Cost-effectiveness Analysis of Inferior Turbinate Reduction and Immunotherapy in Allergic Rhinitis.

BACKGROUND: Allergic rhinitis (AR) is a common condition that is frequently associated with atopic inferior turbinate hypertrophy (ITH) resulting in nasal obstruction. Current guidelines support the use of subcutaneous allergen immunotherapy (SCIT) when patients fail pharmacologic management. However, there is a lack of consensus regarding the role of inferior turbinate reduction (ITR), a treatment that we hypothesize is cost-effective compared with other available treatments. METHODS: We conducted a cost-effectiveness analysis comparing the following treatment combinations over a 5-year time horizon for AR patients presenting with atopic nasal obstruction who fail initial pharmacotherapy: (1) continued pharmacotherapy alone, (2) allergy testing and SCIT, (3) allergy testing and SCIT and then ITR for SCIT nonresponders, and (4) ITR and then allergy testing and SCIT for ITR nonresponders. Results were reported as incremental cost-effectiveness ratios (ICERs). RESULTS: For patients who fail initial pharmacotherapy, prioritizing ITR, either by microdebrider-assisting submucous resection or radiofrequency ablation, before SCIT was the most cost-effective strategy. Probabilistic sensitivity analysis demonstrated that prioritizing ITR before SCIT was the most cost-effective option in 95.4% of scenarios. ITR remained cost-effective even with the addition of concurrent septoplasty. CONCLUSION: For many AR patients who present with nasal obstruction secondary to atopic inferior turbinate hypertrophy that is persistent despite pharmacotherapy, ITR is a cost-effective treatment that should be considered prior to immunotherapy. LEVEL OF EVIDENCE: N/A - Laryngoscope, 2023 Laryngoscope, 2023.

Readability and quality assessment of internet-based patient education materials related to nasal septoplasty.

BACKGROUND: Given that nasal septoplasty is a common procedure in otolaryngology - head and neck surgery, the objective of this study was to evaluate the quality and readability of online patient education materials on septoplasty. METHODS: A Google search was performed using eight different search terms related to septoplasty. Six different tools were used to assess the readability of included patient education materials. These included the Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning-Fog Index, Simple Measure of Gobbledygook Index, Coleman-Liau Index, and Automated Readability Index. The DISCERN tool was used to assess quality and reliability. RESULTS: Eighty-five online patient education materials were included. The average Flesch-Reading Ease score for all patient education materials was 54.9 ± 11.5, indicating they were fairly difficult to read. The average reading grade level was 10.5 ± 2.0, which is higher than the recommended reading level for patient education materials. The mean DISCERN score was 42.9 ± 10.5 and 42% (36/85) of articles had DISCERN scores less than 39, corresponding to poor or very poor quality. CONCLUSION: The majority of online patient education materials on septoplasty are written above the recommended reading levels and have significant deficiencies in terms of their quality and reliability. Clinicians and patients should be aware of the shortcomings of these resources and consider the impact they may have on patients' decision making.

Impact of ENT resource nurses in improving operating room efficiency.

BACKGROUND: Operating room (OR) efficiency is related to minutes spared from surgical time and has been linked to the make up of surgical teams and operating room workplace. The research on the efficiency of surgical nursing staff members is scant. The current study evaluates the effect of ENT trained OR resource nurses on the efficiency of operating time during ENT procedures. METHODS: Five hundred seventy-three ENT surgery cases from 4 surgeons were retrospectively reviewed. Two hundred forty-two cases had ENT OR nursing staff and 331 cases had non-ENT OR nursing staff. Requested operative times (ROT) and true operative times (TOT) were analyzed. The difference between the TOT and ROT was used to measure operating time efficiency. RESULTS: Cases with ROT < 30 min (M = -1.19, SD = 5.01) required 3.34 min less than planned for when an ENT nurse was present compared to those with non-ENT nursing staff which required on average 2.15 min (M = 2.15, SD = 5.68) longer than ROT. Furthermore, cases with ROT > 30 min (M = -4.32, SD = 10.85) required 10.85 min less than planned for when an ENT nurse was present. Conversely with non-ENT nursing staff cases with a ROT > 30 min required on average 6.53 min (M = 6.53, SD = 11.85) longer than ROT. CONCLUSION: ENT resource nurses were shown to improve OR efficiency in cases less than 30 min and greater than 30 min. Cases that were greater than 30 min showed the largest increase in efficiency. Specialized ENT nursing staff improved efficiency during common ENT surgeries.

Parasympathetic baroreflexes and heart rate variability during acute stage of sport concussion recovery.

PRIMARY OBJECTIVE: To assess and compare the parasympathetic state of individuals in healthy vs concussion groups, by measuring cardiovascular metrics under resting and baroreflex conditions using a squat-stand manoeuvre. RESEARCH DESIGN: This was a retrospective mixed-method study, with participants who sustained a medically diagnosed sport concussion (n = 12), being tested within 72-hours post-injury. METHODS AND PROCEDURES: Participant's heart rate (Electrocardiogram, ECG) and blood pressure (finger plethysmography) data was collected during rest and during 10-second squat-stands (10SS, 0.05 Hz). Blood pressure and heart rate standard deviation data was analysed in the 0-5 seconds and 6-10 seconds periods of squatting and standing. Resting and baroreflex ECG data were analysed via Fourier Transformations for %Low Frequency and %High Frequency (%LF and %HF). RESULTS: The control group alleviated more pressure and had a significantly higher standard deviation of heart rate during the 6-10 seconds of squatting (p < 0.05). Overall heart rate standard deviation in the concussion group was significantly lower than healthy controls when standing (p < 0.05). There were no differences in %LF and % HF between groups or between rest and 10SS. CONCLUSION: This study provides preliminary evidence that autonomic function is dysregulated following mTBI within the initial 72 hours of injury.