Otolaryngology Applicant Perspectives on In-person and Virtual Residency Interviews.

OBJECTIVE: The objective of this study was to understand applicant perspectives on in-person and virtual otolaryngology residency interviews. STUDY DESIGN: Survey study. SETTING: Otolaryngology residency applicants who were interviewed during 2022-2023. METHODS: Survey sent to all otolaryngology residency applicants who interviewed during the 2022-2023 interview season. RESULTS: A total of 499 applicants were surveyed with 150 responses (30%). Approximately 48.3% of respondents were offered an in-person interview with 78.9% accepting the offer. Of those who did not accept, reasons included not wanting to travel (21.1%) and time conflicts (15.5%). When comparing virtual versus in-person interviews, those who attended virtual interviews were more likely to disagree that they connected with residents (P = .02) and that they had an improved perspective of the program (P = .002). The majority of applicants agreed that virtual interviews are more inclusive and equitable than in-person interviews (70.4%). When asked which interview style applicants would prefer, 63.1% of applicants preferred an in-person interview when compared to virtual with a second look option (29.5%) and virtual (7.4%). Respondents who self-identified as being underrepresented in medicine were less likely to choose in-person as their preferred interview format (P = .01) and were more likely to decline an in-person interview offer due to monetary limitations (P = .04). CONCLUSIONS: Applicants indicated dissatisfaction with connecting with residents and improving their perspective of the program when in a virtual setting. Applicants felt that virtual interviews were more equitable, but that if the barriers to equity were lessened then they would prefer in-person interviews.

Surgical and audiologic outcomes following revision cochlear implantation in children.

INTRODUCTION: The incidence of cochlear implantation failure is rare; however, complications can arise in which revision surgery becomes necessary. The purpose of this study is to review our institutional experience with revision cochlear implantation to further understand the surgical and audiological outcomes after cochlear implant failure. METHODS: This is a retrospective review of patients who underwent revision cochlear implantation from 2014 to 2022 at a single institution. RESULTS: Twenty-one patients required reimplantation within the 8-year study period. During this time frame, a total of 202 cochlear implants were implanted in 171 pediatric patients, resulting in a reimplantation rate of 5.9 %. Our reimplantation patient population were majority white (61.9 %), female (52.4 %), and insured by Medicaid (61.9 %). The average age at implantation was 54.8 months ±47.5 months and the average age at reimplantation was 100.1 months ±55.9 months. The average time between initial implantation and reimplantation was 46.2 months ±30.2 months. The most common sign of failure was abnormal impedances (47.6 %). Reimplantation was required more often for hard failure (76.2 %), which occurred secondary to trauma in 56.3 % of patients, and occurred more frequently in those ages 5-7. Operative findings were unremarkable in 81 % of patients. Those with audiologic data were noted to have stable or improved thresholds after their revision surgery. Three of the 21 patients discontinued use of their processor on the revised ear. Of these, two had known trauma associated with implant failure that was not immediately addressed. CONCLUSION: We noted increased rates of hard failure, most commonly secondary to trauma. We noted that majority of those who discontinued use of their implant after revision surgery had associated traumatic injuries that ultimately delayed their presentation and surgery.

Direct Bluetooth connectivity results in better hearing aid compliance in children.

OBJECTIVE: To determine if hearing aid use in school aged children is impacted when upgraded to direct Bluetooth® enabled technology. We hypothesized that because children are better able to connect to their devices and headphones, they would be more inclined to use their hearing aids throughout the day, resulting in an increase in hearing aid compliance. METHODS: This retrospective analysis examined changes in datalogging of hours of usage per day in 51 school aged children who underwent an upgrade from non-direct Bluetooth® hearing technology to direct Bluetooth®-enabled hearing technology. RESULTS: Hours per day of hearing aid use in all hearing aid users significantly increased after upgrading to DBT enabled technology (6.82 vs 9.82, <0.001). There were no significant differences noted in hours before and after upgrade depending on race (p = 0.147), gender (p = 0.887), developmental delay (p = 0.749), type of hearing loss (p = 0.218), and degree of hearing loss (p = 0.551). However, when comparing private versus Medicaid insurance, there was noted to be a significant difference with the odds of an increase in hours of usage after upgrade being higher for those patients privately insured (OR = 1.247, p < 0.001, 95 % CI 1.093-1.422). CONCLUSION: Direct Bluetooth® enabled hearing technology positively impacts children's hearing aid compliance, which has the potential improve speech and language outcomes.

Cochlear implantation in a 16-month-old with Chudley-McCullough Syndrome.

OBJECTIVE: The purpose of this report is to describe a case of bilateral cochlear implantation (CI) in a pediatric patient with Chudley-McCullough Syndrome (CMS). By reviewing the literature, we hope to describe common clinical presentations to aid in early diagnosis and management of pediatric patients with CMS. METHODS: Case report with literature review. RESULTS: We present a case of a 16-month-old female with CMS who presented to clinic after a failed newborn hearing screen and was found to have bilateral sensorineural hearing loss. After a failed trial of hearing amplification, the patient underwent successful bilateral CI. The patient had no surgical complications, and her follow up visit showed satisfactory speech and language development. CONCLUSION: This case validates that cochlear implantation in pediatric patients who present with CMS is both safe and efficacious. It also demonstrates the importance of early detection and treatment of sensorineural hearing loss in CMS to prevent speech and language delay.

Postoperative Complications in Obese Patients After Tracheostomy.

OBJECTIVE: To determine the prevalence of varying classes of obesity in patients undergoing tracheostomy and the associated complication rates as compared with nonobese patients. STUDY DESIGN: A retrospective chart review was performed from 2012 to 2018 on all patients who underwent open tracheostomy by the Department of Otolaryngology-Head and Neck Surgery. SETTING: All tracheostomies were performed at a single tertiary care center. METHODS: Patients were classified by body mass index (BMI) according to the World Health Organization classification system: underweight (<18.5), normal-overweight (18.5-29.9), class I (30-34.9), class II (35-39.9), and class III (>40). Charts were reviewed for patient demographic information, Charlson Comorbidity Index score, surgical indication, operative time, tracheostomy tube type, and postoperative complications. RESULTS: A total of 387 patients (mean ± SD BMI, 31.3 ± 14.2) were identified per the inclusion/exclusion criteria. Of patients with BMI >30 (n=153), 34.6% were categorized as obesity class I, 29.4% as class II, and 35.9% as class III. The most common indication for tracheostomy was malignancy in nonobese patients (41.5%) and respiratory failure for obese patients (58.2%). Operative time was significantly longer in obese patients, and most of these patients required an extended-length tracheostomy tube. Patients with a BMI >40 had higher rates of multiple postoperative complications or death (P = .009). Underweight patients also had a higher rate of complication than normal-overweight patients (P = .016). CONCLUSION: Class III and underweight patients had higher rates of postoperative complications, which should be taken into consideration during perioperative counseling.

The impact of continuity of care on antibiotic prescribing in acute otitis media.

BACKGROUND: The rate of antibiotic prescribing for acute otitis media (AOM) remains high despite efforts to decrease inappropriate use. Studies have aimed to understand the prescribing patterns of providers to increase antibiotic stewardship. Watch and wait (WAW) prescriptions are effective at decreasing the number of antibiotic prescriptions being filled by patients. Additionally, poor continuity of care has been associated with higher cost and lower quality health care. OBJECTIVE: To understand the antibiotic prescribing habits for AOM in a largely Hispanic population. METHODS: A retrospective review was performed from 2016 to 2018 of all patients under 25 years old with a diagnosis of AOM seen at multiple outpatient primary care clinics of a single institution. Charts were reviewed for factors including race, ethnicity, gender, insurance status, presence of fever, primary care physician visit, and treatment choice. Data were collected and analyzed using STATA software with t-tests, ANOVA, and Pearson chi squared analysis. RESULTS: Antibiotics were prescribed 95.6% of the time with 3.8% being WAW prescriptions. There was no significant difference in antibiotic prescribing by race (p = 0.66), ethnicity (p = 0.38), gender (p = 0.34) or insurance status (p = 0.24). There was a difference between physicians, nurse practitioners, and physician's assistants and antibiotic prescribing rate (p < 0.01). Additionally, seen by their primary care provider were less likely to be prescribed antibiotics (85.8% vs 94.4%, p = 0.01). CONCLUSION: While a patient's race, ethnicity, gender, and insurance status did not influence the prescribing rate of physicians, continuity of care may play an important role in decreasing inappropriate antibiotic prescribing.