Brooke M. Su

Cost utility analysis of endoscopic sinus surgery for chronic rhinosinusitis.

The purpose of this work was to evaluate the cost‐effectiveness of endoscopic sinus surgery (ESS) compared to medical therapy for patients with chronic rhinosinusitis (CRS).

Cost utility analysis of endoscopic sinus surgery for chronic rhinosinusitis with and without nasal polyposis.

To evaluate the cost‐effectiveness of endoscopic sinus surgery (ESS) compared to medical therapy for patients with chronic rhinosinusitis (CRS) with and without nasal polyposis (NP).

Prevalence of Hearing Loss in US Children and Adolescents: Findings From NHANES 1988-2010

Importance There have been concerns about increasing levels of hearing impairment in children and adolescents, especially in relation to noise exposure, because even mild levels of hearing loss can affect educational outcomes. Objective To further characterize changes in prevalence of hearing loss and noise exposures in the US pediatric population over time. Design, Setting, and Participants This is a retrospective analysis of demographic and audiometric data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994), NHANES 2005-2006, NHANES 2007-2008, and NHANES 2009-2010. The NHANES are nationally representative survey data sets collected and managed by the US National Center for Health Statistics, and this study includes a total of 7036 survey participants ages 12 to 19 years with available audiometric measurements. Exposures Hearing-related behaviors and risk factors such as history of ear infections, noise exposures, firearm use, and hearing protection use. Main Outcomes and Measures Level of hearing loss measured by pure-tone audiometry, as well as high-frequency and low-frequency hearing loss and noise-induced threshold shifts. Results Overall, data from 7036 survey participants ages 12 to 19 years with available audiometric measurements were analyzed. The prevalence of hearing loss increased from NHANES III to NHANES 2007-2008 (17.0% to 22.5% for >15 dB hearing loss; absolute difference, 5.5%; 95% CI, 6.1%-10.3%) but decreased in the NHANES 2009-2010 to 15.2% (absolute difference, 7.2%; 95% CI, 2.0%-12.4%) with no significant overall secular trend identified. There was an overall rise in exposure to loud noise or music through headphones 24 hours prior to audiometric testing from NHANES III to NHANES 2009-2010. However, noise exposure, either prolonged or recent, was not consistently associated with an increased risk of hearing loss across all surveys. The most recent survey cycle showed that nonwhite race/ethnicity and low socioeconomic status are independent risk factors for hearing loss. Conclusions and Relevance This analysis did not identify significant changes in prevalence of hearing loss in US youth ages 12 to 19 years over this time period despite increases in reported noise exposures. No consistent associations were shown between noise exposure and hearing loss, though there was an association between racial/ethnic minority status and low socioeconomic status and increased risk of hearing loss. Ongoing monitoring of hearing loss in this population is necessary to elucidate long-term trends and identify targets for intervention.

The value of frontal sinusotomy for chronic rhinosinusitis with nasal polyps—A cost utility analysis

The number of surgical procedures performed for frontal sinusitis and the associated costs have increased dramatically over the past decade. The purpose of this study was to evaluate the cost‐effectiveness of endoscopic frontal sinusotomy (EFS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP).

What is the role of imaging in the evaluation of the patient presenting with unilateral facial paralysis

BACKGROUND Unilateral facial nerve paralysis can have numerous causes, but most cases are attributed to Bell palsy, a seemingly idiopathic, rapid-onset unilateral paralysis (usually occurring within 72 hours), with up to 90% of patients recovering spontaneously within 12 weeks. In the management of facial paralysis due to trauma, infection, or neoplastic origin, making a timely diagnosis is crucial for addressing the underlying cause, with a possible secondary goal of restoring nerve function. Patients presenting with a unilateral facial paralysis most frequently are evaluated in the primary care or emergency setting, and misdiagnosis of presumed Bell palsy is common. Although Bell palsy has a classic presentation readily identified with a thorough history and physical exam, it remains a diagnosis of exclusion after other potential causes are ruled out. Imaging has been described as a sensitive method for distinguishing among etiologies of unilateral facial paralysis. Specifically, gadolinium-enhanced magnetic resonance imaging (MRI) is the modality of choice for lesions located within the parotid gland, cerebellopontine angle, and internal auditory canal (IAC), whereas high-resolution computed tomography (CT) is preferred for temporal bone pathology. Despite this, there is no consensus for when imaging is actually indicated. Moreover, imaging is not without risk (e.g., contrast-induced side effects) and may carry significant healthcare costs, although to date there have been no studies examining the cost effectiveness of imaging in the diagnosis of facial paralysis. This review aims to determine when it is appropriate to use imaging in the workup of unilateral facial paralysis, and which modality would be most useful for further management.

The impact of asthma on the cost effectiveness of surgery for chronic rhinosinusitis with nasal polyps

The objective of this work was to evaluate the impact of asthma on the cost‐effectiveness profile of endoscopic sinus surgery (ESS) compared to medical therapy for patients with chronic rhinosinusitis with nasal polyps (CRSwNP).

When should a level IIB neck dissection be performed in treatment of head and neck squamous cell carcinoma?: Level IIb Neck Dissection

BACKGROUND Cervical nodal metastases in head and neck squamous cell carcinoma (HNSCC) often follow a predictable pattern of spread. Appropriate management of neck disease is crucial for optimizing patient outcomes and survival. Selective neck dissection (SND) for the clinically negative neck (N0) has emerged as a technique to optimize locoregional control while minimizing morbidity such as injury to the spinal accessory nerve (SAN). Even when the SAN is spared, traction or pressure injury to the nerve can result in significant impairments in shoulder function for the patient. The anatomic boundaries of cervical level IIB include the skull base superiorly, the sternocleidomastoid muscle posterolaterally, and the SAN inferomedially. Dissection of nodal-bearing tissue from level IIB poses a risk of SAN injury and may not always be necessary based on the primary site and pattern of lymph node metastasis. Given the importance of oncologic control as well as quality-of-life considerations, when is it appropriate to include level IIB in elective or therapeutic neck dissections for HNSCC?

An Algorithm for Sellar Reconstruction Following the Endoscopic Endonasal Approach: A Review of 300 Consecutive Cases

Objectives/Hypotheses The endoscopic endonasal approach (EEA) is the workhorse endoscopic procedure for sellar and parasellar pathology. Various reconstruction techniques have been reported following EEA surgery, ranging from no reconstruction to vascularized flaps. We review our institutions experience with sellar reconstruction following EEA and propose an evidence‐based algorithm. Design Retrospective review. Setting Tertiary academic medical center. Participants Patients who underwent endoscopic EEA surgery for sellar or parasellar pathology between March 1, 2013 and August 31, 2016. Main Outcome Measures Patient demographic and clinicopathologic data were collected. Outcome measures included intraoperative and postoperative cerebrospinal fluid (CSF) leak rates and extent of resection (gross or subtotal). Results Three hundred consecutive patients were included. Depending on the presence and grade of intraoperative CSF leak, cases were reconstructed using either a free mucosal graft (FMG) or nasoseptal flap (NSF). Intraoperative and postoperative CSF leak rates were 30.7% and 2.3%, respectively. Multivariable logistic regression found that intraoperative CSF leak was associated with recurrent disease (odds ratio [OR] 2.47, p = 0.004), with no apparent predictors of postoperative CSF leak. Conclusions Based on this large series, we propose the following algorithm for sellar reconstruction: FMG for no CSF leak; fat graft + FMG ± rigid fixation for low‐grade leaks; and fat graft + NSF ± rigid fixation for high‐grade leaks.

Impact of Primary Language and Insurance on Pediatric Hearing Health Care in a Multidisciplinary Clinic

Objective This study aims to describe the effects of primary language and insurance status on care utilization among deaf or hard-of-hearing children under active otolaryngologic and audiologic care. Study Design Cross-sectional analysis. Setting Multidisciplinary hearing loss clinic at a tertiary center. Subjects and Methods Demographics, hearing loss data, and validated survey responses were collected from 206 patients aged 0 to 19 years. Two-sided t tests and χ2 tests were used to obtain descriptive statistics and hypothesis testing. Results Of the sample, 52.4% spoke primarily English at home. Non-English-speaking children and families were less likely to receive psychiatric counseling (12.2% vs 35.2% in the English group, P < .001) and reported more difficulty obtaining educational interventions (P = .016), and 68.9% had public insurance. Parents of publicly insured children were less likely to know the type or degree of their child’s hearing loss (56.9% vs 75.4%, P = .022), and these children were older on presentation to the clinic (8.5 vs 6.5 years of age, P = .01) compared to privately insured children. Publicly insured children were less likely to receive cochlear implants (P = .046) and reported increased difficulty obtaining hearing aids (P = .047). While all patients reported impairment in hearing-related quality of life, publicly insured children aged 2 to 7 years were more likely to perform below minimum thresholds on measures of auditory/oral functioning. Conclusion Even when under active care, deaf or hard-of-hearing children from families who do not speak English at home or with public insurance face more difficulty obtaining educational services, cochlear implants, and hearing aids. These findings represent significant disparities in access to necessary interventions.