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Background: Medialization thyroplasty and injection laryngoplasty are widely accepted treatment options for unilateral vocal fold paralysis. Although both procedures result in similar clinical outcomes, little is known about the corresponding medical care costs. Medialization thyroplasty requires expensive operating room resources while injection laryngoplasty utilizes outpatient resources but may require repeated procedures. The purpose of this study, therefore, is to quantify the cost differences in adult patients with unilateral vocal fold paralysis undergoing medialization thyroplasty versus injection laryngoplasty., Study Design: Cost minimization analysis conducted using a decision tree model., Methods: A decision tree model was constructed to capture clinical scenarios for medialization thyroplasty and injection laryngoplasty. Probabilities for various events were obtained from a retrospective cohort from the London Health Sciences Centre, Canada. Costs were derived from the published literature and the London Health Science Centre. All costs were reported in 2014 Canadian dollars. Time horizon was 5 years. The study was conducted from an academic hospital perspective in Canada. Various sensitivity analyses were conducted to assess differences in procedure-specific costs and probabilities of key events., Results: Sixty-three patients underwent medialization thyroplasty and 41 underwent injection laryngoplasty. Cost of medialization thyroplasty was C$2499.10 per patient whereas those treated with injection laryngoplasty cost C$943.19. Results showed that cost savings with IL were C$1555.91. Deterministic and probabilistic sensitivity analyses suggested cost savings ranged from C$596 to C$3626., Conclusions: Treatment with injection laryngoplasty results in cost savings of C$1555.91 per patient. Our extensive sensitivity analyses suggest that switching from medialization thyroplasty to injection laryngoplasty will lead to a minimum cost savings of C$596 per patient. Considering the significant cost savings and similar effectiveness, injection laryngoplasty should be strongly considered as a preferred treatment option for patients diagnosed with unilateral vocal fold paralysis.

Objective: To describe current management of posterior epistaxis among Canadian otolaryngology-head and neck surgeons., Methods: A cross-sectional Internet-based survey was distributed to all 550 members of the Canadian Society of Otolaryngology-Head and Neck Surgery with an electronic mail contact. The survey consisted of three sections: (1) demographic data, (2) opinions regarding management options for posterior epistaxis, and (3) opinions regarding management of complications after placement of a posterior nasal pack. The survey was available for completion from July 2009 until October 2009. Main outcome measures were ranking of preference, comfort level, and perceived best management option for posterior epistaxis., Results: A total of 152 completed surveys were collected (28% response rate). Respondents were most comfortable with and most preferred inflatable balloon packing for treatment of posterior epistaxis. However, it was felt that endoscopic sphenopalatine arterial ligation was the best available intervention. After placement of a posterior nasal pack, respondents felt that monitoring of vital signs was required for all patients, but a lower-intensity monitoring setting may be sufficient., Conclusions: There is a discrepancy between actual practice and perceived best available management for posterior epistaxis. Respondents also favoured a lower-intensity monitoring setting for patients with posterior nasal packing. Practice guidelines may be helpful in ensuring that patients receive the best possible care while making the best use of limited hospital resources.

Objective: to quantify head and neck injuries in known adult victims of intimate-partner violence (IPV)., Design: retrospective chart review., Setting: sexual assault and domestic violence program in a southeastern Ontario hospital., Methods: all subjects over the age of 16 years consenting for evaluation by a domestic violence nurse from August 2004 until February 2009 were eligible for inclusion. Subjects for which no physical injury was documented were excluded. Data were extracted from body maps and surveys completed by a specially trained domestic violence nurse. Demographic data, mechanisms of injury, relationship to the assailant, and a history of IPV from the same assailant were collected from the survey. The type and anatomic location of the injury were collected from body maps. Injuries were categorized into six larger categories for analysis according to general anatomic area and multiplicity of areas involved., Main Outcome Measure: anatomic location of the injury., Results: one hundred eight visits were eligible for inclusion in the study. Data on 657 injuries were recorded. The frequency of any head and neck injury was significantly greater than no head and neck injury (p < .001). In subjects experiencing multiple areas of injury, head and neck injuries were significantly more common than not (p < .001). In subjects experiencing only one area of injury, head and neck injuries were more common than lower extremity injuries alone (p = .003) and trunk injuries alone (p = .033) but not significantly more common than upper extremity injuries (p = .102)., Conclusions: head and neck injuries are more common than not in known adult victims of IPV.

Objective: Patients with posterior nasal packing are thought to be at high risk for the development of respiratory complications. Controversy exists regarding the evidence in that regard; consequently, the level of vital sign monitoring required for these patients is unclear. The objective of this article is to systematically review the literature describing respiratory complications from nasal packing., Methods: Literature published before July 2009 on Medline and Embase was eligible for inclusion. Original research and review articles whose major topic was nasal packing for epistaxis were included. Nonhuman studies and studies not published in English were excluded. Studies were evaluated for quality using a modified Downs and Black scale. Data regarding respiratory complications of nasal packing were extracted and summarized., Results: Of the 262 studies retrieved, 14 met inclusion criteria (7 case series, 3 cohort studies, and 4 reviews). Six studies discussed pulmonary mechanics, three discussed sleep apnea, two reviews described complications of nasal packing, and three articles focused on the treatment of posterior epistaxis. There was a lack of high-quality literature describing adverse respiratory events following posterior packing., Conclusion: The literature regarding development of respiratory complications from posterior packing is mostly based on expert opinion or case series. There is some suggestion that sleep apnea may develop after placement posterior nasal packing, but the severity appears to be mild. Evidence is lacking to support the contention that all patients with posterior packing are at risk for developing adverse respiratory events or require admission to a monitored setting.