Reema Padia

Eosinophilic esophagitis strongly linked to chronic rhinosinusitis

To determine the relative risk of having eosinophilic esophagitis (EoE) coexist with chronic rhinosinusitis (CRS) in probands and their families using the Utah Population Database (UPDB).

Hospital and Surgeon Adherence to Pediatric Tonsillectomy Guidelines Regarding Perioperative Dexamethasone and Antibiotic Administration.

Objectives To (1) determine adherence to American Academy of Otolaryngology—Head and Neck Surgery Foundation guidelines for pediatric tonsillectomy recommending routine administration of perioperative dexamethasone and against routine antibiotic administration among surgeons and hospitals in a multihospital network and (2) evaluate the impact of adherence on the risk of complications. Study Design Case series with chart review. Setting Multihospital network. Subjects and Methods A case series of 15,950 children aged 1 to 18 years undergoing same-day surgery adenotonsillectomy (T&A) within a multihospital network from 2008 to 2014 was reviewed to determine whether dexamethasone and/or antibiotics were given in the hospital. The frequency of dexamethasone and antibiotic administration was compared among surgeons and hospitals in the years before and after the guidelines were published. The frequency of complications was compared in adhering vs nonadhering surgeons. Results The study cohort included 15,950 children undergoing T&A at 19 hospitals by 74 surgeons. Of the patients before guideline publication, 98.4% (n = 7432) received dexamethasone compared with 98.9% of subjects after guideline publication (n = 8518). In total, 16.1% received antibiotics before the guidelines compared with 13.8% after. Prior to the guidelines, 27 of 74 surgeons (36%) routinely gave antibiotics. After the guidelines were published, 19 surgeons (26%) continued to give antibiotics more than 50% of the time. There was no difference in complication visits between adhering and nonadhering surgeons. Conclusions Most hospitals and surgeons administered perioperative dexamethasone routinely. While the overall frequency of antibiotic administration decreased after the guidelines were published, a significant percentage of surgeons continued to give antibiotics routinely, suggesting the need for improved dissemination and implementation of guidelines to promote adherence.

Surgeon and hospital cost variability for septoplasty and inferior turbinate reduction

Septoplasty and turbinate reduction (STR) is a common procedure for which cost reduction efforts may improve value. The purpose of this study was to identify sources of variation in medical facility and surgeon costs associated with STR, and whether these costs correlated with short‐term complications.

Hospital cost of pediatric patients with complicated acute sinusitis

OBJECTIVE Review costs for pediatric patients with complicated acute sinusitis. METHODS A retrospective case series of patients in a pediatric hospital was created to determine hospital costs using a standardized activity-based accounting system for inpatient treatment between November 2010 and December 2014. Children less than 18 years of age who were admitted for complicated acute sinusitis were included in the study. Demographics, length of stay, type of complication and cost of care were determined for these patients. RESULTS The study included 64 patients with a mean age of 10 years. Orbital cellulitis (orbital/preseptal/postseptal cellulitis) accounted for 32.8% of patients, intracranial complications (epidural/subdural abscess, cavernous sinus thrombosis) for 29.7%, orbital abscesses (subperiosteal/intraorbital abscesses) for 25.0%, potts puffy tumor for 7.8%, and other (including facial abscess and dacryocystitis) for 4.7%. The average length of stay was 5.7 days. The mean cost per patient was

Familial link of otitis media requiring tympanostomy tubes

20,748. Inpatient floor costs (31%) and operating room costs (18%) were the two greatest expenditures. The major drivers in variation of cost between types of complications included pediatric intensive care unit stays and pharmacy costs. CONCLUSION Although complicated acute sinusitis in the pediatric population is rare, this study demonstrates a significant financial impact on the health care system. Identifying ways to reduce unnecessary costs for these visits would improve the value of care for these patients.

In Vitro Growth Effects of Morphine and Naloxone on Various Head and Neck Squamous Cell Cancer Cell Lines

Placement of tympanostomy tubes for recurrent or chronic otitis media is the most commonly performed ambulatory procedure in the United States. Etiologies have been speculated to be environmentally based, and studies have suggested a genetic component to the disease. However, no large‐scale studies have attempted to define a familial component. The objective of this study was to determine the familial risk of otitis media requiring tympanostomy tubes (OMwTT) in a statewide population.

Sequelae of Tympanostomy Tubes in a Multihospital Health System

Understanding the potential effects of mu-agonism and antagonism on cancer cells is important for the perioperative physician. Previous studies suggest some tumor cells may have altered growth with mu-agonism or antagonism. This study investigates the effects of morphine (mu-agonist) and naloxone (mu-antagonist) in head and neck tumor cell lines (laryngeal squamous cell carcinoma (SCC), lateral tongue SCC and base of tongue SCC). Morphine showed no significant effect on tumor cell growth. Naloxone showed significant inhibition of growth in laryngeal SCC, but not in lateral or base of tongue SCC.

Impact of Deductible Health Plans on Parental Decision Making for Common Pediatric Otolaryngology Procedures

Objectives Review the incidence of long-term sequelae after placement of tympanostomy tubes. Study Design Case series with chart review. Setting Multihospital network. Subjects Patients 0 to 3 years old undergoing tympanostomy tube (TT) placement. Methods A case series of 14,058 children between 2004 and 2010 was reviewed. The patients were followed for 5 years to determine number of repeated tube placements, need for surgical removal of tubes, and presence of perforation requiring repair. Results The study cohort included 14,058 children who underwent TT placement. The mean age at time of procedure was 1.4 years. A total of 14.4% of patients required a second set of tubes within the 5 years of follow-up studied, and 4.6% required 3 or more sets. Three percent required removal of a tube, and this occurred at an average time of 34.2 ± 17.6 months postplacement. In total, 5.1% had a resulting perforation after either tube extrusion or tube removal requiring myringoplasty. Conclusions The rate of multiple tube placements and myringoplasty and tympanoplasty to correct resulting perforations has yet to be studied in a single large population. This information allows for more detailed preoperative counseling to patients and families. Better characterization of these populations with accurate rates of sequelae can help to tailor treatment and preoperative counseling in the future.

Systematic review/meta-analysis comparing successful outcomes after single vs. double-stage laryngotracheal reconstruction

Objective To describe how deductible health plans affect parental decision making for common pediatric otolaryngology operations. Study Design A cross-sectional survey study. Setting Tertiary care pediatric hospital. Subjects and Methods Caregivers of patients aged <18 years were surveyed to assess factors in decision making related to common otolaryngologic surgical procedures, including outpatient tympanostomy tubes and adenotonsillectomy, between July 2015 and June 2016. Children in foster care and those who underwent nonelective surgery were excluded. Decision-making factors were statistically analyzed with univariate and multivariate ordinal logistic regression. Results A total of 155 caregivers completed the survey. The median age of the patient at the time of the surgery was 3 years. Surgical procedures included tympanostomy tube placement (51%), adenotonsillectomy (37%), tympanostomy tube placement with adenotonsillectomy (10%), and other (2%). The mean ± SD annual deductible per child was

Effectiveness of Adenotonsillectomy and Risk of Velopharyngeal Insufficiency in Children With Prader-Willi Syndrome

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