Search

Background: Allergic rhinitis (AR) is a common condition that is frequently associated with atopic inferior turbinate hypertrophy (ITH) resulting in nasal obstruction. Current guidelines support the use of subcutaneous allergen immunotherapy (SCIT) when patients fail pharmacologic management. However, there is a lack of consensus regarding the role of inferior turbinate reduction (ITR), a treatment that we hypothesize is cost‐effective compared with other available treatments. Methods: We conducted a cost‐effectiveness analysis comparing the following treatment combinations over a 5‐year time horizon for AR patients presenting with atopic nasal obstruction who fail initial pharmacotherapy: (1) continued pharmacotherapy alone, (2) allergy testing and SCIT, (3) allergy testing and SCIT and then ITR for SCIT nonresponders, and (4) ITR and then allergy testing and SCIT for ITR nonresponders. Results were reported as incremental cost‐effectiveness ratios (ICERs). Results: For patients who fail initial pharmacotherapy, prioritizing ITR, either by microdebrider‐assisting submucous resection or radiofrequency ablation, before SCIT was the most cost‐effective strategy. Probabilistic sensitivity analysis demonstrated that prioritizing ITR before SCIT was the most cost‐effective option in 95.4% of scenarios. ITR remained cost‐effective even with the addition of concurrent septoplasty. Conclusion: For many AR patients who present with nasal obstruction secondary to atopic inferior turbinate hypertrophy that is persistent despite pharmacotherapy, ITR is a cost‐effective treatment that should be considered prior to immunotherapy. Level of Evidence: NA – Laryngoscope, 2023 Laryngoscope, 134:1572–1580, 2024 [ABSTRACT FROM AUTHOR]

Objective: Olfactory disorders are well‐studied in the adult population, however, there is a paucity of literature characterizing olfactory dysfunction in pediatric patients. The purpose of this scoping review was to identify known causes of olfactory loss in pediatric populations, clarify the extent of use and validity of smell tests, and summarize current therapies for olfactory loss. Data Sources: PubMed, Ovid MEDLINE, and Web of Science. Review Methods: Databases were systematically searched in September 2020. Two independent reviewers conducted the title and abstract screen, followed by review of full‐texts for inclusion based on preset inclusion and exclusion criteria. Extracted data included study type, age/age‐range of participants, gender, radiological evidence of olfactory dysfunction, types and results of smell tests used, etiology of olfactory loss, and therapies employed for olfactory loss. Results: A total of 103 articles (n = 1654) were eligible for final data extraction. The University of Pennsylvania Smell Identification Test was used most frequently for smell testing (21% of studies). In total, 45 causes of olfactory dysfunction have been elucidated by this study: 22 congenital and 23 acquired. Few therapies were described, and all were specific to the etiology of olfactory loss. Conclusion: Olfactory dysfunction has a wide range of etiologies in the pediatric population, and clinicians should have a diagnostic algorithm for how to identify a cause should they encounter it in practice. If no etiology can be identified, education around safety should be provided to both the patient and their caregivers. [ABSTRACT FROM AUTHOR]

The article discusses the benefits and evolving understanding of inferior turbinate reduction (ITR) as a treatment for allergic rhinitis (AR). It highlights that ITR can improve symptoms such as sneezing and rhinorrhea, and that it may also have a beneficial effect on nonallergic rhinitis. The article suggests that ITR could be considered as an upfront or concurrent treatment with allergen immunotherapy (AIT), as it offers more immediate effects and may be beneficial for patients who are not candidates for AIT. The article also mentions that societal factors and testing such as acoustic rhinometry are not typically considered in the decision to proceed with ITR. [Extracted from the article]

Objective: To examine postoperative opioid-prescribing patterns following otologic surgery. Study Design: Retrospective population-based descriptive study. Setting: All hospitals in the Canadian province of Ontario. Methods: Of all patients with advanced ear surgery between July 1, 2012, and March 31, 2019, 7 cohorts were constructed: tympanoplasty with or without ossiculoplasty (n = 7812), atticotomy/limited mastoidectomy (n = 1371), mastoidectomy (n = 3717), semicircular canal occlusion (SCO; n = 179), stapedectomy (n = 2735), bone-implanted hearing aid insertion (n = 280), and cochlear implant (n = 2169). Prescriptions filled for narcotics postoperatively were calculated per morphine milligram equivalent (MME) opioid dose. Multivariable regression was used to determine predictors of higher opioid doses. Results: The mean ± SD MMEs prescribed were as follows: tympanoplasty with or without ossiculoplasty, 246.77 ± 1380.78; atticotomy/limited mastoidectomy, 283.32 ± 956.10; mastoidectomy, 280.56 ± 1018.50; SCO, 328.61 ± 1090.86; stapedectomy, 164.64 ± 657.18; bone-implanted hearing aid insertion, 326.11 ± 1054.66; and cochlear implant, 200.87 ± 639.93. SCO (odds ratio [OR], 1.69 [95% CI, 1.16-2.48]) and mastoidectomy (OR, 1.50 [95% CI, 1.36-1.66]) were associated with higher opioid doses than tympanoplasty-ossiculoplasty. Asthma (OR, 1.24 [95% CI, 1.12-1.38]), chronic obstructive pulmonary disease (OR, 1.29 [95% CI, 1.12-1.47]), myocardial infarction (OR, 1.33 [95% CI, 1.05-1.68]), diabetes (OR, 1.22 [95% CI, 1.08-1.39]), and substance-related and addictive disorders (OR, 2.59 [95% CI, 1.67-4.00]) were associated with higher opioid doses prescribed. Overall MME prescribed by year demonstrates a sharp drop from 2017-2018 to 2018-2019. Conclusion: This large comprehensive population study provides insight into the prescribing patterns following otologic surgery. The large amounts prescribed and substantial variation require further study to determine barriers that limit good opioid-prescribing stewardship in the postoperative period. [ABSTRACT FROM AUTHOR]

Objective: Poor hearing outcomes often persist following total drum replacement tympanoplasty. To understand the mechanics of the reconstructed eardrum, we measured wideband acoustic immittance and compared the mechanical characteristics of fascia-grafted ears with the normal tympanic membrane. Study Design: Prospective comparison study. Setting: Tertiary care center. Methods: Patients who underwent uncomplicated total drum replacement with temporalis fascia grafts were identified. Ears with healed grafts, an aerated middle ear, and no other conductive abnormalities were included. All patients underwent pre- and postoperative audiometry. Wideband acoustic immittance was measured with absorbance and impedance computed. Fascia-grafted ears were compared with normal unoperated ears. Results: Eleven fascia-grafted ears without complications were included. Postoperatively, the median air-bone gap was 15 dB (250-4000 Hz), with variation across frequency and between ears. Fifty-six control ears were included. Absorbance of fascia-grafted ears was significantly lower than that of normal ears at 1 to 4 kHz (P <.05) but similar below 1 kHz. Impedance magnitude demonstrated deeper and sharper resonant notches in fascia-grafted ears than normal ears (P <.05), suggesting lower mechanical resistance of the fascia graft. Conclusion: The mechanics of fascia-grafted ears differ from the normal tympanic membrane by having lower absorbance at mid- to high frequencies and thus poor sound transmission. The lower resistance in fascia-grafted ears may be due to poor coupling of the graft to the malleus. To improve sound transmission, grafts for tympanic membrane reconstructions would benefit from refined mechanical properties. [ABSTRACT FROM AUTHOR]