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1.
Otol Neurotol ; 41(6): e705-e711, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32472921

RESUMO

OBJECTIVES/HYPOTHESIS: This study aims to 1) report revision cochlear implantation (CI) rates at a high-volume CI center, 2) describe classifications for revision CI, 3) analyze audiologic and surgical outcomes in patients who undergo revision CI, and 4) describe a new subcategory of soft failures, named presumed soft failures. STUDY DESIGN: Retrospective case series. SETTING: Tertiary care otologic center. PATIENTS: Adults and children undergoing revision CI from 2005 to 2015. MAIN OUTCOME MEASURE: Type and etiology of CI failure, preoperative, and postoperative outcomes (audiologic, surgical). RESULTS: During the study period, 1,469 CI surgeries were performed with a total of 81 (5.51%) revision cochlear implantations, 64 of these meeting inclusion criteria with adequate follow up and clear indications for revision surgery. The most common indication for revision surgery was hard failure (53.1%), followed by soft failure (29.7%), and medical/surgical failure (17.2%). 78.1% (50/64) of revision CI patients showed improvement postoperatively (defined as 15% improvement of speech perceptions scores or improvement of aversive symptoms, according to the 2005 consensus statement guidelines). Hard failures showed improvement in 85.3% (29/34) of cases, medical and surgical failures showed improvement in 72.7% (8/11) of cases, and soft failures showed improvement in 68.4% (13/19) of cases. There was a statistically significant difference in percentage of adult versus pediatric patients by failure subtype, with 84.2% of soft failure patients classified as adults (18 or older) at the time of revision surgery compared with 50% and 36.3% for hard failure and medical/surgical failure patients, respectively (p = 0.02). Similarly, there was a trend, though not statistically significant, towards older age in the soft failure group compared with hard and medical/surgical failure groups (median 43 yr versus 18 and 16, respectively). Within the soft failure group there was a subset of patients that failed to show improvement in audiologic performance or experienced continued aversive symptoms referred to as "presumed soft failures." These patients, by definition, experienced worse outcomes after revision surgery (p < 0.05) and trended towards older age (43 versus 31 yr) and longer time from initial to revision surgery (27.3 versus 24.7 mo) when compared with true soft failures. CONCLUSIONS: The majority of patients improved after revision CI surgery; patients with hard failure demonstrated the highest percentage with improvement, while those with soft failures had worse outcomes. The presumed soft failure group may represent a unique etiology for CI failure that warrants further investigation given worse outcomes after revision surgery.

2.
Otolaryngol Head Neck Surg ; : 194599820915194, 2020 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-32284008

RESUMO

Many considerations affect the value that a new instrument or product may generate in a surgical practice. This review serves as a guide for surgeons considering new purchases and/or wishing to advocate for hospital acquisition of new items. A summary of data from academic and industry practices is presented, with pertinent examples using relevant surgical devices such as disposable devices, laparoscopic trocars, and otologic endoscopes. Surgeons considering incorporating a new instrument or technology within their practice should weigh the following factors before decision making: patient and clinical care factors, surgeon and care team factors, and hospital factors such as cost, revenue, and sourcing. A surgeon well-versed in stakeholder interests who is involved in the purchase of a new instrument may have significant influence in value-based decision making that not only affects his or her practice but ultimately maximizes value for the patient.

3.
Otol Neurotol ; 41(6): e759-e762, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32271262

RESUMO

OBJECTIVE: To report and discuss the effectiveness of stereotactic radiosurgery (SRS) or fractionated radiotherapy (FRT) for tumor control following surgical resection of endolymphatic sac tumors (ELST). STUDY DESIGN: Retrospective case series. SETTING: Multi-institutional academic referral centers. PATIENTS: Patients undergoing surgical resection for ELST followed by SRS or FRT. INTERVENTION(S): Surgical resection followed by radiotherapy. MAIN OUTCOME MEASURES: Local tumor control. RESULTS: Two of the five patients experienced tumor recurrence after gross total microsurgical at 78 and 11 months, respectively. The former patient received salvage 3D conformal radiotherapy (3D-CRT) and while the latter patient underwent three courses of salvage SRS for recurrence, two of which were in-field and was disease-free at last follow up. Two additional patients underwent subtotal tumor resection (STR) followed by intensity-modulated radiation therapy (IMRT) and are currently without disease. One patient underwent STR followed by proton-beam therapy (PBT) and was free of disease at most recent follow-up. CONCLUSION: SRS/FRT remains a useful adjuvant for treatment of residual or recurrent ELSTs, where the risk of revision microsurgical resection is high.

4.
Otolaryngol Head Neck Surg ; 162(6): 942-949, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32204657

RESUMO

OBJECTIVE: To investigate audiometric outcomes and incidence of chronic ear disease following lateral skull base repair (LSBR) of cerebrospinal fluid (CSF) leaks. STUDY DESIGN: Retrospective review. SETTING: Tertiary skull base center. SUBJECTS AND METHODS: Consecutive adults undergoing LSBR of CSF leaks between 2012 and 2018 were reviewed. Audiometric data included mean air conduction pure-tone average (PTA), air-bone gap (ABG), speech recognition threshold (SRT), and word recognition score (WRS). The incidence and management of the following were collected: effusion, retraction, otitis media and externa, perforation, and cholesteatoma. RESULTS: Seventy-three patients underwent transmastoid (n = 5), middle cranial fossa (n = 2), or combined approach (n = 67) for repair of spontaneous leaks (sCSFLs, n = 41) and those occurring in the setting of chronic ear disease (ceCSFLs, n = 32). ABG decreased 7.23 dB (P = .01) in sCSFL patients. Perforations (P = .01) were more likely in ceCSFL. No sCSFL patient developed a cholesteatoma, perforation, or infection. Effusions (n = 7) were transient, and retractions (n = 2) were managed conservatively in the sCSFL cohort. Eight ceCSFL patients required tubes, 3 underwent tympanoplasties with (n = 2) and without (n = 1) ossicular chain reconstruction (OCR), and 1 had tympanomastoidectomy with OCR. CONCLUSION: Lateral skull base repair of CSF leaks maintained or improved hearing. Patients with preexisting chronic ear disease were more likely to require additional intervention to sustain adequate middle ear aeration compared to the sCSFL cohort. LSBR of sCSFL does not appear to increase risk for developing chronic ear disease.

5.
Laryngoscope ; 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32040200

RESUMO

OBJECTIVES/HYPOTHESIS: To measure and report noise exposure at urban music venues and assess the risk of noise-induced hearing loss by comparing these measures to the National Institute of Occupations Safety and Health (NIOSH) guidelines. STUDY DESIGN: Observational study. METHODS: A commercially available smartphone and external calibrated microphone were used to measure sound levels at urban music venues. The maximum sound level, equivalent continuous sound level, and statistical noise levels (L10, L50, L75, L90) were recorded. RESULTS: The average equivalent continuous sound level was 112.0 (±4.9) dBA, and the average maximum sound level was 127.0 (±3.2) dBA. The L90 average (sound levels at or above this loudness for 90% of measured exposure time) was 101.1 (±5.5) dBA, and the L10 average was 115.2 (±5.0) dBA. Based off of NIOSH guidelines, noise exposure duration at the L10 average should not exceed 28 seconds, and those at the L90 average should not exceed 12 minutes. CONCLUSIONS: Smartphone applications using external calibrated microphones can provide useful sound measurements. Data show that randomly sampled music venues may have noise levels that place patrons without hearing protection at risk for noise-induced hearing loss with prolonged exposure. LEVEL OF EVIDENCE: NA Laryngoscope, 2020.

6.
Otol Neurotol ; 41(2): 222-228, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31688612

RESUMO

OBJECTIVE: To improve patient satisfaction and understanding of what to expect after chronic ear surgery and reduce call volume to an otology clinic at an academic tertiary referral center. STUDY DESIGN: Quality improvement initiative. SETTING: A single-academic tertiary referral center. PATIENTS: One hundred and ten patients who underwent chronic ear surgery in March to May 2018. INTERVENTION: Preoperative counseling over the phone 1 week before surgery. MAIN OUTCOME MEASURES: Patient call volume to the clinic within a 2-week postoperative window, patient understanding, and satisfaction of perioperative course. RESULTS: There was a significant increase in patient satisfaction (10.1% increase, 9.8 intervention vs. 8.9 no intervention, p = 0.0032) and in patient understanding of what to expect after surgery (6.7% increase, 9.5 intervention vs. 8.9 no intervention, p = 0.0275). There was a significant decrease in mean number of calls per patient to the clinic (57.6% decrease, 0.31 intervention vs. 0.72 no intervention, p = 0.0105) and in percentage of patients who made any number of calls to the clinic (20% intervention vs. 46%, no intervention, p = 0.00438). CONCLUSIONS: Verbal preoperative counseling over the phone was effective in significantly reducing unnecessary call volume to the clinic and in improving patient satisfaction and overall understanding of what to expect after surgery.

7.
Otol Neurotol ; 41(2): e223-e226, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31664000

RESUMO

OBJECTIVE: To develop and implement a streamlined, patient-centered service delivery model for patients referred for cochlear implantation (CI) at a high-volume academic center. PATIENTS: CI candidate adults. INTERVENTIONS: CI, implementation of new CI delivery model. MAIN OUTCOME MEASURES: Referral-to-surgery time, patient travel burden. RESULTS: Data from 206 adults that underwent CI were used to develop a process map of the initial operational state from referral date to day of surgery (referral-to-surgery time). The initial referral-to-surgery time was 136 days on average, yet the average total work time by all involved providers was 17.6 hours. Prolonged wait times were associated with the following preoperative tasks: appointment scheduling, insurance approval, device ordering and shipment, and surgical scheduling. Patients traveled to the institution on at least two occasions for appointments. A new bundled, patient-centered CI delivery model was developed to address prolonged wait times, travel burden, and process inefficiencies. The new model implemented an interactive electronic medical record, coordinated appointments with same-day surgery, and stocked device inventory to reduce the referral-to-surgery time to 24 days-an improvement of 112 days. In the new model, new patient consultation and surgery were completed in one day, reducing the patient travel burden to the institution. CONCLUSIONS: The new CI program demonstrates that delivery innovations can have a substantial impact on measures of patient convenience and experience, and that these results are achievable without new technologies or changes in medical management. With a focus on patient-centered design, health care delivery models can be augmented to increase value for patients.

8.
Laryngoscope ; 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31774936

RESUMO

OBJECTIVE: To investigate the prevalence and impact of obstructive sleep apnea (OSA) and obesity in lateral skull base cerebrospinal fluid leak repair (LSBR) of various etiologies. METHODS: Retrospective case review at a tertiary skull base center was conducted of consecutive adults undergoing LSBR via transmastoid, middle cranial fossa, or combined approach between 2013-2018. The following data were collected: demographics, comorbidities, radiology and intraoperative findings, and surgical outcomes including complications and need for revision surgery or shunt placement. Patients with incomplete data or leaks following skull base surgery, trauma or chronic ear disease were excluded. RESULTS: Ninety-four patients (67.4% female, mean age 53.5 ± 12.9 years) underwent repair for spontaneous (sCSFL, 44%) and other etiology (nsCSFL) leaks. nsCSFL served as a comparison group consisting of leaks status-post lateral skull base surgery, temporal bone fractures, and chronic ear disease. Class III obesity (P = .02), OSA (P = .03), and imaging findings of empty sella (OR = 3.32, P = .02), and skull base thinning including contralateral tegmen thinning (31%, OR = 4.3, P = .02), arachnoid granulations (26%, OR = 4.35, P = .02), and superior canal dehiscence (15.8%, OR = 8.57, P = .04) were more common in sCSFL. Four patients (4.2%) required surgical revision for recurrence, and another four (4.2%) resolved with shunting. Evidence of elevated intracranial hypertension was present in nine patients with sCSF leaks and was predictive of need for revision or shunt procedures (P < .01). CONCLUSION: Obesity, OSA, and imaging consistent with elevated intracranial pressures were more common among patients with sCSFL. Elevated intracranial pressure predicted outcomes following multilayer repair of spontaneous CSF leaks LEVEL OF EVIDENCE: 4 Laryngoscope, 2019.

9.
Otol Neurotol ; 40(10): e1012-e1017, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31634279

RESUMO

OBJECTIVE: To date, prediction models for estimating risk of acquiring non-serviceable hearing in subjects with observed vestibular schwannoma (VS) have evaluated outcomes primarily based on features at initial diagnosis. Herein, we evaluate the association of rate of hearing decline during the initial period of observation with time to non-serviceable hearing. If significant, rate of hearing decline may inform decision making after an introductory period of observation. SETTING: Two tertiary care centers. PATIENTS: VS patients with serviceable hearing who underwent at least three audiograms and two magnetic resonance imaging (MRI) studies before intervention or being lost to follow-up. The rate of change in pure-tone average (PTA) and word recognition score (WRS) was calculated as the score from the second audiogram minus the score from the first audiogram, divided by the duration in months between the two. MAIN OUTCOME MEASURE(S): Serviceable hearing, defined as PTA ≤50 dB HL and WRS ≥50%. RESULTS: Among 266 patients meeting inclusion criteria, 52 developed non-serviceable hearing at last follow-up. Kaplan-Meier estimated rates of maintaining serviceable hearing (95% CI; number still at risk) at 1, 3, 5, 7, and 10 years were 97% (95-100; 206), 78% (72-85; 98), 68% (60-77; 39), 60% (50-73; 17), and 44% (29-67; 2), respectively. In a univariable setting, each 1 dB increase per month in the rate of initial PTA change was associated with a 96% increased likelihood of acquiring non-serviceable hearing (hazard ratio [HR] 1.96; 95% CI 1.44-2.68; p < 0.001). Each 1% increase per month in the rate of initial WRS change was associated with a decreased likelihood of acquiring non-serviceable hearing (hazard ratio [HR] 0.79; 95% confidence interval [CI] 0.66-0.94; p = 0.009). After multivariable adjustment, both rate of PTA change (HR 2.42; 95% CI 1.72-3.41; p < 0.001) and rate of WRS change (HR 0.81; 95% CI 0.67-0.99; p = 0.043) remained statistically significantly associated with time to non-serviceable hearing. CONCLUSION: Rate of early PTA and WRS decline during the initial period of observation are significantly associated with time to development of non-serviceable hearing. This information may facilitate accurate patient counseling and inform decision-making regarding prospective disease management.

10.
J Am Acad Audiol ; 30(10): 918-926, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274070

RESUMO

BACKGROUND: In current practice, the status of residual low-frequency acoustic hearing in hearing preservation cochlear implantation (CI) is unknown until activation two to three weeks postoperatively. The intraoperatively measured electrically evoked compound action potential (ECAP), a synchronous response from electrically stimulated auditory nerve fibers, is one of the first markers of auditory nerve function after cochlear implant surgery and such may provide information regarding the status of residual low-frequency acoustic hearing. PURPOSE: This study aimed to evaluate the relationship between intraoperative ECAP at the time of CI and presence of preoperative and postoperative low-frequency acoustic hearing. RESEARCH DESIGN: A retrospective case review. STUDY SAMPLE: Two hundred seventeen adult ears receiving CI (42 Advanced Bionics, 82 Cochlear, and 93 MED-EL implants). INTERVENTIONS: Intraoperative ECAP and CI. DATA COLLECTION AND ANALYSIS: ECAP measurements were obtained intraoperatively, whereas residual hearing data were obtained from postoperative CI activation audiogram. A linear mixed model test revealed no interaction effects for the following variables: manufacturer, electrode location (basal, middle, and apical), preoperative low-frequency pure-tone average (LFPTA), and postoperative LFPTA. The postoperative residual low-frequency hearing status was defined as preservation of unaided air conduction thresholds ≤90 dB at 250 Hz. Electrode location and hearing preservation data were analyzed individually for both the ECAP threshold and ECAP maximum amplitude using multiple t-tests, without assuming a consistent standard deviation between the groups, and with alpha correction. RESULTS: The maximum amplitude, in microvolts, was significantly higher throughout apical and middle regions of the cochlea in patients who had preserved low-frequency acoustic hearing as compared with those who did not have preserved hearing (p = 0.0001 and p = 0.0088, respectively). ECAP threshold, in microamperes, was significantly lower throughout the apical region of the cochlea in patients with preserved low-frequency acoustic hearing as compared with those without preserved hearing (p = 0.0099). Basal electrode maximum amplitudes and middle and basal electrode thresholds were not significantly correlated with postoperative low-frequency hearing. CONCLUSIONS: Apical and middle electrode maximum amplitudes and apical electrode thresholds detected through intraoperative ECAP measurements are significantly correlated with preservation of low-frequency acoustic hearing. This association may represent a potential immediate feedback mechanism for postoperative outcomes that can be applied to all CIs.

11.
J Neurol Surg B Skull Base ; 80(3): 283-286, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31143572

RESUMO

Objective To describe the incidence and clinical course of patients who develop delayed facial nerve paralysis (DFNP) after surgical resection of vestibular schwannoma. Setting Tertiary skull base center. Methods Retrospective chart review. Results Two hundred and forty six consecutive patients, who underwent surgical resection for vestibular schwannoma at a single center between 2010 and 2015, were analyzed. Of these patients, 22 (8.9%) developed DFNP, defined here as deterioration of function by at least 2 House-Brackmann (HB) grades within 30 days in patients with immediate postoperative HB ≤ 3. The mean age of DFNP patients was 47.2 years (range: 17-67) and 16 (73%) were female. The mean tumor size in greatest dimension was 2.1 cm (range: 0.7-3.5 cm). At the conclusion of each case, the facial nerve stimulated at the brainstem. Mean immediate postoperative facial nerve function was HB 1.8 (range: 1-3). Average facial nerve function at the 3-week-postoperative visit was 4.4 (range: 2-6). In 1-year, 8 patients (36%) recovered HB 1 function, 10 patients (46%) recovered to HB 2, and 2 patients (9%) were HB 3. The remaining 2 patients did not recover function and were HB 6 at last follow-up. Initial postoperative facial nerve function (HB 1 or HB 2) was associated with improved recovery to normal (HB 1) function ( p = 0.018). Conclusion A majority of patients that develop delayed paralysis will recover excellent facial nerve function. Patients should be counseled; however, a small percentage of patients will not recover function long-term, despite having a previously functioning and anatomically intact nerve.

12.
Ear Hear ; 40(3): 568-576, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29979254

RESUMO

OBJECTIVES: Dizziness, vertigo, and unsteadiness are common complaints of patients who present to primary care providers. These patients often are referred to otology for assessment and management. Unfortunately, there are a small number of specialists to manage these patients. However, there are several dizziness disorders that can be successfully managed by primary care providers if the disorder is properly identified. To assist in the identification of several of the most common dizziness disorders, we developed the dizziness symptom profile (DSP). The DSP is a self-report questionnaire designed to generate one or more differential diagnoses that can be combined with the patient's case history and physical examination. DESIGN: This report describes three investigations. Investigations 1 and 2 (i.e., exploratory and confirmatory investigations, N = 514) describe the development of the DSP. Investigation 3 (N = 195) is a validation study that describes the level of agreement between the DSP completed by the patient, and, the differential diagnosis of the otologist. RESULTS: The final version of the DSP consists of 31 items. Preliminary findings suggest that the DSP is in agreement with the differential diagnoses of ear specialists for Meniere's disease (100% agreement), vestibular migraine (95% agreement), and benign paroxysmal positional vertigo (82% agreement). CONCLUSIONS: Early results suggest that DSP may be useful in the creation of differential diagnoses for dizzy patients that can be evaluated and managed locally. This has the potential to reduce the burden on primary care providers and reduce delays in the diagnosis of common dizziness and vertigo disorders.


Assuntos
Vertigem Posicional Paroxística Benigna/diagnóstico , Doença de Meniere/diagnóstico , Transtornos de Enxaqueca/diagnóstico , Doenças Vestibulares/diagnóstico , Adulto , Idoso , Vertigem Posicional Paroxística Benigna/complicações , Diagnóstico Diferencial , Tontura/etiologia , Feminino , Humanos , Masculino , Doença de Meniere/complicações , Pessoa de Meia-Idade , Transtornos de Enxaqueca/complicações , Atenção Primária à Saúde , Reprodutibilidade dos Testes , Inquéritos e Questionários , Vertigem/etiologia , Doenças Vestibulares/complicações
13.
Otol Neurotol ; 39(10): e992-e995, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30444844

RESUMO

OBJECTIVE: To describe and characterize facial nerve stimulation (FNS) patterns in patients with labyrinthitis ossificans who underwent cochlear implantation (CI) for sensorineural hearing loss. PATIENTS: Five ears in four patients with labyrinthitis ossificans who underwent CI and subsequently developed FNS. INTERVENTIONS: CI, electrode mapping, and/or explantation to resolve FNS. MAIN OUTCOME MEASURES: FNS, postoperative computed tomography imaging, and resolution of FNS. RESULTS: Fourteen ears with labyrinthitis ossificans underwent CI over an 11-year period at a single institution; 5 of these ears exhibited postoperative FNS (35.7% incidence). Four cases had involvement of basal electrodes, while all five cases had middle and/or apical electrode stimulation. All cases had resolution of FNS with CI reprogramming, however, the resultant map in two cases provided minimal audiologic benefit and patients became nonusers in that ear. CONCLUSIONS: FNS arising from all cochlear regions is possible in patients with labyrinthitis ossificans who undergo CI. Mapping and electrode deactivation can resolve symptoms, but resultant audiologic benefit is variable and may lead to explantation.


Assuntos
Implante Coclear/efeitos adversos , Nervo Facial , Labirintite/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Pré-Escolar , Feminino , Perda Auditiva Neurossensorial/cirurgia , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia
14.
JAMA Otolaryngol Head Neck Surg ; 144(9): 802-806, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30335882

RESUMO

Importance: Over two-thirds of the adult population in the United States use Facebook. Despite the high interest in and use of social media by the general public, the presence and accessibility of health care organizations on social media has not yet been fully evaluated. Objective: To determine the use and popularity of social media among otolaryngology residency programs in the United States. Design, Setting, and Participants: A cross-sectional study of the presence of accredited otolaryngology residency programs in the United States in an internet data repository was conducted. Programs were stratified by Doximity Residency Navigator reputation rankings (dividing programs into quartiles) and US News & World Report (comparing programs affiliated with hospitals ranked in the top 50 vs programs affiliated with unranked hospitals). Social media sites and activity for each program were assessed using internet searches. The study was conducted in April 2017. Results: Among 101 otolaryngology residency programs, 30 were found to have social media sites (29.7%). Facebook and Twitter were the most commonly used services, with 25 (24.8%) and 14 (13.9%) accounts, respectively. Based on Doximity Residency Navigator rankings, programs in the first quartile were more likely to have Facebook profiles than programs in the fourth quartile (42.3% vs 12.0%; absolute difference, 30%; 95% CI, 2.9% to 52.6%). First- and second-quartile programs showed increased Facebook activity. There was greater Twitter presence in first- vs fourth-quartile programs (19.2% vs 8.0%; absolute difference, 11.2%; 95% CI, -11.6% to 33.0%). Higher-quartile programs were more active on Twitter and exhibited increased numbers of likes and followers. Analysis of US News & World Report rankings revealed that ranked programs had higher rates of presence, activity, and popularity on both Facebook and Twitter. However, these were smaller differences than seen when comparing Doximity Residency Navigator rankings. Correlation between the 2 ranking systems was indicated (Spearman ρ = 0.59; 95% CI, 0.34 to 0.76). Conclusions and Relevance: This study suggests that otolaryngology residency programs with higher Doximity Residency Navigator reputation rankings have a stronger presence on social media. Smaller trends were observed for programs in the top 50 US News & World Report rankings. Overall, social media use among otolaryngology programs seems relatively low, and this may present an opportunity to increase communication with the public via these technologies.


Assuntos
Internato e Residência , Otolaringologia/educação , Mídias Sociais/estatística & dados numéricos , Estudos Transversais , Humanos , Estados Unidos
15.
Otol Neurotol ; 39(9): e810-e816, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30199499

RESUMO

OBJECTIVE: To evaluate audiologic outcomes following unilateral cochlear implantation with contralateral hearing aid (unilateral CI + HA) versus bilateral CI in children with auditory neuropathy spectrum disorder (ANSD). STUDY DESIGN: Retrospective case review. SETTING: Tertiary Care Otologic Practice. PATIENTS: Twenty-three patients with ANSD who underwent unilateral CI + HA or bilateral CI. INTERVENTIONS: Rehabilitative (CI). OUTCOME MEASURES: Speech perception scores and achievement of open-set speech. RESULTS: Preoperatively, all patients demonstrated lack of open-set speech perception with hearing aids (HAs) alone. Of the 23 patients included, 56.5% (n = 13) had developmental delay. Thirteen patients underwent unilateral CI + HA and 10 patients underwent bilateral CI. The median ages at CI activation were 3.3 and 2.0 years in the unilateral CI + HA and bilateral CI groups, respectively (p = 0.0688), with median lengths of CI use of 45.9 and 47.2 months, respectively (p = 0.8438). The unilateral CI + HA and bilateral CI groups achieved open-set speech perception in 76.9% and 90.0% of cases, respectively (p = 0.6036), within median times of 19.5 and 28.0 months, respectively (p = 0.6334). Within the unilateral CI + HA group, the median aided PTAs in the contralateral ears of patients who did and did not achieve open-set speech were 57.5 dB HL (range, 42.5-91.7 dB HL) and 75.0 dB HL (range, 62.5-111.3 dB HL) (p = 0.0455). CONCLUSIONS: Both bilateral CI and unilateral CI + HA groups achieved high rates of open-set speech perception. Bilateral CI may be beneficial in patients with bilateral hearing loss or those that fail to progress with unilateral CI + HA.


Assuntos
Implante Coclear/métodos , Perda Auditiva Central/cirurgia , Percepção da Fala , Resultado do Tratamento , Adolescente , Criança , Pré-Escolar , Implantes Cocleares , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Percepção da Fala/fisiologia
16.
Otol Neurotol ; 39(8): e704-e711, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30036205

RESUMO

OBJECTIVE: To characterize the risk of progression to nonserviceable hearing in patients with sporadic vestibular schwannomas (VS) who elect initial observation. STUDY DESIGN: Retrospective case series. SETTING: Two tertiary care centers. PATIENTS: VS patients with serviceable hearing who underwent at least two audiograms and two MRI studies before intervention or loss to follow-up. MAIN OUTCOME MEASURE(S): Serviceable hearing, defined as the pure tone average ≤ 50 dB HL and word recognition score ≥ 50%. RESULTS: Four-hundred sixty-six patients (median age of 57 yr and median tumor diameter of 7.3 mm) had serviceable hearing at presentation and were followed for a median of 2.3 years (IQR 1.0 - 4.0). Kaplan-Meier estimated rates of maintaining serviceable hearing (95% CI; number still at risk) at 1, 3, 5, 7, and 10 years following diagnosis were 94% (91-96; 357), 77% (73-82; 172), 66% (60-73; 81), 56% (49-65; 31), and 44% (33-59; 10), respectively. Each 10-dB increase in pure-tone averages at diagnosis was associated with a 2-fold increased likelihood of developing nonserviceable hearing (hazard ratio 2.07; p < 0.001). Each 10% decrease in word recognition score was associated with a 1.5-fold increased likelihood of developing nonserviceable hearing (hazard ratio 1.48; p < 0.001). CONCLUSIONS: Among patients with sporadic VS, good baseline word recognition score and low pure-tone average are jointly associated with maintenance of serviceable hearing. These data may be used to guide patient counseling and optimize management.


Assuntos
Audição/fisiologia , Neuroma Acústico/fisiopatologia , Idoso , Tratamento Conservador , Progressão da Doença , Feminino , Testes Auditivos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/terapia , Estudos Retrospectivos , Resultado do Tratamento
17.
Otol Neurotol ; 39(8): e712-e721, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30001283

RESUMO

OBJECTIVE: To date, less than 150 cases of middle ear adenomatous neuroendocrine tumors (MEANTs) have been reported in the English literature. The objective of this study was to provide a contemporary analysis of these rare lesions and develop a consensus-driven staging system. STUDY DESIGN: Multi-institutional retrospective histopathologic, radiologic, and clinical review. SETTING: Six tertiary referral centers. PATIENTS: Thirty-two patients with pathologically confirmed MEANT. INTERVENTION: Surgical resection, adjuvant therapy. MAIN OUTCOME MEASURES: Clinical manifestations, outcomes, staging system. RESULTS: Patients commonly presented with progressive conductive or mixed hearing loss (90%), aural fullness (50%), and tonal tinnitus (46%). Pulsatile tinnitus (16%), carcinoid syndrome (4%), and facial nerve paresis (4%) were less commonly observed. MEANTs frequently mimicked temporal bone paraganglioma (31%) and cholesteatoma (15%) at presentation. According to a novel T/N/M/S staging system (S = secretory tumor) proposed herein, there were 6 (19%) T1, 19 (59%) T2, and 7 (22%) T3 MEANTs. T3 tumors were significantly more likely to undergo subtotal or near total resection compared with lower staged tumors secondary to adherence to critical neurovascular structures such as the petrous internal carotid artery and facial nerve (p = 0.027). Patients with T3 MEANTs were more likely to experience multiple recurrences, require adjuvant therapy with a somatostatin analogue, or develop permanent facial nerve paresis compared with lower staged tumors. At last follow up, no patients with T1 MEANTs had developed recurrence, whereas 37% (7/19) of patients with T2 MEANT and 57% (4/7) of patients with T3 MEANT experienced either disease recurrence after gross total resection (GTR) or regrowth of known residual tumor requiring additional surgery at a median duration of 72 months (95% CI, 24-84). CONCLUSIONS: Patients with MEANTs can present with nonspecific symptomatology that overlaps with more commonly encountered middle ear lesions. MEANT exhibits a proclivity for recurrence according to T-stage and long-term clinical follow up is necessary, particularly for advanced stage tumors.


Assuntos
Adenoma/patologia , Neoplasias da Orelha/patologia , Orelha Média/patologia , Tumores Neuroendócrinos/patologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasia Residual/patologia , Estudos Retrospectivos , Adulto Jovem
18.
J Surg Educ ; 75(6): 1480-1485, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29753685

RESUMO

OBJECTIVE: Analyze medical student performance using an endoscopic ear surgery (EES) skills trainer over time. DESIGN: Simulation experience. SETTING: Surgical skills lab. PARTICIPANTS: Five medical students and 1 expert surgeon completed 3 training sessions using an EES trainer to practice specific tasks designed to improve instrument control. During each session, participants performed 3 tasks, such as placing beads onto wires, 5 times per session for a total of 15 trials per task. Exercises were scored based on completion time. Results were compared before and after training. Pre- and post-task surveys were administered. RESULTS: Prior to skills training, 0% of medical students reported feeling comfortable holding an endoscope or ear instruments. For students, overall mean completion times decreased significantly for each exercise by the conclusion of the training experience: placing beads on wires improved from 152 to 44 seconds (p < 0.001), placing simulated prostheses from 264 to 93 seconds (p < 0.001), and navigating a pattern from 193 to 66 seconds (p = 0.002). Individual analysis showed varying learning curves among participants and between exercises, with some students exhibiting rapid improvement. At the conclusion of training, 80% of students felt comfortable holding the endoscope and using otologic instruments, and 100% were satisfied with the experience. CONCLUSIONS: Novice surgeons can exhibit significant skill improvement with repetitive practice on an EES trainer. Variable baseline skill and improvement rates highlight the individual characteristics of skill acquisition, which may be important factors during otolaryngology and endoscopic ear surgery training.


Assuntos
Competência Clínica , Educação Médica/métodos , Endoscopia/educação , Otolaringologia/educação , Procedimentos Cirúrgicos Otológicos/educação , Humanos , Treinamento por Simulação
19.
Otol Neurotol ; 39(6): e453-e460, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29664867

RESUMO

OBJECTIVE: To report short (∼4 mo) and long-term (>12 mo) audiometric outcomes following ossiculoplasty using a titanium clip partial ossicular reconstruction prosthesis. METHODS: Case series at a single tertiary referral center reviewing 130 pediatric and adult patients with conductive hearing loss (CHL) secondary to chronic otitis media (n = 121, 93%) or traumatic ossicular disruption (n = 9, 7%) who underwent partial ossiculoplasty from January 2005 to December 2015 with the CliP prosthesis. RESULTS: At both short and long-term follow-up, postoperative air-bone gap (ABG) was significantly improved (18 dB HL, IQ range 13-26, p < 0.0001 and 18 dB HL, IQ range 13-29, p = 0.0002, respectively) when compared with preoperative values (29 dB HL, IQ range 19-37). No significant change in ABG was noted when comparing short and long-term intervals (18 versus 18 dB HL, p = 0.44). Fifty seven percent of cases (51/89) achieved a long-term ABG less than or equal to 20 dB at the time of their last follow-up. The extrusion and displacement rates were 1.5% (2/130), and 0.8% (1/130), respectively. There were no cases of iatrogenic sensorineural hearing loss. CONCLUSIONS: Partial ossiculoplasty with the titanium CliP produces good hearing outcomes with a favorable safety profile. At long-term follow-up (minimum of 12 mo), median ABG was 18 dB and remained stable when compared with short-term follow-up. The majority of patients had successful long-term results, with 57% of patients achieving an ABG is less than or equal to 20 dB. Low rates of extrusion (1.5%) and prosthesis displacement off the stapes (0.8%) support the long-term stability of the CliP prosthesis in the middle ear.


Assuntos
Substituição Ossicular/instrumentação , Instrumentos Cirúrgicos , Titânio , Adolescente , Adulto , Idoso , Audiometria , Feminino , Seguimentos , Perda Auditiva Condutiva/etiologia , Perda Auditiva Condutiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Prótese Ossicular , Substituição Ossicular/métodos , Otite Média/complicações , Implantação de Prótese , Instrumentos Cirúrgicos/efeitos adversos , Resultado do Tratamento , Adulto Jovem
20.
Otol Neurotol ; 39(4): 422-427, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29533331

RESUMO

OBJECTIVE: Evaluate performance and quality of life changes after sequential bilateral cochlear implantation in patients with preoperative residual hearing functioning in a bimodal hearing configuration. STUDY DESIGN: Retrospective analysis using within-subjects repeated measures design. SETTING: Tertiary otologic center. PATIENTS: Twenty-two adult patients with bilateral sensorineural hearing loss who used bimodal hearing before second cochlear implant (CI) meeting the following criteria: 1) preoperative residual hearing (≤80 dB HL at 250 Hz) in the ear to be implanted, 2) implantation with current CI technology (2013-2016), 3) consonant-nucleus-consonant (CNC) speech recognition testing in the bimodal condition preoperatively and bilateral CI condition postoperatively. INTERVENTION: Cochlear implantation. MAIN OUTCOME MEASURES: CNC and AzBio sentence scores in quiet and noise (+5 SNR). Subjective measures of communication difficulty and sound quality were also administered. RESULTS: Twenty-two patients (mean 64 yr, 68% men) were included. At an average follow-up of 11.8 months, CNC scores in the bilateral CI condition (mean 63%, standard deviation [SD] = 22) were significantly better than preoperative bimodal scores with repeated measures analysis (mean 55%, SD = 22) (p = 0.03). AzBio scores in quiet were also higher with bilateral CI (mean 76%, SD = 24) compared with bimodal listening (mean 69%, SD = 29) (p = 0.0007). Global abbreviated profile of hearing aid benefit (APHAB) and overall speech, spatial, and qualities of hearing (SSQ) scores exhibited significant improvement following bilateral implantation (p = 0.006 for both analyses). CONCLUSIONS: For patients using a bimodal hearing configuration with substantial residual hearing in the non-CI ear, bilateral cochlear implantation yields improved audiologic performance and better subjective quality of life, irrespective of the ability to preserve acoustic hearing during the second sided implantation.


Assuntos
Implante Coclear/métodos , Perda Auditiva Bilateral/cirurgia , Perda Auditiva Neurossensorial/cirurgia , Audição , Qualidade de Vida , Adulto , Idoso , Implantes Cocleares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
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