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Objective: Investigate whether nonopioid analgesics (NOA) provide adequate pain control after otologic surgery., Study Design: Retrospective multicenter cohort., Setting: Two quaternary academic medical centers., Patients: Patients over 12 years old who underwent otologic surgery involving the middle ear and/or mastoid at two centers over a 5-month period., Interventions: Patients were prescribed acetaminophen and ibuprofen postoperatively and instructed to contact the surgical team if pain control was inadequate, in which case an opioid medication was prescribed. Level of pain and medication use were assessed with a standardized questionnaire, 1 week after surgery., Main Outcome Measures: Postoperative pain levels during the first week after surgery (0-10); proportion of patients requiring opioid medication., Results: Sixty-seven patients were included. Of these, 37% underwent tympanomastoidectomy, 27% cochlear implant, 19.5% postauricular tympanoplasty, 10.5% transcanal tympanoplasty, and 6% had a different surgery. The median of the average level of pain in the first 7 days was 5/10 (IQR 3-6). The median highest level of pain was 5 (IQR 4-8). The median current level of pain was 3 (IQR 1-5). Seven patients (10%) required breakthrough opioid pain medication. The remaining 90% utilized NOA only. One week after surgery, 60% were taking nonopioid analgesics only while the remaining 40% were not taking any pain medication at all. Although opioids were required infrequently, there were no significant differences in medication use between the two centers., Conclusions: NOA provide adequate pain control for most patients after middle ear and mastoid otologic surgery. Opioid analgesics do not routinely need to be prescribed., Competing Interests: Funding and conflicts of interest: None., (Copyright © 2024, Otology & Neurotology, Inc.)

Meniere's disease (MD) is a complex inner ear disease related to endolymphatic hydrops and with multiple other etiologies suggested including autoimmunity and vascular insufficiency. Statins are lipid-lowering medications with additional effects including reduction of oxidative stress and inflammation. We performed a cross-sectional study comparing patients with MD on statins to those not on statins to see if there is any difference in disease activity (major vertigo spells) and hearing stage utilizing linear and logistic regression. Our analysis showed no difference in the average number of major vertigo spells per month ( β  = .07, P  = .9) between statin users and nonusers; however, statin users were found to have lower odds of worse hearing (odds ratio = 0.46, P  = .047). Further studies are needed to confirm our results., Competing Interests: None., (© 2024 The Author(s). OTO Open published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Purpose: To assess the audiometric outcomes following surgical repair of spontaneous temporal bone cerebrospinal fluid otorrhea and compare different surgical approaches., Materials and Methods: Retrospective review of adults (≥18 years old) who underwent repair of spontaneous CSF leak between 2011 and 2022. Audiometric outcomes were compared across the three surgical groups: transmastoid, middle cranial fossa and combined., Results: Thirty-nine patients (40 ears) met the inclusion criteria (71.8 % females; mean age 59.77 +/- 12.4). Forty-two percent underwent transmastoid, 12.5 % middle cranial fossa and 45 % transmastoid-middle cranial fossa. Four patients (10 %) had recurrence, 3 in the transmastoid group and 1 in the combined approach. The mean change in air-bone gap (ABG) for all patients (postoperative-preoperative) was -7.4 (paired t-test, p-value = 0.0003). The postoperative ABG was closed in 28 (70 %) ears (postoperative ABG ≤ 15). The mean change in pure tone average (PTA) for all patients (postoperative-preoperative) was -4.1 (paired t-test, p-value = 0.13). The mean change in word recognition scores (WRS) for all patients (postoperative-preoperative) was -3 (paired t-test, p-value = 0.35). On multivariable analysis (controlling for site and reconstruction material), there was no significant difference in ABG, PTA and WRS change between surgical groups., Conclusions: Transmastoid, middle cranial fossa and combined approaches are all effective in treatment of spontaneous CSF leaks and all showed mean decrease in post-operative ABG. Transmastoid approach showed the greatest decrease in ABG and PTA (although middle cranial fossa approach shows the greatest decrease, when excluding profound hearing loss in a patient with superior canal dehiscence). Further studies comparing audiometric outcomes are needed., Competing Interests: Declaration of competing interest No conflicts of interest or funding were declared by any of the authors., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To explore outcomes of endolymphatic sac surgery for patients with Meniere's disease with and without the comorbid condition of migraine., Materials and Methods: A retrospective chart review of adult patients undergoing endolymphatic sac surgery at a single tertiary care center from 1987 to 2019 was performed. All adult patients who failed medical therapy and underwent primary endolymphatic sac surgery were included. The main outcome measures were vertigo control and functional level scale (FLS) score. Patient characteristics, comorbidities, and audiometric outcomes were tracked as well., Results: Patients with Meniere's disease and migraine had a stronger association with psychiatric comorbidities (64.29% vs. 25.80%, p =0.01), shorter duration of vertigo episodes (143 vs. 393 min, p =0.02), and younger age (36.6 vs. 50.8 yr, p =0.005) at the time of endolymphatic sac surgery. Postoperative pure tone averages and word recognition scores were nearly identical to preoperative baselines. Class A vertigo control (47.92%) was most common, followed by class B vertigo control (31.25%). The FLS score improved from 4.2 to 2.8 ( p < 0.001). Both patients with and without migraine had classes A-B vertigo control (66.67% vs. 80.95%) without any statistically significant difference ( p =0.59). Of the patients who required secondary treatment (10.42%), none had migraine., Conclusions: Endolymphatic sac surgery is an effective surgical intervention for Meniere's disease with and without migraine. Patients with comorbid migraine tend to be younger and present with psychiatric comorbidities., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Norman A. Orabi et al.)

Objective: To develop a Decision Quality (DQ) tool to measure parents' DQ concerning ventilation tube (VT) insertion in their children., Method: Parental survey during 2017 to 2018 in a tertiary care pediatric otolaryngology clinic comparing a validated Decisional Conflict (DC) scale with a DQ instrument including Shared Decision-Making (SDM) scale, parental treatment goals, and knowledge about VT., Results: Of 100 parent participants, 83% were mothers and 14% were fathers. 94% elected VT insertion, 6% elected monitoring or deferred the decision. 44% of the patients were <18 months, 42% were 19 months to 3 years, and the rest were older. The mean DC score was 8.26 out of 100 (95% CI 4.82-11.69), indicating low DC. Mean DQ score was 82.45 out of 100 (95% CI 80.18-84.72), including mean SDM of 87.71 (95% CI 83.53-91.88,), mean knowledge score of 87.5% (95% CI 84.56-91.59) and mean values score of 7.16 (95% CI 6.90-7.41). Comparisons between those who elected VT and those who did not showed that electors had lower DC scores (7.15 vs 24.74, P < .001), higher DQ scores (83.00 vs 72.61, P = .028) with higher SDM scores (88.70 vs 70.22, P = .044) and higher values score (7.20 vs 6.36, P = .034). Cronbach alpha for the DQ scale was 0.76. Spearman's rho for DQ score versus DC score was -0.458, P < .001., Conclusions: DQ, as measured with this tool, was higher when parents chose to place tubes. Our DQ instrument has potential use for study of why parents may decline VT when their child meets criteria for them.