Adverse patient occurrences in otorhinolaryngology: results of a systematic registry in a tertiary referral hospital.

OBJECTIVE: To identify patient groups at risk for Adverse Patient Occurrences (APOs) to improve the quality of care. STUDY DESIGN: This study was conducted using retrospective analysis. METHODS: APOs have been systematically registered from 1997 to 2006 in all patients (6,932) admitted to the otorhinolaryngology-head and neck surgery department of the University Hospital Maastricht, the Netherlands. Several characteristics such as length of stay, age, gender, season, and diagnosis were related to the incidence and type of APOs. RESULTS: Increasing age and length of stay are related to an increasing incidence of APOs. Children are found to be at high risk too and outpatient treatment (<24 h) is a risk factor for APOs. Of all APOs, 67% were organizational and 33% medical. The three diagnosis-related groups (DRGs), in which APOs occurred most, were the inner ear/cerebellopontine angle (CPA), esophagus, and head and neck oncology group. No seasonal influences on APO occurrences existed. CONCLUSIONS: Male and female patients >60 or <10 years old are at the highest risk for APOs. Their risk increases with their length of stay and is high when admitted less than 24 hours. When patients are among the three most prevalent DRGs, their risk is even higher.

Effect of peri-modiolar cochlear implant positioning on auditory nerve responses: a neural response telemetry study.

CONCLUSIONS: There was no evidence that a reduction in current was needed for nerve stimulation as a result of modiolar placement of a cochlear implant. However, modiolus hugging did reduce the spread of excitation for the basal and apical electrodes. This improved stimulation selectivity may result in improved speech discrimination by implant users. OBJECTIVE: To test the effect of modiolar placement of a cochlear implant on stimulation thresholds, and to confirm whether peri-modiolar electrode placement resulted in the hypothesized reduced spread of excitation. MATERIAL AND METHODS: Auditory nerve responses were measured by means of neural response telemetry (NRT) in 14 subjects. All subjects received a Nucleus CI24R(CS) Contour implant. For each subject, the stimulation threshold and response growth rate were determined on all the odd-numbered electrodes, using a masker-and-probe paradigm. In addition, the spatial spread of excitation was measured on electrodes 1, 6, 11, 16 and 20, using a variable-masker paradigm. All NRT measurements were performed intra-operatively, both before and after peri-modular placement of the electrode by removal of surgical stylet. RESULTS: Removal of the stylet had no significant effect on the threshold and growth rate of NRT responses. It caused a reduction in the spread of excitation for electrodes 1, 6 and 20, but not for electrodes 11 and 16.