associated with a higher risk of infection was the number of extrahospital contacts without personal protective equipment (P = .008). Our study shows that in non-COVID-19 departments, the use of adequate personal protective equipment leads to low rates of infection among health care workers. The prevalent risk of infection was related to extrahospital contact.
Keywords: COVID-19; SARS-CoV-2; coronavirus; hospital; infection; otolaryngology.
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