Systematic Review of Telehealth Cost Minimization for Patients and Health Systems in Otolaryngology

xlomafota13 shared this article with you from Inoreader Systematic Review of Telehealth Cost Minimization for Patients and Health Systems in Otolaryngology Via The Laryngoscope Objective/Hypothesis The COVID-19 pandemic has resulted in telehealth becoming commonplace in many health care fields. Telehealth benefits include improving access, decreasing costs, and elevating patient's experience. A review of cost minimization (CM) analyses was performed in order to explore scientific studies associated with integrating tele-otolaryngology in clinical practice. Our primary objective was to evaluate published literature for cost related to the implementation of telemedicine across otolaryngology, and to determine CM when compared to in-person visits. Study Design Systematic Literature Review. Methods We performed a systematic review using PubMed, EMBASE, and Cochrane in May 2020, to identify studies with a cost analysis of tele-otolaryngology care. Inclusion criteria focused on articles citing CM data from telehealth services. Literature quality was assessed using the MINORS scoring system. Results From 380 original articles screened only nine evaluated cost in otolaryngology. CM in the US ranged from $68 to $900 per visit. Cost was evaluated in general otolaryngology, sleep medicine, otology, and head and neck cancer surgery, the latter had the most benefit. The most common types of telehealth visits were routine follow-up and screening. Data were insufficient for meta-analysis. Conclusions Telemedicine has been trialed across various otolaryngology subspecialties; its incorporation is projected to have a meaningful impact on access to specialty care. This research suggests that the delivery of virtual care reduces cost with the potential of increasing net revenue across multiple otolaryngology subspecialties. Further studies are needed to better discern the entirety of cost savings and the best settings for integration. Level of Evidence 3 Laryngoscope, 131:1741–1748, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Barriers to Voice Therapy Attendance in a Language‐Diverse Population

xlomafota13 shared this article with you from Inoreader Barriers to Voice Therapy Attendance in a Language‐Diverse Population Via The Laryngoscope Objectives/Hypothesis Voice therapy is an effective treatment for many voice disorders, but success depends on attendance and adherence. Many factors hinder treatment attendance, and language discordance with the provider may present an additional obstacle to attending therapy. This study evaluates factors associated with voice therapy attendance at a language-diverse, safety-net hospital. Study Design: Retrospective chart review. Methods Retrospective review of adult patients referred to speech language pathology for treatment of voice disorders from January, 2018 to April, 2019. Primary spoken language, interpreter collaboration, and patient demographics were obtained from medical records. Multivariate analysis compared patient factors with voice therapy attendance versus nonattendance. Results Of 422 patients, 219 (52%) attended at least one therapy session, whereas 203 (48%) did not attend (n = 120) or schedule therapy (n = 83). In multivariate analysis, only the association between public insurance and nonattendance was statistically significant (P = .016). After adjusting for interpreter use and interval between referral and first appointment, patients with private health insurance were 2.35 times more likely to attend therapy compared to those with public insurance (95% confidence interval: 1.18–4.71). Non-English language; interpreter collaboration; distance from hospital; and patient demographics, including age, gender, ethnicity, and birthplace, did not significantly correlate with attendance. Conclusions In a culturally and language-diverse cohort of dysphonic patients, individuals with public health insurance were significantly less likely to attend voice therapy. Language-discordant therapy and interpreter collaboration was not a statistically significant barrier to therapy attendance. Additional investigation is warranted to optimize allocation of voice therapy resources for those with public health insurance and for diverse speakers of all languages. Level of Evidence 4 Laryngoscope, 131:1835–1839, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic Endonasal Prelacrimal Approach: Radiological Considerations, Morbidity, and Outcomes

xlomafota13 shared this article with you from Inoreader Endoscopic Endonasal Prelacrimal Approach: Radiological Considerations, Morbidity, and Outcomes Via The Laryngoscope Objective/Hypothesis This study describes a multicentric experience with the use of prelacrimal approach (PLA), focusing on preoperative radiological parameters potentially associated with surgical outcomes and postoperative morbidity. Study Design Retrospective case-series. Methods A retrospective review of patients undergoing PLA in three European referral centers was performed. The post-operative morbidity was analyzed in relation to two radiological parameters: width of prelacrimal recess (WPR) and internal angle of pyriform notch (APN). Results The study included 28 patients affected by Schneiderian papilloma (20 cases), inflammatory disease (6 cases), schwannoma (1 case), and osteoma (1 case). The most reported sequela was paresthesia of ipsilateral anterior superior alveolar process (25% of the cases). An association between post-operative morbidity and APN was observed (P = .047). Conclusions Preoperative radiological evaluation of WPR is crucial in understanding the feasibility of the approach, while APN measurement may predict postoperative morbidity, which is paramount in the patients' counseling. Level of Evidence 4 case-series Laryngoscope, 131:1715–1721, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Utilization and Influence of Online Support Communities in Idiopathic Subglottic Stenosis Patients

xlomafota13 shared this article with you from Inoreader Utilization and Influence of Online Support Communities in Idiopathic Subglottic Stenosis Patients Via The Laryngoscope Objectives To determine the factors that shape utilization of social media-based online support communities (OSCs) and study the influence of these communities on medical decision-making in patients with Idiopathic Subglottic Stenosis (iSGS). Study design Survey study. Methods A survey investigating OSC use was sent to the 1,056 members of the North American Airway Collaborative (NoAAC) iSGS1000 cohort in January 2018. Responses were merged with the existing NoAAC data set containing extensive demographic data, disease-specific history, and responses to validated patient-reported outcome measures. Results A total of 755 individuals with iSGS and mean age of 51.8 ± 11.6 years were included (99% female, 98% white, 63% college educated) and 58% were OSC users. Younger age, female gender, and college education were each associated with OSC use (P < .05). Users spent 2.5 ± 3.3 hours per week on the platforms. Time spent on OSC was not associated with total number of prior treatments. Higher disease anxiety (FoP-Q, R = 0.26, P < .001), lower social support (MOS, R = −0.12, P = .037), and lower level of shared-decision-making with the treating physician (SDM-Q9, R = −0.16, P = .007) were weakly associated with more hours spent engaging an OSC. OSC use influenced treatment and physician choice in 35% and 26% of users, respectively. Increased time spent on OSC use was associated with increased influence on patient medical decisions regarding treatment, surgery, and physi cian choice (P < .05). Conclusion OSC engagement is common in patients with iSGS. Disease anxiety, social support, and relationship with the physician may influence OSC utilization. More OSC engagement weakly associated with greater OSC influence on patient medical decision-making. Level of Evidence NA. Laryngoscope, 131:1821–1827, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Social Isolation and Loneliness in the Hearing‐Impaired Pediatric Population: A Scoping Review

xlomafota13 shared this article with you from Inoreader Social Isolation and Loneliness in the Hearing‐Impaired Pediatric Population: A Scoping Review Via The Laryngoscope Objective To review existing publications in order to evaluate the effect of hearing loss on social isolation and loneliness in the pediatric population. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines were followed. Eight databases were searched. Studies were independently screened and analyzed by two reviewers. Publications were included if pediatric hearing-impaired individuals and social isolation or loneliness were studied. Discrepancies were resolved by a team of five reviewers. Results Thirty-three studies were included in this review. Sixty percent of studies (12/20) found that hearing loss was related to loneliness and 64.7% found that children with hearing loss experienced more social isolation (11/17). The Asher Loneliness and Dissatisfaction Questionnaire was commonly used to assess loneliness. No commonly used tool for assessing social isolation was found. Six articles found that school type was not associated with loneliness. Difficulty communicating was the most mentioned factor leading to loneliness and social isolation. Frequent recommendations to improve social integration included facilitating interactions with the hearing-impaired and educating the nonhearing-impaired to normalize the disability. Conclusion The majority of studies found that hearing impairment results in a higher prevalence of social isolation and loneliness. However, an association cannot be definitively claimed due to the lack of uniform assessment tools. This review emphasizes the need for standardized methods to assess loneliness and social isolation and highlights methods to improve social integration for the hearing impaired. Laryngoscope, 131:1869–1875, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Polymeric Microspheres Containing Human Vocal Fold Fibroblasts for Vocal Fold Regeneration

xlomafota13 shared this article with you from Inoreader Polymeric Microspheres Containing Human Vocal Fold Fibroblasts for Vocal Fold Regeneration Via The Laryngoscope Objective Most acellular injectable biomaterials for vocal fold (VF) wound treatment have limited regenerative potential due to their fast enzymatic degradation and limited recruitment of native cells postinjection. The injection of cells as therapeutic treatment often results in apoptosis due to stresses within the needle and the immune response of the host. Degradable microspheres may improve treatment effectiveness by increasing cell residence time, shielding cells during injection, and offering early protection against the immune system response. The objective of the present study was to investigate the potential of human VF fibroblasts encapsulated in polymeric microspheres as an injectable therapeutic treatment in vitro. Methods Alginate, alginate-poly-L-lysine, and alginate-chitosan microspheres were fabricated using electrospraying and characterized in terms of biocompatibility, swelling, and mechanical properties as well as cytokine production. Results Alginate microspheres were found to have the most desirable properties for VF regeneration. They were resistant to mechanical challenges. They were found to have a stiffness similar to that reported for native VF-lamina propria. They were found to be biocompatible and increased the proliferation of fibroblasts. Human VF fibroblasts encapsulated in alginate microspheres induced the production of interleukin (IL)-8 and IL-4 at 24 hours. Conclusion The alginate microspheres fabricated in this study were found to offer potential advantages, as cell delivery tool. This study highlights the importance of combining biomaterials and cells to expedite the wound-healing process through cytokine production. Future work is aimed to further analysis of the wound-healing properties the microspheres. Level of Evidence NA Laryngoscope, 131:1828–1834, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prevascularized Tracheal Scaffolds Using the Platysma Flap for Enhanced Tracheal Regeneration

xlomafota13 shared this article with you from Inoreader Prevascularized Tracheal Scaffolds Using the Platysma Flap for Enhanced Tracheal Regeneration Via The Laryngoscope Objectives One of the greatest hurdles in tracheal tissue engineering is insufficient vascularization, which leads to delayed mucosal regeneration, inflammation, and restenosis. This study investigated whether a prevascularized segmental tracheal substitute using platysma can enhance tracheal mucosal regeneration. Methods Three-dimensional (3D) printed scaffolds with (group M) or without (group S) Matrigel coating were implanted under the feeding vessels of the platysma in New Zealand White rabbits (n = 3) to induce vascularization. After 1 or 2 weeks, tracheal defects were created and vascularized scaffolds with feeders of the platysma were transplanted as rotational flaps. As controls, scaffolds with or without Matrigel coating was transplanted into a tracheal defect without prevascularization. Airway patency and epithelization were examined using a rigid bronchoscope every 2 weeks. Surviving animals were euthanized at 24 weeks, and microcomputed tomography and histological evaluation were performed. Results Animals with 2 weeks of prevascularization showed longer survival than animals with 0 or 1 weeks of prevascularization regardless of the Matrigel coating. Wider airway patency was observed in group M than group S. Group M showed migration of epithelium over the scaffold from 4 weeks after transplantation and complete coverage with epithelium at 12 weeks, whereas group S showed migration of the epithelium from 14 weeks and incomplete coverage with epithelium even at 24 weeks. Conclusion This two-step method, utilizing the platysma as an in vivo bioreactor, may be a promising approach to achieve long-term survival and enhanced luminal patency. Matrigel coating on the scaffold had a synergistic effect on epithelial regeneration. Level of Evidence NA Laryngoscope, 131:1732–1740, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.