1
|
Haleem A, Garcia A, Khan S, Shakelly P, Lee DJ. Access to Sudden Sensorineural Hearing Loss Care at Private Equity-Owned Otolaryngology Clinics. Otolaryngol Head Neck Surg 2024; 170:1705-1711. [PMID: 38327257 DOI: 10.1002/ohn.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/14/2023] [Accepted: 01/13/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Characterizing access to sudden sensorineural hearing loss (SSNHL) care at private practice otolaryngology clinics of varying ownership models. STUDY DESIGN Cross-sectional prospective review. SETTING Private practice otolaryngology clinics. METHODS We employed a Secret Shopper study design with private equity (PE) owned and non-PE-owned clinics within 15 miles of one another. Using a standardized script, researchers randomly called 50% of each clinic type between October 2021 and January 2022 requesting an appointment on behalf of a family member enrolled in either Medicaid or private insurance (PI) experiencing SSNHL. Access to timely care was assessed between clinic ownership and insurance type. RESULTS Seventy-eight total PE-owned otolaryngology clinics were identified across the United States. Only 40 non-PE clinics could be matched to the PE clinics; 39 PE and 28 non-PE clinics were called as Medicaid patients; 39 PE and 25 non-PE clinics were called as PI patients; 48.7% of PE and 28.6% of non-PE clinics accepted Medicaid. The mean wait time to new appointment ranged between 9.55 and 13.21 days for all insurance and ownership types but did not vary significantly (P > .480). Telehealth was significantly more likely to be offered for new Medicaid patients at non-PE clinics compared to PE clinics (31.8% vs 0.0%, P = .001). The mean cost for an appointment was significantly greater at PE clinics than at non-PE clinics ($291.18 vs $203.75, P = .004). CONCLUSIONS Patients seeking SSNHL care at PE-owned otolaryngology clinics are likely to face long wait times prior to obtaining an initial appointment and reduced telehealth options.
Collapse
Affiliation(s)
- Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Alejandro Garcia
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Sophia Khan
- Department of Biology, The College of New Jersey, Ewing, New Jersey, USA
| | - Purvi Shakelly
- Department of Biology, The College of New Jersey, Ewing, New Jersey, USA
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Pu K, Li L, Qiu Y, Song H. Lipids and sudden sensorineural hearing loss: A bidirectional two-sample Mendelian randomization analysis. Auris Nasus Larynx 2024; 51:365-370. [PMID: 37993362 DOI: 10.1016/j.anl.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/23/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE While numerous observational studies have indicated an association between lipids and Sudden Sensorineural Hearing Loss (SSNHL), it remains uncertain whether dyslipidemia serves as a causal risk factor for SSNHL. Our objective is to elucidate the potential causal relationship between lipid levels and SSNHL through Mendelian randomization analysis. METHODS The primary and secondary lipid data used in this study were sourced from the UK Biobank (UKBB) and the Global Lipid Genetics Consortium results (GLGC), respectively. These datasets were obtained from large, publicly available genome-wide association studies (GWAS). The outcome data for sudden sensorineural hearing loss (SSNHL) were acquired from the Finnegan Biobank, consisting of 1491 cases and 196,592 controls. Subsequently, both single-variable Mendelian randomization (SVMR) and multivariate Mendelian randomization (MVMR) methods were employed to evaluate the causal relationship between lipids and the occurrence of SSNHL. RESULTS Among the primary lipid data, SVMR analysis showed a significant correlation between high density lipoprotein cholesterol (HDL-C) (OR: 0.822, 95 %CI: 0.694-0.974, p = 0.023) and SSNHL, and triglycerides (TG) (OR: 0.997, 95 %CI: 0.836-1.188, p = 0.975), low density lipoprotein cholesterol (LDL-C) (OR: 1.067, 95 %CI: 0.861-1.322, p = 0.552) did not correlate with SSNHL. In the secondary lipid data, SVMR analysis showed that HDL-C (OR: 0.987, 95 %CI: 0.805-1.210, p = 0.903), TG (OR: 0.991, 95 %CI: 0.787-1.246, p = 0.937) and LDL-C (OR: 1.092, 95 % CI: 0.926-1.287, p = 0.294) did not correlate with SSNHL. MVMR analysis of the primary lipid data showed that HDL-cholesterol (OR: 0.755, 95 % CI: 0.596-0.956, p = 0.019) was significantly associated with SSNHL, while TG (OR: 0.808, 95 %CI: 0.611-1.068, p = 0.134) and LDL-C (OR: 1.146, 95 %CI: 0.869-1.511, p = 0.333) did not correlate with SSNHL, consistent with the results of SVMR. Inverse MR results showed that SSNHL did not correlate with TG (OR: 0.999, 95 %CI: 0.997-1.001, p = 0.835), HDL-C (OR: 1.001, 95 %CI: 0.998-1.003), LDL-C (OR: 0.999, 95 %CI: 0.997-1.002, p = 0.863). CONCLUSIONS Mendelian randomization (MR) results suggest that decreased serum HDL-C levels are an independent risk factor for SSNHL. Monitoring and focusing on lipid levels may be of value in the prevention and treatment of SSNHL.
Collapse
Affiliation(s)
- Kunlin Pu
- Department of Otorhinolaryngology, Pengzhou Hospital of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Li Li
- Department of Otorhinolaryngology, Pengzhou Hospital of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yan Qiu
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hongmei Song
- Department of Otorhinolaryngology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
| |
Collapse
|
3
|
Aldajani NF, Aloufi AM, Binhudayb NA, Yahya BJ, Alkarni AF. Approach to Sudden Hearing Loss Among Primary Care Physicians in Riyadh, Saudi Arabia. Cureus 2024; 16:e55849. [PMID: 38463405 PMCID: PMC10924649 DOI: 10.7759/cureus.55849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 03/12/2024] Open
Abstract
INTRODUCTION A medical emergency known as sudden sensorineural hearing loss (SSNHL) affects the ears suddenly, has a considerable probability of negative cognitive and functional outcomes, and can influence the patient's quality of life. Primary care physicians play a crucial role in diagnosing SSNHL and initiating prompt and efficient management since they are the ones who would likely encounter it initially. This study aims to evaluate the present knowledge, diagnostic, and management perspective of SSNHL among primary care physicians in Riyadh, Saudi Arabia. METHODS A self-generated questionnaire with 17 questions was developed, and a link to the online survey was delivered to primary care physicians (PHPs) in Riyadh, Saudi Arabia, concerning the management of SSNHL. RESULTS The knowledge level regarding SSNHL was evaluated, in which 21 (25%) of the participants had a low knowledge level, 34 (40.5%) had moderate knowledge, and 29 (34.5%) had a high knowledge level. Among 84 participants, 20 (23.8%) were confident in their ability to administer and understand the findings of tuning fork tests (TFT) to differentiate between sensorineural hearing loss and conductive hearing loss, whereas 64 (76.2%) were unsure about it. In addition, to distinguish between sensorineural hearing loss and conductive hearing loss, 62 (73.8%) participants were confident, and 22 (26.2%) participants were skeptical about their ability to interpret a formal audiogram. CONCLUSION Considering SSNHL as a medical emergency, in our survey, many family doctors would make proper referral and treatment decisions. However, TFTs were underutilized for guiding management decisions compared to other ways to distinguish between conductive and sensorineural hearing loss.
Collapse
Affiliation(s)
- Nader F Aldajani
- Otolaryngology-Head and Neck Surgery, King Fahad Medical City, Riyadh, SAU
| | | | - Nujud A Binhudayb
- Clinical Sciences, College of Medicine-Almaarefa University, Riyadh, SAU
| | - Buthaina J Yahya
- Otolaryngology-Head and Neck Surgery, King Fahad Medical City, Riyadh, SAU
| | - Abdullah F Alkarni
- Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| |
Collapse
|
4
|
Aghakhani A, Yousefi M, Yekaninejad MS. Machine Learning Models for Predicting Sudden Sensorineural Hearing Loss Outcome: A Systematic Review. Ann Otol Rhinol Laryngol 2024; 133:268-276. [PMID: 37864312 DOI: 10.1177/00034894231206902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND Machine Learning models have been applied in various healthcare fields, including Audiology, to predict disease outcomes. The prognosis of sudden sensorineural hearing loss is difficult to predict due to the variable course of the disease. Hence, researchers have attempted to utilize ML models to predict the outcome of patients with sudden sensorineural hearing loss. The objectives of this study were to review the performance of these machine learning models and assess their applicability in real-world settings. METHODS A systematic search was conducted in PubMed, Web of Science and Scopus. Only studies that built machine learning prediction models were included, and studies that used algorithms such as logistic regression only for the purpose of adjusting for confounding variables were excluded. The risk of bias was assessed using the Prediction model Risk of Bias Assessment Tool (PROBAST). RESULTS After screening, a total of 7 papers were eligible for synthesis. In total, these studies built 48 ML models. The most common utilized algorithms were Logistic Regression, Support Vector Machine (SVM) and boosting. The area under the curve of the receiver operating characteristic curve ranged between 0.59 and 0.915. All of the included studies had a high risk of bias; hence there are concerns regarding their applicability. CONCLUSION Although these models showed great performance and promising results, future studies are still needed before these models can be applied in a real-world setting. Future studies should employ multiple cohorts, different feature selection methods, and external validation to further validate the models' applicability.
Collapse
Affiliation(s)
- Amirhossein Aghakhani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Yousefi
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Zandi A, Mehrad-Majd H, Afzalzadeh MR. Association between Serum Vitamin D Levels and Risk of Sudden Sensorineural Hearing Loss: A cross-sectional Study. Indian J Otolaryngol Head Neck Surg 2023; 75:2974-2978. [PMID: 37974694 PMCID: PMC10646042 DOI: 10.1007/s12070-023-03917-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/28/2023] [Indexed: 11/19/2023] Open
Abstract
Background Sudden sensorineural hearing loss (SSNHL) is an autoimmune diseases of the inner ear which is usually defined by acute onset of hearing loss in one or both ears, of 30 dB or more on at least three contiguous audiometric frequencies within 3 days or less. This study aimed to compare the serum levels of 25-hydroxyvitamin D (VitD) between patients with SSNHL and healthy controls. Methods A total of 50 patients with SSNHL and 50 healthy individuals without hearing loss as control group were enrolled in this study. Serum levels of VitD and other related laboratory tests such as calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) were measured and compared between two study groups. Results Serum level of VitD was significantly lower in patients suffering from SSNHL compared to the healthy controls (26.55 ± 14.44 vs. 33.51 ± 14.21, P = 0.017, respectively). VitD insufficiency was observed in 70% (n = 35) of the patients with SSNHL as compared to 44% (n = 22) of healthy individuals, demonstrating a significant difference between two study groups. However, no statistically difference was observed for serum levels of Ca, P, and PTH. Conclusion This study indicated an increased prevalence of VitD insufficiency in subjects with SSNHL, suggesting a possible association between serum VitD levels and the development of SSNHL. VitD may protect the hearing loss through its antioxidant role.
Collapse
Affiliation(s)
- Afshin Zandi
- Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Otorhinolaryngology, Faculty of Medicine, Mashhad University of Medical Sciences, P.O. Box: 9176699199, Mashhad, Iran
| | - Hassan Mehrad-Majd
- Clinical Research Development Unit, Faculty of Medicine, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohamad Reza Afzalzadeh
- Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Otorhinolaryngology, Faculty of Medicine, Mashhad University of Medical Sciences, P.O. Box: 9176699199, Mashhad, Iran
| |
Collapse
|
6
|
Huang AE, Chan EP, Stave CM, Patel ZM, Hwang PH, Chang MT. Social Media Utilization in Otolaryngology: A Scoping Review. Laryngoscope 2023; 133:2447-2456. [PMID: 36807152 DOI: 10.1002/lary.30619] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/05/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Social media (SM) is an increasingly popular medium for the medical community to engage with patients, trainees, and colleagues. This review aimed to identify reported uses of SM in otolaryngology-head and neck surgery (OHNS), assess the quality of evidence supporting these uses, and identify gaps in the literature. With the relative lack of regulatory guidelines for the development of SM content, we hypothesized that the quality of content available on SM would be highly variable. DATA SOURCES AND METHODS A scoping review was performed of English-language peer-reviewed studies published to date discussing SM use in any form within OHNS. Three reviewers independently screened all abstracts. Two reviewers independently extracted data of interest from the full text of articles identified from the preliminary abstract screen. RESULTS 171 studies were included, with 94 (54.9%) studies published between 2020 and 2022. 104 (60.8%) studies were conducted in the US. 135 (78.9%) used cross-sectional or survey-based methodology; only 7 (4.1%) were controlled studies. SM was most commonly employed for professional networking (n = 37 [21%]), and within subspecialties of otology (n = 38 [22%]) and rhinology/allergy (n = 25 [15%]). Facebook was most frequently used for study recruitment (n = 23 [13.5%]), YouTube for patient education (n = 15 [14.6%]), and Twitter for professional networking (n = 16 [9.4%]). CONCLUSION SM use within OHNS is increasing rapidly, with applications including patient education, professional networking, and study recruitment. Despite myriad articles, there remains a paucity of well-controlled studies. As SM becomes integrated into healthcare, particularly for applications directly impacting patient care, higher levels of evidence are needed to understand its true impact. Laryngoscope, 133:2447-2456, 2023.
Collapse
Affiliation(s)
- Alice E Huang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Erik P Chan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Christopher M Stave
- Lane Medical Library, Stanford University School of Medicine, Stanford, California, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Michael T Chang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| |
Collapse
|
7
|
Sialakis C, Iliadis C, Frantzana A, Ouzounakis P, Kourkouta L. Intratympanic Versus Systemic Steroid Therapy for Idiopathic Sudden Hearing Loss: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e22887. [PMID: 35399426 PMCID: PMC8980198 DOI: 10.7759/cureus.22887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/19/2022] Open
Abstract
Idiopathic sudden sensorineural hearing loss (ISSHL) is a common condition characterized by hearing threshold reduction, most often of unknown causes. The patient experiences a sudden reduction of the hearing threshold in one or both ears. Steroids are the mainstream of the treatment. This study aims to investigate the effectiveness of intratympanic steroid administration compared with systemic administration and the combination of the two steroid treatments in the hearing recovery of patients with idiopathic sudden sensorineural hearing loss. We searched electronic databases such as PubMed, ScienceDirect, CINAHL, Cochrane (Central), Ovid, and Medline from August 31, 2021, to November 31, 2021, and from February 5 to 10, 2022. We included 12 randomized controlled trials (RCTs) and performed a meta-analysis comparing the efficiency in the hearing recovery of intratympanic versus systemic steroid treatment, systemic versus combined, and intratympanic versus combined steroid treatment. The results of the intratympanic versus systemic steroid therapy comparison showed no actual difference in efficiency and no statistical significance (odds ratio: 1.07 (Mantel-Haenszel (M-H), fixed, 95% confidence interval (CI): 0.76-1.51)). Systemic steroid treatment was inferior to combined steroid treatment and was the only outcome with statistical significance (odds ratio: 0.55 (M-H, fixed, 95% CI: 0.38-0.80)). Intratympanic steroid treatment was inferior to combined steroid treatment, although the results were not statistically significant (odds ratio: 0.65 (M-H, fixed, 95% CI: 0.37-1.16)). In conclusion, systemic steroid therapy was inferior to combined steroid therapy. The comparison of intratympanic with systemic therapy and intratympanic with combined therapy showed no statistical significance. Further research is needed with more RCTs, and side effects should be considered.
Collapse
|
8
|
Jung WW, Hoegerl C. Sudden Sensorineural Hearing Loss and Why It’s an Emergency. Cureus 2022; 14:e21418. [PMID: 35198323 PMCID: PMC8855894 DOI: 10.7759/cureus.21418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/19/2022] [Indexed: 11/21/2022] Open
Abstract
This review shows the importance of sudden sensorineural hearing loss (SSNHL) as a significant cause of hearing loss that often goes under-recognized, especially by primary care physicians. Contrasted with conductive hearing loss, SSNHL involves inner ear damage. This work reviewed the diagnostic methods and treatments of SSNHL in the U.S. and Canada, including treatment options. It is imperative that primary care physicians and providers be able to recognize this condition early so that treatment may be initiated without delay as hearing loss can become permanent if not managed immediately.
Collapse
|
9
|
Chien CY, Tai SY, Li KH, Yang HL, Chan LP, Hsi E, Wang LF, Ho KY, Chang NC. The association of genetic polymorphisms in interleukin-1 receptors type 1 and type 2 with sudden sensorineural hearing loss in a Taiwanese population: a case control study. J Otolaryngol Head Neck Surg 2021; 50:69. [PMID: 34865658 PMCID: PMC8647377 DOI: 10.1186/s40463-021-00550-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022] Open
Abstract
Background Sudden sensorineural hearing loss (SSNHL) is a disease with an unknown etiology; damage to the auditory nerve from inflammation due to viral infection or vascular incidents has been implicated. According to several studies, cytokines, including interleukins, are associated with SSNHL in terms of serum expression and genetic polymorphisms. Interleukin-1 (IL-1) plays a key role in inflammation and may be associated with SSNHL. This study analyzed the association of single nucleotide polymorphisms (SNPs) of IL-1 receptor (IL-1R) genes with SSNHL in Taiwan. Methods We conducted a case–control study involving 401 patients with SSNHL and 730 healthy controls. Four SNPs (IL-1R type 1 gene [IL1R1] [rs3917225 and rs2234650] and IL-1R type 2 gene [IL1R2] [rs4141134 and rs2071008]) were selected. The genotypes were determined using the TaqMan assay. The Hardy–Weinberg equilibrium (HWE) was tested for each SNP, and genetic effects were evaluated. Results The TT genotype of rs2234650 had an adjusted odds ratio (OR) of 2.988 (95% confidence interval [95% CI] 1.27–6.82) (P = 0.012) compared with the CC genotype in patients with SSNHL. The SNP rs2234650 was associated with SSNHL in the recessive model (TT vs. CC + CT, P = 0.0206, OR = 2.681). The CT genotype of rs4141134 had an adjusted OR of 3.860 (95% CI 2.01–7.44; P < 0.0001) compared with the TT genotype, in patients with SSNHL. The SNP rs4141134 was associated with SSNHL under the dominant model (CC + CT vs. TT, P < 0.0001, OR = 4.087). Conclusion These findings suggest that IL1R1 and IL1R2 gene polymorphisms may contribute to an increased risk of SSNHL in Taiwan.
Collapse
|