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1.
Otol Neurotol ; 45(4): e281-e288, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38437816

ABSTRACT

OBJECTIVE: To examine the association between preoperative comorbidities and cochlear implant speech outcomes. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS: A total of 976 patients who underwent cochlear implantation (CI) between January 2015 and May 2022. Adult patients with follow-up, preoperative audiologic data, and a standardized anesthesia preoperative note were included. EXPOSURE: Adult Comorbidity Evaluation 27 (ACE-27) based on standardized anesthesia preoperative notes. MAIN OUTCOME MEASURES: Postoperative change in consonant-nucleus-consonant (CNC) score, AzBio Sentence score in quiet, and AzBio + 10 dB signal-to-noise ratio (SNR). Sentence score of the implanted ear at 3, 6, and 12 months. RESULTS: A total of 560 patients met inclusion criteria; 112 patients (20%) had no comorbidity, 204 patients (36.4%) had mild comorbidities, 161 patients (28.8%) had moderate comorbidities, and 83 patients (14.8%) had severe comorbidities. Mixed model analysis revealed all comorbidity groups achieved a clinically meaningful improvement in all speech outcome measures over time. This improvement was significantly different between comorbidity groups over time for AzBio Quiet ( p = 0.045) and AzBio + 10 dB SNR ( p = 0.0096). Patients with severe comorbidities had worse outcomes. From preop to 12 months, the estimated marginal mean difference values (95% confidence interval) between the no comorbidity group and the severe comorbidity group were 52.3 (45.7-58.9) and 32.5 (24.6-40.5), respectively, for AzBio Quiet; 39.5 (33.8-45.2) and 21.2 (13.6-28.7), respectively, for AzBio + 10 dB SNR; and 43.9 (38.7-49.0) and 31.1 (24.8-37.4), respectively, for CNC. CONCLUSIONS: Comorbidities as assessed by ACE-27 are associated with CI performance. Patients with more severe comorbidities have clinically meaningful improvement but have worse outcome compared to patients with no comorbidities.


Subject(s)
Cochlear Implantation , Cochlear Implants , Speech Perception , Adult , Humans , Retrospective Studies , Comorbidity , Treatment Outcome
2.
J Neurol Surg Rep ; 84(3): e85-e86, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37564630

ABSTRACT

Esthesioneuroblastoma is a rare sinonasal malignancy that arises from the olfactory epithelium. The overall incidence of lymph node metastases is 25%. However, neck disease can present in a delayed fashion. As such, management of the clinically negative neck is controversial, with some advocating for elective neck treatment and others recommending observation with salvage treatment if necessary. At this time, no prospective head-to-head comparisons of elective versus salvage treatment have been performed.

3.
Ann Pharmacother ; 56(5): 533-540, 2022 05.
Article in English | MEDLINE | ID: mdl-34470525

ABSTRACT

BACKGROUND: Evidence for direct oral anticoagulants (DOACs) in patients with cirrhosis is limited. Few patients with Child-Turcotte-Pugh (CTP) class B and C cirrhosis have been studied. OBJECTIVE: To compare major bleeding rates in patients with cirrhosis receiving a DOAC versus warfarin. METHODS: A retrospective cohort study was conducted in adults with cirrhosis receiving a DOAC versus warfarin for venous thromboembolism, portal-vein thrombosis, or atrial fibrillation. The primary outcome was the rate of major bleeding. Secondary outcomes included time to major bleeding, clinically relevant nonmajor bleeding, all bleeding, gastrointestinal bleeding, intracranial bleeding, and new thromboembolic events. The study was approved by the Ochsner Health System Institutional Review Board. RESULTS: A total of 44 patients receiving a DOAC and 41 patients receiving warfarin were included. Major bleeding occurred in 4 patients receiving a DOAC and 6 patients receiving warfarin (9.1% vs 14.6%; P = 0.881). Rates of major bleeding were similar in 24 DOAC and 17 warfarin patients with CTP Class B (4.2% vs 17.6%; P = 0.37) and 8 DOAC and 9 warfarin patients with CTP Class C (37.5% vs 11.1%; P = 0.41) cirrhosis. Secondary bleeding and efficacy outcomes were similar between cohorts. The study was limited by a small sample size. CONCLUSION AND RELEVANCE: Treatment with DOACs in patients with cirrhosis was associated with a similar rate of major bleeding compared with warfarin. Inclusion of CTP class C patients in future studies remains valuable to evaluate safety and efficacy of DOACs in this population.


Subject(s)
Atrial Fibrillation , Thrombosis , Venous Thromboembolism , Adult , Humans , Administration, Oral , Anticoagulants/adverse effects , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , Gastrointestinal Hemorrhage/chemically induced , Gastrointestinal Hemorrhage/drug therapy , Gastrointestinal Hemorrhage/epidemiology , Liver Cirrhosis/complications , Liver Cirrhosis/drug therapy , Retrospective Studies , Thrombosis/drug therapy , Venous Thromboembolism/drug therapy , Warfarin/adverse effects
4.
J Voice ; 35(2): 312-316, 2021 Mar.
Article in English | MEDLINE | ID: mdl-31606224

ABSTRACT

OBJECTIVES: We hypothesized that, in patients with unilateral vocal fold paralysis (UVFP), the auditory-perception of breathiness measured with Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) would be higher preoperatively in patients who undergo medialization laryngoplasty (ML) with arytenoid adduction (AA) compared to ML alone. We further hypothesized that increased breathiness would correlate with increased glottal area at maximum glottal closure. STUDY DESIGN: Retrospective chart review. METHODS: CAPE-V recordings were rated by expert judges in 105 subjects with UVFP (47 ML+AA and 58 ML). Component scores of the CAPE-V prior to laryngeal framework surgery and those at 3 and/or 12 months postoperatively were compared. Assessment of glottal area width during maximum glottal closure was attempted. RESULTS: Breathiness scores prior to laryngeal framework surgery were significantly greater in UVFP patients having ML+AA compared to ML only (P < 0.001). Roughness was greater for ML only (P = 0.003). At 3 months, adjusted for age and previous injection laryngoplasty, the ML+AA group showed greater improvement for breathiness (P <0.001), loudness (P < 0.001), strain (P = 0.037), and pitch (P = 0.039), while the ML only group showed greater improvement in roughness (P = 0.009). Results were similar at 12 months. Only 26% of glottal area widths were ratable using methods previously described; therefore, no further analysis was attempted. CONCLUSIONS: In patients with UVFP baseline perception of breathiness is greater in those clinically selected for ML+AA compared to ML only. Glottal area measurements were not representative of the UVFP cohort and more stringent criteria are needed for valid and reliable glottal area assessment when using clinical flexible stroboscopic exams. Findings support the idea that surgeons may be making decisions about AA based, to at least some degree, on auditory perceptual evaluation of voice.


Subject(s)
Laryngoplasty , Consensus , Humans , Retrospective Studies , Treatment Outcome , Voice Quality
5.
Ann Otol Rhinol Laryngol ; 129(12): 1243-1246, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32517491

ABSTRACT

OBJECTIVES: LMNA-associated familial partial lipodystrophy (FPLD) is a rare autosomal dominant A-type laminopathy characterized by variable loss and redistribution of subcutaneous adipose tissue, dyslipidemia, and insulin resistance. Though A-type lamins play a key role in nuclear membrane structure and regulation of cell proliferation, an association between cancer and LMNA-associated FPLD has not been reported. METHODS AND RESULTS: This report outlines the case of two biological sisters with LMNA-associated FPLD who developed hypopharyngeal squamous cell carcinoma in the absence of any other risk factors for head and neck cancer. CONCLUSION: These observations prompt further investigation into the potential role of A-type lamins in the development and progression of head and neck cancers.


Subject(s)
Hypopharyngeal Neoplasms/complications , Lipodystrophy, Familial Partial/complications , Siblings , Squamous Cell Carcinoma of Head and Neck/complications , Adult , Chemoradiotherapy , Esophageal Neoplasms/complications , Esophageal Squamous Cell Carcinoma/complications , Fatal Outcome , Female , Gastrostomy , Humans , Hypopharyngeal Neoplasms/pathology , Hypopharyngeal Neoplasms/therapy , Lamin Type A/genetics , Laryngectomy , Lipodystrophy, Familial Partial/genetics , Pharyngectomy , Squamous Cell Carcinoma of Head and Neck/pathology , Squamous Cell Carcinoma of Head and Neck/therapy , Tracheostomy
7.
Otolaryngol Head Neck Surg ; 161(6): 929-938, 2019 12.
Article in English | MEDLINE | ID: mdl-31237824

ABSTRACT

OBJECTIVE: This study was performed to outline and analyze the overall Medicare landscape with respect to otolaryngologists and beneficiaries, services, and reimbursements. METHODS: This is a retrospective analysis of publicly available Medicare utilization and payment data for all otolaryngologists in facility and nonfacility practice settings who provided services to Medicare beneficiaries between January 1, 2012, and December 31, 2016. RESULTS: In 2016, a total of $701,195,375 was distributed to 8572 otolaryngology physician providers for 815 unique Healthcare Common Procedure Coding System codes for 13,942,536 procedure claims. Of specialty care, otolaryngology ranks 20th among 54 subspecialties for total Medicare payments. The average number of services coded per provider was 1627. The average otolaryngologist was paid $81,800.67. Thirty-two percent of otolaryngologists did not receive reimbursement for services from Medicare in 2016. DISCUSSION: In 2016, the most significant contributors to Medicare payments to otolaryngologists were large-scale, low-cost events that are relatively short procedures done in clinic. Utilization of nasal endoscopy was up trending from 2012 to 2016. Some of the Current Procedural Terminology codes with the greatest discrepancies between submitted charge and Medicare payment among nonfacility otolaryngology providers are more involved than simple office procedures. IMPLICATIONS FOR PRACTICE: It is increasingly valuable for physicians to know factors that affect reimbursement for procedures and operations in different settings and to be aware of the trends in variation in their specialty. Otolaryngologists should communicate with policy makers in efforts toward sustainable reimbursement models.


Subject(s)
Endoscopy/economics , Insurance Claim Review , Otorhinolaryngologic Surgical Procedures/economics , Practice Patterns, Physicians'/economics , Humans , Medicare , Reimbursement Mechanisms/economics , Retrospective Studies , United States
8.
J Neurosurg ; 132(1): 10-21, 2019 01 04.
Article in English | MEDLINE | ID: mdl-30611138

ABSTRACT

OBJECTIVE: The authors sought to investigate the incidence and predictors of venous thromboembolic events (VTEs) after craniotomy for tumor resection, which are not well established, and the efficacy of and risks associated with VTE chemoprophylaxis, which remains controversial. METHODS: The authors investigated the incidence of VTEs in a consecutive series of patients presenting to the authors' institution for resection of an intracranial lesion between 2012 and 2017. Information on patient and tumor characteristics was collected and independent predictors of VTEs were determined using stepwise multivariate logistic regression analysis. Review of the literature was performed by searching MEDLINE using the keywords "venous thromboembolism," "deep venous thrombosis," "pulmonary embolism," "craniotomy," and "brain neoplasms." RESULTS: There were 1622 patients included for analysis. A small majority of patients were female (52.6%) and the mean age of the cohort was 52.9 years (SD 15.8 years). A majority of intracranial lesions were intraaxial (59.3%). The incidence of VTEs was 3.0% and the rates of deep venous thromboses and pulmonary emboli were 2.3% and 0.9%, respectively. On multivariate analysis, increasing patient age (unit OR 1.02, 95% CI 1.00-1.05; p = 0.018), history of VTE (OR 7.26, 95% CI 3.24-16.27; p < 0.001), presence of motor deficit (OR 2.64, 95% CI 1.43-4.88; p = 0.002), postoperative intracranial hemorrhage (OR 4.35, 95% CI 1.51-12.55; p < 0.001), and prolonged intubation or reintubation (OR 3.27, 95% CI 1.28-8.32; p < 0.001) were independently associated with increased odds of a VTE. There were 192 patients who received VTE chemoprophylaxis (11.8%); the mean postoperative day of chemoprophylaxis initiation was 4.6 (SD 3.8). The incidence of VTEs was higher in patients receiving chemoprophylaxis than in patients not receiving chemoprophylaxis (8.3% vs 2.2%; p < 0.001). There were 30 instances of clinically significant postoperative hemorrhage (1.9%), with only 1 hemorrhage occurring after initiation of VTE chemoprophylaxis (0.1%). CONCLUSIONS: The study results show the incidence and predictors of VTEs after craniotomy for tumor resection in this patient population. The incidence of VTE within this cohort appears low and comparable to that observed in other institutional series, despite the lack of routine prophylactic anticoagulation in the postoperative setting.


Subject(s)
Brain Neoplasms/surgery , Craniotomy , Postoperative Complications/epidemiology , Pulmonary Embolism/epidemiology , Venous Thromboembolism/epidemiology , Venous Thrombosis/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Cerebral Hemorrhage/chemically induced , Cerebral Hemorrhage/epidemiology , Chemoprevention , Female , Humans , Incidence , Intubation, Intratracheal , Karnofsky Performance Status , Male , Middle Aged , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/adverse effects , Platelet Aggregation Inhibitors/therapeutic use , Postoperative Complications/chemically induced , Postoperative Complications/etiology , Postoperative Hemorrhage/chemically induced , Postoperative Hemorrhage/epidemiology , Premedication , Pulmonary Embolism/etiology , Pulmonary Embolism/prevention & control , Risk Factors , Thrombophilia/complications , Thrombophilia/drug therapy , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control , Venous Thrombosis/etiology , Venous Thrombosis/prevention & control , Young Adult
9.
Laryngoscope ; 129(8): 1876-1881, 2019 08.
Article in English | MEDLINE | ID: mdl-30582612

ABSTRACT

OBJECTIVE: Voice outcomes following medialization laryngoplasty (ML) for unilateral vocal fold paralysis (UVFP) were compared to those who underwent ML plus arytenoid adduction (AA) (ML+AA). METHODS: Single institution retrospective review of patients with UVFP undergoing ML and ML+AA (2009-2017). Demographic information and history of laryngeal procedures were collected. Preoperative and postoperative Voice Handicap Index-10 (VHI-10) and Consensus Perceptual Auditory Evaluation of Voice (CAPE-V) were assessed. RESULTS: Of 236 patients, 119 met study criteria. Of those, 70 (59%) underwent ML and 49 (41%) underwent ML+AA. Significant differences between groups at baseline were found for age at time of thyroplasty (P = 0.046), VHI-10 scores (P < 0.001), and CAPE-V scores (P = 0.007). Baseline VHI-10 scores for ML+AA (28 ± 7) were greater than those for ML alone (24 ± 7). At 12 months, overall VHI-10 scores improved compared to baseline for both groups (ML+AA = 9 ± 7, ML = 16 ± 9); however, there was greater improvement for the ML+AA group compared to ML group (P = 0.001). CAPE-V scores at 3 or 12 months improved, but differences between the groups were not statistically significant once controlled for covariates. CONCLUSION: Based on current findings, patients who undergo ML+AA likely have greater voice handicap at baseline compared to those undergoing ML alone. Patients selected for ML+AA improve as much or more than those who underwent ML alone. This highlights the importance of appropriate selection of candidates for AA. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1876-1881, 2019.


Subject(s)
Arytenoid Cartilage/surgery , Laryngoplasty/methods , Vocal Cord Paralysis/surgery , Aged , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Retrospective Studies , Severity of Illness Index , Treatment Outcome , Vocal Cord Paralysis/physiopathology , Voice Quality/physiology
10.
Bone ; 96: 45-50, 2017 03.
Article in English | MEDLINE | ID: mdl-27888056

ABSTRACT

Sclerostin, the product of the SOST gene, is a secreted inhibitor of Wnt signaling that is produced by osteocytes to regulate bone formation. While it is often considered an osteocyte-specific protein, SOST expression has been reported in numerous other cell types, including hypertrophic chondrocytes and cementocytes. Of interest, SOST/sclerostin expression is altered in certain pathogenic conditions, including osteoarthritis and rheumatic joint disease, and it is unclear whether sclerostin plays a protective role or whether sclerostin may mediate disease pathogenesis. Therefore, as anti-sclerostin antibodies are being developed for the treatment of osteoporosis, it is important to understand the functions of sclerostin beyond the regulation of bone formation.


Subject(s)
Bone Morphogenetic Proteins/metabolism , Osteocytes/metabolism , Animals , Disease , Humans , Organ Specificity
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