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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]

Background: Dupilumab, omalizumab, and mepolizumab are the three biologics currently approved for use in CRSwNP in Canada. Despite evidence of efficacy, their cost-effectiveness, which is a key factor influencing prescribing patterns, has not yet been compared to each other. Methods: A cost-effectiveness model using quality-adjusted life years (QALYs) was constructed using a Decision Tree Markov analysis. A third-party healthcare payer perspective and a 10-year time horizon was used. A willingness-to-pay (WTP) threshold of 50,000 Canadian dollars (CAD) per QALY was used to determine cost-effectiveness. Dupilumab, omalizumab, and mepolizumab were each compared to each other. Results: Omalizumab was the most cost-effective biologic using current estimates of cost and efficacy in CRSwNP. Using omalizumab as a baseline, dupilumab had an ICER of $235,305/QALY. Mepolizumab was dominated by omalizumab and dupilumab at the current drug prices and estimates of efficacy. Sensitivity analyses determined that when increasing the WTP threshold to $150,000/QALY, dupilumab became cost-effective compared to omalizumab in 22.5% of simulation scenarios. Additionally, altering dosing frequency had a significant effect on cost-effectiveness. Conclusion: When comparing the relative cost-effectiveness of biologics in recalcitrant CRSwNP, omalizumab currently appears to be the most cost-effective option. Future reductions in drug prices, adjustments to currently approved dosing regimens, better patient selection, and improvements in sinus surgery outcomes will challenge the current cost-effectiveness models and necessitate reassessment as treatments for CRSwNP continue to evolve. [ABSTRACT FROM AUTHOR]

Introduction: Hearing loss (HL) is considered a potentially modifiable risk factor for dementia. We aimed to examine the relationship between HL and incident dementia diagnosis in a province-wide population-based cohort study with matched controls. Methods: Administrative healthcare databases were linked to generate a cohort of patients who were aged ≥40 years at their first claimed hearing amplification devices (HAD) between April 2007 and March 2016 through the Assistive Devices Program (ADP) (257,285 with claims and 1,005,010 controls). The main outcome was incident dementia diagnosis, ascertained using validated algorithms. Dementia incidence was compared between cases and controls using Cox regression. Patient, disease, and other risk factors were examined. Results: Dementia incidence rates (per 1,000 person-years) were 19.51 (95% confidence interval [CI]: 19.26–19.77) and 14.15 (95% CI: 14.04–14.26) for the ADP claimants and matched controls, respectively. In adjusted analyses, risk of dementia was higher in ADP claimants compared with controls (hazard ratio [HR]: 1.10 [95% CI: 1.09–1.12, p < 0.001]). Subgroup analyses showed a dose-response gradient, with risk of dementia higher among patients with bilateral HADs (HR: 1.12 [95% CI: 1.10–1.14, p < 0.001]), and an exposure-response gradient, with increasing risk over time from April 2007-March 2010 (HR: 1.03 [95% CI: 1.01–1.06, p = 0.014]), April 2010-March 2013 (HR: 1.12 [95% CI: 1.09–1.15, p < 0.001]), and April 2013-March 2016 (HR: 1.19 [95% CI: 1.16–1.23, p < 0.001]). Conclusion: In this population-based study, adults with HL had an increased risk of being diagnosed with dementia. Given the implications of HL on dementia risk, understanding the effect of hearing interventions merits further investigation. [ABSTRACT FROM AUTHOR]

Background: The advancement of Otolaryngology—Head and Neck Surgery (OHNS) as a specialty relies on excellence in research. The Journal of Otolaryngology-Head and Neck Surgery is an open access, peer-reviewed journal publishing on all aspects and subspecialities of OHNS. It is the official journal of the Canadian Society of Otolaryngology—Head and Neck Surgery. This study aims to analyze bibliometric trends in authorships and institutional contributions within the Journal of Otolaryngology-Head and Neck Surgery over a 9-year period. Methods: All research articles published online in the journal were analyzed from 2013 to the end of 2021. The professional designation of all authors was recorded along with the article type, article category, institutional affiliations and international collaborations. Cochran–Armitage trend tests were used to assess the change in proportion over time between years and groups. Results: Of the 603 articles, 20 were excluded as they represented correspondence or corrections, or author identity could not be determined. 583 articles with 3409 total authors were included. Number of first authors with a Doctor of Medicine (MD) degree decreased from 90.2 to 85.3% (P = 0.165). Sub-group analysis of non-MD first authors demonstrated a significant increase in medical students as first authors from 1.6 to 11.8% (P = 0.008). Senior author degree demonstrated a significant increase in MD degree from 96.7 to 98.5% (P = 0.002). Analysis of article categories demonstrated a significant decrease in education and head and neck surgery related articles from 8.2 to 2.9% (P = 0.032) and 44.3 to 29.4% (P = 0.028) respectively. Pediatric otolaryngology articles increased significantly from 0 to 5.9% (P < 0.0001). Systematic and scoping reviews significantly increased, from 3.3 to 10.3% (P = 0.015) and original research significantly decreased from 83.6 to 82.4% (P < 0.0001). There was a significant decrease in Canadian/international collaborations from 14.3 to 4.7% (P = 0.037). There was a significant increase in international first and senior authors, from 23.0 to 36.8% (P = 0.008) and 19.7 to 38.2% (P = 0.002) respectively. Conclusion: The landscape of the journal is evolving with increased representation of non-MDs and international authors along with content that reflects higher level of scientific evidence. Future studies should characterize trends in other Otolaryngology journals to understand the research trajectory within the field. [ABSTRACT FROM AUTHOR]

The article discusses research which examined trends in female authorship within the "Canadian Journal of Otolaryngology - Head and Neck Surgery." Topics covered include the method used in the analysis of all research articles published online in the journal from 2013 to the end of 2021, the proportion of gender by authorship, and authorship gender representation by article category.

Background: To achieve effective integration of virtual care into family-centered audiology practices, participatory research methods, including parents as vital participants in the delivery of pediatric audiology care, should be considered. A better understanding of the barriers and facilitators influencing the adoption of virtual care for families is warranted. Objective: This study aimed to develop a conceptual framework of the factors perceived to influence the adoption of remote pediatric hearing aid support among the parents of children with hearing loss. Methods: A total of 12 parents of children who wear hearing aids, between the ages of 0-17 years, were recruited to participate in group or individual interviews as part of the 6-step participatory-based concept mapping (CM) process. Data collection was specific to parents in a Canadian context. Analyses included multidimensional scaling and hierarchical cluster analysis. Results: The CM process resulted in 6 main themes, displayed in a cluster map according to their order of importance. These themes include access to timely, consistent care; technology considerations; convenience; child engagement; cost; and partnership considerations. Key underlying statements and subthemes are highlighted per theme. Conclusions: Findings from this study demonstrate the use of CM in participatory research with parents and as part of a family-centered care model. Future research should aim to investigate the factors that influence the uptake of remote hearing aid support in different contexts, for example, in low- to middle-income countries versus those in high-income countries. [ABSTRACT FROM AUTHOR]

Background: Non‐steroidal anti‐inflammatory drugs (NSAIDs) have emerged as an alternative to opioids for optimal postoperative pain management. However, the adoption of NSAIDs in sinonasal surgery has been impeded by a theoretical concern for postoperative bleeding. Our objective is to systematically review the efficacy and safety of NSAIDs for patients undergoing sinonasal surgery. Methods: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and the WHO International Clinical Trials Registry Platform were searched from inception to January 27, 2022. Randomized controlled trials (RCTs) and comparative observational studies in any language were considered. Screening, data extraction, and risk of bias assessment were performed in duplicate. Our outcomes were postoperative pain scores, requirement for rescue analgesia, and postoperative adverse events (epistaxis, nausea/vomiting). Results: Out of 4661 records, 15 RCTs (enrolling 1210 patients) and two observational studies were included. Following endoscopic sinus surgery, there was no difference in pain scores between NSAIDs and non‐NSAIDs groups (standardized mean differences [SMD] 0.44 units better, 95% CI –0.18 to 1.05). Following septorhinoplasty, NSAIDs decreased pain scores compared to non‐NSAID regimens (SMD 1.14 units better, 95% CI 0.61 to 1.67 units better). Overall, NSAIDs reduced the need for rescue medication with a relative risk (RR) of 0.45 (95% CI 0.24 to 0.84). In addition, NSAIDs decreased the risk of nausea with an RR of 0.62 (95% CI 0.42 to 0.91) and did not increase the risk of epistaxis (RR 0.72, 95% CI 0.23‐2.22). Conclusion: Among patients undergoing sinonasal surgery, NSAIDs are beneficial in postoperative pain management and avoidance of postoperative nausea without increasing the risk of postoperative epistaxis. [ABSTRACT FROM AUTHOR]