Patient Sex Mediates the Influence of Patient Age on Superior Canal Dehiscence Repair Outcome.

OBJECTIVE: To investigate the independent and interactive effects of patient age and sex on superior canal dehiscence (SCD) repair outcomes. METHODS: This was a cohort study of consecutive SCD repairs via the middle fossa approach at an institution between 2011 and 2022. We constructed multivariable regression models assessing surgical outcomes with age and sex as the primary predictors. Models controlled for surgery duration, follow-up duration, and relevant surgical and medical history. Subsequently, we repeated each model with the incorporation of an interaction term between patient age and sex. RESULTS: Among 402 repairs, average age was 50 years, and 63% of cases were females. There was a significant interaction between patient age and sex with respect to symptom resolution score (SRS) (adj. ß 0.80, 95% C.I. 0.04-1.56). Older age was associated with lower SRS among females (-0.84, -1.29 to -0.39 point per year) but not significantly associated with SRS among males (0.04, -0.65 to 0.56 point per year). Furthermore, older age independently predicted a greater magnitude of increase in air conduction at 8000 Hz following surgery regardless of sex (adj. ß 2.1, 0.2-4.0 dB per 10-year increase). CONCLUSIONS: This is the first study on the interactive effect between patient age and sex with respect to SCD repair outcomes. Older age predicted poorer symptomatic response among female patients but did not predict symptomatic response among male patients. Furthermore, older age predicted more severe high-frequency hearing loss following SCD repairs among both female and male patients. LEVEL OF EVIDENCE: 3 Laryngoscope, 2024.

Fungal and Bacterial Microbiome in Sinus Mucosa of Patients with and without Chronic Rhinosinusitis.

OBJECTIVES: Dysbiosis of the sinonasal microbiome has been implicated in the pathogenesis of chronic rhinosinusitis (CRS). However, the mycobiome remains largely understudied, and microbial alterations associated with specific CRS subtypes have yet to be delineated. The objective of this study is to investigate the fungal and bacterial microbiome of sinus mucosa in CRS patients with and without nasal polyposis (CRSwNP and CRSsNP) versus healthy controls. METHODS: Sinus mucosa was obtained from 92 patients (31 CRSsNP, 31 CRSwNP, and 30 controls) undergoing endoscopic sinus/skull base surgery. Data regarding demographics, Lund-MacKay scores, and histopathology were collected. Fungal and bacterial microbiome analysis was performed utilizing internal transcribed spacer amplicon and 16S rRNA sequencing. RESULTS: Beta diversity of the sinonasal mycobiome differed significantly between CRS and controls (p = 0.001) and between CRSwNP and controls (p = 0.049), but not between CRSwNP and CRSsNP (p = 0.32) nor between CRSsNP and controls (p = 0.06). With respect to the bacterial microbiome, significantly lower alpha diversity was observed between CRS and controls (p < 0.001), CRSwNP versus controls (p < 0.001), and CRSsNP versus controls (p < 0.001). Beta diversity was also significantly different at the genus level between CRSwNP and CRSsNP (p = 0.019), CRSwNP and controls (p = 0.002)), and CRSsNP and controls (p < 0.001). However, alpha and beta diversity did not differ significantly between CRS patients with/without eosinophils or correlate with Lund-MacKay scores. CONCLUSIONS: Differences in mycobiota diversity in CRS patients in comparison with controls suggest that alterations in the mycobiome may contribute to disease pathogenesis. Our findings also confirmed that diminished diversity among bacterial communities is associated with CRS and that significant differences are present in microbial composition between CRSwNP and CRSsNP. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:1054-1062, 2024.

Low-Lying Tegmen and Surgical Outcomes Following the Middle Cranial Fossa Repair of Superior Canal Dehiscence.

OBJECTIVE: To compare treatment response from the middle cranial fossa repair of superior canal dehiscence (SCD) between cases with and cases without low-lying tegmen (LLT). STUDY DESIGN: Cohort study. SETTING: Single tertiary care institution. METHODS: Two investigators independently reviewed preoperative high-resolution temporal bone computed tomography images and classified the ipsilateral tegmen as either "low-lying" or "control." Patients completed a symptom questionnaire and underwent audiometric testing pre- and post-operatively. Multivariable regression models assessed for symptomatic resolution and audiometric improvement following surgery with tegmen status as the primary predictor. Models controlled for patient age, sex, bilateral SCD disease, dehiscence location, prior ear surgery status, surgery duration, and follow-up duration. RESULTS: Among a total of 410 cases included, we identified 121 (29.5%) LLT cases. Accounting for all control measures, patients with LLT were significantly less likely to experience overall symptom improvement (adjusted odds ratio: 0.32, 95% confidence interval [CI]: 0.18-0.57, p < .001) and reported a significantly lower proportion of preoperative symptoms that resolved following surgery (adjusted ß: -25.6%, 95% CI: -37.0% to -14.3%, p < .001). However, audiometric outcomes following surgery did not differ significantly between patients with and patients without LLT. CONCLUSION: This is the first investigation on the relationship between LLT and surgical outcomes following the middle fossa repair of SCD. Patients with LLT reported less favorable symptomatic response but exhibited a similar degree of audiometric improvement.

Positive Outcome Bias in the Influential Otolaryngology Clinical Trial Literature.

OBJECTIVE: To assess for the presence of positive outcome bias in the otolaryngology clinical trial literature. Specifically, we investigate the prevalence of clinical trials with positive findings (CTP) and clinical trials with negative findings (CTN), as well as their quality of evidence and subsequent impact. STUDY DESIGN: Retrospective analysis. SETTING: Clinical Trials in the Influential Otolaryngology Literature. METHODS: We reviewed all clinical trials published in 4 major otolaryngology journals between 2000 and 2020. We constructed several multivariable regression models to investigate the relationship of finding direction with randomization status and citation count. Subsequently, we incorporated an interaction term between year and the primary covariate of each model to assess the temporal trajectory of these relationships. All models accounted for sample size, journal, subspecialty, and the affiliated program prestige. RESULTS: Of the 1367 trials analyzed, 1143 (84%) were CTPs, a rate that persisted throughout the study period (aOR 1.00, 95% CI 0.98-1.03). CTPs were significantly less likely to be randomized compared to CTNs (aOR 0.25, 0.17-0.37), a relationship that persisted over time (aOR 1.05, 0.99-1.03). CTPs received significantly more citations compared to CTNs (aIRR 1.41, 1.25-1.60), a disparity that also persisted over time (aIRR 0.99, 0.97-1.01). CONCLUSION: The otolaryngology clinical trial literature has been heavily dominated by positive findings. CTPs were more frequently cited and published even with a lower level of evidence compared to CTNs. This bias may influence the objectivity of evidence used to guide clinical practice and warrants attention when reviewing findings and changing practices.

First-Side and Second-Side Repair of Bilateral Superior Canal Dehiscence.

OBJECTIVE: Bilateral superior canal dehiscence (SCD) may warrant surgeries on both sides. With repairs of unilateral SCD as reference, we investigate the comparative effectiveness of first-side and second-side repairs, in hopes of establishing knowledge that can guide clinical decision-making pertaining the appropriateness of second-side surgeries. METHODS: Middle fossa SCD repairs at an institution between 2011 and 2022 were analyzed. Multivariable regression models assessed symptom resolution and audiometric improvement with surgery cohort (unilateral SCD repair vs. first-side repair vs. second-side repair) as the primary predictor. All models controlled for patient age, sex, surgery duration, prior ear surgery, and follow-up. RESULTS: A total of 407 repairs (180 unilateral SCD, 172 first-side, and 55 second-side repairs) were analyzed. The rates of overall symptom improvement for auditory and vestibular symptoms were as follows: 81% and 67% for unilateral SCD repairs; 73% and 54% for first-side repairs; and 43% and 51% for second-side repairs, respectively. Compared with first-side repairs, which resolved auditory symptoms at similar rates (aOR 95% C.I. 0.36-1.07) but resolved vestibular symptoms at significantly lower rates (aOR 95% C.I. 0.35-0.93) compared with unilateral SCD repairs, second-side repairs resolved auditory symptoms at significantly lower rates (aOR 95% C.I. 0.10-0.51) but resolved vestibular symptoms at similar rates (aOR 95% C.I. 0.45-2.01). CONCLUSIONS: Careful consideration of perioperative symptomatology may inform the appropriateness of second-side surgeries. If auditory symptoms persisted following first-side surgeries, second-side surgeries are less likely to yield resolution. If vestibular symptoms persisted following first-side repairs, second-side repairs may lead to resolution at similar rates as first-side repairs. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:1882-1888, 2024.

Narrowing of Low-Frequency Air-Bone Gap and Its Association with Symptom Resolution Following Superior Canal Dehiscence Repair.

OBJECTIVE: Low-frequency air-bone gap (LABG) on pure tone audiometry is an expected clinical finding of superior canal dehiscence (SCD) syndrome. We investigate how narrowing of LABG following SCD repairs translates to symptom resolution. STUDY DESIGN: Cohort study. SETTING: Tertiary Care Center. METHODS: We analyzed consecutive SCD repairs at an institution between 2012 and 2022. Pure tone audiometry and symptom questionnaires were administered pre- and post-operatively. The independent variable assessed whether the LABG narrowed (≥5 dB) following surgery. Outcome measures were rates of Overall Symptom Improvement (OSI, net resolution of ≥1 symptom) and Symptom Resolution Score (SRS, % symptoms resolved). We conducted multivariable regression analyses with LABG narrowing as the primary predictor. All models controlled for demographics, bilateral disease, prior ear surgery, and follow-up. RESULTS: Among total of 217 repairs analyzed, 161 (74%) reached OSI, and mean SRS was 39 (out of 100). LABG narrowing at 250 Hz (65%), 500 Hz (52%), and 1000 Hz (47%) was associated with a 41-point (ß 95% confidence interval [CI] 5-77) increase in auditory, 15-point (ß 95% CI 1-30) increase in auditory, and 23-point (ß 95% CI 2-45) increase in vestibular SRS, respectively. However, LABG narrowing was not significantly associated with the rates of auditory and vestibular OSI at all frequencies assessed. CONCLUSION: Lack of LABG narrowing following repair was associated with the persistence of a greater proportion of preoperative symptoms but similar likelihood of OSI. This relationship was more prominent for auditory symptoms at 250 to 500 Hz and for vestibular symptoms at 1000 Hz. Additional research is warranted to elucidate the mechanism through which symptoms resolve despite LABG persistence.

Residential Proximity to a Commercial Pesticide Application Site and Risk of Chronic Rhinosinusitis.

Importance: Environmental and occupational toxicants have been shown to be associated with an increased prevalence of chronic rhinosinusitis (CRS). However, few to no studies have evaluated patients for CRS using objective testing and workup protocols that fulfill guidelines for CRS diagnostic criteria. Furthermore, no study, to our knowledge, has investigated the risks of CRS in the context of residential exposure through proximity to a commercial pesticide application site. Objectives: To evaluate associations of residential proximity to a commercial pesticide application site and the prevalence of CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSwoNP). Design, Setting, and Participants: This was a retrospective cohort study of patients who presented to a tertiary care institution for rhinology evaluation between March 1, 2018, and December 31, 2022. Main Outcomes and Measures: The outcome variable was the clinical diagnosis of CRS (CRSwNP, CRSwoNP, or non-CRS control). Patients' residential addresses were utilized to determine pesticide exposure status based on a validated computational geographic information algorithm based on data from the California Pesticide Use Report System. The dichotomous independent variable of exposure status (exposed or non-exposed) was determined by assessing reports of any pesticide applications within 2000 m of each participant's residence in 2017. Multivariable logistic regressions assessing CRS status and CRS subtypes were conducted with pesticide exposure as the primary covariate of interest. The primary study outcome and measurements as well as study hypothesis were all formulated before data collection. Results: Among a total of 310 patients (90 CRSwNP, 90 CRSwoNP, and 130 control), the mean (SD) age was 50 (17) years; 164 (53%) were female. Race and ethnicity information was not considered. Controlling for patient demographic information, smoking history, county of residence, and medical comorbidities, pesticide exposure was associated with an approximately 2.5-fold increase in odds of CRS (adjusted odds ratio, 2.41; 95% CI, 1.49-3.90). Pesticide exposure was associated with similar risks for CRSwNP (adjusted relative risk ratio [aRRR], 2.34; 95% CI, 1.31-4.18) and CRSwoNP (aRRR, 2.42; 95% CI, 1.37-4.30). Conclusions and Relevance: The findings of this retrospective cohort study and analysis revealed that residential exposure to commercial pesticide application within a 2000-m buffer was independently associated with an approximately 2.5-fold increase in odds of being diagnosed with CRS. If validated by additional research, this association would have substantial implications for public health.

Audiometric Outcomes After the Middle Cranial Fossa Repair of Superior Semicircular Canal Dehiscence.

OBJECTIVE: To evaluate the audiometric outcomes after the middle cranial fossa approach (MCF) for superior canal dehiscence (SCD) repair. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: SCD cases presented to a single institution between 2012 and 2022. INTERVENTIONS: The MCF repair of SCD. MAIN OUTCOME MEASURES: Air conduction (AC) threshold (250-8,000 Hz), bone conduction threshold (BC) (250-4,000 Hz), and air bone gap (ABG) (250-4,000 Hz) at each frequency, pure tone average (PTA) (500, 1,000, 2,000, 3,000 Hz). RESULTS: Among 202 repairs, 57% were bilateral SCD disease and 9% had previous surgery on the affected ear. The approach significantly narrowed ABG at 250, 500, and 1,000 Hz. The narrowing of ABG was achieved by both decreased AC and increased BC at 250 Hz, but mediated primarily by increased BC at 500 Hz and 1,000 Hz. Among cases without previous ear surgery, mean PTA remained in the normal hearing range (mean: preop, 21 dB; postop, 24 dB) and clinically important hearing loss (PTA increased by ≥10 dB) after the approach was noted in 15% of cases. Among cases with previous ear surgery, mean PTA remained in the mild hearing loss range (mean: preop, 33 dB; postop, 35 dB) and clinically important hearing loss after the approach was noted in 5% of cases. CONCLUSION: This is the largest study to date examining the audiometric outcomes after the middle cranial fossa approach for SCD repair. Findings of this investigation support that the approach is effective and safe with long-term hearing preservation for most.

An analysis of the inclusion of ear and hearing care in national health policies, strategies and plans.

Ear- and hearing-related conditions pose a significant global health burden, yet public health policy surrounding ear and hearing care (EHC) in low- and middle-income countries is poorly understood. The present study aims to characterize the inclusion of EHC in national health policy by analysing national health policies, strategies and plans in English, French, Spanish, Portuguese and Arabic. Three EHC keywords were searched, including ear*, hear* and deaf*. The terms 'human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)', 'tuberculosis' and 'malaria' were included as comparison keywords as these conditions have historically garnered political priority in global health. Of the 194 World Health Organization Member States, there were 100 national policies that met the inclusion criteria of document availability, searchable format, language and absence of an associated national EHC strategy. These documents mentioned EHC keywords significantly less than comparison terms, with mention of hearing in 15 documents, ears in 11 documents and deafness in 3 documents. There was a mention of HIV/AIDS in 92 documents, tuberculosis in 88 documents and malaria in 70 documents. Documents in low- and middle-income countries included significantly fewer mentions of EHC terms than those of high-income countries. We conclude that ear and hearing conditions pose a significant burden of disease but are severely underrepresented in national health policy, especially in low- and middle-income countries.

Image-derived Metrics Quantifying Hemodynamic Instability Predicted Growth of Unruptured Intracranial Aneurysms.

Background: While image-derived predictors of intracranial aneurysm (IA) rupture have been well-explored, current understanding of IA growth is limited. Pulsatility index (PI) and wall shear stress pulsatility index (WSSPI) are important metrics measuring temporal hemodynamic instability. However, they have not been investigated in IA growth research. The present study seeks to verify reliable predictors of IA growth with comparative analyses of several important morphological and hemodynamic metrics between stable and growing cases among a group of unruptured IAs. Methods: Using 3D images, vascular models of 16 stable and 20 growing cases were constructed and verified using Geodesic techniques. With an overall mean follow-up period of 25 months, cases exhibiting a 10% or higher increase in diameter were considered growing. Patient-specific, pulsatile simulations were performed, and hemodynamic calculations were computed at 5 important regions of each aneurysm (inflow artery, aneurysm neck, body, dome, and outflow artery). Index values were compared between growing and stable IAs using ANCOVA controlling for aneurysm diameter. Stepwise multiple logistic regression and ROC analyses were conducted to investigate predictive models of IA growth. Results: Compared to stable IAs, growing IAs exhibited significantly higher intrasaccular PI, intrasaccular WSSPI, intrasaccular spatial flow rate deviation, and intrasaccular spatial wall shear stress (WSS) deviation. Stepwise logistic regression analysis revealed a significant predictive model involving PI at aneurysm body, WSSPI at inflow artery, and WSSPI at aneurysm body. Conclusions: Our results showed that high degree of hemodynamic variations within IAs is linked to growth, even after controlling for morphological parameters. Further, evaluation of PI in conjunction with WSSPI yielded a highly accurate predictive model of IA growth. Upon validation in future cohorts, these metrics may aid in early identification of IA growth and current understanding of IA remodeling mechanism.

Computed tomography approximated superior semicircular canal dehiscence size and location and their association with clinical presentation.

OBJECTIVE: This study investigates the relationship of superior semicircular canal dehiscence (SSCD) size and location with patient symptomatology and audiometry. METHODS: We retrospectively reviewed SSCD cases presented to a tertiary institution between 2011 and 2022. Dehiscence length and width measured on high-resolution temporal bone computed tomography imaging were used to calculate an approximate dehiscence area (ADA). Dehiscence location was classified employing a six-grade system. Multivariable regression analyses were performed with symptomatology and audiogram metrics as outcome variables and ADA and dehiscence location as the primary covariates of interest. RESULTS: A total of 402 SSCD were included in the analysis. Controlling for patient age, sex, dehiscence laterality, and location, greater ADA was independently associated higher rates of autophony (aOR 1.39; 95% C.I. 1.14-1.71; P = 0.004) and hyper-amplification (aOR 1.39; 1.14-1.70; P = 0.004). Additionally, dehiscences with greater ADA exhibited significantly lower bone conduction threshold at 500 Hz (adjusted ß -1.75, P = 0.006) and 1000 Hz (adjusted ß -1.61, P = 0.018) and significantly wider air-bone gap at 500 Hz (adjusted ß 2.22, P < 0.001) and 1000 Hz (adjusted ß 1.00, P = 0.039). Dehiscence location was not independently associated with any outcome variable examined when accounting for dehiscence size. CONCLUSION: The size of dehiscence is more independently related to clinical presentations than the anatomical location of the dehiscence in the superior semicircular canal. Greater dehiscence size is associated with symptomatology and audiometry consistent with more severe bone conduction hyperacusis.

Clinical Predictors of Symptom Improvement Following Eustachian Tube Balloon Dilation.

OBJECTIVE: This study aims to identify clinical predictors of treatment response to Eustachian Tube Balloon Dilation (ETBD) as measured by changes in Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores. METHODS: One hundred thirteen patients who underwent ETBD at an institution from 2017 to 2021 completed ETDQ-7 pre- and post-operatively. We conducted multivariable regression analyses with ETDQ-7 normalization (<2.1 post-op), minimum clinically important difference (MCID) (>0.5 pre-op - post-op), and quantitative improvement in ETDQ-7 score as outcome variables. Pre-operative ETDQ-7 score, tympanogram type, chronic otitis media, chronic rhinosinusitis (CRS), inferior turbinate hypertrophy, deviated septum, allergic rhinitis, and rhinorrhea were included as covariates. Models controlled for age, sex, ethnicity, prior ear or sinus surgery, and follow-up duration. RESULTS: The mean age was 49 years old. 51% were females, and all patients had pre-operative ETDQ-7 above 2.1. After a mean follow-up period of 13 months, 77% achieved MCID and 37% had normalized. Higher pre-operative ETDQ-7 score was associated with greater ETDQ-7 score improvement (B = 0.60, 95% CI = [0.37, 0.83]) and greater odds of achieving MCID (aOR = 1.65; 95% CI = [1.06, 2.59]). A history of CRS improved chances of achieving MCID (aOR = 4.53; 95% CI = [1.11, 18.55]) and a history of chronic otitis media predicted increased odds of ETDQ-7 normalization (aOR = 2.88; 95% CI = [1.09, 7.58]). CONCLUSIONS: Our findings suggest that ETBD was highly effective among patients with pre-operative ETDQ-7 above 2.1. Furthermore, higher pre-operative ETDQ-7 score, CRS, and chronic otitis media predicted more favorable symptomatic benefit from ETBD. These factors may be important to consider when counseling potential candidates for this procedure.

Postoperative Pneumolabyrinth Following the Middle Cranial Fossa Approach for Superior Semicircular Canal Dehiscence Repair, 2014-2020.

OBJECTIVE: The present study investigates risk factors and clinical outcomes of postoperative pneumolabyrinth following the middle cranial fossa approach for superior semicircular canal dehiscence repair, a complication that has not been documented previously. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary/quaternary care referral center. METHODS: We conducted a retrospective review of 332 middle cranial fossa procedures from 2014 to 2020 at a tertiary/quaternary care institution. Upon identifying pneumolabyrinth cases from postoperative computed tomography temporal bone scans, we conducted multivariable logistic regression analysis to explore demographic and clinical factors that were independently linked to this complication. We also compared the rates of postoperative symptoms among patients with different grades of pneumolabyrinth. RESULTS: We identified 41 (12.3%) pneumolabyrinth cases. Patients with older age, higher preoperative pure tone average, and frank dehiscence were at higher risk for pneumolabyrinth. Furthermore, patients with pneumolabyrinth reported significantly higher rates of postoperative dizziness and exhibited significantly greater pure tone average and air-bone gap postoperatively as compared with patients without pneumolabyrinth. Finally, higher-grade pneumolabyrinth was associated with increased rates of postoperative hearing loss, and grade III pneumolabyrinth was associated with higher rates of postoperative tinnitus vs grade I and II cases. CONCLUSION: Pneumolabyrinth following the middle cranial fossa approach was associated with poor clinical outcomes, including dizziness and auditory impairment. Old age, high preoperative pure tone average, and frank dehiscence were risk factors for this complication. The highlighted parameters may be important to note when considering this approach as a treatment option and while monitoring postoperative recovery.

Postoperative Gabapentin's Effect on Opioid Consumption and Pain Control Following Sinonasal Surgery.

OBJECTIVE: This study investigates the impact of postoperative gabapentin on opioid consumption and pain control following endoscopic sinus surgery (ESS) and/or septoplasty. METHODS: Patients who underwent ESS and/or septoplasty at a single institution from 2021 to 2022 were enrolled. All patients received postoperative hydrocodone-acetaminophen for pain control. Half of the patients were also prescribed gabapentin for the first postoperative day in addition to hydrocodone-acetaminophen. Subjects completed the Revised American Pain Society Patient Outcome Questionnaire 24 h and 7 days after surgery. We conducted a multivariable regression analysis to assess opioid consumption and improvement in pain scores in the first week between gabapentin and non-gabapentin groups. RESULTS: A total of 102 subjects, 51 in each arm, were enrolled. The mean age was 52 years and 53% of participants were female. Controlling for important baseline demographic, clinical, and surgically related variables, the addition of postoperative gabapentin was associated with a 44% (9.5 mg from 21.6 mg) reduction in opioids consumed in the first postoperative week (B = -9.54, 95% C.I. = [-17.84, -1.24], p = 0.025). In addition, patients in both arms exhibited similar improvement in pain severity and sleep interference in the first 7 days (B = -1.59, 95% C.I. = [-5.03, 1.84], p = 0.36). CONCLUSION: To the best of our knowledge, this is the first study to investigate the impact of postoperative gabapentin on opioid consumption and pain control following ESS and/or septoplasty. Our analysis demonstrated that postoperative gabapentin effectively reduced opioid use during the first postoperative week without compromising pain control. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:1065-1072, 2023.

Predictors of Death, Survival, Need for Intubation, and Need for Oxygen Support Among Admitted COVID-19 Patients of the Veterans Affairs Greater Los Angeles Healthcare System.

INTRODUCTION: While risk factors for severe COVID-19 infections have been well explored among the public, population-specific studies for the U.S. Veteran community are limited in the literature. By performing a comprehensive analysis of the demographics, comorbidities, and symptomatology of a population of COVID-19 positive Veterans Affairs (VA) patients, we aim to uncover predictors of death, survival, need for intubation, and need for nasal cannula oxygen support among this understudied community. MATERIALS AND METHODS: A retrospective review was conducted of 124 COVID-19 Veteran patients who were admitted from March to October 2020 to the VA Greater Los Angeles Healthcare System (IRB#2020-000272). Chi-square and Fisher's exact tests were employed to assess differences in baseline demographic and clinical variables between Veterans who survived COVID-19 versus those who succumbed to COVID-19 illness. Multivariate logistic regression and Cox regression analyses were employed to assess predictors of outcome variables, including death, survival, need for intubation, and need for oxygen support (via nasal cannula). Covariates included a wide range of demographic, comorbidity-related, symptom-related, and summary index variables. RESULTS: Our study population consisted of primarily senior (average age was 73) Caucasian and African American (52.5% and 40.7%, respectively) Veterans. Bivariate analyses indicated that need for intubation was significantly associated with mortality (P = 0.002). Multivariate analyses revealed that age (P < 0.001, adjusted odds ratio (OR) = 1.16), dyspnea (P = 0.015, OR = 7.73), anorexia (P = 0.022, OR = 16.55), initial disease severity as classified by WHO (P = 0.031, OR = 4.55), and having more than one of the three most common comorbidities (hypertension, diabetes, and cardiac disease) and symptoms (cough, fever, and dyspnea) among our sample (P = 0.009; OR = 19.07) were independent predictors of death. Furthermore, age (P < 0.001, hazard ratio (HR) = 1.14), cerebrovascular disease (P = 0.022, HR = 3.76), dyspnea (P < 0.001, HR = 7.71), anorexia (P < 0.001, HR = 16.75), and initial disease severity as classified by WHO (P = 0.025, HR = 3.30) were independent predictors of poor survival. Finally, dyspnea reliably predicted need for intubation (P = 0.019; OR = 29.65). CONCLUSIONS: Several independent predictors of death, survival, and need for intubation were identified. These risk factors may provide guidelines for risk-stratifying Veterans upon admission to VA hospitals. Additional investigations of COVID-19 prognosis should be conducted on the larger U.S. Veteran population to confirm our findings and add to the current body of literature.

Trends in Health Care Access Disparities Among Asian and Pacific Islander Health Fair Participants in Los Angeles, 2011-2019.

OBJECTIVES: Given several efforts to improve health care access in California and nationally, we studied whether linguistic and socioeconomic disparities in health care access changed from 2011 to 2019 among Asian and Pacific Islander American (APIA) people in Los Angeles, California. METHODS: We analyzed survey responses from APIA health fair participants (n = 5032) in the Greater Los Angeles area from May 15, 2011, through October 20, 2019. To assess the effect of socioeconomic factors on and shifts in health care access (ie, health insurance status/regular doctor), we used a logistic regression model. Covariates included English proficiency, year, age, sex, ethnicity, income, employment, and education. We also ran an interaction analysis between English proficiency and year. RESULTS: Health insurance access increased and doctor access remained stable throughout the study period; however, disparities in health insurance status widened by a factor of 1.08 per year between participants with high English proficiency (HEP) and participants with low English proficiency (LEP) (P = .01). People with HEP were 2.02 times more likely to have a regular doctor than people with LEP (P < .001), and this disparity persisted from 2011 to 2019 (P = .58). Participants who were young (P < .001) and male (P = .005) were significantly less likely to have health insurance and a regular doctor (P < .001) than participants who were older and female. Chinese participants were significantly more likely than Thai (P = .002) and Korean (P < .001) participants to be insured but not more likely to have a regular doctor, when controlling for health insurance. CONCLUSIONS: Policy changes targeting language and cultural barriers to care for APIA people with LEP may address the disparities observed.

Disparity in Obesity and Hypertension Risks Observed Between Pacific Islander and Asian American Health Fair Attendees in Los Angeles, 2011-2019.

INTRODUCTION: The Pacific Islander American population is understudied due to being aggregated with Asian Americans. In this study, we conduct a comparative analysis of directly measured body mass index (BMI), body fat percentage (%BF), and blood pressure (BP) between Pacific Islander Americans and Asian Americans from health screenings in Los Angeles, California. We hope to reveal intra-APIA health disparities masked by this data aggregation. METHODS: We analyzed BMI, %BF, and BP that were objectively measured by trained personnel at health screenings in Los Angeles between January 2011 and December 2019. We performed multivariable multinomial logistic regression models with obesity and hypertensive categories as outcome variables and ethnicity as the primary independent variable of interest. Models controlled for year of visit, participant age, sex, income, education level, years living in the USA, employment status, English proficiency, regular doctor access, and health insurance status. RESULTS: A total of 4,832 individuals were included in the analysis. Multivariable analyses revealed that Pacific Islander participants were at significantly higher risks for being classified as obese compared with all Asian American subgroups studied, including Chinese, Korean, Thai, Vietnamese, Filipino, and Japanese. Pacific Islanders also exhibited significantly lower predicted probability of having a normal blood pressure compared with Chinese and Thai participants. Some variation between Asian subgroups were also observed. CONCLUSIONS: Pacific Islander participants had higher risk of several sentinel health problems compared to Asian American participants. Disaggregation of PI Americans from the APIA umbrella category in future studies is necessary to unmask the critical needs of this important community.

Modified Endoscopic Denker's Approach for Management of Anterior Maxillary Sinus Tumors: Multicenter Series of 58 Cases.

OBJECTIVES: Tumors involving the anterior portion of the maxillary sinus remain technically challenging to access via an endoscopic approach. The modified endoscopic Denker's (MED) procedure was recently introduced to address such lesions. We present a multicenter series of 58 patients with tumors involving the anterior maxillary sinus successfully resected using a MED procedure and present the clinical outcomes and complications. METHODS: A multi-institution retrospective chart review was performed on patients who underwent the MED approach for the management of tumors involving the anterior maxillary sinus from 2009 to 2020. Demographic data, pathology, surgical outcomes, and complications were reviewed. RESULTS: Fifty-eight patients were identified, including 34 (58.6%) male and 24 (41.4%) female patients. The most common pathologies included: inverted papilloma (n = 27; 46.6%), adenoid cystic carcinoma (n = 9; 15.5%), and squamous cell carcinoma (n = 8; 13.8%). Thirty-eight patients (65.5%) underwent MED alone, while 20 (34.5%) had combined expanded endonasal approaches for lesions extending beyond the maxillary sinus. All maxillary sinus lesions were successfully accessed with the MED procedure without the need for an additional approach. After a mean follow-up of 30 months (range, 1-127), 8 of 58 (13.8%) patients developed complications related to the MED, including epiphora requiring an additional procedure (n = 4; 6.9%), prolonged facial/palatal numbness (n = 3; 5.2%), severe epistaxis (n = 1; 1.7%), and vestibular stenosis (n = 1; 1.7%), the latter of which occurred following postoperative radiation. CONCLUSION: The MED procedure is a safe and highly effective approach for benign and malignant tumors involving the anterior maxillary sinus. However, patients should be counseled preoperatively on potential complications including the risk of facial numbness and epiphora.