Sharps exposures among otolaryngology-head and neck surgery residents.

OBJECTIVES/HYPOTHESIS: Examine the incidence of sharps exposures among otolaryngology residents, assess characteristics of exposures, and determine rates of reporting these potentially career- and life-impacting exposures. STUDY DESIGN: Cohort study of otolaryngology-head and neck surgery residents. METHODS: Survey was administered online to otolaryngology residents in the spring of 2008, gathering demographic information, characteristics of sharps exposures, and residents' self-reporting of sharps exposures. RESULTS: Among 1,407 otolaryngology residents nationwide, 231 completed the survey. Of these, 168 (72.7%) had at least one sharps exposure during residency, with most due to solid-bore needles (51.7%) and occurring in the operating room (67%). Fifty percent of residents reported exposures occurring in postgraduate year (PGY)-3 or PGY-4, whereas exposures occurred at slightly lower rates in the other PGYs. There was no difference in incidence of sharps exposures based on gender (Fisher exact test, P = .2742) or history of sharps exposure during medical school (Fisher exact test, P = .7559). Seventy-four participants had an exposure that they did not report to the hospital, with the most common reason for not reporting being the perceived burden of the hospital testing protocol. CONCLUSIONS: Otolaryngology residents report a high rate of sharps exposures during residency training, with a significant number of these exposures going unreported. Better education may be needed to help decrease these often preventable workplace exposures and to improve compliance with reporting and testing procedures.

Intracranial complications of cochlear implantation.

OBJECTIVE: To describe intracranial complications after cochlear implantation in the pediatric and adult populations. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: A chart review of the intracranial complications and their management in 345 patients undergoing cochlear implantation was undertaken. INTERVENTIONS: Variables, including age, sex, implant manufacturer, cause of deafness, intraoperative findings, and postoperative complications, were collected and analyzed. MAIN OUTCOME MEASURE: Presence of intracranial complication of cochlear implantation. RESULTS: There were 134 Nucleus-22 (Cochlear, Englewood, CO) devices, 50 Nucleus-24 devices, 118 Med-El (Durham, NC) devices, and 43 Advanced Bionics Corporation (Sylmar, CA) devices in 151 adults and 194 children. There was a 9.3% overall complication rate, with most (59%) being related to device failure. There were three intracranial complications (<1%), two in elderly individuals and one in a child. Two minor dural defects with cerebrospinal fluid leak at the site of the receiver/stimulator recess in Med-El devices were repaired intraoperatively with temporalis fascia. One elderly patient experienced an acute extensive subdural hematoma after Nucleus-24 implantation, which was treated successfully with immediate evacuation. CONCLUSION: Intracranial complication rates associated with cochlear implantation are low, although potentially very serious. Surgeons should be aware of intracranial complications, especially in older individuals, and take immediate appropriate action.