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Objectives/Hypothesis To describe the trends in proton pump inhibitor (PPI) prescription rates and durations and compare them to those of H2‐receptor antagonists (H2RAs) between 2013 and 2016 in otolaryngology, gastroenterology, and family practice, following the increasing publications on PPI adverse effects and inappropriate prescribing. Study Design Retrospective review of publicly available Medicare Part D prescribing data. Methods PPI and H2RA prescription and beneficiary data were obtained through the Centers for Medicare and Medicaid Services website. For prescription rates, 30‐day fill counts were analyzed nationally and regionally per 10,000 Medicare members. Days supply per beneficiary was examined to show average prescription durations. Results were compared between otolaryngology, gastroenterology, and family practice. Medication‐related economic burden per year was calculated based on reported drug cost. Results From 2013 to 2016, PPI 30‐day fill counts remained stable, whereas H2RA prescription rates increased by up to 62% per 10,000 Medicare beneficiaries. The South consistently prescribed two to three times as much antireflux medication as the lowest prescribing region over time and across all three specialties. The days supply per beneficiary remained stable and ranged from an average of 128 to 203 days depending on the specialty. Antireflux medication‐related healthcare cost decreased steadily. Conclusions Despite numerous publications describing a multitude of adverse events and inappropriate prescribing patterns of PPIs in the past decade, prescription rates and durations per beneficiary have remained stable in the fields of otolaryngology, gastroenterology, and family practice. Additionally, H2RA prescriptions have increased from 2013 to 2016. Level of Evidence NA Laryngoscope, 130:321–327, 2020

The hallucinogenic “club drugs” 3,4-methylenedioxymethamphetamine (MDMA) and 5-methoxy-N, N-diisopropyltryptamine hydrochloride (Foxy), albeit to different degrees, remain popular as recreational drugs. Much is known about MDMA including observations that in comparison to female rodents, males appear to be more sensitive to the toxic effects associated with abuse. Less is known about the possible sex differences associated with the abuse of Foxy, especially when the consequences of its use are examined during the neuropsychological development period of adolescence. In the present study, adolescent male and female rats were given multiple doses of MDMA, Foxy, or saline across a series of 48-hr “weekends” under conditions approximating that of a rave. Behavioral testing occurred in adulthood when the rats were 131 days old and had been drug free for 66 days. Assessments included general activity, passive avoidance, and a series of Morris water maze spatial and nonspatial memory tasks. Depending on task demands, the performance of MDMA-treated rats was inferior to that of the Foxy-treated rats and saline controls. The performance of both drug groups was comparable and inferior to that of control rats on a spatial learning set task. Generally, greater impairments were observed in MDMA-treated rats than the Foxy-treated rats. Sex differences were observed on some but not all spatial tasks with MDMA-treated males performing significantly worse than similarly treated female rats. The results are in the context of putative sex-mediated differences in sensitivity to MDMA or Foxy and the disruptive effects of these drugs to central serotonergic systems that may contribute to cognitive deficits.

Purpose of review Although tranexamic acid is commonly used in surgical fields such as obstetrics, orthopedics, and trauma, its utilization in facial plastic surgery is a recently emerging concept, and studies examining its potential impact have been few. This review highlights how tranexamic acid may be employed during facial plastic procedures and the promising impact it may have. Recent findings Tranexamic acid is primarily being studied in rhinoplasties and rhytidectomies, with intravenous administration and local infiltration being the most common routs of application, respectively. During rhinoplasties, tranexamic acid has the potential to improve the visualization of the surgical field by decreasing blood loss and to improve postoperative edema and ecchymosis. For rhytidectomies, on the contrary, it may shorten time to attain hemostasis, lessen the rate of hematoma formation, and lead to lower surgical drain output. Its efficacy is preserved at low doses, and significant medication side effects have not been reported after facial plastic procedures. Summary Altogether, tranexamic acid may present a valuable adjuvant to facial plastic surgery, as it could increase both surgeon and patient satisfaction while exhibiting a benign safety profile.

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Objectives: Changes in airflow dynamics after nasal surgery may have implications on voice quality. Multiple studies have evaluated the impact of nasal surgery on voice using heterogeneous outcome measures. We aim to systematically review the impact of nasal surgery on voice quality. Methods: Our study design was a systematic review with meta-analyses. A literature search of PubMed, Ovid, Cochrane from 1997 to 2017 was performed. Inclusion criteria included English language studies containing original data on nasal surgery and voice. Two investigators independently reviewed all manuscripts and performed a comprehensive quality assessment. Meta-analysis was completed on quantitative voice measurements. Results: Of 463 identified, 19 studies with 692 patients fulfilled eligibility. Nasal surgeries performed included endoscopic sinus surgery (11/20), septoplasty (11/20), rhinoplasty (2/20), and turbinate reduction (2/20). Voice outcomes measured included nasalance (8/20), fundamental frequency (11/20), jitter (10/20), shimmer (10/20), harmonic to noise ratio (HRN) (8/20), formants (5/20), and voice handicap index (VHI) (4/20). Voice examinations were assessed preoperatively and 1 to 30 months postoperatively. Meta-analysis revealed statistically significant changes in nasalance, ( P < .01) 1 month postoperatively; there was no significant difference in nasalance at 6 months postoperatively. All other variables analyzed revealed no statistically significant differences. Five of nine studies showed majority of patients did not notice subjective change in voice after surgery, but with high heterogeneity of measurements. Conclusions: There may be a short-term increase in nasalance that resolves at longer follow-up, but there seem to be no other objective changes in voice. There may be subjective changes after surgery, but require further study to evaluate.

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