Trends and postoperative outcomes of thyroidectomy after expansion and rise of health insurance deductibles in the fiscal year.

BACKGROUND: The purpose of this study is to evaluate a relationship between expansion of High Deductible Health Plans (HDHPs) and the number of thyroid surgery cases with associated postoperative outcomes in the fiscal year. METHODS: Data from TriNetX was used to evaluate the trends in thyroid surgery from 2005 and 2021 between the end of the year (Quarter 4) and the beginning of the year (Quarter 1). Risk of postoperative outcomes were statistically interrogated. RESULTS: The average rate of thyroid surgery in cases/year between Quarter 4 and Quarter 1 was similar after expansion of HDHPs (152; 146; p = 0.64). There was no increased risk of postoperative complications. The rate of surgery decreased significantly for patients with Medicare after implementation of the revised American Thyroid Association (ATA) guidelines (Quarter 4: p = 0.03; Quarter 1: p = 0.02). CONCLUSIONS: Patients are less likely to delay thyroid surgery at the end of the year despite higher deductibles.

Familial psychosocial impact of cochlear implantation.

BACKGROUND: Adult cochlear implantation rates are increasing, and the resulting change in hearing capabilities has vast impacts in the psychosocial domain of life for the cochlear implant users and their families. However, there is currently no published evidence synthesis of the ways in which adult cochlear implantation affects the psychosocial sphere of the family unit. OBJECTIVE: (1) Describe the existing literature on the psychosocial impact of cochlear implantation on adults. (2) Assess the range of impacts on the family unit and highlight areas warranting further investigation. DATA SOURCES: Ovid, CINAHL, and Scopus. REVIEW METHODS: Databases were systematically searched from January 1, 2007 to May 1, 2022. Eligibility assessment was performed via two independent investigators. Disagreements in selection were discussed and consulted on with a third investigator as needed. RESULTS: Of the 875 unique articles identified, 13 remained in the final review. The most frequently noted psychosocial impacts on the family was quality of life (100 %), family relations (85 %), conversational access (85 %), everyday hearing (77 %), and less feelings of isolation (77 %). 6 of the studies only considered the viewpoint of the CI user and did not have a congruent survey response from an individual from their family unit. CONCLUSION: This study describes the existing literature on the familial psychosocial impact of adult cochlear implantation, focusing on the general well-being, social integration, and psychological aspects noted post-implantation. This review identifies gaps in this research, with large numbers of studies on CI user benefits and little insight into the impact on the family unit. We recommend shifting research on CI impact toward a focus on the family unit, rather than individual, and an evaluation of familial influence in electing to receive a CI.

An Investigation of the Impact of Expanding High-Deductible Health Plans on Patient Decision for Cochlear Implant Surgery and Postoperative Outcomes.

HYPOTHESIS: After the expansion of high deductibles, patients will delay cochlear implant (CI) surgery to the end of the year, and the risk of postoperative known risks will increase. BACKGROUND: The Affordable Care Act was associated with increased enrollment in high-deductible health plans (HDHPs), which resulted in rising health insurance deductibles. Health insurance plans can cover a patient's cost of healthcare once the deductible is met. Patients have been shown to be economic rational decision makers and make decisions based on cost rather than health. They wait for their deductible to be met, typically at the end of the year, then proceed to have costly care. The goal of this study was to evaluate the impact of rising health insurance deductibles on the rate and postoperative outcomes of cochlear implantation and to assess changes by the Tax Cuts and Jobs Act. METHODS: TriNetX was used to accumulate summary data on patients who obtained a CI between 2005 and 2022 at the beginning (quarter 1) and the end of the year (quarter 4) from the electronic medical records of 75 healthcare organizations. The trends in average rate of cochlear implantation and resultant postoperative known risks or complications were statistically evaluated. RESULTS: After expansion of HDHPs, the rate of cochlear implantation between quarter 4 (19 cases per year) and quarter 1 (17 cases/year) was similar (p = 0.18). For all patient groups, the case volume significantly increased. Between quarter 4 and quarter 1, postoperative tinnitus was more common in the beginning of the year (risk ratio, 0.68; 95% confidence interval, 0.46-0.99). CONCLUSIONS: The number of patients receiving CIs significantly increased despite the expansion of HDHPs. Tinnitus was a rare postoperative known risk in the beginning of the year. Patients are less likely concerned about cost of CI surgery because of the impact of hearing loss on quality of life.

Beyond Hypoglossal Hype: Social Media Perspectives on the Inspire Upper Airway Stimulation System.

In the landscape of sleep surgery, the Inspire® Upper Airway Stimulation (UAS) device has gained prominence as an increasingly popular treatment option for obstructive sleep apnea, prompting significant discourse across social media platforms. This study explores the social media narrative of the UAS device, particularly the nature of multimedia content, author demographics, and audience engagement on Instagram, Facebook, and TikTok. Our analysis encompassed 423 public posts, revealing images (67.4%) and videos (28.1%) as the dominant content types, with over a third of posts authored by physicians. A notable 40% of posts were advertisements, whereas patient experiences comprised 34.5%. TikTok, although presenting a smaller sample size, showed a substantially higher engagement rate, with posts averaging 152.9 likes, compared with Instagram and Facebook at 32.7 and 41.2 likes, respectively. The findings underscore the need for otolaryngologists and healthcare professionals to provide clear, evidence-based information on digital platforms. Given social media's expanding role in healthcare, medical professionals must foster digital literacy and safeguard the accuracy of health information online. In this study, we concluded that maintaining an evidence-based, transparent digital dialogue for medical innovations such as the UAS device necessitates collaborative efforts among physicians, health institutions, and technology companies.

Analysis of Postoperative Outcomes and Economic Behavior Trends of Tympanoplasty and Mastoidectomy With Expansion of High Deductible Health Plans.

HYPOTHESIS: With rising deductibles, patients will delay ear surgeries toward the end of the year, and there will be an increase in postoperative complications. BACKGROUND: The Affordable Care Act (ACA), passed on March 23, 2010, expanded high deductible health plans. The deductible can provide support for patients with high medical costs, but high deductibles deter patients from seeking necessary preventive health care and having elective procedures. Patients may defer care toward the end of the year until the deductible is met. The purpose of this study is to evaluate the relationship between expanding high deductible health plans and the repeal of the ACA's individual mandate on December 22, 2017, with the economic behavior trends of tympanoplasty and mastoidectomy in the fiscal year and surgical outcomes. METHODS: TriNetX was used to obtain summary statistics of patients who had tympanoplasty and/or mastoidectomy from 58 health care organizations. TriNetX is a global federated database that contains de-identified patient data from the electronic medical records of participating health care institutions. This study evaluated the trends in ear surgeries from 2005 to 2021 in the fiscal quarters 1 and 4. Relative risk of developing postoperative complications was statistically interrogated. RESULTS: The average rate of ear surgeries measured in cases/year was higher in Quarter 4 than in Quarter 1 after the expansion of higher deductible health plans (180; 124; p < 0.0001). After the repeal of the ACA's individual mandate, the rate of ear surgeries in Quarter 4 significantly decreased compared to post-ACA (-3.7; 287; p = 0.0002). No statistically significant differences were notable in postoperative complications. CONCLUSIONS: The expansion of high deductible health plans with a rise in deductibles is associated with an increase in ear surgeries toward the end of the year. The repeal of the ACA's individual mandate is associated with a decreased rate of ear surgeries compared to post-ACA implementation. Despite financial concern, there was no increase in postoperative complications toward the end of the year.

Evaluation of Disturbances in Hearing, Tinnitus, and Dizziness as Signs of COVID-19 Infection.

BACKGROUND: There have been reports and studies indicating audiovestibular disturbances in COVID-19 patients with variations in the percentage of sensorineural hearing loss (SNHL). The purpose of this study is to compare the incidence of newly diagnosed SNHL, sudden idiopathic hearing loss (SIHL), tinnitus, and vestibular disturbances between infected and uninfected patients, as well as to identify population groups at risk. METHODS: This study used TriNetX to obtain statistics on COVID-19 (+) and COVID-19 (-) patients from 61 healthcare organizations. Propensity score with 1:1 matching was used to control confounding variables. This study evaluated the relative risk of developing audiovestibular disturbances up to 1 month after a COVID-19 test and further investigated the incidence in COVID-19 (+) subset groups. RESULTS: Between COVID-19 (+) and COVID-19 (-) patients who had an audiogram, there was no statistically significant difference in SNHL or SIHL (SNHL: relative risk [RR] = 0.69, 95% confidence interval [CI] = 0.46-1.04; SIHL: RR = 1.00, 95% CI = 0.42-2.40). Race/ethnicity or specified comorbidity did not affect the incidence of SNHL or SIHL. There was a statistically significant difference in tinnitus and vestibular disturbances between the COVID-19 (+) and the COVID-19 (-) groups (RR = 1.29, 95% CI = 1.01-1.66; RR = 2.33, 95% CI = 2.19-2.48). CONCLUSION: New onset hearing loss is not more common in patients with a positive COVID-19 test than those with a negative COVID-19 test. Audiologic evaluation is needed to verify reported hearing disturbances. Although statistically significant in specific population groups, tinnitus and vestibular disturbances may not be clinically significant due to the low incidence.

Laryngectomy: Social media analysis of patient perception.

BACKGROUND: Social media continues to grow as a relevant information source for the lay public and medical professionals. METHODS: A search of posts on Facebook and Instagram was conducted using the hashtag #laryngectomy. Posts were categorized based upon perspective, media type, timeframe, topic, tone, and popularity. RESULTS: Final analysis included 929 Instagram posts and 355 Facebook posts. Most Facebook posts were made by companies (38%) and physicians (17%) with information (30%) and advertisements (22%) being common topics. Patients (40%) were the largest group of Instagram authors with lifestyle (39%) being the most common topic. Greater than 90% of posts were either neutral or positive in tone across both platforms. CONCLUSIONS: Patient perspective was most commonly represented on Instagram, whereas Facebook more commonly included posts by physicians and companies. The majority of posts carried a neutral or positive tone, which is consistent with positive quality of life patients have shown postoperatively.

Social Media Depictions of Cochlear Implants: An Instagram and TikTok Analysis.

OBJECTIVE: To identify populations of authors who post about cochlear implants (CIs) on Instagram and TikTok, to illustrate the content of these posts, and to elucidate factors that might help surgeons better educate CI patients. STUDY DESIGN: Qualitative study. SETTING: Instagram and TikTok social media platforms. PATIENTS: All public social media posts identified with the search terms below. Posts were excluded if unrelated to CIs or if written in a non-English language. INTERVENTION: Instagram and TikTok were searched for posts from March 2021 through September 2021 with the search terms #cochlearimplant, #cochlearimplants, #cochlearimplantkids, #cochlearkids, and #cochlearfamily. MAIN OUTCOME MEASURES: Posts were subclassified and analyzed for content including topics of posts, authorship, timeframe of posts, depiction of CIs, and popularity. RESULTS: Of 1,942 posts included in the final analysis, 1,400 were found on Instagram and 542 on TikTok. Authors were mostly patients (n = 771, 39.7%), companies (n = 568, 29.2%), and patients' family members (n = 482, 24.8%). Only 21 posts were made by physicians (1.1%). Out of 379 total educational posts examined, patients themselves were the most common authors (n = 219, 57.8%) followed by patients' family members (n = 139, 36.7%). Physicians authored only a small fraction of all educational posts (n = 19, 5.0%). CONCLUSIONS: This study showed minimal physician involvement in the CI social media spheres of Instagram and TikTok. In addition, there were few educational posts on either platform, revealing ample opportunity for physicians to become more involved with CI social media.

Blepharoconjunctivitis and Otolaryngological Disease Trends in the Context of Mask Wearing during the COVID-19 Pandemic.

(1) Purpose: In 2020, wearing of face masks was mandated in the United States in an effort to lessen transmission of the novel 2019 coronavirus disease (COVID-19) pandemic; however, long-term mask wearing may present with unintended side-effects in both ophthalmic and otolaryngologic clinical practice. This study aims to examine if mask wearing increased the incidence of primarily chalazion, blepharoconjunctivitis, and rhinitis occurrence during the mask-mandated COVID-19 pandemic period. (2) Methods: Medical records from tertiary academic center clinics were analyzed for incidence of ophthalmic and otolaryngologic diagnoses of interest (blepharoconjunctivitis- and rhinitis-related disorders). Data were collected from a pre-pandemic (March 2019-February 2020) and a mid-pandemic window (March 2020-February 2021) during which widespread mask mandates were implemented in Texas. Comparison was performed using a t-test analysis between incidence of chosen diagnoses during the described time periods. (3) Results: Incidence of ophthalmic disorders (primarily blepharoconjunctivitis and chalazion) in the pre-pandemic versus mid-pandemic windows did show a significant difference (p-value of 0.048). Similarly, comparison of otolaryngologic diagnoses (primarily rhinitis and related conditions) between the two time periods showed a significant difference (p-value of 0.044) as well. (4) Conclusion: Incidence of the chosen ophthalmic and otolaryngologic disorders did increase during periods of mask mandates. While these findings are preliminary, further studies are warranted to understand other factors that may have played a role in eye and nose pathology.

A rare entity: Benign osteonecrosis of the temporal bone.

Objective: To investigate the factors that may contribute to the rare disease process of benign osteonecrosis of the temporal bone and to differentiate this poorly understood disease from other disorders. Methods: A retrospective chart review using tertiary academic medical center electronic medical records (EMR) for otolaryngology was performed in August 2021. The study included data from January 1, 2014, to June 30, 2020. The patients were identified by a series of predetermined criteria. Their demographic information and clinical course were qualitatively compared. Patients with a history of radiation to the head or neck or who had other otolaryngologic comorbidities were excluded from the study. Inclusion/exclusion criteria were used to filter patients and a thorough chart review was conducted among the patients identified. Results: A total of three patients were identified that met criteria for the study upon thorough chart review. Out of these patients, all were male, fell within the age range of 67-78 years old and had a history of hypertension. Two out of three had diabetes. In all cases, the plan included supportive care and regular follow up appointments. Conclusion: Benign osteonecrosis of the temporal bone is a rare disease that is difficult to diagnose and even more complicated to document. There is no specific ICD-10 code for this disease making it exceedingly difficult to identify patients with a simple EMR search. Several previously hypothesized risk factors were studied in this review. The limited patient population makes it difficult to confidently identify risks. In the patients studied, the commonalities included that they were all men, above the age of 67 when diagnosed, and all had a history of hypertension. To fully understand this rare entity further research must be conducted and more patients must be studied to aid with the identification of risk factors and clinical diagnosis of this condition. Level of Evidence: 4.

Use of biologics for treatment of autoimmune inner ear disease.

OBJECTIVE: Biologic medications are novel therapeutics in the treatment of Autoimmune Inner Ear Disease (AIED), an etiology of Sensorineural Hearing Loss (SNHL). The goal of this study is to review the currently available literature on the efficacy of biologic medications on autoimmune-mediated hearing loss and associated symptomology among patients with AIED. METHODS: A systematic review of Pubmed, Scopus, Cochrane, and Web of Science databases was conducted to identify studies investigating the impact of biologic medications on hearing outcomes. Bias assessment was independently conducted by three authors and studies were stratified based on risk of bias. RESULTS: Of 174 unique abstracts screened, 12 articles met inclusion criteria for formal review. One randomized control trial, seven prospective cohort studies, and four retrospective cohort studies were included. Seven biologic medications, Etanercept, Infliximab, Adalimumab, Golimumab, Rituximab, Anakinra, and Canakinumab, were identified targeting three unique molecular targets, TNF-α, CD20, and IL-1. CONCLUSION: The effects of biologic medications in treating SNHL was highly variable without clear efficacy of a drug or drug category, likely due to rarity of disease, multifactorial etiologies of AIED, and cohort heterogeneity. However, several medications alleviate symptoms associated with AIED, such as vertigo and tinnitus. While biologic medications may be promising therapeutics in AIED patients, the evidence is currently inconclusive. Large-scale randomized control trials and prospective cohort reviews are required to establish the efficacy of biologic medications in treating hearing loss.

Sociodemographic disparities in pediatric cochlear implantation outcomes: A systematic review.

OBJECTIVES: To determine the impact of sociodemographic factors on post-operative performance outcomes among PCI recipients across the world. METHODS: A qualitative systematic review of PubMed, Scopus, Web of Science, and Embase was undertaken for studies analyzing the association of sociodemographic factors with measures of PCI outcomes published before July 18, 2021. Study quality assessment tools from the National Institutes of Health (NIH) were used to assess for risk of bias. RESULTS: Out of 887 unique abstracts initially retrieved, 45 papers were included in the final qualitative systematic review. Sociodemographic disparities in PCI outcomes from 4702 PCI recipients were studied in 19 countries, with 14 studies conducted in the United States of America, published within the years of 1999 to 2021. Parental education and socioeconomic status (e.g. income) were the most investigated disparities in PCI outcomes with 24 and 17 identified studies, respectively. CONCLUSION: Socioeconomic status was a consistently reported determinant of PCI outcomes in the USA and elsewhere, and parental education, the most reported disparity, consistently impacted outcomes in countries outside the USA. This study is limited by our inability to perform a meta-analysis given the lack of standardization across measures of sociodemographic variables and assessment measures for PCI outcomes. Future studies should address the literature gap on racial and ethnic disparities among PCI outcomes and use standardized measures for sociodemographic variables and PCI outcomes to facilitate meta-analyses on the topic. Targeting the mechanisms of these disparities may mitigate the impact of the sociodemographic factors on PCI outcomes.

Surgeon Preference on Sending Routine Tonsillectomy Specimens for Pathological Evaluation.

INTRODUCTION: Despite the presence of a growing body of literature suggesting cost-ineffectiveness of routine pathologic analysis of tonsillectomy specimens, little is known about common institutional policies and practice patterns of pediatric otolaryngologists. The objectives of this study were to determine the prevalence of routine pathological evaluation of tonsillectomy specimens for uncomplicated pediatric adenotonsillectomy procedures and to evaluate opinions regarding this controversy among board-certified pediatric otolaryngologists. METHODS: This was a cross-sectional survey study sent to board-certified pediatric otolaryngologists currently practicing and registered with the American Society of Pediatric Otolaryngology (ASPO) assessing their institutions' or practices' current policies on sending routine tonsillectomy specimens for pathology, their experience with this practice, and their opinions on whether routine pathologic analysis should be employed. Basic statistical analysis was then conducted. RESULTS: Respondents mostly practiced in an academic setting (68.4%), with the next most common being academically affiliated private practice (21.8%), and private practice was the least common (9.8%). Most respondents (85.1%) did not agree with routine pathologic analysis of otherwise uncomplicated pediatric tonsillectomy specimens. CONCLUSION: Most pediatric otolaryngologists who responded to this survey do not support routine pathological analysis of otherwise uncomplicated pediatric tonsillectomy specimens. However, the results are likely biased and should be interpreted carefully, since only a small percentage of pediatric otolaryngologists responded to the survey. Potential cost savings could be seen by patients, payers, and hospital systems with judicious use of surgical pathology, specifically in cases with concurrent signs or symptoms suspicious for malignancy.

Trending Tubes: A Social Media Analysis of Tympanostomy Tubes in Children.

Objective: To investigate the popular social media platforms Instagram and Facebook for public posts related to tympanostomy tubes in children, to discern attitudes and perceptions surrounding tympanostomy tubes, and to evaluate the content of social media posts related to tympanostomy tubes. Study Design: Qualitative study. Setting: Instagram and Facebook social media platforms. Methods: Instagram and Facebook were searched for public posts from 2018 and 2019 including the search terms "ear tubes,""ear tube surgery,""tympanostomy," and "myringotomy." Posts were excluded if they were unrelated to pediatric tympanostomy tubes or written in a non-English language. Relevant posts underwent subgroup analysis based on 6 domains: media type, perspective, topic, timeframe, popularity, and overall tone. Results: Of 1862 public social media posts, the majority (78.2%) were made by the patient's parents/caregivers and the rest by physicians (6.0%), hospitals (8.2%), and chiropractors (6.1%), with a few posts by the patients themselves (0.4%). The majority (79.3%) of posts portrayed tympanostomy tubes positively. Most negative posts were made by chiropractors (50.8%) and the patient's parents/caregivers (42.9%). The most common themes of posts were reassurance regarding surgery (74.9%), advertisements (12.5%), apprehension (12.4%), and education (10.3%). Conclusion: Most social media posts were made by parents/caregivers in the perioperative period, and there was a low percentage of educational posts. This information could be used by otolaryngologists to optimize their interactions with patients and parents and to potentially increase physician involvement and educational material related to tympanostomy tubes on social media.

Qualitative analysis of sinus surgery posts on popular social media platforms.

INTRODUCTION: Social media platforms are constantly evolving and expanding to new populations, exposing their users to various topics and serving as an informal educational resource. Medical ideas and topics are freely discussed online, making understanding of what is present on these platforms of particular importance to the practicing medical professional. In the field of otolaryngology, the public social media portrayal of sinus surgery has not been previously reported. METHODS: Social media posts using keywords related to sinus surgery on Facebook, Instagram, and TikTok were qualitatively analyzed and categorized based on media type, author, subject, timing, depiction, and popularity. RESULTS: The total number of posts included in final analysis was 1798, with a majority stemming from Instagram (68.5%), then Facebook (20.2%) and finally TikTok (11.3%). The most common type of media analyzed was images (69.0%) and patients were more often authors of posts (45.1%) as compared to physicians (34.8%). The subjects of the posts were nearly equally reassurance regarding surgery (41.3%) and educational or informational posts (38.8%) and were most commonly timed in the postoperative period (41.3%). Sinus surgery was depicted in a positive fashion most frequently (56.6%), notably compared against the negative portrayal at 3.2%. Negative posts most commonly cited postoperative pain or bleeding. CONCLUSIONS: Most social media posts analyzed in this multi-platform study depicted sinus surgery in a positive fashion. Patients tended to post in the postoperative or perioperative period, whereas physicians tender to post intraoperative educational posts. Negative posts were most commonly centered around postoperative pain. Cautious interpretation of these results could be used for improving patient care and outreach in the digital age.

Bisphosphonate therapy in otosclerosis: A scoping review.

OBJECTIVE: Otosclerosis, a leading cause of deafness in adults, results from defective bone remodeling of the otic capsule. Bisphosphonates have been used to decrease bone remolding in many diseases, including otosclerosis. This study analyzes whether current literature supports bisphosphonate therapy as an effective treatment for otosclerosis. DESIGN: Scoping review. METHODS: A search was performed in three electronic databases; PubMed, Scopus, and Cochrane Control Trials. Articles were screened independently by two masked reviewers based on prespecified inclusion and exclusion criteria. After unmasking, the two reviewers resolved discrepancies through discussion. RESULTS: From the search, 35 unique articles were identified for analysis. The dates of these publications range from 1982 to 2018. Further title and full-text review identified six articles for inclusion in this review. Three of the studies included are randomized controlled trials (RCT)s, and three are retrospective case reviews. These studies analyzed bisphosphonate therapy regimens, but dose and study length varied, making direct comparisons difficult. Only one RCT study was able to show a statistically significant change between patients treated with bisphosphonates compared to a control group. CONCLUSIONS: The efficacy of bisphosphonates for halting bone remodeling in otosclerosis remains unclear. Reviewing the literature, we found significant variations in experimental design and few studies of high-level evidence. Future RCTs investigating therapies for otosclerosis are needed before a firm conclusion about bisphosphonates efficacy as a pharmacological treatment of otosclerosis.Level of Evidence: 3a.

Gamification in otolaryngology: A narrative review.

INTRODUCTION: The medical field has incorporated gamification elements into education platforms over the past decade. The standard definition for gamification that has been adopted by most research studies is the addition of game elements and game mechanics within a platform to enhance user engagement. In this review, seven established, consolidated components, as well as an additional new or novel component, will be evaluated: a point system/leaderboards, question banks or gradable content, social interaction with other participants, leaderboards, progress or levels, immediate feedback, badges/icons or a reward system, and the novel component, a story line. METHODS: Two reviewers searched MEDLINE, Cochrane, PsycINFO, Web of Knowledge, and the Nursing Registry. This review compares the one identified otolaryngology study with current residency education gamification practices within the medical field.The authors searched "residency AND gamification", "residency AND video games", and "residency AND games". After applying exclusion criteria, the 13 remaining studies included a procedure, questions/scenarios, and at least three gamification elements. RESULTS: Across the 13 studies, the average number of included gamification elements was higher than the minimum threshold of three (3.84). Ten of the studies incorporated leaderboards, feedback, and social interaction; eight incorporated a question bank; and four incorporated progress bars, rewards, and story lines. The otolaryngology study incorporated four of the gamification components: a point system, instant feedback/solution after a question was answered, player-to-player communication, and a leaderboard. CONCLUSION: Review of the current literature found that the medical field has limited research regarding the use of gamification in educational platforms. Despite many simulation studies and attempts at gamification, the medical community has not fully embraced gamification within residency education. In closing, the medical education community should establish a definition of "gamification" and survey residency programs to identify desired gamification elements.

Bilateral Cervical Pilomatricoma: A Diagnostic Dilemma for the Pediatric Otolaryngologist.

Pilomatricomas are benign skin tumors often encountered by otolaryngologists but frequently misdiagnosed. Although they can occur at any age, they commonly present in children as a discolored superficial lesion adhered to the overlying skin. Accurate preoperative diagnosis is crucial for appropriate management, which is surgical in most cases. Here, we present bilateral pilomatricomas mimicking features of several other diagnoses in a pediatric patient. The patient was successfully treated with surgical excision. This case presented a unique diagnostic challenge, as the lesions exhibited features of several common diagnoses. In general, surgical management of pilomatricoma is curative, and recurrence is rare.

Sociodemographic Disparities in Pediatric Cochlear Implantation Access and Use: A Systematic Review.

OBJECTIVES: Pediatric cochlear implantation (CI) is a multistep process, which exposes a healthcare system's potential weaknesses in ability to deliver timely care to deaf children. The current systematic review aims to determine the sociodemographic disparities that predict pediatric CI access and use among CI candidates and recipients across the world. We hypothesize that sociodemographic factors independently influence CI access and use within a given country. STUDY DESIGN: Systematic review. METHODS: A qualitative systematic review of PubMed, Scopus, Web of Science, and Embase databases was conducted for studies investigating the association of sociodemographic factors such as race, income, or insurance status with measures of pediatric CI access, such as age at CI or CI rate. RESULTS: Out of 807 unique abstracts initially retrieved, 39 papers were included in the final qualitative systematic review. Twenty-seven thousand seven hundred and fifty-one CI-candidate children (6,623 CI recipients) were studied in 14 countries, with 21 studies conducted in the United States of America, published within the years of 1993 to 2020. CONCLUSION: Some measures of CI access, such as age at CI and rates of CI, are consistently reported in the CI disparities literature while others such as access to rehabilitation services, willingness to undergo CI, and daily CI use are rarely measured. There are persistently reported disparities in a few key measures of CI access in a few populations, while there are some populations with a paucity of data. Future studies should delineate the nuances in the mechanisms of disparities by conducting multivariable analysis of representative sample data. Laryngoscope, 132:670-686, 2022.

The use of mobile devices in oculoplastic and oral and maxillofacial surgery: A systematic review.

BACKGROUND: The use of smartphones in the United States has more than doubled since 2011. Mobile phone applications have versatile functions in ophthalmology, otolaryngology, and plastic surgery, such as increasing patient engagement in treatment, decreasing no-shows to appointments, and providing patient education. They also provide practical advantages to the clinician, including supplementing an otoscope, laryngoscope, or ophthalmoscope. Their use in oral and maxillofacial surgery (OMFS) and oculoplastic surgery has shown effectiveness for a variety of applications, such as for photography and medical reference. Research suggests that smartphones may improve clinical outcomes and efficiency. OBJECTIVE: The goal of this study is to provide a comprehensive and up-to-date systematic review of the available literature investigating mobile phone use in oculoplastic surgery and OMFS. METHODS: A query of terms relevant to oculoplastic surgery and OMFS was conducted using the databases PubMed, CINAHL, Web of Science, and PsychINFO to identify studies meeting inclusion criteria that investigated the implementation, efficacy, and outcomes of mobile device use in oculoplastic surgery and OMFS. A qualitative summary and discussion of the literature was subsequently synthesized. RESULTS: Out of a total of 289 articles reviewed, 171 were removed due to duplication across the four databases. Of the 118 studies remaining, 19 of them were included within the final qualitative review after screening the abstracts and full text for relevance. The articles were published between 2005 and 2020 from 7 different countries. Review of the relevant articles showed three settings in which mobile devices were used: communication between providers, communication between providers and patients, and as surgical supplementation. The literature review included use of mobile device photography for quality improvement, visual representation of procedures for patient education, and improved communication amongst providers and patients in the setting of oculoplastics and OMFS. CONCLUSION: Mobile device use has become ubiquitous across cultures worldwide. The literature suggests that mobile phone use in oculoplastic surgery and OMFS may improve clinical practice in multiple settings. However, further investigation is necessary to quantify the clinical benefits of mobile device use in oculoplastic and oral and maxillofacial surgery.