Surgical treatment of chronic rhinosinusitis after sinus lift.

BACKGROUND: The sinus lift (or sinus augmentation) is a common procedure to improve maxillary bone stock before dental implantation. Chronic rhinosinusitis (CRS) is a potential complication of this procedure and may be refractory to medical treatment. Functional endoscopic sinus surgery has previously been used to address CRS, however, results of previous studies indicated that implant removal is required. There are limited follow-up data available. OBJECTIVE: The purpose of this study was to characterize the long-term outcomes and efficacy of endoscopic sinus surgery for refractory CRS after sinus lift, including the ability to salvage dental implants. METHODS: This was a retrospective case series that described nine patients who, between June 2011 and September 2016, underwent endoscopic sinus surgery for CRS after a sinus lift procedure. The presenting symptoms of the patients, medical management, imaging results, operative procedures, and outcomes were reviewed. RESULTS: The majority of patients developed symptoms (mucopurulent nasal drainage, facial pain and/or pressure, nasal congestion, and foul smell) within 3 months of implant placement and were treated with at least three courses of antibiotics before referral to an otolaryngologist. All the patients underwent wide endoscopic maxillary antrostomy, with no surgical complications or postoperative reports of infection. There was a statistically significant improvement in 22-item Sino-Nasal Outcome Test scores (t(8) = -2.908; p = 0.02) and discharge, inflammation, and polyps/edema endoscopic scores ([z = -2.539; p = 0.011) between pre- and postsurgical treatment. Four patients had their dental implants removed before presentation. Among the five patients who presented with intact dental implants, none required removal before or after functional endoscopic sinus surgery. CONCLUSION: Functional endoscopic sinus surgery was a reasonable and efficacious treatment option for patients who presented with paranasal sinus disease after a sinus lift. Dental implant removal may not be a requirement for successful treatment of CRS associated with sinus lift procedures.

Hearing loss and falls: A systematic review and meta-analysis.

BACKGROUND: Falls are a devastating condition in older individuals. Identifying potentially modifiable risk factors such as hearing loss would provide a substantial public health benefit. OBJECTIVE: To evaluate the current evidence for an association between hearing loss and falls risk. DATA SOURCES: A systematic search of PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Web of Science, and Cochrane databases was performed in July 2014. STUDY ELIGIBILITY: Studies were eligible for inclusion if they were published in the peer-reviewed literature. All studies used a predetermined definition of hearing loss. Main outcomes and measurements were fall hospitalization records or self-reports of falls by structured interview or validated questionnaires. STUDY APPRAISAL AND SYNTHESIS: Two investigators independently reviewed the literature related to hearing loss, falls, and older adults. We pooled effect sizes from across the studies and performed a meta-analysis to compute an overall effect size. RESULTS AND LIMITATIONS: Twelve eligible studies were identified. The odds of falling were 2.39 times greater among older adults with hearing loss than older adults with normal hearing (pooled odds ratio 2.39, 95% confidence interval [CI]: 2.11-2.68). In sensitivity analyses, we restricted the meta-analysis to studies where hearing loss was audiometrically defined (N = 6) and observed hearing loss to be associated with a 69% increase in the odds of falling (pooled odds ratio 1.69, 95% CI: 1.18-2.19). When we further limited to studies that also performed multivariate regression analyses (N = 4), the overall effect size did not appreciably change (pooled odds ratio 1.72, 95% CI: 1.07-2.37). We observed a potential positive publication bias in the literature. Limitations of the systematic review and meta-analysis are the cross-sectional designs of most studies and the heterogeneity across studies (Q = 631, P < .05, I2 = 98.1%). CONCLUSIONS AND RELEVANCE: In the published literature, hearing loss is associated with a significantly increased odds of falling in older adults. These findings need to be interpreted in light of the potential for positive publication bias in the literature on this topic. LEVEL OF EVIDENCE: NA Laryngoscope, 126:2587-2596, 2016.

Surgical malpractice claims in the United States.

Despite ongoing reform, there is still significant physician concern regarding the impact of medical claims on their practices. It is important that physicians and healthcare risk management professionals have a good understanding of the outcomes of medical malpractice to participate in its restructuring as needed and to prevent potentially harmful practices. In our study, we reviewed National Practitioner Data Bank (NPDB) paid malpractice claim reports from September 1, 1990, through July 30, 2011, and identified the 10 most common surgery-related allegations against physicians, excluding those listed as unspecified. Data were collected on the number of claims, the cost of the claims, and physician and patient characteristics.