Cost-effectiveness Analysis of Inferior Turbinate Reduction and Immunotherapy in Allergic Rhinitis

BACKGROUND

Allergic rhinitis (AR) is a common condition that is frequently associated with atopic inferior turbinate hypertrophy (ITH) resulting in nasal obstruction. Current guidelines support the use of subcutaneous allergen immunotherapy (SCIT) when patients fail pharmacologic management. However, there is a lack of consensus regarding the role of inferior turbinate reduction (ITR), a treatment that we hypothesize is cost-effective compared with other available treatments.

METHODS

We conducted a cost-effectiveness analysis comparing the following treatment combinations over a 5-year time horizon for AR patients presenting with atopic nasal obstruction who fail initial pharmacotherapy: (1) continued pharmacotherapy alone, (2) allergy testing and SCIT, (3) allergy testing and SCIT and then ITR for SCIT nonresponders, and (4) ITR and then allergy testing and SCIT for ITR nonresponders. Results were reported as incremental cost-effectiveness ratios (ICERs).

RESULTS

For patients who fail initial pharmacotherapy, prioritizing ITR, either by microdebrider-assisting submucous resection or radiofrequency ablation, before SCIT was the most cost-effective strategy. Probabilistic sensitivity analysis demonstrated that prioritizing ITR before SCIT was the most cost-effective option in 95.4% of scenarios. ITR remained cost-effective even with the addition of concurrent septoplasty.

CONCLUSION

For many AR patients who present with nasal obstruction secondary to atopic inferior turbinate hypertrophy that is persistent despite pharmacotherapy, ITR is a cost-effective treatment that should be considered prior to immunotherapy.

LEVEL OF EVIDENCE

NA - Laryngoscope, 2023 Laryngoscope, 134:1572-1580, 2024.

Impact of ENT resource nurses in improving operating room efficiency

BACKGROUND

Operating room (OR) efficiency is related to minutes spared from surgical time and has been linked to the make up of surgical teams and operating room workplace. The research on the efficiency of surgical nursing staff members is scant. The current study evaluates the effect of ENT trained OR resource nurses on the efficiency of operating time during ENT procedures.

METHODS

Five hundred seventy-three ENT surgery cases from 4 surgeons were retrospectively reviewed. Two hundred forty-two cases had ENT OR nursing staff and 331 cases had non-ENT OR nursing staff. Requested operative times (ROT) and true operative times (TOT) were analyzed. The difference between the TOT and ROT was used to measure operating time efficiency.

RESULTS

Cases with ROT < 30 min (M = -1.19, SD = 5.01) required 3.34 min less than planned for when an ENT nurse was present compared to those with non-ENT nursing staff which required on average 2.15 min (M = 2.15, SD = 5.68) longer than ROT. Furthermore, cases with ROT > 30 min (M = -4.32, SD = 10.85) required 10.85 min less than planned for when an ENT nurse was present. Conversely with non-ENT nursing staff cases with a ROT > 30 min required on average 6.53 min (M = 6.53, SD = 11.85) longer than ROT.

CONCLUSION

ENT resource nurses were shown to improve OR efficiency in cases less than 30 min and greater than 30 min. Cases that were greater than 30 min showed the largest increase in efficiency. Specialized ENT nursing staff improved efficiency during common ENT surgeries.

Energy-exchange collisions of dark-bright-bright vector solitons

We find a dark component guiding the practically interesting bright-bright vector one-soliton to two different parametric domains giving rise to different physical situations by constructing a more general form of three-component dark-bright-bright mixed vector one-soliton solution of the generalized Manakov model with nine free real parameters. Moreover our main investigation of the collision dynamics of such mixed vector solitons by constructing the multisoliton solution of the generalized Manakov model with the help of Hirota technique reveals that the dark-bright-bright vector two-soliton supports energy-exchange collision dynamics. In particular the dark component preserves its initial form and the energy-exchange collision property of the bright-bright vector two-soliton solution of the Manakov model during collision. In addition the interactions between bound state dark-bright-bright vector solitons reveal oscillations in their amplitudes. A similar kind of breathing effect was also experimentally observed in the Bose-Einstein condensates. Some possible ways are theoretically suggested not only to control this breathing effect but also to manage the beating, bouncing, jumping, and attraction effects in the collision dynamics of dark-bright-bright vector solitons. The role of multiple free parameters in our solution is examined to define polarization vector, envelope speed, envelope width, envelope amplitude, grayness, and complex modulation of our solution. It is interesting to note that the polarization vector of our mixed vector one-soliton evolves in sphere or hyperboloid depending upon the initial parametric choices.

Generalized dark-bright vector soliton solution to the mixed coupled nonlinear Schrödinger equations

We have constructed a dark-bright N-soliton solution with 4N+3 real parameters for the physically interesting system of mixed coupled nonlinear Schrödinger equations. Using this as well as an asymptotic analysis we have investigated the interaction between dark-bright vector solitons. Each colliding dark-bright one-soliton at the asymptotic limits includes more coupling parameters not only in the polarization vector but also in the amplitude part. Our present solution generalizes the dark-bright soliton in the literature with parametric constraints. By exploiting the role of such coupling parameters we are able to control certain interaction effects, namely beating, breathing, bouncing, attraction, jumping, etc., without affecting other soliton parameters. Particularly, the results of the interactions between the bound state dark-bright vector solitons reveal oscillations in their amplitudes under certain parametric choices. A similar kind of effect was also observed experimentally in the BECs. We have also characterized the solutions with complicated structure and nonobvious wrinkle to define polarization vector, envelope speed, envelope width, envelope amplitude, grayness, and complex modulation. It is interesting to identify that the polarization vector of the dark-bright one-soliton evolves on a spherical surface instead of a hyperboloid surface as in the bright-bright case of the mixed coupled nonlinear Schrödinger equations.

Spatial vector soliton and its collisions in isotropic self-defocusing Kerr media

A fairly general form of the two-component (dark-dark) vector one-soliton solution of the integrable coupled nonlinear Schrödinger equation (Manakov model) with self-defocusing nonlinearity is obtained by using the Hirota method. It couples two dark components with the same envelope width, envelope speed, and envelope trough location using two complex arbitrary parameters not only in the envelope amplitude but also in the complex modulation. Although it has the freedom to change its pulse width without affecting its speed, it can also tune its grayness (depth of the pulse relative to background) without disturbing the envelope width and speed. The variations in peak power against the depth of localization of two dark components are investigated with and without a parametric restriction. The collision between many dark-dark vector solitons has also been studied by constructing a multisoliton solution with more free parameters.