Survival outcomes for head and neck patients with Medicaid: A health insurance paradox

xlomafota13 shared this article with you from Inoreader Survival outcomes for head and neck patients with Medicaid: A health insurance paradox Via Head & Neck Abstract Purpose Privately insured patients with head and neck cancer (HNC) typically have better outcomes; however, differential outcome among Medicaid versus the uninsured is unclear. We aimed to describe outcome disparities among HNC patients uninsured versus on Medicaid. Methods A cohort of 18–64‐year‐old adults (n = 57 920) with index HNC from the Surveillance, Epidemiology, and End Results 18 database (2007–2015) was analyzed using Fine and Gray multivariable competing risks proportional hazards models for HNC‐specific mortality. Results Medicaid (sdHR = 1.65, 95% CI 1.58, 1.72) and uninsured patients (sdHR = 1.55, 95% CI 1.46, 1.65) had significantly greater mortality hazard than non‐Medicaid patients. Medicaid patients had increased HNC mortality hazard than those uninsured. Conclusion Compared with those uninsured, HNC patients on Medicaid did not have superior survival, suggesting that there may be underlying mechanisms/factors inherent in this patient population that could undermine access to care benefits from being on Medicaid. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Determination of posterolateral oropharyngeal wall thickness and the potential implications for transoral surgical margins in tonsil cancer

xlomafota13 shared this article with you from Inoreader Determination of posterolateral oropharyngeal wall thickness and the potential implications for transoral surgical margins in tonsil cancer Via Head & Neck Abstract Background Margins in transoral surgery for tonsil cancer can be limited by oropharyngeal wall thickness (OWT), but the normal range is not well established. Methods In 240 noncancer subjects, OWT was measured bilaterally in the vicinity of the tonsils with MRI. Statistical analysis was performed to assess for interaction of age, sex, location, and obesity. Results Mean(SD) OWT measured 3.4(0.6) mm posteriorly, 3.7(2.0) mm between the styloglossus and stylopharyngeus, and 5.3(0.8) mm laterally. OWT was greater in men, correlated with obesity, decreased posteriorly and laterally in the 60–80 versus 40–59 year age groups, and increased when styloglossus/stylopharyngeus were closer. OWT was <5 mm in 36.7%–97.9% of locations, with the largest percentage below this threshold located posteriorly. Conclusions OWT is frequently <5 mm, particularly in the posterior and intermuscular areas, suggesting that a smaller surgical margin may need to be accepted in transoral tonsil cancer surgery for anatomic reasons. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Does the Acoustic Voice Quality Index (AVQI) Correlate with Perceived Creak and Strain in Normophonic Young Adult Finnish Females?

xlomafota13 shared this article with you from Inoreader Does the Acoustic Voice Quality Index (AVQI) Correlate with Perceived Creak and Strain in Normophonic Young Adult Finnish Females? Via Folia Phoniatrica et Logopaedica Background: The Acoustic Voice Quality Index (AVQI) is a correlate of dysphonia. It has been found to differentiate between dysphonic and normophonic speakers and to indicate the effects of voice therapy. This study investigates how the AVQI reacts towards creak and strain, which are common in normophonic speakers. Methods: The material was obtained from an earlier study on 104 Finnish female university students (mean age 24.3 years, SD 6.3 years) with no known pat hology of voice or hearing and a perceptually normal voice (G = 0 in GRBAS), who were recorded while reading aloud a standard text and sustaining the vowel [a:]. Perceptual analysis for the amount of creak and strain was carried out by 2 expert listeners. In this study, the AVQI v03.01 was analyzed and correlated with perceptual evaluations. Samples with low and high amounts of creak and strain were compared with t tests. Results: On average, the AVQI was below the threshold value of dysphonia in the Finnish population. The AVQI (ρ = 0.35, p = 0.000) and its subparameters, smoothed cepstral peak prominence (CPPS; ρ = –0.35, p = 0.000) and harmonics-to-noise ratio (HNR; ρ = –0.30, p = 0.002) showed low but significant correlations with creak. Strain had low but significant correlations with spectral Slope (ρ = 0.38, p = 0.000) and Tilt (ρ = –0.40, p = 0.009). The AVQI was lower (better) in samples that were evaluated as having a high amount of strain, but the difference was not significant. Only CPPS differentiated significantly between low and high amounts of creak. Conclusion: The AVQI does not seem to differentiate between high and low amounts of creak and strain in normophonic speakers. Folia Phoniatr Logop View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

New Visionary in Upper Airway Surgeries–THRIVE, a Tubeless Ventilation

xlomafota13 shared this article with you from Inoreader New Visionary in Upper Airway Surgeries–THRIVE, a Tubeless Ventilation Via Otolaryngology Indian Abstract THRIVE stands for Transnasal Humidified Rapid Insufflation Ventilatory Exchange. Usage of THRIVE technique is common in emergency settings and of late its usage in upper airway surgeries is gaining popularity. (1) To determine the operative time, total anaesthesia time, safety and efficacy of THRIVE in patients undergoing upper airway surgeries for varied pathologies. (2) To assess the surgeon's satisfaction and patients post-operative comfort. An observational study was from May 2019 to Oct 2020. Study was conducted through a detailed proforma which consists of patient demographic details, physical status, co-morbidities and various domains to assess the safety and efficacy of THRIVE. A total of 32 patients were divided into four groups depending on the type of surgery. We had 18 patients in microlaryngeal excision, six in direct laryngoscopy and biopsy, four in tracheostomy and four in balloon dilatation for subglottic stenosis groups. The mean operation time was 16 ± 2 min in the first three groups and 29 ± 0.8 in the fourth group. All the patients underwent successful surgeries without any episodes of desaturation, without complications and with good surgical satisfaction. THRIVE with appropriate safety precautions can be tried in patients undergoing various upper airway surgeries of short duration. All the patients in our study maintained stable vital parameters throughout the surgery. Initial results with the use of THRIVE as per our study and other studies are definitely encouraging to use THRIVE in upper airway surgeries with varied pathologies. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Is Working Memory Compromised in Individuals with Sensorineural Hearing Loss with Auditory Neural Origin?

xlomafota13 shared this article with you from Inoreader Is Working Memory Compromised in Individuals with Sensorineural Hearing Loss with Auditory Neural Origin? Via Otolaryngology Indian Abstract The study aimed to investigate the working memory and speech recognition in noise from individuals with Sensori Neural Hearing Loss (SNHL) with and without auditory neuropathy spectrum disorder (ANSD). The purpose of assessing working memory recommends for a potential intervention program to perceive speech. Twenty participants in the age range of 16–44 years, diagnosed as having mild to moderate SNHL were recruited for the study. The participants were divided into two groups based on the presence and absence of ANSD (10 in each group). The visual working memory was assessed in all the participants using the Operation Span Test, Reading Span Test and Visual Backward Test. Speech perception ability was assessed using the SNR 50 test. There was no significant difference between the scores of Operation Span, Reading Span, and Visual Backward Span for individuals with SNHL with and without ANSD. There was a significant difference between the scores of SNR 50 f or individuals with SNHL with and without ANSD. The visual working memory in individuals with and without ANSD is similar. Speech perception in noise is significantly affected in ANSD than SNHL without ANSD. Thus, it is recommended to use speech reading, which utilizes visual working memory to interpret the message, as previous studies have reported that individuals with ANSD show limited benefit in auditory mode of rehabilitation alone. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cochlear Implantation in Chronic Otitis Media with and without Cholesteatoma: Surgical Considerations and Auditory Outcomes

xlomafota13 shared this article with you from Inoreader Cochlear Implantation in Chronic Otitis Media with and without Cholesteatoma: Surgical Considerations and Auditory Outcomes Via O.R.L. Journal for oto-rhino-laryngology and its borderlands Introduction: Cochlear implant (CI) surgery is a safe and standardized procedure in the presence of normal temporal bone anatomy. However, in the surgery of patients with chronic otitis media (COM), the surgeon may encounter several problems. The aim of this study was to evaluate the impact of COM with and without cholesteatoma on surgical and auditory outcomes of CIs. Methods: The study group consisted of 39 patients with COM who received CIs. Age- and gender-matc hed 38 standard CI patients served as controls. The surgical techniques and complications, pure tone audiometry (PTA) scores, speech discrimination scores (SDS), and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire results of the groups were compared. Results: The presence of COM was associated with a higher rate of complication than controls. Staging the surgeries, presence or absence of cholesteatoma, and type of surgical technique were not associated with surgical outcomes and complications (p #x3e; 0.05). There was no significant difference between the groups in terms of postoperative PTA scores, SDS, and IOI-HA scores (p #x3e; 0.05). Conclusion: Postoperative complications like device failure and skin breakdown are increased in cases of COM compared to standard CI surgeries. However, that increase is not associated with staging the surgeries, presence or absence of cholesteatoma, and type of ear surgery perfor med. It is advocated to close the external ear canal and eustachian tube without mastoid obliteration in the presence of a radical mastoidectomy cavity, which will decrease the postoperative complication rates and allow for radiological follow-up with computed tomography for the possibility of cholesteatoma recurrence. The auditory benefits of CI in patients with and without COM are comparable. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sentinel lymph node biopsy versus elective neck dissection: long-term oncologic outcomes in clinically node-negative tongue cancer

xlomafota13 shared this article with you from Inoreader Sentinel lymph node biopsy versus elective neck dissection: long-term oncologic outcomes in clinically node-negative tongue cancer Via pubmed: "clin exp otorhinola... Clin Exp Otorhinolaryngol. 2021 Mar 30. doi: 10.21053/ceo.2020.02411. Online ahead of print. ABSTRACT OBJECTIVES.: To compare the long-term oncologic outcomes of sentinel lymph node biopsy (SLNB) versus elective neck dissection (END) in clinically node-negative (cN0) tongue cancer. METHODS.: This is a retrospective cohort study of patients with cN0 tongue cancer from a single institution, including 91 patients in the SLNB group and 120 patients in the END group. RESULTS.: Overall recurrence rate was no significant difference in the recurrence rate between the two groups. The regional control rate was also comparable between the two groups (p = 0.49). The 5-year RFS was slightly better in the SLNB group (p = 0.427). The 5-year OS was 89.9% in the SLNB group vs. 91.9% in the END group (p = 0.737). In propensity-matched subgroup analysis, the type of neck management did not affect RFS nor OS. CONCLUSION.: . SLNB showed n on-inferior oncologic outcomes compared to END in patients with cN0 tongue squamous cell carcinoma. PMID:33781056 | DOI:10.21053/ceo.2020.02411 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Modified transoral endoscopic thyroidectomy technique using trapdoor suspension sutures

xlomafota13 shared this article with you from Inoreader Modified transoral endoscopic thyroidectomy technique using trapdoor suspension sutures Via pubmed: "clin exp otorhinola... Clin Exp Otorhinolaryngol. 2021 Mar 30. doi: 10.21053/ceo.2021.00101. Online ahead of print. NO ABSTRACT PMID:33781057 | DOI:10.21053/ceo.2021.00101 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hearing impairment increases economic inequality

xlomafota13 shared this article with you from Inoreader Hearing impairment increases economic inequality Via pubmed: "clin exp otorhinola... Clin Exp Otorhinolaryngol. 2021 Mar 30. doi: 10.21053/ceo.2021.00325. Online ahead of print. ABSTRACT OBJECTIVE: We evaluated the change in income level in a hearing-impaired population. METHODS: The study subjects were selected from the Korean National Health Insurance Service-Health Screening Cohort data from 2002-2015 of Koreans ≥ 40 years old. In all, 5,857 hearing-impaired subjects were matched with 23,428 comparison participants. The difference in the initial income level and the income level at 1, 2, 3, 4, and 5 years post-enrollment were compared between the hearing-impaired and comparison groups. The interaction of time*hearing impairment/comparison was estimated. RESULTS: Both the hearing-impaired group and the comparison group showed increased income levels over time. In the hearing-impaired group, the income levels at 4 and 5 years post-enrollment were higher than the initial income level (each p < 0.001). In the comparison group, the income levels of all the participants after 1-5 years were higher than the initial income level (each p < 0.001). The interaction of time*hearing impairment was statistically significant (p = 0.021). CONCLUSION: The increase in income over time was relatively lower in the hearing-impaired adult population; therefore, the gap in income level widened between this population and the normal-hearing population. PMID:33781058 | DOI:10.21053/ceo.2021.00325 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Development of HIGH-INTENSITY FOCUSED ULTRASOUND(HIFU) Therapy in Inferior Turbinate Hypertrophy

xlomafota13 shared this article with you from Inoreader Development of HIGH-INTENSITY FOCUSED ULTRASOUND(HIFU) Therapy in Inferior Turbinate Hypertrophy Via pubmed: "clin exp otorhinola... Clin Exp Otorhinolaryngol. 2021 Mar 30. doi: 10.21053/ceo.2020.02383. Online ahead of print. ABSTRACT OBJECTIVES: Inferior turbinate (IT) hypertrophy is the main cause of chronic nasal obstruction. We developed a high-intensity focused ultrasound (HIFU) ablation device to treat patients with IT hypertrophy. METHODS: First, computed tomography (CT) images of patients without any evidence of sinonasal disease were evaluated to measure and compared the IT, medial mucosal thickness (MT), and space between the nasal septum and IT according to clinical characteristics such as septal deviation. A HIFU prototype was developed based on human anatomical studies. The experimental study was performed in five pigs; the cross-sectional areas of the nasal cavity airway and histological changes at 1 and 4 weeks postoperatively were evaluated to compare the efficacy of HIFU turbinoplasty with that of radiofrequency turbinoplasty and control. < p>RESULTS: The mean medial MT of the anterior, middle, and posterior portions of the IT were 4.66±1.14, 4.23±0.97, and 6.17±1.29 mm, respectively. The mean medial IT spaces was 2.65±0.79 mm. The diameter and focal depth of the prototype were 4 mm and 3 mm. HIFU showed no postoperative complications including bleeding or scar formation. After HIFU treatment, the cross-sectional area of the nasal airway increased by 196.62(7.8%) mm3 and 193.74(8.3%) mm3 at 1 week and 4 weeks, compared with the increase of 87.20(3.1%) mm3 and 213.81(9.0%) mm3, respectively, after radiofrequency therapy. Qualitative histologic analysis after radiofrequency turbinoplasty showed epithelial layer disruption at 1 week and increased fibrosis along with decreased glandular structure at 4 weeks. The HIFU group had an intact epithelial layer at 1 week postoperatively. However, significant differences were observed at 4 weeks, including increased fibrosis, and decreased glandular structure. CONCLUSION: The efficacy and safety of HIFU turbinoplasty had been observed in an animal study. Our results warrant the need for further human clinical trials. PMID:33781059 | DOI:10.21053/ceo.2020.02383 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Extraction of Aural Foreign Bodies in a Rural Setting: 10-Year Review and a Novel Method to Remove Magnetic Stones

xlomafota13 shared this article with you from Inoreader Extraction of Aural Foreign Bodies in a Rural Setting: 10-Year Review and a Novel Method to Remove Magnetic Stones Via ear nose throat Ear Nose Throat J. 2021 Mar 30:1455613211006007. doi: 10.1177/01455613211006007. Online ahead of print. ABSTRACT BACKGROUND: The external auditory canal's unique anatomical characteristics made the presence of foreign bodies (FBs) a clinical challenge, particularly in rural settings without ready access to tertiary care and specialist intervention. AIMS: Our study surveys the experience in aural FBs surgical management in a rural Australian tertiary center. It proposes a safe, easy, and affordable technique to remove stones from the ear canal. METHODS: We have completed a 10-year retrospective surgical chart review, including 474 patients (52 adults and 428 children) requiring surgical management to remove aural FBs at the Royal Darwin Hospital, Northern Territory, Australia. We surveyed for patient demographics, foreign-body description, complications, location, and removal attempts. We identified what factors determine the need for surgical management and propose a technique for a safe, uncomplicated, and affordable removal of stones from the ear canal after applying this method in a small subgroup. RESULTS: The most common FBs requiring surgery in children were stones. A predominance in the Aboriginal population from remote communities was found, leading to a nasal bridle magnet technique to remove stones in rural settings. This method reduces the number of extraction attempts of the most frequent FB found in children's ears, aimin g to minimize complications, negative experiences, and health cost. CONCLUSION: Contrary to international literature, stones were found to be the most common FB in remote aboriginal populations. The proposed technique reduces the number of extraction attempts of the most frequent FB found in children's ears, aiming to minimize complications, negative experiences, and health cost. PMID:33781128 | DOI:10.1177/01455613211006007 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.