Rhinoplasty Health Inventory and Nasal Outcomes (RHINO) Scale: Translation, Cross-Cultural Adaptation and Validation for Hebrew-Speaking Patients.

Patient-reported outcomes questionnaires are accepted measurement tools to evaluate procedures results. The Rhinoplasty Health Inventory and Nasal Outcomes (RHINO) scale is an English-language validated and reliable quality-of-life instrument that evaluates both functional and aesthetic outcomes after rhinoplasty, and is not available in Hebrew. We followed the forward-and-back-translation method, defined by the European Organization for Research and Treatment of Cancer. Translation of the RHINO scale and merging it into one version were performed, following back-translation and validation on native Hebrew-speaking patients who underwent rhinoplasty and control healthy group. Lastly, we review and analyzed the results. The translated questionnaire had high reliability measures, demonstrating homogeneity (α value 0.800 in the rhinoplasty group and 0.896 in the control group), test-retest reproducibility with no significant difference (p = 0.5), and high agreement scores represented by the Bland-Altman plot (95% limits of agreement ranged from 8.78 to 9.80). Validity demonstrated by significant differences between the two study groups' mean questionnaire scores (p < 0.001 for rhinoplasty vs. controls, p < 0.001 for preoperative vs. postoperative, and p = 0.002 for postoperative vs. control group) and also between the aesthetic scores and functional scores of the rhinoplasty group before and after the surgery (p < 0.001). There were no reported understanding problems. The Hebrew version of the RHINO scale is a reliable and valid tool for pre- and post-rhinoplasty surgery outcomes measuring among Hebrew-speaking patients, and can improve coordination of expectations, follow-up, and quantify subjective evaluation of the surgery. Level of evidence: IV.

Incidental Laryngeal Findings in Routine Laryngopharyngeal Reflux Diagnosis.

BACKGROUND: Laryngopharyngeal reflux (LPR) refers to the backflow of acidic stomach content into the larynx, pharynx, and upper aerodigestive tract. The diagnosis of LPR is based on the patient's history and findings of the laryngoscopy associated with LPR. Other possible manifestations consistent with LPR symptoms include laryngeal cancer, vocal fold granulomas, Reinke's space edema, and vocal polyps. In this study, we compared the characteristics of patients with LPR symptoms and incidental laryngeal findings (ILF) in the laryngoscopic evaluation to those without ILF (WILF). OBJECTIVES: Determine the characteristics of LPR-symptomatic patients with ILF versus WILF. METHODS: In this retrospective study, we examined 160 medical charts from patients referred to the otolaryngology clinic at Galilee Medical Center for LPR evaluation 2016-2018. The reflux symptoms index (RSI), reflux finding score (RFS), and demographics of the patient were collected. All patients with a positive RSI score for LPR (RSI > 9) were included, and the profiles of patients with versus without ILF on laryngoscopy examination were compared. RESULTS: Of the 160 patients, 20 (12.5%) had ILF during laryngoscopy. Most had vocal cord findings such as leukoplakia (20%), polyps (15%), and nodules (20%). Hoarseness, throat clearing, swallowing difficulty, breathing difficulties, and total RSI score were significantly higher in patients with ILF. CONCLUSIONS: Evaluation of LPR symptoms may provide otolaryngologists with a tool to identify patients with other findings on fiberoptic laryngoscopy. A laryngoscopic examination should be part of the examination of every patient with LPR to enable diagnosis of incidental findings.

Cross-cultural adaptation of the Hebrew Nasal Obstruction Symptom Evaluation (NOSE) scale.

Objective: Nasal obstruction is a common complaint. The Nasal Obstruction Symptom Evaluation scale (NOSE) is a reliable validated tool used to assess the quality of life of patients with nasal obstruction. The purpose of this study is to validate the Hebrew version of the NOSE scale (He-NOSE). Methods: A prospective instrument validation was conducted. The NOSE scale was translated primarily from English to Hebrew and then back from Hebrew to English according to the accepted guidelines of the cross-cultural adaptation process. The study group included surgery candidates suffering from nasal obstruction due to a deviated nasal septum and/or inferior turbinate hypertrophy. The study group completed the validated He-NOSE questionnaire twice prior to the surgery and once again, a month post-surgery. A control group of individuals with no history of nasal complaints or surgeries was asked to complete the questionnaire once. Reliability, internal consistency, validity, and responsiveness to change of the He-NOSE were evaluated. Results: Fifty-three patients and 100 controls were included in this study. The scale showed excellent ability to discriminate between the study and the control group, exhibiting significantly lower scores in the control group (73.8 and 7 average scores respectively, p < .001). Good internal consistency (Cronbach's alpha .71 and .76) and test-retest reliability (Spearman rank correlation r = .752, p < .0001) were measured. Moreover, the scale revealed remarkable responsiveness to change (p < .00001). Conclusion: The translated and adapted He-NOSE scale can be a useful tool to be applied in both clinical and research fields when assessing nasal obstruction. Level of evidence: N/A.

Reasons underlying the intention to vaccinate children aged 5-11 against COVID-19: A cross-sectional study of parents in Israel, November 2021.

Vaccination is a key tool to mitigate impacts of the COVID-19 pandemic. In Israel, COVID-19 vaccines became available to adults in December 2020 and to 5-11-year-old children in November 2021. Ahead of the vaccine roll-out in children, we aimed to determine whether surveyed parents intended to vaccinate their children and describe reasons for their intentions. We collected information on parental socio-demographic characteristics, COVID-19 vaccine history, intention to vaccinate their children against COVID-19, and reasons for parental decisions using an anonymous online survey. We identified associations between parental characteristics and plans to vaccinate children using a logistic regression model and described reasons for intentions to vaccinate or not. Parental non-vaccination and having experienced major vaccination side effects were strongly associated with non-intention to vaccinate their children (OR 0.09 and 0.18 respectively, p < .001). Parents who were younger, lived in the socio-economically deprived periphery, and belonged to the Arab population had lower intentions to vaccinate their children. Reasons for non-intention to vaccinate included concerns about vaccine safety and efficacy (53%, 95%CI 50-56) and the belief that COVID-19 is a mild disease (73%, 95%CI 73-79), while a frequent motive for vaccination was the return to normal social and educational life (89%, 95%CI 87-91). Understanding rationales for COVID-19 vaccine rejection or acceptance, as well as parental demographic data, can pave the way for intentional educational campaigns to encourage not only vaccination against COVID-19, but also regular childhood vaccine programming.

Parental intention to vaccinate children aged 5-11 is much lower than vaccine coverage in parental age groupsBeing unvaccinated and having experienced side effects following vaccination were the greatest negative predictors in parents of intention to vaccinate their childrenParents were more likely to accept a COVID-19 vaccine for their children to allow them to return to daily social life and to ensure economic security in the familyParents were more likely to reject a COVID-19 vaccination for health reasons such as safety concerns or due the belief that COVID-19 was a mild disease in children.

Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness.

OBJECTIVE: Studies have demonstrated a potential correlation between low vitamin D status and both an increased risk of infection with SARS-CoV-2 and poorer clinical outcomes. This retrospective study examines if, and to what degree, a relationship exists between pre-infection serum 25-hydroxyvitamin D (25(OH)D) level and disease severity and mortality due to SARS-CoV-2. PARTICIPANTS: The records of individuals admitted between April 7th, 2020 and February 4th, 2021 to the Galilee Medical Center (GMC) in Nahariya, Israel, with positive polymerase chain reaction (PCR) tests for SARS-CoV-2 (COVID-19) were searched for historical 25(OH)D levels measured 14 to 730 days prior to the positive PCR test. DESIGN: Patients admitted to GMC with COVID-19 were categorized according to disease severity and level of 25(OH)D. An association between pre-infection 25(OH)D levels, divided between four categories (deficient, insufficient, adequate, and high-normal), and COVID-19 severity was ascertained utilizing a multivariable regression analysis. To isolate the possible influence of the sinusoidal pattern of seasonal 25(OH)D changes throughout the year, a cosinor model was used. RESULTS: Of 1176 patients admitted, 253 had records of a 25(OH)D level prior to COVID-19 infection. A lower vitamin D status was more common in patients with the severe or critical disease (<20 ng/mL [87.4%]) than in individuals with mild or moderate disease (<20 ng/mL [34.3%] p < 0.001). Patients with vitamin D deficiency (<20 ng/mL) were 14 times more likely to have severe or critical disease than patients with 25(OH)D ≥40 ng/mL (odds ratio [OR], 14; 95% confidence interval [CI], 4 to 51; p < 0.001). CONCLUSIONS: Among hospitalized COVID-19 patients, pre-infection deficiency of vitamin D was associated with increased disease severity and mortality.

Inter-Rater Variability of Reflux Finding Score Amongst Otolaryngologists.

BACKGROUND: Laryngopharyngeal reflux (LPR) is an extra-oesophageal variant of gastro-oesophgeal reflux disease. Patients often do not present with the classic reflux symptoms of heartburn or regurgitation. Accurate diagnosis of LPR can be challenging. The reflux finding score (RFS) is system based on the assessment of eight parameters seen on fibre optic laryngoscopy, used to determine the presence and the severity of laryngopharyngeal reflux (LPR). Scoring the RFS is subjective and highly dependent on the examiner's eye and experience. In this study, we investigated the inter-rater reliability between three otolaryngologists scoring a large library of video-recorded laryngoscopies for RFS. AIM: To evaluate the usefulness of RFS in daily clinical practice by assessing inter-rater reliability among otolaryngologists when interpreting a bank of identical fibre optic laryngoscopy examinations. METHOD: Three board-certified otolaryngologists with different subspecialist interests examined video-recorded fibre optic laryngoscopies of 193 patients with or without LPR symptoms and rated each video for RFS. Statistical analysis was performed. Results were compared to determine the inter-rater reliability. RESULTS: Fair to poor correlation was found between the three expert raters for total RFS score, as well as for RFS component items with nonbinary outcomes. For the dichotomous items, the inter-rater reliability was slight to moderate. Inter-rater correlation for determining whether an examination is pathological or nonpathological was fair. CONCLUSION: The RFS alone was not reliable for confirming the diagnosis of LPR, due to low inter-rater reliability and the subjective nature of the scoring system.

Impact of Tonsillectomy on the Life Quality of Parents to Children With Obstructive Sleep-Disordered Breathing.

OBJECTIVE: Parents of children with any chronic illness may experience increased anxiety and reduced health-related quality of life (QoL). Our objective was to evaluate the change in parental QoL before vs after tonsillectomy. Our hypothesis was that pediatric tonsil surgery with or without adenoidectomy would improve parental QoL. STUDY DESIGN: A prospective cohort study. SETTING: An otolaryngology department in a tertiary academic center. METHODS: We enrolled parents of 79 children <5 years old. Adenotonsillectomy due to an obstructive airway indication was performed in 45 children. A group of 34 parents to healthy children served as a control group. Initially, we validated a modified version of the PAR-ENT-QoL questionnaire; then, we analyzed QoL parameters among parents of children with obstructive sleep-disordered breathing before and after surgical treatment. RESULTS: We found significant differences between the QoL score before and after surgery (P = .003). The QoL score after surgery significantly improved and was even lower than that of the control group (P < .001). CONCLUSIONS: These results highlight the importance of timely diagnosis and treatment of children with obstructive sleep-disordered breathing, as this condition may affect not only the children themselves but also their caregivers.

Vaccine hesitancy due to vaccine country of origin, vaccine technology, and certification.

Vaccine hesitancy is a global health threat which may hinder the widespread acceptance of several COVID-19 vaccines. Following the collection of 2470 responses from an anonymous questionnaire distributed between October and November 2020 across Israel, we analyzed the responses of physicians, life science graduates (biology, virology, chemistry, etc.), and the general public to whether they would obtain a COVID-19 vaccine with particular vaccine characteristics such as vaccine country of origin, technology, side effect profile, efficacy, and other attributes. Physicians and life science graduates were least likely to accept a vaccine based on mRNA technology (30%) while the general population seemed to adopt any vaccine technology if the declared efficacy is above 90% and the country of manufacturing is the USA/UK rather than China or Russia. However, current inoculation rates in Israel far outpace our predicted rate. Our results highlight the importance of tailored vaccine educational campaigns based on population demographic details and specific vaccine concerns.

Auditory Performance in Recovered SARS-COV-2 Patients.

OBJECTIVE: While COVID-19 symptoms impact rhinology (anosmia) and laryngology (airways), two major disciplines of the otolaryngology armamentarium, the virus has seemed to spare the auditory system. A recent study, however, reported changes in otoacoustic emission (OAE) signals measured in SARS-COV-2 positive patients. We sought to assess the effect of COVID-19 infection on auditory performance in a cohort of recovered SARS-COV-2 patients and controls. To avoid a potential bias of previous audiological dysfunction not related to SARS-COV-2 infection, the study encompasses patients with normal auditory history. We hypothesized that if SARS-COV-2 infection predisposes to hearing loss, we would observe subtle and early audiometric deficits in our cohort in the form of subclinical auditory changes. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary referral center. PATIENTS: The Institutional Review Board approved the study and we recruited participants who had been positive for SARS-COV-2 infection, according to an Reverse Transcription Polymerase Chain Reaction (RT-PCR) test on two nasopharyngeal swabs. The patients included in this study were asymptomatic for the SARS-COV-2 infection and were evaluated following recovery, confirmed by repeated swab testing. The control group comprised healthy individuals matched for age and sex, and with a normal auditory and otologic history. INTERVENTIONS: The eligibility to participate in this study included a normal audiogram, no previous auditory symptoms, normal otoscopy examination with an intact tympanic membrane, and bilateral tympanometry type A. None of our volunteers reported any new auditory symptoms following SARS-COV-2 infection. Ototacoustic emissions (OAE) and auditory brainstem response (ABR) measurements were used to evaluate the auditory function. MAIN OUTCOME MEASURES: OAE and ABR measurements. RESULTS: We have found no significant differences between recovered asymptomatic SARS-COV-2 patients and controls in any of transitory evoked otoacoustic emission (TEOAE), distortion product otoacoustic emissions (DPOAE), or ABR responses. CONCLUSIONS: There is no cochlear dysfunction represented by ABR, TEOAE, and DPOAE responses in recovered COVID-19 asymptomatic patients. Retrocochlear function was also preserved as evident by the ABR responses. A long-term evaluation of a larger cohort of SARS-COV-2 patients will help to identify a possible contribution of SARS-COV-2 infection to recently published anecdotal auditory symptoms associated with COVID-19.

COVID-19 Vaccine Acceptance Among Dental Professionals Based on Employment Status During the Pandemic.

The COVID-19 pandemic spread rapidly across the globe, leading governments to impose prolonged lockdowns on both movement and commerce. Although lockdowns decrease the rates of novel infections, they can have devastating consequences on the economy and employment levels. One of the most severely affected sectors during this crisis has been dental medicine. Dental professionals are uniquely exposed to environments with high levels of occupational hazards, conferring additional risks of viral exposure and transmission. We analyzed 506 anonymous questionnaires completed by dentists and residents regarding acceptance of a future potential SARS-CoV-2 vaccine. Our results demonstrate a statistically significant correlation between the individual's unemployment rate and their willingness to inoculate with a SARS-CoV-2 vaccine when it becomes available. This information can be used to predict trends of vaccine acceptance or rejection based on economic burden during the COVID-19 pandemic by different sectors as part of the preparedness toward global vaccination programs.

Translation and cultural adaptation of the Hebrew version of the Pediatric Sleep Questionnaire: a prospective, non-randomized control trial.

PURPOSE: Left untreated, obstructive sleep-disordered breathing (OSDB) are associated with adverse effects on growth and development. History and physical examination alone are used for diagnosing children with OSDB, as polysomnography is not always feasible. Our objective was to develop and validate a Hebrew version of the Pediatric Sleep Questionnaire (PSQ) to help to diagnose and follow-up children before and after adenotonsillectomy surgery for OSDB. METHODS: We conducted a prospective, nonrandomized, controlled trial in an academic medical center. We enrolled parents of children younger than 5 years of age planned for tonsillectomy with or without adenoidectomy due to obstructive airway indication. The parents completed the validated Hebrew version of PSQ questionnaire before and after surgery. We translated the questionnaire through forward-backward translation method. Our main outcome measures were reliability, validity, and responsiveness of the Hebrew version of PSQ. RESULTS: Overall, 45 parents of children with OSDB and 34 controls filled out the questionnaires. We found significant differences between the PSQ scores before and after surgery (p < 0.001). The Hebrew version of PSQ results after surgery were similar to those of the control group (p = 0.206), as expected. We found high reliability of the Hebrew version of PSQ before surgery (α = 0.931). The translated PSQ had a high specificity (87.9%) and sensitivity (77.3%) to identify children with OSDB. CONCLUSION: The Hebrew version of the validated PSQ for parents to children with OSDB can be used as a reliable screening and diagnostic tool to identify children suffering from OSDB, when polysomnography is not feasible.

Local Delivery of Mometasone Furoate from an Eluting Endotracheal Tube Reduces Airway Morbidity Following Long-Term Animal Intubation.

BACKGROUND: upper airway complications are common sequelae of endotracheal tube (ETT) intubation, and systemic corticosteroids are considered a mainstay treatment for this problem. Drug-eluting ETT may present an attractive option for topical steroid delivery while avoiding systemic side effects and improving the therapeutic outcome. The objective of the present study is to evaluate the reduction of tube-related tracheal morbidity via a self-designed steroid-eluting ETT with controlled sustained release properties in an animal model. METHODS: steroid-eluting ETTs were coated by poly(lactic-co-glycolic acid) -electrospun nanofibers loaded with mometasone furoate (MF) as a model drug. Animals were randomly assigned into three equal groups: non-intubated, blank-ETT, and loaded-ETT. The intubation interval was 1 week. Specimens were analyzed by histology, specific fibrosis staining, and scanning electron microscopy (SEM). RESULTS: the blank-ETT group exhibited a significant increase in tracheal mucosal thickness compared to the loaded-ETT and control groups. Average tracheal mucosal thickness was 112 ± 34, 242 ± 49, and 113 ± 43 µm in the control, blank-ETT, and loaded-ETT groups, respectively. The blank-ETT group exhibited a significant increase in tracheal fibrosis compared to the loaded-ETT and control groups. Relative fibrosis values were 0.07 ± 0.05, 0.154 ± 0.1, and 0.0984 ± 0.084% for the control, blank-ETT, and loaded-ETT groups, respectively. While SEM imaging showed normal surface structures in the control group, intubated blank-ETT rats showed severe surface structural damage, whereas only mild damage was observed in the loaded-ETT group. CONCLUSIONS: local sustained release of MF via a self-designed drug-eluting ETT is a potential therapeutic approach which may significantly reduce tube-related upper airway morbidity.

Conjunctivodacryocystorhinostomy (CDCR) success rates and complications in endoscopic vs non-endoscopic approaches: a systematic review.

BACKGROUND: Epiphora due to refractory bicanalicular obstructions is typically managed by conjunctivodacryocystorhinostomy (CDCR) with or without the assistance of nasal endoscopy. However, the evidence for its benefit is unclear. METHODS: A systematic review of the literature on the treatment of epiphora by CDCR was performed (March 1, 2018). All studies reporting original data on patients suffering from epiphora treated with CDCR surgery were included. Primary outcomes were success and satisfaction rates. Secondary outcomes were CDCR complications. A comparison was made between the results obtained in patients undergoing CDCR with vs without assistance of nasal endoscopy. RESULTS: Fifty-four studies representing information on 2555 CDCR procedures were included in the systematic review. All the studies are case series, most of them retrospective. Lester Jones tube (LJT) is the most commonly used in CDCR (66.7%). The overall success rate with all studies included (n = 2555) was 88.9%; 90.8% (n = 890) in CDCR with assistance of nasal endoscope and 87.7% (n = 1575) in the non-endoscopic approach. The overall "tube displacement" rate, the most common complication, was 24.5% (n = 2522), 20.8% (n = 1575) tube displacement in CDCR with assistance of nasal endoscope vs 26.7% (n = 1575) in the non-endoscopic approach. Only 3 studies (5.5%) used patient-reported outcome measures (PROMs) to evaluate epiphora improvement. Due to the low level of evidence and the high bias of the studies, a meta-analysis was not performed. CONCLUSION: Based on the data available in the literature, CDCR is considered an effective procedure for treating epiphora due to proximal obstruction. Controlled and qualitative studies are needed to clarify the significance of the endoscope's contribution to CDCR.

The effect of an interventional program on the occurrence of medication errors in children.

OBJECTIVES: Medication errors in hospitalized children represent a serious health problem; these include dosing errors, administration route errors, errors in identifying the patient and more. The rates of medication errors are considered higher in children compared to adults because, among other reasons, the pediatric dose is calculated according to the child's weight or body surface. This study aims to examine the incidence of pediatric medication dosing errors and the impact of an intervention program in reducing these errors and related adverse effects in a cohort of hospitalized children at an otolaryngology department. METHODS: We reviewed 100 computerized medical reports of hospitalized children from 2017 to 2018, including 50 inpatient admissions prior to the implementation of an intervention program and 50 inpatient admissions following its implementation. Data includes demographic variables, number of hospitalization days, rates and types of medication errors and adverse effects. We have analyzed the rates of medication errors before and after implementation of an interventional program. RESULTS: The average patient age was 5.26 and the demographic features of the two groups were similar. We identified 23.2% medication dosing errors in medications prescribed to the patients (n = 33) and 17.6% medication dosing errors in total medications administered to the patients (n = 64) in the pre-intervention group (PREG). In the post-intervention group (POSG) we identified 10.6% medication dosing errors in prescriptions prescribed to the patients (n = 12) and 7% medication dosing errors in the total drugs administered to the patients (n = 21). The intervention program resulted in 46% reduction of prescription errors; No adverse effects were recorded. CONCLUSIONS: Medication dosing errors among hospitalized children are common, although rates of adverse events are low. The suggested intervention program demonstrates a significant reduction in the rates of these errors, thus improving the safety of hospitalized children.

Vaccine hesitancy: the next challenge in the fight against COVID-19.

Vaccine hesitancy remains a barrier to full population inoculation against highly infectious diseases. Coincident with the rapid developments of COVID-19 vaccines globally, concerns about the safety of such a vaccine could contribute to vaccine hesitancy. We analyzed 1941 anonymous questionnaires completed by healthcare workers and members of the general Israeli population, regarding acceptance of a potential COVID-19 vaccine. Our results indicate that healthcare staff involved in the care of COVID-19 positive patients, and individuals considering themselves at risk of disease, were more likely to self-report acquiescence to COVID-19 vaccination if and when available. In contrast, parents, nurses, and medical workers not caring for SARS-CoV-2 positive patients expressed higher levels of vaccine hesitancy. Interventional educational campaigns targeted towards populations at risk of vaccine hesitancy are therefore urgently needed to combat misinformation and avoid low inoculation rates.

Sino-nasal outcome test-22: Cross-cultural adaptation and validation in Russian speaking patients.

BACKGROUND: Chronic rhinosinusitis (CRS) is a relatively common disease, which significantly affects the patient's quality of life (QoL). Sino-Nasal Outcome Test-22 (SNOT-22) is a QoL questionnaire, which allows quantifying patients' complaints. Our aim was to translate and validated the SNOT-22 into the Russian language. METHODS: Translation and validation of SNOT-22 questionnaire was performed through forward-backward translation technique. After proper translation, the translated questionnaire was completed by CRS patients before and after endoscopic sinus surgery (ESS) and by healthy individuals as controls. RESULTS: Thirty-four native Russian-speaking CRS patients completed the Russian version of the SNOT-22 questionnaire before and after ESS. The internal consistency for reliability assessment was very good (mean Cronbach's alpha = 0.816 for CRS patients). Mean scores for the preoperative, postoperative and control groups were 67.6, 18.1 and 9.2, respectively (P < .001), showing validity and responsiveness of the questionnaire. CONCLUSION: The Russian version of the SNOT-22 questionnaire is a valid outcome measure for patients with CRS.

United by Hope, Divided by Access: Country Mapping of COVID-19 Information Accessibility and Its Consequences on Pandemic Eradication.

Many government websites and mobile content are inaccessible for people with vision, hearing, cognitive, and motor impairments. The COVID-19 pandemic highlighted these disparities when health authority website information, critical in providing resources for curbing the spread of the virus, remained inaccessible for numerous disabled populations. The Web Content Accessibility Guidelines provide comparatively universally accepted guidelines for website accessibility. We utilized these parameters to examine the number of countries with or without accessible health authority websites. The resulting data indicate a dearth of countries with websites accessible for persons with disabilities. Methods of information dissemination must take into consideration individuals with disabilities, particularly in times of global health crises.