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.

The outcomes of hypoglossal nerve stimulation in the management of OSA: A systematic review and meta-analysis

Objectives:Obstructive sleep apnea (OSA) is a prevalent disease with significant health impacts.While first line therapy is CPAP,long-term compliance is low and device misuse is common,highlighting the need for alternative therapies.Upper airway surgery is one alternative,but substantial side effects hamper efficacy.A new alternative is an implantable hypoglossal nerve stimulator (HNS).These devices utilize neuromodulation to dilate/reinforce the airway and reduce side effects associated with traditional surgery.Several recent trials investigated the efficacy of these devices.The purpose of this study was to perform meta-analysis of available HNS studies investigating treatment of OSA to analyze objective and subjective outcomes and side effects.Methods:A comprehensive literature search of PubMed and Scopus was performed.Two independent reviewers examined clinical trials investigating HNS in treatment of sleep apnea in adults.Studies with objective and subjective endpoints in sleep were included for analysis.Adverse events from trials were also recorded.Results:Across 16 studies,381 patients were analyzed.At 6 months (p =0.008),mean SAQLI improved by 3.1 (95%CI,2.6-3.7).At 12 months (p < 0.0001),mean AHI was reduced by 21.1 (95%Cl,16.9-25.3),mean ODI was reduced by 15.0 (95%CI,12.7-17.4),mean ESS was reduced by 5.0 (95%CI,4.2-5.8),mean FOSQ improved by 3.1 (95%CI,2.6-3.4).Pain (6.2%:0.7-16.6),tongue abrasion (11.0%:1.2-28.7),and internal (3.0%:0.3-8.4)/external device (5.8%:0.3-17.4) malfunction were common adverse events.Conclusions:HNS is a safe and effective treatment for CPAP refractory OSA.Further study comparing HNS to other therapies is required.

Emergent and urgent otologic surgeries during the SARS-CoV-2 pandemic: a protocol and review of literature

Objective:To review guidelines for otologic procedures during the SARS-CoV-2 pandemic and to present a protocol for emergent or urgent mastoidectomy at our institution.Data sources:Guidelines regarding emergent and urgent otologic procedures from otolaryngo-logic societies are reviewed.We described a protocol for emergent or urgent mastoidectomy at our institution.Conclusion:Patients requiring urgent or emergent mastoidectomy during the COVID-19 pandemic require prompt treatment.We make the following recommendations:Emergent or urgent otologic procedures should be performed in a contained environment,such as a tent created by the microscope drape.The surgical team should practice using instruments in the tent setup to prepare for real cases.Otologic procedures should adhere to guidelines set for high-risk procedures.

Opioid prescribing patterns within otolaryngology

Objective:Determine current opioid prescribing patterns for adult procedures within an academic Otolaryngology-Head and Neck Surgery training program in order to establish a general guideline and more uniform approach to narcotic prescribing practices.Methods:The is a prospective,single-center pilot study.An online,anonymous survey was sent to all members of the Otolaryngology-Head and Neck Surgery training program at Medical University of South Carolina including residents,fellows,and attending surgeons,and advanced practice providers (APP).The survey consisted of questions including demographics,most commonly prescribed analgesic and the average number of opioid tablets prescribed postoperatively for eleven of the most common adult procedures within Otolaryngology.Results:Forty-two participants responded to the survey.Of the 42 respondents,20 were attending surgeons,11 junior level residents (year 1-3),6 senior level residents (year 4-5),and 5 A.P.P.s.The most commonly prescribed narcotic was hydrocodone-acetaminophen with 83.3% (35/42) of respondents prescribing this medication.Tonsillectomy or uvulopalatopharyngoplasty had the highest average number of tablets prescribed at 32.3 (Range:5 to 90).Neck dissection,parotidectomy,and thyroidectomy procedures all averaged over 20 tablets.Direct laryngoscopy opioid dose was the lowest at 4.8 tablets (range 0-20).Opioid prescriptions by surgery were broken down by provider class with only septoplasty showing a significant difference with attending physicians prescribing an average of 20 tablets vs 14.1 tablets for residents (P =0.034).Conclusion:We believe there remains an unacceptably high variability in current opioid prescribing patterns within otolaryngology especially within more painful procedures.Establishment of standardized post-operative narcotic guidelines is warranted.

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.