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":"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":"1934-1942"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","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":"Long-Term Outcomes After Elective Contralateral Neck Dissection for HPV-Related Oropharyngeal Cancer.","authors":"Ray Y Wang, Molly E Heft Neal, Wade L Thorstad, Hiram A Gay, Anthony J Apicelli, Michael J Moravan, Douglas R Adkins, Peter J Oppelt, Patrik Pipkorn, Jason T Rich, Paul Zolkind, Randal C Paniello, Sidharth V Puram, Ryan S Jackson","doi":"10.1002/ohn.1227","DOIUrl":"10.1002/ohn.1227","url":null,"abstract":"<p><strong>Objective: </strong>Patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC), particularly of the base of tongue, have a high rate of occult nodal disease in the contralateral neck. The risk of failure in the contralateral neck is reduced with elective treatment. The optimal treatment strategy to minimize treatment-related toxicity while preserving regional control in the contralateral neck has not been elucidated.</p><p><strong>Study design: </strong>Cross-sectional study of patients who underwent elective contralateral neck dissection as part of primary surgical treatment for HPV-related OPSCC between January 2002 and December 2018.</p><p><strong>Setting: </strong>Tertiary care center.</p><p><strong>Methods: </strong>Patients who underwent elective contralateral neck dissection as part of primary surgical treatment for HPV-related OPSCC between January 2002 and December 2018 were selected for inclusion. Long-term patient-reported functional outcomes were assessed via telephone at the time of data collection.</p><p><strong>Results: </strong>In total, 64 patients met the criteria for inclusion with a median follow-up of 58.5 months. In total, 56 patients (88%) had a primary cancer within the base of tongue or glossotonsillar sulcus. In total, 12 patients (19%) were found to have occult nodal metastasis in the contralateral neck, of whom 9 received adjuvant contralateral neck radiation. None of the patients who had node-negative contralateral neck dissections went on to receive radiation in the contralateral neck. Two patients (3%) recurred locally, two patients (3%) developed ipsilateral regional recurrence, and four patients (6%) developed distant metastasis. There were no regional recurrences within the contralateral neck. Five-year progression-free survival was 82.0%, whereas 5-year locoregional control was 93.0%. The mean Neck-Dissection Impairment Index was 94.4 with a median interval time of 92 months after surgery.</p><p><strong>Conclusion: </strong>Elective contralateral neck dissection in patients with HPV-related OPSCC provides excellent regional control with minimal long-term functional impairment, and most patients can be spared contralateral neck radiation without compromising oncologic outcomes. This may decrease long-term toxicity related to bilateral neck irradiation.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1954-1961"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658119","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":"The Intersection of Race, Ethnicity, and Sex on Postoperative Complications in Otolaryngology.","authors":"Tatiana Ferraro, Sean M Lee, Abdulla K Ahmed, Sana Smaoui, Esther Lee, Punam Thakkar, Neelima Tummala","doi":"10.1002/ohn.1203","DOIUrl":"10.1002/ohn.1203","url":null,"abstract":"<p><strong>Objective: </strong>Racial and ethnic patient health disparities are well-documented within surgical specialties; however, an intersectional lens studying the combined impact of multiple identities has not been evaluated in this context. We aim to explore the multiplicative effect of race, ethnicity, and sex on postoperative complications across a variety of otolaryngologic procedures.</p><p><strong>Study design: </strong>Cross-sectional analysis of retrospective data.</p><p><strong>Setting: </strong>A multi-institutional cohort using National Surgical Quality Improvement Program (NSQIP) data from 2010 to 2021.</p><p><strong>Methods: </strong>The 100 most common NSQIP cases conducted by otolaryngologists between 2010 and 2021 were included. Primary outcomes included 30-day surgical complications and medical complications. Propensity-weighted data were fitted to logistic regression models, and pairwise post hoc comparisons were performed for each race and ethnicity contrast within each sex.</p><p><strong>Results: </strong>Of 146,461 patients included in the final analysis, the majority identified as white (82.6%) and non-Hispanic (NH; 92.35%). Black NH males had 2.15 times higher odds of experiencing any complication than Asian NH males (OR = 2.15, 95% confidence interval [CI] [2.05, 2.26], P < .001). White Hispanic males were half as likely to experience complications compared to black Hispanic males (OR = 0.50, 95% CI [0.37, 0.70], P = .002). White Hispanic females were 68% less likely to experience surgical complications compared to black Hispanic females (OR = 0.32, 95% CI [0.23, 0.46], P < .001).</p><p><strong>Conclusion: </strong>We demonstrate that black male patients experience increased adverse surgical outcomes despite accounting for multiple relevant comorbidities. These findings contribute to the growing literature on intersectionality, providing a strong argument for prospective strategies to address inequities of surgical care in otolaryngology.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1943-1953"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670554","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":"Impact of Presurgical Second-Touch Visits on Delays in Initiating Adjuvant Radiation Therapy.","authors":"Antonio A Bon-Nieves, Naomi C Wang, Sarah F Wagoner, Rahul Alapati, Maria Feucht, Uma Ramesh, Rohit Nallani, Emma Rea, Colleen Sommer, Amelia S Lawrence, Kevin J Sykes, Kiran Kakarala, Yelizaveta Shnayder, Andrés M Bur, Chelsea S Hamill","doi":"10.1002/ohn.1194","DOIUrl":"10.1002/ohn.1194","url":null,"abstract":"<p><strong>Objective: </strong>Patients with head and neck squamous cell carcinoma (HNSCC) often encounter delays in starting postoperative radiotherapy (PORT), leading to worse outcomes. We investigated whether attending second-touch visits-appointments after the initial clinic visit and before surgery to address treatment-related questions and follow-up expectations-with an advanced practice provider (APP) is associated with reduced PORT delays.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single tertiary referral center.</p><p><strong>Methods: </strong>Adult patients with HNSCC who underwent free flap surgery and PORT between 2020 and 2022 were included. All patients were offered a second-touch visit. The primary outcome was PORT delay, defined as treatment initiation >42 days after surgery. Clinicodemographic and treatment-related data were collected at baseline and at the last known follow-up.</p><p><strong>Results: </strong>Of the 104 patients included, 57.7% attended a second-touch visit. Attendance was associated with receiving radiotherapy (RT) in an academic setting (65.0% vs 40.9%, P = .015) and fewer PORT delays (56.7% vs 79.5%, P = .015). Multivariable analysis revealed a 70% reduction in odds of PORT delay for those attending second-touch visits (adjusted odds ratio [aOR] = 0.298, 95% CI 0.103-0.866, P = .026). PORT delay was more likely in patients with RT in a community setting (aOR = 3.783, 95% CI 1.284-11.146, P = .016), wound complications (aOR = 5.149, 95% CI 1.363-19.460, P = .016), and a higher comorbidity index (aOR = 1.407, 95% CI 1.012-1.957, P = .042).</p><p><strong>Conclusion: </strong>Attendance of a second-touch visit and RT at a tertiary medical center significantly reduced the likelihood of PORT delay. These findings underscore the importance of APP-driven patient navigation in improving timely care and outcomes for patients with HNSCC.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1980-1987"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027585","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":"Longitudinal Speech Changes in Velopharyngeal Function in Submucous Cleft Palate.","authors":"Soukaina Eljamri, Randall Harley, Matthew Ford, Noel Jabbour","doi":"10.1002/ohn.1218","DOIUrl":"10.1002/ohn.1218","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate longitudinal speech changes in surgical and nonsurgical patients with submucous cleft palate (SMCP) and velopharyngeal dysfunction (VPD).</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single academic medical center.</p><p><strong>Methods: </strong>In total, 204 patients with documented SMCP and VPD from January 2002 to 2008 were identified. Using a multilevel mixed-effects model, we examined the association between surgical status and speech score trajectories, adjusting for age, sex, race, and severity.</p><p><strong>Results: </strong>In total, 204 children were included (mean [SD] age, 4.9 [3.1] years; 124 [60.8%] male; 114 [55.9%] furlow palatoplasty). Amongst surgical patients, the postsurgical median baseline score was 4 and scores were predicted to continue to decrease over time at a rate of 0.04 points per year (coefficient [β] -0.04, 95% confidence interval [95% CI] -0.20 to 0.13, P = .64). Presurgical speech scores were predicted to decrease over time at a rate of 0.78 points per year (β -0.78, 95% CI -1.14 to -0.41, P < .001). With a median presurgical score of 14, it would take 9 years to achieve normal speech scores without surgical intervention. In nonsurgical patients, speech scores were predicted to decrease at a rate of 0.23 points per year (β -0.23, 95% CI -0.51 to 0.04, P = .094).</p><p><strong>Conclusion: </strong>Speech production in VPD can improve over time without surgical intervention but is not expected to do so within the critical window for speech development. Surgical intervention improves speech by rates of change that cannot be achieved without surgery.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"2105-2110"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586449","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":"Assessing the Impact of Partial Decellularization on Tracheal Chondrocytes and Extracellular Matrix in Airway Reconstruction.","authors":"Lumei Liu, Jazmin Calyeca, Sayali Dharmadhikari, Zheng Hong Tan, Jane Yu, Ada C Sher, Melwan Izem, Sovannarath Pong, Kimberly M Shontz, Tendy Chiang","doi":"10.1002/ohn.1211","DOIUrl":"10.1002/ohn.1211","url":null,"abstract":"<p><strong>Objective: </strong>Partially decellularized tracheal grafts (PDTG) are potential candidates for tracheal replacement as they support neotissue formation without stenosis or rejection. However, the effects of partial decellularization (PD) on extracellular matrix (ECM) and chondrocytes are not currently understood, limiting PDTG translatability for clinical use. We aim to quantify the impact of PD on trachea using mouse and rabbit models.</p><p><strong>Study design: </strong>An animal model.</p><p><strong>Setting: </strong>Research Institute affiliated with a Tertiary Pediatric Hospital.</p><p><strong>Methods: </strong>PDTG and syngeneic tracheal grafts (STG) were implanted orthotopically in mice for 1 month (N = 10/group). Grafts were analyzed with mechanical testing, chondrocyte viability, and protein integrity. We tested the scalability of PDTG at a pediatric scale using a rabbit model at 3- and 6-month timepoints (N = 3/timepoint). Histologic and radiographic analyses were performed to assess chondrocyte viability and neotissue formation. Rabbit PDTG and native chondrocytes were isolated and cultured assessing PD effect on proliferation.</p><p><strong>Results: </strong>PD of mouse trachea eliminated all epithelial cells, maintained chondrocyte viability, and did not reduce graft mechanical properties or ECM proteins. Overall, collagen and glycosaminoglycans had similar expression and integrity in PDTG and STG. PDTG retained graft patency and supported epithelialization and vascularization. Like mice, PD of rabbit trachea achieved these goals, but had increased radiodensity. Unlike mice, rabbit PDTG had greater chondrocyte and ECM loss in vivo. Unique to rabbits, PD reduced chondrocyte proliferation in vitro compared to native chondrocytes.</p><p><strong>Conclusion: </strong>Despite similar pre-implantation metrics to the successful mouse model and support of neotissue formation, human-scale PDTG demonstrated greater chondrocyte and ECM loss.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"2026-2037"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670553","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":"Botulinum Toxin Type A Timing Efficacy in Patients With Synkinesis After Bell's Palsy.","authors":"Abdurrahman Al-Awady, Vivek Annadata, Ryan Sicard, Avanish Yendluri, Joshua Rosenberg, Mingyang Gray","doi":"10.1002/ohn.1205","DOIUrl":"10.1002/ohn.1205","url":null,"abstract":"<p><strong>Objective: </strong>This study examines whether the timing of botulinum toxin type A (BoNTA) treatments affects outcomes in patients with synkinesis, a sequela of Bell's Palsy characterized by disconjugate facial muscle movement.</p><p><strong>Study design: </strong>A retrospective chart review.</p><p><strong>Setting: </strong>An urban academic medical center.</p><p><strong>Methods: </strong>We reviewed the charts of synkinesis patients treated from 2016 to 2022. Data included procedural notes, intervention dates, and scores from the House-Brackmann (HB), Facial Clinimetric Evaluation (FaCE), Synkinesis Assessment Questionnaire (SAQ), and Facial Grading System (FGS).</p><p><strong>Results: </strong>Sixty-seven patients (median age 54 years, average palsy duration 5.7 years) received BoNTA. Patients treated within 12 months (n = 28), 13 to 24 months (n = 12), and after 24 months (n = 23) showed no significant differences in changes to HB, FaCE, or SAQ scores. However, patients treated within 1 year had significantly higher FGS improvement (36.3) than the other groups (P = .03).</p><p><strong>Conclusion: </strong>While FaCE, HB, and SAQ scores showed no significant differences, early BoNTA treatment within 1 year significantly improved FGS scores, indicating better outcomes. Therefore, early treatment is ideal for optimal response.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1897-1903"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573569","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":"Canal Cholesteatomas: Proposed Guidelines Based on Otologic Practices at a Tertiary Care Center.","authors":"Jan Ynav Quiz, Arunima Vijay, Braeden Lovett, Lauren Mueller, Rex Haberman","doi":"10.1002/ohn.1189","DOIUrl":"10.1002/ohn.1189","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to analyze disease and treatment patterns at a tertiary care center and propose guidelines for the management of canal cholesteatomas.</p><p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>This study involves patients diagnosed and treated with external auditory canal cholesteatomas (EACC) from January 1, 2010, to January 1, 2021 at the University of Florida, a tertiary care center.</p><p><strong>Methods: </strong>Inclusion criteria included a diagnosis of EACC with at least 1 follow-up visit after diagnosis. Patient demographics, risk factors, etiology if acquired, EACC characteristics such as location and staging, and treatment modality were recorded and analyzed. The primary outcome was a recurrence of disease.</p><p><strong>Results: </strong>Out of the 175 patients reviewed, 90 patients and 100 ears met the criteria. Most patients were treated with surgery (81%, N = 81) as opposed to medical management (ie, serial debridement). While there were no factors that were significant for higher odds of surgical intervention, all Stage IV (n = 9) and superior canal wall locations (n = 8) were treated with surgery. Mastoidectomy was more likely to be performed in higher staged cholesteatomas (χ² = 13.41, P = .0012) and posterior canal cholesteatoma location (odds ratio [OR] = 11.20, P = .0001), whereas anterior (OR = 0.11, P = .0390) and inferiorly located EACCs (OR = 0.22, P = .0169) had more odds of being treated with canalplasty/tympanoplasty. Recurrence was seen up to 4.78 years after surgery.</p><p><strong>Conclusion: </strong>Disease location and staging and patient factors should be considered in the shared management decision-making of EACC treatment. Surveillance duration should be up to 5 years.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"2038-2045"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573572","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":"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":"1882-1887"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","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":"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":"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":"1919-1926"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120045/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}