Routine postoperative imaging may be unnecessary after uncomplicated endoscopic ASB surgery because (1) it may not alter patient management; (2) it may not detect the most common complication (CSF leak); and (3) when imaging is positive, the patient has clinical symptoms suggesting a need for intervention.
Our objectives in reporting this case series are to familiarize readers with the rare occurrence of paragangliomas originating along the facial nerve and to provide a literature review. We describe 3 such cases that occurred at our tertiary care academic medical center. Two women and 1 man presented with a tumor adjacent to the vertical segment of the facial nerve. The first patient, a 48-year-old woman, presented with what appeared to be a parotid tumor at the stylomastoid foramen; she underwent a parotidectomy, transmastoid facial nerve decompression, and a shave biopsy of the tumor. The second patient, a 66-year-old man, underwent surgery via a postauricular infratemporal fossa approach, and a complete tumor resection was achieved. The third patient, a 56-yearold woman, presented with a middle ear mass; she underwent complete tumor removal through a transmastoid transcanal approach. All 3 patients exhibited normal facial nerve function both before and after surgery. Paragangliomas of the facial nerve are extremely rare, and their signs and symptoms are unlike those of any other temporal bone glomus tumors. Management options include surgical resection, radiologic surveillance, and radiotherapy. The facial nerve can be spared in selected cases.
ORAL PRESENTATIONSamong those with pathological cVEMP (N = 4 in the pathological VEMP group too small to allow statistical analysis). 14 (58%) patients had recurrent PCBPPV (rPCBPPV). Twelve (86%) of the subjects with rPCBPPV had normal and 2 (14%) had pathological cVEMP. The proportions of subjects having abnormal cVEMP did not differ significantly between the recurrence and non-recurrence groups (Fisher exact test).
Conclusion:Most patients suffering from PCBPPV had normal cVEMP. Reduced symptomatology as quantified by the DHI score was found when the cVEMP was pathological. This finding suggests that functional integrity of the inferior vestibular nerve is required for the complete clinical picture of PCBPPV to take place.
Otology/NeurotologyThe Socioeconomic impact of Revision Otologic Surgery Sahar Nadimi, MD (presenter); John P. Leonetti, MD Objective: To estimate the socioeconomic impact of revision canal wall down (CWD) mastoidectomy.Method: Retrospective chart analysis from our tertiary care medical center that evaluated all adult patients who underwent CWD mastoidectomy by the senior surgeon between 2006 to 2011. Institutional charges and collections for all patients were extrapolated to estimate the overall healthcare cost of revision surgery at state (Illinois) and national levels.
Results:One hundred eighty-nine CWD mastoidectomies were reviewed, of which 89 were primary and 100 were revision procedures. The total charge for this group of revision cases was $2,783,700, and the net reimbursement (collections) was $843,245. Using Illinois Hospital Consortium data, the estimated cost of reimbursement for revision CWD mastoidectomy for 387 cases in FY 2011 was nearly $3.3 million. An additional $2160 per patient in lost wages was predicted to have been related to time away from work. The 9214 patients who underwent revision CWD mastoidectomy in the U.S. represented a national healthcare cost of roughly $80 million.
Conclusion:Known causes for failed CWD mastoidectomy include inadequate meatoplasty, high facial ridge, and residual or recurrent cholesteatoma. A better understanding of these factors can reduce the need for revision surgery, thereby resulting in a positive impact on the socioeconomic strain related to this procedure at local, state, and national levels. Method: This case-control study was performed in 2 groups of normal hearing patients: study group (SG): 68 patients with tinnitus; and control group (CG): 46 patients without tinnitus. Patients were submitted to otoacoustic emissions tests, to THI evaluation, and to anxiety and depression search by Beck Scale.
Otology/NeurotologyResults: Seventy-five ears (67.0%) in SG showed abnormal TOAE versus 18 ears (19.6%) in CG (P < .0001). Sixty-eight ears (65.2%) had abnormal DPOAE in SG versus 46 ears (50%) in the CG (P < .029). There was no correlation between THI and the results of TOAE (P = .799) and DPOAE (P > .7) tests. SG had 44.1% (N = 30) individuals with anxiety versus 17.4% (N = 8) in CG (P < .003). There was a statistical difference betw...
Background: Pharmacological knowledge learning is of great importance to nursing students. The views of nursing graduates in this regard are acknowledged because this will lead to identifying the strengths and weaknesses of educational programs, resources, and trainers. Objectives: Therefore, the aim of this study was to investigate the factors affecting pharmaceutical care learning in clinical education from the viewpoint of nursing students in 2016-2017. Methods: A descriptive cross-sectional study was conducted on nursing students (n = 120) recruited through a census method. The data collection tool was a self-administered questionnaire consisting of two parts. The first part was to gather demographic information including age, sex, semester, history of student work, and written score of the pharmacology course, and the second part was related to the areas affecting the learning process including professional competence of the instructor (11 items), teaching ability of the instructor (13 items), interpersonal communications of the instructor (5 items), clinical teaching environment (11 items), course plan (3 items), and learner characteristics (8 items). The collected data from 100 students were analyzed by SPSS16 software using descriptive statistics. Results: 47 (47%) male students participated in the study and most of the participants (59%) were aged 20-21 years. From the viewpoint of the students, the variables related to the areas of the clinical instructor, learner characteristics, and educational environment were the first to third factors affecting the pharmacological care learning, in sequence. Conclusions: Paying attention to the characteristics of the instructor, adaptation of clinical environment, characteristics and motivators of the students in gaining experience, and understanding the importance and necessity of learning the knowledge and practice of medicines can facilitate and strengthen the pharmaceutical care learning.
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