Self-Identified Patient Barriers to Pursuit of Cochlear Implantation.

INTRODUCTION: Cochlear implantation (CI) is an underutilized treatment for hearing loss in the United States for reasons which remain unclear. This study explores self-identified barriers to CI employing a survey of adults who qualified for CI. METHODS: A single-institutional review of CI candidates between December 2010 and December 2018 was performed to identify patients who did not pursue surgery. A 21-question survey was developed, aimed at rating patients' concerns regarding CI, including surgical risks, adaptation, costs, time commitment, loss of residual hearing, and lack of benefit, among others. Current hearing aid usage and familiarity with other CI users were also analyzed. The survey was administered to patients who did not pursue CI and a control group who eventually did pursue CI, via email or telephone. RESULTS: There were 199 patients who initially did not pursue CI. Fifty-two survey responses were received, comprised of 27 patients who did not pursue CI and 25 patients who did. A belief that CI would not significantly improve the ability to communicate was the most common reported barrier, followed by the postoperative recovery process, risks of surgery, and risks of losing music appreciation. Anesthetic risk and cost were the least important reasons not to pursue CI. Half of patients reported concerns regarding the period of adjustment with the CI. CONCLUSION: The decision not to pursue CI despite eligibility is multifactorial and includes concern for minimal hearing benefit and perioperative risks. These factors should be taken into consideration when counseling patients on CI surgery.

Impact of Patient Factors and Management Strategies on Outcomes After Transverse Posterior Cordotomy.

OBJECTIVES/HYPOTHESIS: Carbon dioxide laser transverse posterior cordotomy (TPC) aims to improve airway aperture in patients with glottic obstruction. Postoperative complications may worsen airway compromise and necessitate additional interventions. We sought to identify factors impacting outcomes after TPC. STUDY DESIGN: Retrospective chart review. METHODS: Medical records of patients who underwent TPC for glottic airway obstruction at a tertiary-care medical center between 2008 and 2018 were reviewed. Demographics, comorbidities, and intra- and postoperative management strategies were analyzed. RESULTS: Twenty patients who underwent TPC for glottic airway obstruction met inclusion criteria. The mean age was 57 years, and 13 patients were female. Mean follow-up time was 442 days. Seven patients had posterior glottic stenosis, and 13 had bilateral vocal fold paralysis. Twelve patients developed postoperative complications including granuloma formation (four patients), hospital readmission for dyspnea due to glottic edema (five patients), need for revision surgery (nine patients), or failure to decannulate tracheotomy (five patients). Eight patients had an uncomplicated recovery with improved dyspnea, with two patients with tracheotomies decannulated. Patients with a history of smoking tobacco were more likely to experience complications (P = .035). There were no significant differences in outcomes with respect to history of head and neck radiation or gastroesophageal reflux disease. Steroid injection at the surgical site and postoperative medications did not significantly impact outcomes. With respect to granuloma formation, none of the variables analyzed reached significance. CONCLUSIONS: History of tobacco use increases complication rates after TPC. Other patient comorbidities and intra- and postoperative management strategies do not impact outcomes. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1066-1070, 2021.

Association of Metformin With the Growth of Vestibular Schwannomas.

OBJECTIVE: To assess whether medication use, specifically statin, metformin, and aspirin, affects the growth of vestibular schwannomas (VSs). STUDY DESIGN: Retrospective case series. SETTING: Single tertiary care academic hospital. SUBJECTS AND METHODS: Patients were enrolled if they were diagnosed with sporadic VS and had at least 2 magnetic resonance imaging (MRI) studies at a minimum of 6 months apart prior to any intervention. Electronic medical records were reviewed for demographic and medication data. Tumor volumes on MRI studies were assessed via BrainLab iPlan. The primary endpoint was VS tumor growth, defined as a 20% increase in tumor volume, between consecutive MRI studies or between the first and last available MRI study. Predictors of volumetric growth, specifically statin, aspirin, or metformin use, were analyzed with t tests, chi-square test, univariate logistic regression, and multivariate logistic regression. RESULTS: A total of 387 patients met inclusion criteria, 53.5% of whom were women. For all patients, the mean age was 60.6 years (range, 18.2-89.2 years); the mean axial tumor diameter, 11.9 mm (range, 1.7-32.0 mm); and the mean tumor volume, 0.85 cm3 (range, 0.01-13.1 cm3). In review of the electronic medical record, 46 patients (11.9%) were taking metformin; 145 (37.5%), a statin; and 117 (30.2%), aspirin. Among patients taking metformin, 39.1% (18/46) exhibited volumetric growth, as opposed to 58.2% (198/340) of nonusers (P = .014). Metformin (odds ratio, 0.497; P = .036) is significantly associated with reduced VS growth when controlling for aspirin, statin, and tumor size on multivariate logistic regression. CONCLUSION: Metformin use is associated with reduced volumetric VS growth.