Otolaryngologic Side Effects After COVID-19 Vaccination

OBJECTIVES

With widespread vaccination against COVID-19, concerns regarding side effects have been raised. We aim to assess the frequency of otolaryngologic adverse events (AEs) following COVID-19 vaccination as compared with other vaccines in a national database.

STUDY DESIGN

Retrospective analysis of national registry.

METHODS

The Food and Drug Administration's Vaccine Adverse Event Reporting System (VAERS) database was queried from December 2020 to May 2021 for all COVID-19 vaccination AEs. Complaints were categorized as otolaryngologic and sub stratified into different anatomic components. Reporting odds ratios (ROR) and proportional reporting ratios (PRR) were determined for AEs of clinical significance.

RESULTS

The total number of AEs reported from vaccination with the Moderna, Pfizer-BioNTech, and Janssen vaccines equaled 1,280,950. Of these, 62,660 (4.9%) were otolaryngologic in nature, with 32.6% associated with the oropharynx/larynx, 18.3% with the nasal cavity/sinuses, 17.1% with the ears/vestibular system, 10.0% with the oral cavity, and 21.9% miscellaneous. Signal ratios reached significance levels for dysgeusia (n = 2124, PRR: 17.33, ROR: 16.36), ageusia (n = 1376, PRR: 2.81, ROR: 2.81), anosmia (n = 983, PRR: 4.01, ROR: 4.01), rhinorrhea (n = 2203, PRR: 2.99, ROR: 3.00), throat tightness (n = 3666, PRR: 4.99, ROR: 5.00), throat irritation (n = 3313, PRR: 4.51, ROR: 4.52), dysphagia (n = 2538, PRR: 2.07, ROR: 2.07), tinnitus (n = 4377, PRR: 3.97, ROR: 3.98), and vertigo (n = 2887, PRR: 3.93, ROR: 3.93). Signal ratios were not significant for facial paralysis, Bell's palsy, anaphylaxis, sinusitis, hearing disability, and ear pain.

CONCLUSIONS

Although several otolaryngologic symptoms were reported, few were found to be clinically significant. Of note, facial paralysis, Bell's palsy, and anaphylaxis did not meet signal thresholds to be determined significant.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:1163-1168, 2024.

Impact of Age on Surgical Outcomes Following Mandible Fracture Repair

OBJECTIVES

Open repair of mandibular fractures are frequently performed surgical procedures. Increasing rates of such fractures are seen in older adults following falls. This study assesses the impact of older age on early complications following mandible fracture repair.

STUDY DESIGN

Retrospective analysis of national registry.

METHODS

The 2013-2018 National Surgical Quality Improvement Program database was queried for all cases of open mandible fracture repair and cases were categorized into younger (18-40), middle (41-65), and older (>65) age cohorts. Demographics and comorbidities were compared between the age groups. Rates of surgical, medical, and wound complications within 30-days of surgery were determined. Multivariable logistic analyses were performed to assess the relationship between age and complications.

RESULTS

Altogether, 1818 cases were included for analysis, of which 1269 (69.8%) were younger, 459 (25.2%) were middle, and 90 (5.0%) were older age. Increased rates of complications were seen in the older groups, including unplanned reoperation, unplanned readmission, wound disruption, and medical complications (p < 0.01). On unadjusted analysis, the older (>65) age group had an increased odds of experiencing a complication compared to the younger (18-40) group (OR: 4.19, p < 0.001). The older age group continued to have a significantly increased odds of medical complications after multivariable adjustment (adjusted OR: 8.64, p < 0.001).

CONCLUSIONS

On this analysis of a national database, advanced age was associated with an increased frequency of early postoperative complications following open mandibular fracture repair. Following multivariable adjustment, advanced age continued to be associated with increased odds of postoperative medical complications within 30 days of surgery.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:287-293, 2023.

Length of Stay in Patients Undergoing Tracheoplasty: A NSQIP Study

BACKGROUND

Prolonged length of stay (LOS) has been associated with increased morbidity and resource utilization in various surgical procedures. We aim to determine factors associated with increased hospital stay in patient undergoing tracheoplasty.

METHODS

The 2012-2018 National Surgical Quality Improvement Program (NSQIP) database was queried for patients undergoing tracheoplasty. Patient LOS was the primary clinical outcome. A LOS >75th percentile was considered as prolonged and was utilized for bivariate analysis of demographic, comorbidity, and operative characteristics. LOS was utilized as a continuous variable for multivariate linear regression analysis.

RESULTS

A total of 252 patients were queried. The majority of patients were female (67.5%), white (82.4%), and over the age of 65 (77.0%). Patients had a median LOS of 7 days with the 75th percentile cutoff being defined at 10 days. On bivariate analysis of associated comorbidities, patients with prolonged LOS were more commonly obese (72.4% vs. 53.1%, p = 0.009), diabetic (37.9% vs. 16.5%, p < 0.001), dyspneic (58.6% vs. 40.7%, p = 0.016), and had chronic steroid use (25.9% vs. 12.9%, p = 0.018). Multivariable logistic regression analysis demonstrated significant associations between prolonged LOS and both chronic obstructive pulmonary disorder (COPD) (OR: 3.43, p = 0.020) and chronic steroid use (OR: 3.81, p = 0.018).

CONCLUSIONS

This study elucidates factors associated with prolonged LOS in patients undergoing tracheoplasty. Patients with COPD and chronic steroid use were significantly associated with prolonged LOS.

LEVEL OF EVIDENCE

4 Laryngoscope, 2022.

Reporting of Research by Matched Otolaryngology Residency Applicants

OBJECTIVES

Matching to an otolaryngology residency program is a competitive process for medical students, and research performed by students is considered as a factor for granting interviews by program directors. Because abstracts, presentations and publications are all reported in combination by the National Resident Matching Program's "Charting Outcomes in the Match" (ChOM) and may be weighted differently by PDs, we specifically investigated the number of publications by past applicants accepted to top otolaryngology residency programs.

METHODS

The top 25 otolaryngology residency programs were identified using Doximity, sorting by reputation. Current residents were determined from the programs' websites. Using PubMed, each resident's number of publications, authorship status, and journal type were recorded.

RESULTS

A total of 24 programs were included in the final analysis and the average number of manuscripts was 2.76 ± 4.01. The mean number of publications in otolaryngology journals was 1.03 ± 1.91.

CONCLUSIONS

The difference between the investigated average number of publications (2.76) and those published by ChOM (10.4) represent a discrepancy due to the lack of delineation between abstracts, presentations and publications. The reported numbers for research may lead medical students to pursue alternate measures to increase their own research. Some options, such as adding a research year are not universally accessible. A clearer and more detailed approach to reporting research statistics would be beneficial to both applicants and PDs for otolaryngology programs.

Microbial health risk posed by table eggs in Trinidad

A survey of the microbial quality of table eggs sold in Trinidad was conducted. For 23 poultry layer farms each visited twice approximately 1 month apart, 25 pooled eggs constituted a composite sample, for 14 shopping malls each visited twice approximately 1 month apart, six pooled eggs made a composite sample and for a total of 102 other retailers across the country each visited once over a 4-month period, six pooled eggs constituted a composite sample. Swabs of egg shells and egg content were tested for selected bacteria. Twenty-four (13.0%), 68 (37.0%), and two (1.1%) of a total of 184 composite eggs (shells, egg content or both) sampled were positive for Salmonella, Escherichia coli, and Campylobacter respectively. All 184 samples tested were negative for Listeria spp. Salmonella was recovered from seven (3.8%) egg shell samples only compared with 14 (7.6%) egg content samples only positive for the pathogen. Fifty-two (28.3%) egg shell samples and seven (3.8%) egg content samples were positive for E. coli. Both isolates of Campylobacter coli originated from egg contents. Of a total of 24 composite egg samples positive for Salmonella, eight different serotypes of Salmonella were isolated from a total of 24 Salmonella-positive composite eggs of which S. Enteritidis was the most prevalent, 58.3% (14/24). Salmonella Georgia was isolated for the first time in Trinidad. Failure to properly handle or heat table eggs sold in Trinidad poses a potential health hazard to consumers because of their poor microbial quality.

Detection of haemoparasites in cattle by reverse line blot hybridisation with a note on the distribution of ticks in Sicily

A reverse line blot hybridisation (RLB) of 21 oligonucleotides with polymerase chain reaction (PCR) amplified regions of 16S rRNA (Ehrlichia/Anaplasma group) or 18S rRNA (Babesia/Theileria group) genes of haemoparasites detected Theileria annulata, T. buffeli/orientalis, Babesia bovis, B. bigemina, B. divergens, Ehrlichia bovis, Anaplasma marginale, A. centrale and unknown species within the Rickettsia tribe.A very high prevalence of mixed infections was detected, which indicated that animals infected with Babesia spp. were also infected with Theileria spp. and/or Anaplasma spp. The tick distribution appeared to be seasonal with Hyalomma marginatum as the most frequently observed tick and Boophilus annulatus and Ixodes ricinus as the least frequently observed ticks. Other species identified in the 818 ticks collected during the five sampling periods between April 1998 and November 1999 included H. lusitanicum, Rhipicephalus sanguineus group, R. bursa, Dermacentor marginatus, Haemaphysalis punctata, B. annulatus and I. ricinus.

Medicinal plants used for dogs in Trinidad and Tobago

This paper documents ethnoveterinary medicines used to treat dogs in Trinidad and Tobago. In 1995, a 4-stage process was used to conduct the research and document the ethnoveterinary practices. Twenty-eight ethnoveterinary respondents were identified using the school-essay method, which is a modified rapid rural appraisal (RRA) technique. Semi-structured interviews were held with these respondents as well as with 30 veterinarians, 27 extension officers and 19 animal-health assistants and/or agricultural officers, and the seven key respondents that they identified. The final step involved hosting four participatory workshops with 55 of the respondents interviewed to discuss the ethnoveterinary data generated from the interviews and to determine dosages for some of the plants mentioned. Supplementary interviews were conducted in 1997 and 1998. Seeds of Carica papaya, and leaves of Cassia alata, Azadirachta indica, Gossypium spp., Cajanus cajan and Chenopodium ambrosiodes are used as anthelmintics. The anthelmintics Gossypium spp. and Chenopodium ambrosiodes are the most frequently used species. Crescentia cujete pulp, Musa spp. stem exudate, the inside of the pods of Bixa orellana, leaves of Cordia curassavica and Eclipta alba plant tops are used for skin diseases. Musa spp. stem exudate, seeds of Manilkara zapota, Pouteria sapota and Mammea americana and leaves of Cordia curassavica, Scoparia dulcis and Nicotiana tabacum are used to control ectoparasites. Dogs are groomed with the leaves of Cordia curassavica, Bambusa vulgaris and Scoparia dulcis. Psidium guajava buds and leaves and the bark of Anacardium occidentale are used for diarrhoea. Owners attempt to achieve milk let-down with a decoction of the leaves of Stachytarpheta jamaicensis. The plant uses parallel those practised in human folk medicine in other Caribbean countries and in other tropical countries.