Objectives: To test the hypothesis that surgical otologic intervention for any type of adult hearing loss decreases the odds for incident adverse life events (ALEs) and medical comorbidities (MCBs). Study Design: Retrospective cohort database study. Methods: Electronic medical record data from the TriNetX Research Network were queried for adults (age >= 18 years) with congenital, sensorineural, conductive, and mixed hearing loss (HL). Patients were further stratified into 3 groups by presence or absence (HL-surgery) of surgical intervention at any point following diagnosis, including (1) stapes surgery (HL + stapes); (2) cochlear implantation and bone-anchored hearing aid (HL + CI); and (3) mastoidectomy alone and tympanoplasty with or without mastoidectomy (HL + TM). Primary outcomes were defined as odds for new ALEs or MCBs at any point given HL treatment status [Odds ratio with 95% confidence interval, (OR; 95% CI, P-value)]. Cohorts were balanced using propensity-score matching (PSM) based on US census-defined demographics and congenital comorbidities. Results: There were 2 577 153 patients included in this study. Matched analysis demonstrated that HL + stapes adults (n = 7985) had 0.37-lower odds (95% CI = 0.30-0.47, P < .0001) of experiencing any incident ALE versus HL-surgery adults (n = 2 518 409). Adults in the HL + CI cohort (n = 17 129) had 0.58-lower odds (0.52-0.66, P < .0001) of experiencing any incident MCB versus HL-surgery adults. Conclusions: This study highlights the benefit of surgical intervention for adult hearing loss on social and medical phenomes. These findings represent the largest cohort study to date demonstrating this association and further support that hearing restoration improves patient socioeconomic and medical outcomes.

OBJECTIVE: To test the hypothesis that patients with poorly controlled type 2 diabetes mellitus are more likely to develop sensorineural hearing loss (SNHL) than non-diabetic patients. STUDY DESIGN: Retrospective cohort study. SETTING: TriNetX US Collaborative Network (2003-2022). METHODS: Electronic medical record data from the TriNetX US Collaborative Network was queried for subjects without prior hearing loss, defined using medical billing codes (ICD-10, CPT, etc.), who were diagnosed with type 2 diabetes mellitus after January 2003. Patients were stratified by most recent HbA1c (8.0-13.9% or >= 14.0%) and by age at diagnosis (21-30, 31-40, 41-50, 51-60, 61-70, >= 71 years). Primary outcome was development of SNHL <= 20 years after diabetes diagnosis. Cohorts were propensity-score matched for age, gender, race, and hearing loss-related conditions, including vascular disease and tobacco/ nicotine use. Hearing loss risk in each cohort were compared against age-matched non-diabetic subjects. RESULTS: All diabetic patients had greater risk of SNHL compared to age-matched controls; having a higher HbA1c (>= 14.0%) additionally associated with greater risk than a lower HbA1c (8.0-13.9%) for all age groups except 21-30 and 31-40 years. Furthermore, risk was higher for older patients of both HbA1c ranges, with patients >= 71 years at diagnosis having greatest risk. Patients >= 71 with HbA1c >= 14.0% (n = 3,870) had a 0.51% (95% confidence interval: 0.28-0.74, p < 0.0001) greater hearing loss risk, and patients with HbA1c 8.0-13.9% (n = 155,066) had 0.24% (0.22-0.27, p < 0.0001) greater risk. CONCLUSION: Type 2 diabetes diagnosis appears to strongly associate with greater risk of developing SNHL, especially in older patients. Audiometric screening may be warranted.

Introduction Postoperative opioid prescription has unfortunately contributed to the development of chronic opioid use, substance use disorder, and eventual overdose in patients. The onus is largely placed on the provider to prescribe a medication plan that provides adequate analgesia while minimizing the risk of opioid-related adverse events. Additionally, concomitant naloxone prescription is contentious in practice guidelines.; This database study analyzes the effects of concomitant naloxone and opioid prescription on rates of substance use disorder, overdose, and death following urologic oncologic surgeries. Methods This retrospective cohort database study with propensity-score matching (PSM) was conducted using the TriNetX database, a global electronic health records database. Procedures included in the analysis were open and laparoscopic radical nephrectomy, partial nephrectomy, open and laparoscopic radical prostatectomy, and radical and partial cystectomy. We extracted a cohort of patients undergoing these procedures who were prescribed opioids, including oxycodone, tramadol, or hydrocodone, post-operatively.; We further stratified these cohorts into patients with and without concomitant naloxone prescription. We hypothesized that patients who were prescribed naloxone concomitantly with opioids (cohort A) have reduced odds of experiencing substance use disorder (SUD; ICD10 F10-19), opioid-related overdose (OD; CPT T50.901), and death (ICD10 R99) within six months of surgery. Odds ratios with 95% confidence intervals were calculated comparing the risk of experiencing an overdose between those prescribed naloxone and those who were not. Results There were 89,644 total patients in this study. The average age was 58.8 years old with 31% female patients in the cohorts. Of those patients, 61,755 (69%) received either oxycodone, tramadol, or hydrocodone post-operatively, with 18,177 (29%) being prescribed concomitant naloxone.;After 1:1 PSM for age and sex, the odds of experiencing new substance use disorder postoperatively in cohort A and controls undergoing urologic procedures was 1.46% vs 1.067% (OR: 0.728, 95%CI: 0.594-0.891, p = 0.001). The odds of experiencing OD postoperatively in cohort A and controls was 0.072% vs 0.055% (OR: 0.769, 95%CI: 0.337-1.754, p = 0.266). The odds of dying within six months postoperatively in cohort A and controls was 3.357% vs 2.305% (OR: 0.679, 95%CI: 0.598-0.771, p = < 0.0001). Conclusions Opioid use is a growing epidemic in the United States, and clinicians are faced with the difficult task of striking a fine balance between adequate analgesia and limiting postoperative opioid use. Prescribing concomitant naloxone and opiates following surgical procedures may be associated with higher rates of substance use disorder and death following urologic procedures.; This could be due to patients being less careful with managing their opioid use as they also have the antidote to overdoses.; Urologists may need to exercise caution when prescribing opiates along with naloxone.; The best method to reduce substance use disorders might be to further limit opioid prescribing.; Although taking a harm reduction approach to opioid use is essential, further studies are indicated to better understand the association between concomitant naloxone prescription and increased incidence of overdose events and mortality.

OBJECTIVES:To test the hypothesis that surgical otologic intervention for any type of pediatric hearing loss decreases the odds for incident adverse cognitive and linguistic developmental outcomes.STUDY DESIGN:Retrospective cohort database study.METHODS:Electronic medical record data from the TriNetX Research Network were queried for children with congenital, sensorineural, conductive, and mixed hearing loss (HL) between ages 0 and 5 years. Patients were further stratified by presence (HL + surgery) or absence (HL-surgery) of surgical intervention at any point following diagnosis, including cochlear implantation, tympanoplasty with or without mastoidectomy, and tympanostomy. Primary outcomes were defined as odds for new adverse cognitive or linguistic outcomes at any point given HL treatment status [odds ratio with 95% confidence interval, (OR; 95%CI, p-value)]. Cohorts were balanced using propensity-score matching (PSM) based on US census-defined demographics and clinically relevant congenital conditions.RESULTS:Of 457,636 total patients included in the study, 118,576 underwent surgery (HL + surgery cohort) and 339,060 did not (HL-surgery). In matched cohorts, surgical otologic intervention significantly decreased the odds of developing cognitive disorders including scholastic, motor, psychological developmental disorders, and pervasive developmental delays (p < 0.01).CONCLUSIONS:Surgical interventions for treatment of pediatric HL including cochlear implantation, tympanoplasty with or without mastoidectomy, and tympanostomy should be considered as they may prevent delays in development.

OBJECTIVE:Tinnitus is a multifactorial phenomenon with quality-of-life detriments for those affected by it. We aim to establish a relationship between subjective tinnitus severity with objective audiometric data in the extended high frequency (EHF) from 9 to 16 khz and with distortion product otoacoustic emissions (DPOAE). We hypothesize that severe subjective tinnitus as measured by the Tinnitus Handicap Inventory (THI) does not correlate with increased hearing thresholds in the EHF range. STUDY DESIGN:Prospective. SETTING:Single Tertiary Care Center. METHODS:Patients identified with tinnitus and normal hearing thresholds within standard frequency range (250-8000 Hz) were consented for participation. Those with underlying otologic disease, trauma, radiotherapy, or ototoxic drug use were excluded. The THI questionnaire was given to eligible patients and audiometric test results were collected. THI scores were categorized by severity groups. An n = 20 to 30 was determined to have an effect size of 0.7 with a significance level of P = .05. RESULTS:THI and audiometric data were collected for 38 patients and categorized into mild (n = 18, 47.4%), moderate (n = 8, 21.1%), slight (n = 7, 18.4%), and severe (n = 5, 13.2%) tinnitus severity groups. Mean THI score was 32.3 ± 19.6 with a statistically significant difference in scores by assigned THI severity group (P < .01). There were no significant differences or linear relationship among hearing thresholds in EHF range or DPOAE stratified by subjective tinnitus group (P = .49, r2 = 0.10) CONCLUSION: Subjective tinnitus severity is not predictive of audiometric outcomes. This finding can be used as a counseling tool to help tinnitus patients manage symptoms, expectations, and overall treatment outcomes.

Abstract Introduction Social disparities is known to have a significant impact on health outcomes including those related to obstructive sleep apnea (OSA). More recently a metric known as area deprivation index (ADI) which combines 17 social determinants of health has been used to better quantify this impact. We aim to examine the relationship between socioeconomic disparities and CPAP adherence among adults with OSA using ADI. Methods Retrospective chart review of patients with diagnosis of OSA and prescribed CPAP from Oct-Dec 2022. Patients were divided into more or less socioeconomically disadvantaged groups using a validated measure, the area deprivation index (ADI). 30 day CPAP compliance was collected. CPAP compliance was defined using Medicare criteria (>4hrs/night 70% of the nights). Long term CPAP data is currently being collected. Results 452 patients included. Patients from the most deprived areas as determined by ADI had significantly lower CPAP compliance than those from the most advantaged areas (34% compared to 56%) (p< 0.05). Patients from areas with lower rates of high school graduates had lower CPAP compliance (p< 0.05). In multivariate regression non-English speaking appeared to be a significantly negative predictor of CPAP compliance. Conclusion Socioeconomic disparities appear to have a significant impact on CPAP compliance. In particular, those from areas that are considered more deprived, areas with lower rates of high school graduates and non English speakers seem to be impacted the most. Patients within these groups may benefit from additional resources and/or closer follow up to improve compliance with treatment. Support (if any)

Perlov, Natalie M. BS1; Urdang, Zachary D. MD, PhD1; Spellun, Arielle MD2; Middleton, Irina AuD1; Croce, Julia AuD1 Author Information

OBJECTIVE:To test the hypothesis that use of cigarettes or other products with either cigarette-like smoke profile or high nicotine content by young populations increases the odds of developing sensorineural hearing loss (SNHL). STUDY DESIGN:Retrospective cohort study. SETTING:TriNetX US Collaborative Network (2003-2022). PATIENTS:Approximately 3.6 million patients at least 18 years old. INTERVENTION:None. MAIN OUTCOME MEASURES:The primary outcome of interest was diagnosis of SNHL, defined using medical billing codes ( International Classification of Diseases, Tenth Revision , Current Procedural Terminology , etc.). Cohort inclusion criteria included electronic health record entry after 2003, age 18 to 54 or 55+ years at index, and status of cigarette, noncigarette nicotine, or cannabis use. Covariates were controlled via 1:1 propensity score matching for SNHL-related conditions, including diabetes mellitus and ischemic diseases. Odds for developing SNHL were calculated against control subjects aged 18 to 54 years who have no record of nicotine/cannabis use. RESULTS:Odds for developing SNHL are higher for people 18 to 54 years old who use any nicotine product (odds ratio [95% confidence interval], 5.91 [5.71-6.13]), cigarettes only (4.00 [3.69-4.33]), chewing tobacco only (9.04 [7.09-11.63]), or cannabis only (3.99 [3.60-4.44]) compared with control. People 55+ years old who use no products also showed increased odds for SNHL (4.73 [4.63-4.85]). CONCLUSIONS:Both nicotine and smoke exposure seem to be strongly associated with increased odds for developing SNHL, with chewing tobacco having the strongest association.

OBJECTIVE:To evaluate the association of postoperative naloxone with the development of new substance use disorder (SUD), overdose, and death within 6 months of otolaryngologic surgery. STUDY DESIGN:Retrospective cohort database study on TriNetX. METHODS:Adult patients who underwent tonsil surgery (noncancerous), thyroid/parathyroid, septorhinoplasty, otology/neurotology, sinus/anterior skull base, and head and neck cancer surgeries between January 2003 and April 2023. Patients were excluded if they had an instance of SUD or overdose recorded in their charts prior to surgery, or had undergone another surgery within that 6-month time frame. We hypothesized that patients prescribed naloxone postoperatively would have decreased odds for experiencing new SUD, overdose, and/or death within 6 months of surgery compared to patients who did not receive naloxone. P < .01 was considered statistically significant. RESULTS:There were 2,305,655 patients in this study. The average age was 36.7 ± 19.5 years old, with 46% female patients. Before matching, cohorts showed equivocal odds for developing new SUD, increased odds for overdose, and mixed odds for dying. After matching for demographic variables and comorbidities such as other substance use, opioid use for other pathologies, and psychiatric conditions, these effects diminished (P > .01). CONCLUSION:Our results suggest that postoperative naloxone may not significantly affect development of new SUD and incident overdose and death in certain otolaryngologic surgeries after controlling for prior SUD and psychiatric conditions. Clinicians should be aware of these comorbidities when considering their postoperative pain management protocol, which may or may not include naloxone.

OBJECTIVE This study sought to validate alternative pain management strategies that can reduce reliance on opioids for postoperative pain management in otology. STUDY DESIGN Prospective cohort study. SETTING Single tertiary-care facility. METHODS Adult patients who underwent outpatient otologic surgery from September 2021 to July 2022 were randomized into treatment cohorts. The opioid monotherapy cohort received a standard opioid prescription. The multimodal analgesia cohort received the same opioid prescription, prescriptions for acetaminophen and naproxen, and additional pain management education with a flyer on discharge. All patients completed a questionnaire 1 week after surgery to evaluate opioid usage and pain scores. RESULTS Eighty-six patients completed the study. The opioid monotherapy cohort (n = 42) and multimodal analgesia cohort (n = 44) were prescribed an average of 42.1 ± 20.4 morphine milligram equivalents (MME) and 38.4 ± 5.7 MME, respectively (p = 0.373). Four patients (9.52%) in the opioid monotherapy cohort required opioid refills compared to 1 patient (2.27%) in the multimodal analgesia cohort (p = 0.156). Multivariate analysis demonstrated that the multimodal analgesia cohort consumed significantly fewer opioids on average than the opioid monotherapy cohort (11.9 ± 15.9 MME vs 22.8 ± 28.0 MME, respectively). There were no significant differences in postoperative rehospitalizations (p = 0.317) or Emergency Department visits (p = 0.150). Pain scores on the day of surgery, postoperative day (POD) 1, POD3, and POD7 were not significantly different between cohorts (p = 0.395, 0.896, 0.844, 0.765, respectively). CONCLUSION The addition of patient education, acetaminophen, and naproxen to postoperative opioid prescriptions significantly reduced opioid consumption without affecting pain scores, refill rates, or complication rates after otologic surgery.