To evaluate the serum expression of SerpinB3/B4/B10 and serum level of interleukin-17 as biomarkers for chronic rhinosinusitis with nasal polyps. This was a cross-sectional study involving 70 patients with CRSwNP and 70 age and gender matched healthy controls. The study patients were assessed using an Arabic version of the Sinonasal Outcome Test 22 score (SNOT-22), an otorhinolaryngology examination, and computed tomography of the nose and paranasal sinuses with grading of the findings using the Lund-Mackay staging system. The patients were divided into 2 subgroups: primary (n = 46) and recurrent (n = 24). Laboratory assessment included an assessment of the serum level of interleukin-17 (IL-17) and the expression of SerpinB3, SerpinB4, and SerpinB10. The values of IL-17, SerpinB3, SerpinB4, and SerpinB10 were higher in the patient group compared with the control group and in the recurrence subgroup compared with the primary subgroup, with statistically significant differences. All 3 serpins had significant potential as biomarkers for CRSwNP and for differentiating primary from recurrent subtypes, with a p value < .001 for the sensitivity and specificity of all markers. There was a significant positive correlation between the serum expression of each of the serpin markers and the serum levels of IL-17, SNOT 22, and Lund-Mackay score (P < .001 for all). The biomarkers studied had significantly higher values in CRSwNP patients, especially the recurrent subgroup. SerpinB3/B4/B10 had significant sensitivity and specificity as biomarkers for CRSwNP, predicting the likelihood of postoperative polyp recurrence, and showing a positive correlation with disease severity.
Evaluation of the clinical efficacy and safety of finafloxacin otic suspension in 2 Phase III clinical trials, in patients 6 months or older, reflective of the populations at risk for acute otitis externa (AOE). Two identical multicenter, randomized, double-masked, vehicle-controlled prospective Phase III studies in which 1234 patients (≥6 months) with AOE of presumed bacterial origin were randomized at 128 sites in the United States and Canada. Patients received finafloxacin otic suspension or vehicle twice daily for 7 days. The primary efficacy endpoint was the proportion of patients with clinical cure (resolution of tenderness, erythema and edema) on day 11 in the pathogen positive subset of the intention to treat (ITT) population. Patients of the pathogen positive subset of the ITT population treated with finafloxacin had a clinical cure rate of 70.2% on day 11 (test of cure visit, ToC) compared to 36.6% in the vehicle group (P < .0001). A comparable effect was observed in the ITT population (finafloxacin 71% cure vs vehicle 49.8%). Finafloxacin eradicated the most common AOE pathogens with high efficiency: 89% for Staphylococcus aureus and 85.3% for Pseudomonas aeruginosa (39.2% and 26.8% in the vehicle group, respectively). Median time to cessation of ear pain was 3.5 days in the finafloxacin group versus 7.0 days in the vehicle group (P < .0001), and thus markedly shorter than durations reported for other otic therapies. Finafloxacin had a safety profile comparable to that of vehicle. Adverse events-primarily ear pruritus, ear discomfort, and dizziness-occurred at similar rates in both groups. Finafloxacin otic suspension was statistically superior to vehicle in clinical cures, pathogen eradication, and median time to ear pain resolution. It also demonstrated high efficacy against the primary AOE pathogens, S. aureus and P. aeruginosa, including fluoroquinolone-resistant pathogens. Finafloxacin was well-tolerated with a safety profile equivalent to vehicle.Clinical trial registry name:ClinicalTrials.gov; URL: https://clinicaltrials.gov/Identifier:NCT01535599 and NCT01535560.
Interactive technologies are evolving along with their applications in medicine. Under this umbrella lie both augmented reality (AR), the process of visually overlaying digital information on top of the physical world, and mixed reality (MR), which builds upon AR with the inclusion of interactions between the digital display and the physical world. Previous reviews of AR and MR in OHNS have been limited in their scope and do not address underlying technological shortcomings. A scoping review of relevant literature was conducted using PRISMA methodology. Electronic databases were screened using keywords including "augmented reality," "mixed reality," "ENT, "OHNS," and "otolaryngology." Editorials, reviews, meta-analyses, unpublished, and -only articles were all excluded. Studies were individually assessed for quality using technological usability heuristics. A total of 107 studies were reviewed with 46 studies meeting our inclusion criteria. Of the included studies, there were 4 (8.7%) studies on preoperative surgical planning, 37 (80.4%) on intraoperative surgical guidance, and 5 (10.9%) on surgical education. The majority of studies on AR or MR in OHNS were in subspecialty Otology/Neurotology with 19 studies, while 10 were in Rhinology, and 7 were in Head and Neck Surgery. The majority have been on intraoperative usage. However, almost all of these were preclinical studies (84.8%). Commonly cited challenges limiting the transition of intraoperative guidance from models to the OR include accuracy of registration and ease-of-use. Current studies in this field have focused on intraoperative guidance and were predominantly in the preclinical phase. The limitations in current AR/MR technology have prevented a greater level of evidence in studies and advancements in AR/MR implementation.
To characterize contemporary workforce trends among physician assistants in otolaryngology-head & neck surgery in the United States. Longitudinal analysis of annual survey of the Society of Physician Assistants in Otorhinolaryngology-Head & Neck Surgery (SPAO-HNS) data, collected 2015 to 2024. The survey captured self-reported practice patterns, compensation models, and clinical responsibilities. Statistical analyses included linear and logistic regressions to evaluate temporal trends and differences by practice setting. A total of 1227 survey responses were analyzed. Most respondents were physician assistants (93.7%), predominantly working in private stand-alone otolaryngology practice environments (66.8%). Majority of respondents reported working an average of 40 hours per week with salary-based compensation (71.8%), though productivity-based bonuses rose over the study period (P =< .001). Common procedures performed independently included cerumen removal, foreign body extraction, and nasal endoscopy or flexible fiberoptic laryngoscopy. Practice setting influenced patient volume and scope of responsibilities, with stand-alone practices reporting higher outpatient volumes. The proportion of respondents planning to leave otolaryngology within 5 years nearly doubled from 17% in 2015 to 29% in 2024. This 10-year longitudinal analysis highlights the integral and evolving contributions of physician assistants and nurse practitioners to otolaryngology care across diverse practice settings. The findings document an expanding role in enhancing access to care and performing office procedures independently. However, the rising proportion of respondents intending to leave the field signals emerging workforce sustainability challenges. Proactive strategies to support recruitment, retention, and professional development are needed to ensure a stable and effective otolaryngology workforce capable of meeting growing patient needs.
Chronic rhinitis (CR) is inflammation of the nasal mucosa, causing a multitude of symptoms. Temperature-controlled radiofrequency neurolysis (RFN) of the posterior nasal nerve (PNN) is a treatment for CR. In allergic rhinitis (AR), Type 2 cytokines are drivers of symptom severity. This study explores whether RFN's symptomatic improvements are linked to changes in nasal airflow and local cytokine levels. This prospective, single-arm study was conducted at the Texas Sinus Institute at The University of Texas Health Science Center at Houston. Patients with ≥6 months of CR symptoms, a reflective total nasal symptom score (rTNSS) ≥6, and refractory to medical management were included. Follow-ups occurred at 4 and 12 weeks, with the primary endpoint at 12 weeks. Symptom improvement, peak nasal inspiratory flow (PNIF) and cytokine changes were assessed.  Seventeen patients were enrolled with 15 patients undergoing the treatment. The procedure was well tolerated with no major adverse events. The rTNSS improved from a median of 7.5 to 4 at 12 weeks (P < .01). Median NOSE scores improved from 52.5 to 17.5 at week 12 (P < .05). Minimal clinically important differences (MCID) were achieved by 67% of patients for rTNSS and 50% for NOSE. There were no significant changes in PNIF. Patient-level change in IL-10 was significantly associated with improvement in NOSE score (r = -.70, P = .011). RFN of the PNN is a safe, effective in-office treatment for CR. While PNIF and group-level cytokines were not consistent indicators of improvement, the correlation between IL-10 and symptom relief suggests a potential link between neural ablation and the local mucosal microenvironment. This investigation shows the feasibility of cytokine monitoring to further investigate the mechanisms of rhinitis treatment.
This study aims to compare the accuracy of the TUNE, American Speech-Language-Hearing Association (ASHA), and Common Terminology Criteria for Adverse Events (CTCAE) grading systems in reflecting the severity of treatment-related hearing loss, as measured by pure-tone audiometry and patient-reported hearing loss using the Speech, Spatial, and Qualities of Hearing scale compare questionnaire (SSQ). This study is a prospective, multicenter, cross-sectional, and observational study from 2018 to 2024 conducted at the Netherlands Cancer Institute - Antoni van Leeuwenhoek Amsterdam, Leiden University Medical Center, and University Medical Center Utrecht. In this trial, 109 patients with an indication for curative platinum-based chemotherapy (dose ≥ 200 mg/m2) were included, of whom 74 were eligible for analysis. Standard frequency and extended high-frequency pure tone audiometry were measured at baseline and follow-up. The SSQ was administered at follow-up to assess patient-reported outcome measures for hearing loss. The TUNE, ASHA, and CTCAE criteria were derived from audiometry. Concordance and Spearman's correlations were evaluated between all 3 grading systems and the SSQ.  The concordance of TUNE with the SSQ was 81%. The concordance of CTCAE and ASHA with the SSQ was 73% and 68%, respectively. A statistically significant Spearman's correlation coefficient of -.35 (P = .01) was found between TUNE and the SSQ. The Spearman's correlation coefficient with CTCAE or ASHA and SSQ was -.10 (P = .10) and .04 (P = .75), respectively. This study found that the TUNE is better in reflecting platinum-related patient-reported hearing loss compared to the CTCAE and ASHA.
This study aimed to assess the effectiveness of local anesthesia in reducing pain associated with fine needle aspiration (FNA) of thyroid nodules, examine the side effects of local anesthesia, and identify factors that influence pain during FNA of thyroid nodules. We conducted a randomized clinical trial in the Department of Otolaryngology at Ramathibodi Hospital. Patients scheduled to undergo FNA of thyroid nodules were divided into four groups and subsequently administered four types of local anesthesia: Group A (Placebo cream), Group B (Cold placebo cream), Group C (Topical anesthetic cream), and Group D (Cold topical anesthetic cream). The primary outcome was the mean difference in pain levels (measured using a visual analog scale [VAS] and a numeric rating scale [NRS]) between the treatment and control groups. Initially, 72 participants were enrolled in this study, and data from 62 participants were analyzed. The VAS scores were measured at 0, 10, and 30 minutes post-procedure, with mean scores of 25.85 ± 4.65 (Group A), 21.26 ± 4.81 (Group B), 18.05 ± 4.51 (Group C), and 16 ± 4.97 (Group D). Although Group D showed the lowest pain scores, statistical analysis revealed no significant differences between groups (all P > .05). Local anesthesia and cooling can decrease the level of pain. However, in this study, topical anesthetic did not significantly reduce pain compared to non-anesthetic treatments. 2.
This experimental study aimed to evaluate the effects of crocin on wound healing and fibrosis in vocal fold injury. Thirty-six male Wistar Albino rats were randomly divided into 3 groups: a sham group, a local crocin treatment group, and a systemic crocin treatment group. In the study, all rats underwent injury to their right vocal folds. Six rats from each group were randomly sacrificed on the 5th and 30th days after surgery. Tissue samples were evaluated for lamina propria thickness, inflammation severity, epithelial regeneration, edema, hyaluronic acid, collagen, elastin, and the cytokines TGF-β1, FGF2, and HGF. In the early phase, less inflammation, more epithelial regeneration, and lamina propria were observed in the systemic treatment group compared to the sham group. In the late phase, Compared to the sham group, both the systemic and local treatment groups showed higher values in lamina propria thickness, elastin, and HGF measurements, while collagen levels were significantly decreased. Furthermore, in the systemic group, TGF-β1 decreased in the late period, while hyaluronic acid and FGF2 levels remained high. When the groups were evaluated within themselves, inflammation and edema were observed to decrease more significantly in the late period in all groups. Hyaluronic acid decreased significantly in the sham and local treatment groups, while this decrease was limited in the systemic treatment group. Lamina propria thickness increased significantly in the treatment groups on day 30 compared to day 5. Crocin treatment applied using different methods has shown positive effects on various parameters, wound healing, and fibrosis reduction in the early and late periods after vocal fold injury. However, more extensive preclinical and clinical studies are needed to determine the efficacy and applicability of this treatment.
Estrogen has been found to impact cochlear blood flow and auditory function, but epidemiological studies on menopause and hearing are inconsistent. This study investigates the associations of menopause, its age at onset, reproductive lifespan, and hormone replacement therapy (HRT) with hearing loss in adult women in the US. Study cohort includes 1778 adult women (40-69 years), from the National Health and Nutrition Examination Survey 2011 to 2012 and 2015 to 2016 who had complete data on audiometry and reproductive health. Hearing loss was defined based on speech-frequency pure-tone average (0.5, 1, 2, and 4 kHz) in better hearing ear. Menopause status was self-reported. Multivariable regression analyses were performed to explore the associations of menopause, age at onset, reproductive lifespan, and HRT with hearing loss. After adjusting for age, demographics, medical comorbidities, and noise exposure, there was no significant association between binary postmenopausal status and hearing loss (β: 0.92 dB, [95% CI: -1.02 to 2.86]). When further considering age of menopause onset and reproductive lifespan, we found that late onset of menopause (vs early onset) was significantly associated with the better hearing (β: -4.60 dB, [95% CI: -8.42 to -0.79]) and longer reproductive lifespan was significantly associated with better hearing (β: -0.16 dB per year, [95% CI: -0.32 to -0.002]). Comparing reproductive lifespan quartiles, the fourth quartile was significantly associated with better hearing relative to the first quartile (β: -4.86 dB, [95% CI: -8.28 to -1.44]). Among post-menopausal women, there was no significant association between hearing loss and HRT (β: 0.45 dB, [95% CI: -1.69 to 2.58]). While menopausal status was not significantly associated with hearing loss, later onset of menopause and longer reproductive lifespan were associated with better hearing. Future studies should evaluate the clinical significance of the associations between hearing and reproductive health and potential causal relationships. 2b.
Inferior turbinate (IT) hypertrophy is a major cause of nasal obstruction. Although surgical intervention is effective, it can be associated with morbidity and prolonged recovery. This study evaluated the safety, efficacy, and tolerability of a novel submucosal fractional radiofrequency (FRF) treatment. A prospective, single-arm, open-label study was conducted from March to November 2024. Patients with nasal obstruction caused by IT hypertrophy unresponsive to at least 1 month of medical treatment were included in the study. The procedure was performed endoscopically under topical anesthesia using FRF. Outcomes were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) scale, Visual Analog Scale (VAS), and endoscopic turbinate grading at baseline, 1 month, and 3 months after the procedure. The safety outcomes included pain scale, adverse events, and complications. A total of 22 patients completed the protocol. The NOSE score improved from 71.2 to 30.0 at 1 month (P < .001). Sustained NOSE score improvement was observed at 3 months (37.1, P < .001). The VAS scores for nasal obstruction decreased from 7.4 to 3.2 at 1 month and 3.9 at 3 months (P < .0001). Endoscopic grading of turbinate size demonstrated a reduction at both follow-up points (P < .05). The average VAS score for pain was 3.4, indicating good tolerability. No bleeding, synechiae, or other adverse events were reported. Crusting appeared in 50% of patients at 1 month, resolving in all but 1 patient by 3 months. A significant correlation was observed between the pulse count and symptom improvement (P = .02). Submucosal FRF treatment leads to significant and sustained improvement in nasal obstruction with minimal pain and no major adverse events. These results support the safety, efficacy, and tolerability of the procedure for IT hypertrophy in an outpatient setting. Larger cohorts and long-term follow-up studies are warranted to refine the treatment and further validate these findings. 3.
While prior literature has demonstrated that patients of lower socioeconomic groups may have larger tumors on presentation and poorer outcomes, there is limited literature on the impact of race and ethnicity on management of vestibular schwannoma (VS). The objective of this study was to determine whether race and ethnicity impacted treatment choice and postoperative management of VS. Retrospective review of patients diagnosed with VS (ICD9 225.1, ICD10 D33.3, and ICD 10 H93.3) who presented to a tertiary care center between January 1, 2018 and October 31, 2023 was completed (IRB H-45412). Primary outcomes, including treatment choice, time to treatment, and postoperative management, were compared among different racial and ethnic groups. Of the 78 patients diagnosed with VS, 46 (59.0%) patients were observed with serial imaging, 12 (15.4%) underwent radiation, and 14 (18.0%) pursued surgery initially. Treatment choice (P = .3917), time to treatment (P = .3310), and loss to follow up (P = .0579) were not significantly different between different races/ethnicities. In patients who pursued surgery, the duration of admission (P = .9300), need for rehabilitation (P = .6271), postoperative facial nerve paresis (P = .8233), and hospital readmission (P = .5680) did not differ significantly. The proportion of patients who qualified for hearing rehabilitation did not differ significantly (P = .3545). However, a significantly higher proportion of White patients chose to pursue hearing rehabilitation compared to the other groups ( P = .0096). Race and ethnicity did not significantly impact choice of treatment, management patterns, or postoperative course for patients with VS.
To assess the effect of rhinophototherapy (RPT) on nasal mucosa and inflammatory cells in allergic rhinitis compared to intranasal corticosteroids (INCS). Adult patients (≥18 years) with newly diagnosed perennial allergic rhinitis (AR) were randomly divided into 2 groups, RPT and INCS. Treatment was administered for 2 weeks. Primary outcome was evaluation of the inflammatory cells and mucosal damage via inferior turbinate biopsy, performed post-treatment. Secondary outcomes measured were visual analogue score (VAS) of clinical symptoms (overall, runny nose, sneezing, nasal block, nasal itchiness and ocular itchiness) and nasal patency using rhinomanometry and peak nasal inspiratory flow (PNIF). Thirty-five patients were included, with 18 patients randomized into RPT and 17 patients into INCS. The mean age of patients was 31.3 ± 9.6 (range: 19-57). There was no statistically significant difference observed in terms of inflammatory cells in both groups. Similarly, both groups had no differences in mucosal damage parameters. Patients in RPT group showed statistically significant improvement for overall and specific symptoms VAS score (P < 0.05). Comparing both groups, patients using INCS reported bigger effect size for overall VAS score and specific VAS score for runny nose, sneezing, nasal and eye itchiness. Both groups showed improvement in PNIF reading post-treatment although only RPT group showed statistical significance (P = .015). In terms of rhinomanometry, both groups showed significant improvement in post-treatment nasal flow rate (P < .05). There was decrease in total nasal resistance observed in both groups, albeit with RPT being statistically significant (P = .004). There were no adverse events reported in both groups. There is no significant difference in inflammatory cells of inferior turbinate mucosa and mucosal damage between RPT and INCS. RPT is a safe and suitable short-term alternative (2 weeks) for AR patients who are contraindicated for or unable to tolerate INCS. The study was registered with ClinicalTrials.gov with the ID: NCT05919316.
To assess the efficacy of adjuvant MMC in the endoscopic treatment of airway stenoses. PubMed/MEDLINE, Cochrane Library, Scopus, Embase, and Google Scholar databases. A literature search was conducted following PRISMA guidelines. The PICOS tool was used to determine the eligibility criteria for this study. A single arm meta-analysis was performed for stenosis resolution, the rate of patients requiring multiple endoscopic procedures, and the rate of patients requiring other surgical treatments. A total number of 358 patients (median age: 48.0 years; 95% CI 44.8-50.8) were included. The median follow-up was 25.2 months (n = 244/358; 95% CI 15.4-38.3). Overall, the cumulative stenosis resolution rate was 76.37% (n = 187/254; 95% CI 59.72-89.64), the rate of patients requiring multiple endoscopic procedures was 52.33% (n = 131/260; 95% CI 32.03-72.25), and the rate of patients requiring other surgical treatments was 4.08% (n = 26/310; 95% CI 0.37-11.48). The median intervention-free interval was 366 days (n = 155/358; 95% CI 270-696). Current evidence does not allow definitive conclusions regarding the efficacy of adjuvant MMC in reducing recurrence or prolonging intervention-free intervals in airway stenosis. Further well-designed prospective studies are needed to clarify the role of MMC and to inform evidence-based guidelines for patient selection and treatment use. NA.
Neonatal suppurative sialadenitis (NSS) is an uncommon but serious complication of salivary gland infection, with few cases reported in literature, most often affecting preterm infants. Typical cases involve the parotid gland and are caused by Staphylococcus aureus infection. Contributing factors include prematurity, dehydration, prolonged hospitalisation, and immature immunity. Sequential bilateral gland involvement through haematogenous spread is rare, and presents significant management challenges in prematurity. We report the case of a preterm infant, born at 30 weeks gestation, who spontaneously developed acute left-sided parotid swelling at 3 weeks old in NICU. Inflammatory markers were significantly elevated and blood cultures grew Staphylococcus epidermidis. Initial treatment was with broad-spectrum intravenous antibiotics, and after no significant improvement, confirmatory ultrasound, and subsequent bedside percutaneous drainage was performed by ear, nose, and throat (ENT) surgeons. Subsequently, they developed a second abscess in the contralateral submandibular gland, needing further bedside aspiration. Pus cultures isolated Staphylococcus aureus, and they improved with culture-driven antibiotics. We highlight the importance of combining early antimicrobial therapy with minimally invasive procedural intervention in managing NSS, as well as the rarity of multiple, sequential gland involvement. Early drainage limits progression when empirical treatment fails and helps guide antimicrobial choice. It minimises the need for more invasive surgical intervention, which is complex in preterm infants. A high index of suspicion, early minimally invasive drainage and prompt initiation of targeted antibiotics, are key to optimal outcomes in NSS, particularly in preterm infants at higher risk of severe disease.
(A) Determine patient and institutional factors associated with increased length of stay (LOS) and complications of tracheostomy, (B) Develop data-driven quality improvement in tracheostomy care. Mixed methods protocol used cross-sectional survey assessing institutional trends in tracheostomy-specific care. Retrospective chart review compared tracheostomy patient outcomes prior to and during implementation of a multidisciplinary tracheostomy care team and standardized guidelines. Patients undergoing tracheostomy from January 2019 to December 2021 at a tertiary hospital. Patient factors, procedure type and indication, tracheostomy tube size, management timeline, insurance, and disease severity using Acute Physiology and Chronic Health Evaluation II (APACHE II) score were analyzed for associations with LOS and adverse events. Multivariate analyses controlled for APACHE II score and payer source. LOS and complications were compared between patients before and during implementation of multidisciplinary tracheostomy care team and standardized guidelines. Three-hundred and eighteen patients met criteria with a 21.7% complication rate, average LOS of 24 days (SD = 28.523), and median LOS post-tracheostomy of 14 days (IQR 7, 29). Departments without standardized protocols had greater LOS (F[1,316] = 28.706, P < .001]) and complication odds (OR = 2.92, P = .015, 95% CI[1.231, 6.930]). Larger tracheostomy tube size was linked to increased LOS (β = .253, t(314) = 4.741, P < .001, 95% CI[4.137, 10.081]). Delays from ventilation discontinuation to cuffless tube exchange and decannulation correlated with increased LOS (β = .406, t(184) = 6.321, P < .001, 95% CI[.928, 1.771]); (β = .554, t(129) = 7.625, P < .001, 95% CI[1.008, 1.715]). When focusing on a single department, comparing 2019 patients to 2021 patients (pre- and post-guideline and care team), overall, LOS decreased from 33.08 to 30.83 days (P = .586). When excluding patients discharged on a ventilator, the 2019 group had average LOS of 37.938 days versus 33.41 days in 2021 (P = .344). Standardized tracheostomy care guidelines and multidisciplinary care teams are critical to improving institutional outcomes. Data-driven approaches to quality improvement ensure efficient and targeted methods to improving patient care. 4.
High blood pressure (BP) or hypertension (HTN) can impair hearing, causes tinnitus and dizziness. We hypothesized that there is an association between increased BP and hearing impairment (HI), tinnitus and dizziness, and decrease in BP improves these parameters and symptoms. The study included 100 newly-diagnosed HTN patients (systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg) and 100 patients without HTN. Tinnitus and dizziness were evaluated through Tinnitus Handicap Inventory (THI) and Dizziness Handicap Inventory (DHI). The auditory status of all patients was assessed for both right ear (RE) and left ear (LE). BP measurements, THI, DHI, and audiometry tests were repeated at follow-up visit during treatment in HTN patients and delta (Δ) values were obtained. The median of THI and DHI score and thresholds for hearing parameters were higher in HTN group. At follow-up visit, SBP, DBP, THI, DHI, and most of the hearing parameters significantly improved. ΔSBP significantly correlated with ΔRE average (logarithmically transformed (log10)) and ΔLE average (log10) in partial correlation analysis adjusted for age and Brinkman index. Multivariate linear regression analysis yielded an independent association of ΔRE average (log10) (Beta Coefficient (BC): 12.07, 95% Confidence Interval (CI): 1.86-22.29, P = .021) and ΔLE average (log10) (BC: 14.89, 95% CI: 5.45-24.33, P = .003) with ΔSBP. However, none of the parameters demonstrated an independent association with ΔDBP. HTN patients suffer from tinnitus, dizziness and HI, and BP decrease is associated with improvements in these symptoms and hearing status. Decrease in SBP rather than DBP is associated with improvements in hearing status.
Sinonasal malignancies (SNM) are rare cancers associated with poor prognosis and impaired quality of life (QOL). The 22-question Sino-Nasal Outcome Test (SNOT-22) has been used to assess QOL in patients with SNM. To determine the minimal clinically important difference (MCID) for the SNOT-22 in patients with SNM. About 264 patients with SNM were drawn from a prospective, longitudinal, multi-institutional study. SNOT-22 scores were collected at pre-treatment baseline and follow-up through 5 years post-treatment. Cronbach's alpha was used to assess the internal consistency of the SNOT-22. Distribution-based approaches were used to estimate the MCID. Multivariable regression identified factors associated with SNOT-22 improvement exceeding the determined MCID. Cronbach's alpha was >.85. The estimated MCIDs were: 1.44 (Cohen's effect size), 1.32 (standard error of the mean), 10.45 (1/2 of baseline standard deviation), and 3.67 (minimum detectable change). The mean MCID across methods was 4.22. Multivariable regression demonstrated higher odds of clinically meaningful improvement from baseline in patients with early-stage disease (odds ratio (OR) 3.510, P = .035), no neck irradiation (OR 11.050, P = .014), and neoadjuvant therapy (OR 16.667, P = .047). The SNOT-22 MCID was estimated as 4.22 in a large multi-center cohort of patients with SNM, suggesting that relatively small QOL changes are clinically relevant. When applying the MCID to the current cohort, advanced stage, treatment of neck disease, and not requiring neoadjuvant therapy were predictive of worse QOL.
The primary objective of this study is to determine the prevalence of Hib and Pneumococcal antibody deficiencies in pediatric patients with persistent or recurrent ENT infections, namely recurrent otitis media and recurrent sinusitis, following ear tube placement or adenoidectomy. This is an IRB approved, single institution, retrospective chart review using the electronic medical record at University of Mississippi Medical Center from January 2013 to December 2023. University of Mississippi Medical Center, a tertiary referral hospital. This study included 43 patients who had undergone either ear tube placement or adenoidectomy with a history of PCV and Hib titers data. Demographic data was obtained and complete vaccination records were confirmed. Prevalence of PCV and Hib titer deficiency was calculated, and statistical analysis was performed using Chi-square tests, Fischer exact test or independent t-test, depending on the variables. More than half (55%) of these patients were found to be indeterminate or have non-protective titers against Hemophilus influenzae type B, and 43% had titers considered non-protective against Pneumococcus. Given vaccination response rates are approximately 95% for the Hib vaccine and 97% to 100% for Prevnar vaccine, this demonstrates that children with recurrent ENT infections are approximately 11 times more likely to have indeterminate or non-protective titers to Hib and 14 times more likely to have non-protective titers to Pneumococcus. This study highlights the potential role of testing these titers in pediatric patients with recurrent ear and sinus infections despite surgical management, and sheds light on the potential role of booster vaccinations in this population.
To explore the surgical effect for patients with different types of tympanosclerosis under total otoendoscopy. A retrospective analysis was performed on the clinical data of 86 patients who were diagnosed with tympanosclerosis and underwent total endoscopic ear surgery. According to the Wielinga classification, the patients were categorized into type II group (n = 34) and type IV group (n = 52). Hearing outcomes were recorded and analyzed at the preoperative, short-term postoperative (≤6 months), and long-term postoperative (≥1 year) periods. Significant differences in average air-bone gap (ABG) were observed among preoperative, short-term, and long-term postoperative periods in type II and IV tympanosclerosis. No difference was found between type II and IV in short-term ABG, whereas a significant difference appeared in long-term outcomes (P < .05). The duration of illness was strongly correlated with tympanosclerosis type and preoperative ABG. The short-term surgical benefits of type II and type IV are similar, while the long-term hearing recovery of type II is better. The bone conduction recovery of type IV is better. The longer the disease course, the more severe the hearing loss.
The prevalence of sleep-disordered breathing, including obstructive sleep apnea, has driven the rapid growth of sleep surgery as a subspecialty. Medicare reimbursement plays a pivotal role in the economic viability of sleep surgery, but trends remain understudied. This study analyzes reimbursement trends for commonly performed sleep surgery procedures from 2000 to 2024, assessing inflation-adjusted changes in facility-based professional reimbursement. The 11 most frequently billed sleep surgery procedures at a single institution in 2024 were identified. Medicare data on facility-based professional reimbursement were extracted from 2000 to 2024 using the CMS Physician Fee Schedule. Inflation adjustments were applied using the CPI Inflation Calculator. Year-to-year percentage changes and linear regression analyses were performed. Among the analyzed CPT codes, a consistent decline in inflation-adjusted facility prices was observed, with an average aggregate decrease of 39.8%. The most pronounced decline was in CPT 42975 (Drug-Induced Sleep Endoscopy), which decreased by 72.1% (R2 = .88). Other procedures, such as CPT 30140 (Submucous Resection of Inferior Turbinate) and CPT 31231 (Diagnostic Nasal Endoscopy), experienced aggregate declines exceeding 58%. Procedures like CPT 30130 (Excision of Inferior Turbinate) showed relatively stable pricing with a 2.6% aggregate reduction. The substantial decline in inflation-adjusted facility prices for sleep surgery procedures underscores challenges in sustaining the financial and operational viability of this growing subspecialty. Reduced reimbursement may hinder innovation, training, and resource allocation, with potential downstream impacts on patient access and care. Policymakers should consider these findings to ensure equitable and sustainable support within the healthcare system. 4.