JAMA otolaryngology-- head & neck surgery
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JAMA Otolaryngol Head Neck Surg · Sep 2015
Prevalence and Patient-Level Risk Factors for 30-Day Readmissions Following Free Tissue Transfer for Head and Neck Cancer.
Hospital readmissions are a marker of surgical care delivery and quality that are progressively more scrutinized. ⋯ In this study, advanced pathologic tumor staging and tumor location were associated with 30-day readmissions in patients with head and neck cancer who receive free flaps. Our results provide a benchmark for risk stratification that can be used in system-based practice improvements, health care cost savings, and postoperative patient counseling.
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JAMA Otolaryngol Head Neck Surg · Sep 2015
Hearing Loss After Vestibular Implantation in Sand Rats With Normal Hearing.
Bilateral vestibular failure is a debilitating condition that may lead to oscillopia and adversely affect quality of life. Researchers have suggested that vestibular function might be restored with implantation of an external mechanical stimulation device. However, it is essential that such a device must not interfere with normal hearing. ⋯ Implantation of a vestibular device is associated with mild to moderate conductive hearing loss in fat sand rats with normal hearing, especially when the device is placed in the posterior and superior semicircular canals. Bilateral implantation is associated with major vestibular pathologic results. Further studies are needed in animals with cochlear or vestibular disorders before it can be definitively concluded that vestibular implantation carries only a minor risk to hearing.
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JAMA Otolaryngol Head Neck Surg · Aug 2015
Review Meta AnalysisAssociation Between Obstructive Sleep Apnea and Spontaneous Cerebrospinal Fluid Leaks: A Systematic Review and Meta-analysis.
Spontaneous cerebrospinal fluid (CSF) leaks are a morbid condition associated with operative intervention for treatment. Understanding associations are key to diagnosis, treatment, and possible early detection. ⋯ The association between OSA and spontaneous CSF leaks as demonstrated by retrospective studies is confounded by heterogeneous patient characteristics. Large prospective controlled studies using polysomnography and elevated intracranial pressure measurements are required to further evaluate the relationship between OSA and spontaneous CSF leaks.
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JAMA Otolaryngol Head Neck Surg · Aug 2015
Randomized Controlled TrialEffect of Endotracheal Tube Size on Vocal Outcomes After Thyroidectomy: A Randomized Clinical Trial.
The optimum size of endotracheal tube (ETT) for general anesthesia remains unresolved. Choice of ETT size may be of particular relevance to thyroid surgery because of the increased risk of laryngeal trauma and concerns regarding postoperative vocal outcomes. ⋯ We did not find evidence that smaller ETT size for thyroidectomy has any significant effect on postoperative vocal outcomes, incidence of laryngeal trauma as assessed by laryngoscopy, or pain scores. However, because of the small sample size, our study may have been underpowered to detect small differences.
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JAMA Otolaryngol Head Neck Surg · Aug 2015
Comparative StudyComparison of Health State Utility Measures in Patients With Head and Neck Cancer.
Accurate measurement of health state utilities (HU) is the cornerstone for cost-utility analyses and the valuation of quality of life for given health states. Current indirect methods of HU derivation lack face validity for patients with head and neck cancer. The appropriateness of these measures compared with direct methods, such as the standard gamble (SG), time trade-off (TTO), and visual analog scale (VAS), have not been assessed in this patient population. ⋯ Indirect HU measures may be more reflective of the health status of patients with head and neck cancer than direct measures. Current instruments lack face validity for attributes germane to this population.