Otolaryngology- Head and Neck Surgery最新文献

{"title":"Private Equity in Otolaryngology: What Is the Impact on Medicare Payments?","authors":"Roshan Dongre, Najm S Khan, Faizaan Khan, Keyvon Rashidi, Heli Majeethia, Isuru Somawardana, Jeffrey T Vrabec, Masayoshi Takashima, Omar G Ahmed","doi":"10.1002/ohn.1154","DOIUrl":"10.1002/ohn.1154","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess whether private equity (PE) acquisitions of otolaryngology-head and neck surgery (OHNS) practices are associated with changes in Medicare payments and procedure volume.</p><p><strong>Study design: </strong>A cross-sectional study.</p><p><strong>Setting: </strong>PitchBook and the Medicare Provider Utilization and Payment Data File.</p><p><strong>Methods: </strong>PE acquisitions of OHNS practices were determined using the PitchBook database and linked to the 2016-2022 Medicare Provider Utilization and Payment Data File based on practice address. Non-PE practices were included as control if located in a state where an acquisition occurred, with the index point corresponding to the year of acquisition. Medicare payments for all procedures were totaled and averaged. PE-affiliated and non-PE-affiliated practices were compared before and after the acquisition.</p><p><strong>Results: </strong>A total of 9 acquisitions of OHNS practices across 7 states were identified. Pre-acquisition, PE-affiliated otolaryngologists performed more procedures per year (1289 vs 1006, P < .001) compared to their non-PE counterparts, with average payments per procedure of $92.8 versus $91.36 (P = .398), respectively. Post-acquisition, PE-affiliated otolaryngologists performed more procedures per year (1166 procedures vs 950, P = .015) compared to their non-PE counterparts, with average payments of $105.2 versus $91.3 (P < .001), respectively.</p><p><strong>Conclusion: </strong>PE-acquired OHNS practices had increases in average Medicare payments per procedure after acquisition with minimal changes in procedure volumes. In addition, PE firms had a greater number of procedures in both periods. This finding suggests that PE may emphasize both performing high-payout procedures and investing in high-volume practices, although this can be firm-dependent.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1272-1280"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066273","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":"Sociodemographic and Clinical Determinants of 12-Month Decision Regret for Head and Neck Cancer Patients.","authors":"Naomi C Wang, Uma R Ramesh, Maria Feucht, Rahul Alapati, Sarah F Wagoner, Rohit Nallani, Kiran Kakarala, Yelizaveta Shnayder, Chelsea S Hamill, Kevin J Sykes, Andrés M Bur","doi":"10.1002/ohn.1151","DOIUrl":"10.1002/ohn.1151","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to identify factors associated with increased decision regret (DR) 12 months following treatment among head and neck cancer (HNC) patients.</p><p><strong>Study design: </strong>A retrospective observational cohort study.</p><p><strong>Setting: </strong>Patients with newly diagnosed HNC at an academic tertiary care center from 2018 to 2023.</p><p><strong>Methods: </strong>Data from a patient registry assessing quality of life (QOL), DR, social support, and anxiety at initial diagnosis and 12 months post-treatment were analyzed. Only patients who completed the decision regret questionnaire at 12 months were included.</p><p><strong>Results: </strong>Among 225 participants, 60% experienced mild DR and 28% reported moderate to severe regret. Stronger regret was associated with advanced disease presentation, free flap reconstructive surgery, chemoradiation, and disease recurrence. Patients with more severe regret had lower QOL at baseline and 12 months, higher anxiety at 12 months, and lower social support at 12 months. Multivariable analysis identified multimodal treatment including radiation (adjusted odds ratio [aOR] 3.67, 95% confidence interval [CI] [1.25-10.78], P = .018), lower 12-month social support (aOR 1.03, 95% CI [1.00-1.05], P = .039), and decreases in QOL (aOR 1.03, 95% CI [1.00-1.06], P = .024) as independent predictors of increased DR.</p><p><strong>Conclusion: </strong>Treatment involving radiation, lower concurrent social support, and diminished QOL are associated with DR 12 months after treatment. This highlights the potential of interventions aimed at enhancing social support, addressing treatment-related sequelae, and strengthening shared decision-making to prevent regret. Further studies are needed to elucidate factors driving regret in HNC patient subgroups and assess the efficacy of proposed mitigative interventions.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1318-1327"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066291","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":"Adjuvant Proton Radiation Following Transoral Robotic Surgery for HPV-Positive Oropharyngeal Squamous Cell Carcinoma.","authors":"Jane Y Tong, Vera Bzhilyanskaya, Matthew J Ferris, Jason K Molitoris, Kyle M Hatten","doi":"10.1002/ohn.1150","DOIUrl":"10.1002/ohn.1150","url":null,"abstract":"<p><strong>Objective: </strong>Advances in the treatment of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) include transoral robotic surgery (TORS) and proton beam therapy (PBT). This study aims to improve understanding of the treatment toxicities associated with adjuvant PBT following TORS for OPSCC.</p><p><strong>Study design: </strong>A retrospective review.</p><p><strong>Setting: </strong>An academic tertiary care center in Baltimore, Maryland.</p><p><strong>Methods: </strong>Patients undergoing TORS followed by adjuvant PBT from 2017 to 2023 were reviewed.</p><p><strong>Results: </strong>Forty-seven patients with HPV-associated OPSCC underwent TORS followed by adjuvant PBT. Forty-one (87.2%) patients were male. The median age at first radiation fraction was 61.7 years. Forty-one (87.2%) identified as white and 6 (12.8%) as African American. Most patients had T1 (23 [48.9%]) or T2 (22 [46.8%]), N1 (41 [87.2%]) disease. The majority (98.3%) of acute toxicities were grade 1 or 2, with only 1 (2.1%) patient developing grade 3 toxicities. Three (6.4%) patients required a feeding tube for nutrition during adjuvant proton radiation treatment. The 3 patients who required feeding tubes during radiation also required postoperative nasogastric tubes for a median of 16 days, compared with 3 days for all other patients (Mann-Whitney U, P = .02). The most common chronic toxicities included xerostomia, dysphagia, dysgeusia, and lymphedema, which decreased over time.</p><p><strong>Conclusion: </strong>HPV-associated OPSCC treated with TORS followed by adjuvant PBT demonstrated a favorable toxicity profile with mostly grade 1 or 2 acute toxicities. Feeding tube requirement during adjuvant PBT was low at 6.4%. Many chronic toxicities appeared to decrease in frequency with time from radiation, although further study is required.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1309-1317"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067134","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":"Risk Factors for Suicidal Ideation and Attempt in Patients With Skull Base Tumors.","authors":"Tony Chung, Shaun Edalati, Vikram Vasan, Alfred Marc Iloreta, Satish Govindaraj","doi":"10.1002/ohn.1124","DOIUrl":"https://doi.org/10.1002/ohn.1124","url":null,"abstract":"<p><strong>Objective: </strong>Patients with head and neck cancer experience suicide rates significantly higher than the general population. However, the relationship between skull base tumors (SBTs) and suicidal ideation and attempt (SIA) remains underexplored. This study aims to identify sociodemographic and clinical risk factors for SIA among patients with SBTs.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the National Inpatient Sample (2016-2019) to analyze 275,195 hospitalizations involving SBTs. Survey-weighted methods were used to assess univariable and multivariable risk factors for SIA.</p><p><strong>Results: </strong>Among SBT patients, 2160 (0.78%) were diagnosed with SIA. Younger age (adjusted odds ratio [aOR]: 0.98; P < .001) and emergent admissions (aOR: 2.25; P < .001) were strongly associated with SIA. Socioeconomic difficulties were one of the most significant predictors (aOR: 7.57; P < .001). Depressive, bipolar, and adjustment disorders were the strongest mental health comorbidity predictors (aOR: 8.18, 7.24, 5.19, respectively; P < .001). Alcohol and cannabis use disorders also elevated SIA risk (aOR: 2.79, 2.29, respectively; P < .001). Protective factors included treatment in Western hospitals (aOR: 0.52; P < .001) and undergoing surgery (aOR: 0.29-0.36; P < .001). Meningiomas were associated with lower SIA odds (aOR: 0.68; P = .013), while pituitary adenomas showed a significant association in univariable analysis.</p><p><strong>Conclusion: </strong>Younger age, socioeconomic difficulties, mental health comorbidities, and substance use are key risk factors for SIA in SBT patients, while surgery and treatment in Western hospitals are protective. Regular suicidality screening and proactive mental health interventions are essential for improving outcomes in this vulnerable population.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":"172 4","pages":"1300-1308"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720856","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":"\"Active Larynx\": Preliminary Evaluation of the Reliability of Visual Assessments of Laryngeal Inflammation.","authors":"Prasanth Pattisapu, Amy M Manning, Michael J Boutros, Megan McNutt, Tendy Chiang, Jonathan M Grischkan, Meredith N Lind, John F P Bridges","doi":"10.1002/ohn.1155","DOIUrl":"10.1002/ohn.1155","url":null,"abstract":"<p><strong>Objective: </strong>The term \"active larynx\" is a nonspecific and subjective term used by otolaryngologists to describe laryngeal inflammation that can influence the timing of airway reconstruction. We sought to measure the reliability of visual assessments of laryngeal inflammation for later scale development.</p><p><strong>Study design: </strong>A cross-sectional study.</p><p><strong>Setting: </strong>Pediatric tertiary care center.</p><p><strong>Methods: </strong>We created an image library from a direct laryngoscopy and bronchoscopy database. Blinded judges were asked to rate the characteristics of laryngeal inflammation (edema, erythema, cobblestoned appearance, and ventricular eversion; 5-point Likert scale), the overall \"activeness\" of the larynx (10-point scale), and whether laryngeal inflammation would influence a delay in reconstructive surgery (yes/no). A tentative scale was also constructed. Intraclass correlations with 2-way random effects, and Fleiss's κ were used to evaluate interrater reliability. The convergent and discriminant validity of the tentative scale were measured.</p><p><strong>Results: </strong>Three pediatric otolaryngologists reviewed 15 larynges for a total of 45 image ratings. Intraclass coefficients indicated substantial agreement for edema (0.76) and erythema (0.83) and moderate agreement for ventricular eversion (0.58). Cobblestoning had low agreement (intraclass correlation coefficient [ICC] < 0.20). The agreement was substantial for overall \"activeness\" (ICC 0.76) and moderate for whether inflammation would delay surgery (ICC 0.47). By Fleiss's κ, edema and erythema had moderate agreement (0.50 and 0.61, respectively), whereas all others had poor agreement. The convergent and discriminant validity of the tentative scale were reassuring.</p><p><strong>Conclusion: </strong>While the reliability of laryngeal inflammation by visual assessment is variable, the creation of an active larynx scale appears feasible.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1342-1347"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383049","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":"Efficacy of Nortriptyline-Topiramate and Verapamil-Paroxetine in Tinnitus Management: A Randomized Placebo-Controlled Trial.","authors":"Mehdi Abouzari, Karen Tawk, Joshua K Kim, Eva D Larson, Harrison W Lin, Hamid R Djalilian","doi":"10.1002/ohn.1063","DOIUrl":"10.1002/ohn.1063","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of 2 drug combinations on tinnitus severity and associated stress, depression, sleep, and anxiety.</p><p><strong>Study design: </strong>A randomized, double-blind, placebo-controlled clinical trial conducted between 2019 and 2023 for an 8-week duration.</p><p><strong>Setting: </strong>Single institution tertiary care center.</p><p><strong>Methods: </strong>The study recruited adult patients with moderate to severe tinnitus for 6 months or more. In total, 81 patients were assessed for eligibility, 78 were enrolled and randomized, and 67 were included in the per-protocol analysis. Patients were randomized into 3 groups (1:1:1). Group NT received nortriptyline-topiramate, group VP received verapamil-paroxetine, and group P received placebo.</p><p><strong>Results: </strong>A total of 19 patients in group NT, 22 in group VP, and 26 patients in group P were included in the per-protocol analysis. In group NT, the Tinnitus Functional Index (TFI) score decreased from 58.4 ± 13.9 (baseline) to 46.3 ± 17.5 (end-of-trial) (P < .001). Similarly, in group VP, the TFI score decreased from 54.6 ± 17.5 to 42.2 ± 16.1 (P = .004). However, group P did not demonstrate any significant decrease in the TFI score from 51.2 ± 18.6 to 45.2 ± 20.1 (P = .086). The between-arm analysis did not yield any statistical significance decrease in the TFI score (analysis of variance, P = .265).</p><p><strong>Conclusion: </strong>Both combinations of drugs were promising in improving tinnitus severity. However, larger-scale trials with longer follow-up periods are warranted to validate our findings between groups.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1348-1356"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716682","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":"Microbiological Profiles and Patterns of Resistance in Patients With Sinus Infections After Endoscopic Sinus Surgery.","authors":"Avraham E Adelman, Akshay Tangutur, Alfredo S Archilla, Gennadiy Vengerovich","doi":"10.1002/ohn.1122","DOIUrl":"10.1002/ohn.1122","url":null,"abstract":"<p><strong>Objective: </strong>Identify common pathogens and antibiotic resistances in chronic rhinosinusitis patients post-endoscopic sinus surgery presenting with an active sinus infection.</p><p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Single-institution rhinology private practice in Southeast Florida.</p><p><strong>Methods: </strong>Recorded postoperative endoscopically-guided sinus cultures from symptomatic patients with purulent drainage on endoscopy from August 2020 to December 2023. When available, pre- or intraoperatively cultured organisms were collected.</p><p><strong>Results: </strong>Of 125 patients, 50.4% were female with a mean age of 51.0. In 34.4% of patients that underwent revision surgery, 76% had nasal polyps and 26.4% had asthma. Of 301 cultures, 264 (87.7%) were positive, 53 (17.6%) were polymicrobial, and 37 (12.3%) were negative. Of 351 total isolates, 165 (47%) were Gram-negative, 125 (35.6%) Gram-positive, 14 (4%) fungi, and 10 (2.8%) anaerobic. 46.9% of postoperative organisms were not cultured preoperatively. Gram-negative bacteria included Enterobacteriaceae (17.7%), Pseudomonas spp. (10.5%), Serratia spp. (5.1%). Gram-positive bacteria included Methicillin-sensitive Staphylococcus aureus (MSSA, 17.1%) and Methicillin-resistant S. aureus (MRSA, 8%). Antibiotic resistances included MSSA to penicillins (52.8%) and clindamycin (32.8%), and MRSA resistance to quinolones (53.6%) and clindamycin (35.7%). Enterobacteriaceae were 42% resistant to amoxicillin-clavulanate and 37.1% to penicillins, while Pseudomonas aeruginosa was 17.7% resistant to quinolones.</p><p><strong>Conclusion: </strong>A cohort of chronic rhinosinusitis patients post-sinus surgery grew a large proportion of Gram-negative organisms and significant Staphylococcal penicillin and Gram-negative amoxicillin-clavulanate resistance. Our findings indicate the benefit of culturing patients with this patient presentation. If cultures cannot be obtained, we suggest broad-spectrum antibiotics that consider wide Gram-negative coverage and local antibiotic resistance patterns.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1442-1449"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932403","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":"Neural Radiance Fields (NeRF) for 3D Reconstruction of Monocular Endoscopic Video in Sinus Surgery.","authors":"Jeremy S Ruthberg, Randall Bly, Nicole Gunderson, Pengcheng Chen, Mahdi Alighezi, Eric J Seibel, Waleed M Abuzeid","doi":"10.1002/ohn.1105","DOIUrl":"10.1002/ohn.1105","url":null,"abstract":"<p><strong>Objective: </strong>To validate the use of neural radiance fields (NeRF), a state-of-the-art computer vision technique, for rapid, high-fidelity 3-dimensional (3D) reconstruction in endoscopic sinus surgery (ESS).</p><p><strong>Study design: </strong>An experimental cadaveric pilot study.</p><p><strong>Setting: </strong>Academic medical center.</p><p><strong>Methods: </strong>Complete bilateral endoscopic sinus surgery was performed on 3 cadaveric specimens, followed by postsurgical nasal endoscopy using a 0° rigid endoscope. NeRF was utilized to generate 3D reconstructions from the monocular endoscopic video feed. Reconstructions were calibrated, scaled, and then co-registered to postoperative computed tomography (CT) image sets to assess accuracy. Reconstruction error was determined by comparing ethmoid sinus measurements on NeRF reconstructions and CT image sets.</p><p><strong>Results: </strong>NeRF-based 3D scene reconstructions were successfully generated and co-registered to corresponding CT images for 5 out of 6 cadaveric nasal cavity sides. The mean reconstruction errors and standard error of the mean (SEM) for ethmoid length and height were 0.17 (SEM 0.59) and 0.70 (SEM 0.44) mm, respectively.</p><p><strong>Conclusion: </strong>NeRF demonstrates significant potential for dynamic, high-fidelity 3D surgical field reconstruction in ESS, offering submillimeter accuracy comparable to postoperative CT data in cadaveric specimens. This innovative approach may ultimately augment dynamic real-time intraoperative navigation through co-registration of the 3D reconstruction with preoperative imaging to potentially reduce the risk of injury to critical structures, optimize surgical completeness and, thereby, improve surgical outcomes. Further refinement and validation in live surgical settings are necessary to fully realize its clinical utility.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1435-1441"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952702","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":"In reference to: Combination Tonsillectomy and Hypoglossal Nerve Stimulation for Sleep Apnea Patients with Oropharyngeal Lateral Wall Collapse.","authors":"Eric J Kezirian","doi":"10.1002/ohn.991","DOIUrl":"10.1002/ohn.991","url":null,"abstract":"","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1487-1488"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351438","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":"Clinician Perspectives on the Management of Hearing Loss in Patients With Limited English Proficiency.","authors":"Aparna Govindan, Adina Singer, Lily Zekavat, Tianyi Jia, Kevin Wong, Jianjing Kuang, Maura K Cosetti, Tiffany P Hwa","doi":"10.1002/ohn.1089","DOIUrl":"10.1002/ohn.1089","url":null,"abstract":"<p><strong>Objective: </strong>Clinicians face challenges in managing the growing population of patients with limited English proficiency (LEP) and hearing loss (HL) in the United States. This study seeks to investigate provider perspectives on evaluating, counseling, and treating HL in LEP patients.</p><p><strong>Study design: </strong>Prospective descriptive study.</p><p><strong>Setting: </strong>Tertiary care center.</p><p><strong>Methods: </strong>Researchers employed a mixed methods design: (1) structured clinician interviews, (2) cross-sectional, national electronic survey, both regarding perspectives on managing hearing loss in LEP patients. Structured interviews were analyzed using modified grounded theory.</p><p><strong>Results: </strong>Twenty-nine providers participated in interviews (16 otologists, 13 audiologists). The most reported non-English language was Spanish, followed by Chinese languages. Four thematic domains were derived: barriers to care, cochlear implant (CI) candidacy evaluation, counseling, and ideal resources. Major barriers were patient desire (97%; n = 28), and lack of validated tests (72%; n = 21). Methods of CI evaluation included improvising on validated speech perception testing (59%; n = 17) and use of non-speech evaluation (52%; n = 15). One-quarter forgoes speech testing in non-Spanish-speaking patients (24%; n = 7). Suggestions to improve management include in-person interpreters (62%; n = 18) and testing battery in all languages (31%; n = 9). National survey results (n = 87 providers) demonstrated that respondents were significantly less confident in the methods of speech perception testing and in counseling on surgical hearing rehabilitation in LEP.</p><p><strong>Conclusion: </strong>Clinicians encounter challenges in managing LEP patients with HL, including limitations in audiometric and CI candidacy assessment, communication barriers, information accessibility, and cultural competency. Opportunities for improving care include developing language-specific test batteries, linguistically and culturally appropriate education materials, and cultural competency training.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1232-1241"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896367","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}