Otolaryngology- Head and Neck Surgery最新文献

{"title":"Health Insurance Coverage and Hearing Aid Utilization in U.S. Older Adults: National Health Interview Survey.","authors":"Diego E Razura, Nikko D Beady, Matthew E Lin, Janet S Choi","doi":"10.1002/ohn.1201","DOIUrl":"https://doi.org/10.1002/ohn.1201","url":null,"abstract":"<p><strong>Objective: </strong>Assess rates of hearing aid use by insurance coverage in U.S. older adults and their changes over time.</p><p><strong>Study design: </strong>Cross-sectional analysis of the National Health Interview Survey 2007-2018.</p><p><strong>Setting: </strong>Participants (≥65 years) with complete data on insurance, hearing aid use, and self-reported hearing limitations.</p><p><strong>Methods: </strong>Rates of hearing aid use among older adults who self-reported hearing limitations and their trends were estimated using survey weights. Sixteen insurance categories were created based on exclusive and combinatorial coverage, with Medicare coverage only as a reference group. The associations between insurance coverage and hearing aid use were examined using multivariable regression analyses.</p><p><strong>Results: </strong>Hearing aid use rate among older adults who self-reported hearing limitations was 51.2% in the United States. In multivariable models adjusting for demographics, socioeconomic status, self-reported hearing loss, and comorbidities, Military insurance only and Military & Medicare groups reported higher hearing aid use rates than Medicare only (odds ratio [OR] 3.14, 95% confidence interval [CI] 1.49-6.64; OR 1.8, 95% CI 1.55-2.09, respectively). During 2007-2018, there were no significant changes in hearing aid use rates by insurance groups among private, Medicaid, and military insurance coverage.</p><p><strong>Conclusion: </strong>While hearing aid use remains low among U.S. older adults, Military-related insurance, which generally provides enhanced coverage for hearing aids, was independently associated with higher use rates compared to Medicare, which does not offer coverage. Future research should examine the direct impact of different insurance policies on hearing aid use and its downstream health benefits.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Stepwise Technology-Based Audiometry With Rapid Results (STARR) Protocol in Minnesota Elementary Schools.","authors":"Autefeh Sajjadi, Morgan McBride, Kimberly Guettler, Stephanie Janasko, Staci House, Cesley Bergsten, Nobles Antwi, Madeline Marker, Soorya Todatry, Stacey Rabusch, Rebecca Maher, Brianne Roby, Abby C Meyer, Andrew Redmann, Sivakumar Chinnadurai, Asitha D L Jayawardena","doi":"10.1002/ohn.1192","DOIUrl":"https://doi.org/10.1002/ohn.1192","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to understand the utility of a stepwise technology-based audiometry with rapid results (STARR) school screening protocol.</p><p><strong>Study design: </strong>A prospective cohort study.</p><p><strong>Setting: </strong>Six elementary schools in a single school district in Minnesota.</p><p><strong>Methods: </strong>Students at 6 elementary schools in Minnesota participated in the STARR protocol and underwent initial technology-based hearing screening, followed by additional comprehensive automated audiometry with insert earphones and point-of-care otoscopy if they were referred. Results were reviewed by an otolaryngologist remotely, and parents received treatment recommendations based on these findings.</p><p><strong>Results: </strong>A total of 454 (81% of eligible) students were screened and 27 students (5.9%) referred. On average, the initial screening took 55 seconds (standard deviation [SD] = 22) for those who passed and 116 seconds (SD = 55) for those who were referred. Comprehensive audiometry screening took 163 seconds (SD = 27) for those who passed and 252 seconds (SD = 100) for those who referred. A team of 6 screeners could screen a class of 30 students in 30 minutes. The total number of nursing encounters required to ensure a student saw a provider after a referral was reduced using the STARR protocol (2.47 encounters per referral) compared to traditional audiometric screening (3.39 encounters per referral) (P < .01).</p><p><strong>Conclusion: </strong>The STARR protocol is a feasible and efficient method of screening in public schools that can reduce false referral rate, provide parents with more information at the point of referral, and reduce nursing burden.</p><p><strong>Implications for practice: </strong>Technology-based hearing screenings should be considered in school settings as a means to provide more patient and family-centered hearing health care. Further research is necessary to understand how the STARR protocol influences loss to follow-up rates after failed hearing screening.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late Flap Failure: Etiology and Management.","authors":"Matthew B Studer, Skylar H Trott, Sara Yang, Farshid Taghizadeh, Mark K Wax","doi":"10.1002/ohn.1193","DOIUrl":"https://doi.org/10.1002/ohn.1193","url":null,"abstract":"<p><strong>Objective: </strong>Late free flap failure is an unusual setback for patients; we investigated the etiology and management of late flap failure.</p><p><strong>Study design: </strong>Single-institution retrospective review of 1959 free flaps from 2010 to 2023 for head and neck defects.</p><p><strong>Setting: </strong>Tertiary Academic Medical Center.</p><p><strong>Methods: </strong>Late failure was defined as initial detection of vascular compromise on postoperative day 6+, who went on to have total or partial flap loss. Variables included age, subsite, medical history, complications, day of detection, failure etiology, and treatment. Late failure cohort was compared to a cohort of 499 patients with long-term flap survival and 37 patients with early flap failure. Oregon Health and Science University (OHSU) Institutional Review Board (IRB) approval obtained; study number IRB00003898.</p><p><strong>Results: </strong>Thirty-one patients had late failure (1.6%). Twenty-five (80.6%) had total flap failure; six (19.4%) had partial failure. The majority (17, 54.8%) were associated with a postoperative complication (infection, fistula, wound dehiscence, or hematoma) which contributed to flap compromise. Average time until detection was 11 days. Patients had two or more reoperations in 21 cases (67.7%); rotational flaps were most common (19, 61.3%) followed by a second free flap (9, 29%). In comparing the late failure and long-term flap survival cohorts, late failure patients had a higher proportion of having had at least one intraoperative pedicle revision (41.9% vs 15.4%, odds ratio [OR] = 3.96 [95% confidence interval (CI) 1.86-8.41]); early flap failure patients had similar pedicle revision rates to late failure patients. Late failure patients had more postoperative infections than early failure patients (41.9% vs 18.9%, OR = 3.10 [95% CI 1.04-9.20]).</p><p><strong>Conclusion: </strong>Patients with late free flap failure require multiple operations for debridement and secondary reconstruction. Patients with both late and early failure are more likely to have had intraoperative pedicle revision. Postoperative infection is more common in late flap failure than early flap failure.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Prognosis of Patients With Non-Syndromic Sensorineural Hearing Loss Associated With Myo15a Mutations.","authors":"Yueying Wang, Shubin Fang, Xiaoqing Cen, Yue Liang, Anhai Chen, Lusha Huang, Juan Wang, Guanxia Xiong, Kaitian Chen","doi":"10.1002/ohn.1200","DOIUrl":"https://doi.org/10.1002/ohn.1200","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the characteristics of hearing loss associated with MYO15A mutations and to analyze the longitudinal prognosis over a 4-year period using different treatment modalities, including cochlear implants (CIs), hearing aids (HAs), and conservative management.</p><p><strong>Study design: </strong>A retrospective case review.</p><p><strong>Setting: </strong>A tertiary referral center.</p><p><strong>Methods: </strong>Sequencing was performed to recruit patients with potentially pathogenic MYO15A mutation-induced hearing loss. Audiological data, radiological imaging, and assessment of hearing and speech performance before and after different treatments were analyzed in combination with patients' genotypes.</p><p><strong>Results: </strong>Sixteen patients with MYO15A mutation-induced deafness from 14 unrelated pedigrees were enrolled, carrying 5 previously unreported mutations: c.3660_3666delinsAA (p.Glu1221fs), c.4635delG (p.Val1545fs), c.6664A>G (p.Met2222Val), c.8215delG (p.Ala2739fs), and c.8897delG (p.Gly2966fs). Inner ear malformations were observed in 3 patients. CI recipients exhibited significant improvements in hearing and speech abilities 1-year post-implantation, while individuals using HAs showed a gradual improvement trend over a 4-year period. Notably, even those with bilateral cochlear aperture atresia achieved satisfactory hearing and speech outcomes following early CIs.</p><p><strong>Conclusion: </strong>Patients with MYO15A mutations who underwent CIs generally demonstrated earlier improvements in hearing and speech development compared to those using HAs. Early genetic detection and timely implementation of assistive acoustic stimulation are recommended for optimal outcomes.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographics and Trends in Outpatient Surgery for Laryngeal Cancer: 2016-2021.","authors":"Jason H Lee, Jamie W Lewis, James D Warren, Alia Tayara, Thanh-Huyen Vu, Anne C Kane","doi":"10.1002/ohn.1198","DOIUrl":"https://doi.org/10.1002/ohn.1198","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the utilization patterns of outpatient laryngoscopic excision procedures for laryngeal cancer in the United States, examining procedural costs and patient demographics to identify disparities in healthcare access.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>National Ambulatory Surgery Sample database of major ambulatory surgeries in the United States, 2016-2021.</p><p><strong>Methods: </strong>Encounters for endoscopic resection of laryngeal cancers were identified focusing on patient demographics and procedural costs. Analysis was performed regarding trends over time.</p><p><strong>Results: </strong>Of 11,371 encounters in 2016-2021, patients were mostly male (82.6%), White (75.3%), and living in metropolitan areas with greater than 1 million residents (54.1%), with an even distribution between income quartiles. Predictors of utilization at urban teaching hospitals progressively decreased in patients residing in smaller metropolitan areas (250-999,000 residents (odds ratio [OR] = 0.451, P ≤ .0001) and 50-249,000 residents (OR = 0.193, P ≤ .0001). Higher utilization was found in non-White patients (Black [OR = 1.673, P = .0075], Hispanic [OR = 1.752, P = .0118]), and those with patients with higher income (2nd quartile [OR = 1.411, P = .0058], 3rd quartile [OR = 2.017, P ≤ .0001], and 4th quartile [OR = 4.422, P < .0001]). These findings were consistent on multivariate analysis, however belonging to a racial minority lost significance (Black patients [P = .0508], Hispanic [P = .3008]).</p><p><strong>Conclusion: </strong>There are existing disparities in endoscopic resection of laryngeal cancers. Our findings add to the literature underscoring the importance of expanding access to minimally invasive laryngeal preserving surgical treatment.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preservation Palatopharyngoplasty for Obstructive Sleep Apnea With High Modified Mallampati Scores: Clinical and Polysomnographic Outcomes.","authors":"Mohamed Abdelwahab, Mohamed Faisal Kassir, Nicolas S Poupore, Robson Capasso, Shaun A Nguyen","doi":"10.1002/ohn.1184","DOIUrl":"https://doi.org/10.1002/ohn.1184","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to describe and evaluate clinical and polysomnographic outcomes of the preservation palatopharyngoplasty procedure, which preserves pharyngeal mucosa and muscles, in patients with obstructive sleep apnea with high modified Mallampati scores (3 or 4).</p><p><strong>Study design: </strong>A retrospective chart review.</p><p><strong>Setting: </strong>A tertiary medical center.</p><p><strong>Methods: </strong>A total of 23 patients who underwent preservation palatopharyngoplasty between November 2022 and May 2024 were included. Outcomes measured were apnea-hypopnea index (AHI), oxygen desaturation index (ODI), Epworth Sleepiness Scale (ESS) scores, and Nasal Obstruction Symptom Evaluation (NOSE) Scale scores pre- and postsurgery. Data were analyzed using unpaired or paired t-tests, and statistical significance was set at P < .05.</p><p><strong>Results: </strong>The mean age of included patients was 51.74 years. Postoperative results showed a significant 25.48% (standard deviation [SD] = 32.59) decrease in AHI (P = .0011) and 35.25% (SD = 11.00) mean decrease in ODI (P = .0030). REM sleep percentage increased from 12.96% to 21.35% (P = .0106), and REM AHI decreased from 55.49 to 40.02 events/h (P = .0255). Significant improvements were also seen in ESS (P = .0123) and NOSE scores (P = .0134). Among the included patients, 12 out of 23 patients achieved surgical success per Sher's criteria.</p><p><strong>Conclusion: </strong>The preservation palatopharyngoplasty significantly improved subjective and objective measures in OSA patients with higher Mallampati scores by enhancing upper airway patency and reducing OSA severity.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between the Dietary Inflammatory Index and Middle Ear Disease in Adults: An NHANES Analysis.","authors":"Gaoke Pan, Shenjie Pan, Weiyuan Gong, Jian Zhang","doi":"10.1002/ohn.1178","DOIUrl":"https://doi.org/10.1002/ohn.1178","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the relationship between the dietary inflammatory index (DII) and middle ear disease (MED) in adults using data from the National Health and Nutrition Examination Survey (NHANES) 2015 to 2020.</p><p><strong>Study design: </strong>A cross-sectional analysis was conducted on a sample of American adults to explore the association between DII and MED.</p><p><strong>Setting: </strong>The study utilized data from 3 NHANES cycles (2015-2020), assessing the health and nutritional status of adults and children in the United States.</p><p><strong>Methods: </strong>We analyzed data from 3743 participants aged 20 and older, with MED defined by abnormal tympanogram results. DII was calculated based on dietary intake data recorded during the 24 hours before the interview. Logistic regression models were used to examine the association between DII and MED, adjusted for various demographic and health-related factors.</p><p><strong>Results: </strong>The results revealed a significant positive association between higher DII scores and the likelihood of MED, particularly in individuals under 60 years of age. A nonlinear relationship was identified, with a threshold effect at a DII value of 2.74, below which higher DII was associated with increased risk of MED, while the association weakened above this threshold.</p><p><strong>Conclusion: </strong>This study suggests that inflammatory dietary patterns are associated with an increased risk of MED, especially in younger adults. The findings underscore the importance of dietary interventions in preventing and managing MED and warrant further prospective studies to confirm these results and understand the mechanisms by which diet affects middle ear health.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Speech Performance Following Intraoperative Correction of Cochlear Implant Electrode Array Tip Fold-Overs.","authors":"Miriam R Smetak, Matthew A Shew, Jordan Varghese, Nedim Durakovic, Cameron C Wick, Craig A Buchman, Jacques A Herzog","doi":"10.1002/ohn.1199","DOIUrl":"https://doi.org/10.1002/ohn.1199","url":null,"abstract":"<p><strong>Objective: </strong>Cochlear implant (CI) electrode array tip fold-overs occur at an increased rate with perimodiolar electrode arrays, necessitating removal and re-insertion. The degree to which an intra-operative correction of tip fold-over affects CI performance and hearing preservation has not been previously reported.</p><p><strong>Study design: </strong>Retrospective chart review of CI recipients receiving a slim perimodiolar electrode array from 2016 to 2023.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Methods: </strong>Low-frequency pure tone average (LFPTA) was defined as the average of thresholds at 125, 250, and 500 Hz. We defined hearing preservation candidacy as LFPTA < 60 dB HL preoperatively, and successful hearing preservation was defined as LFPTA < 80 dB HL at activation. Consonant-nucleus-consonant (CNC) word recognition and AzBio scores in quiet and in +10 dB signal-to-noise ratio (SNR) were collected preoperatively, and at 3- and 6-months postoperatively.</p><p><strong>Results: </strong>From 663 implants, 35 (5.3%) experienced tip fold-over that was identified and corrected intra-operatively. There was no significant difference in 3-month CNC scores between those with fold-overs (44.9%, SD 20.9%) and those without (46.2%, SD 21.0%; P = .98). Similarly, there was no difference in AzBio in quiet (53.1%, SD 21.7% vs 60.8%, SD 28.0%; P = .26) or in AzBio +10 dB SNR (19.1%, SD 23.7% vs 31.5%, SD 27.2%; P = .60). Of 19 hearing preservation candidates that experienced tip fold-over, 6 (31.6%) had preserved hearing at activation compared to 31 of 59 candidates (52.5%; P = .11) without fold-over.</p><p><strong>Conclusion: </strong>While tip fold-over remains a clinical concern, speech performance does not appear to be negatively affected if the fold-over is identified and corrected.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Speech Delay and Hearing Rehabilitation Disparities in Children With Hearing Loss.","authors":"Lacey C Magee, Malek Bouzaher, Mihika Thapliyal, Yi-Chun Liu, Samantha Anne","doi":"10.1002/ohn.1204","DOIUrl":"https://doi.org/10.1002/ohn.1204","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the influence of race and insurance type on speech delay rates and hearing rehabilitation access in children with bilateral hearing loss (HL).</p><p><strong>Study design: </strong>Retrospective cross-sectional study of pediatric patients with bilateral HL who received cochlear implants (CIs) or hearing aids (HAs).</p><p><strong>Setting: </strong>This study used the national Pediatric Health Information System (PHIS) database to identify patients with HL across 52 tertiary care pediatric hospitals in the United States.</p><p><strong>Methods: </strong>Data collected included demographics, CI/HA use, speech delay/disorders, and type of insurance coverage.</p><p><strong>Results: </strong>This study identified 18,422 patients with bilateral HL (40.1% female, 66.3% white, 66.3% on public insurance), with an average age of 5.21 ± 4.37 years. Patients with private insurance were more likely to be white than non-white (48.9% vs 27.5%, P < .001), more likely to receive CI (18.0% vs 14.7%, P < .001), more likely to receive HA (21.3% vs 17.9%, P <.001), and less likely to have speech delay diagnoses (74.9% vs 81.0%, P < .001) compared to patients with public insurance. Compared to non-white patients, white patients were more likely to have CI (16.8% vs 14.7%, P < .001), more likely to have HA (20.6% vs 17.0%, P < .001), and less likely to have speech delay diagnoses (81.1% vs 77.2%, P < .001). When adjusting for other variables, these associations with insurance type and race were still observed.</p><p><strong>Conclusion: </strong>Disparities seen amongst different races and income groups can be observed at the population level and highlight an opportunity for policy interventions to secure equitable access for children with pediatric HL.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial of Ergonomic Risk in Pediatric Adenotonsillectomy.","authors":"David Barkyoumb, Zainab Sandhu, Sukaina Hasnie, Daniel Zhao, Vikram Ramjee, Jack Calvin Borders, Colin Fuller","doi":"10.1002/ohn.1190","DOIUrl":"https://doi.org/10.1002/ohn.1190","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to compare the intraoperative ergonomics of tonsillectomies and adenoidectomies performed in seated versus standing positions for pediatric otolaryngology residents and attending physicians.</p><p><strong>Study design: </strong>A randomized controlled trial.</p><p><strong>Setting: </strong>A tertiary care center.</p><p><strong>Methods: </strong>Intraoperative data were collected for 2 attending physicians and 13 residents as they performed adenoidectomies and tonsillectomies. Each tonsillectomy was randomized to either first tonsil sitting/second tonsil standing or vice versa. Adenoidectomies performed during the same anesthesia were performed in the second of the 2 positions, and thus also randomized. Isolated adenoidectomies were randomized to either the sitting or standing position. The rapid upper limb assessment (RULA) was used to quantify ergonomic risk for each operation on a 0 to 7 scale.</p><p><strong>Results: </strong>Univariate analysis demonstrated a significant difference between sitting and standing positions (P < .001), with the sitting position exhibiting lower mean total RULA scores (mean = 3.26, median = 3.00) compared to standing (mean = 3.76, median = 4.00). This was confirmed using a multi-variable analysis adjusting for demographic variables. Univariate analysis showed that PGY1 residents had the lowest total RULA scores, whereas attending physicians had the highest total RULA scores. However, this was not confirmed by multi-variable analysis. Upper arm, lower arm, and trunk body region scores were higher in the sitting position, while wrist and neck scores were higher in the standing position. These conclusions were drawn from both univariate and multi-variable analysis.</p><p><strong>Conclusion: </strong>Sitting during adenotonsillectomy may mitigate ergonomic risk. Further research is needed to identify ways in which intraoperative ergonomics can be optimized. This study may also have implications for similar intraoral procedures.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}