Assessing the Association Between Head and Neck Cancer and Granulomatosis with Polyangiitis.

Objective: To determine the odds of head and neck cancer (HNC) in patients with a concurrent or prior diagnosis of granulomatosis with polyangiitis (GPA). Methods and Materials: The TriNetX Analytics Network, a federated research platform that aggregates de-identified electronic health record data of over 130 million patients worldwide, was queried for patients with at least one ICD-10 encounter diagnosis of GPA. Patients within this group with an encounter diagnosis of cancer of the sinonasal, oral cavity, oropharynx, nasopharynx, and larynx concurrent or after the initial encounter diagnosis of GPA were recorded and compared to a standardized control population to determine odds ratios with a 95% confidence interval (CI). Relevant confounding variables, including human papillomavirus, Epstein Barr virus, tobacco, and alcohol exposure, were balanced between cohorts by 1:1 propensity matching. Results: Of the patients in the GPA cohort, 126 (0.48%) had an ICD-10 diagnosis of HNC. When stratifying by head and neck subsites, 20 (0.08%), 18 (0.07%), 23 (0.09%), 70 (0.27%), and 22 (0.084%) GPA patients had an ICD-10 encounter diagnosis of cancer involving the sinonasal, nasopharynx, larynx, oral cavity, and oropharynx. When comparing the experimental GPA group with the standardized control population after matching, patients in the GPA group had 1.3 times (95% CI: 1.03-1.175) greater odds of HNC when including cases diagnosed after or concurrently with the diagnosis of the vasculitis. There was no statistical difference in the odds of cancer at each anatomical subsite between the GPA and control cohort after matching. Conclusion: Our study identifies a statistically significant increase in the odds of HNC encounter diagnoses in patients with GPA.

Clinical Characteristics of Primary Snoring vs Mild Obstructive Sleep Apnea in Children: Analysis of the Pediatric Adenotonsillectomy for Snoring (PATS) Randomized Clinical Trial.

Importance: It is unknown whether children with primary snoring and children with mild obstructive sleep apnea (OSA) represent populations with substantially different clinical characteristics. Nonetheless, an obstructive apnea-hypopnea index (AHI) of 1 or greater is often used to define OSA and plan for adenotonsillectomy (AT). Objective: To assess whether a combination of clinical characteristics differentiates children with primary snoring from children with mild OSA. Design, Setting, and Participants: Baseline data from the Pediatric Adenotonsillectomy Trial for Snoring (PATS) study, a multicenter, single-blind, randomized clinical trial conducted at 6 academic sleep centers from June 2016 to January 2021, were analyzed. Children aged 3.0 to 12.9 years with polysomnography-diagnosed (AHI <3) mild obstructive sleep-disordered breathing who were considered candidates for AT were included. Data analysis was performed from July 2022 to October 2023. Main Outcomes and Measures: Logistic regression models were fitted to identify which demographic, clinical, and caregiver reports distinguished children with primary snoring (AHI <1; 311 patients [67.8%]) from children with mild OSA (AHI 1-3; 148 patients [32.2%]). Results: A total of 459 children were included. The median (IQR) age was 6.0 (4.0-7.5) years, 230 (50.1%) were female, and 88 (19.2%) had obesity. A total of 121 (26.4%) were Black, 75 (16.4%) were Hispanic, 236 (51.5%) were White, and 26 (5.7%) were other race and ethnicity. Black race (odds ratio [OR], 2.08; 95% CI, 1.32-3.30), obesity (OR, 1.80; 95% CI, 1.12-2.91), and high urinary cotinine levels (>5 µg/L) (OR, 1.88; 95% CI, 1.15-3.06) were associated with greater odds of mild OSA rather than primary snoring. Other demographic characteristics, clinical examination findings, and questionnaire reports did not distinguish between primary snoring and mild OSA. A weighted combination of the statistically significant clinical predictors had limited ability to differentiate children with mild OSA from children with primary snoring. Conclusions and Relevance: In this analysis of baseline data from the PATS randomized clinical trial, primary snoring and mild OSA were difficult to distinguish without polysomnography. Mild OSA vs snoring alone did not identify a clinical group of children who may stand to benefit from AT for obstructive sleep-disordered breathing. Trial Registration: ClinicalTrials.gov Identifier: NCT02562040.

A Medicare Physician Fee Schedule Analysis of Reimbursement Trends in Laryngology from 2000 to 2021.

OBJECTIVE: The purpose of this study is to characterize Medicare reimbursement trends for laryngology procedures over the last two decades. METHODS: This analysis used CMS' Physician Fee Schedule (PFS) Look-Up Tool to determine the reimbursement rate of 48 common laryngology procedures, which were divided into four groups based on their practice setting and clinical use: office-based, airway, voice disorders, and dysphagia. The PFS reports the physician service reimbursement for "facilities" and global reimbursement for "non-facilities". The annual reimbursement rate for each procedure was averaged across all localities and adjusted for inflation. The compound annual growth rate (CAGR) of each procedure's reimbursement was determined, and a weighted average of the CAGR for each group of procedures was calculated using each procedure's 2020 Medicare Part B utilization. RESULTS: Reimbursement for laryngology procedure (CPT) codes has declined over the last two decades. In facilities, the weighted average CAGR for office-based procedures was -2.0%, for airway procedures was -2.2%, for voice disorders procedures was -1.4%, and for dysphagia procedures was -1.7%. In non-facilities, the weighted average CAGR for office-based procedures was -0.9%. The procedures in the other procedure groups did not have a corresponding non-facility reimbursement rate. CONCLUSION: Like other otolaryngology subspecialties, inflation-adjusted reimbursements for common laryngology procedures have decreased substantially over the past two decades. Because of the large number of physician participants and patient enrollees in the Medicare programs, increased awareness and further research into the implications of these trends on patient care is necessary to ensure quality in the delivery of laryngology care. LEVEL OF EVIDENCE: NA Laryngoscope, 134:247-256, 2024.

Utility of CT or X-ray in the management of adult nasal fracture.

PURPOSE: The primary objective of this study is to evaluate the use of imaging in the management of nasal fracture in adults and determine if imaging is beneficial to clinical decision making when planning for surgery. A secondary objective of this study is to compare surgical rates for nasal fracture between pediatric and adult populations. METHODS: This is a retrospective case-control study of 357 patients seen at University Hospitals Cleveland Medical Center from January 2015 through January 2020 with a diagnosis of nasal fracture. An odds ratio was calculated to determine likelihood of surgical intervention between patients who had imaging of the nasal bones and patients who did not. RESULTS: 82 % of patients had either CT or X-ray imaging. The odds ratio of patients who had surgery after CT or X-ray imaging compared to patients who had surgery without prior imaging was 0.092 (95 % CI: 0.0448-0.1898, p-value <0.0001). A total of 54 (15 %) adult patients had surgery, in comparison to 50 % of pediatric patients with diagnosis of nasal fracture. 202 (57 %) of patients did not follow up after initial diagnosis by radiology. CONCLUSION: The statistical analysis suggests that while CT and X-ray are frequently obtained in the setting of nasal fracture, patients without imaging are more likely to have surgery (p < 0.05) than patients with imaging. This indicates that imaging is likely unnecessary for surgical planning. Most adults do not pursue surgery, and surgical rates for adults with nasal fracture are much lower than those of pediatric patients with nasal fracture.

Measuring food insecurity among a national sample of children with recurrent acute otitis media.

INTRODUCTION: Acute otitis media is one of the most common reasons for pediatric medical visits in the United States. Additionally, past studies have linked food insecurity and malnutrition with increased infections and worse health outcomes. However, there is a lack of information on the risk factors for food insecurity in specific patient populations, including the pediatric recurrent acute otitis media (RAOM) population. METHODS: The 2011 to 2018 National Health Interview Survey (NHIS) datasets were used to obtain a national estimate of the presentation of food insecurity within pediatric patients with RAOM. Relevant sociodemographic information and prevalence were identified. A multivariable logistic regression model was used to determine sociodemographic risk factors. Calculations were conducted using R with the "survey" package to account for the clustering and sampling of the NHIS. RESULTS: Of 3844 children with RAOM who responded to the food insecurity module, 20.8 % (19.0-22.6 %) were food insecure. Age, race/ethnicity, percentage of federal poverty level status, insurance status, and self-reported health status were significant and were not independent of food insecurity status. Using multivariable regression, this study found the following sociodemographic risk factors: age 6-10 and age > 10 (reference: age 0-2); Black (reference: Non-Hispanic White); 100 % to 200 % and <100 % federal poverty level (reference: >200 % federal poverty level); public insurance or uninsured status (reference: private insurance); and poor to fair self-reported health status (reference: good to excellent). DISCUSSION: Children with RAOM who were older, Black, less insured, living in lower-income households, and of poorer health had a greater association with being food insecure. Due to the frequency of RAOM pediatric visits, identifying at-risk groups as well as incorporating food insecurity screening and food referral programs within clinical practice can enable otolaryngologists to reduce disparities and improve outcomes in a targeted approach.

Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children: A Randomized Clinical Trial.

Importance: The utility of adenotonsillectomy in children who have habitual snoring without frequent obstructive breathing events (mild sleep-disordered breathing [SDB]) is unknown. Objectives: To evaluate early adenotonsillectomy compared with watchful waiting and supportive care (watchful waiting) on neurodevelopmental, behavioral, health, and polysomnographic outcomes in children with mild SDB. Design, Setting, and Participants: Randomized clinical trial enrolling 459 children aged 3 to 12.9 years with snoring and an obstructive apnea-hypopnea index (AHI) less than 3 enrolled at 7 US academic sleep centers from June 29, 2016, to February 1, 2021, and followed up for 12 months. Intervention: Participants were randomized 1:1 to either early adenotonsillectomy (n = 231) or watchful waiting (n = 228). Main Outcomes and Measures: The 2 primary outcomes were changes from baseline to 12 months for caregiver-reported Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC) T score, a measure of executive function; and a computerized test of attention, the Go/No-go (GNG) test d-prime signal detection score, reflecting the probability of response to target vs nontarget stimuli. Twenty-two secondary outcomes included 12-month changes in neurodevelopmental, behavioral, quality of life, sleep, and health outcomes. Results: Of the 458 participants in the analyzed sample (231 adenotonsillectomy and 237 watchful waiting; mean age, 6.1 years; 230 female [50%]; 123 Black/African American [26.9%]; 75 Hispanic [16.3%]; median AHI, 0.5 [IQR, 0.2-1.1]), 394 children (86%) completed 12-month follow-up visits. There were no statistically significant differences in change from baseline between the 2 groups in executive function (BRIEF GEC T-scores: -3.1 for adenotonsillectomy vs -1.9 for watchful waiting; difference, -0.96 [95% CI, -2.66 to 0.74]) or attention (GNG d-prime scores: 0.2 for adenotonsillectomy vs 0.1 for watchful waiting; difference, 0.05 [95% CI, -0.18 to 0.27]) at 12 months. Behavioral problems, sleepiness, symptoms, and quality of life each improved more with adenotonsillectomy than with watchful waiting. Adenotonsillectomy was associated with a greater 12-month decline in systolic and diastolic blood pressure percentile levels (difference in changes, -9.02 [97% CI, -15.49 to -2.54] and -6.52 [97% CI, -11.59 to -1.45], respectively) and less progression of the AHI to greater than 3 events/h (1.3% of children in the adenotonsillectomy group compared with 13.2% in the watchful waiting group; difference, -11.2% [97% CI, -17.5% to -4.9%]). Six children (2.7%) experienced a serious adverse event associated with adenotonsillectomy. Conclusions: In children with mild SDB, adenotonsillectomy, compared with watchful waiting, did not significantly improve executive function or attention at 12 months. However, children with adenotonsillectomy had improved secondary outcomes, including behavior, symptoms, and quality of life and decreased blood pressure, at 12-month follow-up. Trial Registration: ClinicalTrials.gov Identifier: NCT02562040.

The perceived impact of curricular and non-curricular factors on specialty interests and choice during medical school at a single center in the United States.

BACKGROUND: Limited information exists regarding how medical students' specialty interests evolve throughout medical school, particularly interest in surgical versus non-surgical specialties. Our objective was to identify medical students' specialty interests before and after medical school and the most important curricular and non-curricular factors that shaped their specialty choice. METHODS: An online 22-question voluntary, anonymized survey was designed to assess specialty interests and factors impacting specialty choice at a single medical school in the United States. The study was pilot-tested with focus groups. The final questionnaire was distributed to final-year medical students from the Classes of 2020 and 2021. Responses were measured on a 5-point Likert scale (1 = strong negative impact to 5 = strong positive impact). RESULTS: 102 of 184 students (55%) from Class of 2020 and 85 of 174 students (49%) from Class of 2021 participated. Of 187 respondents, the majority (60%) decided on their specialty during third year. 74 of 147 students (50%) pursued a specialty among their initial specialty interests. Students with initial surgical interests were significantly (p < 0.001) less likely to choose surgical specialties (42%) compared to students with initial non-surgical interests choosing non-surgical specialties (79%). Pre-clinical years (3.67 ± 0.96) were perceived to have a significantly (p < 0.001) less positive impact on specialty interests and choice compared to clinical years. Among pre-clinical factors, physician shadowing (3.80 ± 0.83) was perceived to have the significantly (p < 0.001) greatest positive impact. During clinicals, 34% of respondents indicated that order of clerkships impacted specialty choice. 112 of 171 respondents (65%) indicated that mentorship impacted specialty choice. Physicians in the chosen specialty were perceived to have the strongest impact (4.67 ± 0.49). 65 of 171 respondents (38%) indicated that peers impacted specialty choice with classmates (3.98 ± 0.87) and near-peers (3.83 ± 0.74) perceived to have a positive impact. CONCLUSIONS: Specialty interests changed during medical school for a significant portion of students (50%). Those with initial surgical interests were more likely to change their specialty interests. Pre-clinicals were reported to have less impact on specialty choice compared to clinicals. Implementing factors such as shadowing and physician/peer mentorship, which may positively impact specialty choice, into pre-clinical curricula warrants further investigation.

Olfactory dysfunction incidence and resolution amongst 608 patients with COVID-19 infection.

PURPOSE: Olfactory dysfunction (OD) is a common presenting sign of coronavirus-19 (COVID-19) infection and remains persistent in up to 7 % of patients one year after diagnosis. However, demographic, socioeconomic, and medical risk factors for persistent OD are not well understood. This study aims to determine risk factors for development and persistence of OD amongst patients with COVID-19 infection. MATERIALS AND METHODS: This prospective, observational questionnaire study was performed at a tertiary-level, academic center. Patients with history of a positive COVID-19 diagnosis were sent an online questionnaire. Patients' self-reported survey responses for OD and resolution were assessed for associations with demographic variables, socioeconomic factors, and clinical data. RESULTS: In total, 608 of 26,094 patients (77.6 % women, mean age 42.7 ± 17.4 years, range 9 months-92 years) completed the survey. OD was reported by 220 (36.2 %) patients, and 139 (63.2 %) patients achieved resolution. Patients with OD were more likely to have other sinonasal and flu-like symptoms, and had a hospitalization rate of 2.7 %. There were no significant differences in age, gender, occupational or residential factors, or medical comorbidities incidence of OD development. Women reported higher rates of persistent OD (88.9 % vs 77.0 %, p = 0.045). The OD recovery rates amongst active and resolved COVID-19 infections was 27.0 % and 70.0 %, respectively (p < 0.001). CONCLUSIONS: There was a low hospitalization rate amongst patients reporting OD. One-third of patients with COVID-19 self-reported OD, and two-thirds of patients achieve OD resolution. Survey respondents with active COVID-19 infection and female gender were more likely to report persistent OD.

Transmission risk of COVID-19 infection with office-based flexible laryngoscopy.

Since the beginning of the Coronavirus pandemic, recommendations to ensure safety in clinical practice have fluctuated. Within the Otolaryngology community, a variety of protocols have emerged to assure safety for both patients and healthcare workers while maintaining standard of care practices, especially surrounding aerosolizing in-office procedures. OBJECTIVES: This study aims to describe our Otolaryngology Department's Personal Protective Equipment protocol for both patients and providers during office laryngoscopy and to identify the risk of contracting COVID-19 after implementation of the protocol. METHODS: 18,953 office visits divided between 2019 and 2020 where laryngoscopy was performed were examined and compared to the rate of COVID-19 contraction for both office staff and patients within a 14 day period after the encounter. Of these visits, two cases were examined and discussed; where a patient tested positive for COVID-19 ten days after office laryngoscopy, and one where a patient tested positive for COVID-19 ten days prior to office laryngoscopy. RESULTS: In the year 2020, 8337 office laryngoscopies were performed, 100 patients tested positive within the year 2020, with only these 2 cases of COVID-19 infections occurring within 14 days prior to or after their office visit. CONCLUSION: These data suggest that using CDC-compliant protocol for aerosolizing procedures, such as office laryngoscopy, can provide a safe and effective method for mitigating infectious risk while providing timely quality care for the otolaryngology patient. LEVEL OF EVIDENCE: 3 LAY SUMMARY: During the COVID-19 Pandemic, ENTs have had to balance providing care while minimizing the risk of COVID-19 transmission with routine office procedures such as flexible laryngoscopy. In this large chart review, we show that the risk of transmission is low with CDC-compliant protective equipment and cleaning protocols.

Reimbursement Trends in Pediatric Otolaryngology From 2000 to 2020: A CMS Physician Fee Schedule Analysis.

OBJECTIVE: The aim of this study was to evaluate the financial trends in Medicare reimbursement rates for the most billed procedures at a single institution from 2000 to 2020 within pediatric otolaryngology. STUDY DESIGN: Retrospective data analysis. SETTING: United States. METHODS: The most billed surgical and in-office procedures in pediatric otolaryngology at our institution were identified in the Physician Fee Schedule Look-up Tool from the Centers for Medicare and Medicaid Services to extract reimbursement data for each CPT code (Current Procedural Terminology). Monetary data were adjusted for inflation to 2020 US dollars per the changes to the consumer price index. Mean annual and total percentage changes in reimbursement were calculated by the adjusted values for all included procedures (N = 25). RESULTS: From 2000 to 2020, without adjusting for inflation, reimbursement for the most billed procedures increased by 10.9%, while the allocated relative value unit per procedure increased by 15.4%. However, when adjusted for inflation, reimbursement for these procedures decreased by 27.5% over the study period. CONCLUSIONS: The study findings identify a downward trend in reimbursement for the most billed procedures in pediatric otolaryngology at our institution. Given the low predominance of pediatric otolaryngology codes within Medicare reimbursement, these codes are rarely reviewed for accurate revaluation. It is imperative that our professional society remain active and engaged within this process to ensure quality delivery of care to our patients.

Prevalence of New-Onset Tinnitus after COVID-19 Vaccination with Comparison to Other Vaccinations.

OBJECTIVE: To investigate how often patients are diagnosed with new-onset tinnitus within 21 days after COVID-19 vaccination in comparison to after three other common vaccinations: influenza, Tdap (tetanus, diphtheria, and acellular pertussis), and polysaccharide pneumococcus. METHODS: The TriNetX Analytics Network, a federated health research network that aggregates the de-identified electronic health record (EHR) data of over 78 million patients, was queried for patients receiving each vaccination. Instances of new-onset tinnitus within 21 days of vaccination were recorded and reported. RESULTS: Out of 2,575,235 patients receiving a first dose of the mRNA COVID-19 vaccine without any prior tinnitus diagnosis, 0.038% (95% CI: 0.036%-0.041%) of patients had a new diagnosis of tinnitus within 21 days. There was a higher risk of a new tinnitus diagnosis after the influenza vaccine (RR: 1.95, 95% CI: 1.72-2.21), Tdap vaccine (RR: 2.36, 95% CI: 1.93-2.89), and pneumococcal vaccine (RR: 1.97, 95% CI: 1.48-2.64) than after the first dose of the COVID-19 vaccine. There was a lower risk of a new tinnitus diagnosis after the second dose of COVID-19 than after the first dose (RR: 0.80, 95% CI: 0.71-0.91). CONCLUSION: The rate of newly diagnosed tinnitus acutely after the first dose of the COVID-19 vaccine is very low. There was a higher risk of newly diagnosed tinnitus after influenza, Tdap, and pneumococcal vaccinations than after the COVID-19 vaccine. The present findings can help to address COVID-19 vaccine hesitancy during the ongoing pandemic. LEVEL OF EVIDENCE: Level 3 Laryngoscope, 133:1722-1725, 2023.

Epidemiology of Eustachian tube dysfunction and related otologic diagnoses among children with achondroplasia.

OBJECTIVE: To investigate the prevalence of diagnosed Eustachian tube dysfunction and related otologic diagnoses among children with achondroplasia as compared to a control population. METHODS: The TriNetX Analytics Network, a federated health research network that aggregates the de-identified electronic health record data of over 78 million patients across the United States, was queried for patients 18 years old or younger with achondroplasia. Patients in this group with any occurrence of diagnosed Eustachian tube dysfunction or specified otologic diagnoses were recorded and reported. RESULTS: Out of 2,195 patients 18 years old or younger with diagnosed achondroplasia, 379 (17.27%, 95% CI: 15.71-18.91) had a diagnosis of Eustachian tube dysfunction with an 8.65 (95% CI: 7.89-9.48) times higher risk than children without achondroplasia (n = 12,818,655). Children with achondroplasia also had higher risks for diagnosed otitis media (RR: 2.21), tympanic membrane retraction (RR: 7.29), middle ear cholesteatoma (RR: 6.35), cleft palate (RR: 12.24), conductive hearing loss (RR: 12.15), and tympanostomy tube placement (RR: 9.71). Each increased risk was maintained when cleft palate patients were removed from the achondroplasia group. CONCLUSION: Children with achondroplasia are at a significantly higher risk for diagnosed Eustachian tube dysfunction and related middle ear diagnoses. Atypical craniofacial anatomy among children with achondroplasia may play a role in the dysfunction of the Eustachian tube and thus the observed epidemiology of otologic conditions. Children with achondroplasia should be monitored closely for middle ear conditions and the constellation of symptoms related to a dysfunctional Eustachian tube.

Efficacy of X-ray in the diagnosis of pediatric nasal fracture.

OBJECTIVE: Nasal fracture is one of the most common pediatric fractures, and diagnosis can be made with clinical findings or with radiographic imaging. The objective of this study is to determine the extent of x-ray utilization in decision-making regarding closed reduction of pediatric nasal fracture. METHODS: This a case-control study of 117 patients ages 0-18 with a diagnosis of nasal fracture seen at University Hospitals Cleveland Medical Center between January 2015 and January 2020. The exposure group had x-ray imaging of the nasal bones, and the control group had no x-ray imaging. RESULTS: A total of 59 (50.4%) patients had surgical intervention. The odds ratio to compare x-ray utilization to the control group for patients who underwent closed reduction surgery was .3951 (95% CI: 0.1848-0.8448, p-value = .0166). CONCLUSION: The statistical analysis suggests that x-ray use is associated with decreased rates of closed reduction surgery. It is likely that while not necessary for the diagnosis of nasal fracture, x-ray serves as an additional data point for diagnosis confirmation, and may reduce the rate of unnecessary surgery for false positive cases of nasal fracture.

Middle ear cholesteatoma prevalence in over 3,600 children with Turner Syndrome.

OBJECTIVE: To investigate the prevalence of middle ear cholesteatoma in children with Turner syndrome (TS) as compared to the general population using a large database. METHODS: The TriNetx Analytics Network, a federated health research network that aggregates the de-identified electronic health record data of over 78 million patients across the United States, was queried for patients 18 years old or younger with TS. Patients in this group with any occurrence of a diagnosed middle ear cholesteatoma were recorded and reported. RESULTS: Out of 3,682 children 18 years old or younger with diagnosed TS, 1.47% (95% CI: 1.10%-1.91%) had a history of middle ear cholesteatoma. Out of 12,836,624 children 18 years or younger without TS, 0.09% (95% CI: 0.09%-0.09%) had a history of diagnosed middle ear cholesteatoma. The relative risk for middle ear cholesteatoma in children with TS was 16.74 (95% CI: 12.84-21.83). The relative risk for diagnosed cleft palate among children with TS was 8.56 (95% CI: 6.67-10.98) which, because of the Eustachian tube dysfunction in this population, may contribute to the cholesteatoma risk. CONCLUSION: The rate of diagnosed middle ear cholesteatoma was found to be 16 times higher in patients with Turner syndrome versus children without Turner syndrome. Of studies examining middle ear cholesteatoma in children with TS, the present study has the largest sample size thus providing reliable evidence for prevalence in this population. Clinical monitoring for cholesteatoma should be especially rigorous and frequent in this population.

Impact of body mass index in patulous Eustachian tube: Does rapid weight loss influence symptom improvement?

OBJECTIVES: Weight loss has been proposed as risk factor for patulous Eustachian tube (PET), however, it has not been well-characterized how this subpopulation responds to standard treatments. This study aimed to evaluate PET symptom improvement in the setting of and absence of rapid weight loss. METHODS: This retrospective case series included patients diagnosed with PET at an academic institution. Demographic characteristics, medical comorbidities, presenting symptoms, treatment, and outcomes of symptom improvement were reviewed. Univariate analysis modeled the likelihood of symptom improvement between rapid weight loss and non-rapid weight loss patients. RESULTS: A total of 124 patients (median age 55 years, 61 % female) were included. At diagnosis, 7 (5.6 %) patients were underweight, 40 (32.3 %) were normal weight, 32 (25.8 %) were overweight, and 45 (36/3 %) were obese. There were 39 (31.5 %) patients who had history of weight loss prior to presentation; of these, 22 (17.7 %) noted rapid weight loss and 17 (13.7 %) had non-rapid weight loss. There were 62 (50.0 %) patients who were recommended conservative treatment, and 62 (50.0 %) who underwent medical and/or surgical treatment. Symptom resolution was achieved in 49 (39.5 %) patients. On univariate analysis, patients with rapid weight loss were significantly more likely to experience improvement (p = 0.006) than non-rapid weight loss. Rapid weight loss patients had a four-fold increased likelihood of symptom improvement compared to non-rapid weight loss patients (OR = 4.8, p = 0.053). CONCLUSIONS: While rapid weight loss and bariatric surgery are reported risk factors for the development of PET, our findings suggest that patients with rapid weight loss are significantly more likely to achieve symptom improvement than non-rapid weight loss.

Nationwide disparities in transportation related delays to care experienced by children with frequent ear infections.

BACKGROUND: Acute otitis media (AOM), or ear infection, is the most common reason for pediatric medical visits in the United States [1]. Additionally, transportation barriers are a significant driver of missed and delayed care across medical specialties [2,3]. Yet, the role of transportation barriers in impeding access for children with frequent ear infections (FEI) has not been investigated. Assessing the prevalence of transportation barriers across sociodemographic groups may help clinicians improve outcomes for children with FEI. METHODS: A retrospective analysis of the U.S. National Health Interview Survey was completed to examine associations between sociodemographic characteristics among children with FEI and transportations barriers to seeking care between 2011 and 2018. RESULTS: Multivariable logistic regression found that income level, insurance status, and health status were linked to disparities in transportation barriers among children with FEI. Those in the middle (aOR 3.00, 95% CI 1.77-5.08, p < 0.001) and lowest income brackets (aOR 6.33, 95% CI 3.80, p < 0.001), who were publicly insured (aOR 3.24, 95% CI 2.00-5.23, p < 0.001) or uninsured (aOR 3.46, 95% CI 1.84-6.51, p < 0.001), and with Poor to Fair health status were more likely to face transportation delays than patients who were in the highest income bracket, privately insured, or had Good to Excellent health status. CONCLUSION: Children with FEI from families that were lower-income, less insured, and less healthy faced more transportation barriers when accessing care than their counterparts. Future interventions to improve health-related transportation should be targeted toward these patient subgroups to reduce gaps in outcomes.

Critical analysis of the evaluation of postoperative dysphagia following an anterior cervical discectomy and fusion.

BACKGROUND AND PURPOSE: Postoperative dysphagia is a known complication of anterior cervical discectomy and fusion (ACDF) with reported incidences ranging from 1 to 79%. No standardized guidelines exist for spine surgeons to evaluate postoperative dysphagia after ACDF. A systematic method may be beneficial in distinguishing transient postoperative dysphagia secondary to intubation from those with postoperative complications. This study evaluates the causes, recognition, and clinical evaluation of postoperative dysphagia following ACDF. METHODS: International classification of disease (ICD) and current procedural terminology (CPT) codes were used to identify ACDF patients and compared to anterior lumbar discectomy and fusion (ALDF), serving as a control group, between the years 2015-2019 and those diagnosed with dysphagia within 1 year. Demographics, operative details, and clinical evaluation were reviewed. Exclusion criteria included history of head and neck procedures, cancer, stroke, radiation, and trauma. RESULTS: One hundred thirty-one ACDF and 93 ALDF patients met inclusion criteria. Twenty-seven (20.6%) ACDF patients were diagnosed with dysphagia within 1 year. Less than half of the dysphagia patients had the word "dysphagia" documented in their 1-month spine surgeon follow up visit. Only 66% of dysphagia patients had specialist evaluation and one third of those patients were referred by their surgeon. Only six patients received diagnostic barium swallow evaluations. CONCLUSION: Postoperative dysphagia risk increases in ACDF compared to ALDF, likely due to underlying anatomy. Postoperative dysphagia symptoms are not effectively documented by spine surgeons and as a result underevaluated by dysphagia specialists. Patients may benefit from more extensive pre- and post-operative screening, evaluation, and referral regarding dysphagia symptoms following ACDF.

Chronic care handoffs in otolaryngology: Pediatric to Adult Care Providers.

OBJECTIVE: The transfer of care from pediatric to adult otolaryngology remains unexplored. Our study investigated practice patterns among pediatric otolaryngologists. METHODS: Twenty-question survey administered to otolaryngologists at the Society for Ear Nose and Throat Advancement in Children (SENTAC) and American Society of Pediatric Otolaryngology (ASPO) in December 2020 and July 2021 respectively. Data analyzed in RedCap including demographics, frequencies, means, and standard deviations. RESULTS: The survey was completed by 48 participants. The majority of respondents practiced for at least 16 years (n = 28) at a University-based practices (n = 38), serving an entirely pediatric population (n = 44). Providers' expertise included chronic ear disease, voice disorders, and laryngeal stenosis. Few respondents (n = 12) had a transfer of care policy formalized at their practice. However, 38.8% of respondents were interested in developing one. Respondents rarely discussed topics such as drugs, tobacco, or alcohol use (mean 30.1%, SD 30.18%) with patients; and only 55.5% (SD 32.98) of providers asked patients 14 years and older to describe their condition, medications, or treatment plans. None of the providers were familiar with standardized transition of care tools. The majority of providers transferred patients between 18 and 25 years old to adult care. CONCLUSION: There is significant variation between otolaryngology providers' awareness and clinical practice patterns surrounding pediatric to adult transfer of care. Further studies are needed to evaluate the implications of these biases for patient outcomes and the opportunities for a standardized approach.

Otitis Media and Tympanostomy Tubes.

Acute otitis media (AOM) is an acute infection of the middle ear and, depending on the age of the child, the certainty of diagnosis, and the severity of symptoms, should be either observed closely or treated (with high-dose amoxicillin, if not allergic). Host-related risk factors such as age, sex, cleft palate, or genetic predisposition or environmental risk factors such as seasonality, day care attendance, or tobacco smoke exposure may contribute to recurrent AOM (RAOM) episodes. Tympanostomy tubes are recommended in children with RAOM and an abnormal ear examination at the time of the clinic evaluation.

Hearing loss patterns in enlarged vestibular aqueduct syndrome: Do fluctuations have clinical significance?

OBJECTIVES: To reveal hearing loss patterns in patients with enlarged vestibular aqueduct (EVA) syndrome according to demographic and clinical characteristics. METHODS: A retrospective, longitudinal study design was utilized to identify patients with EVA. Ears of patients were categorized into one of four cohorts: progressive fluctuating, progressive non-fluctuating, stable fluctuating, and stable non-fluctuating patterns. Pairwise and group comparisons were performed with non-parametric tests to assess vestibular aqueduct (VA) morphology, clinical, and demographic variables between hearing loss pattern cohorts. Rates of hearing loss in the subgroups were determined utilizing a mixed linear effects model. RESULTS: 44 patients (25 female, 19 male, median diagnosis age: 8.06 years) met inclusion criteria. 16 individuals demonstrated unilateral EVA and 29 had bilateral EVA, resulting in 74 total ears with EVA. Amongst the four cohorts, differences in operculum widths amongst groups were statistically significant (p = 0.049) while VA midpoint widths were not (p = 0.522). Progressive hearing loss ears without fluctuations demonstrated a 3.20 dB per year (p < 0.001) progression while progressive hearing loss ears with fluctuations reported a rate of 3.52 dB loss per year (p < 0.001). CONCLUSION: Hearing fluctuations occur similarly in EVA patients with stable and progressive hearing loss. With the exception of increased rates of hearing loss progression for fluctuating progressive hearing loss patients, vestibular aqueduct morphology, demographic, and clinical characteristics commonly reported are likely not strong predictors for whether patients will or will not experience fluctuating patterns of hearing loss.