The influence of obesity on operating room time and perioperative complications in cochlear implantation

Objective:The rising incidence of obesity in the United States is associated with increased healthcare expenditures and resource allocation.Obesity has been associated with prolonged operating times during surgical procedures.The primary objective of this study is to compare body mass index (BMI) to length of surgery during cochlear implantation.Methods:A retrospective case control study from a tertiary academic referral center was performed.Patients included were adults who underwent primary,single-sided cochlear implantation with documented BMI and operating room (OR) times from January 2009 to July 2015.The following data were collected:BMI,total operating room time (TORT),surgical operating room time (SORT),ASA status,perioperative and postoperative complications,age,and gender.Results:Two hundreds and thirty-four patients were included and stratified into obese (BMI ＞30)and non-obese (BMI ＜ 30) categories.Statistical analysis was performed comparing TORT against the obesity category along with other variables.Independent sample t-test demonstrated that obesity increases TORT and SORT by 16.8 min (P ＝ 0.0002) and 9.3 min (P ＝ 0.03),respectively,compared to the non-obese group.Multivariate linear regression analysis demonstrated no statistically significant impact of gender,or ASA status on total operating or surgical time.Obesity was associated with increased perioperative complications (odds ratio [OR],6.21;95％ CI,1.18-32.80;P ＝ 0.03) and postoperative complications (OR,3.97;95％ CI,1.29-12.26;P ＝ 0.02).Conclusions:Obesity leads to longer TORT and SORT during primary cochlear implant surgery.Obesity is also associated with increased perioperative and postoperative complications compared to non-obese patients.These data have implications with utilization of operating room resources.

Preferences in stapes surgery among American otological society otologists

Objective:Stapes surgery is technically challenging,yet its methodology is not standardized.We aim to elucidate preferences in stapes surgery among American Otological Society(AOS)otologists and determine if any common practice patterns exist.Study design:Cross-sectional study via emailed questionnaire.Setting:Surgery centers.Subjects and methods:Members of the AOS were an emailed a survey to quantify variables including surgical volume,anesthetic preference,laser use,type of procedure,footplate sealing technique,antibiotic use,and trainee participation.Results:Most otologists(71%)performed 2 to 5 stapes surgeries per month under general anesthesia(69%)with stapedotomy(71%)as the preferred procedure.Most(56%)used the rosette method of laser stapedotomy with manual pick debris removal for footplate fenestration.Either the handheld potassium titanyl phosphate(KTP)laser(40%)or handheld carbon dioxide(CO2)laser(33%)was used.The heat-activated memory hook(51%)was the preferred prosthesis.Footplate sealing method was variable,as was antibiotic use among respondents.Trainee participation was limited,as 42%of otologists allowed residents to place the prosthesis,and fewer allowed residents to crimp the prosthesis,and laser or drill the footplate.Surgeons with higher surgical volume(≥6 surgeries per month)demonstrated the following statistically significant correlations:footplate fenestration with laser in a rosette pattern and pick for debris removal(rs=-0.365,P=0.014)and trainee participation with fellows only(rs=0.341,P=0.022).Conclusions:Trends in various surgical decisions showed a lack of consensus in all aspects of stapes surgery.

Hyperbaric oxygen therapy in malignant otitis externa:A systematic review of the literature

Objective:To review the role of adjuvant hyperbaric oxygen therapy(HBOT)in the treatment of malignant otitis externa(MOE).Data sources:PubMed,Scopus,Web of Science,Science Direct,and Cochrane Library were searched for the following concepts:“hyperbaric oxygen”and“malignant or necrotizing otitis externa.”Methods:Studies were included if they contained(1)patients with reported evidence of MOE,(2)employment of adjuvant HBOT,(3)details on patients’medical condition,and(4)documented survival outcomes.Extracted information included patient demographics,underlying medical conditions,infectious etiology,signs and symptoms,medical and surgical treatments,duration of medical treatment,mean follow up time,HBOT setting,number of HBOT sessions,complications,survival rate,and all-cause mortality.Results:A total of 16 studies comprising 58 patients(mean age 68.0 years)were included.Diabetes was present in 94.7%of cases and Pseudomonas spp(64.3%)was the most common infectious agent.Cranial nerve VII was involved in 55.2%of cases.Overall,the disease cure rate with adjuvant HBOT was 91.4%and all-cause mortality was 8.6%.Among those who had cranial nerve VII involvement,72.0%had return of function and 93.8%of them survived.Conclusion:HBOT may be an effective treatment option for refractory or advanced MOE but its efficacy remains unproven due to lack of strong scientific evidence.However,its therapeutic value should not be underestimated given good results and few adverse events reported in this study.

Cochlear implantation in patients with Meniere’s disease:A systematic review

Background:Meniere’s disease(MD)is an idiopathic disorder of the inner ear,which manifests as cochleo-vestibular dysfunction.Hearing loss will progress to a profound levelin a subset of patients with MD,and vestibular interventions can independently cause loss of hearing.The aim of this study was to systematically review the published literature describing the safety and efficacy of CI in patients with MD.Materials and methods:A systematic literature review was conducted in accordance PRISMA guidelines to identify articles that assessed at least one functional outcome in patients with MD who underwent CI.Demographic information,disease history,MD symptoms,outcomes measures,and complications related to CI were extracted from included studies.Results:In total,17 studies were included,and 182 patients with MD underwent CI.The weighted-mean age was 61.9 years(range 27-85).Study objective and methodology varied,and there was significant heterogeneity in CI outcome measures reported.In total,179(98.3%)of 182 patients reported objective improvements in at least one hearing metric after CI.A total of 69 patients(37.9%)reported vertigo or severe dizziness prior to CI,compared to 22 patients(15.4%)postoperatively.Two studies reported significant reductions in postoperative Tinnitus Handicap Inventory score(THI).Quality of life assessments varied between studies.Complications rates were low with only nine patients(4.9%)reporting a serious CI-related complication.Conclusions:This systematic review evaluated 17 studies describing the safety and efficacy of CI in patients with MD and encountered many challenges due to small sample sizes,and heterogeneity in study design and outcomes measured.Despite these limitations,this study of 182 patients is to the best of our knowledge the largest systematic review evaluating the safety and efficacy of CI in MD.The results of this study support the need for a standardized approach to evaluating outcomes of CI in patients with MD in future studies.