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ABSTRACT

oor olfactory function has been directly implicated in malnutrition, 1 decreased safety, 2 and overall worse quality of life. 3 It is responsible for more than 200 000 physician visits per year, representing a significant public health burden. 4,5 Emerging evidence suggests that olfactory dysfunction is significantly associated with increased all-cause mortality among older adults. 4,[6][7][8][9][10][11] Most notably, a recent study by Liu et al 12 examining community-dwelling older adults aged 71 to 82 years showed clear evidence that poor olfaction alone explains higher long-term mortality, particularly in individuals with excellent to good health at baseline. Liu et al 12 found the elevated risk of mortality of patients with poor olfaction was only partially explained by neurodegenerative dis-ease, cardiovascular disease, and weight loss. Olfaction is emerging as an early indicator of brain aging that can be objectively measured with a relatively simple smell test in the clinical setting.Choi et al 13 previously used the National Health and Nutrition Examination Survey (NHANES) to demonstrate that objectively measured olfactory dysfunction is associated with cognitive impairment independently of demographics and cardiovascular factors. Herein we further investigate the associations of olfactory dysfunction (measured by both objective smell test and self-report) with all-cause 5-year mortality in US adults 40 years or older, independently of cardiovascular factors, cognition, and depression. IMPORTANCE A study of olfactory dysfunction and mortality in a large national cohort will aid in better understanding their association when accounting for multiple relevant factors and possible underlying mechanisms. OBJECTIVE To investigate the association of olfactory dysfunction with all-cause 5-year mortality in US adults.

Background Chronic rhinosinusitis (CRS) is a common condition encountered in primary care medicine and is estimated to affect 12.5% of the United States population. This study aims to compare methods of assessing health utility in CRS Methods A cross-sectional sample of CRS patients (n=137) were interviewed using direct health utility assessment measures: the visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG). General quality of life (QOL) scores were obtained via the 36-item Short Form Health Survey (SF-36) and converted to SF-6D health utility values using a Bayesian algorithm. Disease specific quality of life was measured with the SNOT-22. A selected subgroup of patients (n=51) not initiating surgery or new treatment for CRS were re-interviewed within three weeks. Results The mean (±SD) health utilities were VAS 0.69(±0.19), TTO 0.80(±0.27), SG 0.93(±0.11), SF-6D 0.72(±0.12) and differed significantly (p<0.001). Only VAS scores differed based on disease state classification or the presence of nasal polyposis. Correlations between methods of determining health utility were weak, but significant. VAS, TTO and SF-6D scores were significantly associated with SNOT-22 (p<0.001 for all), however SG and SNOT-22 were poorly correlated (Spearman correlation=-0.33). The test-retest reliability of TTO (Spearman correlation=0.71) and SG (0.73) was strong. Conclusions CRS patients show significant impairment in quality of life, with health utility values similar to those of patients with AIDS or intermittent claudication using similar methods. The method of ascertainment significantly affects measured health utility, but the degree of impairment warrants improved recognition and appropriate treatment of the condition.

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Objective Nurse practitioners and physician assistants form a growing advanced practice provider (APP) group. We aim to analyze the trends and types of services provided by APPs in otolaryngology. Study Design Cross-sectional study. Setting Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use Files, 2012-2017. Methods The Medicare database was searched for 13 commonly used otolaryngology-specific Current Procedural Terminology ( CPT) codes, and 10 evaluation and management (E/M) codes were evaluated by provider type. Changes in code utilization were compared between physicians and APPs over time. Results From 2012 to 2017, there was a 51% increase in the number of otolaryngology APPs, compared to a 2.2% increase in physician providers. APPs increased their share of new and established patient visits from 4% to 7%d 11% to 15%, respectively. There was not a significant difference over time in number of patient visits performed annually per provider according to provider type. The increase in number of APP vs physician providers was significantly greater for every procedure except for balloon sinus dilation and tympanostomy tube placement. Conclusion Due to increasing numbers, APPs are accounting for more patient visits and procedures over time. The physician workforce and the numbers of procedures performed per physician have remained relatively stable from 2012 to 2017. Increasing complexity of patients seen and a broader range of procedures offered by work-experienced or postgraduate-trained APPs may further improve access to health care in the face of possible physician shortages.

Objectives To study the utilization of balloon catheter dilation(BCD) compared to traditional endoscopic surgery(ESS). Methods Cases identified by CPT codes as BCD(2,717) or traditional ESS(31,059) were extracted from the State Ambulatory Surgery Databases 2011 for California, Florida, Maryland and New York. Patient demographicss, surgical center and surgeon volume, mean charge and OR time were compared. Results 33,776 patients underwent sinus surgery in the included states in 2011. 4.6% of maxillary, 5.6% of sphenoid and 13.9% of frontal procedures were performed using BCD. Adjusted analyses found increased use of BCD in patients with chronic diseases(p<0.001). Patients who had a limited sinus surgery were less likely to have BCD compared to patients who had all 4 sinuses instrumented(p<0.001). Surgeons who performed a medium[odds ratio 1.38(1.14–1.65)] or high[odds ratio 1.71(1.42–2.07)] volume of ESS were more likely to use BCD compared to those who performed a low volume(p <0.001), however among surgeons who utilized BCD there was minimal relationship between the percentage of surgeries performed with BCD and the surgeon's total number of cases(R squared=0.055). Compared to traditional ESS, the median charges for maxillary/ethmoid procedures(Mini-ESS) involving BCD were approximately $4,500(p<0.001) and maxillary/ethmoid/sphenoid/frontal procedures(Pan-ESS) were approximately $2,950(p=0.003) greater, while the median OR time involving BCD was 8 minutes less for Mini-ESS procedures(p=0.01) but not statistically different for Pan-ESS procedures(p=0.58). Conclusions In the study sample, balloon technology was used in 8.0% of ESS cases in 2011. Procedures using BCD were on average more expensive compared to traditional ESS procedures, with minimal decrease in OR time. Level of Evidence 2c