OTO Open最新文献

{"title":"Mental Health Disorders and Pain in Patients Undergoing Head and Neck Free Flap Surgery.","authors":"Kelly L Vittetoe, Marina Aweeda, Lily Gao, Christopher Naranjo, Liping Du, Xiaoke Feng, Wenda Ye, Alexander J Langerman, Kyle Mannion, James L Netterville, Eben L Rosenthal, Robert J Sinard, Michael C Topf, Sarah L Rohde, Alexander H Gelbard, Melanie D Hicks","doi":"10.1002/oto2.70105","DOIUrl":"10.1002/oto2.70105","url":null,"abstract":"<p><strong>Objective: </strong>Determine relationships between pain and mental health disorders (MHDs) in patients undergoing microvascular free flap reconstruction for head and neck cancer (HNC).</p><p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>Tertiary Care Institution in the Southeastern United States.</p><p><strong>Methods: </strong>Clinical data were manually abstracted from digital health records to obtain demographic, MHD, clinical outcomes, and pain data for HNC patients who underwent free flap reconstruction from 2017 to 2023. Univariate and multivariable regression analyses were performed to delineate relationships between MHDs and postoperative pain.</p><p><strong>Results: </strong>The study cohort comprised 283 patients. Ninety-four patients (33%) had preoperative MHDs, which were more common in women (42% vs 30%, <i>P</i> = .04) and in patients with chronic pain (53% vs 32%, <i>P</i> < .01). Preoperative opioid use (<i>P</i> = .03) and preoperative MHD (<i>P</i> = .03) were predictive of higher postoperative day (POD) 5 pain score. Thirty-three patients (11.7%) were diagnosed with a new MHD postoperatively, and 58 patients (20.5%) were started on a new long-term psychiatric medication postoperatively. POD1 pain score was predictive of the need for a new psychiatric medication postoperatively (odds ratio [OR] = 1.27, 95% CI: 1.05-1.56, <i>P</i> = .02).</p><p><strong>Conclusion: </strong>Postoperative pain and MHDs are independently predictive of one another in patients with HNC undergoing microvascular free flap reconstruction. Higher POD5 pain is predicted by the presence of preoperative MHD, and the need for a new psychiatric medication postoperatively is predicted by higher POD1 pain. HNC surgeons should align themselves with psychiatrists, social workers, and other allied fields to meet the complex mental health needs of their patients both preoperatively and postoperatively.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"9 2","pages":"e70105"},"PeriodicalIF":1.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Sexual Orientation and Gender Identity on the Otolaryngology Residency Experience.","authors":"Walter M Jongbloed, Hillary A Newsome, Lawrence Kashat, Kourosh Parham, Erynne A Faucett, Chia-Ling Kuo, Kelin Zhong, Katherine R Kavanagh","doi":"10.1002/oto2.70095","DOIUrl":"10.1002/oto2.70095","url":null,"abstract":"<p><strong>Objective: </strong>This study examines the influence of sexual orientation and gender on residents' experiences in US Otolaryngology residency programs. This study assesses the prevalence of bullying, sexual harassment, discrimination, homophobic remarks and evaluates the workplace environment, well-being, and impact of LGBTQ+ residents/faculty on rank list.</p><p><strong>Study design: </strong>A 26-question REDCap survey was distributed to all US Otolaryngology residencies.</p><p><strong>Methods: </strong>The survey was distributed to program directors over three months. Responses were compared between groups (sexual orientation and gender) using Fisher's exact test (5% significance level).</p><p><strong>Results: </strong>The response rate was 5.9% (104 responses), 15.5% identified as LGBTQ+. LGBTQ+ residents felt less comfortable disclosing relationships to attendings than heterosexuals (68.8% versus 85.3%, <i>P</i> = .005). LGBTQ+ and female respondents perceived a worse residency environment (<i>P</i> < .05). LGBTQ+ residents were less satisfied with their decision to pursue Otolaryngology (75% vs 95.4%, <i>P</i> = .044) and more likely to consider leaving their program (25% vs 6.9%; <i>P</i> = .047). An LGBTQ+ faculty member or resident positively impacted rank lists for LGBTQ+ residents (43.8% vs 12.6%, <i>P</i> = .007; 50% vs 16.1% <i>P</i> = .005). Women reported more discrimination and sexual harassment than men (78.4% vs 14.8%; <i>P</i> < .001; 31.9% vs 11.1%; <i>P</i> = .014, respectively).</p><p><strong>Conclusion: </strong>LGBTQ+ and female respondents perceive a worse residency environment. LGBTQ+ residents are less comfortable disclosing relationships to attendings, less satisfied with their decision to pursue Otolaryngology, more likely to consider leaving programs, and desire representation. Women are at increased risk of sexual harassment and discrimination.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"9 2","pages":"e70095"},"PeriodicalIF":1.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Misjudgments of Hearing Loss and Its Implications for Over-the-Counter Hearing Aids.","authors":"Ayelet Hamburger, Russell Whitehead, Elias Michaelides","doi":"10.1002/oto2.70101","DOIUrl":"10.1002/oto2.70101","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated whether patients' perception of their hearing loss accurately reflects their measured hearing thresholds on their audiogram, specifically relating to a mild to moderate hearing loss, which is the determining candidacy for over-the-counter (OTC) hearing aids.</p><p><strong>Study design: </strong>Retrospective review.</p><p><strong>Setting: </strong>Audiology clinic at a tertiary care center.</p><p><strong>Methods: </strong>This retrospective chart review included 232 ears from 116 patients older than 18 years seen for audiograms at our audiology clinic between 2022 and 2023. Data points were taken using the pure tone average (PTA) thresholds at 500 to 2000 Hz and the PTA thresholds at 2000 to 4000 Hz, as hearing sensitivity at these frequencies is most widely associated with speech comprehension and serves as a reliable measure of hearing.</p><p><strong>Results: </strong>Overall, when using the 2000- to 4000-Hz PTA as an indicator of the degree of hearing loss, only 52% of patients correctly quantified their level of hearing. When using the 500- to 2000-Hz PTA, 61% of patients correctly quantified their degree of hearing loss.</p><p><strong>Conclusion: </strong>This study suggested that individuals are frequently unable to assess their degree of hearing loss with sufficient accuracy to choose the most appropriate care. To ensure that consumers are making informed decisions about the use of OTC hearing aids, the Food and Drug Administration should consider offering additional guidance that directs patients to first seek out a more standardized measure of hearing provided by a hearing health professional. This additional direction can enhance the quality of care of OTC hearing aid consumers.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"9 2","pages":"e70101"},"PeriodicalIF":1.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Multimodal Analgesic Use After Otolaryngologic Surgery-A Single-Institution Experience of 9000 Patients.","authors":"Karolina A Plonowska-Hirschfeld, Jasmeet Saroya, Jose Herrera, Jolie L Chang, Andrew N Goldberg, Rahul Seth, Megan L Durr","doi":"10.1002/oto2.70106","DOIUrl":"10.1002/oto2.70106","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess a quality improvement intervention to decrease opiate prescriptions at discharge and improve patient access to multimodal analgesics (MMA) after otolaryngologic surgery.</p><p><strong>Study design: </strong>Longitudinal quality improvement initiative with retrospective prescription trend review and prospective patient questionnaire collection.</p><p><strong>Setting: </strong>An academic medical center.</p><p><strong>Methods: </strong>Opioid, acetaminophen, and non-steroidal anti-inflammatory drug (NSAID) discharge prescriptions after otolaryngologic procedures were reviewed. Two annual department-wide workshops were carried out to review the literature on published MMA protocols and develop standardized post-operative pain medication instructions to reduce opioid use. Concurrently, a patient survey was distributed to evaluate discharge pain medication use and satisfaction with pain control.</p><p><strong>Results: </strong>Discharge pain medications were reviewed for 9064 procedures between January 2021 and May 2024. After the interventions above, the percentage of patients receiving opioids at discharge decreased from 61.4% to 46.8% (<i>P</i> < .00001). Concurrently, acetaminophen and NSAID discharge prescriptions increased from 24.3% and 10.2% to 67.4% and 46.1%, respectively (both <i>P</i> < .00001). Among 100 patients surveyed, satisfaction with post-operative pain control was high before and after the implementation of standardized discharge instructions, even though fewer post-intervention patients received opioids at discharge (49.1% compared to 76.6% pre-intervention, <i>P</i> = .007). Notably, 27% of patients prescribed opioids reported not taking them and 23% reported saving unused opioids for future use.</p><p><strong>Conclusion: </strong>Implementation of standardized post-operative pain medication instructions at discharge after otolaryngologic procedures led to a substantial decrease in opioids prescribed while maintaining patient satisfaction with post-operative pain management. A significant proportion of patients reported saving unused opioids for future use despite standardized safe disposal instructions.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"9 2","pages":"e70106"},"PeriodicalIF":1.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ototoxicity Monitoring: The Evolution of a Protocol for Head and Neck Cancer Patients.","authors":"Jena Patel, Jacob Beiriger, Kalena Liu, Zach Urdang, Julia Croce, Molly Wolfson, Jacob Hulswit, Olivia Giglio, Jacob B Hunter, Irina Middleton","doi":"10.1002/oto2.70070","DOIUrl":"10.1002/oto2.70070","url":null,"abstract":"<p><strong>Objective: </strong>We evaluated an ototoxicity monitoring program (OMP) for improving audiologic follow-up in head and neck cancer (HNC) patients.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary academic center.</p><p><strong>Methods: </strong>Two hundred and forty patients were recommended for chemotherapy between January 2017 and June 2022. An OMP was implemented in March 2021; every patient received an audiology referral and was contacted to schedule a pretreatment audiogram. Patients were divided into pre-OMP and post-OMP cohorts. Main outcome measures included rates of pretreatment audiograms, posttreatment audiograms, posttreatment otologic symptoms, and hearing aid utilization.</p><p><strong>Results: </strong>There were 131 patients evaluated pre-OMP and 109 evaluated post-OMP. The mean age for all patients was 62.8 ± 11.9 years; 76.3% were male. After the implementation of the OMP, a significantly higher proportion of patients received a pretreatment audiogram (66.1% vs 34.4%, <i>P</i> < .001), with enrolled patients being 3.8 times more likely to obtain 1 (95% confidence interval: 2.2-6.6), <i>P</i> < .001). There was a significant increase in reported otologic symptoms after implementing the program (18% vs 36%, <i>P</i> = .002). However, the rate of hearing aid utilization decreased after OMP implementation (pre-OMP: 33% vs post-OMP: 13%, <i>P</i> = .02).</p><p><strong>Conclusion: </strong>Implementation of an OMP significantly improved the proportion of HNC patients that underwent pretreatment audiograms prior to systemic therapy; however, audiologic follow-up remained largely unchanged in the posttreatment period.</p><p><strong>Level of evidence: </strong>Level 4.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"9 2","pages":"e70070"},"PeriodicalIF":1.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Branch Retrograde Superficial Parotidectomy for Tail of Parotid Lesions.","authors":"Chloe H Amsterdam, Ryan T Judd, Jeremy Godsell, Hilary C McCrary, Janice L Farlow, Enver Ozer","doi":"10.1002/oto2.70053","DOIUrl":"10.1002/oto2.70053","url":null,"abstract":"<p><p>Facial nerve dysfunction following superficial parotidectomy is one of the most well-known and dreaded complications of the procedure, leading to significant postoperative impairments in affected patients. In lesions involving the parotid tail, the marginal mandibular branch is at particular risk. In contrast, injury to the cervical branch is usually of minimal consequence. Classically, facial nerve dissection in parotidectomy is performed anterograde from the main trunk. In patients presenting with benign superficial parotid tail lesions, however, we often begin with the identification of the cervical branch and perform retrograde dissection to decrease the risk of injury to both the main trunk and the marginal mandibular branch. This technique also allows for the preservation of the great auricular nerve, a shorter incision, and a smaller elevated facial flap, yielding better cosmetic and functional results without compromising the integrity of the resection. Here we describe this technique used for 5 consecutive patients with excellent outcomes.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"9 2","pages":"e70053"},"PeriodicalIF":1.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Year Outcomes After Temperature-Controlled Radiofrequency Treatment of Nasal Airway Obstruction.","authors":"William C Yao, Randall Ow, Michael J Sillers, Nathan E Nachlas, Curtis D Johnson, Dale Ehmer, Jordan Pritikin, Henry P Barham","doi":"10.1002/oto2.70111","DOIUrl":"10.1002/oto2.70111","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the long-term safety and effectiveness of temperature-controlled radiofrequency (TCRF) treatment of nasal valve collapse (NVC) in patients with nasal airway obstruction (NAO).</p><p><strong>Study design: </strong>This is an extended follow-up from a prospective, multicenter, single-arm study. The initial study included participants from 12 sites across the United States who were followed for 24 months and additionally agreed to participate in the extended 36-month follow-up.</p><p><strong>Setting: </strong>Procedure was performed in-office with an in-person follow-up at 3 months and subsequent follow-up assessment remotely.</p><p><strong>Methods: </strong>Participants received TCRF treatment of only the nasal valve and participated in the extended 36-month follow-up. The effect of TCRF treatment was determined by analyzing changes in nasal obstruction symptom evaluation (NOSE) score at each follow-up compared to the baseline.</p><p><strong>Results: </strong>Of the 122 participants in the primary study, 66 participated in the extended 36-month follow-up. Compared to baseline, there was a 52.6% decrease in the NOSE score at 36 months (mean change -45.3 [95% CI -52.3 to -38.3]; <i>P</i> < .001), and 83.3% of the participants met the criteria for treatment response at 36 months, as defined by the study endpoint. Post hoc sensitivity analysis of the treatment response for all participants from the time of enrollment was 73.9%. No device or procedure-related adverse events or serious adverse events were reported in the interval between 24 and 36 months.</p><p><strong>Conclusion: </strong>TCRF treatment of only the nasal valve resulted in significant and durable improvement in NAO symptoms through 36 months in participants with NAO due to NVC.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"9 2","pages":"e70111"},"PeriodicalIF":1.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Glove Overuse in Outpatient Specialty Clinics: Cost Reduction and Environmental Benefit.","authors":"M Lauren Lalakea, Julia E Noel, Duncan A Meiklejohn","doi":"10.1002/oto2.70103","DOIUrl":"10.1002/oto2.70103","url":null,"abstract":"<p><p>Gloves are the highest-volume single-use disposable product used in health care. Minimizing unnecessary glove use is relevant in the context of mitigating health care waste and greenhouse gas emissions. We sought to reduce non-sterile glove overuse in the Otolaryngology - Head and Neck Surgery and Plastic Surgery/Burn Clinics affiliated with a tertiary care safety-net teaching hospital by using evidence-based education regarding hand hygiene and appropriate glove use. Baseline use averaged 14,820 gloves/month and 10.8 gloves/patient visit. After intervention, use decreased to 10,100 gloves/month and 7.9 gloves/visit, respectively, representing a 27% reduction in gloves/visit. On an annualized basis, this corresponds to a savings of 56,628 gloves, 180 kilograms of waste, and $3,003.17 per year. Calculated projected reduction in CO₂e emissions is 1472-1767 kg annually, equivalent in impact to 3766-4519 miles driven in a standard gas-powered car. Widespread adoption would provide a significant positive impact given the scale of glove use in US health care settings.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"9 1","pages":"e70103"},"PeriodicalIF":1.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrin Sealants in Facial Plastic Surgery: A National Database Analysis of Complication Risk.","authors":"Hänel W Eberly, Sandeep Pradhan, Jacqueline Tucker, Bao Y Sciscent, Tonya S King, Jessyka G Lighthall","doi":"10.1002/oto2.70102","DOIUrl":"10.1002/oto2.70102","url":null,"abstract":"<p><strong>Objective: </strong>Fibrin sealants (FS) are gaining popularity in surgical practice. However, limited data exist for most facial plastic surgical (FPS) procedures.</p><p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>The TriNetX Research Network.</p><p><strong>Methods: </strong>The TriNetX national database was utilized to identify patients that underwent select FPS procedures. Cohorts included one group with FS recorded on the same day as the procedure, and another without. Demographics, comorbidities, and postoperative complications were investigated.</p><p><strong>Results: </strong>A total of 550,777 patients underwent an FPS procedure, 600 patients with FS and 550,177 without. There was no difference in the rate of overall complications between groups (adjusted odds ratio [aOR] 0.92, [0.71-1.2], <i>P</i> = .54), with adjustment for age, race, ethnicity, marital status, nicotine use, and anticoagulation. However, higher rates of postoperative wound disruption (aOR 1.63, [1.14-2.33], <i>P</i> = .008) were seen in the FS group. Patients in the FS group had higher rates of nicotine use (12.7% vs 8.7%, <i>P</i> < .001) and anticoagulation (39.2% vs 27.7%, <i>P</i> < .001) overall. Subanalyses by procedure found increased rates of any postoperative complications for those with FS (aOR 1.51, [1.01-2.24], <i>P</i> = .044) in patients receiving regional flaps. There were no significant differences in postoperative complications between groups in patients receiving grafts, rhinoplasty, or rhytidectomy.</p><p><strong>Conclusion: </strong>There were no differences in the rates of having any complications between groups overall. Patients receiving regional flaps and grafts experienced more complications. There were no significant differences between groups in patients receiving grafts, rhinoplasty, or rhytidectomy. Surgeons may consider utilizing FS for FPS procedures when appropriate.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"9 1","pages":"e70102"},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Decision to Pursue Sleep Surgery.","authors":"Tiffany Husman, Amrita Bhat, Megan L Durr, Jolie L Chang","doi":"10.1002/oto2.70093","DOIUrl":"10.1002/oto2.70093","url":null,"abstract":"<p><strong>Objective: </strong>To identify predictors of patient decision to pursue sleep apnea surgery following initial consultation with a sleep surgeon.</p><p><strong>Study design: </strong>Retrospective cohort analysis.</p><p><strong>Setting: </strong>Outpatient tertiary care academic center.</p><p><strong>Methods: </strong>A retrospective review of patients with obstructive sleep apnea (OSA) diagnosis, BMI < 35 kg/m², and prior positive airway pressure (PAP) trial who were evaluated at a sleep surgery clinic. Patients who completed drug-induced sleep endoscopy (DISE) and/or surgery were compared to those who did not within at least 4 months of consultation. Surveys on OSA-related symptoms and decisional conflict were completed prior to the consultation for PAP alternatives.</p><p><strong>Results: </strong>Among 437 patients, 321 did not undergo DISE/surgery, whereas 116 completed DISE/surgery within an average of 16.8 months of consultation. Patients who underwent DISE/surgery had a significantly higher Epworth sleepiness scale score (10.1 ± 4.9 vs 8.5 ± 5.1, <i>P</i> = .006) and insomnia severity index (15.6 ± 5.5 vs 14.3 ± 5.8, <i>P</i> = .037) as well as significantly lower decisional conflict scale (DCS) scores (27.9 ± 21.8 vs 38.2 ± 24.9, <i>P</i> < .001). Multivariate analysis revealed that lower preconsultation DCS score (OR = 0.97, 95% CI [0.97, 0.99], <i>P</i> < .001) and lower BMI (OR = 0.91, 95% CI [0.85, 0.99], <i>P</i> = .019) were independently significant predictors of pursuing DISE/surgery.</p><p><strong>Conclusion: </strong>Decisional conflict prior to consultation is significantly associated with completion of DISE/surgery. Those with higher decisional conflict are less likely to proceed with DISE/surgery after consultation on PAP alternatives. Effective interventions that improve patient understanding of OSA and enhance support in decision-making are needed.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"9 1","pages":"e70093"},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}