Objective: The objective of this study is to build upon previous work validating a tablet-based software to measure cochlear duct length (CDL). Here, we do so by greatly expanding the number of cochleae (n = 166) analyzed, and examined whether computed tomography (CT) slice thickness influences reliability of CDL measurements. Study Design: Retrospective chart review study. Setting: Tertiary referral center. Patients: Eighty-three adult cochlear implant recipients were included in the study. Both cochleae were measured for each patient (n = 166). Interventions: Three raters analyzed the scans of 166 cochleae at 2 different time points. Each rater individually identified anatomical landmarks that delineated the basal turn diameter and width. These coordinates were applied to the elliptic approximation method (ECA) to estimate CDL. The effect of CT scan slice thickness on the measurements was explored. Main Outcome Measures: The primary outcome measure is the strength of the inter- and intra-rater reliability. Results: The mean CDL measured was 32.84 ± 2.03 mm, with a range of 29.03 to 38.07 mm. We observed no significant relationship between slice thickness and CDL measurement (F1,164 = 3.04; p = 0.08). The mean absolute difference in CDL estimations between raters was 1.76 ± 1.24 mm and within raters was 0.263 ± 0.200 mm. The intra-class correlation coefficient (ICC) between raters was 0.54 and ranged from 0.63 to 0.83 within raters. Conclusions: This software produces reliable measurements of CDL between and within raters, regardless of CT scan thickness.

Objectives Assess national trends in opioid prescription following pediatric tonsillectomy: 1) overall percentage receiving opioids and mean quantity, 2) changes during 2009–2017, and 3) determinants of prescription patterns. Methods Cross‐sectional analysis using 2009–2017 Optum claims data to identify opioid‐naïve children aged 1–18 with claims codes for tonsillectomy (n = 82,842). Quantities of opioids filled in outpatient pharmacies during the perioperative period were extracted and converted into milligram morphine equivalents (MMEs) for statistical comparison. Demographic, clinical, and socioeconomic predictors of opioid fill rate and quantity were determined using regression analyses. Results In 2009, 83.3% of children received opioids, decreasing to 58.3% by 2017. Rates of all‐cause readmissions and post‐tonsillectomy hemorrhages were similar over time. Mean quantity received was 153.47MME (95% confidence intervals [95%CI]: 151.19, 155.76) and did not significantly change during 2009–2017. Opioids were more likely in older children and those with higher household income, but less likely in children with obstructive sleep apnea, other comorbidities, and Hispanic race. Higher quantities of opioids were more likely in older children, while lower quantities were associated with female sex, Hispanic race, and higher household income. Outpatient steroids were prescribed to 8.04% of patients, who were less likely to receive opioids. Conclusion While the percentage of children receiving post‐tonsillectomy opioids decreased during 2009–2017, prescribed quantities remain high and have not decreased over time. Prescription practices were also influenced by clinical and sociodemographic factors. These results highlight the need for guidance, particularly with regard to opioid quantity, in children after tonsillectomy. Level of Evidence N/A Laryngoscope, 131:E1722–E1729, 2021

Objective To describe opioid stewardship in ambulatory otologic surgery from 2005 to 2017. Study Design Descriptive study of US private insurance claims. Setting Nationwide deidentified private insurance claims database (Clinformatics DataMart; Optum). Methods A total of 17,431 adult opioid-naïve outpatients were included in the study. Patients were identified from CPT-4 codes ( Current Procedural Terminology, Fourth Edition) as having undergone middle ear or mastoid surgery. Multiple regression was used to determine sociodemographic and geographic predictors of postoperative morphine milligram equivalents (MMEs) prescribed, including procedure type, year of procedure, age, sex, education, income level, and geographic region of the United States. Results The mean prescribed perioperative dose over the examined period was 203.03 MMEs (95% CI, 200.27-205.79; 5-mg hydrocodone pill equivalents, 40.61). In multivariate analysis, patients undergoing mastoid surgery were prescribed more opioids than those undergoing middle ear surgery (mean difference, 39.89 MME [95% CI, 34.37-45.41], P < .01; 5-mg hydrocodone pill equivalents, 8.0). Men were prescribed higher doses than women (mean difference, 15.39 [95% CI, 9.87-20.90], P < .01; 5-mg hydrocodone pill equivalents, 3.1). Overall MMEs prescribed by year demonstrates a sharp drop in MMEs from 2015 to 2017. Conclusion While the amount of opioids prescribed perioperatively has declined in recent years, otologists should continue to be cognizant of potential overprescribing in light of previous studies of patients’ relatively low opioid intake.

Objectives/Hypothesis: To present and validate a novel fully automated method to measure cochlear dimensions, including cochlear duct length (CDL).Study Design: Cross-sectional study.Methods: The computational method combined 1) a deep learning (DL) algorithm to segment the cochlea and otic capsule and 2) geometric analysis to measure anti-modiolar distances from the round window to the apex. The algorithm was trained using 165 manually segmented clinical computed tomography (CT). A Testing group of 159 CTs were then measured for cochlear diameter and width (A-and B-values) and CDL using the automated system and compared against manual measurements. The results were also compared with existing approaches and historical data. In addition, pre-and postimplantation scans from 27 cochlear implant recipients were studied to compare predicted versus actual array insertion depth.Results: Measurements were successfully obtained in 98.1% of scans. The mean CDL to 900 was 35.52 mm (SD, 2.06; range, [30.91-40.50]), the mean A-value was 8.88 mm (0.47; [7.67-10.49]), and mean B-value was 6.38 mm (0.42; [5.16-7.38]). The R 2 fit of the automated to manual measurements was 0.87 for A-value, 0.70 for B-value, and 0.71 for CDL. For anti-modiolar arrays, the distance between the imaged and predicted array tip location was 0.57 mm (1.25; [0.13-5.28]). Conclusion:Our method provides a fully automated means of cochlear analysis from clinical CTs. The distribution of CDL, dimensions, and cochlear quadrant lengths is similar to those from historical data. This approach requires no radiographic experience and is free from user-related variation.

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