Prevalence of otolaryngological disease in a refugee population compared to US-born patients.

Objective: Limited data exists regarding otolaryngological (ENT) disease in refugees and we aim to characterize its prevalence. Methods: This is a retrospective descriptive chart review of adult US-born, immigrant, and refugee patients receiving care at a primary care clinic between 2014 and 2017. We report the prevalence of ENT disease by immigration status. Bivariable and multivariable logistic regression models were conducted to assess differences in prevalence of ENT disease by immigration status. Results: Of 995 patients included, 202 US-born, 450 immigrants, and 343 were refugees. Immigrants were older (46 years vs. 34 years among refugees, 35.5 years among US-born, p < .001) and more likely to be women (64% vs. 52% among refugees and 56% among US-born, p = .003). Among refugees, 27% were Central American, 22% Chinese, and 9.3% Middle Eastern. Hearing loss and allergic rhinitis were the top two diagnoses among the three groups of immigration status. More refugees had at least 1 ENT diagnosis compared to the other groups (16% vs 14% among immigrants and 6% US-born, p < .001). Refugees were more likely to have at least 1 ENT diagnosis compared to US-born individuals (age and gender adjusted [aOR] 3.40, 95% CI [1.80-6.95], p < .001) and immigrants (aOR 1.62, [1.05-2.51], p = .03). Conclusion: ENT disease is prevalent among refugees, necessitating standardized evaluation during refugee health assessments and identifying barriers to referral and treatment. Level of evidence: 2b.

Targeted Wellness Initiatives Are Most Effective for Reducing Otolaryngology Resident Burnout.

OBJECTIVE: Investigate the effect of a targeted wellness program on burnout in Otolaryngology residents. METHODS: Residents and faculty collaboratively developed a program aimed at improving resident wellness. Program implementation began in July of 2018 and after 1 year, residents evaluated the program's effects on burnout. We used the Maslach Burnout Inventory (MBI) and a Likert scale to evaluate the effects of the program. RESULTS: After 1 year of the resident wellness program, the MBI results showed an increase in the number of residents in the "engaged" category and a decrease in those rated as "burnout." Residents rated favorably initiatives grouped into the following themes: time away from work, faculty engaging with residents outside of the hospital environment, efforts to enhance residents' self-efficacy, fostering a positive culture among residents, and providing easy access to physical activity. The majority of initiatives were targeted to the "culture of wellness" domain, as defined by the Stanford Well MD framework. Our program targeted to a lesser extent the other 2 domains, "efficiency of practice" and "personal resilience." CONCLUSION: After 1 year, the wellness program resulted in a trend toward improving burnout. Future efforts should be focused on targeting the multidimensional drivers of burnout as defined by established wellness frameworks. Realizing new stressors brought on by the COVID-19 pandemic will also be an area of active effort and research.

Safety and efficacy of Early injection laryngoplasty in pediatric patients.

OBJECTIVE: The major morbidity of unilateral vocal fold immobility (UVFI) in children is due to aspiration. Early injection laryngoplasty (IL) can decrease aspiration risk; however, this has not been well studied in pediatric otolaryngology. This study examines safety and efficacy of early IL in children. METHODS: Retrospective review of pediatric patients undergoing IL with any injectate between 2006 and 2017 within 6 months of onset of UVFI. Outcomes included diet pre- and postprocedure, incidence of aspiration-related sequelae, and adverse events. RESULTS: Seventeen patients met eligibility criteria. Ten (58.8%) were males. Median age was 8 months (interquartile range, 2 months-11.5 years). All patients had prior surgeries; the largest subgroup (11 patients, 64.7%) had UVFI after repair of a congenital cardiac defect. Other causes included thyroidectomy, high vagal injury, and prolonged intubation. Sixteen patients underwent swallowing evaluation prior to IL and 14 patients required dietary modifications due to aspiration risk. Consistency and/or volume of oral intake improved after IL in 10 (71.4%) of them. Five patients underwent gastrostomy tube placement for significant oromotor incoordination. Children with congenital cardiac defects had more previous surgeries (3.0 ± 0.4 vs. 1.2 ± 0.2, P = .006) and were more likely to require G-tube placement due to poor feeding despite IL (45% vs. 0%, P = .05). No patients experienced adverse events due to IL; in particular, none experienced airway symptoms requiring intubation. CONCLUSION: Early IL in pediatric patients with UVFI is safe and can reduce aspiration and improve oral intake. Future studies should elucidate patient subgroups most likely to benefit from this intervention. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1699-1705, 2019.

Geographic health disparities in the Los Angeles pediatric neck abscess population.

OBJECTIVE: To assess geographical sociodemographic differences in neck abscesses that require surgical drainage in Los Angeles. STUDY DESIGN: retrospective review. METHODS: We reviewed the medical records of 119 consecutive pediatric patients at Children's Hospital Los Angeles (CHLA) from 2014 to 2017 with a diagnosis of a neck abscess requiring incision and drainage. Sociodemographic information including zip code of residence was extracted and analyzed with Chi-square, Fisher's exact test, and multivariate logistic regression. RESULTS: The average age of patients with a neck abscess in this study was 3.4 years old, 53.8% were female, 54.6% were Hispanic, and 82.5% had public health insurance. 79% of patients had an abscess located in the superficial neck, and 10.1% had an abscess located in the retropharyngeal space. There were no significant differences in gender, race, type of health insurance, or income between patients that lived within 10 miles of CHLA versus those that lived farther than 10 miles. On multivariate analysis, zip codes with a high volume of neck abscesses were more likely to be lower income neighborhoods. Gender, race, type of health insurance, and distance from CHLA were not associated with zip codes with a high volume of neck abscesses. CONCLUSION: Geographic areas in the greater Los Angeles community with a high volume of neck abscesses requiring incision and drainage at our institution were associated with lower income neighborhoods. LEVEL OF EVIDENCE: IV.

Scapular osteocutaneous free flap for total lower lip and mandible reconstruction.

PURPOSE: Total lower lip and mandible defects following tumor resection present challenging reconstructions. The use of dual free flaps leads to increased donor-site morbidity and risk of flap failure. We present a single scapular free flap approach with unique use of osteotomies for lip reconstruction in a small series of patients. METHODS: A case series was conducted from 2007 to 2012 on three patients with squamous cell carcinoma of the oral cavity requiring large resection. Patients ranged in age from 34 to 64 years. A scapular free flap was used for reconstruction of mandible, floor of mouth, total lower lip and chin defects ranging in size from 7 × 4 cm to 11 × 7 cm. Harvested bone was extended medially beyond the lateral border of scapula. Osteotomies were oriented to support the soft tissue flap to rebuild lip height and restore oral competence. RESULTS: Skin paddles ranged in size from 10-11 cm × 18-25 cm. Bone flap size was not reported but vertical height of osteotomies ranged from 3-4 cm. All flaps survived microvascular transfer. One patient suffered from shoulder dysfunction and sialorrhea necessitating a second procedure. A second patient developed exposed hardware after radiation. Follow-up ranged from 10 to 36 months. All patients achieved good oral competence and cosmesis by 9 months post-operative. CONCLUSIONS: This single-flap approach may provide an alternative to dual free flap reconstruction of total lower lip and mandible. © 2016 Wiley Periodicals, Inc. Microsurgery 36:480-484, 2016.

Speech and Speech-Related Quality of Life After Late Palate Repair: A Patient's Perspective.

Many patients with cleft palate deformities worldwide receive treatment at a later age than is recommended for normal speech to develop. The outcomes after late palate repairs in terms of speech and quality of life (QOL) still remain largely unstudied. In the current study, questionnaires were used to assess the patients' perception of speech and QOL before and after primary palate repair. All of the patients were operated at a cleft center in northeast India and had a cleft palate with a normal lip or with a cleft lip that had been previously repaired. A total of 134 patients (7-35 years) were interviewed preoperatively and 46 patients (7-32 years) were assessed in the postoperative survey. The survey showed that scores based on the speech handicap index, concerning speech and speech-related QOL, did not improve postoperatively. In fact, the questionnaires indicated that the speech became more unpredictable (P < 0.01) and that nasal regurgitation became worse (P < 0.01) for some patients after surgery. A total of 78% of the patients were still satisfied with the surgery and all of the patients reported that their self-confidence had improved after the operation. Thus, the majority of interviewed patients who underwent late primary palate repair were satisfied with the surgery. At the same time, speech and speech-related QOL did not improve according to the speech handicap index-based survey. Speech predictability may even become worse and nasal regurgitation may increase after late palate repair, according to these results.

Partial craniofacial duplication: a review of the literature and case report.

Diprosopus (Greek; di-, "two" + prosopon, "face"), or craniofacial duplication, is a rare craniofacial anomaly referring to the complete duplication of facial structures. Partial craniofacial duplication describes a broad spectrum of congenital anomalies, including duplications of the oral cavity. This paper describes a 15 month-old female with a duplicated oral cavity, mandible, and maxilla. A Tessier type 7 cleft, midline meningocele, and duplicated hypophysis were also present. The preoperative evaluation, surgical approach, postoperative results, and a review of the literature are presented. The surgical approach was designed to preserve facial nerve innervation to the reconstructed cheek and mouth. The duplicated mandible and maxilla were excised and the remaining left maxilla was bone grafted. Soft tissue repair included closure of the Tessier type VII cleft. Craniofacial duplication remains a rare entity that is more common in females. The pathophysiology remains incompletely characterized, but is postulated to be due to duplication of the notochord, as well as duplication of mandibular growth centres. While diprosopus is a severe deformity often associated with anencephaly, patients with partial duplication typically benefit from surgical treatment. Managing craniofacial duplication requires a detailed preoperative evaluation as well as a comprehensive, staged treatment plan. Long-term follow up is needed appropriately to address ongoing craniofacial deformity.