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Scholarly Works (9 results)

  • Article
  • Peer Reviewed
UC Irvine Previously Published Works (2014)
Quantify the relationships between dizziness, falls, and obesity among adults.Cross-sectional analysis of a national health survey.Adult respondents in the 2008 National Health Interview Survey balance module were analyzed. With demographic information, data for balance and dizziness problems, reported falls, injuries from falls, and body mass index were extracted. Associations between balance/dizziness problems and falls or injuries from falls were determined. The additional association between obesity and falls or fall-related injuries in the setting of a balance/dizziness problem was determined.Among 216.8 ± 3.5 million adult Americans, 24.2 ± 0.7 million reported dizziness in the past 12 months (11.1% ± 0.3%; mean age, 45.9 ± 0.2 years; 51.7% ± 0.5% female), 11.5% ± 0.3% had fallen in the prior 12 months, and 26.3% ± 0.4% were obese. Among individuals reporting dizziness, 34.3% ± 1.3% reported falls, whereas only 9.1% ± 0.3% of nondizzy individuals reported a fall (odds ratio [OR]: 5.1; P < .001). Among dizzy individuals who reported a fall, 45.8% ± 2.1% were injured by the fall versus 35.6% ± 1.4% nondizzy individuals who fell (OR: 1.5; P < .001). The addition of obesity to dizziness increased the odds of falling by 1.3 (95% confidence interval: 1.2-1.5; P < .001) but did not significantly increase the odds of fall-related injury (P = .110).Dizziness/balance problems are strongly associated with both an increased tendency to fall and increased injury rate from falls among adults. The addition of obesity to dizziness was associated with a higher rate of falling but was not associated with a significantly higher rate of fall-related injury. Balance problems in conjunction with obesity need to be targeted in fall-prevention efforts.2b.
    Cover page: Impact of dizziness and obesity on the prevalence of falls and fall‐related injuries
    • Article
    • Peer Reviewed
    UC Irvine Previously Published Works (2014)
    The Medicare provider utilization and payment public use datafile for 2012 was analyzed with respect to otolaryngology specialty providers to characterize otolaryngology services billed to and reimbursed by Medicare, both overall and according to provider characteristics. Among 8450 otolaryngology specialty providers submitting claims, the top 5 billed services were (count in millions): 99213 (2.23), 95165 (1.81), 99203 (0.92), 99214 (0.83), and 69210 (0.71), and the top 5 total reimbursed services were (aggregate total reimbursements in millions): 99213 ($114), 99203 ($68), 99214 ($63), 31231 ($60), and 31575 ($47). There was a mean of 1567 services billed per provider with an average (yearly) total reimbursement from Medicare of $76,068 per provider. These data characterize the current level of provision of otolaryngology services to the Medicare population.
      Cover page: Characteristics of Otolaryngology Claims to Medicare in 2012
      • Article
      • Peer Reviewed
      UC Irvine Previously Published Works (2015)
        Cover page: In response to Impact of dizziness and obesity on the prevalence of falls and fall‐related injuries
        • Article
        • Peer Reviewed
        UC Irvine Previously Published Works (2018)

        Accidental injuries are a leading cause of morbidity and mortality in the United States. Hearing problems may be associated with an increased risk for such injuries.

        To investigate associations between hearing difficulty and risk of accidental injuries among US adults.

        Cross-sectional analysis of responses of a nationally representative sample of 232.2 million individuals 18 years or older who participated in the National Health Interview Survey from 2007 to 2015 and responded to the questions related to the hearing and injury modules.

        The main outcome variable was accidental injury in the preceding 3 months. Hearing status was self-reported as "excellent," "good," "a little trouble," "moderate trouble," "a lot of trouble," and "deaf." Prevalence of accidental injuries was analyzed based on demographic characteristics and hearing status. Odds ratios (ORs) and 95% CIs for injuries adjusted for demographics were calculated for degrees of hearing difficulty. A secondary outcome was association of hearing status with type of injury and was classified as driving related, work related, or leisure/sport related.

        Of 232.2 million US adults, 120.2 million (51.7%) were female, and 116.3 million (50.1%) considered their hearing to be less than excellent. Accidental injuries occurred in 2.8% of survey respondents. In comparison with normal-hearing adults (those with self-rated excellent or good hearing), the odds of accidental injury were higher in those with a little trouble hearing (4.1%; OR, 1.6; 95% CI, 1.5-1.8), moderate trouble hearing (4.2%; OR, 1.7; 95% CI, 1.4-1.9), and a lot of trouble hearing (4.8%; OR, 1.9; 95% CI, 1.6-2.3). Work- and leisure-related injuries were more prevalent among those with self-perceived hearing difficulty. Multivariate analysis, adjusted for age and sex, revealed leisure-related injuries was most consistently associated with various degrees of hearing difficulty. Odds ratios were 1.2 (95% CI, 1.0-1.4) in those with a little trouble hearing, 1.4 (95% CI, 1.1-1.9) in those with moderate trouble hearing, and 1.5 (95% CI, 1.1-2.2) in those with a lot of trouble hearing.

        Hearing difficulty is significantly associated with accidental injury, especially injury related to work or leisure. Increased awareness about hearing difficulty and its proper screening and management may assist in decreasing accidental injury.

          Cover page: Self-reported Hearing Difficulty and Risk of Accidental Injury in US Adults, 2007 to 2015.
          • Article
          • Peer Reviewed
          UC Irvine Previously Published Works (2015)

          Importance

          Direct laryngoscopy, once an inpatient procedure, is now commonly performed in the outpatient setting. To ensure that safety follows the adoption of novel techniques and practice patterns, it is important to analyze the complication and revisit rates of these ambulatory surgery practices.

          Objective

          To determine revisit rates and complications after ambulatory adult direct laryngoscopy procedures.

          Design, setting, and participants

          This was a retrospective cross-sectional analysis of cases of adult patients who had undergone a direct laryngoscopic procedure extracted from multistate ambulatory surgery and hospital databases (State Ambulatory Surgery Databases for New York, Florida, Iowa, and California for 2010 and 2011). The analysis was performed on December 1, 2014. Index cases were linked to the corresponding State Emergency Department Databases and the State Inpatient Databases for visit encounters occurring within a 7-day postoperative window. All index cases were ambulatory surgery, without overnight stay or 23-hour observation.

          Participants

          Adult patients who had undergone a direct laryngoscopy procedure.

          Exposures

          Direct laryngoscopy performed in an ambulatory setting. Patients who underwent flexible laryngoscopy, lesion destruction, laryngectomy, cordectomy, or a secondary nonlaryngoscopy procedure were specifically excluded.

          Main outcomes and measures

          Data regarding sex, age, revisit occurrence with associated complications, and mortality were analyzed.

          Results

          A total of 7743 cases of ambulatory laryngoscopy were identified (mean age, 60.4 years; 61% were male). The 7-day revisit rate was 3.0% (232 revisits). Serious airway complications occurred in 0.27% of cases (n = 21) and accounted for 9.1% of revisits. The rates of other major complications and minor complications were 0.15% (n = 12) and 0.75% (n = 58), respectively. There were no cases of anoxic brain injury. Two deaths occurred at the time of the revisit (7-day mortality rate, 0.03%; 95% CI, 0.01%-0.09%).

          Conclusions and relevance

          Adult ambulatory direct laryngoscopy has a favorable safety profile. Serious airway complications occur in fewer than 3 patients per 1000 cases. The risk of death following outpatient laryngoscopy is extremely low. Outpatient laryngoscopy is not universally suited for all patients, and careful preoperative selection and counseling are imperative.
            Cover page: Safety of Adult Ambulatory Direct Laryngoscopy: Revisits and Complications
            • Article
            • Peer Reviewed
            UC Irvine Previously Published Works (2017)

            Objective

            Identify contemporary noise exposures and hearing protection use among adults.

            Study design

            Cross-sectional analysis of national health survey.

            Methods

            Adult respondents in the 2014 National Health Interview Series hearing survey module were analyzed. Potentially harmful exposures to occupational and recreational noises in the past 12 months were extracted and quantified. Patterns of hearing protection use also were analyzed.

            Results

            Among 239.7 million adults, "loud" and "very loud" occupational noise exposures were reported by 5.3% and 21.7%, respectively. Of those exposed to "loud" or "very loud" sounds at work, only 18.7% and 43.6%, respectively, always used hearing protection. A total of 38.2% (1.9 million) of those with "very loud" occupational exposures never used hearing protection. Frequent (> 10/year) "loud" and "very loud" recreational noise exposures were reported by 13.9% and 21.1%, respectively, most commonly to lawn mowers (72.6% and 55.2%, respectively). When exposed to recreational "loud/very loud" noise, only 11.4% always used hearing protection, whereas 62.3% (6.3 million) never used any protection. Lifetime exposure to firearm noise was reported by 36.6% of adults, 11.5% of whom had used firearms in the prior 12 months. Of those, only 58.5% always used hearing protection, whereas 21.4% (7.4 million) never used hearing protection.

            Conclusion

            Substantial noise exposures with potentially serious long-term hearing health consequences frequently are occurring in occupational and recreational settings, and with the use of firearms. Only a minority of those exposed consistently are using hearing protection. Healthcare providers should actively identify and encourage the use of hearing protection with those patients at risk.

            Level of evidence

            4. Laryngoscope, 127:E340-E346, 2017.
              Cover page: Epidemiology of firearm and other noise exposures in the United States
              • Article
              • Peer Reviewed
              UC Irvine Previously Published Works (2015)

              Objective

              Determine rates and reasons for revisits after ambulatory adult thyroidectomy.

              Study design

              Cross-sectional analysis of multistate ambulatory surgery and hospital databases.

              Setting

              Ambulatory surgery data from the State Ambulatory Surgery Databases of California, Florida, Iowa, and New York for calendar years 2010 and 2011.

              Subjects and methods

              Ambulatory thyroidectomy cases were linked to state ambulatory, emergency, and inpatient databases for revisit encounters occurring within 30 days. The numbers of revisits, mortality, and associated diagnoses were analyzed.

              Results

              A total of 25,634 cases of ambulatory thyroid surgery were identified: 44.2% total thyroidectomy (TT) and 55.8% partial thyroidectomy (PT). Common indications for surgery included goiter/cyst (39.5%), benign/uncertain neoplasm (24.2%), and malignant neoplasm (24.0%). The 30-day revisit rate was 7.2% (n = 1858; 61.8% emergency department, 22.4% inpatient admission, and 15.8% ambulatory surgery center). The most common diagnosis at revisit was hypocalcemia (20.8% of revisits), followed by wound hematoma/seroma/bleeding (7.1%). Higher rates of revisit, hypocalcemia, and hematoma/seroma/bleeding were seen in patients undergoing TT (P < .016 for all). Sixteen patients had bleeding less than 24 hours after the index procedure (0.1% overall, 0.9% of revisits). Most hypocalcemia and hematoma/bleeding occurred over the first postoperative week. Three deaths occurred within 30 days of the index procedure.

              Conclusion

              In carefully selected patients, ambulatory thyroidectomy demonstrates a good postoperative morbidity and mortality profile. Common reasons for revisits included hypocalcemia and bleeding/seroma/hematoma, which occurred with relatively high frequencies as late as a week after surgery. Quality improvement measures should be targeted at lowering revisit rates and safely managing complications.
                Cover page: Ambulatory Thyroidectomy
                • Article
                • Peer Reviewed
                UC Irvine Previously Published Works (2016)

                Importance

                Tinnitus is a common problem for millions of individuals and can cause substantial negative effects on their quality of life. A large epidemiologic study of tinnitus and its management patterns in the US adult population is lacking.

                Objectives

                To quantify the epidemiologic features and effect of tinnitus and to analyze the management of tinnitus in the United States relative to the 2014 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) clinical practice guidelines.

                Design, methods, and participants

                This cross-sectional analysis of the representative 2007 National Health Interview Survey (raw data, 75 764 respondents) identified a weighted national sample of adults (age, ≥18 years) who reported tinnitus in the preceding 12 months. Data were collected in November 2014 at the University of California, Irvine, and Harvard Medical School.

                Main outcomes and measures

                In addition to quantifying prevalence, severity, duration, and regularity of tinnitus, specific data regarding noise exposure and tinnitus management patterns during health care visits were analyzed.

                Results

                Among an estimated (SE) 222.1 (3.4) million US adults, 21.4 (3.4) million (9.6% [0.3%]) experienced tinnitus in the past 12 months. Among those who reported tinnitus, 27% had symptoms for longer than 15 years, and 36% had nearly constant symptoms. Higher rates of tinnitus were reported in those with consistent exposure to loud noises at work (odds ratio, 3.3; 95% CI, 2.9-3.7) and during recreational time (odds ratio, 2.6; 95% CI, 2.3-2.9). Years of work-related noise exposure correlated with increasing prevalence of tinnitus (r = 0.13; 95% CI, 0.10-0.16). In terms of subjective severity, 7.2% reported their tinnitus as a big or a very big problem compared with 41.6% who reported it as a small problem. Only 49.4% had discussed their tinnitus with a physician, and medications were the most frequently discussed recommendation (45.4%). Other interventions, such as hearing aids (9.2%), wearable (2.6%) and nonwearable (2.3%) masking devices, and cognitive behavioral therapy (0.2%), were less frequently discussed.

                Conclusions and relevance

                The prevalence of tinnitus in the United States is approximately 1 in 10 adults. Durations of occupational and leisure time noise exposures correlated with rates of tinnitus and are likely targetable risk factors. Management options suggested by the recently published AAO-HNSF guidelines were followed infrequently.
                  Cover page: Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States
                  • Article
                  • Peer Reviewed
                  UC Irvine Previously Published Works (2017)

                  Objectives/hypothesis

                  Quantify the relationships between tinnitus, and anxiety and depression among adults.

                  Study design

                  Cross-sectional analysis of a national health survey.

                  Methods

                  Adult respondents in the 2007 Integrated Health Interview Series tinnitus module were analyzed. Data for tinnitus symptoms and severity and reported anxiety and depression symptoms were extracted. Associations between tinnitus problems and anxiety, depression, lost workdays, days of alcohol consumption, and mean hours of sleep were assessed.

                  Results

                  Among 21.4 ± 0.69 million adult tinnitus sufferers, 26.1% reported problems with anxiety in the preceding 12 months, whereas only 9.2% of those without tinnitus reported an anxiety problem (P < .001). Similarly, 25.6% of respondents with tinnitus reported problems with depression, whereas only 9.1% of those without tinnitus reported depression symptoms (P < .001). Those reporting tinnitus symptoms as a "big" or "very big" problem were more likely to concurrently report anxiety (odds ratio [OR]: 5.7; 95% CI: 4.0-8.1; P < .001) and depression (OR: 4.8; 95% CI: 3.5-6.7; P < .001) symptoms. Tinnitus sufferers reported significantly fewer mean hours of sleep per night (7.00 vs. 7.21; P < .001) and greater mean days of work missed (6.94 vs. 3.79, P < .001) compared to those who did not report tinnitus. Mean days of alcohol consumption between the two groups were not significantly different.

                  Conclusions

                  Tinnitus symptoms are closely associated with anxiety, depression, shorter sleep duration, and greater workdays missed. These comorbidities and sequelae should be recognized and addressed to optimally manage patients with chronic and bothersome tinnitus.

                  Level of evidence

                  4 Laryngoscope, 2016 127:466-469, 2017.
                    Cover page: Relationships between tinnitus and the prevalence of anxiety and depression
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