Evaluating Resident Education Practices in Endoscopic Sinus Surgery

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A Social Media Quality Review of Popular Sinusitis Videos on TikTok

Objective: Social media may inform health care decisions among younger patient populations. TikTok is a social media platform that allows users to post short-form videos. This study aimed to assess the quality of sinusitis-related videos on TikTok. Study Design: We searched TikTok on January 29, 2023, for sinusitis-related hashtags: #sinusitis, #sinus, #sinusinfection. Setting: Internet. Methods: The number of views/shares per day, uploader type (nonmedical influencer, lay individual, and medical professional) content categories (medical advice, marketing, comedy, and lifestyle/acceptability), and content type (educational vs factual) were collected. The Patient Education Materials Assessment Tool for Audiovisual Material and Journal of the American Medical Association criteria score was used to measure understandability, actionability, and reliability. The Global Quality Scale (GQS) was used to evaluate the quality of videos; the harm/benefit score was used to evaluate causative effects. Analyses were performed using analysis of variance (α = .05). Results: There were 221 videos identified, which garnered over 300 million views and 1 million shares. Almost half of the videos were published by nonmedical influencers. When controlling for covariates, nonmedical influencers and lay uploaders were more likely to have harmful harm/benefit scores, less understandable videos, and lower GQS scores compared to medical professionals. Less than half of videos posted by nonmedical influencers categorized as educational were factual (46.7%); lay individuals and medical professionals had higher rates of factual educational content (79.9% and 83.7%, respectively). Conclusion: Most nonmedical influencer-posted TikTok videos about sinusitis are inaccurate, despite being portrayed as medical advice/educational. Rhinologists must find modern ways to disseminate true disease-related content via social media to combat medical misinformation.</p

Impact of social determinants of health on access to rhinology care and patient outcomes: A pilot study

Objective: This novel pilot study constructs a social deprivation index (SDI) and utilizes an area deprivation index (ADI) to evaluate the link between social determinants of health and rhinology patient experiences. Methods: Adult patients undergoing outpatient care of chronic rhinitis and chronic rhinosinusitis at a tertiary academic medical center were recruited to participate in a telephone survey assessing symptoms, social/emotional consequences of disease, and barriers to care on a 5-point Likert scale. Sociodemographic characteristics were utilized to rate SDI on an 8-point scale. ADI was obtained by area code of residence. Ordered logistic regression was used to examine associations between the SDI/ADI and perceptions of rhinology care. Results: Fifty patients were included. Individuals with higher SDI scores (i.e., more socially deprived) experienced more severe nasal congestion (p = .007). Furthermore, higher national ADI correlated with increased severity of smell changes (p = .050) and facial pressure (p = .067). No association was seen between either deprivation index and global/psychiatric symptoms. While no correlations were found between higher SDI and difficulties with the costs of prescriptions, rhinologist's visits, or saline, higher SDI was correlated with decreased difficulty with surgery costs (p = .029), and individuals with higher national ADI percentile had increased difficulties obtaining nasal saline (p = .029). Conclusion: Worse social deprivation is associated with difficulties obtaining saline rinses and increased severity of nasal/sinus symptoms in an urban, underserved, majority-Black population. These findings suggest social factors affect access to and quality of rhinology care in a complex and nuanced way and highlight the need for a specific SDI to further study social determinants of health in rhinology. Level of Evidence: 2c.</p

A Carbon Nanotube Optical Reporter Maps Endolysosomal Lipid Flux

Lipid accumulation within the lumen of endolysosomal vesicles is observed in various pathologies including atherosclerosis, liver disease, neurological disorders, lysosomal storage disorders, and cancer. Current methods cannot measure lipid flux specifically within the lysosomal lumen of live cells. We developed an optical reporter, composed of a photoluminescent carbon nanotube of a single chirality, that responds to lipid accumulation via modulation of the nanotube’s optical band gap. The engineered nanomaterial, composed of short, single-stranded DNA and a single nanotube chirality, localizes exclusively to the lumen of endolysosomal organelles without adversely affecting cell viability or proliferation or organelle morphology, integrity, or function. The emission wavelength of the reporter can be spatially resolved from within the endolysosomal lumen to generate quantitative maps of lipid content in live cells. Endolysosomal lipid accumulation in cell lines, an example of drug-induced phospholipidosis, was observed for multiple drugs in macrophages, and measurements of patient-derived Niemann–Pick type C fibroblasts identified lipid accumulation and phenotypic reversal of this lysosomal storage disease. Single-cell measurements using the reporter discerned subcellular differences in equilibrium lipid content, illuminating significant intracellular heterogeneity among endolysosomal organelles of differentiating bone-marrow-derived monocytes. Single-cell kinetics of lipoprotein-derived cholesterol accumulation within macrophages revealed rates that differed among cells by an order of magnitude. This carbon nanotube optical reporter of endolysosomal lipid content in live cells confers additional capabilities for drug development processes and the investigation of lipid-linked diseases

Pain Reporting, Opiate Dosing, and the Adverse Effects of Opiates After Hip or Knee Replacement in Patients 60 Years Old or Older

Our goal was to determine whether there were age-related differences in pain, opiate use, and opiate side effects after total hip or knee arthroplasty in patients 60 years old or older. We hypothesized that there would be no significant differences between age groups in (1) mean pain score, (2) opiate use after adjusting for pain, or (3) opiate side effects after adjusting for opiate use and pain score. We retrospectively reviewed the electronic and paper charts of all patients undergoing total joint replacements at our institution over 3 years who met the following criteria: (1) 60 years old or older, (2) primary single total knee or total hip replacement, and (3) no preoperative dementia. Preoperative, intraoperative, and postoperative course data were collected using a customized data entry process and database. We divided the patients into 2 age groups, those 60 to 79 years old and those 80 years old or older. Using a marginal model with the panel variable of postoperative day, we investigated the associations between age group and pain, age group and pain adjusting for opiate use, and age group and complications (respiratory depression, naloxone usage as a measure of respiratory arrest, delirium, constipation, and urinary retention) adjusting for opiate use (Xtgee, Stata10, Stata Corp. LP, College Station, Texas). Significance was set at P < .05. We found no significant difference in pain scores between groups, but the older group had significantly fewer opiates prescribed yet significantly more side effects, including delirium (odds ratio 4.2), than did the younger group, even after adjusting for opiate dose and pain score

Retrospective Review of Surgical Site Infections after Endoscopic Endonasal Sellar and Parasellar Surgery: Multicenter Quality Data from the North American Skull Base Society

Abstract Introduction  Transnasal access to the anterior skull base provides a minimally invasive approach for sellar and parasellar masses compared with its open counterparts. The unique microbiome of the sinonasal mucosa provides distinct challenges not encountered with other cranial approaches. The use of antibiotics in these cases has not been standardized, and data remain scarce regarding infectious outcomes. Methods  We conducted a multicenter retrospective analysis of shared quality data points for the endoscopic endonasal approach (EEA) for pituitary adenomas, along with other sellar and parasellar region masses that were included by participating institutions. Patient and operative characteristics, perioperative and postoperative antibiotic regimens and their durations, intraoperative and postoperative cerebrospinal fluid leak, and onset of postoperative meningitis and sinusitis were compared. Results  Fifteen institutions participated and provided 6 consecutive months' worth of case data. Five hundred ninety-three cases were included in the study, of which 564 were pituitary adenomectomies. The incidences of postoperative meningitis and sinusitis were low (0.67 and 2.87% for all pathologies, respectively; 0.35% meningitis for pituitary adenomas) and did not correlate with any specific antibiotic regimen. Immunocompromised status posed an increased odds of meningitis in pituitary adenomectomies (28.6, 95% confidence interval [1.72–474.4]). Conclusions  The results show no clear benefit to postoperative antimicrobial use in EEA, with further larger studies needed