Traumatic Hearing Loss in the Context of Blast-Related Tympanic Membrane Perforation.

OBJECTIVE: Identify associated clinical factors and characterize the various forms of hearing loss in the context of blast-related traumatic tympanic membrane (TM) perforation sustained in the combat setting. METHODS: A prospective study of 41 patients who sustained a TM perforation secondary to blast injury between 2010 and 2012 while serving in combat. Clinical examinations and audiograms were obtained for all patients by a single-institution Otolaryngology service with comparative data generated from review of pre and post-trauma hearing screens. Follow-up clinical and audiogram data were obtained on all available subjects. RESULTS: 59 TM perforations were documented with audiograms. A conductive hearing loss of 14.8, 22.4, 20.3, and 18.9 dB and sensorineural hearing loss (SNHL) of 18.0, 13.5, 19.9, and 22.0 dB at 500, 1,000, 3,000, and 4,000 Hz, respectively, were observed. 49% of all hearing loss was SNHL. Clinical factors did not correlate statically to hearing loss (p > 0.05). On average, patients demonstrated a 51% improvement in SNHL at time of follow-up. CONCLUSION: In the subacute setting, patients with traumatic TM perforations secondary to combat blast injury demonstrate both a conductive hearing loss and SNHL, with 49% of all loss being sensorineural. An average SNHL improvement of 51% was seen at follow-up.

An anatomically based analysis of objectively measured pediatric snoring: a pilot study.

OBJECTIVE: To assess pediatric habitual snoring (PS) using home sleep test (HST) technology and attempt to correlate the objective components of PS to specific upper airway anatomy. In addition, the effects of adenotonsillectomy (±turbinoplasty) on objective measures of PS were evaluated. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Pediatric patients with a chief complaint of snoring and probable obstructive sleep apnea underwent an HST (SNAP Diagnostics, Wheeling, Illinois) with a detailed acoustical snoring analysis prior to adenotonsillectomy (±turbinoplasty). During surgery, detailed anatomical measurements were performed and correlated to snoring analysis results. After surgery, patients were offered another HST with snoring analysis. Data analysis was performed using descriptive statistics and statistical correlation with attention to the multiple-comparisons paradox. RESULTS: Twenty-two patients (45% male; mean age, 5.4 years [range, 2.4-8.4 years]) completed the preoperative HST and operative measurements. Unlike typical adult snoring, only a minority of PS was from palatal flutter (mean palatal component, 24%; median, 10%). The resistance occurrence percentage (ROP, percentage of breathing events with snoring noise) was associated with body mass index (BMI; Spearman ρ=0.55; P=.017), subjective turbinate size (0.54; P=.032), palatal obstruction (0.63; P=.008), and mean oxygen saturation (-0.729; P=.0003) but not adenotonsillar hypertrophy. Twelve patients (54%) completed a postoperative HST. The ROP was significantly reduced (median, 20.5% vs 6.5%; P=.006, sign rank test) postoperatively. The magnitude of the ROP reduction was proportional to the volume of the removed tonsils (0.74; P=.022). CONCLUSION: Pediatric snoring has different acoustical characteristics than adult snoring. Objective PS is associated with BMI, turbinate size, and palatal obstruction. Adenotonsillectomy (±turbinoplasty) may significantly reduce objective PS.

YouTube as an information source for pediatric adenotonsillectomy and ear tube surgery.

OBJECTIVES: Assess the overall quality of information on adenotonsillectomy and ear tube surgery presented on YouTube (www.youtube.com) from the perspective of a parent or patient searching for information on surgery. METHODS: The YouTube website was systematically searched on select dates with a formal search strategy to identify videos pertaining to pediatric adenotonsillectomy and ear tube surgery. Only videos with at least 5 (ear tube surgery) or 10 (adenotonsillectomy) views per day were included. Each video was viewed and scored by two independent scorers. Videos were categorized by goal and scored for video/audio quality, accuracy, comprehensiveness, and procedure-specific content. STUDY DESIGN: Cross-sectional study. SETTING: Public domain website. RESULTS: Fifty-five videos were scored for adenotonsillectomy and forty-seven for ear tube surgery. The most common category was educational (65.3%) followed by testimonial (28.4%), and news program (9.8%). Testimonials were more common for adenotonsillectomy than ear tube surgery (41.8% vs. 12.8%, p=0.001). Testimonials had a significantly lower mean accuracy (2.23 vs. 2.62, p=0.02), comprehensiveness (1.71 vs. 2.22, p=0.007), and TA specific content (0.64 vs. 1.69, p=0.001) score than educational type videos. Only six videos (5.9%) received high scores in both video/audio quality and accuracy/comprehensiveness of content. There was no significant association between the accuracy and comprehensive score and views, posted "likes", posted "dislikes", and likes/dislikes ratio. There was an association between "likes" and mean video quality (Spearman's rho=0.262, p=0.008). CONCLUSION: Parents/patients searching YouTube for information on pediatric adenotonsillectomy and ear tube surgery will generally encounter low quality information with testimonials being common but of significantly lower quality. Viewer perceived quality ("likes") did not correlate to formally scored content quality.

How good is Google? The quality of otolaryngology information on the internet.

OBJECTIVE: To assess the quality of the information a patient (parent) may encounter using a Google search for typical otolaryngology ailments. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary care center. METHODS: A Google keyword search was performed for 10 common otolaryngology problems including ear infection, hearing loss, tonsillitis, and so on. The top 10 search results for each were critically examined using the 16-item (1-5 scale) standardized DISCERN instrument. The DISCERN instrument was developed to assess the quality and comprehensiveness of patient treatment choice literature. RESULTS: A total of 100 Web sites were assessed. Of these, 19 (19%) were primarily advertisements for products and were excluded from DISCERN scoring. Searches for more typically chronic otolaryngic problems (eg, tinnitus, sleep apnea, etc) resulted in more biased, advertisement-type results than those for typically acute problems (eg, ear infection, sinus infection, P = .03). The search for "sleep apnea treatment" produced the highest scoring results (mean overall DISCERN score = 3.49, range = 1.81-4.56), and the search for "hoarseness treatment" produced the lowest scores (mean = 2.49, range = 1.56-3.56). Results from major comprehensive Web sites (WebMD, EMedicinehealth.com, Wikipedia, etc.) scored higher than other Web sites (mean DISCERN score = 3.46 vs 2.48, P < .001). CONCLUSION: There is marked variability in the quality of Web site information for the treatment of common otolaryngologic problems. Searches on more chronic problems resulted in a higher proportion of biased advertisement Web sites. Larger, comprehensive Web sites generally provided better information but were less than perfect in presenting complete information on treatment options.