Journal of Otolaryngology - Head & Neck Surgery最新文献

{"title":"Pooled Analysis of 2 Randomized Clinical Trials to Evaluate the Efficacy and Safety of Clotrimazole 1% Otic Solution for the Treatment of Otomycosis in Adults.","authors":"Ansley J F, Bernal-Sprekelsen M, Butehorn H F, Todorov S, Tzvetkov V, Douglis F, Georgiev K, Moreira da Silva F","doi":"10.1177/19160216251330629","DOIUrl":"https://doi.org/10.1177/19160216251330629","url":null,"abstract":"<p><p>ImportanceThere is no antifungal otic drug for the treatment of otomycosis approved in the United States. Some current clotrimazole formulations in the market are used off-label.ObjectiveTo evaluate the efficacy and safety of clotrimazole 1% otic solution compared to placebo in treating otomycosis in adults.DesignTwo independent twin multicenter, randomized (2:1), double-blind, controlled clinical trials with identical designs were conducted from February 2020 to October 2021.SettingFifty-three sites located in the United States, Mexico, and Europe.ParticipantsAdults with uncomplicated otomycosis presented with symptoms, debris, and drainage clinically consistent with fungal infection.InterventionPatients received clotrimazole or placebo twice daily for 14 days and were evaluated on visit 1 (day 1), visit 2 (day 8-10), visit 3 (day 15), and follow-up visit 4 (day 24-26).Main Outcome MeasuresAt each visit, pruritus, otalgia, otorrhea, and ear fullness were assessed. Ear exudate was taken for a mycological and microbiological evaluation at baseline and, if present, at subsequent visits. The primary endpoint was a therapeutic cure (mycological and clinical) at visit 4 in the randomized population with positive fungal culture at baseline [mycological intent-to-treat (MITT)].ResultsThree hundred ninety-three patients received study medication (261 clotrimazole and 132 placebo). Efficacy data from the 228 patients (157 clotrimazole and 71 placebo) included in the MITT were analyzed. The clotrimazole group achieved a higher proportion for the primary endpoint than those with the placebo group (68.2% vs 25.4%; <i>P</i> < .0001), with a 42.8 difference in response rate (95% confidence interval: 30.3, 55.3). The treatment was safe and well tolerated, with 2.7% of related adverse events in the clotrimazole versus 1.5% in the placebo group.ConclusionsClotrimazole 1% otic solution has demonstrated its superiority over the placebo in each study and the pooled analysis. These are the results of the first international, multicenter clinical trials in which clotrimazole 1% otic solution demonstrates efficacy for the treatment of otomycosis.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251330629"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023634","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":"Oncocytes in Thyroid Aspirates-Implications of Clinical Parameters and Cytologic Diagnosis.","authors":"Joanna K M Ng, Joshua J X Li, Matrix M H Fung, Philip P C Ip, Karen K W Yuen, Philippe Vielh","doi":"10.1177/19160216251333358","DOIUrl":"10.1177/19160216251333358","url":null,"abstract":"<p><p>ImportanceThe clinical significance of oncocytes in thyroid aspirate is uncertain, leading to inconsistent and possible over-treatment.ObjectiveTo determine the predictive significance of clinico-radiological parameters and cytologic diagnosis on the risks of malignancy (ROM) and neoplasia.DesignData of thyroid aspirates with the presence of oncocytes were reviewed for outcomes and clinical-radiological-pathological parameters.SettingThree regional institutes performing thyroid surgery and investigations.ParticipantsFrom a population base of 1.3 million across a 9-year period, totaling 371 aspirates with oncocytes with an 85.0-month average follow-up.InterventionFine-needle aspiration of thyroid.ResultsOn clinical follow-up, the ROM for Bethesda categories C1-C6 was 15.4%/2.7%/9.2%/6.9%/37.5%/100%, while the risk of neoplasm (considering thyroidectomy follow-up) was 45.5%/23.8%/56.3%/61.9%/50%/100%, including 52 oncocytic follicular lesions (4 carcinomas and 48 adenomas) and 26 other carcinomas/malignancies. C5+ diagnoses were associated with malignancy (<i>P</i> = .003), and C3+ was associated with neoplasm on thyroidectomy (<i>P</i> = .006). Malignant/neoplastic outcomes did not correlate with sex or age (<i>P</i> > .05). High free triiodothyronine/free thyroxine levels were associated with a benign clinical outcome (<i>P</i> = .001). Cystic change on ultrasound was associated with a lower malignancy (<i>P</i> = .012) and neoplasm risk (<i>P</i> = .041). Lesion size, echogenicity, vascularity, multinodularity, lymphadenopathy, and solid areas on ultrasound were not significant in predicting malignancy or neoplasm (<i>P</i> > .05).ConclusionThe presence of oncocytes in thyroid aspirates does not increase malignancy risk. Most malignant oncocytic thyroid aspirates are not attributable to oncocytic carcinomas but papillary thyroid carcinomas. Ultrasound and thyroid function tests are helpful in the risk assessment of these cases.RelevanceFor treatment or follow-up decisions in patients with oncocytes in thyroid aspirates.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251333358"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078835","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":"Environmental Impact and Provider Satisfaction Associated with ePrescriptions in Otolaryngology: A Quality Improvement Study.","authors":"Abiram J Chandiramohan, Sarah Zahabi, Leigh Sowerby, Peng You, Jacob Davidson, Celia Dann, Julie E Strychowsky","doi":"10.1177/19160216251328883","DOIUrl":"10.1177/19160216251328883","url":null,"abstract":"<p><p>ImportanceePrescriptions are associated with increased patient satisfaction, decreased provider burden, decreased administrative costs, and a positive impact on planetary health. However, ePrescription uptake by physicians is historically low and acts as a barrier to reaping the benefits therein.ObjectiveWe aimed to attain 20% overall usage of ePrescriptions in the Department of Otolaryngology-Head and Neck Surgery (OHNS) at the London Health Sciences Centre (LHSC) by December 2023 through systematic implementation of change ideas.DesignPre-post intervention design.SettingAmbulatory clinics in OHNS at LHSC, an academic hospital.ParticipantsFourteen staff and 15 resident physicians in OHNS; 38 patients in pediatric otolaryngology clinic.Intervention or ExposureA root-cause analysis identified potential obstacles to ePrescribing. Change ideas, including educational seminars, surveys, quarterly reporting of ePrescription usage, and public encouragement of top ePrescribers in the department, were implemented and tested using Plan-Do-Study-Act cycles.Main Outcome MeasuresPercent ePrescription usage and carbon footprint savings associated with ePrescriptions were measured. Provider and patient satisfaction surveys were conducted as balancing measures to assess for the perception of increased burden on providers.ResultsDuring the pre-intervention and post-intervention phases, a total of 400 and 1000 ePrescriptions were prescribed by the department, respectively. There was a statistically-significant increase in the mean proportion of ePrescriptions used before (mean: 9.7%; sd = 7.6) and after (mean: 40.7%; sd = 6.4) the intervention (<i>p</i> < 0.001), which exceeded the goal. SPC charting suggested special cause variation, signifying a statistically-significant improvement. Additionally, a reduction of 125.9 lbs of CO₂ equivalents was associated with ePrescription use. 66.7% of providers rated overall satisfaction with ePrescriptions at 7/10 or higher, and 76.9% indicated that patients either sometimes, usually, or always opted for ePrescriptions when given the choice.Conclusion and RelevantOur change ideas increased ePrescription usage in an academic OHNS department and were associated with increased planetary health savings and provider satisfaction.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251328883"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730539","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":"Efficiency of Cephalic Vein Only Anastomosis During Radial Forearm Free Flap.","authors":"Dorsa Mousa-Doust, Khanh Linh Tran, Anat Bahat-Dinur, Jamie Jae Young Kwon, Emily C Deane, Donald W Anderson, J Scott Durham, Eitan Prisman","doi":"10.1177/19160216241307547","DOIUrl":"10.1177/19160216241307547","url":null,"abstract":"<p><strong>Importance: </strong>The closure technique for the radial forearm free flap (RFFF), a commonly utilized flap in head and neck reconstruction, remains a debated topic as there are unique advantages and drawbacks to each technique.</p><p><strong>Objective: </strong>The present study aims to report on the outcomes of the closure of the RFFF with the superficial cephalic vein (CV)-only system in terms of venous compromise and flap survival.</p><p><strong>Methods (design, setting, participants, intervention, measures): </strong>A retrospective review of patients who underwent head and neck reconstruction with RFFF between January 2015 and May 2021 at the authors' institution was performed. Cases were categorized as superficial, dual, and deep systems. Multiple population and operative variables were collected for the study group.</p><p><strong>Results: </strong>In total, 221 cases of RFFF were included, of which 169 (76.5%) cases were performed using the CV alone, whereas the remaining 52 (22.5%) cases utilized either the dual or the deep system alone. The operative time in the superficial group was 265 minutes. There were 9 venous complications in the CV group, of which 5 required re-exploration in the operating room and 4 were treated conservatively. All venous-related flap complications were salvaged.</p><p><strong>Conclusion and relevance: </strong>A majority of the RFFF cases could successfully be completed using the CV as the sole venous drainage, with high rates of flap survival, low complications, and low operative time.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216241307547"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408856","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":"Ninety-Day Emergency Department Rebound Following Adult Tonsillectomy: A Retrospective Cohort Study.","authors":"Kalpesh Hathi, Gizelle Francis, JoAnne Douglas, Evan Nemeth, Paul Hong","doi":"10.1177/19160216251333350","DOIUrl":"10.1177/19160216251333350","url":null,"abstract":"<p><p>ImportancePost-tonsillectomy complications often present in emergency departments (EDs). Reducing postoperative ED visits is one strategy to relieve the strain on healthcare systems and patients.ObjectiveTo assess the rate and reason for ED visits within 90-days post-discharge from adult tonsillectomy.DesignRetrospective cohort study.SettingNova Scotia, Canada.ParticipantsAll adult patients (≥16 years old) with a Nova Scotia Healthcare card who underwent a tonsillectomy in Nova Scotia, Central Zone from April 1, 2016 to March 31, 2022, and had an ED visit anywhere in Nova Scotia from April 1, 2016 to June 30, 2022, to allow a 90-days post-discharge window.MethodsRetrospective chart review utilizing administrative datasets for province-wide ED visits within 90-days post-discharge from an adult tonsillectomy. The patients' first ED visit postoperation was analyzed.ResultsOverall, 356 adult patients underwent tonsillectomy, of which 129 (36.2%) presented to the ED within 90 days. Of these, 99 were related to the tonsillectomy, resulting in a surgery-specific ED rebound rate of 27.8%. Most surgical ED visits (84/99, 84.8%) occurred within 7 days, most commonly for bleeding (47/99, 47.5%) and pain (36/99, 36.4%). Of the surgical visits, 26/99 (26.3%) were admitted, with 22/26 (84.6%) for bleeding. Of the surgical visits not related to bleeding, 48/52 (92.3%) were discharged home or left without being seen, which suggests 48/99 (48.5%) surgical ED visits may be preventable.ConclusionThe ED rebound rate for visits related to the tonsillectomy was 27.8% in our population. Given the potentially severe consequences of post-tonsillectomy bleeding, a high ED visit rate may be necessary. However, optimization of postoperative pain control along with greater access to urgent outpatient otolaryngology and primary care resources may reduce the burden of ED visits. This data adds to recent literature suggesting a higher rate of healthcare usage post-adult tonsillectomy.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251333350"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030986","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 Effect of Cochlear Implant Electrode Array Type on Hearing Preservation.","authors":"Matthew Zimmermann, Cathy Sucher","doi":"10.1177/19160216251316217","DOIUrl":"10.1177/19160216251316217","url":null,"abstract":"<p><p>ObjectiveTo compare hearing preservation outcomes between lateral wall and perimodiolar electrode arrays for cochlear implant patients.Study DesignRetrospective cohort study.SettingA large Western Australian cochlear implant clinicMethodsA total of 311 adult cochlear implant recipients (321 ears) implanted between 2017 and 2022 were included. Of these, 174 presented with postlingual hearing loss and preoperative functional low-frequency hearing. The change in low-frequency pure-tone average was assessed as the difference between preoperative to 3-, 6-, and 12-months postoperative measurements. Data were analyzed through linear mixed-effects modeling and one-way ANOVA.ResultsPreoperative low-frequency, pure-tone average was higher for those implanted with perimodiolar compared with lateral wall electrodes (<i>P</i> < .05). The linear mixed-effects model revealed that change in low-frequency pure-tone average at all postoperative timepoints was similar between lateral wall and perimodiolar electrodes (<i>P</i> > .05).ConclusionThere were similar changes in residual postoperative hearing between all electrode types when controlling for preoperative low-frequency hearing and age implanted. These data suggest that newer, thinner perimodiolar and lateral wall electrodes could be considered for individuals with greater levels of preoperative low-frequency hearing.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251316217"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692477","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":"Convolutional Neural Network for Classification of Oropharynx Cancer with Video Nasopharyngolaryngoscopy.","authors":"Ryan Gifford, Abigail Reid, Sachin R Jhawar, Kyle VanKoevering, Samantha Krening","doi":"10.1177/19160216251326590","DOIUrl":"10.1177/19160216251326590","url":null,"abstract":"","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251326590"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657336","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":"In-Office Balloon Dilation for Idiopathic Subglottic Stenosis: A Pilot Study.","authors":"Catherine F Roy, Antonia Lagos-Villaseca, José A Correa, Jennifer A Silver, Eli Layous, Anne V Gonzalez, Jonathan Young, Karen M Kost","doi":"10.1177/19160216251314764","DOIUrl":"10.1177/19160216251314764","url":null,"abstract":"<p><p>ImportanceIdiopathic subglottic stenosis is a debilitating and recurrent disease, often requiring reintervention. Balloon dilation is a well-recognized, minimally invasive treatment to alleviate symptoms, and is typically performed in the operating room. In-office balloon dilation in the awake patient has rarely been reported, and may obviate the need for general anesthesia in this patient population.ObjectiveThis study aims to detail the safety and efficacy of in-office balloon dilation for mild to moderate subglottic stenosis.DesignMixed-methods study.SettingSingle tertiary-care institution in Montreal, Canada.Participants and InterventionAll adult patients with Cotton-Myer Grade I-II idiopathic subglottic stenosis undergoing in-office balloon dilation between June 1, 2022 and August 1, 2023 were prospectively recruited.Main Outcome MeasuresPre- and post-procedure validated dyspnea and voice scales, airway diameter and spirometry values were obtained. Patient- and physician-reported adverse events were thoroughly documented.ResultsEleven patients underwent in-office balloon dilation during the study period (F:M 10:1, mean age 55.8 years). The median Dyspnea Index and voice handicap index-10 scores both significantly decreased following the procedure. In-office balloon dilation improved airway patency, with an estimated median of 40% to 10% stenosis (median difference -25%, 95% CI (-45, -15), <i>P</i> = .003). The normalized peak expiratory flow percentage significantly increased from a median of 62% to 99% (median difference 27%, 95% CI (19, 40), <i>P</i> = .004). The median time to regular activities was one day. Six patients having previously undergone the procedure under general anesthesia indicated a preference for in-office dilation. There were no severe adverse events.Conclusion and RelevanceIn-office balloon dilation is a safe and effective option for the management of mild-moderate idiopathic subglottic stenosis, with demonstrated improvement in both patient-reported outcomes and objective measures.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251314764"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753084","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":"Punch Biopsy for Preoperative Depth of Invasion Assessment in Early Oral Tongue Squamous Cell Carcinoma: A Prospective Pilot Study.","authors":"Béatrice Voizard, Gabriel S Dayan, Olguta-Ecaterina Gologan, Tareck Ayad, Eric Bissada, Louis Guertin, Paul Tabet, Guillaume B Cardin, Laurent Létourneau-Guillon, Apostolos Christopoulos","doi":"10.1177/19160216251321452","DOIUrl":"10.1177/19160216251321452","url":null,"abstract":"<p><p>ImportanceThe inclusion of depth of invasion (DOI) in the American Joint Committee on Cancer's staging system for oral tongue squamous cell carcinoma (OTSCC) has major clinical implications. Few studies have evaluated the accuracy of preoperative biopsy to predict DOI.ObjectiveTo evaluate the reliability of preoperative punch biopsy for measuring DOI in early OTSCC and compare it to evaluation by digital palpation. Secondarily, to assess the punch biopsy's ability to differentiate between carcinoma in situ (Tis) and invasive carcinoma.DesignA prospective single-center cohort study.SettingCenter Hospitalier de l'Université de Montréal, a tertiary center in Canada.ParticipantsPatients with suspected early stage OTSCC.InterventionPunch biopsy was used to sample the deepest part of tumors to measure biopsy-derived DOI (bDOI). In addition, DOI was estimated via digital palpation: clinical DOI (cDOI) by surgeons.Main Outcome MeasuresPathologic DOI (pDOI) from final histopathology reports was the gold standard. Spearman's correlations were calculated between cDOI, bDOI, and pDOI. Diagnostic performance metrics were calculated for the ability to distinguish pDOI of ≥2 mm, and to differentiate Tis from invasive carcinoma.ResultsAmong 27 patients, correlation coefficients between bDOI and pDOI, and cDOI and pDOI were 0.603 (95% CI: 0.202-0.884) and 0.894 (95% CI: 0.749-0.955), respectively. Punch biopsy sensitivity and specificity were 0.88 (95% CI: 0.62-0.98) and 0.91 (95% CI: 0.59-0.99) to detect pDOI ≥ 2 mm, and 0.89 (95% CI: 0.65-0.99) and 0.86 (95% CI: 0.42-1.00) for distinguishing Tis from invasive carcinoma. Digital palpation sensitivity and specificity for pDOI ≥ 2 mm were 0.86 (95% CI: 0.57-0.98) and 1.00 (95% CI: 0.63-1.00).ConclusionsPunch biopsy and clinical palpation demonstrate high diagnostic yield for identifying lesions with pDOI ≥ 2 mm. Punch biopsy appears to be reliable to distinguish Tis from invasive carcinoma.RelevanceLarger studies are needed to corroborate these findings and assess the role of punch biopsy in guiding elective neck dissection decisions.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251321452"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764197","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":"Management of Anterior Epistaxis in the Emergency Department Using Rapid Rhino and Merocel: A Cost Analysis.","authors":"Dhatri Shukla, James Fowler, Taciano Rocha, Sisira Sarma, Leigh Sowerby","doi":"10.1177/19160216251321459","DOIUrl":"10.1177/19160216251321459","url":null,"abstract":"<p><strong>Importance: </strong>Epistaxis affects approximately 60% of the population over their lifetime. When conservative attempts fail, nasal tampons are often required to stop anterior bleeding. Health economics is critical in our publicly funded system. Determination of cost-effective interventions is crucial.</p><p><strong>Objective: </strong>To compare the total cost of Merocel and Rapid Rhino from the perspective of a provincial payer and an academic hospital for the management of anterior epistaxis.</p><p><strong>Design: </strong>Retrospective review.</p><p><strong>Setting: </strong>London Health Sciences Centre emergency department (Victoria and University campus).</p><p><strong>Participants: </strong>Patients ≥18 years of age presenting with anterior epistaxis. The participants were 67% men and 33% women. Approximately, 63% were on anticoagulant medication, and 35% used an ambulance to arrive at the hospital.</p><p><strong>Intervention: </strong>Rapid Rhino or Merocele, which was dependent on the site of presentation.</p><p><strong>Main outcome measures: </strong>Rebleed rate.</p><p><strong>Results: </strong>The rate of rebleeds with Merocel was 42% (26/62), whereas it was 24% (4/17) with Rapid Rhino. The inverse probability weighted regression adjustment results show that patients receiving Rapid Rhino did not have a statistically significant difference in costs per patient ($62.40, 95% CI: -$25.75 to $150.55) from the hospital perspective or the provincial health care payer perspective ($78.25, 95% CI: -$18.38 to $174.89).</p><p><strong>Conclusion and relevance: </strong>There was no significant difference in cost between Rapid Rhino and Merocel for anterior epistaxis from a hospital or provincial payer perspective.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251321459"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468517","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}