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1.
Laryngoscope ; 131(3): 496-501, 2021 03.
Article in English | MEDLINE | ID: mdl-32619309

ABSTRACT

OBJECTIVE: There is a paucity of data regarding financial trends for procedural reimbursements in otolaryngology. The purpose of this study was to evaluate monetary trends in Medicare reimbursement rates for the 20 most commonly billed otolaryngology procedures from 2000 to 2019. STUDY DESIGN: Analysis of physician reimbursement. METHODS: The American Academy of Otolaryngology-Head and Neck Surgery database was queried to determine the 20 most performed otolaryngology procedures. Next, the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services was utilized to assess each of the top 20 most utilized Current Procedural Terminology (CPT) codes in otolaryngology, and reimbursement data was extracted. All monetary data was adjusted for inflation to 2019 U.S. dollars using changes to consumer price index. Average annual and total percentage change in reimbursement were calculated based on adjusted values for all included procedures. RESULTS: After adjusting for inflation, the average reimbursement for the total 20 procedures decreased by 37.63% from 2000 to 2019. The greatest single mean decrease was seen in CPT code 61782 for stereotaxis procedures on the skull, meninges, and brain (-59.96%), whereas the smallest mean decrease was in CPT code 30520 for septoplasty (-1.50%). From 2000 to 2019, the adjusted reimbursement rate for the combined procedures decreased by an average of 2.33% each year. CONCLUSION: Medicare reimbursement for included procedures has decreased from 2000 to 2019. Increased awareness and consideration of these trends will be important for policy makers, hospitals, and surgeons in order to assure continued access to meaningful otolaryngology care in the United States. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:496-501, 2021.


Subject(s)
Ambulatory Surgical Procedures/economics , Insurance, Health, Reimbursement/trends , Medicare/trends , Otolaryngology/economics , Otorhinolaryngologic Surgical Procedures/economics , Aged , Aged, 80 and over , Current Procedural Terminology , Databases, Factual , Humans , United States
2.
Adv Radiat Oncol ; 4(1): 43-49, 2019.
Article in English | MEDLINE | ID: mdl-30706009

ABSTRACT

PURPOSE: To quantitatively assess volumetric changes after hypofractionated stereotactic radiation therapy (HFSRT) in patients treated for vestibular schwannomas and meningiomas. METHODS AND MATERIALS: We retrospectively reviewed records of patients treated with HFSRT at our institution from 2002 to 2014. Patients received a median dose of 25 Gy in 5 fractions. After treatment, they underwent clinical and radiologic follow-up with magnetic resonance imaging (MRI) at 3- to 12-month intervals. Gross tumor volume was outlined on each thin slice of contrast-enhanced T1 series before and on each scan after HFSRT. Volumetric changes were calculated and compared with neuroradiologist interpretations. RESULTS: Forty-three patients underwent 182 MRI scans. Tumor types included vestibular schwannoma (n = 34) and meningioma (n = 9). Median follow-up time was 29 months. Median gross tumor volume was 3.1 cm3. Local control was 81.4% for the entire cohort at the time of last follow-up. Transient volume expansion was noted in 17 patients (50%) with vestibular schwannoma and 2 (22%) with meningioma. For all patients, transient volume expansion and subsequent regression occurred at a median time of 5.5 and 12 months, respectively. Neuroradiologist agreement with regard to tumor regression, progression, or stability occurred in 155 of 182 total reports (85%). The largest discordance identified was a stable finding on the MRI interpretation when the measured volumetric change exceeded 20% (n = 24 [13%]). CONCLUSIONS: HFSRT is associated with excellent local control and a low incidence of toxicity. With volumetric MRI measurement, transient volume expansion was a common finding and was associated with temporary adverse effects. Although the neuroradiologist's interpretation generally agreed with the volumetric MRI measurement, the overall 15% discordance rate emphasizes the potential benefit of considering volumetric measurements, which may help clinicians correlate posttreatment symptoms with MRI findings.

3.
Otol Neurotol ; 38(7): 948-955, 2017 08.
Article in English | MEDLINE | ID: mdl-28604576

ABSTRACT

OBJECTIVES: To compare the diagnostic yield of high-resolution volumetric T2-weighted MRI (HRT2-MRI) with high-resolution computed tomography (HRCT) for diagnosis of large vestibular aqueduct (LVA). STUDY DESIGN: Three board-certified neuroradiologists performed an independent, blinded radiological review for diagnosing LVA with 2:1 age-matched controls on patients with both HRCT and HRT2-MRI imaging. SETTING: Tertiary referral center. PATIENTS: All patients between 2002 and 2016 with hearing loss who underwent both HRCT and HRT2-MRI and were diagnosed with LVA on either modality. MAIN OUTCOME MEASURES: Concordance rate for LVA between HRCT and HRT2-MRI. RESULTS: Concordance rate for HRCT and HRT2-MRI for diagnosing LVA was 88% (124/141) when assessing both the midpoint and external aperture diameters. Fifteen ears had LVA on computed tomography (CT), but not on magnetic resonance imaging (MRI); in comparison, two ears had LVA on MRI, but not on CT (p = 0.002). Excellent inter-rater reliability among the three radiologists was demonstrated. CONCLUSION: Historically, HRCT has been the imaging modality of choice for diagnosing LVA. Although a higher concordance rate of HRT2-MRI was found compared with previous studies utilizing earlier MRI technology, HRCT still detected a larger number of patients with clinically significant hearing loss compared with MRI. Given the high concordance rate and efficacy of both modalities in diagnosing LVA, the ultimate decision of which modality to choose may depend on other patient-specific and clinical factors.


Subject(s)
Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Vestibular Aqueduct/diagnostic imaging , Adolescent , Adult , Child , Child, Preschool , Female , Hearing Loss/diagnostic imaging , Humans , Image Processing, Computer-Assisted , Infant , Male , Middle Aged , Observer Variation , Reproducibility of Results , Retrospective Studies , Vestibular Aqueduct/abnormalities , Young Adult
4.
Cochlear Implants Int ; 18(4): 226-229, 2017 07.
Article in English | MEDLINE | ID: mdl-28235385

ABSTRACT

OBJECTIVES: To determine whether the cochlea basal diameter (A value) measurement can be consistently and precisely obtained from high-resolution temporal bone imaging for use in cochlear length estimation. METHODS: A feasibility study at a tertiary referral center was performed using the temporal bone CTs of 40 consecutive patients. The distance from the round window to the lateral wall was measured for each cochlea by two independent reviewers, a neuroradiologist and an otolaryngologist. The interrater reliability was calculated using the intraclass correlation coefficient (ICC) and the Bland-Altman plot. RESULTS: Forty patients (19 males, 21 females) for a total of 80 cochleae were included. Interrater reliability on the same ear had a high level of agreement by both the ICC and the Bland-Altman plot. ICCs were 0.90 (95% CI: 0.82, 0.94) for the left ear and 0.96 (95% CI: 0.92, 0.98) for the right ear. Bland-Altman plot confirmed interrater reliability with all 96% of measurements falling within the 95% limits of agreement. CONCLUSIONS: Measurement between the round window and lateral cochlear wall can be consistently and reliably obtained from high-resolution temporal bone CT scans. Thus, it is feasible to utilize this method to estimate the cochlear length of patients undergoing cochlear implantation.


Subject(s)
Cochlea/diagnostic imaging , Round Window, Ear/diagnostic imaging , Temporal Bone/diagnostic imaging , Tomography, X-Ray Computed/statistics & numerical data , Adult , Cochlea/anatomy & histology , Feasibility Studies , Female , Humans , Male , Middle Aged , Observer Variation , Reproducibility of Results , Round Window, Ear/anatomy & histology , Temporal Bone/anatomy & histology
5.
Laryngoscope ; 127(8): 1916-1919, 2017 08.
Article in English | MEDLINE | ID: mdl-27726152

ABSTRACT

Pantopaque (iophendylate) is an oily contrast medium historically used during spine imaging. Due to its persistence in the subarachnoid space and the potential to lead to severe arachnoiditis, it is no longer used today. We present a 40-year-old male with new-onset headaches, imbalance, and vertigo. Brain magnetic resonance imaging revealed a 2-mm T1 -hyperintense intracanalicular lesion. Numerous hyperdense foci were scattered throughout the subarachnoid space on computed tomography. Further history revealed the patient received Pantopaque 30 years prior, after sustaining spinal trauma. Remnant Pantopaque contrast is an important differential when evaluating a patient with a suspected intracranial tumor in order to avoid unwarranted surgical intervention. Laryngoscope, 127:1916-1919, 2017.


Subject(s)
Cerebellopontine Angle/diagnostic imaging , Cerebellopontine Angle/metabolism , Contrast Media/adverse effects , Contrast Media/metabolism , Ear, Inner/diagnostic imaging , Ear, Inner/metabolism , Iophendylate/adverse effects , Iophendylate/metabolism , Magnetic Resonance Imaging , Neuroma, Acoustic/diagnostic imaging , Tomography, X-Ray Computed , Adult , Diagnosis, Differential , Humans , Male , Time Factors
6.
Laryngoscope ; 127(5): 1195-1198, 2017 May.
Article in English | MEDLINE | ID: mdl-27578452

ABSTRACT

OBJECTIVE: To describe the postural orthostatic tachycardia syndrome (POTS), including clinical presentation, pathophysiology, diagnostic methods, and current management models. DATA SOURCES: PubMed, Cochrane Library were searched for articles available prior to October 30, 2015. METHODS: Review of the available English-language literature. RESULTS: Postural orthostatic tachycardia syndrome presentation is discussed, along with underlying associated physiology for POTS and recommended nonpharmacologic and pharmacologic management strategies. CONCLUSION: Postural orthostatic tachycardia syndrome patients commonly present with complaints of postural lightheadedness, or dizziness, which can be associated with various other conditions. Nonpharmacologic and pharmacologic treatment methods are available to improve the underlying pathophysiology of the disorder. Laryngoscope, 127:1195-1198, 2017.


Subject(s)
Otolaryngologists , Postural Orthostatic Tachycardia Syndrome , Humans , Postural Orthostatic Tachycardia Syndrome/diagnosis , Postural Orthostatic Tachycardia Syndrome/physiopathology , Postural Orthostatic Tachycardia Syndrome/therapy
7.
J Neurol Surg B Skull Base ; 77(6): 503-509, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27857878

ABSTRACT

Objective The objective of this study was to determine the prevalence of facial nerve vascular contact on magnetic resonance imaging (MRI) in patients without hemifacial spasm (HFS). Study Design Our radiology database was queried to identify consecutive adult patients without a history of HFS, intracranial tumor, brain radiation therapy, intracranial surgery, traumatic brain injury, or trigeminal nerve vascular compression. One hundred high-resolution MRIs of the posterior fossa were independently reviewed by two neuroradiologists for facial nerve vascular contact (200 sides). Main Outcome Measures The prevalence of vascular nerve contact in the non-HFS patient, the location of contact along the facial nerve, the culprit vessel, and severity of compression was recorded. Results The presence of vascular contact in the non-HFS patient may be as high as 53%. It is typically mild to moderate in severity, most commonly involves the cisternal portion, and usually caused by the anterior inferior cerebellar artery. Conclusion Vascular contact of the facial nerve is frequently identified in asymptomatic individuals but tends to be more peripheral and mild compared with previous descriptions of neurovascular contact in HFS patients. These results should be considered in assessing the candidacy of HFS patients for microvascular decompression.

8.
Otol Neurotol ; 37(6): 708-12, 2016 07.
Article in English | MEDLINE | ID: mdl-27050653

ABSTRACT

OBJECTIVE: Estimate the prevalence of craniocervical pneumatization (CCP) and describe successful treatment of this condition with clinical and radiologic correlation. PATIENTS: Individuals with documented CCP on computed tomography (CT). INTERVENTION(S): CT scans of the head, temporal bone, face, neck, and cervical spine. Cessation of habitual Valsalva maneuver (VM) and insertion of pressure-equalization (PE) tubes. MAIN OUTCOME MEASURE: The prevalence of CCP on CT examinations performed during two decades in a large academic healthcare system. Documentation of symptomatic and imaging improvement following treatment of CCP. RESULTS: Radiology database review identified two cases of CCP out of a total of 636,854 head and neck CT scans (0.00031%) or 43,553 temporal bone CT scans (0.0046%). Both CCP patients were symptomatic (aural fullness, hearing loss, vertigo) and practiced habitual VM. One patient showed decreased CCP 4 months following cessation of VM, whereas the other patient improved symptomatically and demonstrated reversion of CCP to normal bone on magnetic resonance imaging (MRI) within 3 years following PE tube placement. CONCLUSIONS: Acquired CCP is exceedingly rare and, when successfully treated, reversion to normal bone may accompany symptom resolution.


Subject(s)
Pneumocephalus/epidemiology , Pneumocephalus/therapy , Valsalva Maneuver , Adult , Aged , Cervical Vertebrae/pathology , Female , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , Skull Base/pathology , Tomography, X-Ray Computed
9.
Otolaryngol Head Neck Surg ; 154(6): 1014-8, 2016 06.
Article in English | MEDLINE | ID: mdl-26980913

ABSTRACT

OBJECTIVES: To compare reconstructive techniques, operative times, duration of hospitalization, and need for subsequent flap revisions between reconstructive approaches to lateral skull base defects. STUDY DESIGN: Case series with chart review. SETTING: Tertiary academic referral center. SUBJECTS: Patients (n = 31) undergoing reconstruction of composite lateral skull base defects from 2002 to 2014. METHODS: Data were analyzed for demographics, tumor characteristics, reconstructive technique, operative time, duration of hospitalization, complications, and outcomes. RESULTS: Thirty-one patients were identified for inclusion. Lateral temporal bone defects resulted from resection of malignant lesions, including squamous cell carcinoma (n = 25), basal cell carcinoma (n = 2), and other carcinoma (n = 4). Defects were reconstructed with submental flaps (n = 16), pedicled latissimus dorsi flaps (n = 6), and free anterolateral thigh flaps (n = 9). All cases involved neurosurgery, neurotology, and head and neck surgery services. Although time of surgical resection was similar, time saving was noticed with submental reconstruction. Compared with free flaps, submental flap reconstruction was associated with significantly reduced total operative time (mean, 544 vs 683 min; P = .00817) and duration of hospitalization (4.9 vs 9.8 days; P = .02067). Submental flaps were significantly less likely to require revision debulking procedures (mean = 0.6) compared with latissimus dorsi flaps (mean, 1.3; P < .00001) and free flaps (mean, 1.6; P < .00001). There was 100% flap survival. CONCLUSION: The musculocutaneous submental flap provides an excellent option for reconstruction of lateral skull base defects given its proximity, reliability, ease of harvest, and exceptional color match. Submental flap reconstruction was associated with reduced operative time, hospitalization duration, and flap revisions.


Subject(s)
Plastic Surgery Procedures/methods , Skull Base Neoplasms/surgery , Surgical Flaps , Adult , Aged , Aged, 80 and over , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Operative Time , Postoperative Complications , Reoperation/statistics & numerical data , Retrospective Studies , Treatment Outcome
11.
Otol Neurotol ; 36(8): 1349-56, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26171672

ABSTRACT

INTRODUCTION: Cochlear implantation (CI) is a common intervention for severe-to-profound hearing loss in high-income countries, but is not commonly available to children in low resource environments. Owing in part to the device costs, CI has been assumed to be less economical than deaf education for low resource countries. The purpose of this study is to compare the cost effectiveness of the two interventions for children with severe-to-profound sensorineural hearing loss (SNHL) in a model using disability adjusted life years (DALYs). METHODS: Cost estimates were derived from published data, expert opinion, and known costs of services in Nicaragua. Individual costs and lifetime DALY estimates with a 3% discounting rate were applied to both two interventions. Sensitivity analysis was implemented to evaluate the effect on the discounted cost of five key components: implant cost, audiology salary, speech therapy salary, number of children implanted per year, and device failure probability. RESULTS: The costs per DALY averted are $5,898 and $5,529 for CI and deaf education, respectively. Using standards set by the WHO, both interventions are cost effective. Sensitivity analysis shows that when all costs set to maximum estimates, CI is still cost effective. CONCLUSION: Using a conservative DALY analysis, both CI and deaf education are cost-effective treatment alternatives for severe-to-profound SNHL. CI intervention costs are not only influenced by the initial surgery and device costs but also by rehabilitation costs and the lifetime maintenance, device replacement, and battery costs. The major CI cost differences in this low resource setting were increased initial training and infrastructure costs, but lower medical personnel and surgery costs.


Subject(s)
Cochlear Implantation/economics , Cochlear Implants/economics , Deafness/economics , Deafness/therapy , Education/economics , Audiology/economics , Child, Preschool , Cost-Benefit Analysis , Deafness/rehabilitation , Equipment Failure/economics , Health Care Costs , Hearing Loss, Sensorineural/economics , Hearing Loss, Sensorineural/therapy , Humans , Infant , Nicaragua/epidemiology , Quality-Adjusted Life Years , Speech Therapy/economics , Treatment Outcome
12.
Otol Neurotol ; 36(6): 1045-7, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25853615

ABSTRACT

OBJECTIVE: To investigate the clinical value of intraoperative plain radiographs in determining correct placement of cochlear implants. PATIENTS: All cochlear implant insertions over a 10-year period by a single surgeon. INTERVENTIONS: Cochlear implantation with intraoperative imaging. MAIN OUTCOME MEASURE: Whether intraoperative imaging affects clinical/surgical management. RESULTS: A consecutive retrospective review of 207 cochlear implantations performed in 187 patients was performed. All implants performed had intraoperative plain film imaging. Etiology of hearing loss, surgical variations, gender, age, and implant type did not affect intraoperative imaging. Four cases were identified where variations in intraoperative imaging interpreted by the surgeon warranted further discussion. In one patient, the intraoperative x-ray interpretation missed an incorrectly placed electrode. Postoperative CT scan confirmed implant electrode within the superior semicircular canal. In three patients, intraoperative x-ray results aided management by confirming surgical findings; however, no subsequent clinical or surgical alterations were made based on imaging. One of these three patients experienced a noticeable function decline postoperatively that correlated with altered positioning of the cochlear implant on intraoperative radiographs. In all surgeries, no changes were made to the electrode placement based on the intraoperative radiographs. CONCLUSION: Intraoperative plain film imaging during cochlear implantation, although commonly employed, does not typically affect clinical management. For select cases, imaging may continue to be useful based on the surgeon's discretion and intraoperative findings for confirmatory purposes.


Subject(s)
Cochlea/diagnostic imaging , Cochlear Implantation/methods , Electrodes, Implanted , Intraoperative Neurophysiological Monitoring , Surgery, Computer-Assisted/methods , Adolescent , Adult , Aged , Child , Female , Humans , Male , Reoperation , Retrospective Studies , Semicircular Canals/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome
13.
Otol Neurotol ; 36(1): 12-3, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25226373

ABSTRACT

OBJECTIVE: A patient with a well-healed, functional cochlear implant (CI) experienced a CI and mastoid infection shortly after initiating large-volume nasal irrigations after sinus surgery. The goal of this report is to bring attention to a rare complication and to question if large-volume nasal irrigation is safe in CI recipients. PATIENTS: Single patient at a tertiary care hospital. INTERVENTIONS: A CI recipient began using large-volume nasal irrigations with saline and budesonide after undergoing sinus surgery. MAIN OUTCOME MEASURES: CI infection and mastoiditis. RESULTS: Two weeks after starting nasal irrigations, the patient presented with mastoiditis and CI infection. Mastoid and intranasal middle meatal cultures both grew Group A streptococcus. CONCLUSION: Large-volume nasal irrigations may be related to our patient's CI infection, ultimately leading to explantation. Though a causal relationship cannot be definitively proven, awareness of this potential safety issue should be disseminated.


Subject(s)
Budesonide/administration & dosage , Cochlear Implants/microbiology , Mastoiditis/etiology , Nasal Lavage/adverse effects , Sodium Chloride/administration & dosage , Administration, Intranasal , Aged , Anti-Inflammatory Agents/administration & dosage , Cochlear Implantation , Female , Humans , Male , Paranasal Sinuses/surgery , Rhinitis/surgery , Sinusitis/surgery
16.
Otolaryngol Head Neck Surg ; 148(6): 912-8, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23520071

ABSTRACT

OBJECTIVE: Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care center and residency program. SUBJECTS AND METHODS: Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology-head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data. RESULTS: Five of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P = .0097), 11.3 minutes for a tonsillectomy (P < .0001), 27.4 minutes for a parotidectomy (P = .028), 38.3 minutes for a septoplasty (P < .0001), and 51 minutes for tympanomastoidectomy (P < .0021). Thyroidectomy showed no operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training-related costs. CONCLUSION: Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.


Subject(s)
Education, Medical, Graduate/economics , Health Care Costs , Internship and Residency/economics , Operative Time , Otolaryngology/education , Otorhinolaryngologic Surgical Procedures/economics , Clinical Competence/economics , Cost-Benefit Analysis , Databases, Factual , Education, Medical, Graduate/methods , Female , Humans , Internship and Residency/methods , Male , Operating Rooms/economics , Otolaryngology/economics , Otorhinolaryngologic Surgical Procedures/methods , Retrospective Studies , United States
17.
Otolaryngol Head Neck Surg ; 146(3 Suppl): S1-35, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22383545

ABSTRACT

OBJECTIVE: Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SHL. The guideline primarily focuses on sudden sensorineural hearing loss (SSNHL) in adult patients (aged 18 and older). Prompt recognition and management of SSNHL may improve hearing recovery and patient quality of life (QOL). Sudden sensorineural hearing loss affects 5 to 20 per 100,000 population, with about 4000 new cases per year in the United States. This guideline is intended for all clinicians who diagnose or manage adult patients who present with SHL. PURPOSE: The purpose of this guideline is to provide clinicians with evidence-based recommendations in evaluating patients with SHL, with particular emphasis on managing SSNHL. The panel recognized that patients enter the health care system with SHL as a nonspecific, primary complaint. Therefore, the initial recommendations of the guideline deal with efficiently distinguishing SSNHL from other causes of SHL at the time of presentation. By focusing on opportunities for quality improvement, the guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients. RESULTS: The panel made strong recommendations that clinicians should (1) distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL; (2) educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures. The panel made recommendations that clinicians should (1) assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings; (2) diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination; (3) evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up; (4) offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and (5) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL. The panel offered as options that clinicians may offer (1) corticosteroids as initial therapy to patients with ISSNHL and (2) hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL. The panel made a recommendation against clinicians routinely prescribing antivirals, thrombolytics, vasodilators, vasoactive substances, or antioxidants to patients with ISSNHL. The panel made strong recommendations against clinicians (1) ordering computerized tomography of the head/brain in the initial evaluation of a patient with presumptive SSNHL and (2) obtaining routine laboratory tests in patients with ISSNHL.


Subject(s)
Evidence-Based Medicine/standards , Glucocorticoids/administration & dosage , Hearing Loss, Sudden/therapy , Hyperbaric Oxygenation/methods , Otolaryngology/standards , Humans , Hyperbaric Oxygenation/standards , Injections , Tympanic Membrane
18.
Int Tinnitus J ; 16(2): 168-73, 2011.
Article in English | MEDLINE | ID: mdl-22249877

ABSTRACT

BACKGROUND: Recent studies in noise-induced and idiopathic sensorineural hearing loss have suggested that magnesium supplementation may lessen both hearing loss and the severity of tinnitus in patients. Further epidemiological evidence indicates that all age groups of Americans fall short of the recommended daily allowance for magnesium by 100 mg daily. PURPOSE: The purpose of this study was to examine any potential benefit in lessening the severity of tinnitus in patients taking supplemental magnesium. RESEARCH DESIGN: The study was a single-arm, open-label, before-and-after study of oral magnesium (532 mg per day) in 26 patients for 3 months. Tinnitus severity was evaluated and recorded daily by the patient using the Tinnitus Distress Rating (TDR) scale of 0 (no tinnitus) to 10 (worst possible tinnitus). The Tinnitus Handicap Inventory (THI) was administered before and at the end of the study, and scores were converted to the grades of the 5-item Tinnitus Severity Scale (TSS). The purpose of this phase 2 study was to investigate whether the treatment was effective at all, and, as such, a placebo control was not performed. All data were collected at Mayo Clinic in Scottsdale, Arizona, between March 6 and December 10, 2008. STUDY SAMPLE: Patients with moderate to very severe tinnitus (TDR score of 3 through 8). INTERVENTION: Daily magnesium supplementation, 532 mg; patient completion of the THI; and daily self-report of TDR. DATA COLLECTION AND ANALYSIS: The main outcome measures were mean TDR scale scores and THI scores as converted to TSS grades. The primary analysis was done on the basis of intention to treat. RESULTS: Twenty-six patients were enrolled; 19 completed the study. The extent of handicap, as measured by THI/TSS, for subjects with slight or greater impairment was significantly decreased (P=.03). Patients who ranked slight or greater on the THI/TSS before intervention showed a significant decrease in the severity of their tinnitus at post-testing (P=.008). CONCLUSION: The results suggest that magnesium may have a beneficial effect on perception of tinnitus-related handicap when scored with the THI.


Subject(s)
Magnesium Deficiency/complications , Magnesium Deficiency/drug therapy , Magnesium/administration & dosage , Tinnitus/drug therapy , Tinnitus/etiology , Adult , Aged , Disability Evaluation , Female , Follow-Up Studies , Humans , Magnesium/adverse effects , Magnesium Deficiency/psychology , Male , Middle Aged , Patient Satisfaction , Severity of Illness Index , Surveys and Questionnaires , Tinnitus/psychology , Treatment Outcome
19.
Neurologist ; 16(2): 138-40, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20220455

ABSTRACT

BACKGROUND: : Bell palsy is idiopathic peripheral facial weakness that typically resolves without severe clinical sequelae. Treatment with corticosteroids and antiviral drugs is often initiated to improve the likelihood of a favorable outcome. OBJECTIVE: : Are corticosteroid and antiviral medications effective in the treatment of Bell palsy? METHODS: : The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a structured question, search strategy, critical appraisal, results, evidence summary, commentary, pre- and postassessment, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and a clinical content expert in the field of Otolaryngology. RESULTS: : The largest (18 trials involving 2786 patients) current systematic review and meta-analysis for pharmacologic treatment of Bell palsy was selected for appraisal. The meta-analysis demonstrated a clear benefit of oral corticosteroids, alone, in preventing unsatisfactory recovery of facial weakness (relative risk, 0.69 [95% confidence interval {CI}, 0.55-0.87], number needed to treat 11 [95% CI, 8-25]). Treatment with antiviral medication, alone, was not associated with a reduced risk of unsatisfactory recovery. When administered concurrently with corticosteroids, antiviral treatments displayed a trend toward reduced risk of unsatisfactory recovery, compared with corticosteroids alone (relative risk, 0.75 [95% CI, 0.56-1.00]). CONCLUSION: : Corticosteroids effectively reduce the risk of an unfavorable outcome in Bell palsy. Antiviral agents, when administered concurrently with corticosteroids, may result in additional benefit.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , Antiviral Agents/therapeutic use , Bell Palsy/drug therapy , Adrenal Cortex Hormones/adverse effects , Drug Therapy, Combination , Humans , Meta-Analysis as Topic , Review Literature as Topic , Risk , Treatment Outcome
20.
Otol Neurotol ; 31(6): 893-8, 2010 Aug.
Article in English | MEDLINE | ID: mdl-20142796

ABSTRACT

OBJECTIVE: To identify the prevalence of individual electrode failures as a result of open and short circuits in the Nucleus N24 and Freedom series and the Advanced Bionics CII and HR90k (Helix and 1J) devices. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Age at implantation, date of surgery, device type, and other relevant demographic data in addition to telemetry and impedance data were collected on 636 implants. INTERVENTION(S): Individual electrode circuit failures were identified using impedance testing performed intraoperatively and during subsequent programming sessions. MAIN OUTCOME MEASURE(S): Individual electrode failures were categorized as either "short" or "open" circuits as determined by manufacturer software algorithms. RESULTS: Combining all devices, the risk of 1 or more failures as determined by impedance telemetry is 9.0%. Three or more individual electrode circuit failures within an array may indicate impending deterioration of device performance and future need of reimplantation. CONCLUSION: Open and short circuits are routinely encountered. They can be managed by deactivating the affected electrode(s), and conventional wisdom states that this has little impact on performance. However, it is true that multiple failures are often associated with decreased performance and often lead to revision surgery. Certainly, every patient would prefer to have a fully functional device. Continued reporting of individual electrode circuit failures is critical to product development and improving overall device reliability.


Subject(s)
Cochlear Implants/statistics & numerical data , Prosthesis Failure , Adult , Age Factors , Aged , Electric Impedance , Electronics , Female , Humans , Longitudinal Studies , Male , Middle Aged , Replantation/statistics & numerical data , Retrospective Studies , Telemetry , Time Factors , Treatment Outcome
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