Work-related musculoskeletal disorders among otolaryngology-head and neck surgery residents.

PURPOSE: Surgical residents are at high risk for work-related musculoskeletal disorders which can impact surgical training and overall quality of life. We sought to assess musculoskeletal symptoms among current United States otolaryngology-head and neck surgery residents. We focused on the upper extremity given fine motor control for microsurgical procedures and increased keyboarding requirements. This study builds on previous research by evaluating setting attribution and attitudes toward ergonomics among otolaryngology residents. MATERIALS AND METHODS: A web-based, cross-sectional survey incorporating Nordic Musculoskeletal Questionnaire and ergonomics-related questions was sent to otolaryngology residency program directors in September of 2021. Descriptive statistics, Spearman's correlation, logistic regression, and comparison of proportions were utilized. RESULTS: Overall, 148 otolaryngology residents completed the survey; 70 were female (45 %), 83 male (54 %), and 1 non-binary (0.6 %). MSK symptoms were reported in the neck (77.0 %), lower back (45.5 %), and upper back (31.8 %) most frequently. Symptoms were work-related for 80 % of residents, with 84.7 % deemed operating-room-related. Some required treatment (14.5 %) or formal evaluation (11.0 %) of their injury. Injuries prevented residents from working (7.4 %), operating (9.5 %), and performing activities of daily living (27.0 %). Many reported they would use ergonomic equipment (94.2 %), dictation software (74.1 %), and scribes (81.3 %) if available. CONCLUSIONS: Despite increased surgical ergonomic awareness, musculoskeletal symptoms are still prevalent among otolaryngology residents. Nearly 1 in 9 residents required evaluation and treatment of their musculoskeletal symptoms, and one third reported lacking various ergonomic measures. Given the high prevalence of work-related musculoskeletal disorders, ergonomic practices for O-HNS trainees should be emphasized by residency programs.

Use of dexmedetomidine for controlled hypotension in middle ear surgery: A systematic review and meta-analysis.

BACKGROUND: Microsurgical operations such as middle ear surgery rely heavily on visibility of the surgical field. Anesthetic techniques such as controlled hypotension have been developed to improve surgical field visibility by attempting to decrease bleeding. Many agents have been utilized to achieve controlled hypotension intraoperatively. Dexmedetomidine is a relatively newer agent which works on alpha-2 receptors to decrease sympathetic tone. This paper sought to determine the efficacy of dexmedetomidine for optimizing surgical field visibility in MES. METHODS: A comprehensive search strategy was used in PubMed, SCOPUS, CINAHL, and CENTRAL through August 9, 2022 for this systematic review and meta-analysis. INCLUSION CRITERIA: adult patients undergoing middle ear surgery with dexmedetomidine used for controlled hypotension to improve surgical field visibility. Risk of bias was assessed via Cochrane RoB 2. Meta-analysis of mean difference for surgical field scores and risk ratios for positive surgical field scores were used to compare dexmedetomidine with placebo or other agents. RESULTS: Fourteen studies were included in this review. Statistically significant mean difference was found to favor dexmedetomidine over placebo for Fromme-Boezaart surgical field scores. Statistically significant results were also demonstrated favoring dexmedetomidine over other agents in risk ratio for receiving positive surgical field scores, as well as surgeon and patient satisfaction scores. CONCLUSIONS: Controlled hypotension is an invaluable tool for surgical field visibility. Improved surgical field visibility was observed with dexmedetomidine compared with placebo and various other agents. Risk of sub-optimal bleeding scores was significantly lower with dexmedetomidine. Dexmedetomidine is effective at improving surgical field visibility in middle ear surgery.

The Use of Portable, Very Low-field (0.064T) MRI to Image Cochlear Implants: Metallic Image Artifact in Comparison to Traditional, Stationary 3T MRI.

Objective: To assess image artifact when imaging a cochlear implant (CI) with a conventional 3T MRI machine compared with a very low-field (0.064T) MRI. Patients: None. Intervention: Diagnostic study. Main Outcome Measure: Image artifact size associated with the CI affixed to an MRI phantom at very low-field 0.064T MRI versus 3T MRI. Results: The longest diameter of the image artifact was 125 mm for the 3T MRI and 86 mm for the 0.064T MRI, representing 45% longer image artifact generated in the 3T MRI. The actual volume of the imaging phantom was 1371 cm3. The volume of the image artifact was measured as 379 cm3 in the 3T MRI, representing a loss of 27.6% of the actual volume of the imaging phantom. The volume of image artifact was measured as 170 cm3 in the 0.064T MRI, representing a loss of 12.4% of the phantom volume. Conclusions: 3T MRI had better image quality. This result was not surprising given that larger magnetic field strength is known to provide higher resolution. There was 15% less image artifact generated in the very low-field MRI machine compared with a conventional 3T device. And there was also subjectively increased distortion of the imaging phantom at 3T MRI compared with the 0.064T MRI. With minimized safety concerns and a much lower cost than conventional 3T machines, very low-field scanners may find expanded clinical uses. This preclinical study explores the potential utility of very low-field MRI in scanning CI recipients.

Diagnostic accuracy and management concordance of otorhinolaryngological diseases through telehealth or remote visits: A systematic review & meta-analysis.

INTRODUCTION: COVID-19 has led to delays in providing healthcare in both emergency and non-emergency settings, especially in surgical subspecialties which rely heavily on referrals and in-person visits. Without an established telehealth infrastructure, many otorhinolaryngological departments experienced decreases in consultations. Telemedicine has attempted to bridge the gap between pre- and post-pandemic periods by creating a safe avenue of communication between otorhinolaryngologists and patients. This review hopes to address the accuracy of telemedicine in patient diagnosis and management. METHODS: Searches were conducted since study conception until June 30, 2022, on multiple databases including PubMed, SCOPUS, and CINAHL for this systematic review and meta-analysis. Diagnostic accuracy, management accuracy, kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were meta-analyzed by comparing virtual visits to in-person visits (gold standard). RESULTS: Nineteen studies were included in this review. A total of 1518 patients were included across all studies. When comparing virtual visits against in-person visits, accurate diagnosis was made in 86.2% [82.1,89.9, I2 = 73.5%, P < 0.0001] of patients and management accuracy was 91.5% [86.1,95.7, I2 = 81.8%, P < 0.0001] when treating patients. Kappa value determining interrater reliability was 0.8 [0.7,0.9, I2 = 81.8%, P < 0.0001]. CONCLUSION: Our data suggest that diagnostic and management concordance is above 80% when comparing diagnosis and management strategies in patients who underwent both telehealth and in-person visits with an otorhinolaryngologist. In uncomplicated patients, telehealth might be a reliable source for diagnosis and management however, in-person consultation is likely still required for pathologies in which physical exam, imaging or procedural elements represent a vital component of the work-up.

Otolaryngologic Presentations to Emergency Departments During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

OBJECTIVES: To perform a systematic review of otolaryngologic presentation rates to emergency department settings before and after lockdown due to the COVID-19 pandemic. SOURCES: PubMed, Scopus, and CINAHL. METHODS: A systematic search was conducted following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) for studies describing otolaryngologic presentations to emergency department and rapid access clinic settings both in the before-lockdown and after-lockdown periods. The start of after-lockdown period varied based on initiation of lockdown, ranging from March 1st to June 1st of 2020 across general emergency department studies. RESULTS: A total of 14 studies were included in this review. About 10 were general emergency departments, 3 were specifically pediatric emergency departments, and 1 study focused on the geriatric population (>65 years). A total of 13 790 patients were included, with 9446 in the before-lockdown period (68.5%) and 4344 in the after-lockdown period (31.5%). Meta-analysis of proportions for otolaryngologic presentations across general emergency departments was performed. Comparison of weighted proportions found significant differences between before-lockdown and after-lockdown presentation rates for infectious etiologies, tonsillitis specifically, foreign bodies, non-infectious airway issues, and epistaxis among these studies. CONCLUSIONS: The increased proportions of various non-infectious presentations (eg, epistaxis, foreign bodies, and airway issues) following lockdown might be associated with proportional decreases in infectious pathologies, given decreased social contact to prevent SARS-CoV-2 transmission. Overall, it is important for otolaryngologists to recognize what presentations might more commonly be seen and require evaluation and potential intervention in light of a global pandemic.

Supine Pharyngeal Width Is Associated With Complete Concentric Palatal Collapse During Drug-Induced Sleep Endoscopy and Hypoglossal Nerve Stimulator Outcomes.

OBJECTIVE: Hypoglossal nerve stimulation (HNS) implantation in the US requires preoperative drug-induced sleep endoscopy (DISE) screening for complete concentric palatal collapse (CCC) to establish treatment candidacy. We hypothesized that supine pharyngeal width (SPW) in awake patients is associated with CCC and HNS therapy outcomes. METHODS: Adults with moderate to severe obstructive sleep apnea underwent awake measurement of SPW followed by DISE screening for CCC. Eligible patients electing for HNS implantation underwent postoperative polysomnography per standard of care. RESULTS: SPW was measured in 73 patients. For SPW >20 mm, the positive likelihood ratio for absence of CCC was 6.67 with pre- and post-test odds of 6.3 and 42.0, respectively. Postoperative PSG data were available from 31 of 44 (70.5%) patients subsequently implanted with HNS. Patients with SPW >20 mm had a greater rate of HNS response than those with SPW ≤20 (62 vs 30%; P < .05). Only SPW and BMI were significantly associated with CCC and HNS response in regression models. CONCLUSION: In a retrospective cohort study, SPW was significantly associated with CCC and postoperative apnea-hypopnea index following HNS implantation. SPW may be a viable screening tool for HNS candidacy.