Journal of Otolaryngology - Head & Neck Surgery最新文献

{"title":"Formal Mentorship in Surgical Training: A Long-Term Prospective Interventional Study.","authors":"Sepideh Mohajeri, Hadi Seikaly, Yaser Alrajhi, Erin D Wright, Hamdy El-Hakim, Han Zhang","doi":"10.1177/19160216241307555","DOIUrl":"10.1177/19160216241307555","url":null,"abstract":"<p><strong>Objective: </strong>Surgical training programs have a high prevalence of trainee stress and burnout. Formal mentorship programs (FMP) have been shown to alleviate these factors and improve quality of life (QOL) in short-term follow-up. This study aims to determine the long-term effects of an FMP on the well-being of a single-center cohort of surgical trainees.</p><p><strong>Methods: </strong>A voluntary FMP was established at a surgical training program comprised 8 resident physicians. To quantitatively measure stress and burnout, the Perceived Stress Survey (PSS) and Maslach Burnout Inventory (MBI) were administered at baseline, 3, 6, 9, 12, 18, and 24 months. The World Health Quality of Life-Bref Questionnaire (WH-QOL) was administered at baseline, 12 and 24 months.</p><p><strong>Results: </strong>Baseline levels of stress and burnout were high among all residents with an average PSS of 18.5 and MBI of 47.6, 50.6, and 16.5 for the emotional, depersonalization, and personal achievement domains respectively. After FMP implementation, PSS was reduced to 7.9 at 12 months (<i>P</i> = .001). These scores were sustained at 24 months (6.8, <i>P</i> = 1). MBI scores improved in emotional exhaustion (14.9, <i>P</i> < .0001), depersonalization (20.1, <i>P</i> < .0001), and personal achievement (40.1, <i>P</i> < .0001) at 12 months. All these benefits were sustained at 24 months. Baseline overall WH-QOL scores reflected low QOL (71.9). These significantly improved at 12 months (37.5, <i>P</i> = .002) with further improvement by 24 months (17.2, <i>P</i> = .03).</p><p><strong>Conclusion: </strong>Long-term follow-up of a previously successful academic surgical FMP showed lasting improvements in stress, burnout, and overall QOL, despite new life challenges.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216241307555"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11696942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perineural Invasion Unveiled: Deciphering the Prognostic Impact of Diameter and Quantity Subcategories in Oral Cancer.","authors":"Hui-Wen Cheng, Li-Han Lin, Hung-Pin Lin, Chung-Ji Liu","doi":"10.1177/19160216251316219","DOIUrl":"10.1177/19160216251316219","url":null,"abstract":"<p><strong>Importance: </strong>Perineural invasion (PNI) is an established prognostic factor in oral squamous cell carcinoma (OSCC), but the impact of its subcategories on survival is not fully understood. This study quantifies the number and diameter of PNI foci to assess their prognostic relevance in OSCC.</p><p><strong>Objective: </strong>To evaluate the prognostic significance of PNI subcategories, specifically the number and diameter of PNI foci, as predictors of overall survival (OS) and disease-free survival (DFS) in OSCC patients.</p><p><strong>Design: </strong>Retrospective cohort study, adhering to STROBE guidelines.</p><p><strong>Setting: </strong>Single-center study at MacKay Memorial Hospital, Taiwan, including patients diagnosed with OSCC from 2005 to 2018.</p><p><strong>Participants: </strong>Nine hundred twenty-six patients with biopsy-proven OSCC, excluding those with perioperative mortality or incomplete follow-up.</p><p><strong>Exposure: </strong>Histological evaluation of PNI, including quantifying the number and diameter of invaded nerves, along with clinicopathological features such as tumor stage and lymphovascular invasion (LVI).</p><p><strong>Main outcome measures: </strong>OS and DFS, assessed via Cox proportional hazards models, Kaplan-Meier survival analysis, and receiver operating characteristic curve analysis for PNI foci subcategories.</p><p><strong>Results: </strong>PNI was present in 138 (14.9%) patients and was significantly associated with adverse histologic features, advanced tumor stage, nodal involvement, metastasis, and LVI. Multivariate analysis revealed that both the number of PNI foci greater than 4 and nerve diameters exceeding 0.21 mm were significantly associated with poorer OS and DFS (<i>P</i> < .05). After adjusting for clinical variables, PNI remained an independent predictor of worse OS [hazard ratio (HR): 1.37] and DFS (HR: 1.46).</p><p><strong>Conclusions and relevance: </strong>PNI is a significant independent prognostic factor in OSCC. Patients with more than 4 PNI foci or nerve involvement greater than 0.21 mm in diameter experienced significantly worse survival outcomes. These findings suggest that detailed assessment of PNI subcategories should be incorporated into OSCC management, guiding treatment decisions and potentially informing the need for adjuvant therapies.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251316219"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 Pandemic on Retirement Among Canadian Otolaryngologists.","authors":"Nick Sahlollbey, Arunima Vijay, Michele M Carr","doi":"10.1177/19160216251321458","DOIUrl":"10.1177/19160216251321458","url":null,"abstract":"<p><p>IntroductionOtolaryngologists were among the physicians with the highest risk of exposure to SARS-CoV-2, and more than half of them reported anxiety and distress during the pandemic. Consequences of this experience on retirement plans among otolaryngologists are unknown. This study aimed to describe the effect of the pandemic on retirement plans among otolaryngologists.MethodsA cross-sectional survey assessed retirement plans of physicians in the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) between May and June 2023. Participants were recruited through CSOHNS membership lists. Respondents shared demographic information and rated 4 pandemic-related factors and 13 independent factors on a 5-point Likert scale from least important to most important in influencing retirement.ResultsEighty-two members responded, of which 20 (24.4%) were females. All female participants were 65 or younger, whereas 25 (40.3%) males were 65 or older. Half of the participants were in academic practice; 39% reported no change to their anticipated retirement date prior to the pandemic, whereas 25% reported either earlier or later dates. A greater proportion of female otolaryngologists reported earlier dates of retirement than originally planned compared with males (40% vs 19.3%). The factors most commonly rated as \"important\" were the desire for time with loved ones (mean: 3.82, SD: 1.179), the desire to improve their quality of life (mean: 3.65, SD: 1.344), and increased workload (mean: 3.26, SD: 1.210). Significant differences were observed between genders and age groups (≤55 years vs >55 years) regarding increased workload, desire for improved quality of life, personal and loved ones' health concerns, pandemic-related concerns, psychological/emotional issues, and burnout (<i>P</i> < .05).ConclusionsPandemic-related factors play a limited role in retirement decisions made by otolaryngologists. More females reported earlier retirement dates after the pandemic, which may further exacerbate preexisting gender inequalities in the otolaryngology workforce.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251321458"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Cultural Adaptation and Translation of the Neck Dissection Impairment Index (NDII) into Spanish.","authors":"Lismelia Vargas, Jake Langlie, Christie McGee, Ruixuan Ma, Olivia Perdigon, Stephen Y Lai, Douglas Chepeha, Francisco J Civantos","doi":"10.1177/19160216251321457","DOIUrl":"10.1177/19160216251321457","url":null,"abstract":"<p><p>ImportanceSelective, modified radical, and radical neck dissections are common surgical procedures that can result in significant musculoskeletal issues of the neck and shoulder. Quality-of-life evaluations after neck dissection must assess and quantify these dysfunctions to allow subsequent comparison of outcomes after different treatments.ObjectiveThere is no validated Spanish-language questionnaire designed to evaluate neck and shoulder dysfunction after cervical lymphadenectomy. We therefore sought to translate a version of the Neck Dissection Impairment Index (NDII) into Spanish.Design, Settings, and ParticipantsA three-phased approach was used. Phase 1: The NDII was translated from English to Spanish using a \"forward and backward\" translational technique following international guidelines. Phase 2: The questionnaire was administered to six patients from our head and neck surgery clinic who were bilingual and fluent in both English and Spanish. Phase 3: The final version was administered prospectively to 34 patients with prior history of neck dissection (ND). These patients were asked to complete the questionnaire a second time 3 to 6 weeks after their first response. Test-retest reliability was calculated with Spearman's correlation. Internal consistency was elicited using Cronbach's alpha.Main Outcome(s) and Measure(s)NDII score at initial administration and follow-up administration 6 weeks later, demographic data.ResultsNDII was successfully translated and validated into Spanish. Cronbach's alpha revealed high internal consistency at both the first time point 0.95 (mean standardized score: 95 (88.1, 97.5), 95% CI: 0.89, 0.97) and at the second time point 0.90 (mean standardized score: 92.5 (80.6, 100.0), 95% CI: 0.81, 0.95). The Spearman's correlation for test-retest reliability of overall score was strong (rho = 0.772, <i>P</i> < 0.001). The intraclass correlation coefficient of the overall score was moderate (ICC = 0.683, <i>P</i> < 0.001).Conclusions and RelevanceNDII is a recognized, previously validated quality-of-life (QOL) tool for the identification of ND-related dysfunction. This validated Spanish version will allow clinicians to adequately assess the neck and shoulder-related QOL for the Spanish-speaking population who are under-represented in head and neck research.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251321457"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optokinetic After-Nystagmus: A Marker for Migraine? A Prospective Observational Study.","authors":"Mikaël Kassin-Dufresne, Marie-Catherine Charest Bossé, Margaret Aron","doi":"10.1177/19160216241307553","DOIUrl":"10.1177/19160216241307553","url":null,"abstract":"<p><strong>Introduction: </strong>Vestibular migraine (VM), particularly its chronic variant, poses a diagnostic challenge. Patients suffering from VM may not have the characteristic headaches associated with the dizziness. In these cases, a marker for migraine pathology in general could help appropriately diagnose certain types of dizziness as migrainous despite these patients not meeting current diagnostic criteria for VM. Migraine patients in general (headache and vestibular) are known to share a tendency toward intolerance of certain stimuli, including busy visual stimuli. True optokinetic stimulation, measured by the production of optokinetic after-nystagmus (OKAN) simulates these busy visual stimuli.</p><p><strong>Methods: </strong>Prospective observational study comparing response to optokinetic stimulation between migraine patients and controls. Questionnaires regarding general sensitivities to busy visual stimuli were completed prior to beginning the study. Both subjective and objective markers of stress were measured before and after exposure to the stimulus. Initial slow-phase velocity, slow cumulative eye position, and adjusted time constant of OKAN were compared between the 2 groups.</p><p><strong>Results: </strong>The groups differed only with regard to sensitivity to blinking lights and history of motion sickness on initial questionnaire. Regarding subjective symptoms of discomfort, migraine patients tended to report higher scores than controls both before and after testing, but there was no significant difference from before to after stimulus in each group's scores. There were no statistically-significant differences between initial slow-phase velocity, slow cumulative eye position, and adjusted time constant of OKAN between groups.</p><p><strong>Conclusions: </strong>In this study, OKAN measurements were not useful in differentiating migraine patients at large from control subjects. We hypothesize that there may be a distinct subgroup of migraine patients that are more sensitive to visually-disturbing situations that may differ from other migraine sufferers. Future studies will aim to identify such patients and compare them to controls.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216241307553"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"My Quality of Life is Not There. I'm Dying Here. I Cannot Take This Anymore.\" Exploring Patient Experiences With Surgical Wait Times in Otolaryngology: A Mixed Methods Study.","authors":"Shelley Vanderhout, Shipra Taneja, Amr Hamour, Eric Monterio, Janet Chung","doi":"10.1177/19160216251321456","DOIUrl":"10.1177/19160216251321456","url":null,"abstract":"<p><p>BackgroundNew patient referral models are needed to reduce long wait times for otolaryngology surgical procedures, such as a Single-Entry Model (SEM). However, patient perspectives about SEM in otolaryngology remain unexplored.MethodsIn this mixed methods study, a retrospective chart review was conducted to examine the times from referral to consultation (T1) and from consent to surgery (T2) for all elective otolaryngology surgical procedures at a large community hospital between 2020 and 2023. We then conducted journey mapping interviews with 10 patients and parents of pediatric patients who underwent otolaryngologic surgeries to understand their experiences of waiting for their own or their child's procedure, and perspectives on how an SEM might impact patient experiences. Data were analyzed using descriptive statistics and thematic analysis.ResultsWe identified that average wait times among 2414 elective (oncologic and non-oncologic) otolaryngology procedures often exceeded provincial target wait times. On average, oncology procedures had the shortest wait times (T1: 34 ± 47; T2: 101 ± 161 days), and otologic procedures had the longest (T1: 67 + 72; T2: 355 ± 285 days). While patients often did not wait as long to have a consultation with their surgeon, the time between consenting to and receiving surgery tended to drive wait time duration. Patients who had endured extended wait times experienced poor quality of life, worsening symptoms, and often worried about how long they would need to wait. Systems such as an SEM that could shorten wait times were generally well-perceived. However, patients emphasized the importance of trusting relationships with referring physicians and surgeons, which could be an enabling factor for implementing an SEM.ConclusionLong surgical wait times in otolaryngology are negatively impacting patients. A SEM could offer a way to improve patient experiences and outcomes.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251321456"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Economic Burden of Management of Pituitary Adenomas: A Propensity-Score-Matched Cost Analysis.","authors":"Lisa Caulley, Andrea Lasso, Brandon Zagorski, Andrew S Wilton, Refik Saskin, Nick Sahlollbey, Jeanne M Séguin, Kednapa Thavorn, Mary-Anne Doyle, Janine Malcolm, Fahad Alkherayf, Stephanie Johnson-Obaseki, David Schramm, Shaun Kilty","doi":"10.1177/19160216251314793","DOIUrl":"10.1177/19160216251314793","url":null,"abstract":"<p><strong>Importance: </strong>Pituitary adenomas (PAs) present a notable economic burden on healthcare systems due to their management's reliance on multimodal, often costly interventions.</p><p><strong>Objective: </strong>To determine total and relative healthcare costs for PAs at Ontario-based institutions.</p><p><strong>Design: </strong>A retrospective, propensity-score-matched cohort analysis.</p><p><strong>Setting: </strong>Ontario, Canada, encompassing public healthcare facilities and covering costs over a 6-year study period.</p><p><strong>Participants: </strong>Adults diagnosed with PA (n = 1675) between April 1, 2013, and March 31, 2019, compared to a general population cohort and a hospitalized control cohort matched on demographics and health factors.</p><p><strong>Intervention/exposures: </strong>Analysis of healthcare cost components (inpatient, outpatient, and diagnostic services) and cost trajectories postsurgery for PAs.</p><p><strong>Main outcome measures: </strong>Primary outcome was total annualized healthcare costs for patients with PA relative to the general and hospitalized cohorts. Relative costs were estimated using a negative binomial regression model.</p><p><strong>Results: </strong>Of 1675 patients with PA, total annualized costs were $49,992. Highest total costs were associated with inpatient hospitalization ($24,796) and physician services/diagnostic evaluations ($20,075). After propensity score matching, patients with PA had 12.7 times higher costs [95% confidence interval (CI) (10.9, 14.8), <i>P</i> < .0001] during the preadmission/admission period, which remained elevated postoperatively (<i>P</i> < .05). Total costs did not differ between patients with PA and the hospitalized cohort [RR 0.97, 95% CI (0.92, 1.03); <i>P</i> = .3271] in the preadmission/admission period; however, follow-up costs were 37% lower for patients with PA in the 1st follow-up year [RR 0.63, 95% CI (0.51, 0.77); <i>P</i> < .0001], and up to 50% lower by the 5th year [RR 0.50, 95% CI (0.36, 0.68); <i>P</i> < .0001].</p><p><strong>Conclusions: </strong>This study provided a comprehensive assessment of the economic burden of PAs on the publicly-funded healthcare system. Patients with PA had higher annualized total costs across all observed time periods compared to the general population and lower annualized total costs compared to patients admitted to a surgical ward.</p><p><strong>Relevance: </strong>This study highlights the financial impact of PA management on healthcare resources and provides a basis for future research aimed at cost-efficiency improvements in long-term PA care.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251314793"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nomogram Prediction of Response to Neoadjuvant Chemotherapy Plus Pembrolizumab in Locally Advanced Hypopharyngeal Squamous Cell Carcinoma.","authors":"Zhangwei Hu, Yi Chen, Renqiang Ma, Wei Sun, Lin Chen, Zhimou Cai, Weiping Wen, Wenbin Lei","doi":"10.1177/19160216251318255","DOIUrl":"10.1177/19160216251318255","url":null,"abstract":"<p><strong>Importance: </strong>The objective response (ORR) rate in patients with locally advanced hypopharyngeal squamous cell-carcinoma (LA-HPSCC) following neoadjuvant chemotherapy (NACT) of albumin-bound paclitaxel plus carboplatin is low. At present, it is unclear whether the addition of pembrolizumab could increase the ORR or not.</p><p><strong>Objective: </strong>To investigate whether the addition of pembrolizumab could increase the ORR, and to develop a nomogram to predict the response of pembrolizumab addition.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>This study was conducted at a single institution.</p><p><strong>Participants: </strong>This study included 129 patients who conformed to the inclusion criteria.</p><p><strong>Intervention or exposures: </strong>NACT with or without pembrolizumab for patients with LA-HPSCC.</p><p><strong>Main outcome measures: </strong>The ORR was analyzed according to the RECIST 1.1 criteria and a nomogram was developed based on least absolute shrinkage and selection operator and multivariable Cox regression analysis. Predictive accuracy and discriminative ability of the nomogram were evaluated by receiver operating characteristics, precision recall, calibration curves, and decision curve analysis.</p><p><strong>Results: </strong>Eighty-two patients received NACT and 47 also received pembrolizumab. ORR was higher in patients receiving additional pembrolizumab (66.0% vs 47.6%, χ² = 4.074, <i>P</i> = .044). The nomogram identified pretreatment levels of lymphocytes and red blood cells as independent predictors of a high ORR, while basophil levels were an independent predictor of a low ORR. Calibration curve showed that the nomogram-based predictions corresponded well with actual observations. C-index of the nomogram was 0.925 (0.848-1.002) and the area under curve was 0.925. Decision curve analysis affirmed that the nomogram had important clinical value.</p><p><strong>Conclusions and relevance: </strong>Pembrolizumab could improve the ORR in LA-HPSCC patients treated with NACT. Furthermore, a risk-prediction nomogram incorporating readily assessable routine pretreatment blood parameters can accurately estimate the response to NACT with pembrolizumab, leading to precise treatment and minimizing the waste of medical resources.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251318255"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resource Utilization and Cost Analysis of Pediatric Esophageal Foreign Bodies.","authors":"Tanya Chen, Jennifer M Siu, Yasmine Madan, Gar-Way Ma, Peter J Gill, Nicholas Carman, Evan J Propst, Nikolaus E Wolter","doi":"10.1177/19160216251318256","DOIUrl":"10.1177/19160216251318256","url":null,"abstract":"<p><strong>Objective: </strong>Impacted esophageal foreign bodies (EFBs) are a common but preventable presentation in children, requiring prompt removal in the operating room by esophagoscopy. Our objective was to describe the overall cost of impacted pediatric EFBs and determine factors that increase resource burden.</p><p><strong>Methods: </strong>A cost analysis of pediatric patients undergoing esophagoscopy for EFB removal from 2010 to 2021 was performed. Characteristics of each EFB, patient transfer, and hospital course were collected. Direct and indirect healthcare costs were calculated using hospital-specific costs and provincial fees. Amounts were calculated in Canadian dollars.</p><p><strong>Results: </strong>Six hundred and eighty patients were included. The total amount spent on pediatric EFBs from 2010 to 2021 was $2,673,288. The mean total cost per child with an EFB was $3469. An extra hour of delay before Otolaryngology-Head and Neck Surgery (OHNS) consultation at a tertiary hospital corresponded to an $816 cost [95% confidence interval (CI; 244.7-1287.4)]. On average, children requiring transfer to a tertiary care center cost $1965 more than those initially presenting to a tertiary care center (<i>P</i> = .001). Higher-risk EFBs (n = 165, 24%) were associated with a longer hospital stay and greater complication rate and resulted in a $4095 increase in overall cost compared to lower-risk EFBs [$6829 (standard deviation (SD) $11,347) vs $2734 (SD $10,451), <i>P</i> = .02]. Button battery ingestions cost 8.8 times more than non-dangerous EFBs, such as coins. Longer distance for transfer was associated with a higher likelihood of having complications [odds ratios (OR) 1.5, 95% CI (1.1-1.8)].</p><p><strong>Conclusion: </strong>EFBs pose a significant economic burden to the healthcare system, driven by transfer to a tertiary care center, delays in transfer to the operating room, and high-risk EFBs. It is critical to identify areas for improved efficiency such as increased parental education for primary prevention, early involvement of the OHNS team and improving the capacity of community hospitals to manage EFB to limit transfers when possible.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251318256"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Critical Role of Otolaryngologists in Managing Lassa Fever Sequelae: A Call for Action.","authors":"Sulymon A Saka","doi":"10.1177/19160216251326559","DOIUrl":"10.1177/19160216251326559","url":null,"abstract":"","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251326559"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}