Americans with disabilities act cases initiated by individuals with cochlear implants in the United States.

OBJECTIVE: The Americans with Disabilities Act (ADA) is a federal law that forbids discrimination against individuals with certain disabilities, including hearing impairment. This study aimed to determine the nature of ADA discrimination complaints in individuals with cochlear implants. METHODS: A search for court decisions containing the terms "cochlear implant" and ("Americans with Disabilities Act" or "ADA") from 1985 to 2021 was performed with the Westlaw Campus Research legal database. Cases were included and analyzed if at least one of the plaintiffs had a cochlear implant and was claiming discrimination related to their hearing impairment based on the ADA. RESULTS: 24 cases initiated between 2003 and 2021 in 19 US states were identified based on inclusion criteria. The highest number of cases occurred in California (N = 4, 16.7 %). The alleged discrimination most frequently took place at a K-12 school (N = 9, 37.5 %), workplace (N = 7, 29.2 %), or during an encounter with police/correctional officers (N = 4, 16.7 %). Fourteen (58.3 %) cases involved complaints under Title II (Public Services) of the ADA. Seven (29.2 %) involved Title I (Employment) and 4 (16.7 %) involved Title III (Public Accommodations). Summary judgment was given in favor of the defendant or the case was dismissed entirely in 16 (66.7 %) of the cases. CONCLUSION: Patients with cochlear implants are still at risk of discrimination because of their disability. Cochlear implantees, school employees, workplace supervisors, and law enforcement personnel can benefit from ADA education.

Laryngeal surgery for congenital laryngomalacia: NSQIP-P analysis of complications.

OBJECTIVE: To evaluate predictors of complications in children with congenital laryngomalacia who underwent laryngeal surgery. METHODS: Multi-institutional retrospective analysis using the American College of Surgeons-NSQIP-P database (2014-2019). CPT code 31541 and ICD-10 code Q35.1 (congenital laryngomalacia) were used to select patients <18 years. Variable predictors included demographics and medical co-morbidities. Main outcomes assessed included total length of hospital stay (LOS), reintubation, reoperation and readmission. RESULTS: 1092 children were identified, 450 (41.1%) females and 642 (58.6%) males, with a mean age of 1.1 years (95% CI 1.0-1.2). Mean LOS was 3.9 days (95% CI 3.3-4.6). Sixteen (1.5%) were reintubated, 30 (2.7%) were readmitted, and 18 (1.6%) were reoperated within 30 days. Thirty-one (2.8%) were still in hospital at 30 days. Regression analysis revealed an increase in LOS for several groups; the largest effect was seen for patients with preoperative ventilator dependence, admission within the first 28 days of life, and those who were discharged to other healthcare facilities (p < .001). Preoperative co-morbidities significantly associated with a higher frequency of reintubation included ventilator dependence (p = .003), history of prematurity (p = .016) and chronic lung disease (p = .041). Children undergoing surgery in the first 28 days of life were 10.16 times as likely to return to the OR for a related reason within 30 days than older children (p = .038). CONCLUSION: Complications were rare after laryngeal surgery with a postop diagnosis of laryngomalacia. Recognizing pertinent clinical factors can help with risk assessment and management.

A pilot study of stellate ganglion block paired with exposure therapy: Feasibility and acceptability in combat veterans with posttraumatic stress disorder.

BACKGROUND: There is growing evidence that stellate ganglion block (SGB) combined with trauma-focused therapy may help veterans with posttraumatic stress disorder (PTSD) whose symptoms have not responded to traditional treatments. By combining SGB with in vivo exposure, veterans may be more able to fully engage in treatment and see improvement in their overall functioning. OBJECTIVE: The primary aim of this project was to conduct a nonrandomized pilot trial on the feasibility and acceptability of delivering SGB paired with individual psychotherapy to veterans with combat-related PTSD. METHOD: Eligible veterans (N = 14) constructed a hierarchy of in vivo exposure exercises, received the SGB procedure, and attended four additional weekly psychotherapy sessions with a focus on exposure exercises. Participants completed measures at baseline, weekly during treatment, and follow-up assessments immediately posttreatment and 1-month later. RESULTS: The recruitment target was easily met, session attendance was strong, and dropout was relatively low (21.4%). SGB was well tolerated with only mild, transient side effects. Participants reported satisfaction with the treatment they received as measured by the Client Satisfaction Questionnaire (M = 28.8). Paired t test analyses revealed a significant decrease in PTSD symptoms as measured by the PTSD Checklist for DSM-5. We also observed a significant reduction in PTSD symptoms as measured by the Clinician-Administered PTSD Scale for DSM-5 in mixed models, F(2, 13) = 8.68, p = .004. There were no significant improvements in psychosocial functioning or quality of life. CONCLUSION: SGB paired with psychotherapy is feasible and acceptable to veterans and holds promise for symptom reduction among veterans with combat-related PTSD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Delayed Anaphylactic Reaction to Midazolam in the Absence of Immediate Respiratory or Skin Manifestations.

Anaphylaxis, a type 1 hypersensitivity reaction, is a feared but uncommon complication of medications administered in the perioperative period. The incidence of perioperative hypersensitivity reactions has been reported to range from 1 in 20,000 to 1 in 1,361. Anesthesiologists are well aware of common causes of hypersensitivity such as paralytics and antibiotics; however, less common triggers of anaphylaxis need to be considered as well. Midazolam, a short acting benzodiazepine metabolized by cytochrome P450 enzymes, is considered very safe with a minimal risk profile. Previous reports have described adverse reactions to occur within seconds to minutes following the administration of midazolam. We describe a patient with no known history of asthma or allergies who underwent elective hydrocelectomy with spinal analgesia without incident until 42 minutes later at the conclusion of the procedure, when they experienced circulatory collapse necessitating immediate emergency treatment. This case emphasizes the necessity to improve knowledge and awareness of delayed hypersensitivity reactions following the administration of perioperative medications such as midazolam.

Does Medical School Rank Impact Matching into Otolaryngology?

OBJECTIVE(S): To describe how medical school rank may be associated with matriculation into otolaryngology residency programs. METHODS: A list of medical students who matched into otolaryngology residencies in 2020, 2021, and 2022 was obtained from Otomatch (Otomatch.com). For each student, their medical school, U.S. News & World Report Best Medical School (Research) ranking, and region based on the U.S. Census divisions were recorded. The medical schools were divided into four Tiers according to rank: 1-40 (Tier 1), 41-80 (Tier 2), 81-124 (Tier 3), and 125-191 (Tier 4). Residency programs were also grouped by region, whether they were large (>3 residents/year) or small (<3 residents/year), and their Doximity reputation ranking: 1-31 (Tier 1), 32-61 (Tier 2), 62-91 (Tier 3), and 92-125 (Tier 4). RESULTS: Nine hundred and ninety-five medical students were included in this study. The majority of residency matriculants were MDs (N = 988, 99.3%) who came from Tier 1 (N = 410, 41.2%) or Tier 2 (N = 313, 31.5%) medical schools. Those who attended higher-tier medical schools were more likely to match into higher-tier residency programs (p < 0.001). 57.8% (N = 237) of the applicants who attended Tier 1 medical schools matriculated into a Tier 1 residency program, whereas only 24.7% (N = 42) of the applicants from Tier 4 medical schools matriculated into a Tier 1 residency program. CONCLUSION: Applicants who attend top-tier medical schools represent significantly more residents at top-tier otolaryngology residency programs than those from lower tier medial schools. LEVEL OF EVIDENCE: NA Laryngoscope, 133:3353-3357, 2023.

Outcomes After Injection-Based Therapy: A Pain Outcomes Questionnaire for Veterans Univariate Analysis.

Background: The Pain Outcomes Questionnaire-For Veterans (POQ-VA) was developed within the Veterans Health Administration (VHA) as a brief but psychometrically sound pain outcomes instrument that assesses key domains. In routine clinical practice, it is valid and reliable for evaluating effectiveness of treatment of chronic noncancer pain in veterans. We hypothesized that POQ-VA scores would improve across multiple domains in the veteran population following injection-based interventional treatment for chronic pain. Methods: We aggregated all available POQ-VA reports from veterans who underwent ≥ 1 interventional pain procedures between April 1, 2009 and April 1, 2019. Patients were included who had pre- and posttreatment POQ-VA results separated by ≤ 6 months (N = 112). A paired-samples t test was used to compare means, standard deviations, and ranges for each POQ-VA domain. Individual question responses were analyzed using a nonparametric Wilcoxon matched-pairs signed-rank test. Results: All POQ-VA domains showed a statistically significant decrease posttreatment (P ≤ .03). Directionally, the responses to 17 of 20 individual POQ-VA questions reflect a small but statistically significant positive treatment response (P < .04). Conclusions: Most veterans undergoing injection therapy for chronic pain had statistically significant improvements in POQ-VA measures within a 6-month period. To conduct more rigorous, multivariate studies, continued and widespread use of the POQ-VA instrument is warranted.

Otolaryngology Residency Match During the COVID-19 Pandemic.

Objective To review changes made by otolaryngology residency program directors (PDs) during the 2020-2021 National Resident Matching Program (NRMP) match cycle and describe their attitudes toward the 2021-2022 match cycle. Methods Cross-sectional study using an anonymous 31-item online survey in Research Electronic Data Capture (REDCap) with questions regarding the 2020-2021 NRMP match. This survey was distributed to 125 PDs from Accreditation Council for Graduate Medical Education (ACGME)-accredited otolaryngology residency programs. Results Thirty-three PDs responded (26.4%). Of the PDs, 78.8% had an online info-session prior to the start of the cycle, and 30.3% reported that an increased number of applicants contacted them compared to the prior cycle. There were no changes made in Step 1 criteria (72.7%), and 81.8% reported no changes in interview selection. Of the PDs, 54.5% reported interviewing more candidates. Respondents reported a decreased cancellation rate (66.7%) and cost of recruiting (87.9%); 87.9% said that they did not change the way they developed their rank order list (ROL), and 84.8% reported matching at their usual level compared to prior years. Of the respondents, 42.4% reported making a change that was an overall improvement for their program. Of the PDs, 34.4% were unsure whether they would sustain virtual interviews in 2021-2022, 25% stated that they would not incorporate virtual interviews, and 40.7% stated that they would incorporate a virtual interview in some part of the cycle. Conclusion Otolaryngology PDs approached virtual interviewing in different ways. Despite the changes made, applicants can find comfort in knowing that match outcomes were perceived as typical by a majority of PDs.

Readmission and reoperation after laryngeal dilation in children: NSQIP-P analysis.

OBJECTIVE: To identify specific comorbidities and their relationship to complications in children who underwent laryngeal dilation, specifically comparing children with tracheostomy versus no tracheostomy as well as differences in outcomes between age groups. METHODS: Retrospective study analyzing data collected in the American College of Surgeons National Surgical Improvement - Pediatric Database (2015-2018). Patients were selected using Current Procedural Terminology code 31528. Variables analyzed include demographics, comorbidities, readmission, reoperation, reintubation and total length of stay. RESULTS: 982 cases were identified. Comorbidities significantly higher (p < .001) in age group 1 (Age ≤ 1 year, N = 245) versus age groups 2 (Age >1 but ≤ 3 years, N = 151) and 3 (Age > 3 years, N = 270) include premature birth, ventilator dependent, oxygen support, cardiac risk factors, steroid use, nutritional support, and hematologic disorders. Comorbidities significantly higher (p < .001) in children without a tracheostomy include premature birth, history of asthma, bronchopulmonary dysplasia/chronic lung disease, oxygen support, structural pulmonary/airway abnormality, esophageal/gastric/intestinal disease, history of previous cardiac surgery, developmental delay/impaired cognitive status, cerebral palsy, neuromuscular disorder, steroid use, and nutritional support. Younger children were significantly more likely (p < .001) to require reintubation and remain in the hospital longer. Children without a tracheostomy were significantly more likely (p < .001) to return to the operating room and remain in the hospital longer. CONCLUSION: Younger children and those without a tracheostomy are more likely to have adverse outcomes after laryngeal dilation. Awareness of these associations and outcomes is helpful in establishing benchmarks for outcomes in this group.