Search

Objectives: To study differences in care of patients admitted for epistaxis during the weekend compared to the weekday. Study Design: Retrospective database review. Setting: 2003 to 2014 National Inpatient Sample. Methods: Patients admitted for a primary diagnosis of epistaxis were extracted from the National Inpatient Sample from 2003 to 2014. Univariate and multivariate analyses were applied to assess differences in patient demographics, clinical characteristics, treatment, and outcomes between weekend and weekday admissions. Results: A total of 39,329 cases were included in our study cohort, with 28,458 weekday admissions and 10,892 weekend admissions. There was no significant difference in patient race, gender, insurance status, hospital ownership status, or location between weekend and weekday admissions (p >.05). Most weekend admissions were emergent (82.2%) and were treated with packing (51.8%). Upon performing logistic regression, the likelihood of emergent admission (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.32‐1.51, p <.001) and prolonged length of stay (OR 1.11, 95% CI 1.05‐1.17, p <.001) was higher for weekend admissions versus weekday admissions. Moreover, odds of packing for epistaxis were significantly higher (OR 1.14, 95% CI 1.09‐1.19, p <.001) on the weekend, while odds of ligation (OR 0.88, 95% CI 0.80‐0.97, p =.013) and endovascular arterial embolization (OR 0.74, 95% CI 0.65‐0.84, p <.001) were lower. There were no significant differences in in‐hospital mortality, patient discharge disposition, and total hospital charges (p >.05). Conclusion: Patients primarily admitted for epistaxis over the weekend were more likely to be emergent, experienced prolonged length of stay, and be treated nonoperatively with packing, than weekday admissions. No significant differences in patient insurance or hospital ownership were identified. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objective: This study reviews the presentation, management, and outcomes of patients with rhinolithiasis. Data Sources: An electronic database search of PubMed, SCOPUS, CINAHL, and the Cochrane Library was performed in accordance with the PRISMA 2020 updated guidelines for reporting systematic reviews. Review Methods: Case reports and case series published from 2004 to 2020 were included. Data collected included patient demographics, clinical symptoms at presentation, diagnosis, treatment, complications, and follow‐up. Relevant descriptive statistics were computed using Microsoft Excel 2013 (Microsoft Corp). Results: Fifty‐five case reports and five case series were included (n = 122). The majority were female (60.7%). The mean age was 29.4 years (range, 4‐80 years). The most common symptoms were rhinorrhea (81.1%), nasal obstruction (79.5%), nasal malodor (38.5%), and headache (27.9%). Computed tomography imaging was obtained in 109 (91.5%) cases. Concurrent rhinosinusitis (35.2%) and deviated nasal septum (28.7%) were commonly identified. Rhinoliths were commonly found in the right nostril (52.5%) and in between the inferior turbinate and nasal septum (26.9%). All rhinoliths were fully excised using endoscopic sinonasal surgery, accompanied by a septoplasty (9.2%). The nidus was identified in 27 (22.2%) patients. There were no recurrences or complications over an average follow‐up of 8.5 months (range, 0.25‐36 months). Conclusion: Rhinolithiasis is an uncommon entity of the nasal cavity and should be suspected in patients with long‐standing unilateral nasal obstruction, rhinorrhea, and nasal malodor. Rigid nasal endoscopy and endoscopic sinonasal surgery are the most important methods for diagnosis and treatment, respectively. [ABSTRACT FROM AUTHOR]

Objective: Kaposi sarcoma (KS) of the larynx is a rare disease with few cases reported in the literature. This study aims to provide a comprehensive review of laryngeal KS, including patient characteristics, treatment, and clinical outcomes. Data Sources: PubMed, CINAHL, SCOPUS, and Cochrane Library. Review Methods: A systematic review of the published English literature was conducted. An electronic search and bibliographic examination of articles pertaining to laryngeal KS were performed. Demographic data, tumor site, treatment strategies, follow‐up, and outcome were analyzed. Results: A total 77 cases from 50 articles were included in the review. The mean age was 47.6 years (range, 8‐81). There was an 8.6:1 male:female ratio. The most common presenting symptoms were dyspnea (n = 35) and hoarseness (n = 25). Laryngeal KS arose most frequently in the supraglottic region (n = 16). Chemotherapy alone (n = 27) was the most common treatment modality in patients with AIDS‐associated KS, and surgical excision alone (n = 7) was most common in patients with other subtypes of KS (eg, classic, transplant associated). Average follow‐up was 20.4 months (range, 0.75‐120). Most patients with AIDS‐associated KS died of other causes (n = 25), but most patients with other subtypes of KS were alive with no evidence of disease at follow‐up (n = 13). Conclusion: This review contains the largest pool of laryngeal KS cases to date. Long‐term outcomes were generally unfavorable, often due to advanced HIV disease at the time of diagnosis. [ABSTRACT FROM AUTHOR]

Objective: To examine factors associated with hospital safety net burden and its impact on survival for patients with sinonasal squamous cell carcinoma (SNSCC). Study Design: Retrospective database study. Setting: National Cancer Database from 2004 to 2016. Methods: SNSCC cases were identified in the National Cancer Database. Hospital safety net burden was defined by percentage of uninsured/Medicaid patients treated, namely ≤25% for low‐burden hospitals, 26% to 75% for medium‐burden hospitals, and >75% for high‐burden hospitals (HBHs). Univariate and multivariate analyses were used to investigate patient demographics, clinical characteristics, and overall survival. Results: An overall 6556 SNSCC cases were identified, with 1807 (27.6%) patients treated at low‐burden hospitals, 3314 (50.5%) at medium‐burden hospitals, and 1435 (21.9%) at HBHs. On multivariate analysis, Black race (odds ratio [OR], 1.39; 95% CI, 1.028‐1.868), maxillary sinus primary site (OR, 1.31; 95% CI, 1.036‐1.643), treatment at an academic/research program (OR, 20.63; 95% CI, 8.868‐47.980), and treatment at a higher‐volume facility (P <.001) resulted in increased odds of being treated at HBHs. Patients with grade III/IV tumor (OR, 0.70; 95% CI, 0.513‐0.949), higher income (P <.05), or treatment modalities other than surgery alone (P <.05) had lower odds. Survival analysis showed that hospital safety net burden status was not significantly associated with overall survival (log‐rank P =.727). Conclusion: In patients with SNSCC, certain clinicopathologic factors, including Black race, lower income, treatment at an academic/research program, and treatment at facilities in the West region, were associated with treatment at HBHs. Hospital safety net burden status was not associated with differences in overall survival. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the impact of facility volume on Patient Safety Indicator (PSI) events following transsphenoidal pituitary surgery (TSPS). Study Design: Retrospective database review. Setting: National Inpatient Sample database (2003‐2011). Methods: The National Inpatient Sample was queried for TSPS cases from 2003 to 2011. Facility volume was defined by tertile of average annual number of TSPS procedures performed. PSIs, based on in‐hospital complications identified by the Agency of Healthcare Research and Quality, and poor outcomes, such as mortality and tracheostomy, were analyzed. Results: An overall 16,039 cases were included: 804 had ≥1 PSI and 15,235 had none. A greater proportion of male to female (5.8% vs 4.3%) and Black to White (7.0% vs 4.5%) patients experienced PSIs. There was an increased likelihood of poor outcome (odds ratio [OR], 3.1 [95% CI, 2.5‐3.7]; P <.001) and mortality (OR, 30.1 [95% CI, 18.5‐48.8]; P <.001) with a PSI. The incidence rates of PSIs at low‐, intermediate‐, and high‐volume facilities were 5.7%, 5.1%, and 4.2%, respectively. Odds of poor outcome with PSIs were greater at low‐volume facilities (OR, 3.3 [95% CI, 2.4‐4.4]; P <.001) vs intermediate (OR, 3.1 [95% CI, 2.1‐4.2]; P <.001) and high (OR, 2.5 [95% CI, 1.7‐3.8]; P <.001). Odds of mortality with PSIs were greater at high‐volume facilities (OR, 43.0 [95% CI, 14.3‐129.4]; P <.001) vs intermediate (OR, 40.0 [95% CI, 18.5‐86.4]; P <.001) and low (OR, 17.3 [95% CI, 8.0‐37.7]; P <.001). Conclusion: PSIs were associated with a higher likelihood of poor outcome and mortality following TSPS. Patients who experienced PSIs had a lower risk of poor outcome but increased mortality at higher‐volume facilities. [ABSTRACT FROM AUTHOR]

Objective: This study aims to provide an age-stratified analysis of associations with patient sex in pediatric inpatients with acute rhinosinusitis (ARS). Study Design: Retrospective cohort study. Setting: National administrative database. Methods: The 2016 Kids' Inpatient Database was queried for pediatric inpatients (<21 years old) with ARS (ICD-10 J01). Orbital and intracranial sequelae were selected via ICD-10 codes. Statistical associations by sex were determined via univariate and multivariable analyses. Weighted measures are reported to provide national estimates. Results: Of the 5882 patients identified with ARS, 2404 (40.9%) were female and 3478 (59.1%) were male. Male patients were younger than female patients (mean, 9.3 vs 9.9 years; P <.001). Multivariable analysis indicated that males and females had similar total charges ($71,094 vs $66,892, P =.464) and length of stay (5.8 vs 6.1 days, P =.263). However, male patients underwent more procedures (1.8 vs 1.5, P <.001). Mortality was similar between male and female patients (odds ratio [OR], 0.91; P =.664). Male patients also had increased odds for having orbital (OR, 1.58; P <.001) and intracranial (OR, 1.99; P <.001) complications. Differences in sex-dependent sequela risk were starkest in patients aged 14 to 20 years, with male patients being more likely to have orbital (OR, 2.91; P <.001) and intracranial (OR, 3.86; P <.001) complications. Conclusion: In a cohort of pediatric inpatients with ARS, males have increased odds for orbital and intracranial sequelae and undergo more procedures than females. However, males and females have similar charges and length of stay. Our study highlights age-stratified differences in ARS across patient sex. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to analyze national trends in human papillomavirus (HPV) testing for patients diagnosed with sinonasal squamous cell carcinoma (SNSCC). Study Design: Retrospective database study. Setting: National Cancer Database (2010-2016). Methods: Cases from 2010 to 2016 with a primary SNSCC diagnosis and known HPV testing status were extracted from the National Cancer Database. Univariate and multivariate analyses were then performed to assess differences in socioeconomic, hospital, and tumor characteristics between tested and nontested patients. Results: A total of 2308 SNSCC cases were collected, with 1210 (52.4%) HPV tested and 1098 (47.6%) not tested. On univariate analyses, patient age, insurance, income quartile, population density, treatment facility location, and tumor grade were significantly associated with HPV testing status. After multivariate logistic regression modeling, living in a suburban area had lower odds of HPV testing as compared with living in urban areas (odds ratio, 0.74 [95% CI, 0.55-0.99]; P =.041), while tumor grade III/IV had higher odds than grade I (odds ratio, 1.73 [95% CI, 1.29-2.33]; P <.001). HPV-tested patients had a similar 5-year overall survival to nontested patients (48.3% vs 45.3%, log-rank P =.405). A sharp increase in HPV testing rates was observed after 2010 (P <.001). Conclusion: Among patients with SNSCC, those with high-grade tumors were more likely to be tested for HPV, while patients with a suburban area of residence were less likely. Additionally, there was no significant survival benefit to HPV testing, with tested and nontested groups having similar overall survival. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Objective: To analyze population-level data for Burkitt's lymphoma of the head and neck. Study Design: Retrospective study of a national cancer database. Setting: Academic medical center. Methods: The SEER database (Surveillance, Epidemiology, and End Results) identified all patients with primary Burkitt's lymphoma of the head and neck from 1975 to 2015. Demographic, clinicopathologic, and treatment characteristics were analyzed. Multivariable Cox regressions analyzed factors associated with survival while controlling for baseline differences. Results: A total of 920 patients with a mean (SD) age of 37.6 years (25.0) were identified. A majority of patients were White (82.8%) and male (72.3%). The most primary common sites included the lymph nodes (61.3%), pharynx (17.7%), and nasal cavity/paranasal sinuses (5.2%). The majority of patients received chemotherapy (90.5%), while fewer underwent surgery (42.1%) or radiotherapy (12.8%). Choice of treatment differed significantly among patients of different ages, year of diagnosis, primary site, nodal status, and Ann Arbor stage. Overall 10-year survival was 67.8%. On multivariable Cox regression, patients with older age (hazard ratio [HR], 1.05 per year; P <.001) and higher stage at presentation had increased risk of mortality (P <.001). Furthermore, cases diagnosed between 2006 and 2015 (HR, 0.35; P <.001) and 1996 and 2005 (HR, 0.53; P =.001) had lower mortality when compared with those diagnosed between 1975 and 1995. Treatment including surgery and chemotherapy tended to have the best survival (P <.001). Conclusion: Burkitt's lymphoma of the head and neck diagnosed in more recent years has had improved survival. Factors significantly associated with survival include age, Ann Arbor stage, and treatment regimen. Treatment including surgery and chemotherapy was associated with the highest survival. [ABSTRACT FROM AUTHOR]

Objective: To investigate the demographics of CORE grant recipients (Centralized Otolaryngology Research Efforts) over the last decade and evaluate disparity among recipients as compared with otolaryngology overall. To assess whether procurement of a grant predicts pursuit of an academic career. Study Design: Analysis of grant recipients' bibliometrics. Setting: Academic medical center. Methods: The list of recipients of grants from 2010 to 2019 was obtained from the website of the American Academy of Otolaryngology–Head and Neck Surgery. Demographics of recipients were collected through an internet search, including gender, race, residency program, and h -index. Recipients from 2010 were searched to determine current academic faculty rank. Univariate and multivariate analyses were used to compare these factors with otolaryngology overall. Results: The distribution of gender among recipients over the last decade remained nearly constant, with no significant difference versus residents in otolaryngology (P >.05). However, there were significantly more female recipients when adjusted for gender differences in the field overall (P <.01). Asians were relatively overrepresented, while Black and Hispanic residents were underrepresented (P <.01). Many recipients (52.6%) trained at institutions recognized as the best training programs with reputations for quality research output. The h -index of recipients decreased over the last decade (P <.01). The h -index of duplicate winners was significantly higher than those of nonduplicate winners (P <.01). After adjusting for gender and rank, recipients were significantly more likely to hold academic positions (P <.01). Conclusion: CORE grants are favorably distributed as related to gender and racial disparities, and recipients frequently go on to achieve high levels of academic success. [ABSTRACT FROM AUTHOR]

Objective: Although extranodal extension (ENE) is a known indicator of poor prognosis for head and neck malignancies, its value as an indicator for sinonasal squamous cell carcinoma (SCC) has not been well characterized. This study seeks to assess the usefulness of ENE as a prognostic marker for sinonasal SCC. Study Design: Retrospective database review. Setting: National Cancer Database from 2010 to 2015. Methods: The National Cancer Database was queried from 2010 to 2015 for all patients with sinonasal SCC with available ENE status (n = 355). These cases were divided into those with pathologically confirmed ENE (n = 146) and those without ENE (n = 209). Univariate and multivariate analyses were used to examine survival differences and predictors of ENE status. Results: Most patients with ENE were ≥60 years old (61.7%), male (61.6%), and white (83.6%). Patients aged 60 to 69 and 80+ years were more likely to have ENE than those under 60 years (P <.05). Patients with ENE had worse 1-year overall survival than those without ENE (58.2% vs 70.8%, log-rank P =.008). After multivariate regression, however, there was no survival difference detected between ENE-positive and ENE-negative cases (hazard ratio, 1.14 [0.775-1.672], P =.508). Conclusion: ENE status did not have a significant effect on survival in patients with sinonasal SCC. Thus, ENE alone may not necessarily be a helpful indicator for sinonasal SCC prognosis. [ABSTRACT FROM AUTHOR]

Objective: Adenoid cystic carcinoma is a malignant minor salivary gland tumor that represents <1% of all laryngeal tumors. The submucosal location of laryngeal adenoid cystic carcinoma (LACC) results in delayed presentation. Here, we present the first systematic review of reported cases of LACC to determine trends in presentation, diagnostic and treatment modalities, and patient outcome. Data Sources: PubMed, Web of Science, MEDLINE, and EMBASE databases. Methods: A search of the above databases was done to identify articles reporting cases of LACC. The variables included in the analysis were patient demographics, presenting symptoms, tumor location, imaging, treatment, follow-up time, recurrence, and outcome. Results: A total of 50 articles and 120 cases were included in the review. The most common presenting symptom was dyspnea (48.8%), followed by hoarseness (43.9%). LACC arose most frequently from the subglottis (56.7%). At presentation, 14.6% (13 of 89) of patients had regional disease. The average follow-up time was 54.0 months. At follow-up, distant metastasis was reported in 30 cases (33.3%). Surgery alone (43.3%) and surgery with radiotherapy (43.3%) were used most frequently and resulted in 57.1% and 55.3% of patients alive with no evidence disease at follow-up, respectively. Conclusion: LACC was most often located in the subglottis. Patients commonly presented with dyspnea and hoarseness. In this systematic review, surgery with radiotherapy and surgery alone were the most commonly employed treatment modalities, and both resulted in slightly more than 50% of patients alive with no evidence of disease at follow-up. [ABSTRACT FROM AUTHOR]

Objective: The impact of diabetes mellitus (DM) on surgical outcomes and cost of care for patients undergoing surgery for head and neck cancer (HNCA) is not well established. We used the Nationwide Inpatient Sample to analyze the postoperative impact of DM on HNCA patients.Study Design: Population-based inpatient registry analysis.Setting: Academic medical center.Subjects and Methods: Discharge data from the Nationwide Inpatient Sample were analyzed for patients undergoing HNCA surgery from 2002 to 2010. Patient demographics, comorbidities, length of stay, hospital charges, and postoperative complications were compared between HNCA patients with and without DM.Results: Of 31,075 patients, 4029 patients (13.0%) had a DM diagnosis. DM patients were older (65.7 ± 10.8 vs 61.1 ± 14.1 years old; P < .001), had more preexisting comorbidities, had longer hospitalizations, and incurred greater hospital charges. Compared with the non-DM cohort, DM patients experienced significantly higher rates of postoperative infections (2.6% vs 2.1%, P = .025), cardiac events (9.0% vs 4.3%, P < .001), pulmonary edema/failure (6.6% vs 5.7%, P = .023), acute renal failure (3.3% vs 1.5%, P < .001), and urinary tract infections (2.8 % vs 2.1%, P = .005). No differences in surgical wound healing rates were observed (0.1 vs 0.1, P = .794). On multivariate logistic regression corrected for age and race, DM patients had greater odds of postoperative infections (1.382, P = .007), cardiac events (1.893, P < .001), and acute renal failure (2.023, P < .001).Conclusions: DM is associated with greater length of stay and hospital charges among HNCA patients. DM patients have significantly greater rates of postoperative complications, including postoperative infections, cardiac events, and acute renal failure. [ABSTRACT FROM AUTHOR]

Objectives: Malignant peripheral nerve sheath tumors (MPNSTs) are a group of tumors that arise from peripheral nerves or from the various elements of the nerve sheath, including Schwann cells and perineural fibroblasts. Head and neck MPNSTs (HN-MPNSTs) are rare, accounting for 8% to 16% of all soft tissue sarcomas. This study analyzes the demographic, clinicopathologic, and survival characteristics of HN-MPNSTs and establishes comparisons with MPNSTs at other body sites (other-MPNSTs).Study Design: Analysis of population-based tumor registry.Setting: Academic medical center.Subjects and Methods: The SEER database (Surveillance, Epidemiology, and End Results; 1973-2012) was queried for HN-MPNSTs (324 cases) and other-MPNSTs (1680 cases). Data were analyzed comparatively with respect to various demographic and clinicopathologic factors. Disease-specific survival was analyzed with the Kaplan-Meier model.Results: Mean age at diagnosis for HN-MPNST was 49.1 years, compared with 46.1 years for other-MPNSTs (P = .0169). There was a sex predilection for males in HN-MPNSTs (60.2%) versus a female predilection for other-MPNSTs (54.2%; P < .0001). Average tumor size for HN-MPNSTs was 4.9 cm, compared with 8.7 cm for other-MPNSTs (P < .0001). HN-MPNSTs were more commonly of low histologic grade types, whereas other-MPNSTs were mostly of high histologic grade (P = .0073). HN-MPNSTs had a higher 5-year disease-specific survival than other-MPNSTs (65.1% vs 57.4%; P = .0209).Conclusions: HN-MPNSTs are rare entities. This study represents the largest series of HN-MPNSTs to date. Although HN-MPNSTs and other-MPNSTs share a common histology, there are important clinical differences between the 2 groups. [ABSTRACT FROM AUTHOR]

In the setting of COVID-19 (coronavirus disease 2019)–associated moderate and severe acute respiratory distress, persistently hypoxemic patients often require prone positioning for >16 hours. We report facial pressure wounds and ear necrosis as a consequence of prone positioning in patients undergoing ventilation in the intensive care unit in a tertiary medical center in New York City. [ABSTRACT FROM AUTHOR]