Association of COVID-19 Vaccination With Changes in Smell and Taste.

Since the introduction of vaccines for severe acute respiratory syndrome coronavirus 2 in the United States, there has been significant vaccine hesitancy, in part due to fear of adverse effects. We sought to investigate the rates of smell and taste changes after COVID-19 vaccination compared to other common vaccines. Our study cohort included individuals identified by Current Procedural Terminology code in the TriNetX database receiving the COVID-19 first series, COVID-19 booster, influenza, tetanus, diphtheria, pertussis (TDAP), or pneumococcal vaccines between December 15, 2020, and August 15, 2023. After 1:1 propensity score matching, postvaccination incidence of disturbance of smell and taste was significantly less likely after COVID-19 first series vaccine compared to influenza (odds ratios, OR: 0.27 [95% confidence interval, CI: 0.20-0.36]), TDAP (OR: 0.35 [95% CI: 0.26-0.47]), and pneumococcal vaccines (OR: 0.17 [95% CI: 0.09-0.32]). Similarly, incidence of disturbance of smell and taste was significantly less likely after COVID-19 booster vaccine compared to the influenza (OR: 0.60 [95% CI: 0.48-0.76]), TDAP (OR: 0.63 [95% CI: 0.47-0.85]), and pneumococcal vaccines (OR: 0.44 [95% CI: 0.28-0.68]). This study builds upon the literature demonstrating the safety of COVID-19 vaccination.

Hearing Loss: Self-Reported Onset and Etiology Among Older Adults in the United States.

This study investigated self-reported age of onset and etiology of hearing loss among older adults in the United States. Study cohort included older adult (≥70 years) survey respondents from the 2017 to 2020 National Health and Nutrition Examination Survey (n = 797). Overall, 51.1% [95% confidence interval [CI]: 46.1-56.1] of older adults self-reported hearing loss. Among older adults who reported hearing loss, the most reported age of onset was age 70 or older (41.7% [95% CI: 38.1%-45.3%]), followed by sequentially younger age brackets including ages 60 to 69 years (27.3% [95% CI: 23.6%-31.3%]) and ages 40 to 59 years (15.7% [95% CI: 12.9%-19.0%]). The most common etiology of hearing loss was aging (66.3% [95% CI: 60.8%-71.4%]) followed by loud long-term noise (30.3% [95% CI: 26.2%-34.9%]) and loud brief noise (13.8% [95% CI: 10.3%-18.4%]). Our study describes the most common age of onset and etiologies of hearing loss among a representative sample of United States older adults.

Trends in Management of Ménière Disease: A TriNetX Network Database Analysis.

This study investigated management practices for Meniere's disease (MD) and their temporal trends from 2008 to 2022 within the TriNetX network database. Study cohort included adult patients (≥18 years) with the diagnosis of MD from TriNetX's multi-institutional medical records (n = 77,493). MD diagnosis and management were queried based on the international classification of diseases, tenth revision, current procedural terminology, and RXNorm codes. Temporal trends were analyzed using joinpoint regression. There was significant increase in rates of relevant medications prescribed within 12 months of MD diagnosis from 2008 to 2022 (annual percent change [APC]: 1.2 [95% confidence interval, CI: 0.4-1.9]). There were no significant changes in rate of intratympanic injection within 12 months of MD diagnosis (1.7 [95% CI: -1.1 to 4.5]). Rate of endolymphatic sac surgery and labyrinthectomy any time after MD diagnosis gradually decreased from 2008 to 2022 at APC of -8.1 (95% CI: -11.8 to -4.2) and -11.0 (95% CI: -14.0 to -7.7), respectively. Use of relevant medications has significantly increased during the early management of MD and the overall use of surgical treatments has decreased.

Association of Symptomatic Dizziness With All-Cause and Cause-Specific Mortality.

Importance: Dizziness is a highly prevalent complaint with wide-ranging causes and resultant morbidity. Whether symptomatic dizziness and its various manifestations are associated with all-cause and cause-specific mortality is unknown. Objective: To examine the associations of symptomatic dizziness and its manifestations with all-cause and cause-specific mortality. Design, Setting, and Participants: This cohort study is a mortality follow-up study based on the 1999-2004 National Health and Nutrition Examination Survey. The study cohort included adults 40 years and older who completed questions about symptomatic dizziness, including problems with dizziness, balance, falling, and positional dizziness, within the past 12 months. Respondents were linked to mortality data through December 31, 2019. Data were analyzed from February to August 2023. Exposure: Self-reported symptomatic dizziness. Main Outcomes and Measures: All-cause and cause-specific (cardiovascular disease, diabetes, cancer, and unintentional injuries) mortality. Cox proportional hazard regression models were used to examine associations between symptomatic dizziness and all-cause and cause-specific mortality while adjusting for demographics and medical history. Results: In this nationally representative cohort of 9000 middle-aged and older US adults (mean [SD] age, 61.8 [13.8] years; 4570 [50.8%] female), prevalence of symptomatic dizziness was 23.8%. Specifically, 18.3% reported problems with dizziness, 14.5% reported problems with balance, 5.7% reported problems with falling, and 3.8% reported dizziness when turning in bed (positional dizziness). At a median (range) of 16.2 (0.1-20.6) years of follow-up, all-cause mortality for adults with symptomatic dizziness was higher than for those without (45.6% vs 27.1%). Symptomatic dizziness was associated with elevated risk for cause-specific mortality from diabetes (hazard ratio [HR], 1.66; 95% CI, 1.23-2.25), cardiovascular disease (HR, 1.33; 95% CI, 1.12-1.55), and cancer (HR, 1.21; 95% CI, 0.99-1.47) but not unintentional injuries (HR, 0.98; 95% CI, 0.51-1.88). Reporting problems with balance or falling was associated with increased all-cause mortality (balance: HR, 1.27; 95% CI, 1.17-1.39; and falling: HR, 1.52; 95% CI, 1.33-1.73), cardiovascular disease-specific mortality (balance: HR, 1.41; 95% CI, 1.20-1.66; and falling: HR, 1.49; 95% CI, 1.15-1.94), and diabetes-specific mortality risks (balance: HR, 1.74; 95% CI, 1.26-2.39; and falling: HR, 2.01; 95% CI, 1.26-3.18). There was no association between positional dizziness and mortality (HR, 0.98; 95% CI, 0.82-1.19). Conclusions and Relevance: In this cohort study, symptomatic dizziness was associated with increased risk for all-cause and diabetes-, cardiovascular disease-, and cancer-specific mortality. The imprecision of the effect size estimate for cancer-specific mortality prevents making a definitive conclusion. Future studies are needed to determine whether symptomatic dizziness indicates underlying health conditions contributing to mortality or if early intervention for imbalance and falls can reduce mortality risk.

COVID-19 in the Clinic: Trial of an Aerosol Containment Mask for Endoscopic Clinic Procedures.

OBJECTIVE: Create an aerosol containment mask (ACM) for common otolaryngologic endoscopic procedures which also provides nanoparticle-level protection to patients. STUDY DESIGN: Prospective feasibility study. SETTING: In-person testing with a novel ACM. METHODS: The mask was designed in Solidworks and 3-dimensional printed. Measurements were made on 100 consecutive clinic patients who underwent medically necessarily endoscopy, 50 rigid nasal and 50 flexible, by 9 surgeons. RESULTS: Of the 50 patients who underwent rigid nasal endoscopy with the ACM, 0 of 25 patients with the suction off and 0 of 25 patients with the suction on had evidence of leakage of 0.3 µm particles. Of the 50 patients who underwent flexible endoscopy with the ACM, 0 of 25 patients with the suction off and 0 of 25 patients with the suction on had evidence of leakage of 0.3 µm particles. In terms of comfort, 73% of patients found the ACM somewhat or very comfortable without suction, compared to 86% with the suction on. Surgeons were able to visualize all necessary anatomic areas in 98% of procedures. In 97% of procedures, the masks were able to be placed easily. CONCLUSION: ACM can accommodate rigid nasal and flexible endoscopes and may prevent leakage of patient-generated aerosols, thus avoiding contamination of the room and protecting health care workers from airborne contagions. LEVEL OF EVIDENCE: The level of evidence is 2.

Unplanned 30-Day ER Visit Rate and Factors Associated With ER Visits After Ambulatory Sinus Surgery.

BACKGROUND: Emergency room (ER) visits after surgery can be inconvenient and costly to the patient and the healthcare system. Estimates of the 30-day ER visit rate following ambulatory sinus procedures and their risk factors are largely unknown in the literature. OBJECTIVE: To determine the 30-day postoperative ER visit rate following ambulatory sinus procedures and the causes and risk factors associated with ER visits. METHODS: This is a retrospective, cohort study using data from the State Ambulatory Surgery and Services Databases (SASD) and the State Emergency Department Databases (SEDD) for California, New York, and Florida in 2019. We identified adult (18 years old) patients with chronic rhinosinusitis who underwent ambulatory sinus procedures from the SASD. Cases were linked to the SEDD to identify ER visits occurring within 30 days after the procedure. Logistic regression models were used to identify patient- and procedure-related risk factors associated with the 30-day postoperative ER visit. RESULTS: Among the 23 239 patients, the 30-day postoperative ER visit rate was 3.9%. The most common reason for ER visit was bleeding (32.7%). A total of 56.9% of the ER visits occurred within the first week. In the multivariate analysis, factors associated with ER visits included Medicare (odds ratio [OR] 1.29 [1.09-1.52], P = .003), Medicaid (OR 2.06 [1.69-2.51], P < .001), self-pay/no insurance (OR 1.44 [1.03-2.00], P = .031), chronic kidney disease/end-stage renal disease (OR 1.63 [1.06-2.51], P = .027), chronic pain/opioid use (OR 2.70 [1.02-7.11], P = .045), and a disposition other than home (OR 12.61 [8.34-19.06], P < .001). CONCLUSION: The most common reason for ER visit after ambulatory sinus procedures was bleeding. An increased ER visit rate was associated with certain demographic factors and medical comorbidities but not with procedure characteristics. This information can help us identify the patient populations who are at higher risk for ER visits to improve their postoperative recovery.

Telemedicine in an Otolaryngology Clinic Serving the Incarcerated Population.

OBJECTIVE: There is a paucity of data investigating the effect of implementation of telehealth on vulnerable populations, particularly the incarcerated. Our objective is to evaluate patient and physician satisfaction with telehealth (telephone visits) used in an outpatient otolaryngology clinic serving the incarcerated population. METHODS: Incarcerated patients who were served by otolaryngologists via telephone visits from a large tertiary care center from June 2021 to January 2022 were included (n = 20) in this pilot study. Patient and physician satisfaction with the encounters were evaluated using the Telehealth Satisfaction Questionnaire and a modified physician satisfaction questionnaire, respectively. RESULTS: Consultations for various otolaryngological complaints were completed via telephone for incarcerated patients including hearing loss, tinnitus, facial fracture, dysphonia, and tonsillitis. Mean patient and physician satisfaction scores were high at 4.25 ± 0.12 and 4.65 ± 0.13 respectively (score range 1-5). Patient satisfactions subdomain scores were 3.92 ± 0.13 for quality of care provided, 3.99 ± 0.13 for similarity to face-to-face encounter, and 4.2 ± 0.17 for perception of the interaction. Imaging or audiogram was available prior to appointment in 60% of cases, with labs, imaging, or audiogram ordered after in 40% of cases and initial pharmaceutical treatment provided to 10% of patients. 45% of patients required follow up in-person, while 40% were discharged pro re nata, and 15% were followed up with another phone visit. There was no statistically significant association between demographic or clinical characteristics and patient or physician satisfaction scores. CONCLUSIONS: Consultations for various otolaryngological complaints were completed via telephone with high patient and physician satisfaction within an incarcerated population in this pilot study. Telephone visit is likely a feasible alternative format that can advance otolaryngological care. Studies with larger sample sizes are required to ensure quality of care and advance social justice for this chronically underserved population.

COVID-19 in the Clinic: Human Testing of an Aerosol Containment Mask for Endoscopic Clinic Procedures.

OBJECTIVE: To create an aerosol containment mask (ACM) for common otolaryngologic endoscopic procedures that also provides nanoparticle-level protection to patients. STUDY DESIGN: Prospective feasibility study . SETTING: In-person testing with a novel ACM. METHODS: The mask was designed in Solidworks and 3D printed. Measurements were made on 10 healthy volunteers who wore the ACM while reading the Rainbow Passage repeatedly and performing a forced cough or sneeze at 5-second intervals over 1 minute with an endoscope in place. RESULTS: There was a large variation in the number of aerosol particles generated among the volunteers. Only the sneeze task showed a significant increase compared with normal breathing in the 0.3-µm particle size when compared with a 1-tailed t test (P = .013). Both the 0.5-µm and 2.5-µm particle sizes showed significant increases for all tasks, while the 2 largest particle sizes, 5 and 10 µm, showed no significant increase (both P < .01). With the suction off, 3 of 30 events (2 sneeze events and 1 cough event) had increases in particle counts, both inside and outside the mask. With the suction on, 2 of 30 events had an increase in particle counts outside the mask without a corresponding increase in particle counts inside the mask. Therefore, these fluctuations in particle counts were determined to be due to random fluctuation in room particle levels. CONCLUSION: ACM will accommodate rigid and flexible endoscopes plus instruments and may prevent the leakage of patient-generated aerosols, thus avoiding contamination of the room and protecting health care workers from airborne contagions. LEVEL OF EVIDENCE: 2.

Exogenous l-lactate promotes astrocyte plasticity but is not sufficient for enhancing striatal synaptogenesis or motor behavior in mice.

l-Lactate is an energetic and signaling molecule that may be produced through astrocyte-specific aerobic glycolysis and is elevated in striatal muscle during intensive exercise. l-Lactate has been shown to promote neurotrophic gene expression through astrocytes within the hippocampus, however, its role in neuroplasticity within the striatum remains unknown. This study sought to investigate the role of peripheral sources of l-lactate in promoting astrocyte-specific gene expression and morphology as well as its role in neuroplasticity within the striatum of healthy animals. Using in vitro primary astrocyte cell culture, administration of l-lactate increased the expression of the neurotrophic factors Bdnf, Gdnf, Cntf, and the immediate early gene cFos. l-Lactate's promotion of neurotrophic factor expression was mediated through the lactate receptor HCAR1 since application of the HCAR1 agonist 3,5-DHBA also increased expression of Bdnf in primary astrocytes. Similar to our previous report demonstrating exercise-induced changes in astrocytic structure within the striatum, l-lactate administration to healthy mice led to increased astrocyte morphological complexity as well as astrocyte-specific neurotrophic expression within the striatum. Our study failed to demonstrate an effect of peripheral l-lactate on synaptogenesis or motor behavior. Insufficient levels and/or inadequate delivery of l-lactate through regional cerebral blood flow within the striatum may account for the lack of these benefits. Taken together, these novel findings suggest a potential framework that links peripheral l-lactate production within muscle and intensive exercise with neuroplasticity of specific brain regions through astrocytic function.