Impact of COVID-19 on nationwide pediatric complicated sinusitis trends throughout 2018-2022.

OBJECTIVES: To describe and analyze the trends of pediatric sinusitis cases from 2018 to 2022 across the country utilizing the Pediatric Hospital Information System (PHIS) database focusing on volumes, socioeconomics, and severity of cases. STUDY DESIGN: Retrospective Cohort Study. METHODS: A retrospective cohort study using the Pediatric Health Information System (PHIS) database, which consists of 50 children's hospitals was performed. Regions were defined according to PHIS guidelines. We evaluated percentage of sinusitis cases demographic and socioeconomic information and subgrouped by region throughout 2018-2022. RESULTS: In all regions there were a greater number of sinusitis cases post-COVID compared to pre-COVID, with notable increases in major and extreme severity. The years 2020 and 2021 saw a decrease in total sinusitis cases in all locations. Both surgical intervention and severity of sinusitis were significant factors affecting length of stay. Age and severity were the most significant predictors regarding the odds of having sinus surgery. Age and insurance type were significant predictors of severity, with increasing age and government insurance associated with higher odds of major or extreme severity of sinusitis. CONCLUSIONS: There appears to be a trend of both increased number and worsening severity of acute sinusitis cases in the post-COVID era compared to pre-COVID. There was a decrease in cases in 2020-2021 during the pandemic, consistent with trends of other communicable diseases.

Evaluation of cost data associated with pediatric cochlear implantation (CI) throughout 2016-2021.

INTRODUCTION: Cochlear Implants (CI) are a mainstay in the treatment of severe sensorineural hearing loss with proven cost-effectiveness and improved quality of life. However, costs associated with CI are variable. During the Covid-19 pandemic, elective surgeries decreased. The investigation into how the pandemic affected CI procedures, costs, and demographic utilization has not been elucidated. METHODS: A retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 50 children's hospitals, was performed. Regions were defined according to PHIS guidelines. We evaluated number of CIs, total charges and costs, Charge to Cost Ratios (CCR), demographic information, and subgrouped this analysis by region throughout 2016-2021. Charges were adjusted by CMS wage index for hospital location. RESULTS: During the years of 2016-2021, there was a rising number of CIs every year except for 2020 which had a decrease, largely driven by the southern and midwestern regions. The median number of cases did not differ between the years. The median adjusted charges increased every year, but not significantly ($103,883-$125,394). The median CCR also did not differ throughout the years (2.7-3.1). Still, there was a larger interquartile range in 2021 (2.3-4.4) for the median CCR compared to all other years (2.1-3.8), particularly in the South. The percentage of white, non-Hispanic/Latino patients who underwent CI was larger in 2020-2021 (78-79.8 %) compared to 2016-2019 (73.3-77.5 %). CONCLUSIONS: The number of CIs in 2020 was lower than in 2019 or 2021. The median CCR for CI procedures increased from 2016 to 2021 but not significantly. The range of CCR was larger in 2021 compared to the years prior, suggestive of cost shifting by some hospitals to offset the loss in revenue. There was a small but significant increase in white, non-Hispanic patients receiving CI in 2020 and 2021, suggestive of a socio-economic shift in care post pandemic.

FDA MAUDE database analysis of titanium middle ear prosthesis.

PURPOSE: Partial ossicular replacement (PORP) and total ossicular replacement prostheses (TORP) are used to restore ossicular chain function. Despite favorable auditory outcomes, these interventions have associated risks and complications. This study examines the FDA MAUDE database for ossicular chain prosthesis adverse events to highlight complications, interventions, and root cause analysis (RCA) findings. MATERIALS AND METHODS: The MAUDE database was searched for Medical Device Reports (MDRs) relating to PORPs and TORPs from 2010 to 2020. MDR event descriptions were reviewed, and adverse events were identified as a device issue, patient issue, and/or packaging issue that occurred intraoperatively or postoperatively. RESULTS: Our search identified 70 MDRs which included 110 reported adverse events. Events consisted of 63 device issues, often due to device breaks and displacements, 39 patient issues, including common complaints of hearing loss and erosion, and 8 packaging issues. When comparing PORPs and TORPs, TORPs had more reported device issues whereas PORPs had more packaging issues. Intraoperative device issues were commonly resolved by completing the procedure with a backup device and most postoperative device issues required additional surgery. For devices returned to the manufacturer, RCA determined that most breaks were caused by modification and/or mishandling or that the product met specifications with an undetermined cause for the break. CONCLUSION: Device issues were the most common adverse events and frequently required subsequent intervention. Displacement occurred more often with TORPs and was associated with changes in hearing or erosion. The findings of this study are purely descriptive and may not have direct clinical relevance.

Soft tissue distribution pattern of facial soft tissue fillers with different viscoelastic properties.

BACKGROUND: Soft tissue filler product distribution and tissue integration have been shown to depend on myriad factors including the injector type, injector size, and injection angle. AIM: This study aims to investigate the magnitude of product spread across fascial soft tissue layers in relation to product viscoelastic properties. PATIENTS/METHODS: A total of 168 injection procedures were conducted in two female Caucasian body donors with a mean age of 80 years (range: 79-81) and a mean body mass index of 23.6 kg/m2 (range: 21.0-26.6). The injection procedures were performed in the forehead, scalp, zygomatic arch, mandible, clavicle, and sternum. The injected materials included Belotero® Soft, Belotero® Balance, Belotero® Intense, Belotero® Volume, Radiesse® , and Radiesse® Plus. Layer-by-layer dissections were performed to investigate the vertical distribution of the injected product. RESULTS: The mean product spread was for Belotero® Soft 4.54 ± 0.91; Belotero® Balance 3.85 ± 1.19; Belotero® Intense 3.04 ± 1.34; Belotero® Volume 2.58 ± 1.27; Radiesse® 1.31 ± 0.47; and Radiesse® Plus 1.27 ± 0.45 with P < .001. Bivariate correlations between product spread and storage modulus (G') revealed an inverse relationship of moderate strength with rp  = -0.651 and P < .001. CONCLUSION: The results of the present study revealed that products that were more fluid and less viscous distributed into more superficial fascial layers than products that were less fluid and more viscous (P < .001). This relationship held true irrespective of injected location.

How to best utilize the line of ligaments and the surface volume coefficient in facial soft tissue filler injections.

BACKGROUND: Recent advances in facial anatomy have increased our understanding of facial aging and where to best position facial soft tissue fillers. AIM: Aim of this study was to investigate a novel injection protocol which makes use of concepts like the line of ligaments or the surface - volume coefficient. MATERIALS AND METHODS: A total of 306 Caucasian patients (270 females, mean age 45.1 ± 11.4 years; 36 males, mean age 45.9 ± 11.6 years) were retrospectively investigated after the injection following a standardized protocol. This protocol comprised a total of six boluses and one retrograde fanning injections in the infraorbital area utilizing a 22G and a 25G blunt-tip cannula, respectively. Medial midfacial distances were measured using skin surface landmarks and compared after the injection of the partial and the total algorithm. RESULTS: Distances between the dermal location of the lateral SOOF and the dermal location of the mandibular ligament increased by 0.17 ± 0.11 mm with P < .001, to the corner of the mouth by 0.20 ± 0.09 mm with P < .001 and to the nasal ala by 0.20 ± 0.11 mm with P < .001. The repositioning of the facial soft tissues resulted also in a decrease of the height of the lower eyelid by 0.49 ± 0.13 mm with P < .001. CONCLUSION: The results revealed that utilizing these novel anatomic concepts, a mean amount of 0.32 cc high G-prime soft tissue filler injected in the lateral SOOF can change midfacial distances by an average of 0.19 mm.

Can smiling influence the blood flow in the facial vein?-An experimental study.

BACKGROUND: The understanding of functional facial anatomy and the interplay between facial structures is crucial for safe and effective minimally invasive and cosmetic surgical procedures. AIM: In this experimental study, we investigate the hypothesis that smiling can alter the blood flow in the angular/facial vein. MATERIALS AND METHODS: Twenty-six observations from 15 healthy volunteers (6 men, 9 women) with a mean age of 50.53 ± 13.27 (range: 24-66) were obtained. Doppler ultrasound imaging of the infraorbital segment of the angular vein (cranial to the zygomaticus major muscle) was performed and the venous flow was measured in a smiling and a resting, nonsmiling facial position. RESULTS: A statistically significant change in venous blood flow was detected upon smiling: a reduction in flow from 6.12 ± 3.0 cm/s to 0.52 ± 1.3 cm/s (P = .001). After three seconds, 80.8% of the observations had a blood flow of 0.0 cm/s. Increasing age was significantly correlated with a persistent blood flow during smiling (rp  = .469; P = .016). No differences between gender and sides of the face were observed. CONCLUSION: The results of this experimental study reveal that smiling can significantly reduce the venous flow in the angular/facial vein. Contraction of the zygomaticus major muscle compresses the vein against the underlying maxilla. Both minimally invasive and surgical procedures that alter the SMAS, the periocular musculature or the deep midfacial fat compartments might affect angular/facial venous flow.

Relationship between forehead motion and the shape of forehead lines-A 3D skin displacement vector analysis.

OBJECTIVE: Neuromodulator injections of the forehead are often performed using standardized protocols. This study was designed to identify the individual skin motion pattern of the forehead and to relate this pattern to the underlying frontalis muscle morphology to offer guidance for neuromodulator placement. MATERIAL AND METHODS: Thirty-seven healthy volunteers (29 Caucasians, six African Americans, two Asians) with a mean age of 39.84 ± 14.4 years [range: 22-73] were enrolled. 3D images of the forehead were analyzed using a Vectra H1 camera system computing skin displacement vectors between the noncontracted and the maximally contracted forehead of the volunteers. Relationships between the shape of the horizontal forehead lines (straight vs wavy) and the forehead motion pattern were calculated. RESULTS: Independent of age or gender, a greater forehead motion angle was associated with the presence of wavy forehead lines 21.34°± 5.9 with P < 0.001, whereas straight forehead lines were associated with a smaller forehead motion angle 6.68°± 2.9 P < 0.001. Females had more frequently straight horizontal forehead lines versus males: 68.4% vs 44.4% (P = 0.037). Young volunteers (<39.8 years) did not differ in their mean forehead motion angle when compared to older volunteers (>39.8 years): 13.70°± 9.0 vs 12.39°± 8.0 with P = 0.530. CONCLUSION: Injections of neuromodulators in the forehead can be individualized by respecting the shape of the horizontal forehead lines. Wavy lines require injection points that are located more laterally, whereas straight lines require more centrally located injection points.