OBJECTIVES:Radiation therapy (RT) for head and neck cancer (HNC) commonly causes dysphagia. Swallowing rehabilitation programs (SRPs) during RT improve functional outcomes, but adherence remains low due to RT-related pain. Motor imagery (MI) incorporated into SRPs may provide a low-burden adjunct to improve participation and outcomes. The purpose of this prospective pilot study is to evaluate adherence and clinical outcomes of an MI-based SRP for HNC patients undergoing RT. METHODS:Between April 2021 and November 2023, 20 HNC patients receiving RT enrolled in an MI-incorporated SRP at a tertiary care center were compared with historical data of 36 HNC patients undergoing RT with standard-of-care SRP. MI-approach participants performed motor execution (ME) exercises for the first 3 weeks of RT, switching to MI-based exercises thereafter. The standard-of-care approach was ME-based exercises throughout RT. The primary outcome was SRP adherence, measured as the percentage of prescribed exercises completed weekly. Exploratory outcomes included pain, opioid prescriptions, weight, feeding tube dependency, and swallowing-related quality-of-life. Linear and logistic mixed-effects models assessed changes over time and between approaches. RESULTS:About 70% of MI participants achieved strong adherence ($\ge 70\%$ completion of prescribed exercises). Adherence increased after transitioning to MI at week 4 despite rising pain levels. Though not statistically significant, the MI-approach showed a greater decline in pain scores (slope $-1.67$ vs $-0.50$), lower final pain scores ($1.01$ vs $1.68$), reduced post-treatment opioid use (mean log-MME $2.85$ vs $3.97$), smaller average monthly slope of decline in log-weight (slope $-0.125$ vs $-0.132$), lower odds of feeding tube dependency (aOR $0.18$), coughing while drinking (aOR $0.75$), and discomfort while eating with others (aOR $0.68$) as compared to standard of care. CONCLUSIONS:Incorporating MI into SRPs for HNC patients undergoing RT may improve SRP adherence and clinical outcomes. Larger, randomized studies are needed to validate the benefit.
OBJECTIVE:The aim of this study is to assess sociodemographic and medical factors associated with repeat bilateral myringotomy with tympanostomy tube placement (rBMT) in the diverse patient population at our academic medical center. STUDY DESIGN:Retrospective chart review. SETTING:Tertiary academic medical center. METHODS:A retrospective chart review of pediatric patients seen at a quaternary medical center who underwent BMT was conducted. Demographic, medical, and socioeconomic information was collected. Fisher's exact test was used to estimate the association between rBMT with all nominal responses. Logistic regression was used to estimate the association between patient variables and rBMT. RESULTS:There were 216 (69% male) patients who underwent rBMT. The mean number of BMT surgeries in those requiring rBMT was 3.09. Black & Hispanic individuals were less likely to undergo rBMT (P < .05). There were no statistically significant association between social vulnerability index (SVI), type of insurance or distance from the medical center and rBMT (P > .05). CONCLUSION:When looking at sociodemographic disparities in those who underwent rBMT, our study demonstrates race and ethnicity were statistically significant factors for decreased likelihood of repeat BMT. SVI, insurance type, and distance from the medical center were not statistically significant in terms of likelihood of rBMT.
OBJECTIVES:Head and neck paragangliomas (HNPGLs) are rare neuroendocrine tumors with heterogeneous behavior, making prognostic assessment challenging. Although generally indolent, a subset exhibits malignant potential, and robust prognostic determinants remain insufficiently defined. This study aimed to identify clinical and pathological factors independently associated with overall survival (OS) in patients with HNPGLs. METHODS:We performed a retrospective Surveillance, Epidemiology, and End Results (SEER)-based cohort study (1975-2021). Demographic, clinicopathologic, and treatment variables were evaluated using Kaplan-Meier survival estimates, Cox regression models, and receiver operating characteristic (ROC)-derived cutoffs. RESULTS:Among 280 patients, most tumors originated in the carotid body (77.5%). In univariable analyses, extra-carotid location, tumor size ≥ 34.5 mm, absence of surgery, advanced stage, and older age were associated with poorer OS. In multivariable analysis, older age, advanced stage, and lack of surgery remained independently associated with reduced OS. CONCLUSIONS:Age at diagnosis, disease stage, and surgical resection status were independently associated with OS, with stage emerging as the strongest determinant in HNPGLs. Associations involving tumor size and extra-carotid location should be interpreted as exploratory findings.
OBJECTIVES:The objective of this study was to analyze the demographics and comorbidities associated with different recruitment methods employed for a clinical study investigating olfactory dysfunction in older adults. We hypothesize that a targeted approach would produce greater demographic and socioeconomic representation than recent online approaches. METHODS:This cross-sectional study analyzed the recruiting methods used to enroll Community-dwelling adults over 50 years of age. Participants were recruited from October 2024 to September 2025. A total of 376 participants were recruited. Recruitment methods were divided into 1 of 8 categories. After recruitment, participants would fill out a survey containing demographic information, comorbidities, and olfactory health. Descriptive statistics were used to analyze the cohort. RESULTS:Targeted recruitment resulted in more Non-Whites, lower educational status, lower alcohol use, and higher rates of hypertension, non-insulin dependent diabetes, and cardiac comorbidities than non-targeted methods. CONCLUSION:This study demonstrates the ability to recruit a representative population through the use of tailored recruiting methods. Underrepresentation in clinical research is a widespread problem that affects a host of fields. This study addresses this issue and demonstrates that it can be improved upon through the use of targeted recruiting strategies.
Background: Subglottic stenosis (SGS) is a challenging clinical condition with several endoscopic treatments available. This systematic review aims to update the evidence on the efficacy and safety of endoscopic procedures for managing SGS in adult patients. Methods: Following PRISMA guidelines, we conducted a comprehensive literature search across 4 databases, covering studies from inception to August 2024. We included studies that evaluate different endoscopic interventions for SGS in adult patients. The primary outcome was the success rate of endoscopic procedures, with secondary outcomes including recurrence rate, the need for open surgery, decannulation rate, and procedure-related complications. Results: Fifty-five studies involving 3091 patients were included. The overall success rate of endoscopic treatments was 72.9%, with CO 2 laser and YAG laser demonstrating success rates of 76.8% and 93.8%, respectively. Balloon dilatation exhibited a success rate of 66.8%. The recurrence rate across all endoscopic interventions was 60.5%, with specific procedures, such as balloon dilatation, showing a higher recurrence rate of 68.4%. The overall rate of requiring open surgery was 7%, and the overall decannulation rate after tracheostomy was 60.1%, with balloon dilation showing the highest rate of successful decannulation among (82.8%). The overall complication rate was 5%. Conclusion: Endoscopic management of adult subglottic stenosis yields variable success with high recurrence rates. Heterogeneity across studies limits interpretation, and comparative conclusions cannot be drawn. Future studies should standardize outcome definitions, disease severity reporting, and follow-up duration to guide evidence-based practice.
OBJECTIVES:To assess the safety and efficacy of intrathecal fluorescein administration during transmastoid repair of temporal lobe encephaloceles and identify predictors for intraoperative fluorescein identification. METHODS:This was a retrospective case-control study of consecutive adult patients with temporal lobe encephaloceles repaired via transmastoid approach from October 2012 to October 2024 at a single tertiary academic medical center. Medical records of qualifying patients were searched for demographics, diagnostic workup, disease characteristics, and intraoperative and postoperative outcomes. Analysis incorporated the Wilcoxon rank-sum, Pearson's X2, and Fisher's exact tests, along with unadjusted Kaplan-Meier estimates. Outcomes included encephalocele recurrence and symptomatic resolution rates, fluorescein complications, and rates and predictors of intraoperative fluorescein identification. RESULTS:38 patients met inclusion criteria (age 59.8 + 11.9 years, BMI 35.8 + 8.7 kg/m2, 23 [60.5%] female). Recurrence (0% vs 11.5%, P = .54) and symptom resolution (83.3% vs 88.5%, P = .64) rates did not differ between patients who received and did not receive intrathecal fluorescein. No fluorescein-related complications were reported. Fluorescein was intraoperatively detected in six-twelfths cases, yielding a sensitivity of 50%. No demographic or clinical variables, including higher BMI, history of prior encephalocele, and size of largest defect, were associated with intraoperative fluorescein identification. CONCLUSIONS:Intrathecal fluorescein administration preliminarily appears to be a safe adjunctive tool to identify the leak source in the transmastoid repair of temporal lobe encephaloceles, but its risk-benefit ratio remains up for debate. Higher-powered studies are necessary to explore its utility in specific circumstances and to determine which patients may benefit most.
OBJECTIVE:The aim of this scoping review is to identify and categorize uncommon disorders of hearing instability, enabling a better understanding of their clinical presentations and treatments. METHODS:The framework for the review was developed using the PRISMA-ScR. Literature was pulled from Medline, Web of Science, Embase, and Cochrane Central and screened independently by 3 reviewers with an extended inclusion and exclusion criteria. Once included, data extraction included etiological category of the disease, hearing loss type (sudden, fluctuating, or both), associated symptoms, comorbidities, treatments administered, and hearing recovery outcomes. RESULTS:A total of 334 studies were included after screening, and data from 2247 patients was extracted. The most common etiologies per study were infectious (30.2%, n = 101 studies), neoplastic (29.6%, n = 99 studies), and vascular (28.1%, n = 94 studies). Average age across cases was 45.9 years (range: 0-90). Among patients, 89.8% exhibited sudden hearing loss, while 8.18% experienced fluctuating hearing loss. Neoplastic-related hearing instability had the highest number of total patients (n = 1101 patients), predominantly involving vestibular schwannomas (n = 582 patients) while infectious diseases had the second highest number of patients (n = 493 patients), with COVID-19 as the most reported infection (n = 146 patients). Causes identified without a known association with hearing loss in other literature include acute or chronic myeloid leukemia (n = 24), metastatic tumor disease (n = 10), or infective endocarditis (n = 3). CONCLUSION:Hearing instability can arise from a variety of uncommon causes. Increased awareness of these conditions may help clinicians initiate appropriate treatment sooner, potentially improving patient outcomes.
BACKGROUND:Ingested metallic foreign bodies in the aerodigestive tract often require prompt endoscopic or surgical retrieval, but visualization failures despite radiographic confirmation pose diagnostic and therapeutic challenges. This report describes a novel use of a magnetic-tipped bridle to localize and retrieve an unusual sieve-derived metal fragment during microlaryngoscopy. CASE PRESENTATION:A 45-year-old female presented after accidentally swallowing a small piece of metal from a kitchen sieve. Plain X-ray confirmed a 2 cm linear radiopaque foreign body in the upper aerodigestive tract. Flexible nasendoscopy and initial microlaryngoscopy failed to visualize it. During microlaryngoscopy under general anesthesia, a bridle nasogastric tube with distal magnet was advanced trans orally; magnetic attraction to the laryngeal sidewall enabled precise localization and atraumatic retrieval without complications. The patient was discharged the next day with no sequelae. CONCLUSIONS:Magnetic bridle-assisted microlaryngoscopy offers a safe, innovative adjunct for radiopaque metallic foreign bodies occult to direct visualization, avoiding rigid endoscopy or open surgery. This technique repurposes standard NG securement tools effectively in ENT practice.
OBJECTIVE:Endotracheal intubation can cause laryngeal injury, with clinical presentation ranging from transient hoarseness to persistent vocal cord immobility. This study examines the incidence, clinical features, and outcomes of post-intubation laryngeal injuries following procedures traditionally considered low risk for such complications. METHODS:We conducted a retrospective review of adult patients who underwent tracheal intubation for surgical procedures between May 1, 2018, and December 31, 2024, and subsequently presented with postoperative laryngeal injury-related symptoms. Patients who underwent cardiothoracic, thyroid, parathyroid, or anterior cervical spine procedures were excluded. We reviewed patient demographics, airway and intubation characteristics, treatments, and clinical outcomes. RESULTS:Among 267 824 patients undergoing 454 924 general anesthetics, 30 developed postoperative laryngeal injury (6.6/100 000; 95% CI 4.5-9.4) which did not resolve spontaneously and required laryngology evaluation. Of these 22 (67%) had well defined movement abnormalities: unilateral (n = 15) and bilateral vocal cord immobility (n = 1), unilateral hypomobility (n = 4), bilateral hypomobility (n = 1), combined unilateral vocal cord immobility with contralateral hypomobility (n = 1), and 11 (33%) had no movement abnormality. Twenty-one (64%) were intubated via video laryngoscopy. Follow-up was available for 21 patients (70%) with a median [IQR] duration of 12 [9-35] months; 15 (72%) showed partial improvement without complete resolution, while 6 showed no improvement. CONCLUSION:Laryngeal injury following general anesthesia with tracheal intubation is a uncommon complication. In our series, approximately two-thirds of patients had identifiable injuries, while one-third exhibited no structural abnormality. While 75% of patients demonstrated partial symptomatic improvement, however, complete resolution was not observed in any of the patients who received follow-up in our institution, underscoring the severity of this complication.
Background: Vocal cord cysts are common benign lesions causing dysphonia, while sulcus vocalis, a groove on the vocal fold, can coexist with cysts and complicate treatment. This study compares clinical characteristics and voice outcomes in patients with vocal cord cysts, with and without sulcus vocalis. Methods: This retrospective study was conducted at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, from 2012 to 2023. Patients with vocal cord cysts who underwent microlaryngeal surgery were included. Sulcus vocalis was suspected preoperatively using videostroboscopic examination and confirmed intraoperatively during microlaryngoscopy with visual inspection and palpation. They were divided into 2 groups: with and without coexisting sulcus vocalis. Voice outcomes were assessed using pre- and postoperative Voice Handicap Index-10 (VHI-10) scores. Results: A total of 54 patients with vocal cord cysts were included, with 31 (57.4%) having coexisting sulcus vocalis and 23 (42.6%) without. Patients with sulcus vocalis were significantly older (median age 30 vs 22 years, P = .008) and had lower smoking rates (6.45% vs 52.17%, P < .001). They also exhibited worse voice outcomes, with higher preoperative (30 vs 22, P = .002) and postoperative VHI-10 scores (20 vs 10, P < .001) and smaller median VHI-10 improvements (8 vs 12 points, P = .047). Mucosal bridges were more common in the sulcus group (19.35% vs 0%, P = .032), but no significant differences in cyst type (epidermoid or mucus retention), recurrence rates, or follow-up duration were observed between the 2 groups. Conclusion: Sulcus vocalis worsens voice outcomes in patients with vocal cord cysts, highlighting the need for comprehensive preoperative evaluation. Future research should explore combined surgical treatments for both conditions.
INTRODUCTION:Pediatric patients, especially those under 5 years of age, are at increased risk of laryngeal injury and subsequent posterior glottic stenosis (PGS) after prolonged or repeated intubations. Despite various surgical options, optimal management remains unclear, and restenosis is a common complication. Steroid-eluting stents, such as the Propel™, have shown promise in sinus applications but are underreported in airway stenosis and reconstruction. METHODS:We present a case of a 2-year-old female with transverse myelitis and neuromuscular respiratory failure with bilateral vocal cord paresis, which led to multiple intubations and subsequent PGS. She ultimately underwent tracheostomy due to recurrent respiratory failure with viral infections and associated failure to thrive. Once stable, preparations for decannulation began. The patient underwent endoscopic division of posterior glottic scar tissue, followed by placement of a Propel™ steroid-eluting stent to the interarytenoid and arytenoid mucosa. RESULTS:At 2-week follow-up, laryngoscopy revealed significant reduction in scar tissue without restenosis, with progressive resolution of granulation tissue and edema. Despite persistent vocal cord paresis, airway patency was maintained. At 3-month follow-up, there was marked improvement of stenosis sufficient to allow tracheostomy capping. CONCLUSION:This case highlights the off-label use of a steroid-eluting stent as adjunctive therapy in a pediatric patient with PGS. Outcomes demonstrated reduced scar tissue and improved airway patency, allowing progression toward decannulation. Further studies are needed to evaluate the role of steroid-eluting stents in the management of complex laryngeal disorders.
OBJECTIVE:Evaluation of the clinical efficacy and safety of finafloxacin otic suspension in 2 Phase III clinical trials, in patients 6 months or older, reflective of the populations at risk for acute otitis externa (AOE). METHODS:Two identical multicenter, randomized, double-masked, vehicle-controlled prospective Phase III studies in which 1234 patients (≥6 months) with AOE of presumed bacterial origin were randomized at 128 sites in the United States and Canada. Patients received finafloxacin otic suspension or vehicle twice daily for 7 days. The primary efficacy endpoint was the proportion of patients with clinical cure (resolution of tenderness, erythema and edema) on day 11 in the pathogen positive subset of the intention to treat (ITT) population. RESULTS:Patients of the pathogen positive subset of the ITT population treated with finafloxacin had a clinical cure rate of 70.2% on day 11 (test of cure visit, ToC) compared to 36.6% in the vehicle group (P < .0001). A comparable effect was observed in the ITT population (finafloxacin 71% cure vs vehicle 49.8%). Finafloxacin eradicated the most common AOE pathogens with high efficiency: 89% for Staphylococcus aureus and 85.3% for Pseudomonas aeruginosa (39.2% and 26.8% in the vehicle group, respectively). Median time to cessation of ear pain was 3.5 days in the finafloxacin group versus 7.0 days in the vehicle group (P < .0001), and thus markedly shorter than durations reported for other otic therapies. Finafloxacin had a safety profile comparable to that of vehicle. Adverse events-primarily ear pruritus, ear discomfort, and dizziness-occurred at similar rates in both groups. CONCLUSIONS:Finafloxacin otic suspension was statistically superior to vehicle in clinical cures, pathogen eradication, and median time to ear pain resolution. It also demonstrated high efficacy against the primary AOE pathogens, S. aureus and P. aeruginosa, including fluoroquinolone-resistant pathogens. Finafloxacin was well-tolerated with a safety profile equivalent to vehicle.Clinical trial registry name:ClinicalTrials.gov; URL: https://clinicaltrials.gov/Identifier:NCT01535599 and NCT01535560.
Objective: To evaluate the serum expression of SerpinB3/B4/B10 and serum level of interleukin-17 as biomarkers for chronic rhinosinusitis with nasal polyps. Methods: This was a cross-sectional study involving 70 patients with CRSwNP and 70 age and gender matched healthy controls. The study patients were assessed using an Arabic version of the Sinonasal Outcome Test 22 score (SNOT-22), an otorhinolaryngology examination, and computed tomography of the nose and paranasal sinuses with grading of the findings using the Lund-Mackay staging system. The patients were divided into 2 subgroups: primary (n = 46) and recurrent (n = 24). Laboratory assessment included an assessment of the serum level of interleukin-17 (IL-17) and the expression of SerpinB3, SerpinB4, and SerpinB10. Results: The values of IL-17, SerpinB3, SerpinB4, and SerpinB10 were higher in the patient group compared with the control group and in the recurrence subgroup compared with the primary subgroup, with statistically significant differences. All 3 serpins had significant potential as biomarkers for CRSwNP and for differentiating primary from recurrent subtypes, with a p value < .001 for the sensitivity and specificity of all markers. There was a significant positive correlation between the serum expression of each of the serpin markers and the serum levels of IL-17, SNOT 22, and Lund-Mackay score ( P < .001 for all). Conclusion: The biomarkers studied had significantly higher values in CRSwNP patients, especially the recurrent subgroup. SerpinB3/B4/B10 had significant sensitivity and specificity as biomarkers for CRSwNP, predicting the likelihood of postoperative polyp recurrence, and showing a positive correlation with disease severity.
INTRODUCTION:Rhinomanometry, a reference measure for the nasal airway, is often considered a research tool with only weak-to-moderate correlations with patient symptoms. However, like lung spirometry curves offer information beyond forced expiratory volume (FEV), rhinomanometry curves (rhinograms) have characteristics beyond simple nasal resistance at 150 Pascals. This study explored the correlation between rhinogram curve features and patient-reported outcomes (PROMs), when compared with nasal airway resistance. METHODS:A diagnostic cross-sectional study was conducted on patients from a rhinology clinic. PROMs collected included ordinal nasal obstruction and visual analogue scale (VAS) of the more obstructed side. Rhinomanometry curves underwent mathematical polynomial fitting to extract 835 features. The primary outcome was correlation using Spearman's rho (ρ) comparing curve-derived features with nasal airway resistance at 150 Pascals. Machine learning was applied to the top 8 correlated features to generate an AI predictive model. RESULTS:About 601 patients (mean age 45 ± 16 years, 45% female) were analysed. Curve-derived features (ρ = 0.305) correlated more than total NAR at 150 Pa (ρ = 0.222) with VAS. Similarly with ordinal nasal obstruction, curve-derived features correlated more (ρ = 0.230) than total NAR at 150 Pa (ρ = 0.112). The best performing AI prediction models achieved correlations of 0.133 (VAS) and 0.117 (nasal obstruction). CONCLUSION:This study offers a novel method for rhinogram analysis with curve-derived features for correlation and predictive modelling. Whilst correlation scores remain weak-moderate with PROMs, they outperform nasal airway resistance. Therefore, rhinograms produced from rhinomanometry may offer more clinical information than a simplistic numerical resistance testing.
OBJECTIVE:To explore the surgical effect for patients with different types of tympanosclerosis under total otoendoscopy. MATERIALS AND METHODS:A retrospective analysis was performed on the clinical data of 86 patients who were diagnosed with tympanosclerosis and underwent total endoscopic ear surgery. According to the Wielinga classification, the patients were categorized into type II group (n = 34) and type IV group (n = 52). Hearing outcomes were recorded and analyzed at the preoperative, short-term postoperative (≤6 months), and long-term postoperative (≥1 year) periods. RESULTS:Significant differences in average air-bone gap (ABG) were observed among preoperative, short-term, and long-term postoperative periods in type II and IV tympanosclerosis. No difference was found between type II and IV in short-term ABG, whereas a significant difference appeared in long-term outcomes (P < .05). The duration of illness was strongly correlated with tympanosclerosis type and preoperative ABG. CONCLUSION:The short-term surgical benefits of type II and type IV are similar, while the long-term hearing recovery of type II is better. The bone conduction recovery of type IV is better. The longer the disease course, the more severe the hearing loss.
OBJECTIVE:Inferior turbinate (IT) hypertrophy is a major cause of nasal obstruction. Although surgical intervention is effective, it can be associated with morbidity and prolonged recovery. This study evaluated the safety, efficacy, and tolerability of a novel submucosal fractional radiofrequency (FRF) treatment. METHODS:A prospective, single-arm, open-label study was conducted from March to November 2024. Patients with nasal obstruction caused by IT hypertrophy unresponsive to at least 1 month of medical treatment were included in the study. The procedure was performed endoscopically under topical anesthesia using FRF. Outcomes were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) scale, Visual Analog Scale (VAS), and endoscopic turbinate grading at baseline, 1 month, and 3 months after the procedure. The safety outcomes included pain scale, adverse events, and complications. RESULTS:A total of 22 patients completed the protocol. The NOSE score improved from 71.2 to 30.0 at 1 month (P < .001). Sustained NOSE score improvement was observed at 3 months (37.1, P < .001). The VAS scores for nasal obstruction decreased from 7.4 to 3.2 at 1 month and 3.9 at 3 months (P < .0001). Endoscopic grading of turbinate size demonstrated a reduction at both follow-up points (P < .05). The average VAS score for pain was 3.4, indicating good tolerability. No bleeding, synechiae, or other adverse events were reported. Crusting appeared in 50% of patients at 1 month, resolving in all but 1 patient by 3 months. A significant correlation was observed between the pulse count and symptom improvement (P = .02). CONCLUSION:Submucosal FRF treatment leads to significant and sustained improvement in nasal obstruction with minimal pain and no major adverse events. These results support the safety, efficacy, and tolerability of the procedure for IT hypertrophy in an outpatient setting. Larger cohorts and long-term follow-up studies are warranted to refine the treatment and further validate these findings. LEVEL OF EVIDENCE:3.
OBJECTIVE(S):To (1) report on the long-term recurrence rate of surgically managed pleomorphic adenoma (PA) and (2) assess long-term surgical outcomes after parotidectomyMethods:Cross-sectional survey of all patients with a pathologic diagnosis of PA who underwent surgical management in a tertiary care center from 01/1997 to 12/2023 and had access to an electronic patient portal. Surveys were delivered via electronic patient portal or phone call with 6 questions to assess recurrence and long-term surgical outcomes. Time to first recurrence and recurrence free survival were analyzed using a Kaplan-Meier curve. RESULTS:Seven hundred-forty-five patients met inclusion criteria and received the survey, with a 56% response rate (n = 420). The clinical median follow-up length was 51 days, which extended to a median length of 6.2 years following the survey. The median change in follow-up length was 5.37 years (P < .001). The recurrence rate was 1% at 5 years, with a median time to first recurrence of 7.54 years. 13% and 9% of responders reported facial asymmetry and incisional cosmetic concerns, respectively. 33% of patients reported experiencing Frey syndrome, which increased from 5.2% of survey responders with documented Frey syndrome at their original post-operative assessment. CONCLUSION:Long-term assessment of PA outcomes confirms low recurrence rates, suggesting regular surveillance of recurrence is likely unnecessary. Complaints of Frey syndrome increased in frequency with longer term follow-up, which should be considered during patient counseling. LEVEL OF EVIDENCE:3.
Objective: While prior literature has demonstrated that patients of lower socioeconomic groups may have larger tumors on presentation and poorer outcomes, there is limited literature on the impact of race and ethnicity on management of vestibular schwannoma (VS). The objective of this study was to determine whether race and ethnicity impacted treatment choice and postoperative management of VS. Methods: Retrospective review of patients diagnosed with VS (ICD9 225.1, ICD10 D33.3, and ICD 10 H93.3) who presented to a tertiary care center between January 1, 2018 and October 31, 2023 was completed (IRB H-45412). Primary outcomes, including treatment choice, time to treatment, and postoperative management, were compared among different racial and ethnic groups. Results: Of the 78 patients diagnosed with VS, 46 (59.0%) patients were observed with serial imaging, 12 (15.4%) underwent radiation, and 14 (18.0%) pursued surgery initially. Treatment choice ( P = .3917), time to treatment ( P = .3310), and loss to follow up ( P = .0579) were not significantly different between different races/ethnicities. In patients who pursued surgery, the duration of admission ( P = .9300), need for rehabilitation ( P = .6271), postoperative facial nerve paresis ( P = .8233), and hospital readmission ( P = .5680) did not differ significantly. The proportion of patients who qualified for hearing rehabilitation did not differ significantly ( P = .3545). However, a significantly higher proportion of White patients chose to pursue hearing rehabilitation compared to the other groups ( P = .0096). Conclusion: Race and ethnicity did not significantly impact choice of treatment, management patterns, or postoperative course for patients with VS.
OBJECTIVE:(A) Determine patient and institutional factors associated with increased length of stay (LOS) and complications of tracheostomy, (B) Develop data-driven quality improvement in tracheostomy care. DESIGN:Mixed methods protocol used cross-sectional survey assessing institutional trends in tracheostomy-specific care. Retrospective chart review compared tracheostomy patient outcomes prior to and during implementation of a multidisciplinary tracheostomy care team and standardized guidelines. PARTICIPANTS:Patients undergoing tracheostomy from January 2019 to December 2021 at a tertiary hospital. METHODS:Patient factors, procedure type and indication, tracheostomy tube size, management timeline, insurance, and disease severity using Acute Physiology and Chronic Health Evaluation II (APACHE II) score were analyzed for associations with LOS and adverse events. Multivariate analyses controlled for APACHE II score and payer source. LOS and complications were compared between patients before and during implementation of multidisciplinary tracheostomy care team and standardized guidelines. RESULTS:Three-hundred and eighteen patients met criteria with a 21.7% complication rate, average LOS of 24 days (SD = 28.523), and median LOS post-tracheostomy of 14 days (IQR 7, 29). Departments without standardized protocols had greater LOS (F[1,316] = 28.706, P < .001]) and complication odds (OR = 2.92, P = .015, 95% CI[1.231, 6.930]). Larger tracheostomy tube size was linked to increased LOS (β = .253, t(314) = 4.741, P < .001, 95% CI[4.137, 10.081]). Delays from ventilation discontinuation to cuffless tube exchange and decannulation correlated with increased LOS (β = .406, t(184) = 6.321, P < .001, 95% CI[.928, 1.771]); (β = .554, t(129) = 7.625, P < .001, 95% CI[1.008, 1.715]). When focusing on a single department, comparing 2019 patients to 2021 patients (pre- and post-guideline and care team), overall, LOS decreased from 33.08 to 30.83 days (P = .586). When excluding patients discharged on a ventilator, the 2019 group had average LOS of 37.938 days versus 33.41 days in 2021 (P = .344). CONCLUSIONS:Standardized tracheostomy care guidelines and multidisciplinary care teams are critical to improving institutional outcomes. Data-driven approaches to quality improvement ensure efficient and targeted methods to improving patient care. LEVEL OF EVIDENCE:4.
Objectives: The prevalence of sleep-disordered breathing, including obstructive sleep apnea, has driven the rapid growth of sleep surgery as a subspecialty. Medicare reimbursement plays a pivotal role in the economic viability of sleep surgery, but trends remain understudied. This study analyzes reimbursement trends for commonly performed sleep surgery procedures from 2000 to 2024, assessing inflation-adjusted changes in facility-based professional reimbursement.Methods: The 11 most frequently billed sleep surgery procedures at a single institution in 2024 were identified. Medicare data on facility-based professional reimbursement were extracted from 2000 to 2024 using the CMS Physician Fee Schedule. Inflation adjustments were applied using the CPI Inflation Calculator. Year-to-year percentage changes and linear regression analyses were performed.Results: Among the analyzed CPT codes, a consistent decline in inflation-adjusted facility prices was observed, with an average aggregate decrease of 39.8%. The most pronounced decline was in CPT 42975 (Drug-Induced Sleep Endoscopy), which decreased by 72.1% (R2 = .88). Other procedures, such as CPT 30140 (Submucous Resection of Inferior Turbinate) and CPT 31231 (Diagnostic Nasal Endoscopy), experienced aggregate declines exceeding 58%. Procedures like CPT 30130 (Excision of Inferior Turbinate) showed relatively stable pricing with a 2.6% aggregate reduction.Conclusion: The substantial decline in inflation-adjusted facility prices for sleep surgery procedures underscores challenges in sustaining the financial and operational viability of this growing subspecialty. Reduced reimbursement may hinder innovation, training, and resource allocation, with potential downstream impacts on patient access and care. Policymakers should consider these findings to ensure equitable and sustainable support within the healthcare system.Level of evidence: 4.
