Sociodemographic Disparities in Pediatric Cochlear Implantation Access and Use: A Systematic Review

xlomafota13 shared this article with you from Inoreader Sociodemographic Disparities in Pediatric Cochlear Implantation Access and Use: A Systematic Review Via The Laryngoscope Objectives Pediatric cochlear implantation (CI) is a multistep process, which exposes a healthcare system's potential weaknesses in ability to deliver timely care to deaf children. The current systematic review aims to determine the sociodemographic disparities that predict pediatric CI access and use among CI candidates and recipients across the world. We hypothesize that sociodemographic factors independently influence CI access and use within a given country. Study Design Systematic review. Methods A qualitative systematic review of PubMed, Scopus, Web of Science, and Embase databases was conducted for studies investigating the association of sociodemographic factors such as race, income, or insurance status with measures of pediatric CI access, such as age at CI or CI rate. Results Out of 807 unique abstracts initially retrieved, 39 papers were included in the final qualitative systematic review. Twenty-seven thousand seven hundred and fifty-one CI-candidate children (6,623 CI recipients) were studied in 14 countries, with 21 studies conducted in the United States of America, published within the years of 1993 to 2020. Conclusion Some measures of CI access, such as age at CI and rates of CI, are consistently reported in the CI disparities literature while others such as access to rehabilitation services, willingness to undergo CI, and daily CI use are rarely measured. There are persistently reported disparities in a few key measures of CI access in a few populations, while there are some populations with a paucity of data. Future studies should delineate the nuances in the mechanisms of disparities by conducting multivariable analysis of representative sample data. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sinonasal Issues After Maxillectomy With Free Flap Reconstruction: Incidence and Clinical Approach

xlomafota13 shared this article with you from Inoreader Sinonasal Issues After Maxillectomy With Free Flap Reconstruction: Incidence and Clinical Approach Via The Laryngoscope Objective To characterize the clinical features associated with sinonasal complaints after maxillectomy with free flap reconstruction as well as propose a screening and treatment algorithm. Methods Retrospective review of patients who underwent maxillectomy and free flap reconstruction at a tertiary care center. Results Fifty-eight patients were included, 25 (43.1%) of them had documented sinonasal complaints postoperatively. Eleven patients subsequently underwent revision surgery for sinonasal complaints. Among the 25 patients with sinonasal complaints, 22 patients (88.0%) had nasal crusting, 17 (68.0%) had nasal obstruction, 12 (48.0%) had rhinorrhea, 9 (36.0%) had facial pain or pressure, and 7 (28.0%) had foul odor. Twenty-two patients (88.0%) had multiple sinonasal complaints. There was a higher incidence of both sinonasal complaints and surgical intervention in patients who underwent adjuvant radiation, but this was not statistically significant (47.7% vs 28.6%, P = .235; 29.4% vs 7.1%, P = .265). Conclusions Sinonasal complaints are common following free flap reconstruction for a maxillectomy defect and should be screened for at postoperative visits, with early referral to a rhinologist for consideration of endoscopic sinus surgery. Nonsurgical treatment strategies include large-volume nasal saline irrigations, xylitol irrigations for persistent inflammatory symptoms, and culture-directed antibiotic irrigations for persistent infectious symptoms. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sleep Performance and Chronotype Behavior in Unilateral Vestibular Hypofunction

xlomafota13 shared this article with you from Inoreader Sleep Performance and Chronotype Behavior in Unilateral Vestibular Hypofunction Via The Laryngoscope Objective To evaluate sleep behavior and its relation to otoneurological parameters in a group of patients with chronic unilateral vestibular hypofunction (UVH) without self-reported sleep disturbances when compared with healthy subjects serving as a control group (CG). Methods Fifty-one patients affected by UVH underwent a retrospective clinical and instrumental otoneurological examination, a 1-week actigraphy sleep analysis, and a series of self-report and performance measures (SRM/PM). A CG of 60 gender- and age-matched healthy subjects was also enrolled. A between-group analysis of variance was performed for each variable, while correlation analysis was performed in UVH patients between otoneurological, SRM/PM, and actigraphy measure scores. Results When compared with CG subjects, UVH patients were found to be spending less time sleeping and taking more time to go from being fully awake to asleep, based on actigraphy-based sleep analysis. Also, SRM/PM depicted UVH patients to have poor sleep quality and to be more prone to an evening-type behavior. Correlations were found between vestibular-related functionality indexes and subjective sleep quality, as well as between longer disease duration and reduced sleep time. Conclusion For the first time, a multiparametric sleep analysis was performed on a large population-based sample of chronic UVH patients. While a different pattern in sleep behavior was found, the cause is still unclear. Further research is needed to expand the extent of knowledge about sleep disruption in vestibular disorders. Level of Evidence Level 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tonsillectomy Outcomes for Children With Severe Obesity

xlomafota13 shared this article with you from Inoreader Tonsillectomy Outcomes for Children With Severe Obesity Via The Laryngoscope Objectives/Hypothesis To determine the success of an adenotonsillectomy (T&A) in treating children with severe obesity utilizing a more accurate obesity scale. Study Design Retrospective cohort. Methods A retrospective cohort of children with obesity between 5 and 10 years of age who underwent a T&A at Children's Hospital of Colorado (CHCO) was used. This study also utilized publicly available data from the Childhood Adenotonsillectomy Trial (CHAT) study. The cohort was divided into three obesity classes using age- and sex-specific body mass index (BMI) expressed as a percentage of the 95th percentile (%BMIp95) and compared for operative success differences. Results There were 132 patients included in our primary analysis, with obesity distribution as follows: Class 1 to 53 patients (40%), Class 2 to 45 patients (34%), and Class 3 to 34 patients (26%). Overall, 52 patients (35.9%) experienced a cure (obstructive apnea/hypopnea index [OAHI] <1), with 27 (52%) patients in Class 1 obesity, 18 (35%) in Class 2, and 7 (13%) in Class 3. Class 3 had a significantly lower obstructive sleep apnea cure rate compared with Class 1 patients (P = .013), but after adjusting for covariates, this difference was no longer present (P > .05). There was no significant difference in the preoperative to postoperative percent change in mean oxygen saturation (P = .82 CHCO, P = .43 CHAT), oxygen nadir (P = .20 CHCO, P = .49 CHAT), or OAHI (P = .12 CHCO, P = .26 CHAT) between the obesity classes. Conclusion After adjusting for covariates, children with Class 3 obesity are as likely to be cured with a T&A as those with Class 1 obesity. A T&A should be considered a first line treatment for all children with obesity. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical predictors of psoriatic arthritis and osteoclast differentiation

xlomafota13 shared this article with you from Inoreader Clinical predictors of psoriatic arthritis and osteoclast differentiation Via Experimental Dermatology Abstract Psoriasis and psoriatic arthritis (PsA) are inter-related inflammatory diseases. Psoriasis usually precedes PsA onset and represents a well-established risk factor for PsA development. Bone erosion is a hallmark of PsA, and the contribution of cutaneous psoriatic inflammation in this process has been demonstrated. However, little is still known on the pathogenetic mechanisms that link psoriatic skin to joint damage. Clinical features of psoriatic disease, including specific body site involvement, seem to be important risk predictors of PsA. The aim of this pilot research study was to investigate if psoriatic cutaneous inflammation, affecting these anatomical predictive sites for PsA, could be linked to osteoclast differentiation and activity. Our results showed that psoriasis skin localizations were positively related to the osteoclastogenic profile in psoriatic patients. These results provide new insights into the fascinating skin-joint axis concept. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Three-Dimensional Measurements in Assessing the Results of Inferior Turbinate Surgery

xlomafota13 shared this article with you from Inoreader Three-Dimensional Measurements in Assessing the Results of Inferior Turbinate Surgery Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Jul 1:34894211028516. doi: 10.1177/00034894211028516. Online ahead of print. ABSTRACT OBJECTIVES: Acoustic rhinometry is widely used in evaluating patients with nasal congestion, but it only has a partial correlation with patient symptoms. The use and focus of cone beam computed tomography (CBCT) scans are mainly on the paranasal sinuses and less on the nasal cavities. Therefore, information acquired from CBCT scans is not used to its full exte nt. In our present study, we have studied patients with enlarged inferior turbinates. Our aim was to investigate and compare the use of 3D volumetric measurements and cross-sectional area measurements taken from CBCT scans to results obtained from acoustic rhinometry. MATERIAL AND METHODS: In total, 25 patients with enlarged inferior turbinates were studied. CBCT scans were obtained preoperatively and at twelve months postoperatively. 3D volumetric and cross-sectional area measurements were compared to results from acoustic rhinometry, the visual analogue scale (VAS) and Glasgow Health Status Inventory (GHSI) questionnaires. RESULTS: A statistically significant change in 3D volume and cross-sectional area was measured in the anterior part of the inferior turbinate and surrounding air space after inferior turbinate surgery. VAS and GHSI results had mild correlations with the 3D volume and cross-sectional area measurements of the anterior part of the inferior turbinate. Ac oustic rhinometry correlated with the air space 3D volume measurements in the anterior part. CONCLUSIONS: Fully utilized CBCT scans provide more comprehensive and accurate information. Furthermore, 3D analysis of the inferior turbinates provides valuable information and more precise measurements compared to acoustic rhinometry. PMID:34192975 | DOI:10.1177/00034894211028516 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Laceration of Aberrant Internal Carotid Artery Following Myringotomy: A Case Report and Review of Literature

xlomafota13 shared this article with you from Inoreader Laceration of Aberrant Internal Carotid Artery Following Myringotomy: A Case Report and Review of Literature Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Jul 1:34894211028468. doi: 10.1177/00034894211028468. Online ahead of print. ABSTRACT INTRODUCTION: The presence of an aberrant internal carotid artery (ICA) in the middle ear is rare. Patients may be asymptomatic or complain of conductive hearing loss, otalgia, pulsatile tinnitus, or aural fullness. Otoscopic exam findings can include a pulsating erythematous lesion on the tympanic membrane (TM). It may be misdiagnosed as a glomus tumor, heman gioma, or serous otitis media, or go unrecognized until surgical exploration. Early recognition is important as intraoperative discovery carries risk of iatrogenic injury, hemorrhage and subsequent neurologic sequelae. Prevention requires adequate preoperative suspicion and can be confirmed with radiologic examination via computed tomography (CT) scan or magnetic resonance angiography (MRA). Management of iatrogenic injury of an aberrant ICA can include packing, vessel embolization and/or surgical ligation. PATIENT CASE: We report the case of an aberrant ICA injury in a pediatric patient undergoing a myringotomy with tube placement, who sustained neurologic deficits that eventually resolved following treatment with packing and coil embolization. DISCUSSION AND CONCLUSIONS: An aberrant ICA can cause life-threatening complications without prior diagnosis in a routine myringotomy. Suspicious exam findings should prompt temporal bone CT to rule out aberrant ICA or other vasc ular pathology of the middle ear prior to surgery. In the case of iatrogenic injury of an aberrant ICA, there is no consensus in existing literature on optimal management. We reviewed 37 studies to compare therapeutic options and subsequent outcomes. Though complications are rare regardless of management, cases in which solely packing was utilized demonstrated an increased incidence of hemiparesis, aphasia, hearing loss, re-bleeding, and delayed pseudoaneurysm, as compared to an approach coupling packing with embolization or ligation, both of which have comparable outcomes. PMID:34192882 | DOI:10.1177/00034894211028468 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Perceived Impact of USMLE Step 1 Score Reporting to Pass/Fail on Otolaryngology Applicant Selection

xlomafota13 shared this article with you from Inoreader Perceived Impact of USMLE Step 1 Score Reporting to Pass/Fail on Otolaryngology Applicant Selection Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Jul 1:34894211028436. doi: 10.1177/00034894211028436. Online ahead of print. ABSTRACT OBJECTIVES: Recently, the decision was made to transition the United States Medical Licensing Examination (USMLE) Step 1 score from a three-digit numerical score to a pass/fail system. Historically, Step 1 scores have been important for otolaryngology resident applicant selection. The purpose of this study was to understand and evaluate otolaryngology residenc y program directors' (OPDs) opinions on the impact following the change in Step 1 score reporting. METHODS: A 22-question survey administered through Qualtrics was sent to 113 academic otolaryngology residency program directors in April 2020. Information about demographics, impressions on the new Step 1 score format, anticipated changes in applicant selection, impact on mental health, and importance of various other factors in selecting applicants were queried. Descriptive statistics were used to analyze survey results. RESULTS: A total of 41 out of 113 (36.3%) OPDs completed this survey. A majority of surveyed OPDs (80.5%) do not support the decision to change Step 1 to a pass/fail system. In the absence of a three digit numeric USMLE Step 1 score, OPDs indicated prioritization of away rotations, letters of recommendation (LORs), personal prior knowledge of the applicant, grades in required clerkship, and class ranking or quartile. 53.7% of OPDs anticipate requiring USM LE Step 2 Clinical Knowledge for interview consideration following this change. CONCLUSION: OPDs believe a pass/fail Step 1 score will decrease the importance of this exam and that this change will lead to the implementation and evaluation of additional metrics such as a required Step 2 CK score. PMID:34192891 | DOI:10.1177/00034894211028436 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Relationship Between Obstructive Sleep Apnea and Pediatric Obesity: A Nationwide Analysis

xlomafota13 shared this article with you from Inoreader The Relationship Between Obstructive Sleep Apnea and Pediatric Obesity: A Nationwide Analysis Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Jul 1:34894211028489. doi: 10.1177/00034894211028489. Online ahead of print. ABSTRACT OBJECTIVE: Pediatric obstructive sleep apnea (OSA) can have both acute and chronic consequences when untreated. We hypothesize that a link exists between childhood obesity and OSA at nationwide level, with race, gender, and socioeconomic status conferring their own risk for pediatric OSA. METHODS: This study examined nationwide discharges in 2016 using t he Kids' Inpatient Database (KID). The International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes for obesity (E66.0) and OSA (G47.33) were used. Prevalence rates and odds ratios (ORs) were used to quantify associations between the obesity and OSA groups in the general pediatric inpatient population. Multiple binary logistic regression was utilized to compare cohorts of pediatric inpatient admissions. RESULTS: There were 36 266 285 weighted discharges in the 2016 KID. Among patients included in our dataset, 0.426% (26 684) were diagnosed with obesity and 0.562% (35 242) had OSA. Obesity was independently associated with a significantly increased risk of OSA (OR = 22.89; 95% C.I. = 21.99-23.84). Within the OSA inpatient population, obesity was associated with non-Hispanic black race, Hispanic ethnicity, and Native American race/ethnicity (OR = 1.45, 1.32, 2.51; 95% C.I. = 1.33-1.58, 1.21-1.44, 1.73-3.63). CONCLUSIONS: Obesity is indep endently associated with OSA in children after controlling for adenotonsillar hypertrophy. Non-Hispanic black race and Hispanic ethnicity are independent risk factors for OSA and are associated with obesity in the OSA inpatient population, which suggests that obesity may play a role in the increased risk of OSA within these groups. PMID:34192945 | DOI:10.1177/00034894211028489 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Preliminary Investigation of In vitro, Bidirectional Vocal Fold Muscle-Mucosa Interactions

xlomafota13 shared this article with you from Inoreader Preliminary Investigation of In vitro, Bidirectional Vocal Fold Muscle-Mucosa Interactions Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Jul 1:34894211028497. doi: 10.1177/00034894211028497. Online ahead of print. ABSTRACT OBJECTIVE: Oversimplified clinical dogma suggests that laryngeal diseases fall into two broad, mutually exclusive diagnostic categories-mucosal injury or neuromuscular/functional disorders. Extensive investigation in the lower airway as well as other organ systems suggest complex interactions between tissue types underlying both tissue health and pathological states. To date, no such relationship has been described in the vocal folds, likely the most bioactive organ in the body. We hypothesize interactions between the vocal fold muscle and mucosa likely contribute to aberrant phonatory physiology and warrant further investigation to ultimately develop novel therapeutic strategies. METHODS: Primary culture of myoblasts from rat thyroarytenoid muscle and fibroblasts from the vocal fold mucosa were established. Co-culture and conditioned media experiments were performed to established bidirectional interactions between cell types. Transforming Growth Factor (TGF)-β was employed to stimulate a fibrotic phenotype in culture. In addition to quantitative PCR, standard migration and proliferation assays were performed as well as immunocytochemistry. RESULTS: Bidirectional cell-cell interactions were observed. Without TGF-β stimulation, myoblast conditioned media inhibited fibroblast migration, but enhanced proliferation. Conversely , fibroblast conditioned media increased both myoblast proliferation and migration. Myoblast conditioned media decreased TGF-β-mediated gene expression and of particular interest, ACTA2 mRNA expression. In both co-culture and in response to fibroblast conditioned media, myosin heavy chain (Myh2) mRNA expression decreased in myoblasts. CONCLUSIONS: These data are the first to describe interactions between cell types within the vocal fold. The implications for these interactions in vivo warrant further investigation to develop and refine optimal treatment strategies. PMID:34192972 | DOI:10.1177/00034894211028497 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cost-Effectiveness of Open vs. Endoscopic Repair of Zenker's Diverticulum

xlomafota13 shared this article with you from Inoreader Cost-Effectiveness of Open vs. Endoscopic Repair of Zenker's Diverticulum Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Jul 1:34894211028507. doi: 10.1177/00034894211028507. Online ahead of print. ABSTRACT OBJECTIVE: To evaluate the cost-effectiveness of open versus endoscopic surgical repair of Zenker's diverticulum. METHODS: In this study, an economic decision tree was utilized to compare the cost-effectiveness of open surgery compared to endoscopic surgery. The primary outcome in this analysis was the incremental cost-effectiveness ratio (ICER) that was calculated based on the economic decision tree. The probability of post-operative esophageal perforation complications, revision rates, and effectiveness of each procedure along with associated costs were extracted to construct the decision tree. Univariate sensitivity analysis was then utilized to determine how changes in esophageal perforation rate affect the cost-effectiveness of each surgical approach. RESULTS: The ICER of open surgery for Zenker's diverticulum was $67 877, above most acceptable willingness to pay (WTP) thresholds. Additionally, if the probability of esophageal perforation with endoscopic surgery is above 5%, then open surgery becomes a more cost-effective option. Probabilistic sensitivity analysis using Monte Carlo simulations also showed that at the WTP thresholds of $30 000 and $50 000, endoscopic surgery is the most cost-effective method with 83.9% and 67.6% certainty, respectively. CONCLUSION: Open surgery and endoscopic surgery are 2 treatment strategies for Zenker's diverticulum that each have their own advantages and disadvantages that can complicate the decision-making process. With no previous cost-effectiveness analysis of open versus endoscopic surgery for Zenker's diverticulum, our results support the endoscopic approach at most common WTP thresholds. Particularly with the current focus on rising healthcare costs, our results can serve as an important adjunct to medical decision-making for patients undergoing treatment for Zenker's diverticulum. PMID:34192947 | DOI:10.1177/00034894211028507 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.