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Lewis AT, Backous D, Choi BY, Jaramillo R, Kong K, Lenarz T, Ray J, Thakar A, Järbrink K, Hol MKS. Healthcare consumption among subjects with otitis media undergoing middle ear surgery-analysis of cost drivers. Eur Arch Otorhinolaryngol 2023; 280:175-181. [PMID: 35731293 PMCID: PMC9813026 DOI: 10.1007/s00405-022-07483-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/31/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE To map healthcare utilized by subjects with chronic otitis media, with or without cholesteatoma and perform a cost analysis to determine key drivers of healthcare expenditure. METHODS A registry study of 656 adult subjects with chronic otitis media that underwent a middle ear surgery between 2014 and 2018. Healthcare contacts related to all publicly funded specialist ENT care, audiological care and primary care for a disease of the ear and mastoid process were extracted. The data are extracted from the Swedish National Patient Registry on subjects that reside in western Sweden. RESULTS Subjects made 13,782 healthcare contacts at a total cost 61.1 million SEK (6.0 million EUR) between 2014 and 2018. The mean cost per subject was 93,075 SEK (9071 EUR) and ranged between 3971 SEK (387 EUR) and 468,711 SEK (45,683 EUR) per individual. In the most expensive quartile of subjects, mean cost was 192,353 SEK (18,747 EUR) over the 5-year period. These subjects made 3227 ENT contacts (roughly four each year) and 60% of total costs were associated with in-patient ENT care. CONCLUSION Patients with chronic otitis media are associated with high ENT resource utilization that does not diminish after surgical intervention and the disease places a long-term burden on healthcare systems. Significant costs are attributed to revision surgeries, indicating that these patients could be managed more effectively. In many such cases, reoperation cannot be avoided, especially due to recurrence of cholesteatoma. However, in some patients, when the indication for subsequent surgery is only hearing improvement, alternative options, such as hearing aids or implants, should also be considered. This is especially true in difficult cases, where revision ossiculoplasty is likely.
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Affiliation(s)
| | | | - Byung Yoon Choi
- Bundang Hospital, Seoul National University, Seongnam, South Korea
| | | | | | | | - Jaydip Ray
- ENT Department, Sheffield Teaching Hospitals, Sheffield, UK
| | - Alok Thakar
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Myrthe K. S. Hol
- Department of Otorhinolaryngology, Donders Centre for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands ,Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, Groningen, The Netherlands
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Backous D, Choi BY, Jaramillo R, Kong K, Lenarz T, Ray J, Thakar A, Hol MKS. Hearing Rehabilitation of Patients with Chronic Otitis Media: A Discussion of Current State of Knowledge and Research Priorities. J Int Adv Otol 2022; 18:365-370. [PMID: 35894534 PMCID: PMC9404322 DOI: 10.5152/iao.2022.21428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Although chronic otitis media is a major cause of conductive and mixed hearing loss, auditory rehabilitation is currently not optimal for this patient group. Planning for hearing rehabilitation must accompany strategies for infection control when surgically managing patients with chronic otitis media. Several barriers prevent adequate hearing restoration in such a heterogeneous patient population. A lack of standardized reporting of surgical interventions, hearing, and quality of life outcomes impedes meta-analyses of existing data and the generation of high-quality evidence, including cost-effectiveness data, through prospective studies. This, in turn, prevents the ability of clinicians to stratify patients based on prognostic indicators, which could guide the decision-making pathway. Strategies to improve reporting standards and methods have the potential to classify patients with chronic otitis media preoperatively, which could guide decision-making for hearing restoration with ossiculoplasty versus prosthetic hearing devices. Appropriately selected clinical guidelines would not only foster directed research but could enhance patient-centered and evidence-based decision-making regarding hearing rehabilitation in the surgical planning process.
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Affiliation(s)
| | - Byung Yoon Choi
- Bundang Hospital, Seoul National University, Seongnam, South Korea
| | | | | | | | - Jaydip Ray
- ENT Department, Sheffield Teaching Hospitals, Sheffield, UK
| | - Alok Thakar
- All India Institute of Medical Sciences, New Delhi, India
| | - Myrthe K S Hol
- Department of Otorhinolaryngology, Donders Centre for Neurosciences, Radboud University Medical Center, Nijmegen, Netherlands; Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Research School of Behavioral and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, Netherlands
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Singh J, Patel U, Backous D. Primary external auditory canal meningioma: Case report and review of the literature. Am J Otolaryngol 2022; 43:103215. [PMID: 34536924 DOI: 10.1016/j.amjoto.2021.103215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/05/2021] [Indexed: 11/17/2022]
Abstract
Meningiomas are tumors that arise from arachnoid cells attached to both the pia mater and the inner portion of the arachnoid. They are common intracranial tumors, representing 12-25% of intracranial neoplasms. Intracranial meningiomas can spread extracranially to involve surrounding structures, including the ear and temporal bone. Ectopic meningiomas, described as primary meningiomas with no intracranial involvement, are rare. We describe a case of a primary external auditory canal meningioma with no evidence of intracranial involvement. We present pre-operative imaging findings proving no intracranial involvement prior to surgical intervention. A literature review of this uncommon clinical entity is presented and a discussion regarding its prognosis and treatment is reviewed.
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Affiliation(s)
- Jeffrey Singh
- Puget Sound Ear, Nose and Throat, 21911 76th Ave W, Edmonds, WA, 98026, United States of America.
| | - Uresh Patel
- Swedish Neuroscience Institute, 747 Broadway, Seattle, WA 98122, United States of America
| | - Douglas Backous
- Puget Sound Ear, Nose and Throat, 21911 76th Ave W, Edmonds, WA, 98026, United States of America
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Smith S, Kozin ED, Kanumuri VV, Barber SR, Backous D, Flávio Nogueira J, Lee DJ. Initial Experience with 3-Dimensional Exoscope-Assisted Transmastoid and Lateral Skull Base Surgery. Otolaryngol Head Neck Surg 2019; 160:364-367. [PMID: 30598049 DOI: 10.1177/0194599818816965] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extracorporeal video microscopes, or "exoscopes," provide high-definition views of the operative field and are alternatives to the operating microscope or loupes for large-corridor surgical approaches. In this proof-of-concept study, we aim to determine the feasibility of 3-dimensional exoscopes as alternatives to operating microscopes in otology and neurotology, espeically in conjunction with endoscopes. Eleven consecutive cases were performed using 3-dimensional exoscopes in place of, or as adjuncts to, the operating microscope. The exoscope was the sole visualization tool in 7 cases, with 4 including the use of an endoscope or microscope. There were no perioperative complications. Potential subjective advantages include superior ergonomics, compact size, and an equal visual experience for surgeons and observers. Limitations include low lighting in small surgical corridors and pixilation at high magnification. Exoscopes are potentially viable alternatives to the microscope in otologic and neurotologic surgery.
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Affiliation(s)
- Sullivan Smith
- 1 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Elliott D Kozin
- 1 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Vivek V Kanumuri
- 1 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel R Barber
- 1 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,3 Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | | | - João Flávio Nogueira
- 5 Sinus & Oto Centro-Hospital Geral de Fortaleza, Rua Dr. José Furtado, Fortaleza, Brazil
| | - Daniel J Lee
- 1 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Kim S, Reilly D, Backous D. Two-stage surgical management of delayed otalgia in single-channel cochlear implant users. Cochlear Implants Int 2003. [DOI: 10.1002/cii.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bishop R, Littman T, Balko K, Watson S, Backous D. Speech understanding in noise with post-lingual adult cochlear implant users: a comparison of devices. Cochlear Implants Int 2003. [DOI: 10.1002/cii.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kim S, Reilly D, Backous D. Two-stage surgical management of delayed otalgia in single-channel cochlear implant users. Cochlear Implants Int 2003; 4 Suppl 1:50-1. [DOI: 10.1179/cim.2003.4.supplement-1.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Balko K, Fordyce D, Blankenship K, Littman T, Backous D. Conversion deafness in a cochlear implant patient. Cochlear Implants Int 2003; 4 Suppl 1:19-20. [DOI: 10.1179/cim.2003.4.supplement-1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Bishop R, Littman T, Balko K, Watson S, Backous D. Speech understanding in noise with post-lingual adult cochlear implant users: a comparison of devices. Cochlear Implants Int 2003; 4 Suppl 1:4-5. [DOI: 10.1179/cim.2003.4.supplement-1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Luetje CM, Brackman D, Balkany TJ, Maw J, Baker RS, Kelsall D, Backous D, Miyamoto R, Parisier S, Arts A. Phase III clinical trial results with the Vibrant Soundbridge implantable middle ear hearing device: a prospective controlled multicenter study. Otolaryngol Head Neck Surg 2002; 126:97-107. [PMID: 11870337 DOI: 10.1067/mhn.2002.122182] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The goal of the study was to evaluate the performance of a semi-implantable middle ear hearing device (Vibrant Soundbridge System [VSB]; Symphonix Devices, Inc). STUDY DESIGN A prospective, single-subject, repeated-measures multicenter study was conducted to determine the safety and efficacy of the VSB using analog and digital external processors. Measures included residual hearing, functional gain, speech recognition, acoustic feedback, occlusion, and patient self-assessment to determine satisfaction, perceived performance, and device preference compared with an appropriately fit acoustic hearing aid. Fifty-three adult subjects with moderate to severe sensorineural hearing loss were evaluated at 4 or more intervals after implantation. RESULTS Improvements in satisfaction, performance, and preference were statistically significant with the VSB, as was functional gain across all test frequencies (P < 0.001). Occlusion and feedback were virtually eliminated. Aided speech recognition was comparable between VSB and the hearing aid. Residual hearing was unchanged. CONCLUSION The VSB is a safe and effective treatment option for adults with moderate to severe sensorineural hearing loss.
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