BackgroundThere are substantial gaps in our understanding of the influence of the endoscopic endonasal approach (EEA) for endoscopic skull base surgery on sinonasal‐specific quality of life (QOL) as well as the instruments available for assessment. Our primary objective in this study was to characterize postoperative changes in sinonasal QOL, specifically using the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), with a secondary objective of delineating weaknesses in our current understanding of patient symptomatology after EEA for skull base surgery.MethodsA comprehensive literature review was conducted using PubMed, CINAHL, Cochrane Library, and SCOPUS for studies reporting SNOT‐22 data pre‐ and postoperatively in patients who underwent EEA for skull base pathologies. Studies were limited to patients ≥18 years of age and excluded patients diagnosed with chronic rhinosinusitis (CRS).ResultsNineteen unique studies with 27 separate data sets and a total of 1025 patients were used in this meta‐analysis. Overall SNOT‐22 scores statistically improved at the 6‐month (p = 0.0009) and 1‐year (p = 0.002) time‐points. Patients with preoperative SNOT‐22 scores ≥20 achieved postoperative improvements at 12‐week (p < 0.00001), 6‐month (p < 0.0001), 1‐year (p < 0.00001), and long‐term follow‐up (p < 0.0001). Patients with preoperative SNOT‐22 scores <20 remained stable and did not worsen postoperatively.ConclusionPatients undergoing EEA for skull base pathologies who have impaired sinonasal QOL preoperatively demonstrated significant postoperative QOL improvements. Those patients with relatively normal preoperative sinonasal QOL remained asymptomatic postoperatively. This study supports the need for development of a contemporary disease‐ and approach‐specific, validated QOL instrument for skull base pathologies.
Objective
Determine current opioid prescribing patterns for adult procedures within an academic Otolaryngology-Head and Neck Surgery training program in order to establish a general guideline and more uniform approach to narcotic prescribing practices.
Methods
The is a prospective, single-center pilot study. An online, anonymous survey was sent to all members of the Otolaryngology-Head and Neck Surgery training program at Medical University of South Carolina including residents, fellows, and attending surgeons, and advanced practice providers (APP). The survey consisted of questions including demographics, most commonly prescribed analgesic and the average number of opioid tablets prescribed post-operatively for eleven of the most common adult procedures within Otolaryngology.
Results
Forty-two participants responded to the survey. Of the 42 respondents, 20 were attending surgeons, 11 junior level residents (year 1–3), 6 senior level residents (year 4–5), and 5 A.P.P.s. The most commonly prescribed narcotic was hydrocodone-acetaminophen with 83.3% (35/42) of respondents prescribing this medication. Tonsillectomy or uvulopalatopharyngoplasty had the highest average number of tablets prescribed at 32.3 (Range: 5 to 90). Neck dissection, parotidectomy, and thyroidectomy procedures all averaged over 20 tablets. Direct laryngoscopy opioid dose was the lowest at 4.8 tablets (range 0–20). Opioid prescriptions by surgery were broken down by provider class with only septoplasty showing a significant difference with attending physicians prescribing an average of 20 tablets
vs
14.1 tablets for residents (
P
= 0.034).
Conclusion
We believe there remains an unacceptably high variability in current opioid prescribing patterns within otolaryngology especially within more painful procedures. Establishment of standardized post-operative narcotic guidelines is warranted.
These results demonstrate the limited diagnostic value of word recognition scores measured under earphones for patients undergoing CIE. Nevertheless, aided word recognition is rarely measured before CIEs, which limits the information available to determine CI candidacy and referral for CIEs. Earlier and routine measurement of aided word recognition may help guide clinical decision making by determining the extent to which patients are achieving maximum benefit with their hearing aids or should consider cochlear implantation.
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