Restarting Antithrombotic Therapies After Endoscopic Sinus Surgery: A Systematic Review.

OBJECTIVES: Antithrombotic therapies, comprised of both anticoagulant and antiplatelet agents, are routinely paused prior to endoscopic sinus surgery (ESS) to reduce the risk of perioperative hemorrhage. At present, no clear guidelines exist to guide otolaryngologists on when to resume these agents after ESS. Our goal was to systematically review the existing literature related to this topic. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically queried the PubMed, Embase, Ovid, Web of Science, Cochrane, and CINAHL databases to identify publications reporting on antithrombotic and antiplatelet therapy in the context of ESS. The primary outcomes we sought were recommendations on the timing of antithrombotic therapy resumption after ESS. RESULTS: Of the 104 unique articles identified, all were screened for relevance by 2 independent reviewers based on title and abstract, 20 underwent full-text review, and 6 met inclusion criteria for analysis. Of these, 3 were literature reviews, 2 were case-control studies, and 1 was a cohort study. All publications discussed when to pause antithrombotic therapy prior to surgery while only 3 articles discussed resumption of these agents. Recommendations were mixed. CONCLUSION: A paucity of literature exists on the resumption of antithrombotic therapies after ESS. As a major determining factor in patient morbidity, guideline-based resumption of these therapies is needed.

Environmental Impact of a Direct Laryngoscopy: Opportunities for Pollution Mitigation.

OBJECTIVE: To quantify the environmental impact of standard direct laryngoscopy surgery and model the environmental benefit of three feasible alternative scenarios that meet safe decontamination reprocessing requirements. STUDY DESIGN: This is a life cycle assessment (LCA) modeling study. SETTING: Yale-New Haven Hospital (YNHH), a 1541-bed tertiary medical center in New Haven, Connecticut, USA. METHODS: We performed cradle-to-grave LCA of DLS at Yale New Haven Hospital in 2022, including global warming potential (GWP), water consumption, and fine particulate matter formation. Three alternative scenarios were modeled: disinfecting surgical tools using high-level disinfection rather than steam sterilization, substituting non-sterile for sterile gloves and gowns; and reducing surgical towel and drape sizes by 30%. RESULTS: Changes in disinfection practices would decrease procedure GWP by 11% in each environmental impact category. Substituting non-sterile gowns and gloves reduced GWP by 15%, with nominal changes to water consumption. Linen size reduction resulted in 28% less procedure-related water consumption. Together, a nearly 30% reduction across all environmental impact categories could be achieved. CONCLUSIONS: Not exceeding minimum Center for Disease Control (CDC) decontamination standards for reusable devices and optimizing non-sterile consumable materials could dramatically reduce healthcare-associated emissions without compromising safety, thereby minimizing the negative consequences of hospital operations to environmental and human health. Findings extend to other non-sterile surgical procedures. LEVEL OF EVIDENCE: N/A Laryngoscope, 2024.

3D printing for virtual surgical planning of nasoseptal flap skull-base reconstruction: A proof-of-concept study.

KEY POINTS: 3D printing for virtual surgical planning of nasoseptal flap skull base reconstruction is a viable approach. Results indicate improved mucosal preservation but further research is needed to define impact on quality of life.

Adverse Events Associated With Bioabsorbable Nasal Implants: A MAUDE Database Analysis.

Bioabsorbable implants (eg, Latera) have recently been approved for addressing nasal valve collapse. The purpose of this study is to summarize adverse events and treatment sequelae associated with bioabsorbable nasal implants queried in the Manufacturer and User Facility Device Experience (MAUDE) database. Of the 26 device reports entered between March 2017 and April 2022, the most frequently reported complications included abscess (n = 13) and implant protrusion (n = 5). Other common symptoms reported greater than 1-year postimplantation included facial pain/discomfort (n = 3) and failure to absorb (n = 3). Management of adverse events included treatment with antibiotics (n = 9), steroid injections (n = 4), and explantation (n = 20). In 3 reports, adverse reactions required a biopsy of adjacent tissue for pathologic analysis. These findings suggest that further research is required to assess the potential long-term complications and optimize the management of bioabsorbable nasal implants. Furthermore, standardized reporting templates may improve the utility of the MAUDE database.

Trends in Billing and Medicare Reimbursement for In-Office Cerumen Removal by Otolaryngologists and Other Providers.

OBJECTIVES: To analyze trends in billing patterns, Medicare reimbursement, and practice-setting for otolaryngologists (ORLs) and other provider types performing in-office cerumen removal. METHODS: This retrospective study included data on Medicare-billing providers from the Medicare Part B: Provider Utilization and Payment Datafiles (2012-2018). Number of providers performing in-office cerumen removal, total sums and medians for Medicare reimbursements and services, and services per patient were gathered along with geographic distributions. RESULTS: There have been near linear declines in number of general physicians and other provider types performing cerumen extractions with 42.6% and 40.7% declines, respectively, and near linear growth in number of ORLs and advanced practice providers (APPs) with 9.7% and 51.1% growth, respectively. At the median, general physicians, APPs, and other provider types have been billing for a similar and constant number of cerumen extractions per provider, while ORLs have seen a 10.6% increase. Total Medicare reimbursement to general physicians and other provider types has fallen 45.0% and 32.5%, respectively, and to ORLs and APPs has grown 16.9% and 103.4%, respectively. Compared to non-ORLs, ORLs tend to bill for cerumen extraction out of an urban setting rather than a rural setting (P < .001). CONCLUSIONS: General physicians and other provider types are increasingly referring cerumen disimpaction patients to ORL physicians and allowing APPs to perform these procedures, indicating a change in landscape of medical practice among these providers. General physicians may be filling a need in the rural setting, where there are fewer ORLs practicing.

Medicare Utilization and Reimbursement Variation Between Rural and Urban Otolaryngologists.

OBJECTIVE: To compare billing practices, reimbursement rates, and patient populations of otolaryngology (ORL) physicians practicing in rural and urban settings. STUDY DESIGN: Retrospective cross-sectional study. SETTING: Medicare Provider Utilization and Payment Data: Physician and Other Supplier Data. METHODS: Medicare-allowed payments, number of services, and number of patients were gathered along with patient population comorbidity statistics, including average hierarchical condition category risk scores. RESULTS: In 2019, 92% of the overall total 8959 ORL physicians practiced in an urban setting. These 8243 urban ORL physicians, on average, billed for 51 (interquartile range [IQR], 31-67) unique Healthcare Common Procedure Coding System (HCPCS) codes, cared for 393 (IQR, 172-535) Medicare patients, performed 1761 (IQR, 502-2070) services, and collected $139,957 (IQR, $55,527-$178,479) per provider. In contrast, the 704 rural ORL physicians, on average, billed for a greater number of unique HCPCS codes (59; IQR, 37-77; P < .001), treated more Medicare patients (445; IQR, 242-614; P < .001), and performed more services (2330; IQR, 694-2748; P < .001) but collected about the same per provider ($141,035; IQR, $56,555-$172,864; P = .426). Older age was associated with rural practice (P = .027). Among both urban and rural ORL physicians, the variety and complexity of procedures and patient comorbidity profiles were comparable. CONCLUSION: Most ORL physicians practice in large urban settings, a finding potentially related to financial sustainability and career opportunity. With an already small workforce, the aging rural ORL physician population is an identifiable weak point in the otolaryngology specialty that must be addressed with geo-specific recruitment campaigns, rural work incentivization, and the development of career advancement opportunities in rural areas.

Crosstalk between leukocytes triggers differential immune responses against Salmonella enterica serovars Typhi and Paratyphi.

Enteric fevers, caused by the Salmonella enterica serovars Typhi (ST), Paratyphi A (PA) and Paratyphi B (PB), are life-threatening illnesses exhibiting very similar clinical symptoms but with distinct epidemiologies, geographical distributions and susceptibilities to antimicrobial treatment. Nevertheless, the mechanisms by which the host recognizes pathogens with high levels of homology, such as these bacterial serovars, remain poorly understood. Using a three-dimensional organotypic model of the human intestinal mucosa and PA, PB, and ST, we observed significant differences in the secretion patterns of pro-inflammatory cytokines and chemokines elicited by these serovars. These cytokines/chemokines were likely to be co-regulated and influenced the function of epithelial cells, such as the production of IL-8. We also found differing levels of polymorphonuclear leukocyte (PMN) migration among various infection conditions that either included or excluded lymphocytes and macrophages (Mϕ), strongly suggesting feedback mechanisms among these cells. Blocking experiments showed that IL-1ß, IL-6, IL-8, TNF-α and CCL3 cytokines were involved in the differential regulation of migration patterns. We conclude that the crosstalk among the lymphocytes, Mϕ, PMN and epithelial cells is cytokine/chemokine-dependent and bacterial-serotype specific, and plays a pivotal role in orchestrating the functional efficiency of the innate cells and migratory characteristics of the leukocytes.

The evolving roles of computer-based technology and smartphone applications in facial plastic surgery.

PURPOSE OF REVIEW: This article aims to provide a comprehensive review of the established and emerging applications of various computer-based technologies and smartphone applications in the field of facial plastic surgery. RECENT FINDINGS: Computer-based technologies and smartphone applications have widespread utility across various domains of facial plastic surgery; these include preoperative consultation, surgical planning, intraoperative navigation, custom implant creation, postoperative assessment, physician productivity, communication, and education. Smartphone applications are being utilized for assessment of patients such as those with facial paralysis. Three-dimensional (3D) imaging and 3D printing has influenced preoperative counseling, surgical planning, and execution. The incorporation of intraoperative navigation has the potential to improve the accuracy and precision of facial reconstruction. SUMMARY: Current advances in computer-based technology have made a significant impact on the practice of facial plastic and reconstructive surgery. These technological advances have influenced how we counsel patients, perform procedures, assess outcomes, and learn new techniques.