Assessing the Impact of Military Service on Patient Health Literacy in an Otolaryngology Clinic.

OBJECTIVE: To examine the impact of military service on health literacy. STUDY DESIGN: Prospective, cross-sectional study. SUBJECTS AND METHODS: The validated Brief Health Literacy Screen (BHLS) with military supplement was administered to sequential adult patients (military and civilian) treated at two outpatient academic military otolaryngology clinics between November and December 2019. Inadequate health literacy, defined by a BHLS score ≤9, was the primary outcome measure. Secondary outcome measures included comparisons of inadequate BHLS scores with patient demographics and history of military service. RESULTS: Three hundred and eighty-two patients were evaluated during the study period. The median age was 48-57 years, with a majority being male (230, 60.2%), White (264, 69.1%), married (268, 70.2%), and active duty military (303, 79.3%). A minority reported history of PTSD (39, 13%) or traumatic brain injury (29, 9.6%). Overall, very few subjects (10, 2.6%) demonstrated inadequate health literacy. Patients with prior (1.6% vs 6.3%, P < .05) or current (0% vs 5.0%, P < .05) military service had lower rates of inadequate health literary as compared to civilians. Gender, race, marital status, history of PTSD, and history of traumatic brain injury did not significantly impact health literacy. In a multivariate regression model exploring history of military service, age was not predictive of inadequate health literacy. CONCLUSIONS: Both history of and current military service predict higher health literacy rates for patients treated at military otolaryngology clinics. Widely accessible health care and mandatory health evaluations for service members to maintain deployment readiness may contribute to this finding but warrant additional study.

Cochlear Implantation in the Active Duty Military Population: A Survey Assessing Military Readiness and Satisfaction.

OBJECTIVE: Evaluate the impact of cochlear implantation (CI) on retention for United States active duty (AD) service members. STUDY DESIGN: Retrospective observational study. SETTING: Tertiary military CI centers. PATIENTS: AD service members who underwent CI and completed a telephonic survey. MAIN OUTCOME MEASURES: The ability for military personnel to maintain AD status following CI as determined by the nonvolitional hearing-related AD separation rate and whether subjects would recommend CI to other qualified candidates. RESULTS: Twenty AD service members who underwent CI between 2004 and 2020 completed a telephonic survey. Fifteen (75%) were single-sided deafness (SSD) and five were traditional CI candidates. The mean age was 40.3 years (range 27.5-64.3), 19 (95%) were male, and 12 (80%) were Caucasian. Ten (50%) were officers and 14 (70%) were noncombat support personnel. Idiopathic sudden sensorineural hearing loss was the most common cause of hearing loss (8, 40%) followed by occupational noise exposure (4, 20%). Sixteen (80%) maintained AD status yielding 46.15 person-years of AD service following CI. For SSD, 14 (93%) maintained AD status yielding 40.54 person-years of AD service. The nonvolitional hearing-related patient separation rate for CI recipients with bilateral hearing loss was 35.65 cases per 100 AD person-years and 0 cases per 100 person-years for SSD candidates. Nineteen (95%) stated they would recommend CI to other AD CI candidates. CONCLUSIONS: The vast majority of AD CI recipients, and particularly those with SSD, are able to remain on AD after surgery and report a high degree of satisfaction with their implant.

A Dizzying Complaint: Investigating the Intended Meaning of Dizziness Among Patients and Providers.

OBJECTIVE/HYPOTHESIS: To assess for semantic differences regarding the definition of dizziness among otolaryngology patients, otolaryngologists, and non-otolaryngologist providers. STUDY DESIGN: Cross-sectional survey. METHODS: Between March and May 2020, a survey consisting of 20 common descriptors for dizziness within five domains (lightheadedness, motion sensitivity, imbalance, vision complaints, and pain) was completed by patients at two outpatient otolaryngology clinics. Surveys were subsequently obtained from otolaryngology and non-otolaryngology providers attending a multidisciplinary dizziness lecture. The primary outcome measure was to assess for differences in definition of dizziness between patients and providers. Secondary outcome measures included assessing differences between otolaryngologists and non-otolaryngologists. RESULTS: About 221 patients and 100 providers participated. Patients selected a median of 7 terms compared to 8 for providers (P = .375), although providers had a larger overall distribution of number of terms selected (P = .038). Patients were more likely than providers to define dizziness according to the following domains: lightheadedness (difference 15.0%; 95% confidence interval [CI] 5.5%-25.3%), vision complaints (difference 21.6%, 95% CI 12.0%-29.6%), and pain (difference 11.5%, 95% CI 4.7%-17.1%). Providers were more likely to define dizziness according to the motion sensitivity domain (difference 13.8%, 95% CI 6.8%-19.6%). Otolaryngology and non-otolaryngology providers defined dizziness similarly across symptom domains. CONCLUSION: Although patients and providers both view dizziness as imbalance, patients more commonly describe dizziness in the context of lightheadedness, vision complaints, and pain, whereas providers more frequently define dizziness according to motion sensitivity. These semantic differences create an additional barrier to effective patient-provider communication. LEVEL OF EVIDENCE: 4. Laryngoscope, 131:E1443-E1449, 2021.

Intranasal tissue necrosis associated with opioid abuse: Case report and systematic review.

OBJECTIVE: Opioid abuse is a common disorder affecting over 2 million Americans. Intranasal tissue necrosis is a previously described sequela of nasal opioid inhalation, with a similar presentation to invasive fungal rhinosinusitis (IFRS). The goal of this case report and systematic review is to evaluate the evidence supporting this uncommon disease, with qualitative analysis of the presentation, management and treatment outcomes. DATA SOURCES: MEDLINE, EMBASE, Google Scholar, Scopus, and Web of Science. REVIEW METHODS: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were utilized to identify English-language studies reporting intranasal mucosal injury associated with prescription opioid abuse. Primary outcomes included clinical presentation, treatment strategies, and outcomes. RESULTS: Systematic review identified 61 patients for qualitative analysis. Common clinical features include facial pain without a history of chronic sinusitis or known immunodeficiency. Diagnostic nasal endoscopy revealed superficial debris with underlying tissue necrosis, consistent with a preliminary diagnosis of IFRS. Characteristic pathologic findings include mucosal ulceration with an overlying acellular substrate, often with polarizable material. Fungal colonization is often reported, with several accounts of angiocentric invasion in immunocompetent patients. Complete symptom resolution is expected following surgical debridement with cessation of intranasal opioid inhalation, with 89% of identified patients experiencing a complete resolution of disease. CONCLUSION: Intranasal opioid abuse is a prevalent condition associated with chronic pain and tissue necrosis that is clinically concerning for invasive fungal disease. Whereas IFRS must be excluded, even in patients without known immunodeficiency, complete resolution of symptoms can be expected following surgical debridement with cessation of opioid abuse. Laryngoscope, 1767-1771, 2018.