Comparison of Hemodynamics in Jet Ventilation vs. Intermittent Apnea for Airway Stenosis Surgery.

OBJECTIVE: The objective of this study is to assess the impact of two different ventilation techniques, jet ventilation and apneic anesthesia with intermittent ventilation (AAIV), on patient hemodynamics and operative time during endoscopic laryngotracheal stenosis surgery. METHODS: Retrospective chart review of patients who underwent airway dilation for laryngotracheal stenosis by a single surgeon at a single institution from October 1, 2000 through January 2, 2020. Logistic regression, Mann-Whitney U tests and chi square analysis were used to determine statistical significance. RESULTS: A total of 157 patients, 43 (27.4%) male and 114 (72.6%) female, and 605 total encounters were included for analysis. There were no significant differences in hemodynamic outcomes when comparing the AAIV and jet ventilation groups. Specifically, there was no significant difference in either peak end-tidal CO2 or nadir O2 saturation between the AAIV and jet ventilation groups (p = 0.4016) and (p = 0.1357), respectively. The patients in the AAIV group had a significantly higher median BMI 32.93 (27.40-39.40) compared with 28.80 (24.1-32.65) (p = 0.0001). Although not necessarily clinically significant, patients with higher BMI had lower median O2 nadirs (97.8%) than non-obese patients (99.2%) (p < 0.0001). The median total procedure time was equivalent when comparing the two ventilation techniques. CONCLUSION: AAIV is a safe method of ventilation for patients undergoing endoscopic laryngotracheal stenosis surgery with no significant differences in patient hemodynamics or procedure time when compared with jet ventilation. AAIV was the preferred method of ventilation for obese patients undergoing endoscopic laryngotracheal stenosis surgery. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:1343-1348, 2024.

Investigating Patient Preferences in Medical Student Attire in the Outpatient Otolaryngology Setting.

BACKGROUND: The authors sought to investigate patient preferences on physician and medical student attire in the outpatient otolaryngology setting. METHODS: A prospective sample of 50 (23 males, 27 females) patients presenting to an otolaryngology clinic in a North American teaching hospital, Boston, MA, were included. Patients were seen by a researcher wearing a white coat and either (1) a shirt and tie or (2) surgical scrubs, then completed a Likert-style survey evaluating feelings of trust, comfort, and professionalism. Statistical significance was set at α = 0.05. RESULTS: Most patients (82%, 41/50) believed that attire was important. Men and older patients were significantly more likely to believe attire was important (P = .01 and .005, respectively). Patients were significantly more comfortable when seen by a provider wearing a shirt and tie compared to scrubs (U = 109.5, P = .021); however, there was no difference in feelings of trust or professionalism (P = .5* and .6*, respectively). CONCLUSIONS: Physician attire is important for patients presenting to otolaryngology clinic. Patients favored a white coat with a shirt and tie. Level of Evidence: NA.

Readability of online patient education materials for parents after a failed newborn hearing screen.

OBJECTIVE: A cross-sectional study design was utilized to evaluate the readability of patient education materials on the newborn hearing screen from Google and major institutions. METHODS: The top 55 websites from the Google search "failed newborn hearing screen" and websites from major institutions (the U.S. News & World Report ranked top 10 children's hospitals, the top 5 pediatric otolaryngology fellowships as ranked by Doximity Residency Navigator, the Centers for Disease and Control, the American Academy of Pediatrics and the American Academy of Otolaryngology-Head and Neck Surgery) were compiled. Text from each website was edited to remove extraneous text. Readability grade was calculated using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score, Gunning-Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index, and Automated Readability Index. Intra- and inter-observer reliability were assessed. RESULTS: 26 websites from Google and 29 websites from major institutions were evaluated. From Google, provider-oriented websites (n = 2) were more difficult to read than patient-oriented websites (n = 24) with statistical significance for FKGL (p < 0.001), GFI (p < 0.013) and SMOG (p < 0.001). From the major institutions, more than half were at a reading level that exceeded the average American adult with an average FKGL 9.71 ±â€¯2.69. Intra- and inter-observer reliability were both excellent with an intra-class correlation coefficient for each readability tool ≥0.950 (p < 0.001). CONCLUSION: Online patient education materials about the newborn hearing screen may be too difficult for the average reader. Revisions to these materials and redirection to more readable online resources may be necessary to benefit a more inclusive patient population.