Correlation Between Intolerance of Uncertainty and Post-Operative Regret in Otolaryngology Patients.

OBJECTIVE: To determine if intolerance of uncertainty, depression, anxiety, worry, or stress are related to post-op regret in otolaryngology patients. METHODS: Adult patients or parents giving consent for pediatric patients meeting criteria for otolaryngologic surgery were recruited and completed the Intolerance of Uncertainty Scale (IUS-12), Penn State Worry Questionnaire (PSWQ), and Depression, Anxiety and Stress Scale-21 (DASS-21) preop and the Decisional Regret (DR) scale 1-month post-op. Pearson correlations were calculated. RESULTS: The cohort included 109 patients, 73 (67%) males and 36 (33.3%) females. 43 (39.5%) were college graduates and 66 (60.9%) were not. Mean IUS-12 score was 22.9 (95% CI 21.0-24.8), mean PSWQ score was 46.9 (95% CI 44.5-49.3). DASS-21 mean score was 11.9 (95% CI 9.6-14.3). Mean DR score was 11.1 (95% CI 8.6-13.6). IUS-12 subscales Prospective Anxiety mean score was 14.2 (95% CI 12.8-15.5) and Inhibitory Anxiety mean score was 16.5 (95% CI 14.5-18.6). The Pearson correlation coefficient for post-op DR and total preop IUS was .188 (P = .027) and the correlation coefficient for post-op DR and preop Prospective Anxiety subscale of IUS score was .174 (P = .037). Correlations with PSWQ and DASS-21 scores and DR were not statistically significant. CONCLUSION: Intolerance of uncertainty is a psychological construct that is associated with post-op DR. More work is needed to determine whether screening for IU and behavior modification directed at IU for those with high levels would improve post-op decisional regret.

Depression and Intolerance of Uncertainty: Association with Decisional Conflict in Otolaryngology Patients.

OBJECTIVE: To determine if anxiety, stress, depression, worry, and intolerance of uncertainty were related to pre-operative decisional conflict (DC), shared decision making (SDM), or demographic variables in adult otolaryngology surgical patients. METHODS: Consecutive adult patients meeting criteria for otolaryngological surgery were recruited and completed DC and SDM scales, Penn State Worry Questionnaire (PSWQ), Intolerance of Uncertainty Scale (IUS-12), and Depression, Anxiety and Stress Scale-21 (DASS-21). RESULTS: The cohort included 118 patients, 61 (51.7%) males and 57 (48.3%) females. Surgery was planned for a benign process in 90 (76.3%) and 46 (39.3%) had previous otolaryngologic surgery. SDM and DC scores did not significantly differ across gender, age, education level, previous otolaryngologic surgery or whether or not surgery was for malignancy. Patients with no malignancy had significantly higher DASS-21 Stress scores (mean 12.94 vs 8.15, P < .05) and total IUS-12 scores (mean 28.63 vs 25.56, P = .004). Women had lower PSWQ scores (41.56 vs 50.87 for men, P = .006). IUS-12 and PSWQ declined with age. DC scores correlated positively with DASS-21 Depression (r = .256, P = .008) and IUS-12 scores (r = .214, P = .024). SDM correlated negatively with DASS-21 Depression (r = -.208, P = .030). Linear regression model for DC scores revealed a significant relationship with DASS depression (B = 0.674, P = .048). CONCLUSION: Preoperative decisional conflict is associated with increased depression and intolerance of uncertainty in adults undergoing otolaryngologic surgery. Screening for and management of depression, anxiety, and related concerns may improve surgical outcomes in this group.

Body Dysmorphic Disorder Insights in an Inpatient Psychiatric Setting.

Body dysmorphic disorder is a chronic disorder involving imagined or partial appearance defects that lead to significant impairment in everyday life. It is quite prevalent but remains a clinically underdiagnosed psychiatric condition especially in the inpatient psychiatric setting. Onset of body dysmorphic disorder typically begins in adolescence with subclinical symptoms. Over time, symptoms progress to patients meeting the full Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Severe cases of the body dysmorphic disorder are often camouflaged by concurrent diseases like major depressive disorder, obsessive-compulsive disorder, substance use disorder, and social anxiety disorder. Further, compounding the complexity of body dysmorphic disorder is a treatment of patients who present with coinciding suicidal ideations. Here, we present a unique case of a 40-year-old female admitted to an inpatient psychiatric unit for treatment of ongoing depression and suicidal symptoms. Early on in her inpatient course, she had symptoms of obsessive-compulsive disorder, social anxiety disorder, and alcohol use disorder. The constellation of symptoms prompted evaluation for body dysmorphic disorder and subsequent targeted treatment. This case report highlights the complexities associated with diagnosing body dysmorphic disorder, the importance of considering it a branch point for other psychiatric conditions, and the treatment for patients who present with coinciding suicidal behavior.

Shared Decision Making: The 9-Item Shared Decision Making Questionnaire Does Not Discriminate Between Surgeons.

Purpose To determine if shared decision making (SDM) scores vary between individual otolaryngologists in a large specialty clinic.  Methods Consecutive patients that consented to surgery were surveyed using the 9-item Shared Decision Making Questionnaire (SDM-Q-9), a validated scale for SDM. Demographic details included the respondent's age, gender, education level, marital status, whether the consent was for themselves or their child, whether surgery was for malignancy, and surgery being performed. Scores were evaluated for all demographic variables, as well as individual surgeons, surgeons' gender, age category, and subspecialty. Results A total of 233 patients completed the surveys. No significant differences were found among individual and total scores for SDM when compared among or between patient demographics (p > 0.05). A total of 10 surgeons for whom five or more SDM-Q-9s were completed were included in the study. No significant difference was found when SDM was evaluated for surgeon characteristics as well (p > 0.05).  Conclusion SDM scores do not vary between these otolaryngologists.

Assessment of Pediatric Middle Ear Effusions With Wideband Tympanometry.

OBJECTIVE: To determine if wideband tympanometry (WBT) can differentiate types of middle ear effusion (MEE): serous, mucoid, and purulent. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary care children's hospital. METHODS: Children who met American Academy of Otolaryngology-Head and Neck Surgery's guidelines for ventilation tube insertion had WBT after anesthesia induction but before tympanotomy. MEE was categorized into 1 of 4 comparison groups: serous effusion, mucoid effusion, purulent effusion, or no effusion. WBT measurements were averaged to 16 one-third octave frequency bands, and comparison of the absorbance patterns for each MEE type was performed through a linear mixed effects model. RESULTS: A total of 118 children (211 ears) were included: 47 females (39.8%) and 71 males (60.2%). The mean age was 2.73 years (95% CI, 2.25-3.22); mean weight, 14.35 kg (95% CI, 12.85-15.85); and mean Z score, 1.13 (95% CI, -0.64 to 2.33). Effusions included 61 mucoid (28.9%), 30 purulent (14.2%), and 14 serous (6.6%), with 106 (50.2%) having no effusion. No significant differences were found for sex, race, age, weight, or Z score among the 4 types of effusion (P < .05). WBT showed a significant difference in median absorption among the effusion groups (P < .001), with a medium effect size of 0.35. CONCLUSIONS: WBT has potential use to differentiate types of MEE and should be studied further as a tool for investigating how the natural history and management of serous and mucoid effusions may differ.

Program Directors' Opinions About Otolaryngology Resident Teaching Medical School Anatomy.

Purpose To evaluate whether otolaryngology residency program directors (PDs) provide residents to teach pre-clinical medical students anatomy and to outline their perceptions of this practice. Methods An anonymous online survey was sent to active U.S. otolaryngology residency PDs in 2019, assessing each program's involvement in teaching medical student anatomy. Results Forty-five of 121 (37.1%) of surveyed otolaryngology PDs responded. Sixteen of the 44 (36.4%) residency programs that were associated with a medical school provided residents to teach anatomy ("Teaching Programs"). The 29 (64.4%) remaining programs did not provide residents ("Non-teaching Programs"). No significant differences were found between Teaching and Non-teaching Programs (P<0.05) for the size of the program, the presence of fellowships, the size of medical school, whether residents had won teaching awards, or the number of otolaryngology residency applicants from that school. In general, all PDs responded positively about residents teaching medical school anatomy. Non-teaching Programs primarily cited not being approached by the medical school as a reason for not providing residents to teach. Conclusion The majority of respondent otolaryngology PDs have a positive view of residents teaching medical students but few do it. Otolaryngology departments will need to take the lead on developing opportunities to put students and residents together for anatomy education.

A Case of Pediatric Aspiration of a Metallic Spring.

Prolonged retention of a foreign body after aspiration can lead to numerous respiratory complications. We present a case in which an unwitnessed aspiration of a metal spring by a child led to several months of unilateral wheezing and subsequent physical changes in his left mainstem bronchus. The prompt removal of an airway foreign body requires a high index of suspicion by the physician in order to facilitate proper workup to confirm the diagnosis, allow for prompt management, and minimize damage to the airway.

Parental fatigue before and after ventilation tube insertion in their children.

OBJECTIVE: To determine if there is a difference in fatigue for caregivers of children with otitis media pre and post ventilation tube insertion (VTI). METHODS: Consecutive parents presenting with children at a pediatric otolaryngology practice at an academic medical center with recurrent otitis media who met criteria for VTI or who were following up within 6 weeks of VTI were surveyed with the Chalder Fatigue Scale (CFQ), a Visual Analogue Fatigue Scale (VAS-F), and demographic questions. RESULTS: No significant demographic differences were found (P < 0.05) in the preop versus postop groups. 101 parents participated, 88 mothers and 13 fathers. 59.4% were married or cohabitating, 18.8% were single, 10.9% were divorced, and 10.9% declined to answer. 45.5% were aged 18-29 years, 50.1% were 30-39 years, 2.9% were 40+ years, 1.0% declined to answer. 53.0% were college graduates. 46 (45.5%) were preop and 55 (54.5%) were postop. There were no statistical differences between these groups for age, gender, marital status, education level or number or children in the household. Mean VAS-F, with 0 being worst fatigue and 10 being normal, was 5.256 in the preop group and 6.777 in the postop group (p < 0.001). Mean CFQ, with higher numbers meaning worse fatigue, was 15.749 in the preop group and 11.804 in the postop group (p = 0.002). CONCLUSION: Parental fatigue can have significant effects on the family. Fatigue in parents whose children have otitis media has not been previously described. VTI for recurrent otitis media in children is associated with improved fatigue in their parents.

Obstructive Sleep Apnea with Paradoxical Vocal Cord Movement in Children during Sleep Endoscopy: Case Series.

OBJECTIVE: To describe a series of pediatric cases of obstructive sleep apnea (OSA) with paradoxical vocal cord movement noted on drug-induced sleep endoscopy (DISE). MATERIALS AND METHODS: Case series and chart review of children who had undergone DISE for OSA that showed PVCM. RESULTS: Three cases where paradoxical vocal cord motion (PVCM) was noted during DISE are described. Two had an enlarged adenoid, and one had no other site of obstruction. Two were treated with adenoidectomy and antireflux medications. One received proton pump inhibitors alone. In all 3 cases, OSA symptoms resolved. CONCLUSION: This case series of documented obstructive sleep apnea related to paradoxical vocal cord movement suggests that this entity occurs during sleep with airway obstruction. Further clarification of etiology of PVCM during OSA and its management is needed.

Surgical Team Exposure to Cautery Smoke and Its Mitigation during Tonsillectomy.

OBJECTIVES: To assess the exposure of surgical personnel to known carcinogens during pediatric tonsillectomy and adenoidectomy (T&A) and compare the efficacy of surgical smoke evacuation systems during T&A. STUDY DESIGN: Prospective, case series. SETTING: Tertiary children's hospital. SUBJECTS AND METHODS: The present study assessed operating room workers' exposure to chemical compounds and aerosolized particulates generated during T&A. We also investigated the effect of 3 different smoke-controlling methods: smoke-evacuator pencil cautery (SE), cautery with suction held by an assistant (SA), and cautery without suction (NS). RESULTS: Thirty cases were included: 12 in the SE group, 9 in SA, and 9 in NS. The chemical exposure levels were lower than or similar to baseline background concentrations, with the exception of methylene chloride and acetaldehyde. Within the surgical plume, none of the chemical compounds exceeded the corresponding occupational exposure limit (OEL). The mean particulate number concentration in the breathing zone during tonsillectomy was 508 particles/cm3 for SE compared to 1661 particles/cm3 for SA and 8208 particles/cm3 for NS cases. NS was significantly different compared to the other two methods (P = .0009). CONCLUSIONS: Although the exposure levels to chemicals were considerably lower than the OELs, continuous exposures to these chemicals could cause adverse health effects to surgical personnel. These findings suggest that the use of a smoke-evacuator pencil cautery or an attentive assistant with handheld suction would reduce exposure levels to the aerosolized particles during routine T&A, compared to the use of cautery without suction.

Maxillary Frenulum in Newborns: Association with Breastfeeding.

OBJECTIVE: To relate maxillary and lingual frenulum configuration to breastfeeding success. STUDY DESIGN: Cross-sectional study. SETTING: Newborn nursery in tertiary care academic hospital. SUBJECTS AND METHODS: Newborns were observed between 24 and 72 hours after birth. Mothers were asked a series of questions relating to their breastfeeding experience. The maxillary and lingual frenula were examined and scored. Corresponding LATCH scores were recorded. RESULTS: A total of 161 mothers with newborns participated. The mean gestational age of newborns was 38.81 weeks (95% CI, 38.65-38.98); 82 (50.9%) male and 79 (49.1%) female newborns were included. In sum, 70.8% had the maxillary frenulum attached to the edge of the alveolar ridge; 28.6%, attached to the fixed gingiva; and 0.6%, attached to mobile gingiva. In addition, 3.7% had anterior ankyloglossia, and 96.3% had no obvious anterior ankyloglossia. There was no significant correlation between maxillary frenulum scores or lingual frenulum scores and LATCH scores (P > .05). Of the mothers included in the study, 56.5% were first-time mothers. Overall, 43.5% of the mothers had other biological children, with 70.0% of those mothers having previously breastfed. Experienced mothers who had breastfed for >3 months had significantly higher LATCH scores. Those who had previously breastfed had a mean LATCH score of 9.16 (95% CI, 8.80-9.52), as compared with those who had not, with a mean of 8.14 (95% CI, 7.43-8.85). CONCLUSION: We did not find that maxillary frenulum configuration correlated with LATCH scores. Mothers experienced with breastfeeding had better LATCH scores. Attention toward breastfeeding education, particularly in new mothers, should precede maxillary frenotomy in neonates with breastfeeding difficulties.