44.
Nutrients. 2020 Feb 29;12(3). pii: E665. doi: 10.3390/nu12030665.
A Review of Zinc-L-Carnosine and Its Positive Effects on Oral Mucositis, Taste Disorders, and Gastrointestinal Disorders.
Abstract
Zinc-L-carnosine (ZnC), also called polaprezinc known as PepZin GI™, is a chelated compound that contains L-carnosine and zinc. It is a relatively new molecule and has been associated with multiple health benefits. There are several studies that support ZnC's benefits in restoring the gastric lining, healing other parts of the gastrointestinal (GI) tract, improving taste disorders, improving GI disorders, and enhancing skin and liver. Oral mucositis is a common complication of cytotoxic radiotherapy and/or chemotherapy. It occurs in almost every person with head and neck cancer who receive radiotherapy. It is often overlooked because it is not considered life threatening. However, mucositis often leads to a decreased quality of life and cessation of treatment, ultimately decreasing positive outcomes. Therefore, solutions to address it should be considered. The primary mechanisms of action are thought to be localized and related to ZnC's anti-inflammatory and antioxidant functions. Therefore, the purpose of this review is to discuss the research related to ZnC and to explore its benefits, especially in the management of conditions related to damaged epithelial cells, such as oral mucositis. Evidence supports the safety and efficacy of ZnC for the maintenance, prevention, and treatment of the mucosal lining and other epithelial tissues. The research supports its use for gastric ulcers (approved in Japan) and conditions of the upper GI and suggests other applications, particularly for oral mucositis.
KEYWORDS:
carnosine; oral mucositis; taste disorders; zinc
45.
Microorganisms. 2020 Feb 29;8(3). pii: E345. doi: 10.3390/microorganisms8030345.
Strategies to Prevent Biofilm Infections on Biomaterials: Effect of Novel Naturally-Derived Biofilm Inhibitors on a Competitive Colonization Model of Titanium by Staphylococcus aureus and SaOS-2 Cells.
Reigada I1, Pérez-Tanoira R2,3, Patel JZ4, Savijoki K1, Yli-Kauhaluoma J4, Kinnari TJ2, Fallarero A1.
Abstract
Biofilm-mediated infection is a major cause of bone prosthesis failure. The lack of molecules able to act in biofilms has driven research aimed at identifying new anti-biofilm agents via chemical screens. However, to be able to accommodate a large number of compounds, the testing conditions of these screenings end up being typically far from the clinical scenario. In this study, we assess the potential applicability of three previously discovered anti-biofilm compounds to be part of implanted medical devices by testing them on in vitro systems that more closely resemble the clinical scenario. To that end, we used a competition model based on the co-culture of SaOS-2 mammalian cells and Staphylococcus aureus (collection and clinical strains) on a titanium surface, as well as titanium pre-conditioned with high serum protein concentration. Additionally, we studied whether these compounds enhance the previously proven protective effect of pre-incubating titanium with SaOS-2 cells. Out of the three, DHA1 was the one with the highest potential, showing a preventive effect on bacterial adherence in all tested conditions, making it the most promising agent for incorporation into bone implants. This study emphasizes and demonstrates the importance of using meaningful experimental models, where potential antimicrobials ought to be tested for the protection of biomaterials in translational applications.
KEYWORDS:
SaOS-2; Staphylococcus aureus; biofilm; biomaterials; co-culture; implanted devices
46.
Int J Mol Sci. 2020 Feb 28;21(5). pii: E1661. doi: 10.3390/ijms21051661.
Cell-Type Specific Metabolic Response of Cancer Cells to Curcumin.
Abstract
In order to support uncontrolled proliferation, cancer cells need to adapt to increased energetic and biosynthetic requirements. One such adjustment is aerobic glycolysis or the Warburg effect. It is characterized by increased glucose uptake and lactate production. Curcumin, a natural compound, has been shown to interact with multiple molecules and signaling pathways in cancer cells, including those relevant for cell metabolism. The effect of curcumin and its solvent, ethanol, was explored on four different cancer cell lines, in which the Warburg effect varied. Vital cellular parameters (proliferation, viability) were measured along with the glucose consumption and lactate production. The transcripts of pyruvate kinase 1 and 2 (PKM1, PKM2), serine hydroxymethyltransferase 2 (SHMT2) and phosphoglycerate dehydrogenase (PHGDH) were quantified with RT-qPCR. The amount and intracellular localization of PKM1, PKM2 and signal transducer and activator of transcription 3 (STAT3) proteins were analyzed by Western blot. The response to ethanol and curcumin seemed to be cell-type specific, with respect to all parameters analyzed. High sensitivity to curcumin was present in the cell lines originating from head and neck squamous cell carcinomas: FaDu, Detroit 562 and, especially, Cal27. Very low sensitivity was observed in the colon adenocarcinoma-originating HT-29 cell line, which retained, after exposure to curcumin, a higher levels of lactate production despite decreased glucose consumption. The effects of ethanol were significant.
KEYWORDS:
PHGDH; PKM1; PKM2; SHMT2; STAT3; ethanol; intracellular localization; serine
47.
Cancers (Basel). 2020 Feb 28;12(3). pii: E557. doi: 10.3390/cancers12030557.
Can Bioelectrical Impedance Analysis and BMI be a Prognostic Tool in Head and Neck Cancer Patients? A Review of the Evidence.
Abstract
Keywords: head and neck cancer; bioelectrical impedance analysis; body mass index; weight loss; prognostic factor.
48.
Cancers (Basel). 2020 Feb 27;12(3). pii: E552. doi: 10.3390/cancers12030552.
Evaluation of the 8th Edition TNM Classification for Anaplastic Thyroid Carcinoma.
Onoda N1,2, Sugitani I1,3, Ito KI1,4, Suzuki A1,5, Higashiyama T1,6, Fukumori T1,7, Suganuma N1,8, Masudo K1,9, Nakayama H1,10, Uno A1,11, Yane K1,12, Yoshimoto S1,13, Ebina A1,14, Kawasaki Y1,15, Maeda S1,16, Iwadate M1,17, Suzuki S1,17.
Abstract
BACKGROUND:
The tumor-node-metastasis (TNM) classification system to categorized anaplastic thyroid cancer (ATC) was revised.
METHODS:
The revised system was evaluated using a large database of ATC patients.
RESULTS:
A total of 757 patients were analyzed. The proportion and median overall survival values (OS: months) for each T category were T1 (n = 8, 1.1%, 12.5), T2 (n = 43, 5.7%, 10.9), T3a (n = 117, 15.5%, 5.7), T3b (n = 438, 57.9%, 3.9), and T4 (n = 151, 19.9%, 5.0). The OS of the N0 and N1 patients were 5.9 and 4.3, respectively (log-rank p < 0.01). Sixty-three (58.3%) patients migrated from stage IV A to IV B by revision based on the existence of nodal involvement and 422 patients (55.7%) were stratified into stage IV B, without a worsening of their OS (6.1), leaving 45 patients (5.9%) in stage IV A with fair OS (15.8). The hazard ratios for the survival of the patients of stage IV B compared to stage IV A increased from 1.1 to 2.1 by the revision. No change was made for stage IV C (n = 290, 38.8%, 2.8).
CONCLUSION:
The revised TNM system clearly indicated the prognoses of ATC patients by extracting rare patients with fair prognoses as having stage IV A disease and categorized many heterogeneous patients in stage IV B.
KEYWORDS:
TNM classification; anaplastic thyroid cancer; disease stage; prognosis; prognostic index
49.
Nature. 2020 Feb;578(7795):367-369. doi: 10.1038/d41586-020-00328-6.
Loss of p53 protein strikes a nerve to aid tumour growth.
KEYWORDS:
Cancer; Medical research; Neuroscience
Comment on
50.
BMC Med Genet. 2020 Jan 2;21(1):1. doi: 10.1186/s12881-019-0942-4.
Post-lingual non-syndromic hearing loss phenotype: a polygenic case with 2 biallelic mutations in MYO15A and MITF.
Abstract
BACKGROUND:
Hearing loss (HL) represents the most common congenital sensory impairment with an incidence of 1-5 per 1000 live births. Non-syndromic hearing loss (NSHL) is an isolated finding that is not part of any other disorder accounting for 70% of all genetic hearing loss cases.
METHODS:
In the current study, we reported a polygenic mode of inheritance in an NSHL consanguineous family using exome sequencing technology and we evaluated the possible effect of the detected single nucleotide variants (SNVs) using in silico methods.
RESULTS:
Two bi-allelic SNVs were detected in the affected patients; a MYO15A (. p.V485A) variant, and a novel MITF (p.P338L) variant. Along with these homozygous mutations, we detected two heterozygous variants in well described hearing loss genes (MYO7A and MYH14). The novel MITF p. Pro338Leu missense mutation was predicted to change the protein structure and function.
CONCLUSION:
A novel MITF mutation along with a previously described MYO15A mutation segregate with an autosomal recessive non-syndromic HL case with a post-lingual onset. The findings highlight the importance of carrying whole exome sequencing for a comprehensive assessment of HL genetic heterogeneity.
KEYWORDS:
Congenital hearing loss; MITF; MYO15A; Non-syndromic hearing loss; Whole exome sequencing
- PMID:
- 31898538
- PMCID:
- PMC6941291
- DOI:
- 10.1186/s12881-019-0942-4
- [Indexed for MEDLINE]
51.
Environ Sci Pollut Res Int. 2020 Jan;27(1):562-570. doi: 10.1007/s11356-019-06883-4. Epub 2019 Dec 5.
Urinary biomarkers of polycyclic aromatic hydrocarbons and the association with hearing threshold shifts in the United States adults.
Abstract
Polycyclic aromatic hydrocarbons (PAHs) are regarded as environmental pollutants that contribute to several adverse health outcomes. There is no research evidence to support a connection between PAH exposure and hearing loss. Our study aimed to determine the association between PAH exposure and hearing threshold shifts using the National Health and Nutrition Examination Survey (NHANES) dataset. A cross-sectional study was conducted among 1,071 US adults participating in the NHANES from 2001 to 2004. The association between PAH metabolites and the log-transformed hearing threshold was investigated using multivariate regression models, which included log-transformed, low-frequency and high-frequency thresholds. After additional pertinent adjustments, a positive correlation between PAH metabolite concentration and log-transformed hearing thresholds was observed. Individuals in the fourth quartile of PAH metabolite concentration had higher hearing thresholds compared with those in the first quartile of PAH metabolite concentration. Exposure to PAHs is related to hearing threshold shift at both low and high frequencies in the US adult population.
KEYWORDS:
Polycyclic aromatic hydrocarbons, Hearing threshold, National Health and Nutrition Examination Survey, Hearing impairment, Oxidative stress, Inflammatory stress
52.
J Laryngol Otol. 2019 Dec;133(12):1103-1106. doi: 10.1017/S0022215119002500. Epub 2019 Dec 3.
Analysis of the relationship between changes in the auditory brainstem response and prognosis in patients with sudden hearing loss.
Abstract
OBJECTIVE:
To analyse how the auditory brainstem response changes in patients with sudden sensorineural hearing loss.
METHOD:
Data were collected via retrospective medical chart review.
RESULTS:
Forty-three patients were included in this study. The mean latency of auditory brainstem response wave 1 was significantly longer for the affected side than for the unaffected side (p = 0.003). The mean latency of auditory brainstem response wave 1 was significantly shorter, and the mean amplitude of auditory brainstem response wave 1 was significantly larger, in the good response group compared to the poor response group. In forward conditional logistic regression analysis, auditory brainstem response wave 1 latency was an independent predictor of a good response (odds ratio = 34.37, 95 per cent confidence interval = 1.56-757.15, p = 0.025).
CONCLUSION:
In patients with sudden sensorineural hearing loss, the latency of wave 1 of the auditory brainstem response was significantly increased and was related to prognosis.
KEYWORDS:
Auditory Brain Stem Response; Prognosis; Retrocochlear Diseases; Sensorineural Hearing Loss
53.
Ann Otol Rhinol Laryngol. 2020 Apr;129(4):388-393. doi: 10.1177/0003489419889371. Epub 2019 Nov 28.
The Usefulness of Respiratory Mechanic Instability in Evaluating the Effect of Continuous Positive Airway Pressure for Obstructive Sleep Apnea.
Abstract
OBJECTIVES:
Respiratory mechanics instability (RMI) based on paradoxical movement is correlated with respiratory disturbance such as apnea-hypopnea index (AHI) and reflects the severity of obstructive sleep apnea (OSA). The purpose of this study was to identify RMI as a method for assessing the effectiveness of continuous positive airway pressure (CPAP) in the management for OSA.
METHODS:
A total of 71 consecutive OSA patients with CPAP titration were included in this study. We compared sleep (sleep efficiency, arousal index, and sleep stages), respiratory (AHI, oxygen desaturation index ≥3% [ODI3], and lowest oxygen saturation), and RMI parameters (events, index, duration, and % of stage duration) between diagnostic polysomnography and CPAP titration data.
RESULTS:
All RMI parameters (events [157.5 ± 80.9 vs 80.0 ± 47.1; P < .001], index [25.3 ± 12.4 vs 12.7 ± 7.0; P < .001], duration [182.6 ± 96.2 vs 79.8 ± 88.9; P < .001], and % of stage duration [49.0 ± 24.4 vs 20.5 ± 21.3; P < .001]) were significantly improved by the alleviation of obstructive respiratory disturbance parameters (AHI [45.1 ± 23.0 vs 4.2 ± 4.3; P < .001], ODI3 [44.9 ± 22.6 vs 4.8 ± 4.6; P < .001], and lowest oxygen saturation [77.7 ± 7.3 vs 89.3 ± 3.8; P < .001]) compared to diagnostic polysomnography and CPAP titration data.
CONCLUSION:
RMI may be a useful method for evaluating the effect of CPAP in OSA patients.
KEYWORDS:
apnea-hypopnea index; continuous positive airway pressure; obstructive sleep apnea; respiratory mechanic instability; thoracoabdominal movement
54.
J Laryngol Otol. 2019 Dec;133(12):1059-1063. doi: 10.1017/S0022215119002329. Epub 2019 Nov 27.
Effects of nasal lavage with and without mupirocin after endoscopic endonasal skull base surgery: a randomised, controlled study.
Abstract
BACKGROUND:
Nasal lavage with mupirocin has the potential to reduce sinonasal morbidity in endoscopic endonasal approaches for skull base surgery.
OBJECTIVE:
To evaluate the effects of nasal lavage with and without mupirocin after endoscopic endonasal skull base surgery.
METHODS:
A pilot randomised, controlled trial was conducted on 20 adult patients who had undergone endoscopic endonasal approaches for skull base lesions. These patients were randomly assigned to cohorts using nasal lavages with mupirocin or without mupirocin. Patients were assessed in the out-patient clinic, one week and one month after surgery, using the 22-item Sino-Nasal Outcome Test questionnaire and nasal endoscopy.
RESULTS:
Patients in the mupirocin nasal lavage group had lower nasal endoscopy scores post-operatively, and a statistically significant larger difference in nasal endoscopy scores at one month compared to one week. The mupirocin nasal lavage group also showed better Sino-Nasal Outcome Test scores at one month compared to the group without mupirocin.
CONCLUSION:
Nasal lavage with mupirocin seems to yield better outcomes regarding patients' symptoms and endoscopic findings.
KEYWORDS:
Endoscopic Surgical Procedure; Minimally Invasive Surgery; Mupirocin; Nasal Lavage; Skull Base
55.
BMC Health Serv Res. 2019 Nov 26;19(1):888. doi: 10.1186/s12913-019-4700-2.
Manifestations of verbal and physical violence towards doctors: a comparison between hospital and community doctors.
Abstract
BACKGROUND:
Healthcare workers, in the hospital and in community clinics, are frequently exposed to verbal and physical abuse that can lead to frustration and despair. This study's objectives were to evaluate trends in violence towards hospital and community doctors in the Negev region of Israel and to compare them to the results of a previous 2005 study.
METHODS:
A convenience sample of doctors in the hospital and in the community completed anonymous questionnaires on previous exposure to work place violence and their attitudes to it. The data were collected in 2017.
RESULTS:
One hundred forty-five doctors participated in the study, of who 63 were hospital doctors and 82 were community doctors. Fifty nine percent of the doctors reported that they experienced at least one incident of verbal abuse over the previous year and 9% were exposed to physical abuse, compared to 56 and 9%, respectively, in the previous study. More hospital doctors (58.7%) were exposed to verbal abuse on the part of family members than community doctors (35.8%) (P = 0.007). The most common reason for a violent outbreak was long waiting times, followed by dissatisfaction with treatment, both consistent with the findings in the previous study. Seventy one percent said that violence was a major problem for doctors. The majority (73.9%) had not participated in a workshop or other training for preventing workplace violence or coping with it, an improvement over the 83% who reported not receiving any training in the previous study.
CONCLUSIONS:
Workplace violence is a major issue, which affects hospital and community physicians alike. There is a rise in the number of doctors who have undergone training in this area, although the majority have yet to receive formal training.
KEYWORDS:
Community doctors; Hospital doctors; Physical abuse; Verbal abuse; Violence
- PMID:
- 31771580
- PMCID:
- PMC6880572
- DOI:
- 10.1186/s12913-019-4700-2
- [Indexed for MEDLINE]
56.
Ann Otol Rhinol Laryngol. 2020 Apr;129(4):401-410. doi: 10.1177/0003489419891450. Epub 2019 Nov 24.
Functional and Aesthetic Outcomes of Extracorporeal Septoplasty: A Systematic Review and Meta-Analyses.
Abstract
OBJECTIVE:
The safety and efficacy of extracorporeal septoplasty (ECS) has long been debated. Our objective was to determine this technique's functional and aesthetic outcomes and complications through a systematic review of the literature.
DATA SOURCES:
PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science databases were evaluated for studies detailing functional or aesthetic outcomes of ECS.
REVIEW METHODS:
Bias was evaluated using the Cochrane Risk of Bias Tool and the Methodological Index for Non-randomized Studies (MINORS) score. Aesthetic and functional outcomes in addition to complications were evaluated using subjective and objective measures. Meta-analyses were performed when appropriate.
RESULTS:
Seventeen studies encompassing 1418 patients were included. The average MINORS score for observational studies was 9.2. Overall there was a significant improvement in subjective nasal function with a preoperative average Nasal Obstruction Symptom Evaluation (NOSE) score of 75 (±16) decreasing to 19.5 (±16.5) postoperatively for a mean difference (MD) of -55 (95% confidence interval (CI): -60 to -49.5). In terms of objective nasal function, at 6 months postoperatively, there was an improvement of nasal flow measured by rhinometry ranging from 70 to 71% across studies. Anthropometric measurements were utilized for objective aesthetic outcomes. There was a significant improvement in I-shaped deviations (MD: -2.7°, 95% CI: -5.6 to -0.16) and C-shaped deviations improved by 11.9° (95% CI +2.8-+21.2). Complication rates ranged from 0 to 18%.
CONCLUSION:
ECS can achieve significant improvements in the subjective and objective function of the nose. The associated complication rate is low but variable between surgeons.
KEYWORDS:
NOSE; rhinometry; rhinoplasty; septoplasty; systematic review
57.
Ann Otol Rhinol Laryngol. 2020 Apr;129(4):369-375. doi: 10.1177/0003489419887990. Epub 2019 Nov 21.
Comparison of Referral Pathways in Otolaryngology at a Public Versus Private Academic Center.
Abstract
OBJECTIVE:
Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC).
METHODS:
Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period.
RESULTS:
PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities.
CONCLUSIONS:
Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care.
LEVEL OF EVIDENCE:
2c.
KEYWORDS:
health disparities; process improvement; referrals
58.
Ann Otol Rhinol Laryngol. 2020 Apr;129(4):361-368. doi: 10.1177/0003489419889066. Epub 2019 Nov 20.
Office-Based Steroid Injections for Idiopathic Subglottic Stenosis: Patient-Reported Outcomes, Effect on Stenosis, and Side Effects.
Abstract
OBJECTIVE:
Office-based steroid injection has shown promise for idiopathic subglottic stenosis (iSGS). It is important to understand safety and patient-lived experience. We report patient experience related to airway restriction, voice, and side effects.
METHODS:
Sixteen patients (51 ± 14 years) with mild-moderate (20-50%) stenosis undergoing office-based transnasal steroid injections were included; fourteen had prior operations. Patients typically underwent three injections, 1 month apart, followed by transnasal tracheoscopy 1 month later to evaluate outcome; number of injections can vary based on disease severity and response. Outcomes were Dyspnea Index (DI), Modified Medical Research Council (MMRC) dyspnea scale, voice handicap index-10 (VHI-10), and degree of stenosis (estimated from procedural video). At each visit, patients were queried about post-injection airway restriction and side effects. Paired t-tests compared values at baseline versus follow-up tracheoscopy.
RESULTS:
DI decreased (t = 3.938, P = 0.0013), as did MMRC (t = 2.179, P = 0.0457). There was no change in VHI-10 (t = 1.354; P = 0.1957) scores. Airway stenosis decreased (t = 4.331; P = 0.0006); this was not correlated with change in DI (r = 0.267, P = 0.318). Side effects included airway restriction lasting <48 hours (n = 5), cough (n = 3), and nasal pain (n = 2).
CONCLUSION:
Steroid injections improved upper airway symptoms. Side effects were mild and transient. Improvement in DI did not correlate with percent stenosis.
KEYWORDS:
dyspnea index; idiopathic subglottic stenosis; modified medical research council dyspnea scale; steroid injection; voice handicap index
59.
J Laryngol Otol. 2019 Dec;133(12):1064-1067. doi: 10.1017/S0022215119002330. Epub 2019 Nov 19.
The utility of lateral neck radiographs in the management of fish bones.
Abstract
BACKGROUND:
Lateral neck radiographs are commonly used in the investigation and management of patients presenting with suspected fish bone impaction. The effectiveness of these is questioned, as many fish do not have radio-opaque bones.
OBJECTIVE:
This study evaluated the utility of lateral neck radiographs in the management of patients presenting with fish bones retained in the upper aerodigestive tract, with the creation of a treatment algorithm to guide further management.
METHODS:
An audit of practice was undertaken at the University Hospital of Southampton, identifying all patients admitted with potential fish bone impaction in the upper aerodigestive tract. Following analysis, a treatment algorithm was constructed for use by junior doctors.
RESULTS:
In total, 34 per cent of patients with a normal radiograph were subsequently found to have a fish bone present under local or general anaesthetic assessment. The sensitivity of radiographs in the detection of fish bones was found to be 51.6 per cent.
CONCLUSION:
Lateral neck radiographs have limited value in the management of suspected fish bone impaction, and should only be used following detailed clinical examination of the upper aerodigestive tract.
KEYWORDS:
Algorithms; Hospitals, University; Humans; Otolaryngology; Radiography
60.
J Laryngol Otol. 2019 Dec;133(12):1083-1086. doi: 10.1017/S0022215119002421. Epub 2019 Nov 18.
Reliability of diffusion-weighted magnetic resonance imaging in differentiation of recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy.
Abstract
OBJECTIVE:
To assess the reliability of diffusion-weighted magnetic resonance imaging in differentiating recurrent cholesteatoma from granulation tissue after intact canal wall mastoidectomy.
METHODS:
A prospective study was conducted of 56 consecutive patients with suspected cholesteatoma recurrence after intact canal wall mastoidectomy who underwent diffusion-weighted imaging and delayed contrast magnetic resonance imaging of the temporal bone. The final diagnosis was recurrence in 38 patients and granulation tissue in 18 patients.
RESULTS:
Cholesteatoma detection on diffusion-weighted imaging based on two sets of readings had sensitivity of 94.7 and 94.7 per cent, specificity of 94.4 and 88.9 per cent, and accuracy of 94.6 and 92.8 per cent, with good intra-observer agreement (Κ = 0.72, p = 0.001). Cholesteatoma detection on delayed contrast magnetic resonance imaging had sensitivity of 81.6 and 78.9 per cent, specificity of 77.8 and 66.7 per cent, and accuracy of 80.4 and 75.0 per cent, with fair intra-observer agreement (Κ = 0.57, p = 0.001). The mean cholesteatoma diameter on diffusion-weighted imaging was 7.7 ± 1.8 and 7.9 ± 1.8 mm, with excellent intra-observer agreement (Κ = 0.994, p = 0.001).
CONCLUSION:
Diffusion-weighted imaging is a reliable method for differentiating recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy.
KEYWORDS:
Cholesteatoma; Diffusion-Weighted MRI; Magnetic Resonance Imaging
61.
J Laryngol Otol. 2019 Dec;133(12):1074-1078. doi: 10.1017/S0022215119002408. Epub 2019 Nov 18.
Canal wall down mastoidectomy with obliteration versus canal wall up mastoidectomy in primary cholesteatoma surgery.
Abstract
OBJECTIVE:
This study sought to compare disease recidivism rates between canal wall up mastoidectomy and a canal wall down with obliteration technique.
METHODS:
Patients undergoing primary cholesteatoma surgery at our institution over a five-year period (2013-2017) using the aforementioned techniques were eligible for inclusion in the study. Rates of discharge and disease recidivism were analysed using chi-square statistics.
RESULTS:
A total of 104 ears (98 patients) were included. The mean follow-up period was 30 months (range, 12-52 months). A canal wall down with mastoid obliteration technique was performed in 55 cases and a canal wall up approach was performed in 49 cases. Disease recidivism rates were 7.3 per cent and 16.3 per cent in the canal wall down with mastoid obliteration and canal wall up groups respectively (p = 0.02), whilst discharge rates were similar (7.3 per cent and 10.2 per cent respectively).
CONCLUSION:
Our direct comparative data suggest that canal wall down mastoidectomy with obliteration is superior to a canal wall up technique in primary cholesteatoma surgery, providing a lower recidivism rate combined with a low post-operative ear discharge rate.
KEYWORDS:
Cholesteatoma; Ear, Middle; Mastoidectomy; Otitis Media; Recurrence; Retrospective Studies; Treatment Outcome; Tympanoplasty
62.
Ann Otol Rhinol Laryngol. 2020 Apr;129(4):347-354. doi: 10.1177/0003489419888232. Epub 2019 Nov 18.
Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program.
Abstract
OBJECTIVE:
To identify demographic predictors of patients undergoing cochlear implantation evaluation and surgery.
METHODS:
Consecutive adult patients between 2009 and 2018 who underwent cochlear implantation evaluation at a university cochlear implantation program were retrospectively identified to determine (1) cochlear implantation qualification rate and (2) pursuit of surgery rate with respect to age, gender, race, primary spoken language, marital status, insurance type, and distance to the cochlear implantation center.
RESULTS:
A total of 823 cochlear implantation evaluations were analyzed. Overall, 76.3% of patients qualified for cochlear implantation and 61.5% of these patients pursued surgery. Age was the only independent predictor for cochlear implantation qualification, such that, for each year younger, the odds of qualifying for cochlear implantation increased by 2.5% (OR 0.98; 95% CI: 0.96-0.99). Age, race, marital status, and insurance type were each independent predictors of the decision to pursue surgery. The odds of pursuing surgery increased by 2.8% for each year younger (OR 1.03; 95% CI: 1.01-1.05). Compared to White patients, non-Whites were half as likely to pursue surgery (OR 0.47; 95% CI: 0.25-0.88). Single (OR 0.49; 95% CI: 0.26-0.94) and widowed patients (OR 0.46; 95% CI: 0.23-0.95) were about half as likely to pursue surgery as compared to married patients. Patients with military insurance were 13 times more likely to pursue surgery as compared to patients with Medicare (OR 13.0; 95% CI: 1.67-101.4).
CONCLUSION:
Younger age is an independent predictor for a higher cochlear implantation qualification rate, suggesting the possibility for delayed candidacy referral. Rate of surgical pursuit in qualified cochlear implantation candidates is lower for racial minorities, single and widowed patients, and older patients.
KEYWORDS:
cochlear implantation; demographics; hearing loss
63.
Ann Otol Rhinol Laryngol. 2020 Apr;129(4):333-339. doi: 10.1177/0003489419889373. Epub 2019 Nov 15.
Utility of Audiometry in the Evaluation of Patients Presenting with Dysphonia.
Abstract
OBJECTIVES:
Hearing loss has been implicated in dysphonia secondary to voice misuse, although the data supporting this claim are scant. Determining the prevalence of hearing loss in patients with dysphonia and correlating it with self-perception of vocal handicap may help clarify the value of audiometry in evaluation of patients with dysphonia.
METHODS:
This is a retrospective chart review of all new voice patients (n = 405) presenting with dysphonia to the primary investigator between 2015 and 2018. Each new patient routinely undergoes audiometric and voice objective analyses. Main outcomes measured include prevalence, severity of hearing loss, and voice handicap index-10 (VHI-10).
RESULTS:
Of the 405 subjects reviewed, mean age was 49.0 years (SD = 17.4). 60.7% of subjects were female and 39.3% male. Patients with hearing loss defined as >25 dB in worse ear with pure tone average (PTA) thresholds at 0.5, 1, 2, and 3 kHz (PTA-S) accounted for 18% of the total cohort. The prevalence of previously undiagnosed hearing loss in this cohort was 13.1% (53 of 405 subjects). Of these subjects, 62.3% (33 subjects) reported no perception of hearing loss while 37.7% (20 subjects) suspected they had some hearing loss, yet never sought evaluation. Only increased PTA-S, speech discrimination, Reflux Symptom Index, and female gender demonstrated a significant relationship with VHI-10 when analyzed with multivariate linear regression analysis.
CONCLUSIONS:
The prevalence of hearing loss in patients presenting with dysphonia in this cohort is similar to normative population data. This study has also demonstrated that the majority of these patients did not perceive any hearing loss. The reasons behind this may be a result of or associated with the patients' dysphonia. Furthermore, clinicians should consider performing audiometric evaluation in patients with abnormal VHI-10 scores in the appropriate clinical context.
KEYWORDS:
VHI-10; dysphonia; hearing loss; hoarseness; laryngology; voice
64.
Ann Otol Rhinol Laryngol. 2020 Apr;129(4):326-332. doi: 10.1177/0003489419889069. Epub 2019 Nov 15.
Pediatric Thyroidectomy: NSQIP-P Analysis of Adverse Perioperative Outcomes.
Abstract
BACKGROUND:
This study identifies risk factors and 30-day adverse outcomes of pediatric patients undergoing thyroidectomy.
METHODS:
Retrospective analysis utilizing the American College of Surgeons National Surgical Quality Improvement-Pediatric Database (2015-2016). Study population includes pediatric patients (≤18 years) who underwent hemithyroidectomy (HT), total thyroidectomy (TT), and total thyroidectomy with central neck dissection (TT+ND).
RESULTS:
A total of 720 cases were identified; mean age at time of surgery was 14.1 years, with a female-to-male ratio of 3.4:1. Following hospital discharge, there were 10 related readmissions, with 1 patient requiring reoperation for neck hematoma evacuation. Regression analysis revealed anesthesia time had a significant impact on total length of stay (P = .0020).
CONCLUSION:
Contemporary pediatric thyroidectomy has a low incidence of 30-day general surgical postoperative complications. Future research efforts are necessary once thyroidectomy specific variables are incorporated into ACS-NSQIP-P, which will provide further insights into managing this unique patient population.
KEYWORDS:
NSQIP; malignancy; outcomes; pediatric; thyroidectomy
65.
Ann Otol Rhinol Laryngol. 2020 Apr;129(4):313-325. doi: 10.1177/0003489419888947. Epub 2019 Nov 15.
Validity and Reliability of the Reflux Sign Assessment.
Lechien JR1,2,3,4, Rodriguez Ruiz A1,3, Dequanter D1,3, Bobin F1,5, Mouawad F6, Muls V1,7, Huet K1,4, Harmegnies B1,4, Remacle S8, Finck C1,8, Saussez S1,2,3.
Abstract
OBJECTIVE:
To develop and validate the Reflux Sign Assessment (RSA), a clinical instrument evaluating the physical findings of laryngopharyngeal reflux (LPR).
METHODS:
A total of 106 patients completed a 3-month treatment based on the association of diet, pantoprazole, alginate, or magaldrate with the LPR characteristics (acid, nonacid, mixed). Forty-two asymptomatic individuals completed the study (control group). The RSA results and reflux finding score (RFS) were documented for the LPR patients at baseline and after treatment. Intrarater reliability was assessed through a test-retest blinded evaluation of signs (7-day intervals). Interrater reliability was assessed by comparing the RSA evaluations of three blinded otolaryngologists through Kendall's W. Responsiveness to change was evaluated through a comparison of the baseline and 3-month posttreatment findings. The RSA cutoffs for determining the presence and absence of LPR were examined by receiver operating characteristic (ROC) analysis.
RESULTS:
A total of 102 LPR patients completed the study (68 females). The mean age was 53 years. The mean RSA at baseline was 25.95 ± 9.58; it significantly improved to 18.96 ± 7.58 after 3 months of therapy (P < .001). RSA exhibited good intra- (r = 0.813) and interrater (Kendall's W = 0.663) reliabilities (N = 56). There was no significant association between the RSA, gastrointestinal endoscopy findings, and the types of reflux (acid, nonacid, or mixed) according to impedance-pH monitoring. An RSA >14 may be suggestive of LPR.
CONCLUSION:
The RSA is a complete clinical instrument evaluating both laryngeal and extralaryngeal findings associated with LPR. The RSA demonstrated high intra- and interrater reliabilities and responsiveness to change.
KEYWORDS:
finding; laryngitis; laryngopharyngeal; outcome; reflux; sign; tool
66.
J Laryngol Otol. 2019 Dec;133(12):1041-1045. doi: 10.1017/S0022215119002159. Epub 2019 Nov 12.
Interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma.
Abstract
OBJECTIVES:
To report on the efficacy and adverse effects of interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma.
METHODS:
A retrospective chart review was conducted of eight patients with vocal process granuloma resistant to anti-reflux therapy who underwent interarytenoid botulinum toxin A injection. The mean dosage of botulinum toxin A injected was 6.56 U.
RESULTS:
Fifty per cent of patients had complete regression of the lesion and 50 per cent had partial regression. The main side effects were breathiness (n = 4), voice breaks (n = 1) and aspiration (n = 1).
CONCLUSION:
Interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma is an effective mode of therapy, with transient vocal and swallowing side effects.
KEYWORDS:
Botulinum Toxin; Granuloma; Injections; Voice
67.
Ann Otol Rhinol Laryngol. 2020 Apr;129(4):394-400. doi: 10.1177/0003489419887403. Epub 2019 Nov 9.
Presentation and Management of Killian Jamieson Diverticulum: A Comprehensive Literature Review.
Abstract
OBJECTIVE:
To examine the clinical presentation, diagnostic evaluation, and management of Killian-Jamieson diverticula (KJD) through literature review.
METHODS:
A comprehensive literature review was conducted through December 2018 using keywords Killian-Jamieson diverticula/diverticulum. Data extracted included clinical presentation, imaging characteristics, surgical management, and postoperative care.
SOURCES:
PubMed and Google Scholar.
RESULTS:
Sixty-eight cases of KJD in 59 reports (29M:39F; median 58 years old) were identified for review. The most common presentation was dysphagia (n = 39), suspected thyroid nodule (n = 24) and globus (n = 14). The majority of KJD (n = 51) occur on the left, with rare reports of right side (n = 11) and bilateral (n = 5) presentation. Thirty-two cases describe surgical management: 22 utilizing a transcervical approach, with (n = 13) or without (n = 9) cricopharyngeal myotomy; and 10 reported endoscopic surgery. Diverticula managed transcervically averaged 3.8 cm in size in comparison to average 2.8 cm in the endoscopic group. Time to diet initiation after transcervical surgery averaged 4 days versus 2 days after endoscopic surgery. Complications were reported in 2/68 cases; both were diverticula recurrence after endoscopic surgery.
CONCLUSION:
Killian-Jamieson diverticula is a rare diagnosis that should be considered in the evaluation of dysphagia, globus, and also suspected thyroid nodule. When patient symptoms warrant intervention, a transcervical approach, with or without cricopharyngeal myotomy, is most commonly utilized. In recent years, an endoscopic approach has been presented as an alternative for smaller diverticula. Further understanding of the optimal treatment and postoperative management for KJD requires larger cohorts.
LEVEL OF EVIDENCE:
4.
KEYWORDS:
Killian–Jamieson; diverticula; diverticulum; pharyngoesophageal diverticulum
68.
Biosci Biotechnol Biochem. 2020 Feb;84(2):268-278. doi: 10.1080/09168451.2019.1687280. Epub 2019 Nov 5.
Cryptotanshinone attenuates allergic airway inflammation through negative regulation of NF-κB and p38 MAPK.
Abstract
This study is to determine the role and mechanism of cryptotanshinone (CTS) in allergic airway inflammation. Asthma induced by OVA was established in BALB/c mice. We found increased airway hyperresponsiveness (AHR), increased inflammatory cell infiltration, elevated levels of TNF-α, interleukin-1β (IL-1β), IL-4, IL-5, IL-6 and IL-13, decreased interferon gamma (IFN-γ) in lung tissue, increased content of total immunoglobulin E (IgE), OVA specific IgE, Eotaxin, ICAM-1, VCAM-1, nuclear factor-kappaB (NF-κB) and phosphorylation of p38 MAPK in lung tissue. However, the administration of CTS significantly decreased AHR in asthmatic mice, reduced inflammation around the bronchioles and inflammatory cells around airway, regulated cytokine production, reduced the total IgE and OVA-specific IgE levels, and inhibited NF-κB activation and p38 MAPK phosphorylation. In vitro experiments in 16 HBE cells revealed that CTS attenuated CAM-1 and IL-6 expression. These results indicate that CTS alleviates allergic airway inflammation by modulating p38 MAPK phosphorylation and NF-κB activation.
KEYWORDS:
Cryptotanshinone; NF-κB; airway remodeling; asthma; p38 MAPKs
69.
Br J Oral Maxillofac Surg. 2019 Dec;57(10):1003-1008. doi: 10.1016/j.bjoms.2019.08.010. Epub 2019 Aug 29.
Comparison of endoscope-assisted versus conventional resection of parotid tumors.
Abstract
Endoscopically-assisted partial parotidectomy for benign tumours has been reported, but we have evaluated its feasibility through different concealed incisions compared with conventional parotidectomy. A total of 124 patients with parotid tumours were enrolled in this retrospective study: an endoscopically-assisted group (n=37) compared with a group operated on conventionally (n=87). The incision for endoscopically-assisted partial, total parotidectomy and selective neck dissection was based on location and pathological characters of the parotid tumour. The sex and age of the patients, diameter of the tumour, and histopathological features were comparable between the two groups. The mean length of the incision in the endoscopic group was significantly shorter than that in the conventional group. However, intraoperative blood loss, operating time, and duration of hospital stay were significantly reduced, and postoperative secretion of saliva was significantly improved in the endoscopic group, among whom there were no recurrences of tumour. More importantly, all patients who had endoscopically-assisted operations were satisfied with the cosmetic result. Endoscopically-assisted parotidectomy is superior to conventional resection as judged by postoperative cosmetic and functional outcomes. It is noteworthy that the site of incision depends mainly on location, and on the suspected low grade of malignancy of the parotid tumour seen on preoperative computed tomography and magnetic resonance images.
Copyright © 2019. Published by Elsevier Ltd.
KEYWORDS:
complications; cosmetic outcome; endoscopic surgery; parotidectomy; tumours
70.
Otol Neurotol. 2019 Aug;40(7):980-982. doi: 10.1097/MAO.0000000000002308.
Differentiating the General Vestibular Schwannoma Patient Population, Tertiary Referral Center Cohorts, and the Acoustic Neuroma Association Survey Respondents: A Response to the Benefits and Drawbacks of Survey-Based Studies.
Comment on
- Influence of Selection Bias in Survey Studies Derived From a Patient-Focused Organization: A Comparison of Response Data From a Single Tertiary Care Center and the Acoustic Neuroma Association. [Otol Neurotol. 2019]
- Are Acoustic Neuroma Association Patients Characteristically Different Than the General Population Patients? The Benefits and Drawbacks of Survey-Based Studies. [Otol Neurotol. 2019]
71.
Otol Neurotol. 2019 Aug;40(7):979-980. doi: 10.1097/MAO.0000000000002307.
Are Acoustic Neuroma Association Patients Characteristically Different Than the General Population Patients? The Benefits and Drawbacks of Survey-Based Studies.
Comment in
Comment on
72.
Eur J Orthod. 2020 Jan 27;42(1):101-106. doi: 10.1093/ejo/cjz038.
Relationship between cephalometric parameters and the apnoea-hypopnoea index in OSA patients: a retrospective cohort study.
Abstract
OBJECTIVE:
The purpose of this study was to assess the relationship between cephalometric parameters and apnoea-hypopnoea index (AHI) controlling for the effect of gender, age, and body mass index (BMI) on a large sample of patients with obstructive sleep apnoea (OSA).
METHODS:
This retrospective cohort study was conducted on the lateral cephalograms of 253 Caucasian adult OSA patients. Cephalometric analyses were performed using 14 parameters for skeletal and soft tissue morphology, including antero-posterior and vertical jaw relationships, hyoid bone position, soft palate length and thickness, airway space, and tongue length and height. A hierarchical regression was run to examine the amount of variability in AHI that cephalometric variables explained after controlling for patients' general characteristics (gender, age, and BMI).
RESULTS:
After controlling for gender, age, and BMI, the increase in AHI variance accounted for by cephalometric parameters was equal to 0.103. Among the cephalometric variables, only MP-H and PNS-P were statistically significant (P < 0.05).
LIMITATIONS:
Given the retrospective nature of the study, it is difficult to assess whether other confounding variables not considered in the present study could have influenced the relationship between cephalometric parameters and AHI.
CONCLUSIONS:
This study revealed the existence of a relationship between OSA severity and some cephalometric parameters. Indeed soft palate length and vertical position of the hyoid bone were significant predictors of AHI in adult Caucasian OSA patients.
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.
73.
Infant Behav Dev. 2019 Nov;57:101322. doi: 10.1016/j.infbeh.2019.04.004. Epub 2019 May 15.
Effects of children's hearing loss on the synchrony between parents' object naming and children's attention.
Abstract
Children's attentional state during parent-child interactions is important for word learning. The current study examines the real-time attentional patterns of toddlers with and without hearing loss (N = 15, age range: 12-37 months) in parent-child interactions. High-density gaze data recorded from head-mounted eye-trackers were used to investigate the synchrony between parents' naming of novel objects and children's sustained attention on the named objects in joint play. Results show that the sheer quantities of parents' naming and children's sustained attention episodes were comparable in children with hearing loss and their peers with normal hearing. However, parents' naming and children's sustained attention episodes were less synchronized in the hearing loss group compared to children with normal hearing. Possible implications are discussed.
Copyright © 2019 Elsevier Inc. All rights reserved.
KEYWORDS:
Children with hearing loss; Children’s attention; Eye-tracking; Parent-child interactions; Synchrony in interaction; Word learning
- PMID:
- 31102946
- PMCID:
- PMC6856413
- [Available on 2020-11-01]
- DOI:
- 10.1016/j.infbeh.2019.04.004
- [Indexed for MEDLINE]
74.
Int Forum Allergy Rhinol. 2019 May;9(5):493-500. doi: 10.1002/alr.22291. Epub 2019 Jan 18.
Long-term olfaction outcomes in transnasal endoscopic skull-base surgery: a prospective cohort study comparing electrocautery and cold knife upper septal limb incision techniques.
Puccinelli CL1, Yin LX1, O'Brien EK1, Van Gompel JJ2, Choby GW1, Van Abel KM1, Janus JR1, Stokken JK1.
Abstract
BACKGROUND:
Olfactory nerve fibers are at risk of injury during transnasal endoscopic skull-base approaches. Olfactory outcomes for various techniques have not been thoroughly investigated. This study aims to report long-term olfactory outcomes when a cold knife upper septal limb incision technique is used compared to monopolar cautery.
METHODS:
A prospective cohort study was performed at a tertiary referral center. Adult patients undergoing endoscopic approaches with septal incisions were randomized to cold knife or monopolar cautery groups. Patient demographics, clinical history, surgical data, and outcomes were collected. Preoperative, 3-month, and 12-month postoperative scores on the University of Pennsylvania Smell Inventory Test (UPSIT) and 22-item Sino-Nasal Outcome Test (SNOT-22) were measured. Fisher's exact tests were performed for categorical variables and t tests were performed for continuous variables.
RESULTS:
Twenty-two (22) patients (10 cold knife, 12 cautery) were enrolled between March 2016 and August 2017. The average age ± standard deviation was 50.2 ± 14.0 years (p = 0.59), 54% (p = 0.69) were female, and the primary pathology was pituitary adenoma (73%, p = 1.00). Preoperative, 3-month, and 12-month postoperative UPSIT scores were similar between the cold knife and cautery groups (32.8 vs 32.4, p = 0.80; 33.1 vs 33.0, p = 0.96; 33.6 vs 33.3, p = 0.84). On the "sense of smell/taste" question of the SNOT-22, there was also no difference at all time points (p > 0.22).
CONCLUSION:
There was no significant change in patient UPSIT scores 1 year after transnasal skull-base approaches, and no short-term or long-term differences between cold knife and cautery upper septal limb incision techniques. Our study supports an individualized approach based on surgeon preference.
© 2019 ARS-AAOA, LLC.
KEYWORDS:
endoscopic endonasal skull-base surgery; nasoseptal flap; olfaction; pituitary surgery; quality of life; rescue flap; transsphenoidal
75.
Int Forum Allergy Rhinol. 2019 May;9(5):458-465. doi: 10.1002/alr.22289. Epub 2019 Jan 18.
Correlation between systemic inflammatory response and quality of life in patients with chronic rhinosinusitis.
Abstract
BACKGROUND:
Local sinonasal inflammation resulting from altered T-cell immune signaling is a contributor to the pathogenesis of chronic rhinosinusitis (CRS). CRS patients experience negative impacts on quality of life (QOL) and suffer from comorbidities linked to systemic inflammation. However, systemic inflammatory profiling to evaluate the association between systemic inflammation and QOL in CRS has not been performed. Our objectives were to compare local and systemic inflammatory gene expression in patients with CRS to determine if systemic markers of inflammation associate with disease severity and disease-specific QOL.
METHODS:
A prospective observational study was conducted comparing 16 patients with CRS to 10 controls. Inflammatory gene expression in the anterior ethmoid tissues and peripheral blood of patients was measured using multiplex gene expression analysis and correlated to disease severity (computed tomography and nasal endoscopy) and disease-specific QOL (22-item Sino-Nasal Outcome Test [SNOT-22] and Rhinosinusitis Disability Index) using linear regression analyses.
RESULTS:
Patients with CRS showed significant increases in the expression of ctla4 and jak1 in sinonasal tissue and blood (p < 0.05), whereas the gene expression of hla-dqa1, hla-dqb1, and dusp4 was significantly decreased in patients with CRS compared to controls (p < 0.05). Soluble and local ctla4 and jak1 showed a significant positive correlation with clinical markers of disease severity and disease-specific QOL (p < 0.05).
CONCLUSION:
Local and systemic gene expression involved in T-cell immune signaling was found to be significantly altered in the blood and sinonasal tissues of patients with CRS compared to controls and significantly correlated to disease severity and QOL in patients with CRS.
© 2019 ARS-AAOA, LLC.
KEYWORDS:
SNOT-22; chronic rhinosinusitis; disease severity; quality of life; sinusitis
- PMID:
- 30657646
- PMCID:
- PMC6491244
- [Available on 2020-05-01]
- DOI:
- 10.1002/alr.22289
- [Indexed for MEDLINE]
76.
Int Forum Allergy Rhinol. 2019 May;9(5):479-485. doi: 10.1002/alr.22283. Epub 2019 Jan 17.
An analysis of RUC methodology for determining the RVU valuation of sinus surgery.
Abstract
BACKGROUND:
The Relative Value Scale Update Committee, commonly known as the RUC, is responsible for defining the value of Current Procedural Terminology (CPT) codes. The RUC process uses survey responses reporting operative times to determine procedure reimbursement, but it is limited by low response rates, small sample sizes, and unclear generalizability of the results. By comparing actual reported intraoperative times to the times determined by the RUC process, in this study we sought to assess the performance of RUC methodology in endoscopic sinus surgery (ESS).
METHODS:
The ESS CPT codes that were reassessed in 2016 using the RUC method were examined in this study. Intraoperative time data for these codes were retrospectively collected from 14 medical facilities, using time stamps in the electronic health record. These actual intraoperative times were compared with the 2016 RUC survey results.
RESULTS:
There were 143 RUC physician survey responses and 446 actual procedure times included in the final analysis. There was significant variability within the RUC survey responses (ie, unilateral anterior ethmoidectomy times varied from 5 to 90 minutes). There was also a significant difference between the RUC survey results and actual intraoperative times (p < 0.001). For example, frontal sinus surgeries showed a particularly poor correlation between actual and RUC times.
CONCLUSION:
The RUC process may not accurately estimate or value actual intraoperative times. Real-world intraoperative times are readily accessible and may be an alternative to survey-based methodology in the future.
© 2019 ARS-AAOA, LLC.
KEYWORDS:
RUC; database; endoscopic sinus surgery; survey; value
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου