Factors associated with patient no-show rates in an academic otolaryngology practice.

OBJECTIVES/HYPOTHESIS: Factors affecting access to healthcare is an expanding area of research. This study seeks to identify factors associated with no-show rates in an academic otolaryngology practice to improve clinical efficiency and patient access to care. STUDY DESIGN: Retrospective review. METHODS: A retrospective review of scheduled clinical appointments from February 1, 2015 to January 30, 2016 at a single academic otolaryngology department was performed. Statistical analysis was completed to examine the association of no-show rates with the following: otolaryngology subspecialty, clinic location (e.g., main campus vs. satellite), patient demographic factors, attending seniority, temporal factors, insurance types, rurality, and visit type. RESULTS: There was an overall no-show rate of 20% for 22,759 scheduled clinic visits. Satellite clinics had the highest no-show rates at 25% (P < .001). New patient visits had the highest no-show rate at 24% (P < .001). Among subspecialties, facial plastic surgery had the lowest no-show rate (12.6%), whereas Pediatrics had the highest (23%) (P < .001). No significant association between gender and no-show rates was observed (P = .29), but patients over 60 years old had the lowest no-show rate (12.7%, P < .0001). Patients with Medicaid (28%), Medicare (15.3%), and commercial insurance (12.9%) had significantly different overall no-show rates (P < .0001). CONCLUSIONS: Increased clinic no-show rates are associated with satellite clinics, new patient visits, younger age, and insurance type. No-show rates varied among subspecialties. Further investigation is warranted to assess barriers to appointment compliance and to develop interventions to improve access to care. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:626-631, 2018.

Noncontact diffuse optical assessment of blood flow changes in head and neck free tissue transfer flaps.

Knowledge of tissue blood flow (BF) changes after free tissue transfer may enable surgeons to predict the failure of flap thrombosis at an early stage. This study used our recently developed noncontact diffuse correlation spectroscopy to monitor dynamic BF changes in free flaps without getting in contact with the targeted tissue. Eight free flaps were elevated in patients with head and neck cancer; one of the flaps failed. Multiple BF measurements probing the transferred tissue were performed during and post the surgical operation. Postoperative BF values were normalized to the intraoperative baselines (assigning "1") for the calculation of relative BF change (rBF). The rBF changes over the seven successful flaps were 1.89 ± 0.15, 2.26 ± 0.13, and 2.43 ± 0.13 (mean ± standard error), respectively, on postoperative days 2, 4, and 7. These postoperative values were significantly higher than the intraoperative baseline values (p<0.001), indicating a gradual recovery of flap vascularity after the tissue transfer. By contrast, rBF changes observed from the unsuccessful flaps were 1.14 and 1.34, respectively, on postoperative days 2 and 4, indicating less flow recovery. Measurement of BF recovery after flap anastomosis holds the potential to act early to salvage ischemic flaps.

Assessment of Appalachian region pediatric hearing healthcare disparities and delays.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to examine the timing of diagnostic and therapeutic services in cochlear implant recipients from a rural Appalachian region with healthcare disparity. STUDY DESIGN: Retrospective analysis. METHODS: Cochlear implant recipients from a tertiary referral center born with severe congenital sensorineural hearing loss were examined. Rural status and Appalachian status of their county of origin were recorded. A log-rank test was used to examine differences in the distributions of time to definitive diagnosis of hearing loss, initial amplification fitting, and cochlear implantation in these children. Correlation analysis of the rural status of each county and the timing of services was assessed. RESULTS: A total of 53 children born with congenital hearing loss were included in the study (36 from rural counties and 17 from urban/suburban counties). The distribution of weeks after birth to diagnosis (P=.006), amplification (P=.030), and cochlear implantation (P=.002) was delayed in rural children compared with urban children. An analysis factoring in the effect of implementation of mandatory infant hearing screening in 2000 demonstrated a similar delay in rural children for weeks to diagnosis (P=.028), amplification (P=.087), and cochlear implantation (P<.0001). CONCLUSIONS: Children with severe hearing loss in very rural areas, such as Appalachia, may have significant delays in diagnostic and rehabilitative services. Further investigation is warranted to assess causative factors in delays of cochlear implantation and to develop interventions to promote timely diagnosis and care. LEVEL OF EVIDENCE: 3b.

Hot or cold? Is monothermal caloric testing useful and cost-effective?

OBJECTIVES: Videonystagmography (VNG) is used widely in the assessment of balance dysfunction. The full test battery can be time-consuming and can induce patient discomfort. The purpose of this study was to examine the value of monothermal caloric testing in predicting unilateral caloric weakness, as well as abnormal VNG vestibular and nonvestibular eye movement, while considering the time and reimbursement associated with these tests. METHODS: In a retrospective review of 645 patients who completed a comprehensive VNG test battery with bithermal caloric testing, we calculated the specificity, sensitivity, and predictive values of monothermal caloric testing in relation to bithermal caloric results and noncaloric VNG results. RESULTS: With unilateral vestibular weakness (UVW) defined as a 25% interear difference, warm-air monothermal caloric testing yielded a sensitivity of 87% and a negative predictive value of 90% for predicting UVW. With a 10% UVW definition, the warm-air caloric testing sensitivity increased to 95% and the negative predictive value to 92%. Warm-air monothermal caloric testing had a positive predictive value of 85% and a negative predictive value of 18% for predicting noncaloric VNG findings; cold-air monothermal and bithermal testing displayed similar results. CONCLUSIONS: Isolated monothermal testing is a sensitive screening tool for detecting UVW, but is not adequate for predicting noncaloric VNG results.

Current epidemiology and management trends in acoustic neuroma.

OBJECTIVE: The objective of this study was to assess the epidemiology of acoustic neuroma and determine current trends in therapy using tumor registry techniques. STUDY DESIGN: Analysis of a national database. SUBJECTS AND METHODS: The Surveillance Epidemiology and End Results (SEER) database is a national tumor registry that began to identify and abstract benign and borderline tumors of the brain and central nervous system in the year 2004. Coding for International Classification of Diseases for Oncology (ICD-O-3) codes for schwannoma (9560/0) with collaborative staging (CS) coding for acoustic nerve (72.4) was used to identify acoustic neuromas. Demographic data, tumor size, and treatment data were analyzed. RESULTS: A total of 1621 patients with acoustic neuroma were identified, for an incidence rate of 1.1/100,000. Mean age was 53.1 years. Tumors were equally distributed across gender and tumor laterality, with the majority (84%) occurring in Caucasians. Nine hundred sixty-four patients (59.5%) were treated with surgery, whereas 341 (21.0%) were treated with radiation. A total of 1.6 percent received combined therapy over the study period, with the remaining patients receiving either no treatment or unknown therapy. Of tumors less than 2 cm, 27.2 percent were treated with radiotherapy. Statistically significant associations were observed with the increased use of radiotherapy for small (< 2 cm) tumors (P = 0.0001). CONCLUSION: Unlike data from single series, which usually represent individual treatment preferences and techniques, use of SEER data allows for the assessment of demographics and treatment trends at the national level. The results and potential applications are discussed.