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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]

Introduction: The prevalence of hearing loss in Canada is high, with many patients requiring implantable hearing devices (IHDs) as treatment for their disease severity. Despite this need, many eligible patients do not pursue these interventions. The objective of this study was to examine rates of IHD based on geographic location to understand locoregional variation in access to care. Study Design: This was a retrospective population-based cohort study. Setting: All hospitals in the Canadian province of Ontario. Methods: Of all patients with IHD between April 1, 1992, and March 31, 2021, cochlear implants (CIs) (4,720) and bone-anchored hearing aids (BAHA) (1,125) cohorts were constructed. Place of residence was categorized based on Local Health Integrated Network (LHIN). Summary statistics for place of surgical institution based on LHIN at first surgery, name of institution of first surgery and "as the crow flies" distance (in km) between place of residence and surgical institution were calculated. Rate of implantations was calculated for LHIN regions based on number of surgeries per 1,000,000 persons/years. Results: Toronto Central, Central, Central East, and Champlain regions had >10% of patients undergoing BAHA and CI. 1,019 (90.6%) and 4,232 (89.7%) of patients receiving BAHA and CI, respectively, resided in urban/suburban regions and 94 patients (8.4%) and 436 (9.2%) resided in rural regions. The median distance between residential location and the institution was 46.4 km (interquartile range [IQR], 18.9–103.6) and 44.7 km (IQR, 15.7–96.9) for BAHA and CI, respectively. From 1992 to 2021, the number of CI and BAHA performed across Ontario increased by 17 folds and 6 folds, respectively. Conclusion: This large comprehensive population study provides longitudinal insight into the access to care of IHD based on geographic factors. Our findings of the present population-based study indicate an overall increase in access to devices with disproportionate access to care based on geographic locations. Further work is needed to characterize barriers to IHD access to align with demands. [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]