Educational Quality of YouTube Videos for Patients Undergoing Elective Procedures.

INTRODUCTION: YouTube has become a main resource used by patients for self-education on medicine. It is important for surgeons to understand the quality and reliability of videos that patients are likely to view about elective procedures. METHODS: Videos were categorized by view count and content creators. The top 20 videos for each term, sorted by relevance, were evaluated using DISCERN criteria, a question set externally validated to assess the quality of information regarding health treatment choices. DISCERN score (DS) closer to 5 indicate higher quality information and 1 indicates the opposite. Total scores were given: 15-26 (very poor), 27-38 (poor), 39-50 (fair), 51-62 (very good), and 63-75 (excellent). Search terms included "Wound Care", "Skin Grafting", "Tracheostomy", and "percutaneous endoscopic gastrostomy tube placement". RESULTS: In total, 80 unique videos were evaluated with a total view of 8,848,796. The mean overall DS was 2.15 and a mean bias DS was 2.46. The median DISCERN total score for each key term was Tracheostomy: 35 (poor), Skin Grafting 26 (very poor), percutaneous endoscopic gastrostomy: 32 (poor), and Wound Care: 40 (fair). CONCLUSIONS: YouTube videos surrounding elective procedures should be viewed cautiously in patient education despite wide availability. The videos in this study show high levels of bias and low DS. Healthcare providers should be aware of poor-quality consumer health information often disseminated in online media such as YouTube.

A review of bilateral sudden sensorineural hearing loss in pediatric patients.

OBJECTIVE: Bilateral, sudden sensorineural hearing loss (SSNHL) in the pediatric population is a rare phenomenon potentially detrimental to language acquisition and social development. This study comprehensively reviews and analyzes existing literature to determine any correlation or commonality in etiologies, presentations, and management of this condition. METHODS: PubMed, Cochrane, Scopus, and Web of Science databases were systematically searched for articles related to pediatric SSNHL from 1970 to 2021. Case series, case reports, and cohort studies were included. Data on patient demographics, etiology, diagnostic testing, management, and hearing recovery were collected. RESULTS: Excluding duplicates, 553 unique titles were identified by established search criteria, of which 342 titles were relevant to pediatric sudden hearing loss. Forty-six papers reported cases of bilateral SSNHL, totaling 145 individual cases. Not included in the analysis were 45 cases documented as non-organic hearing loss. The average age of the total 145 included patients was 8.5 years and 51 were male. Reported etiologies included cytomegalovirus (n = 3), meningitis (n = 13), mumps (n = 5), ototoxin exposure (n = 13), and enlarged vestibular aqueduct (n = 9). Tinnitus (n = 30) was the most reported concurrent symptom, followed by vertigo (n = 21). Systemic steroid therapy was the most common treatment and, when follow up was reported, most patients (51.2%) had complete or partial recovery of hearing. CONCLUSIONS: This is a comprehensive review of pediatric bilateral SSNHL. Though often idiopathic, etiologies also include infectious, structural, and autoimmune. Treatment largely consists of systemic steroid therapy, with variables rates of recovery. Further studies on intratympanic administration of steroids may guide future treatment.

Ambivalence and Stigma Beliefs About Medication Treatment Among Young Adults With Opioid Use Disorder: A Qualitative Exploration of Young Adults' Perspectives.

PURPOSE: Young adults with opioid use disorder (OUD) have low engagement in treatment with medication for opioid use disorder (MOUD). The objective of this study is to explore the beliefs and attitudes about MOUD among young adults. METHODS: We conducted a single-site qualitative study of 20 young adults ages 18-29 years with a diagnosis of OUD receiving care at an outpatient program and who spoke English. We used a flexible interview guide with the following domains: experience with MOUD, sources and impact of stigma, and interactions with family, healthcare professionals, and social networks. We conducted a thematic analysis based on deductive codes related to the domains and emergent codes from the interviews. RESULTS: We identified three themes. First, participants perceived being on MOUD as stigmatizing. They regarded MOUD as lifesaving but ultimately as a "crutch" hindering their full recovery. Second, young adults expressed ambivalence, distinct from stigma, about MOUD. This ambivalence was related to fear of withdrawal symptoms and concerns about their ability to live independent lives, side effects, and unknown treatment duration. Third, participants felt that MOUD was more than just a means to reduce risk of overdose, it was a means to become fully functioning in their lives. DISCUSSION: In this study of young adults in treatment for OUD, we found that stigma and ambivalence concerning MOUD could explain young adults' low engagement in care. Interventions addressing concerns about the stigmatizing effects of MOUD and the ambivalence young adults experience related to MOUD could improve engagement and retention of young adults.

Kaposi Sarcoma of the Larynx: A Systematic Review.

OBJECTIVE: Kaposi sarcoma (KS) of the larynx is a rare disease with few cases reported in the literature. This study aims to provide a comprehensive review of laryngeal KS, including patient characteristics, treatment, and clinical outcomes. DATA SOURCES: PubMed, CINAHL, SCOPUS, and Cochrane Library. REVIEW METHODS: A systematic review of the published English literature was conducted. An electronic search and bibliographic examination of articles pertaining to laryngeal KS were performed. Demographic data, tumor site, treatment strategies, follow-up, and outcome were analyzed. RESULTS: A total 77 cases from 50 articles were included in the review. The mean age was 47.6 years (range, 8-81). There was an 8.6:1 male:female ratio. The most common presenting symptoms were dyspnea (n = 35) and hoarseness (n = 25). Laryngeal KS arose most frequently in the supraglottic region (n = 16). Chemotherapy alone (n = 27) was the most common treatment modality in patients with AIDS-associated KS, and surgical excision alone (n = 7) was most common in patients with other subtypes of KS (eg, classic, transplant associated). Average follow-up was 20.4 months (range, 0.75-120). Most patients with AIDS-associated KS died of other causes (n = 25), but most patients with other subtypes of KS were alive with no evidence of disease at follow-up (n = 13). CONCLUSION: This review contains the largest pool of laryngeal KS cases to date. Long-term outcomes were generally unfavorable, often due to advanced HIV disease at the time of diagnosis.

Mucosal Melanoma of the Oral Cavity: What is the Role of Elective Neck Dissection?

OBJECTIVES: Mucosal melanoma (MM) is a rare malignancy that can present in the head and neck (H&N). The Oral cavity is the second most common primary site in the H&N after sinonasal mucosa. This study investigates the impact of demographic and clinical factors on survival in oral cavity MM. Further, it investigates the outcomes and utility of elective neck dissections (END) in the management of oral MM. METHODS: The National Cancer Database was used to evaluate 432 patients with oral cavity MM from 2004 to 2016. Kaplan-Meir and Cox regression analyses were used to determine variables associated with survival. RESULTS: The mean age was 64.0 ± 16.0 years. Most patients were white (85.1%) and male (60.0%). Gingiva (37.6%) and hard palate (36.1%) were the most common primary subsites in the oral cavity. Five-year overall survival was 31.0%. Age (Hazards Ratio [95% Confidence Interval], 1.03 [1.01-1.06]), N-stage (1.94 [1.10-3.42]), M-stage (10.13 [3.33-30.86]), male sex (1.79 [1.06-3.03]), and African-American race (2.63 [1.14-6.11]) were significantly associated with worse survival. 199 patients (46.9%) underwent neck dissection including 118 with lymph node yield (LNY) ≥ 18. The rate of occult nodal positivity was 45.4% for LNY ≥ 18 and 28.3% for LNY ≥ 1. ENDs were not associated with improved outcomes. However, occult lymph node involvement was associated with worse overall survival (p = 0.004). CONCLUSIONS: Oral cavity MM has a poor prognosis. Lymph node involvement, distant metastasis, age, race, and male sex are associated with worse outcomes. Performing an END did not improve survival. However, END may have a prognostic role and help select patients for treatment intensification. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:317-326, 2023.

An Exploration of Young Adults With Opioid Use Disorder and How Their Perceptions of Family Members' Beliefs Affects Medication Treatment.

BACKGROUND: Young adults with opioid use disorder (OUD) have low engagement and retention in medication treatment. Families are uniquely situated to play an important role in treatment decisions. This qualitative study explored how young adults with OUD perceive their families' beliefs about OUD and medication treatment, and how those beliefs impacted young adults' beliefs about their own treatment decisions. METHODS: We conducted a qualitative study of a convenience sample of 20 English-speaking young adults with OUD receiving care from an urban safety net hospital in Massachusetts. We explored young adults' perceptions of how families viewed medication treatment. We conducted semi-structured interviews that were recorded and transcribed. We analyzed interviews using hybrid inductive and deductive categorization to support thematic analysis. RESULTS: We identified 3 themes. First, family history of substance use disorder and treatment negatively impacted how young adults perceive their OUD and medication treatment. Second, young adults shared that many families held negative or stigmatizing views of medication treatment. Finally, acceptance by family was important but young adults acknowledged that keeping treatment decisions from family was sometimes necessary. CONCLUSIONS: In this qualitative exploration of young adults with OUD, we found that young adults felt that their families held important beliefs about the kind of treatment family members found most appropriate, and these perceived family beliefs impacted their treatment choices. Future research to improve engagement and retention of youth adults with OUD could target the beliefs of family members.

Sex Disparities in Pediatric Acute Rhinosinusitis: A National Perspective.

OBJECTIVE: This study aims to provide an age-stratified analysis of associations with patient sex in pediatric inpatients with acute rhinosinusitis (ARS). STUDY DESIGN: Retrospective cohort study. SETTING: National administrative database. METHODS: The 2016 Kids' Inpatient Database was queried for pediatric inpatients (<21 years old) with ARS (ICD-10 J01). Orbital and intracranial sequelae were selected via ICD-10 codes. Statistical associations by sex were determined via univariate and multivariable analyses. Weighted measures are reported to provide national estimates. RESULTS: Of the 5882 patients identified with ARS, 2404 (40.9%) were female and 3478 (59.1%) were male. Male patients were younger than female patients (mean, 9.3 vs 9.9 years; P < .001). Multivariable analysis indicated that males and females had similar total charges ($71,094 vs $66,892, P = .464) and length of stay (5.8 vs 6.1 days, P = .263). However, male patients underwent more procedures (1.8 vs 1.5, P < .001). Mortality was similar between male and female patients (odds ratio [OR], 0.91; P = .664). Male patients also had increased odds for having orbital (OR, 1.58; P < .001) and intracranial (OR, 1.99; P < .001) complications. Differences in sex-dependent sequela risk were starkest in patients aged 14 to 20 years, with male patients being more likely to have orbital (OR, 2.91; P < .001) and intracranial (OR, 3.86; P < .001) complications. CONCLUSION: In a cohort of pediatric inpatients with ARS, males have increased odds for orbital and intracranial sequelae and undergo more procedures than females. However, males and females have similar charges and length of stay. Our study highlights age-stratified differences in ARS across patient sex.