Kerstin Hoffmann

Middle ear surgery in Thuringia, Germany: a population-based regional study on epidemiology and outcome.

Objective To evaluate population-based data on incidence and efficiency of middle ear surgery. Study Design Retrospective review. Setting All otolaryngology departments in one federal state in Germany. Patients All 1,037 middle ear surgeries performed in Thuringia in 2005. Interventions Middle ear surgery. Main Outcome Measure Analysis of preoperative and postoperative audiometric results, preoperative diagnostics, and postoperative complications. Univariate statistical tests were used to analyze predictors for air-bone gap (ABG) improvement, complications, and need for resurgery. Population data were used to calculate incidences of middle ear diseases admitted for surgery and annual rates of middle ear surgeries. Results ABG improved after surgery for chronic otitis media without and with cholesteatoma, otosclerosis, trauma cases, or complication after acute otitis media/externa (p < 0.0001; p < 0.0001; p < 0.0001; p = 0.005; p = 0.004; respectively). Middle ear surgery significantly improved bone conduction in cases of otosclerosis (p = 0.008), sudden deafness (p = 0.006), and acute otitis media/externa with complication (p = 0.004). There was a trend of more complication in patients older than 60 years (p = 0.055). Surgery was indicated for chronic otitis media without cholesteatoma in 17.4/100,000 persons, for cholesteatoma in 15.0/100,000, for otosclerosis in 5.7/100,000, for sudden deafness with suspicion of perilymph fistula in 1.5/100,000, and for trauma with affection of the lateral cranial base and hearing loss or otitis media with complication in 1.3/100,000 habitants, respectively. A cochlear implant was indicated in 1.0/100,000 habitants. Conclusion This population based analysis is showing that middle ear surgery is performed country-wide with good results and low risk on important scale in daily routine by ear surgeons.

Inpatient Treatment of Patients Admitted for Dizziness: A Population-based Healthcare Research Study on Epidemiology, Diagnosis, Treatment, and Outcome

OBJECTIVE To determine inpatient treatment rates of patients with dizziness with focus on diagnostics, treatment and outcome. STUDY DESIGN Retrospective population-based study. SETTING Inpatients in the federal state Thuringia in 2014. PATIENTS All 1,262 inpatients (62% females, median age: 61 yr) treated for inpatient dizziness were included. MAIN OUTCOME MEASURES The association between analyzed parameters and probability of improvement and recovery was tested using univariable and multivariable statistics. RESULTS Final diagnosis at demission was peripheral vestibular disorder (PVD), central vestibular disorder (CVD), cardiovascular syndrome, somatoform syndrome, and unclassified disease in 75, 9, 3, 0.6, and 13%, respectively. The most frequent diseases were acute vestibular neuritis (28%) and benign paroxysmal positional vertigo (22%). The follow-up time was 38 ± 98 days. 88.5% of patients showed at least an improvement of complaints and 31.4% a complete recovery. The probability for no improvement from inpatient dizziness was higher if the patient had a history of ear/vestibular disease (hazard ratio [HR] = 1.506; 95% confidence interval [CI] = 1.301-1.742), and was taking more than two drugs for comorbidity (HR = 1.163; CI = 1.032-1.310). Compared with final diagnosis of cardiovascular syndrome, patients with PVD (HR = 1.715; CI = 1.219-2.415) and CVD (HR = 1.587; CI = 1.076-2.341) had a worse outcome. CONCLUSIONS Inpatient treatment of dizziness was highly variable in daily practice. The population-based recovery rate was worse than reported in clinical trials. We need better ways to implement clinical trial findings for inpatients with dizziness.