Totten, Douglas J.

AbstractObjectiveTo report the first steps of a project to automate and optimize scheduling of multidisciplinary consultations for patients with longstanding dizziness utilizing artificial intelligence.Study DesignRetrospective case review.SettingQuaternary referral center.MethodsA previsit self‐report questionnaire was developed to query patients about their complaints of longstanding dizziness. We convened an expert panel of clinicians to review diagnostic outcomes for 98 patients and used a consensus approach to retrospectively determine what would have been the ideal appointments based on the patient's final diagnoses. These results were then compared retrospectively to the actual patient schedules. From these data, a machine learning algorithm was trained and validated to automate the triage process.ResultsCompared with the ideal itineraries determined retrospectively with our expert panel, visits scheduled by the triage clinicians showed a mean concordance of 70%, and our machine learning algorithm triage showed a mean concordance of 79%.ConclusionManual triage by clinicians for dizzy patients is a time‐consuming and costly process. The formulated first‐generation automated triage algorithm achieved similar results to clinicians when triaging dizzy patients using data obtained directly from an online previsit questionnaire.

Objective This study sought to determine whether a history of pregnancy or bilateral oophorectomy is associated with subsequent otosclerosis development or disease severity. Study Design Population‐based case‐control study. Setting Olmsted County, Minnesota. Methods Women diagnosed with otosclerosis were matched to 3 women without otosclerosis based on age and historical depth of medical records. Associations of prior delivery and bilateral oophorectomy with subsequent development of otosclerosis and with pure‐tone average (PTA) at the time of otosclerosis diagnosis were evaluated. Results We studied 1196 women: 299 cases of otosclerosis and 897 matched controls. The odds ratio for the association of ≥1 delivery with otosclerosis was 1.16 (95% confidence interval [CI] 0.85‐1.60; P =. 35). Odds ratios for the associations of 1, 2, 3, or ≥4 deliveries with otosclerosis were 1.22 (0.83‐1.80), 1.09 (0.71‐1.68), 1.28 (0.77‐2.12), and 1.00 (0.54‐1.84), respectively. The odds ratio for the association of prior bilateral oophorectomy with otosclerosis was 1.12 (0.58‐2.18; P =. 73). In cases with otosclerosis, PTA at diagnosis was not significantly higher for women with ≥1 delivery as compared with those without (median 45 dB hearing loss [HL] [interquartile range {IQR} 36‐55] vs 43 [IQR 34‐53]; P = 0.18) but was significantly higher for women with bilateral oophorectomy compared with those without (median 54 dB HL [IQR 44‐61] vs 44 [IQR 34‐53]; P =. 03). Conclusion These data do not support a relationship between endogenous estrogen exposure and development of otosclerosis. Women with otosclerosis who had a history of pregnancy did not have significantly worse hearing at the time of diagnosis, suggesting that pregnancy is not associated with disease severity.

Objective:Although it is commonly held that otosclerosis has become increasingly uncommon over recent decades, no population-based data exist to characterize this trend. Moreover, because most large epidemiologic databases within the United States primarily include cancer data, even the modern incidence of otosclerosis is unknown. The chief objective of the current work was to characterize the trend in the incidence of otosclerosis over 70 years using the unique resources of the Rochester Epidemiology Project.Study Design:Population-based study.Patients:Residents of Olmsted County, Minnesota diagnosed with otosclerosis.Main Outcome Measure:Disease incidence from 1950 to 2017.Results:From 1950 to 2017, 614 incident cases of otosclerosis were identified. The incidence rose from 8.9 per 100,000 person-years in the 1950s to a peak of 18.5 from 1970 to 1974. From this peak, the incidence significantly declined to 6.2 per 100,000 person-years by the early-1990s and reached a nadir of 3.2 from 2015 to 2017 (p<0.001). From 1970 to 2017, age at diagnosis (p = 0.23) and the proportion of bilateral cases (p = 0.16) did not significantly change; pure-tone average at diagnosis did not clinically appreciably change over the study period (median difference <5 dB across decades,p = 0.034).Conclusions:The incidence of otosclerosis drastically declined since the early-1970s. Historically considered one of the most common causes of acquired hearing loss, the low modern incidence of otosclerosis renders it legally a “rare disease” within the United States. These trends require consideration when determining trainee case requirements and developing practice guidelines.

Stapedectomy remains a joint key‐indicator case with ossiculoplasty for otolaryngology residents in the United States. Yet, residents consistently report feeling inadequately prepared to perform stapes surgery following graduation. Applying recently described age‐ and sex‐standardized incidence rates of surgically confirmed cases of otosclerosis to the US populace, upper and lower estimates of residents’ case exposure to stapedectomy can be approximated. With this, uppermost projections estimate 6484 new cases of stapes surgery are performed annually nationwide. With approximately 1424 otolaryngology residents nationally, the average case exposure is 7.8 stapedectomies throughout their training, with upper and lower estimates of 17.1 and 4.2 cases, respectively. As such, proficiency in stapedectomy is no longer a realistic expectation for US graduating residents. This reality supports the removal of “stapedectomy” from the list of 14 key‐indicator case requirements, leaving ossiculoplasty as its own key‐indicator case, thereby reinforcing true competence in this fundamental procedure for the graduating otolaryngologist.

Objective: To report and discuss the effectiveness of stereotactic radiosurgery (SRS) or fractionated radiotherapy (FRT) for tumor control following surgical resection of endolymphatic sac tumors (ELST). Study Design: Retrospective case series. Setting: Multi-institutional academic referral centers. Patients: Patients undergoing surgical resection for ELST followed by SRS or FRT. Intervention(s): Surgical resection followed by radiotherapy. Main Outcome Measures: Local tumor control. Results: Two of the five patients experienced tumor recurrence after gross total microsurgical at 78 and 11 months, respectively. The former patient received salvage 3D conformal radiotherapy (3D-CRT) and while the latter patient underwent three courses of salvage SRS for recurrence, two of which were in-field and was disease-free at last follow up. Two additional patients underwent subtotal tumor resection (STR) followed by intensity-modulated radiation therapy (IMRT) and are currently without disease. One patient underwent STR followed by proton-beam therapy (PBT) and was free of disease at most recent follow-up. Conclusion: SRS/FRT remains a useful adjuvant for treatment of residual or recurrent ELSTs, where the risk of revision microsurgical resection is high.

Objective: Several reports have suggested that the incidence of otosclerosis is declining. However, due to the limitations of epidemiologic databases within the United States, little is known about the incidence of congenital stapes footplate fixation (CSFF), much less epidemiological trends over the past 50 years. The current study was conceived to characterize the epidemiology of CSFF over the past five decades using the unique resources of the Rochester Epidemiology Project (REP). Study Design: Population-based study. Patients: The medical records of every resident of Olmsted County, Minnesota who was diagnosed with CSFF was reviewed from January 1, 1970 to December 12, 2017 using the REP. The population of Olmsted County on January 1, 2017 was 159,689 persons. Main Outcome Measure: Incidence of CSFF. Results: Sixteen cases of CSFF were identified at a median age at diagnosis of 8 years (IQR, 6–17), eight of whom confirmed by exploratory tympanotomy. Three of the 16 (19%) cases were bilateral, and the median pure-tone average (500, 1k, 2k, 3k Hz) at time of diagnosis was 37 dB (IQR, 31–48). Two (13%) cases were identified in patients bearing a syndromic condition and one (6%) case demonstrated a malformed external ear on physical examination. The incidence rate of surgically confirmed cases among residents of Olmsted County was 0.31 per 100,000 person-years from 1970 to 1979 and 0.28 from 2000 to 2009. No incident cases among residents of Olmsted County were identified since 2010. Conclusions: CSFF constitutes a rare disease. Unlike epidemiological trends in otosclerosis, the incidence of surgically confirmed cases of CSFF remained stable over the past 50 years.