Use of a non-ICU specialty ward for immediate post-operative management of head and neck free flaps; a randomized controlled trial.

OBJECTIVES: Compare length of stay, flap failure rate, medical and surgical complications and cost when patients undergoing head and neck free flap reconstruction are monitored in an intensive care unit (ICU) versus a specialty ward unit postoperatively. MATERIALS AND METHODS: A prospective, non-inferiority, randomized controlled trial was conducted from 7/22/2016 to 9/12/2018 at a single institution. Patients were randomized to the ICU or specialty ward unit. Flap check protocols were identical between the groups. Perioperative and postoperative outcome variables were assessed and compared. RESULTS: 131 patients were enrolled in the study and 118 ultimately underwent head and neck free flap reconstruction. 57 were randomized to the ICU and 61 to the specialty ward unit. There were no significant differences between the ICU and specialty ward unit groups with regard to demographic variables including age, gender, co-morbidities, tobacco or alcohol use, prior chemotherapy or radiation therapy treatment. There were no significant differences in perioperative variables including need for transfusion, tracheostomy, ischemia time, blood loss, fluid administration or post-operative antibiotic use. There was no significant difference in the primary outcome variable, length of stay. There were no significant differences in the number of the medical or surgical complications, flap failure rate, or hospital costs. CONCLUSION: In this prospective, randomized controlled trial, head and neck free-flap patients cared for on a specialty ward in the immediate post-operative period had equivalent outcomes to those cared for in the ICU.

Effects of sensorineural hearing loss on interaural discrimination and virtual localization.

Cross-frequency binaural processing was investigated in listeners with normal hearing (NH) and with bilateral high-frequency sensorineural hearing impairment (IH). In experiment 1 just-noticeable-differences for interaural time and interaural intensity were measured using 1/3-octave narrow-band noises (NBNs) centered at 0.5 and 4 kHz. These stimuli were presented in isolation and in different cross-frequency interaural combinations. IH listeners displayed the best interaural time discrimination when the 0.5-kHz NBN was dichotic and the best intensity discrimination when both bands were dichotic. Both NH listeners (time) and IH listeners (time and intensity) displayed the poorest interaural discrimination when the NBNs were presented simultaneously with interaural differences in only the 4-kHz NBN (0.5 kHz NBN dichotic). Localization accuracy was measured in experiment 2 using the 0.5- and 4-kHz NBNs in isolation and with 0.5-kHz target/4-kHz interferer and 4-kHz target/0.5-kHz interferer conditions. Best localization of NH and IH subjects was seen for the 0.5-kHz target, with or without an interferer. Poorest localization of IH subjects was observed for the 4-kHz target and 0.5-kHz interferer. Results suggest that for these IH subjects, localization is most difficult when they are forced to rely on interaural information in a higher-frequency region with conflicting interaural information at low frequencies.