Dynamics of Co-Infection with Bartonella henselae Genotypes I and II in Naturally Infected Cats: Implications for Feline Vaccine Development.

Bartonella henselae is an emerging bacterial pathogen causing cat-scratch disease and potentially fatal bacillary angiomatosis in humans. Bacteremic cats constitute a large reservoir for human infection. Although feline vaccination is a potential strategy to prevent human infection, selection of appropriate B. henselae strains is critical for successful vaccine development. Two distinct genotypes of B. henselae (type I, type II) have been identified and are known to co-infect the feline host, but very little is known about the interaction of these two genotypes during co-infection in vivo. To study the in vivo dynamics of type I and type II co-infection, we evaluated three kittens that were naturally flea-infected with both B. henselae type I and type II. Fifty individual bloodstream isolates from each of the cats over multiple time points were molecularly typed (by 16S rRNA gene sequencing), to determine the prevalence of the two genotypes over 2 years of persistent infection. We found that both B. henselae genotypes were transmitted simultaneously to each cat via natural flea infestation, resulting in mixed infection with both genotypes. Although the initial infection was predominately type I, after the first 2 months, the isolated genotype shifted to exclusively type II, which then persisted with a relapsing pattern. Understanding the parameters of protection against both genotypes of B. henselae, and the competitive dynamics in vivo between the two genotypes, will be critical in the development of a successful feline vaccine that can ultimately prevent B. henselae transmission to human contacts.

The use of the submental island flap in reconstructing palatal and facial defects in a surgical camp in East Africa.

BACKGROUND: The goals of successful reconstructive surgery are to restore function and cosmesis; however, limitation of resources can become an important consideration in low-middle income countries. METHODS: We describe our experience using the submental island flap in two cases during a short-term surgical camp in East Africa. RESULTS: The submental island flap was utilized as an excellent alternative to a free flap to reconstruct a subtotal maxillectomy and a parotidectomy defect in two patients. CONCLUSIONS: We demonstrate the successful use of this flap and describe some necessary modifications to achieve optimal results in a resource limited setting.

A Smartphone Application and Education Program for Hearing Health Promotion in High School Teenagers.

OBJECTIVES: To assess knowledge retention after video-based hearing health education and measure headphone listening behavior change using a novel smartphone application. METHODS: In this prospective longitudinal study, students participated in video-based hearing health education and hearing screening sessions. Hearing health knowledge was assessed in students and parents after 6 weeks. A novel smartphone application was created to measure daily noise exposure based on volume settings with headphone use and to display the National Institute for Occupational Safety and Health (NIOSH) noise doses with alerts for cumulative daily doses nearing the maximum. RESULTS: Seventy-six teenage students and parents participated. Eighty three percent of participants identified as a racial or ethnic minority and 66% were of low-income socioeconomic status. Hearing health knowledge was retained in students 6 weeks after education and parents' knowledge improved from baseline. The smartphone app was installed on 12 student phones, and 25% of days monitored exhibited noise doses that exceeded the NIOSH maximum. App use for at least 10 days by nine students showed a significant reduction in average daily noise dose and time spent at the highest volume settings during the second-half of app use. CONCLUSIONS: Video-based hearing health education with knowledge question reinforcement was associated with knowledge retention in students and improved parental attitudes and knowledge about hearing conservation. A smartphone app with a real-time display of headphone cumulative noise exposure dose identified at-risk students. The integration of hearing health education, hearing screening, and digital health tools has promised to promote positive behavior changes for long-term hearing conservation. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:2007-2013, 2023.

Disparities in Speech Therapy for Voice Disorders Between English- and Non-English-Speaking Patients.

OBJECTIVES/HYPOTHESIS: To evaluate whether language of choice affects compliance with speech therapy for voice disorders. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective study was performed at Kaiser Permanente Northern California to compare compliance with referrals to speech therapy for voice disorders between English- and non-English-speaking patients. Patients referred from January 2012 through December 2017 were included. Logistic regression models were used to calculate the adjusted odds ratios (aOR) and to determine social and demographic factors affecting compliance. RESULTS: Of 7,333 patients referred to speech therapy for a voice disorder, 7,171 were identified as English speaking and 162 as non-English speaking. The two cohorts were similar in terms of gender and proportion over 65 years of age, although non-English-speaking individuals were more likely to be Hispanic or Asian than English speakers, who were more likely to be White or African American. Overall compliance was lower among non-English-speaking patients than English speakers (63% vs 74%) (P = .0011). Logistic regression showed that the need for an interpreter was significantly associated with higher noncompliance (aOR 1.56, 95% CI 1.11-2.18), as was age less than 65 and income less than the study aggregate median income. Being multiracial or having a voice disorder of neurologic origin was associated with better compliance. CONCLUSION: This study demonstrates significant noncompliance with speech therapy for a variety of voice disorders. This problem is exacerbated for patients who do not speak English and who are younger, of lower income, or are referred for functional voice disorders. In-person interpreters or multilingual speech therapists may help to improve compliance. LEVEL OF EVIDENCE: IV Laryngoscope, 131:E2298-E2302, 2021.

Academic and Gender Differences Among U.S. Otolaryngology Board Members.

OBJECTIVES: To determine the representation of women in leadership positions within otolaryngology societies and to compare their academic rank and research productivity to men. METHODS: The leadership positions of all U.S. otolaryngology societies were compiled. The Medicare Physician Compare database was used to obtain gender and medical school graduation year for all otolaryngologists. An online search was used to determine board member's academic faculty rank. The Scopus database was used to determine an individual's number of publications, citations, and h-index. All websites were accessed from July 2019 to October 2019. RESULTS: Of the 200 leadership positions, there were 160 unique individuals available for analysis. Of those, 23% were female. In comparison, 18% of all otolaryngologists in the United States are female. The average medical school graduation year was significantly more recent for female leaders (1997 vs. 1990, P < .001) than males, which is similar to all otolaryngologists (2001 vs. 1993, P < .001). Stratifying by gender alone, women averaged significantly fewer publications, citations, and h-indices compared to men (P < .05), and were also less likely to be professors (P < .01). When considering both gender and graduation year, significant differences among academic productivity were only noted for those graduating between 1990 to 1999. Among all board members who graduated after 2000, women comprised a majority of those in leadership positions (52%). CONCLUSION: Leadership positions in otolaryngology societies reflect the changing demographic of otolaryngologists in the United States. There is proportionate representation, and the more recently graduated female physicians show the same research productivity as their male counterparts. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:731-736, 2021.

Primary Immunodeficiency and Rhinosinusitis.

Refractory rhinosinusitis can be related to comorbid medical conditions, including primary immunodeficiency. Given the prevalence of immunodeficiency, clinicians should have a low threshold to consider these diagnoses. This article reviews primary immunodeficiencies contributing to chronic rhinosinusitis, including a proposed diagnostic work-up and the evidence for treatment in this unique population.

Ear Preference and Interaural Threshold Asymmetry.

OBJECTIVE: To define the relationships among ear preference strength, audiometric interaural asymmetry magnitude, and hearing impairment. STUDY DESIGN: Prospective, cross-sectional. SETTING: Academic audiology clinic. PATIENTS: Adults. INTERVENTIONS: Diagnostic. MAIN OUTCOME MEASURES: Patient-reported ear preference strength using a seven-category preference (no preference; left or right somewhat, strongly, or completely) scheme, hearing disability level on the Speech, Spatial, and Qualities of Hearing scale, and audiometric interaural threshold asymmetry were analyzed in three study cohorts: 1) normal hearing (thresholds ≤ 25 dB, n = 66), 2) symmetric hearing loss (any single threshold > 25 dB, n = 81), and 3) asymmetric hearing loss (maximum average interaural threshold difference at any two adjacent frequencies (IThrDmax2)≥ 15 dB, n = 112). RESULTS: Receiver operating characteristic curves for somewhat, strongly, and completely ear preference levels using IThrDmax2 cutoff values at 15, 30, and 45 dB showed good to excellent classifier performance (all curve areas ≥ 0.84). The mapping of ear preference strength to the most likely IThrDmax2 range by odds ratio analysis demonstrated: no preference (< 15 dB), somewhat (15-29 dB), strongly (30-44 dB), and completely (≥ 45 dB). Complete dependence on one ear was associated with the most severe degradation in spatial hearing function. CONCLUSION: Categorical ratings of ear preference strength may be mapped to ranges of audiometric threshold asymmetry magnitude and spatial hearing disability level. Querying ear preference strength in routine clinical practice would enable practitioners to identify patients with asymmetric hearing more expeditiously and promote timely evaluation and treatment.