Background and Significance There is a high and growing prevalence of age-related hearing loss (ARHL), defined as presbycusis or bilateral, symmetric sensorineural hearing loss in older adults. Due to the increasing prevalence of ARHL, the potential delays in its diagnosis and treatment, and the significant disability associated with ARHL, the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) convened a Measures Development Group (MDG) to develop quality measures (QMs) of clinical practice that could be incorporated into the AAO-HNSF’s data registry Reg-ent. Although the AAO-HNSF has been engaged in robust clinical practice guideline development since 2006, the development of quality and performance measures is more recent. Methods We report the process, experience, and outcomes in developing a de novo QM set for ARHL in the absence of a preexisting clinical practice guideline on this topic. Steps include the MDG review of evidentiary literature on ARHL, followed by stakeholder discussions to develop measure specifications. Key considerations included discussion on the relative importance, usability, and feasibility of each measure within the Reg-ent or similar databases. Results The MDG created 4 QMs for the diagnosis and treatment of AHRL. These measures represent the AAO-HNSF’s quality initiatives to develop evidence-based QMs and improve patient care and outcomes, and they are intended to assist providers in enhancing quality of care. Conclusion Development of the ARHL measures is intended for clinicians to evaluate the patient perception, structure, process, and outcomes of care. This process represents a new stage in the AAO-HNSF’s measure development efforts to facilitate future efforts in evidence-based QM.
Objective To offer pragmatic, evidence-informed advice on administering corticosteroids in otolaryngology during the coronavirus disease 2019 (COVID-19) pandemic, considering therapeutic efficacy, potential adverse effects, susceptibility to COVID-19, and potential effects on efficacy of vaccination against SARS-CoV-2, which causes COVID-19. Data Sources PubMed, Cochrane Library, EMBASE, CINAHL, and guideline databases. Review Methods Guideline search strategies, supplemented by database searches on sudden sensorineural hearing loss (SSNHL), idiopathic facial nerve paralysis (Bell’s palsy), sinonasal polyposis, laryngotracheal disorders, head and neck oncology, and pediatric otolaryngology, prioritizing systematic reviews, randomized controlled trials, and COVID-19–specific findings. Conclusions Systemic corticosteroids (SCSs) reduce long-term morbidity in individuals with SSNHL and Bell’s palsy, reduce acute laryngotracheal edema, and have benefit in perioperative management for some procedures. Topical or locally injected corticosteroids are preferable for most other otolaryngologic indications. SCSs have not shown long-term benefit for sinonasal disorders. SCSs are not a contraindication to vaccination with COVID-19 vaccines approved by the US Food and Drug Administration. The Centers for Disease Control and Prevention noted that these vaccines are safe for immunocompromised patients. Implications for Practice SCS use for SSNHL, Bell’s palsy, laryngotracheal edema, and perioperative care should follow prepandemic standards. Local or topical corticosteroids are preferable for most other otolaryngologic indications. Whether SCSs attenuate response to vaccination against COVID-19 or increase susceptibility to SARS-CoV-2 infection is unknown. Immunosuppression may lower vaccine efficacy, so immunocompromised patients should adhere to recommended infection control practices. COVID-19 vaccination with Pfizer-BioNTech, Moderna, or Johnson & Johnson vaccines is safe for immunocompromised patients.
tive results for p40. During the neck dissection, we resected the omohyoid muscle as a muscle biopsy, which showed perivascular mononuclear cells infiltration and perifascicular atrophy (Figure 2B). Immunohistochemical analysis showed higher expression of CD3 than CD20. Based on these findings, we made a definitive diagnosis of CUPHN.After the surgery, the dermatomyositis symptoms including dysphagia were stable, and postoperative radiotherapy (total dose: 60 Gy) was given. During radiotherapy, we started administration of prednisolone and tacrolimus. At 1 month after postoperative radiotherapy, contrast-enhanced CT revealed multiple liver and bone metastases, and the patient received treatment with cetuximab in combination with cisplatin and fluorouracil. After 3 courses of the chemotherapy, although dermatomyositis was controlled, the distant metastatic tumor progressed. After a prolonged period of 11 months from the first visit, the patient received palliative care in the last month of his life.Discussion | A wide range of malignant diseases have been described in relation to dermatomyositis, and they are known to occur in about 15% to 24% of dermatomyositis cases. 3 As for head and neck cancer, nasopharyngeal carcinoma is considered one of the most common malignant diseases associated with dermatomyositis. To the best of our knowledge, this report is the first case of dermatomyositis with CUPHN.Diagnosis of dermatomyositis is based on clinical features and various findings on examination. Among the examinations, muscle biopsy to identify inflammation is the most important. 1,4 In this case, it was possible to diagnose dermatomyositis by muscle biopsy of the cervical muscles during neck dissection. Muscle biopsy of the cervical muscles can be 1 option for patients with dermatomyositis, particularly if neck dissection is needed for treatment. 5 Conclusions | Although it is difficult to decide which treatment should be prioritized, control of dermatomyositis was achieved in this case owing to the preceding CUPHN treatment. In addition, muscle biopsy of the cervical muscles may be an option for a definitive diagnosis of dermatomyositis.
Similar to the case of device implantation, device explantation should be a multidisciplinary and collaborative decision with the patient and the family's desires at the centre. While every case is different, we offer a CI explantation discussion to assist in clinical decision-making, patient counselling and education.
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