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Yesantharao LV, Sriram S, Litvack JR, Chandrasekhar SS, Galaiya DJ. Is a Simple Checklist Associated With Improvement in Gender Representation at the AAO-HNSF Annual Meeting? Otolaryngol Head Neck Surg 2024. [PMID: 38591747 DOI: 10.1002/ohn.743] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE In September 2017, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) added 2 questions querying panel organizers if gender/racial diversity was considered in selecting panel presenters, beginning with the 2018 Annual Meeting (AM). This study examines how this checklist impacted the gender diversity of panel presenters at the AAO-HNS AM. STUDY DESIGN This was a cross-sectional investigation comparing female representation before and after the addition of questions inquiring about diversity in 2018. SETTING A review of abstract submissions for the AMs from 2015 to 2021. METHODS AM Official Program Abstracts were used to obtain presenter names and specialty area for each panel. The percentage of female presenters, in total and stratified by specialty area, were compared before and after 2018 to quantify changes following the addition of the checklist. RESULTS There was a significant increase in the proportion of female panel presenters from 22.3% (total n = 1199) in 2015 to 2017 to 33.0% (total n = 1868) in 2018 to 2021 (P < .001) and in all panel specialties. The number of female moderated panels also significantly increased after checklist implementation from 22% to 38% (P < .001). Correspondingly, the number of panels with no female representation decreased from 42% in 2015 to 2017 to 23% in 2018 to 2021 (P < .001). CONCLUSION The addition of a checklist asking panel organizers to consider diversity in selecting panelists was associated with an increased proportion of female presenters at the AM. This simple strategy can be implemented by all medical conferences to help close the gender gap.
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Affiliation(s)
- Lekha V Yesantharao
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Shreya Sriram
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jamie R Litvack
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | | | - Deepa J Galaiya
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Litvack JR, Lindsay RW. Moving Toward Professional Equity in Otolaryngology. Otolaryngol Clin North Am 2021; 55:11-22. [PMID: 34823709 DOI: 10.1016/j.otc.2021.08.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Gender-based equity in compensation, access to opportunity and resources, and leadership roles are critical to the health and future of otolaryngology; however, significant gaps continue to persist. Professional equity in otolaryngology will be achieved by leadership prioritization of equity as mission critical, improving organizational culture and developing systems for advocacy, understanding what constitutes equal pay in otolaryngology, the development of transparent and reoccurring equity review processes and the promotion of women and underrepresented minorities into leadership positions.
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Affiliation(s)
- Jamie R Litvack
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Everett, Spokane, Tri-Cities, Vancouver
| | - Robin W Lindsay
- Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA.
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Marra CM, Maxwell CL, Ramchandani M, Tantalo LC, Sahi SK, Dunaway SB, Litvack JR. Hearing loss in individuals at risk for neurosyphilis. Int J STD AIDS 2020; 31:1178-1185. [PMID: 32928054 DOI: 10.1177/0956462420947584] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Otosyphilis is a serious complication of syphilis.329 participants enrolled in a study of cerebrospinal fluid (CSF) abnormalities in syphilis underwent portable audiometry (250 Hz to 8000 Hz at 5-75 dB); it was repeated in 33 after otosyphilis treatment. Treponema pallidum spp pallidum (T. pallidum) DNA in blood was quantitated by polymerase chain reaction. Odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CIs) were determined by logistic, ordinal or Cox regression.166 (50.5%) had normal hearing; 15 (4.6%) had low frequency (LF) loss alone, 93 (28.3%) had high frequency (HF) loss alone, and 55 (16.7%) had both. Adjusted odds of any hearing loss were higher with detectable blood T. pallidum DNA (3.00 [1.58-5.69], p = 0.001), CSF pleocytosis (2.02 [1.12-3.66], p = 0.02), and older age (2.22 per 10-year increase, [1.70-2.91], p < 0.001). HRs of normalization of LF and HF loss were lower for older individuals (0.20 [0.07-0.63, p = 0.005] and 0.22 [0.05-0.94, p = 0.04]), and HRs for normalization of HF loss were lower for those with more severe loss (0.09 [0.02-0.43], p = 0.002), and in those with CSF pleocytosis (0.32 [0.11-0.96], p = 0.04).Older age and CSF pleocytosis increase the likelihood of otosyphilis and impair hearing recovery after otosyphilis treatment.
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Affiliation(s)
- Christina M Marra
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Clare L Maxwell
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Meena Ramchandani
- Department of Medicine (Infectious Diseases), University of Washington School of Medicine, Seattle, WA, USA.,Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA
| | - Lauren C Tantalo
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Sharon K Sahi
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Shelia B Dunaway
- Department of Medicine (Infectious Diseases), University of Washington School of Medicine, Seattle, WA, USA
| | - Jamie R Litvack
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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4
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Maxwell JH, Randall JA, Dermody SM, Hussaini AS, Rao H, Nathan AS, Malekzadeh S, Litvack JR. Gender and compensation among surgical specialties in the Veterans Health Administration. Am J Surg 2020; 220:256-261. [DOI: 10.1016/j.amjsurg.2020.02.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/17/2020] [Accepted: 02/23/2020] [Indexed: 10/24/2022]
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Maxwell JH, Randall JA, Dermody SM, Hussaini AS, Rao H, Nathan AS, Malekzadeh S, Litvack JR. Pay Transparency among Surgeons in the Veterans Health Administration: Closing the Gender Gap. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.827] [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: 10/25/2022]
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Meyer TK, Bergmark R, Zatz M, Sardesai MG, Litvack JR, Starks Acosta A. Barriers Pushed Aside: Insights on Career and Family Success from Women Leaders in Academic Otolaryngology. Otolaryngol Head Neck Surg 2019; 161:257-264. [PMID: 30987521 DOI: 10.1177/0194599819841608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although the literature adequately identifies the current gender inequality that exists in academic otolaryngology and describes the barriers to advancement of women in academic medicine, there is little information regarding the daily details of how successful women in academic otolaryngology achieve work-life balance. This study was designed to better understand how women in academic otolaryngology achieve work-life balance while negotiating family and childrearing commitments, clinical workload, and scholarly activity, as well as to highlight coping strategies and behaviors that women have used to achieve these successes. STUDY DESIGN Qualitative research design. METHODS Thirteen successful women in academic otolaryngology with children were recruited using a networking/snowball sampling methodology to participate in a semistructured qualitative interview about the daily process of work-life balance in an academic otolaryngology practice. A focus group of 7 additional participants was held to validate critical topics/themes. RESULTS Four broad categories of findings emerged from the study: (1) participants' strong commitment to academic medicine, (2) the fluid/elusive nature of work-life balance, (3) specific approaches to successfully managing home life, and (4) insights related to achieving psychoemotional health. CONCLUSIONS The conflicting demands between home and professional life are one of the barriers to recruiting, promoting, and retaining women in academic otolaryngology. Fostering a better environment for work-life balance is critical to promote the advancement of women in otolaryngology and otolaryngology leadership.
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Affiliation(s)
- Tanya K Meyer
- 1 Department of Otolaryngology Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Regan Bergmark
- 3 Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Marcy Zatz
- 1 Department of Otolaryngology Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Maya G Sardesai
- 1 Department of Otolaryngology Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Jamie R Litvack
- 1 Department of Otolaryngology Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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Theeuwen H, Whipple M, Litvack JR. Otosyphilis: Resurgence of an Old Disease. Laryngoscope 2018; 129:1680-1684. [PMID: 30592050 DOI: 10.1002/lary.27635] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/29/2018] [Accepted: 10/03/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To describe the clinical characteristics of patients presenting with a new diagnosis of otosyphilis over the past 10 years in a large, urban, safety-net hospital affiliated with a large county sexually transmitted disease clinic. METHODS Retrospective case series. A chart review was performed of all patients who presented to an adult otolaryngology clinic with a new diagnosis of syphilis and hearing loss from January 2008 to December 2017. RESULTS Twelve patients met the criteria for "suspected" or "likely" otosyphilis based on Centers for Disease Control and Prevention definitions. The average age was 48 years (range 19-59). All were male. Nine (75%) were men who have sex with men. Eight (67%) were positive for human immunodeficiency virus. One (8%) presented with primary, nine (75%) with secondary, and two (17%) with early latent syphilis. Seven (58%) presented with bilateral audiogram-confirmed hearing loss, two (17%) with unilateral hearing loss, and three (25%) with suspected hearing loss based on fluctuating symptoms. Nine (75%) presented with tinnitus and two (17%) with vertigo. The median duration of otologic symptoms prior to presentation was 2 weeks (range: 0-16 weeks). All presented within the last 2 years surveyed. CONCLUSION We have seen an increase in the number of otosyphilis cases in our clinic. We suspect otosyphilis may be underdiagnosed and emphasize the importance of screening for syphilis in patients with new audiologic symptoms of vertigo, tinnitus, or hearing loss. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1680-1684, 2019.
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Affiliation(s)
- Hailey Theeuwen
- University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Mark Whipple
- University of Washington School of Medicine, Seattle, Washington, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Jamie R Litvack
- Department of Otolaryngology-Head and Neck Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, U.S.A
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8
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Litvack JR, Wick EH, Whipple ME. Trends in female leadership at high‐profile otolaryngology journals, 1997–2017. Laryngoscope 2018; 129:2031-2035. [DOI: 10.1002/lary.27707] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/22/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Jamie R. Litvack
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Washington School of Medicine Seattle, Washington
| | - Elizabeth H. Wick
- Department of Otolaryngology–Head and Neck SurgeryWashington University of St. Louis School of Medicine St. Louis Missouri U.S.A
| | - Mark E. Whipple
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Washington School of Medicine Seattle, Washington
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9
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Dermody SM, Litvack JR, Randall JA, Malekzadeh S, Maxwell JH. Compensation of Otolaryngologists in the Veterans Health Administration: Is There a Gender Gap? Laryngoscope 2018; 129:113-118. [PMID: 30152025 DOI: 10.1002/lary.27311] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if gender pay disparity exists amongst otolaryngologists employed by the Veterans Health Administration (VHA). STUDY DESIGN cross-sectional analysis. METHODS Board-certified otolaryngologists employed at all complex Veterans Affairs Medical Centers (VAMCs) in 2016 were identified. Salaries were collated using the Enterprise Human Resources Integration-Statistical Data Mart dataset. Additional variables, including gender, years since medical school graduation, professorship status, h-index, and geographic location were collected. A multivariate linear regression analysis was performed where salary was the primary outcome of interest and gender was accounted for as an independent predictor while controlling for professional characteristics, geographic location, and seniority. RESULTS Sixty-nine VHA surgical programs with an operative designation of "complex" were identified. Two hundred sixty board-certified otolaryngologists, including 197 (75.8%) men and 63 (24.2%) women, were identified. Salary data were available on 210 of these otolaryngologists. In 2016, the mean salary for male and female otolaryngologists was not significantly different ($266,707 ± $31,624 vs. $264,674 ± $27,027, P = .918) nor were salaries in early career ($243,979 ± $31,749 vs. $254,625 ± $24,558, respectively; P = .416). On multivariate linear regression analysis, number of years since graduation (P = .009) and h-index (P = .049) were independent predictors of salary, but gender, geographic location, and faculty rank were not. CONCLUSIONS Although the gender pay gap persists in many areas of medicine and surgery, otolaryngologists employed at complex VAMCs do not experience gender pay disparity. The use of specific and objective criteria to establish and adjust salaries can reduce and potentially eliminate gender pay disparity. These findings may help to guide institutional policies in other practice environments. LEVEL OF EVIDENCE 2b. Laryngoscope, 129:113-118, 2019.
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Affiliation(s)
- Sarah M Dermody
- Georgetown University School of Medicine, Washington, DC, U.S.A
| | - Jamie R Litvack
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A.,Veterans Affairs Puget Sound Healthcare Seattle Division, Seattle, Washington, U.S.A
| | | | - Sonya Malekzadeh
- Georgetown University School of Medicine, Washington, DC, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, U.S.A.,Washington DC Veterans Affairs Medical Center, Washington, DC, U.S.A
| | - Jessica H Maxwell
- Georgetown University School of Medicine, Washington, DC, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, U.S.A.,Washington DC Veterans Affairs Medical Center, Washington, DC, U.S.A
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10
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Remenschneider AK, D’Amico L, Litvack JR, Gray ST, Holbrook EH, Gliklich R, Metson R. Long-Term Outcomes in Sinus Surgery. Otolaryngol Head Neck Surg 2014; 151:164-70. [DOI: 10.1177/0194599814529536] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/07/2014] [Indexed: 11/16/2022]
Abstract
Objective The 6-question EuroQol 5-Dimension Health Assessment (EQ-5D) is a widely used, simple instrument that monitors general health-related quality of life (HRQoL) in chronic disease. It has not previously been applied to US patients undergoing endoscopic sinus surgery (ESS). Study Design Prospective cohort study. Setting Academic Medical Center. Subjects and Methods The study population consisted of 267 patients with chronic rhinosinusitis (CRS) who completed 2 disease-specific instruments—the Chronic Sinusitis Survey (CSS) and the Sinonasal Outcomes Test-22 (SNOT-22)—and 1 general health-related quality-of-life instrument—the EQ-5D—before and after ESS for CRS. Baseline scores were compared to those collected 3 and 12 months after surgery and to the general US population. Results Surveys were completed at all time points by 186 patients, for a response rate of 69.7%. Patients with CRS, when compared to the US population, reported more problems in the domains of pain/discomfort (73.1% vs 40.8%, P < .01), anxiety/depression (50.5% vs 26.4%, P < .01), and usual activities (30.6% vs 15.0%, P < .01). One year following ESS, there was a significant decrease in patients who reported problems with pain/discomfort (54.3%, P < .001), anxiety/depression (30.6%, P < .001), and usual activities (21.5%, P < .01). After surgery, CRS anxiety/depression scores were no different from those of the US general population. Chronic Sinusitis Survey and SNOT-22 scores demonstrated similar postoperative improvements. Conclusion The EQ-5D assessment provides meaningful general health outcomes data with low patient burden. Application of this instrument demonstrated long-term improvement in the quality of life of patients who undergo sinus surgery.
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Affiliation(s)
- Aaron K. Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura D’Amico
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Jamie R. Litvack
- Department of Surgery, Washington Veterans Affairs Medical Center, Department of Otolaryngology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Stacey T. Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric H. Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Gliklich
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ralph Metson
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
BACKGROUND Little is known regarding the epidemiology of chronic rhinosinusitis (CRS) in racial and ethnic minorities in the United States. This study was designed to comprehensively evaluate the current prevalence of CRS across various treatment settings to identify possible disparities in health care access and use between racial and ethnic populations. METHODS The National Health Interview Survey (NHIS), National Ambulatory Medical Care Survey (NAMCS), and National Hospital Ambulatory Medical Care Survey (NHAMCS) database registries were extracted to identify the national prevalence of CRS in race/ethnic populations and resource use in ambulatory care settings. Systematic literature review identified studies reporting treatment outcomes in minority patients electing endoscopic sinus surgery (ESS). Data were supplemented using a multi-institutional cohort of patients undergoing surgical treatment. RESULTS National survey data suggest CRS is a significant health condition for all major race/ethnic groups in the United States, accounting for a sizable portion of office, emergency, and outpatient visits. Differences in insurance status, work absenteeism, and resource use were found between race/ethnic groups. Despite its prevalence, few published studies include information regarding minority patients with CRS. Most (90%) cohort studies did not provide details of race/ethnicity for ESS outcomes. Prospective cohort analysis indicated that minority surgical patients accounted for only 18%, when compared with national census estimates (35%). CONCLUSION CRS is an important health condition for all major race/ethnic groups in the United States. Significant differences may exist across racial and ethnic categories with regard to CRS health status and health care use. Given current demographic shifts in the United States, specific attention should be given to understanding CRS within the context of racial and ethnic populations. Public clinical trial registration (www.clinicaltrials.gov) I.D. No. NCT00799097.
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Affiliation(s)
- Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Quintanilla-Dieck L, Litvack JR, Mace JC, Smith TL. Comparison of disease-specific quality-of-life instruments in the assessment of chronic rhinosinusitis. Int Forum Allergy Rhinol 2012; 2:437-43. [PMID: 22696495 DOI: 10.1002/alr.21057] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 04/04/2012] [Accepted: 04/24/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Many disease-specific, quality-of-life (QOL) instruments exist for chronic rhinosinusitis (CRS), resulting in confusion about the best application and use of each instrument. We hypothesized that the most prevalently utilized instruments do not strongly correlate in all domains, but rather act in complementary fashion for QOL assessment. METHODS A systematic literature review (MEDLINE) was performed to identify the type and frequency of available CRS-specific QOL instruments. Univariate analyses of the 3 most common instruments (Rhinosinusitis Disability Index [RSDI], Chronic Sinusitis Survey [CSS] and 22-item Sinonasal Outcomes Test [SNOT-22]) were performed using a multi-institutional prospective cohort of sinusitis patients. RESULTS Systematic literature review found that the SNOT-20 (and its derivatives), RSDI, and CSS are the most commonly utilized CRS-specific QOL instruments. The majority of RSDI domains were weakly or not correlated with the CSS domains (r = 0.097-0.501; p < 0.001). In contrast, the RSDI was highly correlated with the SNOT-22 (r ≥ 0.666; p < 0.001). Patients with asthma and/or allergies reported significantly worse CSS scores (p < 0.001). Comorbidities had no significant impact on RSDI or SNOT-22 responses. CONCLUSION Different disease-specific CRS QOL instruments measure different aspects of the patient's experience. The RSDI and SNOT-22 are more sensitive to measuring the emotional impact of CRS, whereas the CSS examines medication use and symptoms. These instruments play complementary roles in the evaluation of CRS treatment outcomes.
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Affiliation(s)
- Lourdes Quintanilla-Dieck
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR 97239, USA
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13
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Abstract
OBJECTIVE To prospectively measure the prevalence and effect of symptomatic depression on chronic rhinosinusitis (CRS) patients' quality of life (QOL), disease severity, and outcomes of endoscopic sinus surgery (ESS). STUDY DESIGN Prospective cohort study. SETTING Academic, tertiary care center. SUBJECTS AND METHODS Seventy-six patients with CRS were enrolled prior to ESS and followed postoperatively for a mean (SD) of 13.3 (5.4) months. Lund-Mackay computed tomography score, Lund-Kennedy endoscopy score, Patient Health Questionnaire-9 (PHQ-9), 2 disease-specific QOL instruments (Rhinosinusitis Disability Index [RSDI] and Chronic Sinusitis Survey [CSS]), and 1 general QOL instrument (Medical Outcomes Study Short Form-36 [SF-36]) were measured. Differences in outcome scores were analyzed using univariate and multivariate analyses. RESULTS Only 7 (9.2%) patients reported a history of depression, but 19 (25.0%) patients scored in the range of moderate or severe depression on the PHQ-9. Mean (SD) preoperative scores were significantly worse in depressed patients on the RSDI (62.7 [18.2] vs 45.3 [16.3]; P < .001) and 7 of 8 SF-36 domains (all P ≤ .011). Patients with depression significantly improved on both disease-specific QOL instruments (mean [SD] change; RSDI: 33.5 [24.7], P = .017; CSS: 25.0 [20.9], P = .012) and 3 SF-36 domains (all P ≤ .050). Postoperative change scores were not significantly different from patients without depression on the RSDI, CSS, or SF-36. Severity of depression significantly improved postoperatively in depressed patients (preoperative PHQ-9 scores: 13.4 [2.0] vs 6.1 [4.5], P = .017). CONCLUSION CRS patients with depression had worse baseline QOL than other CRS patients but experienced comparable postoperative improvement in QOL after ESS. Interestingly, depression severity significantly improved after ESS.
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Affiliation(s)
- Jamie R Litvack
- Department of Otology and Laryngology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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14
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Mace JC, Michael YL, Carlson NE, Litvack JR, Smith TL. Correlations between endoscopy score and quality of life changes after sinus surgery. ACTA ACUST UNITED AC 2010; 136:340-6. [PMID: 20403849 DOI: 10.1001/archoto.2010.34] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess whether change in endoscopy score correlates with change in health-related quality of life (HRQOL) following endoscopic sinus surgery for chronic rhinosinusitis. DESIGN Prospective open cohort. SETTING Tertiary rhinology clinic. PATIENTS One hundred two adult patients with and without nasal polyposis who elected to undergo endoscopic sinus surgery and were followed up for 12 +/- 2 months postoperatively. INTERVENTION Patient characteristics and Lund-Mackay computed tomography scores were recorded preoperatively. Lund-Kennedy endoscopy scores and 2 HRQOL surveys, the Rhinosinusitis Disability Index and Chronic Sinusitis Survey, were examined before and after surgery. MAIN OUTCOME MEASURES Postoperative changes in endoscopy score and HRQOL were examined using bivariate and multivariate analyses. RESULTS Statistically significant improvements were found in endoscopy score (P < .001) and for all total and subscale HRQOL measures (P < .001). After controlling for baseline status and comorbid factors, improvement in endoscopy score significantly correlated with 12-month improvement on the total Rhinosinusitis Disability Index (P = .01), the physical (P = .01) and functional (P = .02) subscales of the Rhinosinusitis Disability Index, and the symptom subscale of the Chronic Sinusitis Survey (P = .003) but could explain only 25.5% to 36.6% of the linear variation for these HRQOL improvements. CONCLUSIONS For most patients, endoscopy scores and disease-specific HRQOL significantly improve after endoscopic sinus surgery. Changes in endoscopy scores explain a portion of the improvement in HRQOL. For patients with chronic rhinosinusitis, improvements in disease-specific HRQOL outcomes are complex, multidimensional constructs that cannot be entirely explained by surgical changes measured by endoscopic examination. Trial Registration clinicaltrials.gov Identifier: NCT00799097.
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Affiliation(s)
- Jess C Mace
- Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, 97239, USA
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Smith TL, Litvack JR, Hwang PH, Loehrl TA, Mace JC, Fong KJ, James KE. Determinants of outcomes of sinus surgery: a multi-institutional prospective cohort study. Otolaryngol Head Neck Surg 2010; 142:55-63. [PMID: 20096224 PMCID: PMC2815335 DOI: 10.1016/j.otohns.2009.10.009] [Citation(s) in RCA: 192] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 09/21/2009] [Accepted: 10/07/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVES 1) To measure the proportion of patients with chronic rhinosinusitis (CRS) who experience clinically significant improvement after endoscopic sinus surgery (ESS) in a prospective, multi-institutional fashion. 2) To identify preoperative characteristics that predict clinically significant improvement in quality of life (QOL) after ESS. STUDY DESIGN Prospective, multi-institutional cohort study. SETTING Academic tertiary care centers. SUBJECTS AND METHODS A total of 302 patients with CRS from three centers were enrolled between July 2004 and December 2008 and followed for an average of 17.4 months postoperatively. Preoperative patient characteristics, CT scan, endoscopy score, and pre- and postoperative quality of life (QOL) data were collected. Univariate and multivariate analyses were performed. RESULTS Patients improved an average of 15.8 percent (18.9 points) on the Rhinosinusitis Disability Index and 21.2 percent (21.2 points) on the Chronic Sinusitis Survey (both P < 0.001). Patients significantly improved on all eight Medical Outcomes Study Short Form-36 (SF-36) subscales (all P < 0.001). Among patients with poor baseline QOL, 71.7 percent of patients experienced clinically significant improvement on the RSDI and 76.1 percent on the CSS. Patients undergoing primary surgery were 2.1 times more likely to improve on the RSDI (95% confidence interval [CI], 1.2, 3.4; P = 0.006) and 1.8 times more likely to improve on the CSS (95% CI, 1.1, 3.1; P = 0.020) compared with patients undergoing revision surgery. CONCLUSION In this prospective, multi-institutional study, most patients experienced clinically significant improvement across multiple QOL outcomes after ESS. Specific patient characteristics provided prognostic value with regard to outcomes.
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Affiliation(s)
- Timothy L. Smith
- The Division of Rhinology, Oregon Sinus Center, Department of Otolaryngology – Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Jamie R. Litvack
- The Division of Rhinology, Oregon Sinus Center, Department of Otolaryngology – Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Peter H. Hwang
- The Department of Otolaryngology – Head and Neck Surgery, Stanford University Medical Center, Stanford, CA
| | - Todd A. Loehrl
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology & Communication Sciences, the Medical College of Wisconsin, Milwaukee, WI
| | - Jess C. Mace
- The Division of Rhinology, Oregon Sinus Center, Department of Otolaryngology – Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | | | - Kenneth E. James
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR
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Litvack JR, Smith T, Loehrl T, Mace JC, James K, Hwang P. Prospective multi-institutional sinus surgery outcomes study. Otolaryngol Head Neck Surg 2009. [DOI: 10.1016/j.otohns.2009.06.361] [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: 11/29/2022]
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Litvack JR, Mace J, Smith TL. Model Building, Effect Modification, and Outcomes after Sinus Surgery. Otolaryngol Head Neck Surg 2009. [DOI: 10.1016/j.otohns.2009.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jamie R. Litvack
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center Department of Otolaryngology–Head and Neck Surgery Oregon Health & Science University, Portland, OR
| | - Jess Mace
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center Department of Otolaryngology–Head and Neck Surgery Oregon Health & Science University, Portland, OR
| | - Timothy L. Smith
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center Department of Otolaryngology–Head and Neck Surgery Oregon Health & Science University, Portland, OR
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Abstract
BACKGROUND Olfactory dysfunction is deemed to be a significant contributor to poor quality of life (QOL). However, little is known about the relationship of olfactory testing to other measures of disease burden in patients with chronic rhinosinusitis (CRS). In this study, we examine the relationship of olfactory function to computed tomography (CT) scores, endoscopy scores, and QOL measures in patients with CRS. METHODS A multi-institutional, cross-sectional analysis of 367 patients was performed. Several objective measures were collected: the Smell Identification Test, Lund-MacKay CT score, Lund-Kennedy endoscopy score, two validated disease-specific QOL instruments, the Rhinosinusitis Disability Index and the Chronic Sinusitis Survey, and a general health-related QOL instrument, the Medical Short Form-36. Analysis of variance was performed. Correlation coefficients were calculated. RESULTS Patients with olfactory dysfunction had significantly worse mean endoscopy scores (normosmics, 4.16 [+/- 3.97]; hyposmics, 6.26 [+/- 4.21]; anosmics, 9.61 [+/- 4.48]; p < 0.001) and significantly worse CT scores (normosmics, 9.11 [+/- 5.40]; hyposmics, 11.16 [+/- 5.96]; anosmics, 17.62 [+/- 5.37]; p < 0.001). Endoscopy scores were moderately correlated with olfactory scores (r = -0.46; 95% CI, -0.38, -0.54; p < 0.001). CT scores were moderately correlated with olfactory scores (r = -0.53; 95% CI, -0.45, -0.60; p < 0.001). Olfactory function was not correlated with disease-specific or general health-related QOL measures. CONCLUSION Although previous studies have suggested that olfactory impairment is associated with poor QOL, this study found no such correlation. In contrast, olfaction scores correlated well with other objective measures of CRS, namely, endoscopy and CT scores.
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Affiliation(s)
- Jamie R Litvack
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health and Science University, Portland, Oregon 97239, USA
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Park RE, Litvack JR, Lasarev MR, Smith TL. The Effect of Smoking on Disease Presentation in Chronic Rhinosinusitis. Laryngoscope 2009. [DOI: 10.1002/lary.20472] [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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Litvack JR, Mace JC, Smith TL. Does Olfaction Improve After Endoscopic Sinus Surgery? Otolaryngol Head Neck Surg 2008. [DOI: 10.1016/j.otohns.2008.05.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective No large, prospective, multi-institutional cohort studies have objectively examined the impact of surgery on olfaction with long-term follow-up. The aim of this study was to objectively examine the impact of endoscopic sinus surgery (ESS) on olfactory dysfunction (hyposmia) would benefit from ESS, whereas patients with severe olfactory dysfunction (anosmia) would not. Methods In this prospective, multi-institutional cohort study, 111 patients presenting for ESS for treatment of CRS were examined pre-operatively and at 6 and 12 months postoperatively. Demographic, co-morbidity and Smell Identification Test (SIT) data were collected at each time point. Univariate and multivariate analyses were performed. Results The prevalence of gender-adjusted olfactory dysfunction prior to surgery was 67.5%: 50.4% of patients were hyposmic and 17.1% were anosmic. Surprisingly, hyposmic patients did not significantly improve after surgery (baseline, 6 month, 12 month mean SIT scores: 28.8, 30.0, 29.5). In contrast, patients with anosmia significantly improved after ESS (baseline, 6 month, 12 month mean SIT scores: 9.3, 21.3, 21.7; p=0.001); furthermore, improvement was sustained at 12-month follow-up (p=0.001). Multivariate linear regression analysis showed that baseline olfactory category and nasal polyposis were significantly associated with improvement in postoperative olfactory function (p=0.035, p=0.002), whereas age, gender, and disease-severity as measured by CT and endoscopy scores were not. Conclusions Contrary to our hypothesis, patients with severe olfactory dysfunction significantly improved after ESS and sustained improvement over time, whereas patients with mild olfactory dysfunction did not.
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Poetker DM, Litvack JR, Mace JC, Smith TL. Recurrent acute rhinosinusitis: presentation and outcomes of sinus surgery. ACTA ACUST UNITED AC 2008; 22:329-33. [PMID: 18588769 DOI: 10.2500/ajr.2008.22.3177] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with recurrent acute rhinosinusitis (RARS) represent a challenging subset of patients with rhinosinusitis. Data regarding the outcomes of care for these patients is extremely limited. The purpose of this study was to evaluate objective and patient-based measures in patients diagnosed with RARS before and after surgical intervention. METHODS A prospective, nested case-control study was performed. Cases of RARS (n = 22) were matched to patients with chronic rhinosinusitis (CRS) without polyposis (n = 22) by age, sex, and race/ethnicity. Preoperative computed tomography (CT) and pre- and postoperative endoscopic examinations, the Chronic Sinusitis Survey, and the Rhinosinusitis Disability Index were scored and compared between cases and controls. RESULTS Patients with RARS were less likely to have asthma or previous sinus surgery. Patients with CRS underwent more extensive surgery. There were no significant differences in preoperative CT, endoscopy, or patient-based, quality-of-life (QOL) scores. Both groups showed statistically significant improvements in total postoperative QOL scores. Patients with CRS showed significant improvement on endoscopy scores. Patients with RARS used significantly fewer sinus medications after endoscopic sinus surgery. CONCLUSION Patients with RARS were more often primary surgical patients and underwent less extensive surgery than their CRS counterparts. Both groups reported improved QOL after surgery.
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Affiliation(s)
- David M Poetker
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
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Abstract
OBJECTIVES First, to examine the impact of endoscopic sinus surgery (ESS) on endoscopic and quality-of-life (QOL) outcomes after revision ESS as compared to primary ESS. Second, to evaluate whether or not other risk factors and/or co-morbidities influence the relationship between revision surgery status and outcomes of ESS. STUDY DESIGN Prospective observational study with an internal comparison group. METHODS Preoperative computed tomography scores, pre and postoperative endoscopy scores, and two validated disease-specific QOL instruments, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS), were collected on a prospective cohort of patients undergoing ESS for chronic rhinosinusitis. Data were analyzed using Pearson's chi and multiple logistic regression models. RESULTS Mean preoperative Lund-Mackay computed tomography scan scores were similar in primary and revision surgery patients. In patients without polyps, revision ESS patients were 3.88 times more likely to improve on endoscopy scores than primary ESS patients (95% confidence interval 1.70, 8.83; P = .001). In nasal polyp patients, there was no difference by revision status (odds ratio 0.48; 95% confidence interval 0.15, 1.59; P = .23). The odds of improving on the RSDI (odds ratio 0.51, 95% confidence interval 0.25, 1.04, P = .065) and CSS (odds ratio 0.98, 95% confidence interval 0.51, 1.89, P = .950) were not significantly different by revision status. CONCLUSIONS Both revision and primary ESS patients improved after ESS with regard to endoscopy, RSDI, and CSS scores. In non-polyp patients, revision ESS patients were more likely to improve on endoscopy scores than primary ESS patients; there was no difference in polyp patients by revision status. Revision ESS patients and primary ESS patients were equally as likely to improve on two QOL instruments.
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Affiliation(s)
- Jamie R Litvack
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, Portland, OR 97201, USA.
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