Diagnosis and Management of Barosinusitis: A Systematic Review.

OBJECTIVE: To perform a systematic review to investigate the common presenting symptoms of barosinusitis, the incidence of those findings, the methods for diagnosis, as well as the medical and surgical treatment options. METHODS: A review of PubMed/MEDLINE, EMBASE, and Cochrane Library for articles published between 1967 and 2020 was conducted with the following search term: aerosinusitis OR "sinus squeeze" OR barosinusitis OR (barotrauma AND sinusitis) OR (barotrauma AND rhinosinusitis). Twenty-seven articles encompassing 232 patients met inclusion criteria and were queried for demographics, etiology, presentation, and medical and surgical treatments. RESULTS: Mean age of patients was 33.3 years, where 21.7% were females and 78.3% were males. Causes of barotrauma include diving (57.3%), airplane descent (26.7%), and general anesthesia (0.4%). The most common presentations were frontal pain (44.0%), epistaxis (25.4%), and maxillary pain (10.3%). Most patients received topical steroids (44.0%), oral steroids (28.4%), decongestants (20.7%), and antibiotics (15.5%). For surgical treatment, most patients received functional endoscopic sinus surgery (FESS) (49.6%). Adjunctive surgeries include middle meatal or maxillary antrostomy (20.7%), septoplasty (15.5%), and turbinate surgery (9.1%). The most efficacious medical treatments are as follows: 63.6% success rate with oral steroids (66 treated), 50.0% success rate with topical steroids (102 treated), and 50.0% success rate analgesics (10 treated). For surgical treatments received by greater than 10% of the sample, the most efficacious was FESS (91.5% success rate, 108 treated). CONCLUSION: Oral and topical steroids should be first line therapies. If refractory, then functional endoscopic sinus surgery is an effective treatment.

RealSelf Social Media Analysis of Rhinoplasty Patient Reviews.

BACKGROUND: Social media has become increasingly important for patients when deciding whether they should undergo rhinoplasty. The purpose of this study is to analyze patient satisfaction of rhinoplasty procedures through RealSelf social media reviews. METHODS: We collected data from 583 rhinoplasty reviews published on the RealSelf portal. In posts dated between 2016 and 2020, we included those which were labeled as "Worth It" and "Not Worth It." Posts that were labeled as "Unsure" or were left unlabeled were excluded from the study. In addition, posts not including the cost of their rhinoplasty were excluded. Taking into account patient demographics and cost of the procedure, we analyzed reasons for choosing to undergo surgery, reasons for choosing surgeons, and reasons for liking or disliking their procedure. RESULTS: Of the 583 reviews analyzed, most (45.4%) were categorized from the 18-24 years age group and there was an overall 93.8% satisfaction rate. While there was no statistically significant difference in the cost of rhinoplasty surgeries between "Worth It" and "Not Worth It" groups, the average cost of recorded rhinoplasties was US$ 8043 with a standard deviation ± $3296. According to our analysis, younger patients aged 18-24 years relied more on social media to choose their surgeons and desired a more natural appearance to their nose while older ones preferred compatible physician personalities and increased self-esteem for rhinoplasty. CONCLUSION: This study offers a unique perspective into the distinguishing characteristics of different age groups and the values they place in pursuing rhinoplasty, choosing their surgeons, and why they like/dislike their surgical outcomes.

Otologic Manifestations of Langerhans Cell Histiocytosis: A Systematic Review.

OBJECTIVE: To perform a systematic review to investigate common otologic manifestations of Langerhans cell histiocytosis, the incidence of these findings, methods for diagnosis, as well as medical and surgical management. DATA SOURCES: PubMed/MEDLINE, Embase, and Cochrane Library. REVIEW METHODS: A search of PubMed/MEDLINE, Embase, and Cochrane Library for all articles published between 1963 to 2020 was performed with variations and combinations of the following search terms: Langerhans cell histiocytosis, eosinophilic granuloma, Letterer-Siwe, Hand-Schüller-Christian, otitis, otologic, ear. A review of the references of all included articles was also conducted. RESULTS: Sixty-two articles encompassing 631 patients met inclusion criteria. Otologic symptoms at presentation were found in 246 (39%) patients in the reported studies with 48% reporting bilaterality. The mean age was 14.8 years with a male predominance (64%). The most common otologic presenting symptom was otorrhea (46%). A majority had the multisystem variant (52%). The most common treatment modalities were chemotherapy (52%), followed by surgery (50%), systemic steroids (45%), and radiotherapy (31%). Surgery was performed in 75.8% with unisystem involvement and in 50.6% with multisystem involvement. The most effective treatments included radiotherapy (56% success rate, 17% of treated patients), systemic steroids (44% success, 20% treated), chemotherapy (41% success, 21% treated), and surgical modalities (36% success, 19% treated). CONCLUSIONS: Otologic manifestations that occur with the multisystem variant or are at high risk for central nervous system involvement necessitate systemic treatment. For unifocal lesions, surgery is recommended. Lastly, radiotherapy should be reserved for extensive lesions involving vital structures or presenting in older patients.

Flipping the Classroom: An Evaluation of Teaching and Learning Strategies in the Operating Room.

OBJECTIVES: With increasing restraints on resident's experiences in the operating room, with causes ranging from decreased time available to increasing operating room costs, focus has been placed on how to improve resident's education. The objectives of our study are to (1) determine barriers in education in the operating room, (2) identify effective learning and teaching strategies for residents in the operating room with a focus on the tonsillectomy procedure. METHODS: An online survey was sent to all otolaryngology residents and residency programs for which contact information was available from January 2016 to March 2016 with 139 respondents. The 12-question survey focused on information regarding limitations to learning how to perform tonsillectomies as well as difficulties with teaching the same procedure. Resident responses were separated based on PGY level, and analysis was performed using t-tests and Chi squared analysis. RESULTS: Common themes emerged from responses for both teaching and learning how to perform tonsillectomies. A significant limitation in learning the procedure was lack of visualization during the surgery (57% learning vs 60% teaching). For both learners and teachers, the monopolar cautery instrument was found to be the most preferred instrument to use during tonsillectomy (80% each). The majority of resident respondents (93%) felt that an instructional video would be beneficial for both learning and teaching the procedure. CONCLUSIONS: Significant limitations for learning and teaching in the operating room were identified for performing tonsillectomies. Future endeavors will focus on resolving these limitations to improve surgical education. EVIDENCE LEVEL: Level IV.

Diagnosis and management of eosinophilic otitis media: a systematic review.

BACKGROUND: Eosinophilic Otitis Media (EOM) is a relatively newly defined entity of recurrent and resistant otitis media. OBJECTIVE: To perform a systematic review of otologic manifestations, diagnosis and management of eosinophilic otitis media (EOM). METHODS: 393 patients diagnosed with EOM of 26 studies met inclusion criteria and were assessed for demographics, otologic manifestations, diagnostic criteria fulfilled, and medical and surgical treatments. RESULTS: Most common otologic manifestations were hearing loss (65%), otitis media with effusion (16%), tympanic membrane perforation (13%), and otorrhea (13%). 93% had a predominantly eosinophilic middle ear effusion, 95% had asthma, 85% had a highly viscous middle ear effusion, 71% had nasal polyposis, and 58% had resistance to conventional treatment. For treatment, 39% received intratympanic steroid injections, 33% received systemic steroids, 17% received steroid ear drops and 13% received a biological agent. 39% of patients underwent a surgical intervention with 26% receiving functional endoscopic sinus surgery and 18% receiving myringotomy with tube insertion. Success rates were highest with use of intratympanic steroids (45%), systemic steroids (26%), and biological agents (58%). CONCLUSION: Intratympanic steroids show the most efficacy in treating EOM, and aggressive optimization of asthma may be beneficial in resolving otologic symptoms. Surgery should be reserved for refractory cases and complications.

Tracheal Resection in the Management of Thyroid Cancer: An Evidence-Based Approach.

OBJECTIVE: Determine the effect of patient demographics and surgical approach on patient outcomes after tracheal resection in the management of thyroid cancer. STUDY DESIGN: Systematic review and meta-analysis. METHODS: Systematic review of literature was performed using PubMed, Embase, and Cochrane Library to identify patients with thyroid carcinoma who underwent tracheal resection. Pooled estimates for patient demographics, presenting findings, complications, and outcomes are determined using random-effects meta-analyses. RESULTS: Ninety-six relevant studies encompassing 1,179 patients met inclusion criteria. Meta-analysis pooled rates of complications: 1.7% (confidence interval [CI] 0.8-2.5; P < .001; I2 = 1.85%) airway complications, 2.8% (CI 1.6-3.9; P < .001; I2 = 13.34%) bilateral recurrent laryngeal nerve paralysis, 2.2% (CI 1.2-3.1; P < .001; I2 = 6.72%) anastomotic dehiscence. Circumferential resection pooled estimates major complications, locoregional recurrence, distal recurrence, overall survival: 14.1% (CI 8.3-19.9; P < .001; I2 = 35.26%), 15% (CI 9.6-20.3; P < .001; I2 = 38.2%), 19.7% (CI 13.7-25.8; P < .001; I2 = 28.83%), 74.5% (CI 64.4-84.6; P < .001; I2 = 85.07%). Window resection estimates: 19.8% (CI 6.9-32.8; P < .001; I2 = 18.83%) major complications, 25.6% (CI 5.1-46.1; P < .014; I2 = 84.68%) locoregional recurrence, 15.6% (CI 9.7-21.5; P < .001; I2 = 0%) distal recurrence, 77.1% (CI 58-96.2; P < .001; I2 = 78.77%) overall survival. CONCLUSION: Management of invasive thyroid carcinoma may require tracheal resection to achieve locoregional control. Nevertheless, postoperative complications are not insignificant, and therefore this risk cannot be overlooked when counseling patients perioperatively. Laryngoscope, 131:932-946, 2021.

Incorporation of telemedicine by rhinologists: The COVID-19 pandemic and beyond.

OBJECTIVES: The current analysis queries rhinologists' attitudes about the use of telemedicine, including the degree to which it has impacted practice patterns during the COVID-19 pandemic. Our objective was to survey rhinologists and understand the extent to which telemedicine serves as a rejoinder to in-person consultation: appreciation of relevant factors may be important in planning for present and future considerations. METHODS: A 14-question anonymous survey sent out to the American Rhinologic Society (ARS) membership in April 2020. It included demographic factors and detailed questions examining the extent of telemedicine use. Numerous topics including the degree of use, satisfaction with services, and utility of services were evaluated. RESULTS: There were 134 respondents. Most reported seeing ≤30% of typical in-person volume, with 14.8% not seeing any patients at all. 88.1% used telemedicine; 82.0% reported some level of satisfaction with telemedicine. The vast majority utilized platforms employing audio and video (83.3%), and a plurality reported spending 5-15 min on calls. Numerous reasons were cited for the use of telemedicine, including significant public health benefits amid the crisis (89.7%). Only 12.0% of respondents reported using telemedicine for hospital consultation. CONCLUSION: Rhinologists have embraced telemedicine during the COVID-19 pandemic in an attempt to improve accessibility, patient satisfaction, and revenue stream. When utilized appropriately, this technology obviates the need for seeing at-risk patients and performing procedures such as nasal endoscopy. Only a minority of rhinologists was dissatisfied, viewing this as a temporary fix during the pandemic.

The novel corona virus and rhinology: Impact on practice patterns and future directions.

OBJECTIVES: To evaluate the impact of the novel coronavirus pandemic on practice patterns, clinical behavior, personal health, and emotional/psychological concerns of rhinologists. METHODS: A 15-question survey was sent out to the American Rhinologic Society's (ARS) membership to determine the impact of COVID-19 during the crisis. Demographic factors and practice patterns were collected and evaluated. RESULTS: There were 224 total respondents out of 835 ARS members queried (26.8% response rate). Study queries were sent in April 2020. Notably, 17.8% reported illness in themselves or their staff and 74.4% noted a psychological/emotional impact. A plurality of rhinologists noted their practice volume and in-office procedure volume has become 20.0% and 0.0% of their prior volumes, respectively. In addition, 96.2% were noted to be using telemedicine in our subspecialty. CONCLUSION: In addition to severely impacting volume and the perception of future decreases in patients and revenue, the COVID-19 pandemic has had a physical and emotional impact on rhinologists in ways that need to be further studied. These data include significantly novel and objective information. The COVID-19 crisis also reveals the important role of telemedicine in rhinology. Guidelines regarding personal protective equipment for in-office visits, nasal endoscopy, and other in-office and operating room procedures would be particularly helpful as future waves are expected.

Local Blocks and Regional Anesthesia in the Head and Neck.

Local anesthesia is commonly used for head and neck procedures. Many anesthetic agents are available, with differing properties that can alter their durations of action and lengths of time to onset. These agents can be used acutely for laceration repair or as adjuncts to intravenous sedation. Local and regional anesthetic agents can also be used for chronic conditions. Several local anesthetic blocks are available. Local anesthesia has the potential for complications, ranging from issues with injection process, such as a broken needle, to reactions of the anesthetic agent. Some populations are more at risk for certain reactions to anesthesia.

Influence of Gender and Racial Diversity on the Otolaryngology Residency Match.

OBJECTIVE: (1) Understand attitudes of otolaryngology residency applicants regarding gender and racial diversity within programs. (2) Examine how program diversity affects applicant decisions during the residency match. (3) Compare the importance of racial and ethnic program diversity among applicants. STUDY DESIGN: Web-based survey distributed in February and March 2019. SETTING: Tertiary care university setting. SUBJECTS AND METHODS: An anonymous web-based survey was distributed to 418 applicants in the 2019 otolaryngology match. Respondents were queried about the importance of program diversity and its effects on the match process. Ratings were based on a scale of 1 to 5 (with 5 being extremely important or significant effect). RESULTS: The response rate was 35%; 53% of responders were male; and 59% were white, 25% Asian, 6% black, and 6% Hispanic/Latino. Applicants rated the importance of having female faculty and residents as 4.1 (SD = 1.1) and 4.2 (SD = 1.1), respectively. Applicants rated the importance of having diverse faculty and residents as 3.9 (SD = 1.1) and 4 (SD = 1.2). Overall, 7.6% of applicants canceled interviews due to a lack of female residents and 5.5% due to a lack of female faculty; furthermore, 5.5% of applicants canceled interviews due to a lack of diverse residents and 4.9% due to a lack of diverse faculty. Female and nonwhite applicants prioritized females and diversity within programs more so than male and white applicants. CONCLUSIONS: Although residency applicants felt that program diversity was important, this did not significantly affect decision making during the match process, likely due to the competitive nature of the match. Women and nonwhite applicants prioritized program diversity more than white male applicants.

Perioperative analgesia for patients undergoing otologic surgery: An evidence-based review.

OBJECTIVES/HYPOTHESIS: Opioid misuse and diversion is a major concern, with a negative impact on both the individual and society. The objective of this study was to perform an evidence-based systematic review of the efficacy of perioperative analgesic regimens following otologic surgery. METHODS: Embase, Cochrane Library, and PubMed/MEDLINE databases (January 1, 1947 to June 30, 2018) were searched for studies investigating pain management in otologic surgeries. All studies were assessed for quality and bias using the Cochrane bias tool. Patient demographics, type of surgery, medication class, dose, administration characteristics, pain scores, and adverse events were reported. RESULTS: Twenty-three studies encompassing 1,842 patients met inclusion criteria. In 21.4% of studies, an overall reduction in pain scores was reported when the treatment group included more than one analgesic. Nausea and vomiting were the most common adverse events across all medication types (10.2%), with local anesthetic patients experiencing these side effects most frequently (38.0%). Perioperative acetaminophen was reported to have the fewest adverse drug reactions overall (6.1%), but did not reduce pain scores as much as other modalities, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or combination analgesics. CONCLUSIONS: There is evidence that combination analgesics, such as acetaminophen plus codeine, provide superior pain relief to monotherapy analgesics in the perioperative pain management of otologic surgeries. NSAIDs, α-agonists, and nerve blocks may also be viable single-therapy options. Further prospective randomized controlled trials into perioperative analgesia for patients undergoing otologic surgery may be helpful in establishing a definitive consensus. Laryngoscope, 130:190-199, 2020.

Perioperative Desmopressin for Patients Undergoing Otolaryngologic Procedures: A Systematic Review.

OBJECTIVE: Desmopressin (DDAVP) is a hemostatic agent used to manage bleeding in patients with hemostatic disorders, and there is a lack of published data to guide its use during otolaryngology procedures. The objective of this study was to conduct an evidence-based systematic review of the reported uses, efficacy, and adverse effects of DDAVP in the otolaryngology surgical setting. DATA SOURCES: PubMed, MEDLINE, and EmBase were searched for articles on the use of DDAVP in otolaryngology. REVIEW METHODS: The Methodological Index for Non-Randomized Studies criteria and Cochrane bias tool were used to assess study quality. Patient demographics, DDAVP dosing and route, and outcomes such as bleeding and adverse events were collected. A summary of evidence table was created specifying levels of evidence, benefits, and harm. RESULTS: Nineteen studies encompassing 440 patients were included. Sixteen studies discussed DDAVP for prophylaxis, and 3 discussed postoperative use. DDAVP effectively prevented bleeding in high-risk patients and successfully facilitated a dry surgical field when necessary. DDAVP had a 100% success rate when used symptomatically. Five studies described adverse effects, including hyponatremia (12.3%), nausea (2.0%), emesis (0.9%), and seizure (0.2%). The aggregate level of evidence for its use was Level B for adenotonsillectomy, septoplasty, and turbinate procedures and Level C for rhinoplasty. CONCLUSION: Current literature supports the use of DDAVP in otolaryngology surgical procedures as both a perioperative prophylactic agent and a postoperative symptomatic intervention for bleeding. Both modalities are effective with minimal adverse events. Further well-designed randomized trials are necessary to conclusively formulate guidelines for DDAVP use in otolaryngology.

Rhinogenic headache in pediatric and adolescent patients: an evidence-based review.

BACKGROUND: Although some causes of rhinogenic headache, such as acute sinusitis, have clear diagnostic criteria, others, such as "sinus headache" and mucosal contact points, are more nebulous. Misdiagnosis of these entities and primary headaches may result in unnecessary medical or surgical treatment. The purpose of this systematic review is to delineate current understanding of diagnosis and treatment of rhinogenic headaches, including sinus and mucosal contact point headaches, in children. METHODS: PubMed, SCOPUS, and the Cochrane databases were searched for studies on sinus headache and mucosal contact point headaches in children. Studies were assessed for level of evidence, and risk of bias was assessed by Methodological Index for Non-Randomized Studies (MINORS) scoring. Diagnostic criteria, management strategies, and other clinical data were analyzed. RESULTS: Eight studies met the inclusion criteria. Level of evidence was predominantly 4. Forty percent of pediatric patients with migraine had been previously misdiagnosed with sinus headache. Of 327 pediatric patients in two studies, between 55% and 73% had at least 1 cranial autonomic symptom associated with their migraine. For children with mucosal contact point headaches, surgical management in select patients improved headache intensity or severity in 17 (89%) cases. CONCLUSION: The majority of pediatric patients with sinus headache harbor a primary headache disorder, with migraine being most common. Physicians should suspect primary headache disorders in pediatric patients with chronic headaches and a normal exam. Although some case series are supportive of surgical management for mucosal contact point headaches in children, the level of evidence supporting these recommendations is insufficient. High-quality clinical trials are necessary for continuing to improve outcomes in patients with these clinical entities.

An evaluation of geographic trends in the otolaryngology residency match: home is where the heart is.

IMPORTANCE: Securing an otolaryngology residency position has become an increasingly competitive endeavor in recent years. Recent studies have investigated the applicant criteria used by residency programs as part of the ranking process. However, to our knowledge, no studies have comprehensively investigated the role of geographic location in the match process. OBJECTIVE: To evaluate geographic trends in the otolaryngology national residency match process. DESIGN, SETTING, AND PARTICIPANTS: We conducted a cross-sectional examination of 56 otolaryngology residency programs including 810 residents to determine resident demographic information, including matriculated medical schools. MAIN OUTCOMES AND MEASURES: The geographic locations of residency programs and the residents' matriculated medical schools were evaluated for trends. Residents' program locations were compared with the locations of their medical schools of matriculation, and the numbers of residents attending a program affiliated with their medical schools were also identified. RESULTS: Overall, 810 residents were identified from the 56 programs included in our study. Of these, 169 residents (20.9%) attended the program affiliated with their medical school. The Midwest had the highest proportion of residents graduating from the affiliated medical school (25.7%), and the West had the lowest proportion (12.5%) (P = .008). A total of 473 residents attended a program within the same region as their medical school (58.4%). The South had the highest proportion of residents from the same region (68.2%), and the West had the lowest proportion (31.3%) (P < .001). CONCLUSIONS AND RELEVANCE: While it is not clear why a geographic bias was identified, a significant proportion of residents in our study attended a program in the same region as their medical school. This geographic association was strongest in the Midwest and South. Furthermore, a significant proportion of residents attended the program affiliated with their medical schools. This information is valuable to all future applicants as they choose where to apply, and to all residency programs as they decide how geographic location factors in to whom they decide to interview.

Scholarly investigation into otitis media: who is receiving funding support from the National Institutes of Health?

OBJECTIVES/HYPOTHESIS: Otitis media (OM) is highly prevalent and represents a major public health concern. We evaluate National Institutes of Health (NIH) funding support for OM research and examine the role of otolaryngology primary investigators (PIs). STUDY DESIGN: Examination of bibliometrics and funding history of NIH grant recipients. METHODS: The NIH RePORTER database was examined for PIs funded for otitis media-related projects. The specialty, education level, academic department, scholarly impact (as measured by the h-index), and funding levels of PIs were obtained. RESULTS: There were 320 projects funded for 1,102 fiscal years supporting OM research. Since 2000, there has been >$280 million in support. PhDs received 47.5% of awards, more than any single medical specialty. Pediatricians received 54.8% of grants awarded to physicians followed by otolaryngologists (29.9%). Pediatric infectious disease specialists and pediatric otolaryngologists had the greatest funding per PI upon considering subspecialties, whereas non-fellowship-trained otolaryngologists had the lowest funding levels. Funded otolaryngologists had lower scholarly impact than several specialties. Aggregate funding levels to otolaryngologists decreased between 2000 and 2013. CONCLUSIONS: The NIH provided considerable grant support for researchers studying OM as awards to practitioners in numerous specialties exceeded a quarter of a billion dollars since 2000. Although awards to otolaryngologists were significant, the share of grants awarded to otolaryngologists has declined, suggesting that increased recruitment of basic scientists and enhanced cooperation with other specialists may facilitate further scholarship. These findings suggest a need for improving initiatives that prepare otolaryngology trainees interested in translational OM research for the rigorous NIH peer-review grant process.

Evaluation of otolaryngology residency program websites.

IMPORTANCE: Prior to applying or interviewing, most prospective applicants turn to the Internet when evaluating residency programs, making maintenance of a comprehensive website critical. While certain "intangibles" such as reputation may not be communicated effectively online, residency websites are invaluable for conveying other aspects of a program. Prior analyses have reported that certain criteria such as research experience and didactics are important considerations for applicants. OBJECTIVE: To evaluate the comprehensiveness of otolaryngology residency websites. DESIGN AND PARTICIPANTS: Review of otolaryngology residency program websites. Websites of 99 civilian residency programs were searched for the presence of 23 criteria. MAIN OUTCOMES AND MEASURES: Presence of 23 criteria for application process, incentives, instruction, research, clinical training, and other. RESULTS: Only 5 programs contained at least three-quarters of the criteria analyzed; on average programs reported less than 50% of information sought. Among the 99 residency program websites, a description of the following criteria was noted: comprehensive faculty listing (88%), didactics (80%), contact e-mail (77%), current residents (74%), description of facilities (70%), intern schedule (70%), research requirements (69%), otolaryngology rotation schedule (64%), other courses (61%), ERAS (Electronic Residency Application Service) link (55%), year-to-year responsibility progression (47%), call schedule (40%), active/past research projects (37%), area information (34%), message from the program director (33%) or chair (23%), selection criteria (30%), salary (directly on site) (23%), surgical statistics (18%), parking (9%), and meal allowance (7%). The mean (SD) percentage present of factors encompassing "clinical training" was 55% (23%), significantly higher than the mean (SD) percentage of factors covered under the "incentives" category (19% [11%]; P = .01). The proportion of overall criteria present on websites did not differ on organizing programs by region (range, 42%-49%). Sites for "large" programs (≥3 residents per year) were more comprehensive (49% vs 42%; P = .04). CONCLUSIONS AND RELEVANCE: While further survey of prospective applicants would be invaluable in determining which factors are of greatest interest, many residency websites appear to be inadequately comprehensive. Despite the relative comprehensiveness of criteria relevant to clinical training when compared with other aspects of websites such as incentives, several crucial aspects of training are still not addressed in many sites.

Assault by battery: battery-related injury in the head and neck.

OBJECTIVES/HYPOTHESIS: To estimate nationwide incidence of emergency department (ED) visits for battery-related injury (BRI) occurring in the head and neck, and analyze demographic and anatomic-specific trends. METHODS: The National Electronic Injury Surveillance System (NEISS) was searched for BRI in the head and neck, with analysis for incidence, anatomic site, age and gender, and specific diagnoses. RESULTS: There were an estimated 18,803 head and neck BRI ED visits from 2003 to 2012. A total of 65.8% of patients were male. A total of 92.8% of patients were treated/examined and then released, and 4.7% of patients were admitted. A plurality (34.2%) of patients had BRI related to nose injures, and this represented the youngest cohort (median: 3 years old). The vast majority of ear and nose diagnoses were "foreign bodies"; two-thirds of mouth injuries were related to burns, whereas lacerations predominated in the face and head. Nearly half of ED visits involved patients between 2 and 5 years of age. A total of 45.2% of cases involving patients ≥ 65 years of age were related to hearing aid batteries as foreign bodies. CONCLUSION: BRI in the head and neck results in a significant amount of ED visits. Mechanisms of injury vary by age and anatomic location, but a considerable male predilection exists. Whereas pediatric patients are primarily affected, particularly patients between 2 to 5 years of age, injuries do occur among adults. Importantly, the prevalence of dislodged hearing-aid batteries in the elderly necessitates comprehensive patient education to increase awareness and counseling regarding this complication. Awareness of demographic and anatomic-specific trends reported in this analysis may be an invaluable adjunct for history-taking and clinical examination.