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"Otolaryngol Head Neck Surg"[jour]
These pubmed results were generated on 2020/04/15
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1.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820915487. doi: 10.1177/0194599820915487. [Epub ahead of print]
Comparing Kadish and Modified Dulguerov Staging Systems for Olfactory Neuroblastoma: An Individual Participant Data Meta-analysis.
Abstract
OBJECTIVE:
To compare the Kadish and the modified Dulguerov staging of individual participants to determine the impact of stage and other prognostic factors on disease-free (DFS) and overall survival (OS).
DATA SOURCES:
Systematic review of EMBASE, MEDLINE, Cochrane Library, and CINAHL databases.
REVIEW METHODS:
The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) was followed for this study. Articles including patients with olfactory neuroblastoma (ONB) staged with both Kadish and Dulguerov staging systems were reviewed. The raw data from eligible studies were requested to perform an individual participant data (IPD) meta-analysis.
RESULTS:
Pooled data from 21 studies representing 399 patients with ONB undergoing treatment with curative intent showed that increasing age, treatment with chemotherapy, and positive or unreported margin status portended worse DFS (P < .05). Increasing stage for both Kadish and Dulguerov staging systems was prognostic for worse DFS and OS (P < .05), with Kadish C representing a heterogeneous group with regard to outcome and corresponding Dulguerov T stage. Using the Akaike information criterion, the Dulguerov staging system had superior performance to the Kadish system for DFS (1088.72 vs 1092.54) and OS (632.71 vs 644.23).
CONCLUSION:
This study represents the first IPD meta-analysis of ONB directly comparing the outcomes of Kadish and Dulguerov staging systems in patients treated with primary surgery. Both systems correlated with DFS and OS, with superior performance in the Dulguerov system. Furthermore, the Kadish C group represented a heterogeneous group with regard to outcomes after stratification by the Dulguerov system. Dulguerov T4 patients had the worst outcome, with most being approached with open resection.
KEYWORDS:
craniofacial region; endoscopic skull base surgery; esthesioneuroblastoma; external sinus surgery; meta-analysis; outcomes
2.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820919741. doi: 10.1177/0194599820919741. [Epub ahead of print]
A Commentary on Safety Precautions for Otologic Surgery during the COVID-19 Pandemic.
Abstract
There are insufficient data regarding the safety of otologic procedures in the setting of the coronavirus disease 2019 (COVID-19) pandemic. Given the proclivity for respiratory pathogens to involve the middle ear and the significant aerosolization associated with many otologic procedures, safety precautions should follow current recommendations for procedures involving the upper airway. Until preoperative diagnostic testing becomes standardized and readily available, elective cases should be deferred and emergent/urgent cases should be treated as high risk for COVID-19 exposure. Necessary otologic procedures on positive, suspected, or unknown COVID-19 status patients should be performed using enhanced personal protective equipment, including an N95 respirator and eye protection or powered air-purifying respirator (PAPR, preferred), disposable cap, disposable gown, and gloves. Powered instrumentation should be avoided unless absolutely necessary, and if performed, PAPR or sealed eye protection is recommended.
KEYWORDS:
COVID-19; coronavirus; exposure; otology; safety precautions
3.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820920649. doi: 10.1177/0194599820920649. [Epub ahead of print]
Otolaryngology Providers Must Be Alert for Patients with Mild and Asymptomatic COVID-19.
Cheng X1, Liu J2, Li N3, Nisenbaum E4, Sun Q5, Chen B1, Casiano R4, Weed D4, Telischi F4, Denneny JC 3rd6, Liu X4, Shu Y1.
Abstract
More than half of COVID-19 patients are afebrile early in the disease course, yet mildly ill or asymptomatic patients can still spread SARS-CoV-2 with high efficiency. Atypically presenting patients may be seen in noninfectious disease settings such as otolaryngology, which is a specialty prone to occupational exposure. Otolaryngologists have been infected with COVID-19 at higher rates than other specialties in China and other countries. Otolaryngology providers should maintain high clinical suspicion for mild and asymptomatic COVID-19 patients. Protective strategies should be implemented including preappointment screening, triaging, restriction of nonurgent visits and surgeries, telemedicine, and appropriate personal protective equipment use.
KEYWORDS:
2019-nCoV; COVID-19; SARS-CoV-2; coronavirus; health care worker protection
4.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820919748. doi: 10.1177/0194599820919748. [Epub ahead of print]
Pediatric Otolaryngology Divisional and Institutional Preparatory Response at Seattle Children's Hospital after COVID-19 Regional Exposure.
Parikh SR1,2, Bly RA1,2, Bonilla-Velez J1,2, Dahl JP1,2, Evans SS1,2, Horn DL1,2, Johnson KE1,2, Manning SC1,2, Ou HC1,2, Pattisapu P1,2, Perkins JA1,2, Sie KCY1,2.
Abstract
Coronavirus disease 2019 (COVID-19) is a novel coronavirus resulting in high mortality in the adult population but low mortality in the pediatric population. The role children and adolescents play in COVID-19 transmission is unclear, and it is possible that healthy pediatric patients serve as a reservoir for the virus. This article serves as a summary of a single pediatric institution's response to COVID-19 with the goal of protecting both patients and health care providers while providing ongoing care to critically ill patients who require urgent interventions. A significant limitation of this commentary is that it reflects a single institution's joint effort at a moment in time but does not take into consideration future circumstances that could change practice patterns. We still hope dissemination of our overall response at this moment, approximately 8 weeks after our region's first adult case, may benefit other pediatric institutions preparing for COVID-19.
KEYWORDS:
COVID-19; endoscopy; pediatric otolaryngology; preparatory response
5.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820919751. doi: 10.1177/0194599820919751. [Epub ahead of print]
COVID-19 Pandemic: What Every Otolaryngologist-Head and Neck Surgeon Needs to Know for Safe Airway Management.
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has unfolded with remarkable speed, posing unprecedented challenges for health care systems and society. Otolaryngologists have a special role in responding to this crisis by virtue of expertise in airway management. Against the backdrop of nations struggling to contain the virus's spread and to manage hospital strain, otolaryngologists must partner with anesthesiologists and front-line health care teams to provide expert services in high-risk situations while reducing transmission. Airway management and airway endoscopy, whether awake or sedated, expose operators to infectious aerosols, posing risks to staff. This commentary provides background on the outbreak, highlights critical considerations around mitigating infectious aerosol contact, and outlines best practices for airway-related clinical decision making during the COVID-19 pandemic. What otolaryngologists need to know and what actions are required are considered alongside the implications of increasing demand for tracheostomy. Approaches to managing the airway are presented, emphasizing safety of patients and the health care team.
KEYWORDS:
COVID-19; airway management; coronavirus disease; difficult airway; infection; intubation; patient safety; quality improvement; tracheostomy
6.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820911725. doi: 10.1177/0194599820911725. [Epub ahead of print]
Outpatient versus Inpatient Parotidectomy: A Systematic Review and Meta-analysis.
Abstract
OBJECTIVE:
Parotidectomies are commonly performed procedures by head and neck surgeons. Although parotidectomies are historically inpatient procedures, recent observational evidence has highlighted the potential for parotidectomies to be performed on an outpatient basis. This systematic review and meta-analysis sought to compare complications and unplanned health care utilization between patients undergoing outpatient versus inpatient parotidectomy.
DATA SOURCES:
A systematic review was performed using MEDLINE, EMBASE, and the Cochrane Library.
REVIEW METHODS:
Studies comparing the outcomes of outpatient parotidectomy with those of inpatient parotidectomy were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. Postoperative complications (hematoma, facial nerve dysfunction, seroma, fistulisation, Frey syndrome, and wound infection) and rates of 30-day readmission, reintervention, and emergency department presentation were compared.
RESULTS:
We screened 1018 nonduplicate articles to include 5 studies, all of which were retrospective cohort studies. There were fewer complications found in the outpatient group (relative risk = 0.61, 95% confidence interval: 0.40-0.93). Outpatient procedures were more commonly performed on patients who lived close to the hospital, had fewer comorbidities, and had less extensive planned surgery.
CONCLUSION:
Outpatient parotidectomy appears safe in select patients with outcomes comparable with inpatient surgery. However, evidence overall is of low quality, and further work is needed to delineate a satisfactory set of criteria for appropriate patient identification.
KEYWORDS:
ambulatory surgery; inpatient surgery; meta-analysis; outpatient surgery; parotidectomy; systematic review
7.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820913003. doi: 10.1177/0194599820913003. [Epub ahead of print]
Multicenter Advanced Pediatric Otolaryngology Fellowship Prep Surgical Simulation Course with 3D Printed High-Fidelity Models.
Abstract
OBJECTIVE:
To assess the effect of 3-dimensional (3D)-printed surgical simulators used in an advanced pediatric otolaryngology fellowship preparatory course on trainee education.
STUDY DESIGN:
Quasi-experimental pre/postsurvey.
SETTING:
Multicenter collaborative course conducted at a contract research organization prior to a national conference.
SUBJECTS AND METHODS:
A 5-station, 7-simulator prep course was piloted for 9 pediatric otolaryngology fellows and 17 otolaryngology senior residents, with simulators for airway graft carving, microtia ear framework carving, and cleft lip/palate repair. Prior to the course, trainees were provided educational materials electronically along with presurveys rating confidence, expertise, and attitude around surgical simulators. In October 2018, surgeons engaged in simulation stations with direction from 2 attending faculty per station, then completed postsurveys for each simulator.
RESULTS:
Statistically significant increases (P < .05) in self-reported confidence (average, 53%; range, 18%-80%) and expertise (average, 68%; range, 9%-95%) were seen across all simulators, corresponding to medium to large effect sizes as measured by Cohen's d statistic (0.41-1.71). Positive attitudes around 3D printing in surgical education also demonstrated statistically significant increases (average, 10%; range, 8%-13%). Trainees commented positively on gaining such broad exposure, although consistently indicated a preference for more practice time during the course.
CONCLUSION:
We demonstrate the benefit of high-fidelity, 3D-printed simulators in exposing trainees to advanced procedures, allowing them hands-on practice in a zero-risk environment. In the future, we hope to refine this course design, develop standardized tools to assess their educational value, and explore opportunities for integration into use in milestone assessment and accreditation.
KEYWORDS:
3D printing; airway reconstruction; cleft lip; cleft palate; fellowship training; microtia framework; pediatric otolaryngology; simulation
8.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820915478. doi: 10.1177/0194599820915478. [Epub ahead of print]
Outcomes and Complications with Topical Epinephrine in Endoscopic Sinus Surgery: A Systematic Review and Meta-analysis.
Abstract
OBJECTIVE:
To assess the safety and efficacy of topical epinephrine in adults undergoing endoscopic sinus surgery (ESS).
DATA SOURCES:
PubMed, Embase, and Ovid MEDLINE online databases.
REVIEW METHODS:
Non-case report English articles studying the effects of topical epinephrine as the topical vasoconstrictor used in adult ESS were found from the online databases through January 2019. The PRISMA literature selection process was used (Preferred Reporting Items for Systematic Reviews and Meta-analyses).
RESULTS:
An overall 2216 articles were identified, with 9 meeting inclusion criteria involving a total of 5043 patients. All 9 studies assessed the safety of topical epinephrine, while 5 examined efficacy. Intraoperative average blood loss (ABL) ranged from 60 to 426 mL. Topical epinephrine concentrations varied from 1:1000 to 1:100,000, and 3 major complications were found for a rate of 0.06%. There were no reports of ophthalmic, orbital, or skull base injury, nor were there reports of cerebrospinal fluid leaks. A meta-analysis was performed on the 4 studies examining ABL. Estimated mean (95% CI) ABL was 119.4 mL (39.1-199.6) in the higher-concentration cohort (>1:10,000) and 372.2 mL (296.8-447.5) in the lower-concentration cohort (≤1:10,000) (P = .001).
CONCLUSION:
Topical epinephrine is generally safe and provides acceptable hemostasis during ESS, with higher concentrations (>1:10,000) providing improved hemostasis. Caution is advised for its use in patients with preexisting cardiovascular disease or in combination with other topical or injected vasoconstrictive agents. More prospective comparative studies are necessary to determine the ideal hemostatic concentration of epinephrine in ESS.
KEYWORDS:
ESS; adrenaline; endoscopic sinus surgery; epinephrine; hemostasis; safety
9.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820915194. doi: 10.1177/0194599820915194. [Epub ahead of print]
Should I Buy This? A Decision-Making Tool for Surgical Value-Based Purchasing.
Abstract
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.
KEYWORDS:
decision making; devices; instruments; purchasing; technology; value
10.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820915472. doi: 10.1177/0194599820915472. [Epub ahead of print]
Patterns in Pain and Opiate Use after Endoscopic Sinus Surgery.
Abstract
OBJECTIVE:
To evaluate postoperative opiate use and patients' opinions regarding pain management after endoscopic sinus surgery (ESS).
STUDY DESIGN:
Case series with planned data collection.
SETTING:
Tertiary referral medical center.
SUBJECTS AND METHODS:
We prospectively evaluated postoperative opiate utilization in adults undergoing ESS over a 2-year period at an academic medical facility. Exclusion criteria included use of nasal packing, intracranial or orbital procedures, tumor surgery, and any use of endoscopic drills. All patients underwent bilateral maxillary antrostomy, total ethmoidectomy, sphenoidotomy, and frontal sinusotomy with or without septoplasty. Patients were discharged with 30 oxycodone-acetaminophen (5-325 mg) and a survey assessing pain and narcotic/nonnarcotic use on postoperative days 0 to 7.
RESULTS:
A total of 64 patients completed surveys. Mean ± SD narcotic use over the 7-day postoperative period was 7.7 ± 7.6 pills. Patients with high narcotic use (>6 pills total) had no differences in demographic or surgical factors from those with low use (≤6 pills) but did report a higher level of postoperative day 1 pain (4.8 ± 1.1 vs 2.0 ± 1.4, P < .001). Narcotic use declined during this period, with <30% of patients requiring narcotics by postoperative day 3.
CONCLUSION:
Our results support reduced opiate prescription and encouragement of nonnarcotic use after ESS without compromising effective pain management.
KEYWORDS:
adult; narcotics; otolaryngology; postoperative period; surveys and questionnaires
11.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820917397. doi: 10.1177/0194599820917397. [Epub ahead of print]
Epidemiology of Pediatric Tympanostomy Tube Placement in the United States.
Abstract
The prevalence of pediatric tympanostomy tube placement (TTP) in the United States has not been reassessed in the past decade. To assess the prevalence of TTP and frequent ear infections (FEI), the National Health Interview Survey for the calendar year 2014 was used. Among 73.1 million children, 6.26 million (8.6%) had TTP. The incidence of FEI was 3.49 million (4.8%). Males (9.6%) were more likely than females (7.5%) to undergo TTP (P = .004). Among children under 2 years of age, 9.1% reported FEI, compared to 3.9% of children aged 3 to 17 years. Among children under 2 years of age, 25% with FEI received TTP vs 1.5% without FEI (P < .001). Among children aged 3 to 17 years, 31.1% with FEI received TTP vs 8.6% without FEI (P < .001). TTP may be increasing nationally, although further assessment of adherence to clinical practice guidelines is needed to investigate this potential trend.
KEYWORDS:
acute otitis media; myringotomy; pediatric; tympanostomy tube; ventilation tube
12.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820920850. doi: 10.1177/0194599820920850. [Epub ahead of print]
Navigating the Ethics of COVID-19 in Otolaryngology.
Abstract
The COVID-19 pandemic has dramatically altered how otolaryngologists contemplate and assume their roles in health care delivery. The ethical implications of this pandemic upon our practice are formidable and distinct from other surgical fields. The salient ethical issues of public health stewardship and safety, distributive justice, and nonabandonment are distilled for the practicing otolaryngologist.
KEYWORDS:
COVID19; pandemic response; public health ethics
13.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820915741. doi: 10.1177/0194599820915741. [Epub ahead of print]
Cognitive and Behavioral Functioning in Hearing-Impaired Children with and without Language Delay.
Abstract
Poor language development in patients with sensorineural hearing loss (SNHL) may be related to an auditory deficit and/or other neurologic condition that influences the ability to communicate. A retrospective chart review of children (mean age = 4.0 years) with congenital, bilateral SNHL was performed to assess for linguistic and nonlinguistic neurodevelopmental differences between those who were language-impaired (LI) versus non-language-impaired (NLI). Language, neurodevelopmental functioning, and behavior were assessed. Twenty-two patients were identified: 12 were LI and 10 were NLI. Average pure-tone thresholds and nonverbal intelligence were not different between the language groups, but the LI group demonstrated significantly lower median overall adaptive skills, personal living skills, and motor skills. Behavioral dysregulation was significantly higher in the LI versus NLI group (58% vs 10%; P = .031), although the median neurodevelopmental scores did not differ significantly. These findings introduce the possibility that nonlinguistic processing deficit(s) may be confounding the ability to develop language.
KEYWORDS:
behavioral dysregulation; language delay; language impairment; motor skills; processing delay; sensorineural hearing loss
14.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820915469. doi: 10.1177/0194599820915469. [Epub ahead of print]
Slide Tracheoplasty to Repair Stenotic Tracheal Cartilaginous Sleeve with Advanced Surgical Planning.
KEYWORDS:
Apert syndrome; slide tracheoplasty; surgical planning; tracheal cartilaginous sleeve
15.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820915457. doi: 10.1177/0194599820915457. [Epub ahead of print]
Clinical Consensus Statement: Ankyloglossia in Children.
Messner AH1, Walsh J2, Rosenfeld RM3, Schwartz SR4, Ishman SL5, Baldassari C6, Brietzke SE7, Darrow DH6, Goldstein N3, Levi J8, Meyer AK9, Parikh S10, Simons JP11, Wohl DL12, Lambie E13, Satterfield L13.
Abstract
OBJECTIVE:
To identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology-Head and Neck Surgery clinical consensus statements.
METHODS:
An expert panel of pediatric otolaryngologists was assembled with nominated representatives of otolaryngology organizations. The target population was children aged 0 to 18 years, including breastfeeding infants. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus, per established methodology published by the American Academy of Otolaryngology-Head and Neck Surgery.
RESULTS:
After 3 iterative Delphi method surveys of 89 total statements, 41 met the predefined criteria for consensus, 17 were near consensus, and 28 did not reach consensus. The clinical statements were grouped into several categories for the purposes of presentation and discussion: ankyloglossia (general), buccal tie, ankyloglossia and sleep apnea, ankyloglossia and breastfeeding, frenotomy indications and informed consent, frenotomy procedure, ankyloglossia in older children, and maxillary labial frenulum.
CONCLUSION:
This expert panel reached consensus on several statements that clarify the diagnosis, management, and treatment of ankyloglossia in children 0 to 18 years of age. Lack of consensus on other statements likely reflects knowledge gaps and lack of evidence regarding the diagnosis, management, and treatment of ankyloglossia. Expert panel consensus may provide helpful information for otolaryngologists treating patients with ankyloglossia.
KEYWORDS:
ankyloglossia; breastfeeding; frenectomy; frenotomy; frenuloplasty; frenulotomy; lingual frenulum; lip tie; maxillary frenotomy; maxillary labial frenulum; tongue-tie
16.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820914298. doi: 10.1177/0194599820914298. [Epub ahead of print]
Trends in Ambulatory Surgery Center Utilization for Otolaryngologic Procedures among Medicare Beneficiaries, 2010-2017.
Abstract
OBJECTIVE:
Surgical care is increasingly shifting to freestanding ambulatory surgical centers (ASCs). The extent to which otolaryngologists use ASCs has implications for patient safety and health care spending. This study characterizes trends in utilization and resultant financial implications for common otolaryngologic procedures performed at ASC and hospital outpatient departments (HOPDs).
STUDY DESIGN:
Retrospective cross-sectional analysis.
SETTING:
ASCs, HOPDs.
SUBJECTS AND METHODS:
Subjects included Medicare beneficiaries undergoing outpatient otolaryngologic procedures between 2010 and 2017. Procedures included the 20 highest-volume procedures performed by otolaryngologists at ASCs in 2017. Main outcomes included absolute and relative percentage difference in the proportion of procedures furnished at ASCs and HOPDs and estimated Medicare cost savings resulting from increased ASC utilization between 2011 and 2017.
RESULTS:
The proportion of outpatient otolaryngologic procedures performed at ASCs increased by 1.8% (relative difference: 10.0%; mean annual relative increase: 1.60%), and the proportion located at HOPDs decreased by 6.0% (relative difference: -11.8%; mean annual relative decrease: -1.6%) between 2010 and 2017. Rhinoplasty accounted for the largest absolute increase in ASC utilization over the study period (absolute [relative] 8.9% [33.5%]). Increased ASC utilization resulted in an estimated $7.1 million in cost savings to Medicare between 2011 and 2017.
CONCLUSION:
Otolaryngologists shifted outpatient surgical care from HOPDs to ASCs between 2010 and 2017, with resultant reductions in Medicare expenditures. Further research is necessary to examine the impact of this shift on patient safety.
KEYWORDS:
ambulatory surgery centers; otolaryngology; patient safety; payment reform
17.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820915458. doi: 10.1177/0194599820915458. [Epub ahead of print]
Additional Benefits of Facial Nerve Monitoring during Otologic Surgery.
Abstract
OBJECTIVE:
This study assesses the role of facial nerve monitoring (FNM) for intraoperative decision making during otologic surgery and possible benefits beyond protecting facial nerve integrity.
STUDY DESIGN:
This prospective study examines intraoperative FNM data and structured interviews collected during 52 otologic procedures.
SETTING:
Tertiary referral center.
SUBJECTS AND METHODS:
Subjects include adults and children undergoing middle ear or mastoid surgery. Data include intraoperative neuromonitoring activity and structured interviews conducted with the operating surgeon immediately following surgery.
RESULTS:
Facial nerve stimulation was used to confirm the position of the nerve in 42 of 52 surgical procedures. In 26.9% of cases, the patient became "light" and moved under anesthesia, which was predicted by neuromonitoring 71.4% of the time. Through structured interviews, the operating surgeons reported the following. (1) The facial nerve took an unexpected anatomic course in 7.8% of patients and was difficult to identify in 39.2%. (2) The nerve was at increased risk of injury in 66.7% of cases due to chronic disease or previous surgery. (3) Among these high-risk cases, the monitor helped reduce the risk of nerve damage 100% of the time. (4) Neuromonitoring allowed the surgeon to operate faster 86.5% of the time, and (5) FNM allowed the resident to perform more of the operation 68.9% of the time. No patients experienced postoperative facial weakness.
CONCLUSIONS:
Beyond potentially protecting facial nerve integrity, this study identified additional benefits of FNM, including warning of patient movement during anesthesia, confirming facial nerve anatomic location, reducing operative time, and enhancing resident surgical experience.
KEYWORDS:
facial nerve monitor; intraoperative facial nerve monitoring; mastoid surgery; middle ear surgery; otology
18.
Otolaryngol Head Neck Surg. 2020 Apr 14:194599820915465. doi: 10.1177/0194599820915465. [Epub ahead of print]
Next-Day Loading of a Bone-Anchored Hearing System: Preliminary Results.
Abstract
OBJECTIVES:
To demonstrate the feasibility and efficacy for next-day loading of a percutaneous bone-anchored hearing device.
STUDY DESIGN:
Multicenter prospective cohort study.
SETTING:
Tertiary neurotologic referral centers.
SUBJECT AND METHODS:
In this multicenter prospective study, a 4.5-mm laser-etched bone-anchored hearing device was implanted in adult subjects who had conductive/mixed hearing loss or single-sided deafness. One day following implantation, the surgical site was assessed for soft tissue reaction per the Holgers Scale, and implant stability was evaluated by manual palpation and resonance frequency analysis. On the same day, subjects were fitted with the processor. Follow-up evaluations were at 1 week, 4 weeks, 3 months, 6 months, and 12 months. The Glasgow Benefit Inventory and Abbreviated Profile of Hearing Aid Benefit questionnaires were completed postoperatively.
RESULTS:
Fourteen devices were implanted in 12 subjects. Two subjects underwent bilateral implantation. Implant stability was rated as firm at every interval for all ears, and the Implant Stability Quotient values at 3 months were stable or increased as compared with day 1 measurements. Skin irritation was limited to Holgers grade 0 and 1, with the majority having no skin irritation. The mean Glasgow Benefit Inventory global score was +43.8, and the mean Abbreviated Profile of Hearing Aid Benefit global benefit score was 60.2%. All 14 implants have remained firmly anchored.
CONCLUSIONS:
Next-day loading of this 4.5-mm-diameter percutaneous bone-anchored hearing device appears to be a feasible alternative to the original 3-month delayed loading. Although this is a preliminary study, the results support continued investigation of a next-day loading strategy.
KEYWORDS:
BAHA; implant stability quotient; next-day loading; osseointegrated device
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