Head and Neck Injuries and Electronic Scooter Use in the United States

OBJECTIVE: To quantify electric scooter injuries encountered in United States emergency departments, focusing on the head and neck, to understand the safety impact of these scooters to improve safe usage. STUDY DESIGN: Retrospective cross-sectional study from January 2009 to December 2019 of patients presenting to United States emergency departments with electric scooter injuries collected from a national database. About 2,823 cases of injuries were related to electric scooter use from January 2009 to December 2019. Stratified weighted counts and incidence rates were estimated for injury characteristics. Piecewise linear regression quantified the yearly change in incidence of injuries before and after introduction of rideshare programs. RESULTS: The estimated national total of electric scooter cases from 2009 to 2019 was 103,943 (95% CI: 79,650-128,237). Incidence grew in 2019 to 8.63 cases per 100,000 person-years from 4.46 in 2018 to 2.42 in 2017. Head and neck injuries represented 28.5% of total injuries (weighted estimate = 29,610). The most common age group of head and neck injuries before 2018 was ≤17 years, but injuries in 18- to 44-year-olds grew significantly to become the most injured group in 2018 to 2019 (P \u3c .001). From 2009 to 2017, incidence of head and neck injuries fell by 0.02 cases per 100,000 person-years, but cases grew by 1.22 cases per 100,000 person-years post-2017 (P \u3c .001). CONCLUSION: Injuries following the launch of rideshare electric scooter programs increased significantly, especially in patients 18 to 44 years of age. Head and neck injuries represent many of these injuries. User safety education must be addressed to prevent injury as programs become more pervasive in the United States. LEVEL OF EVIDENCE: Level 2 Laryngoscope, 2021

Entry of the Hearing Impaired into the Health Care System

The current system of referral of patients complaining of hearing loss usually requires a dual appointment with otolaryngology and audiology. Most of these patients have sensorineural hearing loss for which there is rarely surgical or medical treatment. This study tests the hypothesis that these patients would receive appropriate treatment and that health care dollars would be saved if an audiological assessment could identify those patients who require medical or surgical care. One hundred consecutive patients whose sole complaint was hearing loss were evaluated using audiograms and hearing abilities questionnaires by five audiologists using subjective and objective criteria to determine the need for referral to otolaryngology. Audiologists determined the need for referral with an accuracy of 55% and 72% utilizing subjective and objective criteria, respectively. The questionnaire was found to be of little value. Audiologists may be able to function as the entry point into the health care system for patients complaining of hearing loss. We are encouraged by the results of this preliminary study, but improvement in the system by which audiologists detect disease is necessary

Impact of a specialty trained billing team on an academic otolaryngology practice

PURPOSE: To determine how the incorporation of specialty specific training for coders within a focused billing team affected revenue, efficiency, time to reimbursement, and physician satisfaction in an academic otolaryngology practice. MATERIALS AND METHODS: Our academic otolaryngology department recently implemented a new billing system, which incorporated additional training in otolaryngology surgical procedures for medical coders. A mixed model analysis of variance was used to compare billing outcomes for the 6 months before and 6 months after this new approach was initiated. The following metrics were analyzed: Current Procedural Terminology codes, total charges, time between services rendered and billing submission, and time to reimbursement. A survey of department physicians assessing satisfaction with the system was reviewed. RESULTS: There were 4087 Current Procedural Terminology codes included in the analysis. In comparing the periods before and after implementation of the new system, statistically significant decreases were found in the mean number of days to coding completion (19.3 to 12.0, respectively, p \u3c 0.001), days to posting of charges (27.0 to 15.2, p \u3c 0.001), days to final reimbursement (54.5 to 27.2, p \u3c 0.001), and days to closure of form (179.2 to 76.6, p \u3c 0.001). Physician satisfaction with communication and coder feedback increased from 36% to 64% after initiation of the new program. CONCLUSIONS: The implementation of additional specialty training for medical coders in the otolaryngology department of a large medical system was associated with improved revenue cycle efficiency. Additionally, this model appears to improve physician satisfaction and confidence with the coding system

Why and When to Treat Snoring

It is estimated that half of the adult population older than 60 years snores. This article discusses the many aspects of snoring, including impacts on bed partners, the individual who snores, and when and how to appropriately evaluate, diagnose, and treat the perpetrator. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of the phenomenon of snoring. It is estimated that half of the adult population over the age of 60 years of age snores. This chapter discusses snoring, including the impact on bed partners, the individual that snores and when and how to treat the snorer. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of patients who snores

Sleep Disorders in the Elderly

Although some physiologic changes in sleep are a normal part of the aging process, other sleep complaints made by elderly patients can indicate a primary or secondary sleep disorder. It is important to recognize the difference between normal age-related changes and what may require further testing to make an accurate diagnosis. Proper diagnosis and treatment of sleep disorders can improve the quality of life and safety for the elderly and their families

Palatal Procedures for Obstructive Sleep Apnea

Uvulopalatopharyngoplasty was the first surgical procedure described, other than tracheostomy, for the treatment of obstructive sleep apnea (OSA) in 1981. It was recognized then that there were responders who were cured of OSA with the procedure and others that were not. It took many years for a staging system to be described that categorized patients based on Mallampati score, tonsil size, and body mass index to better predict success rates. It was recognized that individuals with retro-palatal obstruction as the cause of the airway obstruction responded well but that the morbidity associated with the inpatient procedure was often problematic

Ketorolac usage in tonsillectomy and uvulopalatopharyngoplasty patients

OBJECTIVE: Postoperative pain for tonsillectomy with or without adenoidectomy or uvulopalatopharyngoplasty (UPPP) can be severe. Ketorolac is a nonsteroidal anti-inflammatory drug that can be administered for analgesia in these patients. In the literature, ketorolac has been associated with an increased risk of hemorrhage after tonsillectomy with or without adenoidectomy. Many other surgical fields have successfully utilized this medicine for postoperative pain control without increased incidence of hemorrhage. The goal of this study was to analyze the effectiveness of ketorolac after tonsillectomy with or without adenoidectomy or UPPP in adults on postoperative hemorrhage rates. METHODS: Adult patients older than 18 years of age who underwent tonsillectomy with or without adenoidectomy and UPPP between 2013 and 2018 were assessed to determine hemorrhage rates. Hemorrhage rates were assessed based on patients presenting to the emergency department with complaint of hemorrhage. RESULTS: There was no significant difference between groups in the postoperative hemorrhage rates (P = .331) or the method of hemorrhage control. CONCLUSION: Ketorolac did not increase postoperative hemorrhage rates in patients posttonsillectomy with or without adenoidectomy or UPPP. LEVEL OF EVIDENCE: 4 Laryngoscope, 2019