Odds of Influenza in Patients Receiving Intra-articular Corticosteroid Injections: A Cohort Study.

OBJECTIVE: Although intra-articular corticosteroid (IACS) is injected locally, some systemic absorption occurs, potentially causing immunosuppression in recipients. This study examined the odds of influenza in patients who received IACS compared with matched controls. DESIGN: Adults in the authors' health system who received IACS from May 2012 through April 2018 were 1:1 matched to adults without IACS. The primary outcome was overall odds of influenza. Secondary analyses examined influenza odds by timing of IACS, joint size, and vaccination status. RESULTS: A total of 23,368 adults (mean age, 63.5 yrs, 62.5% female) received IACS and were matched to a control. Although there was no difference in influenza odds by IACS status overall (odds ratio, 1.13; 95% confidence interval, 0.97-1.32), patients receiving IACS during influenza season had higher odds of influenza than matched controls (odds ratio, 1.34; 95% confidence interval, 1.03-1.74). Furthermore, unvaccinated patients who received IACS during influenza season had higher influenza odds compared with matched controls (odds ratio, 1.41; 95% confidence interval, 1.04-1.91]), whereas there was no difference among vaccinated patients. CONCLUSION: Patients receiving IACS injections during influenza season had higher odds of influenza. However, vaccination seemed to mitigate this risk. Patients receiving IACS injections should be counseled on infection risk and importance of vaccinations. Further research is needed to examine IACS effects on other viral illnesses. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Identify potential adverse effects of intra-articular corticosteroids; (2) Recognize risk factors for influenza diagnosis; and (3) Describe importance of influenza vaccination. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.

Outcomes in Pediatric Endoscopic Skull Base Surgery: A Systematic Review.

Objectives The frequency of endoscopic skull base surgery in pediatric patients is increasing. This study aims to systematically review the literature for endoscopic skull base surgery outcomes in children/adolescents aged 0 to 18 years. Design A systematic review of the literature was performed in PubMed and SCOPUS databases querying studies from 2000 to 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Final inclusion criteria included: case series with more than 10 patients with pediatric patients aged ≤18 years, endoscopic or endoscopic-assisted skull base surgery, and outcomes reported. Setting This study was conducted at a tertiary care medical center. Participants Children/adolescents aged 0 to 18 years who underwent endoscopic skull base surgery were participated in this study. Main Outcome Measures Patient demographics, pathology, reconstructive technique, intraoperative findings, intraoperative, and postoperative surgical complications were measured through this study. Results Systematic literature search yielded 287 publications. Of these, 12 studies discussing a total of 399 patients aged 0 to 18 years met inclusion criteria for final analysis. Seven of the 12 studies discussed a single pathology. The most common pathology was a skull base defect causing cerebrospinal fluid (CSF) leak. The majority of skull base repairs were made with free tissue grafts. The most common postoperative complication was CSF leak ( n = 40). Twelve cases of meningitis occurred postoperatively with two of these episodes resulting in death. Conclusion Endoscopic skull base surgery has been performed recently in the pediatric population in a variety of disease states. Inconsistent individual-level data and reporting standards are present in existing studies posing challenges for comparative analysis. Standardized reporting will aid future reviews and meta-analysis for rare skull base pathology.

Speech-in-Speech Recognition and Spatially Selective Attention in Children and Adults.

Purpose Knowing target location can improve adults' speech-in-speech recognition in complex auditory environments, but it is unknown whether young children listen selectively in space. This study evaluated masked word recognition with and without a pretrial cue to location to characterize the influence of listener age and masker type on the benefit of spatial cues. Method Participants were children (5-13 years of age) and adults with normal hearing. Testing occurred in a 180° arc of 11 loudspeakers. Targets were spondees produced by a female talker and presented from a randomly selected loudspeaker; that location was either known, based on a pretrial cue, or unknown. Maskers were two sequences comprising spondees or speech-shaped noise bursts, each presented from a random loudspeaker. Speech maskers were produced by one male talker or by three talkers, two male and one female. Results Children and adults benefited from the pretrial cue to target location with the three-voice masker, and the magnitude of benefit increased with increasing child age. There was no benefit of location cues in the one-voice or noise-burst maskers. Incorrect responses in the three-voice masker tended to correspond to masker words produced by the female talker, and in the location-known condition, those masker intrusions were more likely near the cued loudspeaker for both age groups. Conclusions Increasing benefit of the location cue with increasing child age in the three-voice masker suggests maturation of spatially selective attention, but error patterns do not support this idea. Differences in performance in the location-unknown condition could play a role in the differential benefit of the location cue.

Management of submucous cleft palate.

PURPOSE OF REVIEW: Submucous cleft palate (SMCP) represents an uncommon congenital palatal anomaly with a variable rate of velopharyngeal dysfunction or resulting speech abnormality. Classic teaching regarding management of this entity involves delayed repair until a perceptual speech assessment by a skilled speech-language pathologist can be performed, typically at age 3-5 years. An assessment of timing of intervention, surgical techniques, and patient comorbidities is critical for optimized outcomes. RECENT FINDINGS: Early diagnosis and surgical intervention for SMCP are associated with improved speech outcomes. Expanding indications for surgery are being actively investigated. Timing of intervention and surgical technique may be influenced by a syndromic diagnosis, specifically 22q11.2 deletion syndrome. SUMMARY: Diagnosis of classic SMCP and occult SMCP may be difficult based on provider experience. Variable surgical techniques may be used with good outcomes; patient comorbidities including syndromic diagnoses may determine best surgical technique. Expanding indications for surgery and timing of repair continue to evolve and warrant additional study.

The Binaural Interaction Component of the Auditory Brainstem Response Under Precedence Effect Conditions.

The purpose of this study was to measure the binaural interaction component (BIC) derived from click-evoked auditory brainstem responses (ABRs) using stimuli configured to elicit the Precedence Effect. The hypothesis was that the contribution of binaural processing to echo suppression can be evidenced by a diminished or absent BIC associated with the echo. Ten normal-hearing young adults provided ABRs generated by sequences of click pairs. Results showed that BICs elicited by diotic clicks in isolation were obliterated when those diotic clicks were preceded by a click pair having an interaural time difference of 400 µs and where the interclick interval was 8.4 ms. The presence of the leading click pair increased the latency of the ABR generated by the lagging diotic click pair but did not decrease its amplitude. The results were interpreted as indicating a contribution of binaural processing at the level of the brainstem to echo suppression, at least for the conditions tested here.

Streamlining care in cystic fibrosis: survey of otolaryngologist, pulmonologist, and patient experiences.

BACKGROUND: Care coordination for cystic fibrosis (CF) is essential. The objectives of this study were to: (1) compare otolaryngologists' and pulmonlogists' understanding of long-term chronic rhinosinusitis (CRS) management; and (2) query patient perceptions of otolaryngologic care and CRS. METHODS: A cross-sectional survey was administered by the Cystic Fibrosis Foundation in 2018 to patients with CF or their caregivers, otolaryngologists, and pulmonologists. Statistical analysis was performed comparing specialists. Descriptive statistics were computed for patient/caregiver-reported data. RESULTS: Respondents included 126 otolaryngologists, 115 pulmonologists, and 186 patients with CF or their caregivers. Pulmonologists had greater experience caring for CF patients compared with otolaryngologists (66.7% vs 43.2% with 13+ years of experience, respectively), but more otolaryngologists cared for both adult and pediatric CF patients (39.2% vs 10.4%, respectively). Significantly more otolaryngologists advocated for establishing otolaryngologic care at time of CF diagnosis (64.8%) compared with pulmonologists (14.4%, p < 0.001), of whom 60.4% recommended otolaryngologist referral when sinonasal symptoms affect quality of life. More otolaryngologists perceived sinus surgery as beneficial for pulmonary function (74.5% vs 57.7%, p = 0.009); 60.8% of patients first sought otolaryngologic care in infancy or childhood (<13 years). Median number of sinus surgeries was 3 (interquartile range, 2-5). The most common perceived benefits of surgery according to patients/caregivers included improved breathing (31.2%) and improved sinonasal symptoms (23.7%). Top patients/caregiver otolaryngologic priorities included symptom/infection control (49.0%) and care coordination (15.0%). CONCLUSION: Our results highlight variable patient/caregiver experiences, and suggest that otolaryngologist and pulmonologist perceptions of CF otolaryngologic care also differ in some respects requiring improved interspecialty coordination/education.

Craniofacial Interventions in Children.

Craniofacial interventions are common and the surgical options continue to grow. The issues encountered include micrognathia, macroglossia, midface hypoplasia, hearing loss, facial nerve palsy, hemifacial microsomia, and microtia. In addition, a unifying theme is complex upper airway obstruction. Throughout a child's life the focus of interventions may change from airway management to speech, hearing, and language optimization, and finally to decannulation and procedures aimed at social integration and self-esteem. Otolaryngologists play an important role is this arena and provide high-quality care while continuing to expand what can be done for our patients.

Otolaryngology boot camps: Current landscape and future directions.

OBJECTIVES: Simulation-based boot camps have gained popularity over the past few years, with some surgical specialties implementing mandatory national boot camps. However, there is no consensus in otolaryngology on boot camp timing, learner level, or curriculum. The purpose of this study is to examine the current landscape and gather opinions regarding future curriculum and standardization of boot camps in otolaryngology. METHODS: A survey was developed to examine current resident participation and boot camp content while also seeking opinions regarding improving boot camp enrollment and standardizing curriculum. A cross-sectional survey of all otolaryngology residency program directors in the United States and Puerto Rico was performed via SurveyMonkey. Responses were collected anonymously, and results were analyzed by descriptive statistical analysis. RESULTS: Of the 45% (48 of 106) who responded, 76.6% reported their residents participate in boot camps. The most common skills taught were basic suturing and airway management skills. The majority (95%) was likely to send residents to a local boot camp, with 56% favoring early postgraduate year (PGY)-1 participation and 42% favoring a 1-day boot camp. Subsidized expenses, improved regional access, and supplementary boot camp information would help the program director in their decision to send residents to boot camp. Only 32% felt boot camps should be standardized, and 27% felt they should be mandatory. CONCLUSION: Many otolaryngology residency programs participate in boot camps. Additional data on the benefits of boot camps, improved access, and reduced financial burden may improve participation. Further discussion of ideal timing, PGY level, and standardized curriculum should occur in conjunction with the otolaryngology academic societies and oversight from accreditation and certifying bodies. LEVEL OF EVIDENCE: NA Laryngoscope, 129:2707-2712, 2019.

Food security status of households in Appalachian Ohio with children in Head Start.

This study measured food security and hunger of households involved in Head Start in a rural Appalachian county and assessed factors that could affect food security and hunger. A convenience sample of households with children enrolled in the Head Start program in Athens County, Ohio, were sampled (n=710), with adults from 297 (42%) households responding. The survey instrument included the 18-question US Household Food Security Survey Module for measuring hunger and food insecurity. Of those responding, 152 households (51.2%) were food secure and 145 (48.8%) were food insecure. Ninety (30.3%) had experienced hunger in the previous 12 months, and 41 (13.8%) households were classified as food insecure with childhood hunger. Hunger was related to a variety of household characteristics and associated with several factors, including participation in food banks, dependence on family members and friends outside of the household for food, lacking reliable transportation, and not having a garden.