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Donzo MW, Nguyen G, Nemeth JK, Owoc MS, Mady LJ, Chen AY, Schmitt NC. Effects of socioeconomic status on enrollment in clinical trials for cancer: A systematic review. Cancer Med 2024; 13:e6905. [PMID: 38169154 PMCID: PMC10807561 DOI: 10.1002/cam4.6905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/07/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To achieve equitable access to cancer clinical trials (CCTs), patients must overcome structural, clinical, and attitudinal barriers to trial enrollment. The goal of this systematic review was to study the relationship between socioeconomic status (SES), assessed either by direct or proxy measures, and CCT enrollment. METHODS The review team and medical librarian developed search strategies for each database to identify studies for this systematic review, which was conducted according to PRISMA guidelines. Inclusion criteria were as follows: studies published in relevant scientific journals between January 2000 and July 2022, primary sources, English literature, and studies conducted in the US. Sixteen studies fulfilled the inclusion criteria and were reviewed. The risk of bias assessment was conducted independently by two reviewers using the Newcastle Ottawa scale. RESULTS The initial search yielded 4070 citations, and 16 studies were included in our review. Four of the studies included used patient reported annual income as a measure of SES, while the remaining 12 studies used patient zip code as a proxy measurement of SES. Consistent with our hypothesis, 13 studies showed a positive association between high SES (patient-reported or proxy measurement) and CCT enrollment. Two studies showed a negative association, and one study showed no relationship. CONCLUSIONS The existing literature suggests that low SES is associated with lower participation in CCT. The small number of studies identified on this topic highlights the need for additional research on SES and other barriers to CCT participation.
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Affiliation(s)
- Maja Wichhart Donzo
- Department of Otolaryngology – Head and Neck SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
- The Winship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
| | - Grace Nguyen
- Department of Otolaryngology – Head and Neck SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
- The Winship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
| | - John K. Nemeth
- Woodruff Health Sciences Center LibraryEmory UniversityAtlantaGeorgiaUSA
| | - Maryanna S. Owoc
- University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Leila J. Mady
- Department of Otolaryngology – Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Amy Y. Chen
- Department of Otolaryngology – Head and Neck SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
- The Winship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
| | - Nicole C. Schmitt
- Department of Otolaryngology – Head and Neck SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
- The Winship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
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Owoc MS, Rubio ME, Brockway B, Sadagopan S, Kandler K. Embryonic medial ganglionic eminence cells survive and integrate into the inferior colliculus of adult mice. Hear Res 2022; 420:108520. [PMID: 35617926 DOI: 10.1016/j.heares.2022.108520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/29/2022] [Accepted: 05/14/2022] [Indexed: 11/20/2022]
Abstract
Acoustic overexposure can lead to decreased inhibition in auditory centers, including the inferior colliculus (IC), and has been implicated in the development of central auditory pathologies. While systemic drugs that increase GABAergic transmission have been shown to provide symptomatic relief, their side effect profiles impose an upper-limit on the dose and duration of use. A treatment that locally increases inhibition in auditory nuclei could mitigate these side effects. One such approach could be transplantation of inhibitory precursor neurons derived from the medial ganglionic eminence (MGE). The present study investigated whether transplanted MGE cells can survive and integrate into the IC of non-noise exposed and noise exposed mice. MGE cells were harvested on embryonic days 12-14 and injected bilaterally into the IC of adult mice, with or without previous noise exposure. At one-week post transplantation, MGE cells possessed small, elongated soma and bipolar processes, characteristic of migrating cells. By 5 weeks, MGE cells exhibited a more mature morphology, with multiple branching processes and axons with boutons that stain positive for the vesicular GABA transporter (VGAT). The MGE survival rate after 14 weeks post transplantation was 1.7% in non-noise exposed subjects. MGE survival rate was not significantly affected by noise exposure (1.2%). In both groups the vast majority of transplanted MGE cells (>97%) expressed the vesicular GABA transporter. Furthermore, electronmicroscopic analysis indicated that transplanted MGE cells formed synapses with and received synaptic endings from host IC neurons. Acoustic stimulation lead to a significant increase in the percentage of endogenous inhibitory cells that express c-fos but had no effect on the percentage of c-fos expressing transplanted MGE cells. MGE cells were observed in the IC up to 22 weeks post transplantation, the longest time point investigated, suggesting long term survival and integration. These data provide the first evidence that transplantation of MGE cells is viable in the IC and provides a new strategy to explore treatment options for central hearing dysfunction following noise exposure.
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Affiliation(s)
- Maryanna S Owoc
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Medical Scientist Training Program, University of Pittsburgh - Carnegie Mellon University, Pittsburgh, PA, United States; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States.
| | - María E Rubio
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, United States; Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Brian Brockway
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Srivatsun Sadagopan
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Medical Scientist Training Program, University of Pittsburgh - Carnegie Mellon University, Pittsburgh, PA, United States; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, United States; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, United States
| | - Karl Kandler
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Medical Scientist Training Program, University of Pittsburgh - Carnegie Mellon University, Pittsburgh, PA, United States; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, United States; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, United States
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Pfaff MJ, Fenton R, Mittal A, Mocharnuk JW, Owoc MS, Bruce MK, Beiriger JW, Losee JE, Goldstein JA. The Clinical Significance of Clinocephaly in Late-Presentation Sagittal Craniosynostosis. Cleft Palate Craniofac J 2022; 60:521-525. [PMID: 35538850 DOI: 10.1177/10556656211064484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The diagnosis of late-presentation sagittal suture craniosynostosis (SCS) can be challenging, especially in the setting of subtle physical exam findings. The clinical significance of clinocephaly-a retro-coronal concavity along the midvault-in this context remains unknown. The aim of this study is to evaluate the predictive value of clinocephaly in identifying late-presentation SCS. A retrospective chart review of all patients >1 year old presenting to the craniofacial clinic with a concern for SCS was performed. The presence or absence of SCS in the setting of clinocephaly was recorded following diagnostic imaging. Student's t test, Chi Square test, and multivariate logistic regression analysis were performed to determine predictors for SCS. 75 patients met inclusion criteria. 32 patients (42.7%, 6% female) were diagnosed with SCS. No difference in age between patients with and without SCS was detected. Stratification of patients by age (1-2, 2-4, and >4 years) revealed a higher rate of SCS in younger patients (P = 0.04). The cephalic index (C.I.) of those with sagittal synostosis was significantly smaller but within the normal range, indicating a more scaphocephalic shape (P = 0.003). Logistic regression analysis revealed that C.I. was a strong predictor for SCS (P = 0.003). Of those with SCS, a mix of complete and partial fusion of the sagittal suture was appreciated. This study found that 42.7% of patients with clinocephaly had SCS. C.I. was the only predictor for SCS and unique suture fusion patterns were identified in those with SCS. This study suggests that clinocephaly should be considered a core component of the exam and work-up for SCS. Future studies aimed at evaluating the positive predictive value of this exam finding and identifying risk factors associated with late-presentation SCS are underway.
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Affiliation(s)
- Miles J Pfaff
- Pediatric Plastic Surgery, 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Regina Fenton
- Pediatric Plastic Surgery, 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Aditya Mittal
- Pediatric Plastic Surgery, 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joseph W Mocharnuk
- Pediatric Plastic Surgery, 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Maryanna S Owoc
- Pediatric Plastic Surgery, 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Madeleine K Bruce
- Pediatric Plastic Surgery, 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Justin W Beiriger
- Pediatric Plastic Surgery, 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joseph E Losee
- Pediatric Plastic Surgery, 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jesse A Goldstein
- Pediatric Plastic Surgery, 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Reitz KM, Terhorst L, Smith CN, Campwala IK, Owoc MS, Downs-Canner SM, Diego EJ, Switzer GE, Rosengart MR, Myers SP. Healthcare providers' perceived support from their organization is associated with lower burnout and anxiety amid the COVID-19 pandemic. PLoS One 2021; 16:e0259858. [PMID: 34797847 PMCID: PMC8604356 DOI: 10.1371/journal.pone.0259858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/27/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Professional burnout represents a significant threat to the American healthcare system. Organizational and individual factors may increase healthcare providers' susceptibility or resistance to burnout. We hypothesized that during the COVID-19 pandemic, 1) higher levels of perceived organizational support (POS) are associated with lower risk for burnout and anxiety, and 2) anxiety mediates the association between POS and burnout. METHODS In this longitudinal prospective study, we surveyed healthcare providers employed full-time at a large, multihospital healthcare system monthly over 6 months (April to November 2020). Participants were randomized using a 1:1 allocation stratified by provider type, gender, and academic hospital status to receive one of two versions of the survey instrument formulated with different ordering of the measures to minimize response bias due to context effects. The exposure of interest was POS measured using the validated 8-item Survey of POS (SPOS) scale. Primary outcomes of interest were anxiety and risk for burnout as measured by the validated 10-item Burnout scale from the Professional Quality (Pro-QOL) instrument and 4-item Emotional Distress-Anxiety short form of the Patient Reported Outcome Measurement Information System (PROMIS) scale, respectively. Linear mixed models evaluated the associations between POS and both burnout and anxiety. A mediation analysis evaluated whether anxiety mediated the POS-burnout association. RESULTS Of the 538 participants recruited, 402 (75%) were included in the primary analysis. 55% of participants were physicians, 73% 25-44 years of age, 73% female, 83% White, and 44% had ≥1 dependent. Higher POS was significantly associated with a lower risk for burnout (-0.23; 95% CI -0.26, -0.21; p<0.001) and lower degree of anxiety (-0.07; 95% CI -0.09, -0.06; p = 0.010). Anxiety mediated the associated between POS and burnout (direct effect -0.17; 95% CI -0.21, -0.13; p<0.001; total effect -0.23; 95% CI -0.28, -0.19; p<0.001). CONCLUSION During a health crisis, increasing the organizational support perceived by healthcare employees may reduce the risk for burnout through a reduction in anxiety. Improving the relationship between healthcare organizations and the individuals they employ may reduce detrimental effects of psychological distress among healthcare providers and ultimately improve patient care.
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Affiliation(s)
- Katherine M. Reitz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Lauren Terhorst
- School of Health and Rehabilitation Sciences, University of Pittsburgh, PA, United States of America
- Department of Clinical and Translational Science, University of Pittsburgh, PA, United States of America
| | - Clair N. Smith
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Insiyah K. Campwala
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Maryanna S. Owoc
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Stephanie M. Downs-Canner
- Department of Surgery, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Emilia J. Diego
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Galen E. Switzer
- Department of Clinical and Translational Science, University of Pittsburgh, PA, United States of America
- Department of General Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States of America
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
| | - Matthew R. Rosengart
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Clinical and Translational Science, University of Pittsburgh, PA, United States of America
| | - Sara P. Myers
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
- * E-mail:
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Baddour K, Fadel M, Zhao M, Corcoran M, Owoc MS, Thomas TH, Sabik LM, Nilsen ML, Ferris RL, Mady LJ. The cost of cure: Examining objective and subjective financial toxicity in head and neck cancer survivors. Head Neck 2021; 43:3062-3075. [PMID: 34235804 DOI: 10.1002/hed.26801] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 06/15/2021] [Accepted: 06/28/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Little is documented regarding objective financial metrics and their impact on subjective financial toxicity in head and neck cancer (HNC) survivors. METHODS In a cross-sectional analysis, 71 survivors with available claims data for HNC-specific out-of-pocket expenses (OOPE) completed a survey including patient-reported, subjective financial toxicity outcome tools: the Comprehensive Score for financial Toxicity (COST) and the Financial Distress Questionnaire (FDQ). RESULTS Worse COST scores were significantly associated with lower earnings at survey administration (coefficient = 3.79; 95% CI 2.63-4.95; p < 0.001); loss of earnings after diagnosis (coefficient = 6.03; 95% CI 0.53-11.52; p = 0.032); and greater annual OOPE as a proportion of earnings [log10(Annual OOPE:Earnings at survey): coefficient = -5.66; 95% CI -10.28 to -1.04; p = 0.017]. Similar results were found with FDQ. CONCLUSION Financial toxicity is associated with particular socioeconomic characteristics which, if understood, would assist the development of pre-treatment screening tools to detect at-risk individuals and intervene early in the HNC cancer survivorship trajectory.
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Affiliation(s)
- Khalil Baddour
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mark Fadel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Meng Zhao
- Strategic Analysis of Clinical Affairs, UPMC Insurance Services, Pittsburgh, Pennsylvania, USA
| | - Michael Corcoran
- Strategic Analysis of Clinical Affairs, UPMC Insurance Services, Pittsburgh, Pennsylvania, USA
| | - Maryanna S Owoc
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Teresa H Thomas
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Marci L Nilsen
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Leila J Mady
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Mady LJ, Lyu L, Owoc MS, Peddada SD, Thomas TH, Sabik LM, Johnson JT, Nilsen ML. Understanding financial toxicity in head and neck cancer survivors. Oral Oncol 2019; 95:187-193. [PMID: 31345389 DOI: 10.1016/j.oraloncology.2019.06.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/21/2019] [Accepted: 06/22/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES (1) Describe financial toxicity (FT) in head and neck cancer (HNC) survivors and assess its association with personal/health characteristics and health-related quality of life (HRQOL); (2) examine financial coping mechanisms (savings/loans); (3) assess relationship between COmprehensive Score for financial Toxicity (COST) and Financial Distress Questionnaire (FDQ). PATIENTS AND METHODS Cross-sectional survey from January - April 2018 of insured patients at a tertiary multidisciplinary HNC survivorship clinic who completed primary treatment for squamous cell carcinoma of the oral cavity, oropharynx, or larynx/hypopharynx. RESULTS Of 104 survivors, 30 (40.5%) demonstrated high FT. Patients with worse FT were more likely (1) not married (COST, 25.33 ± 1.87 vs. 30.61 ± 1.34, p = 0.008); (2) of lower education levels (COST, 26.12 ± 1.47 vs. 34.14 ± 1.47, p < 0.001); and (3) with larynx/hypopharynx primaries (COST, 22.86 ± 2.28 vs. 30.27 ± 1.50 vs. 32.72 ± 1.98, p = 0.005). Younger age (4.23, 95%CI 2.20 to 6.26, p < 0.001), lower earnings at diagnosis (1.17, 95%CI 0.76 to 1.58, p < 0.001), and loss in earnings (-1.80, 95%CI -2.43 to -1.16, p < 0.001) were associated with worse FT. COST was associated with HRQOL (0.08, p = 0.03). Most survivors (63/102, 60%) reported using savings and/or loans. Worse FT was associated with increased likelihood of using more mechanisms (COST, OR1.06, 95%CI 1.02 to 1.10, p = 0.004). Similar results were found with FDQ. CONCLUSIONS We found differences in FT by primary site, with worst FT in larynx/hypopharynx patients. This finding illuminates potential site-specific factors, e.g. workplace discrimination or inability to return to work, that may contribute to increased risk. FDQ correlates strongly with COST, encouraging further exploration as a clinically-meaningful screening tool.
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Affiliation(s)
- Leila J Mady
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Lingyun Lyu
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States
| | - Maryanna S Owoc
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Shyamal D Peddada
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States
| | - Teresa H Thomas
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States
| | - Jonas T Johnson
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Marci L Nilsen
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States
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Owoc MS, Kozin ED, Remenschneider A, Duarte MJ, Hight AE, Clay M, Meyer SE, Lee DJ, Briggs S. Medical and bioethical considerations in elective cochlear implant array removal. J Med Ethics 2018; 44:174-179. [PMID: 28947504 DOI: 10.1136/medethics-2016-103655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Cochlear explantation for purely elective (e.g. psychological and emotional) reasons is not well studied. Herein, we aim to provide data and expert commentary about elective cochlear implant (CI) removal that may help to guide clinical decision-making and formulate guidelines related to CI explantation. DATA SOURCES We address these objectives via three approaches: case report of a patient who desired elective CI removal; review of literature and expert discussion by surgeon, audiologist, bioethicist, CI user and member of Deaf community. REVIEW METHODS A systematic review using three scientific online databases was performed. Included articles addressed the benefits and/or complications of cochlear implantation in young children, CI explantation with or without revision surgery and the ethical debate between the medical and Deaf communities on cochlear implantation and explantation. CONCLUSIONS The medical and audiological perspectives identify a host of risks related to implant removal without reimplantation, including risk from surgery, general anaesthesia, cochlear ossification and poor audiometric outcomes. The member of the deaf community and bioethicist argue that physicians need to guide the principles of beneficence, non-maleficence and patient autonomy. Taken together, patient desires should be seen as paramount, if the patient is otherwise fit for surgery and well informed. IMPLICATIONS FOR PRACTICE Similar to the case of device implantation, device explantation should be a multidisciplinary and collaborative decision with the patient and the family's desires at the centre. While every case is different, we offer a CI explantation discussion to assist in clinical decision-making, patient counselling and education.
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Affiliation(s)
- Maryanna S Owoc
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Elliott D Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria J Duarte
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ariel Edward Hight
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, Massachusetts, USA
| | - Marjorie Clay
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Philosophy, Worcester State University, Worcester, MA, USA
| | - Susanna E Meyer
- Department of Communication Sciences and Disorders, Worcester State University, Worcester, Massachusetts, USA
| | - Daniel J Lee
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Selena Briggs
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology, Georgetown University School of Medicine, Washington, DC, USA
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Kaplan AB, Kozin ED, Puram SV, Owoc MS, Shah PV, Hight AE, Sethi RK, Remenschneider AK, Lee DJ. Auditory brainstem implant candidacy in the United States in children 0-17 years old. Int J Pediatr Otorhinolaryngol 2015; 79:310-315. [PMID: 25577282 PMCID: PMC4477282 DOI: 10.1016/j.ijporl.2014.11.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The auditory brainstem implant (ABI) is an option for hearing rehabilitation in profoundly deaf patients ineligible for cochlear implantation. Over the past decade, surgeons have begun implanting ABIs in pediatric patients who are unable to receive cochlear implants due to congenital or acquired malformations of the inner ear. No study has examined the potential population-level demand for ABIs in the United States (US). Herein, we aim to quantify the potential need for pediatric ABIs. METHODS A systematic literature review was conducted to identify studies detailing the rates of congenital cochlear and/or cochlear nerve (CN) anomalies. Absolute indications for ABI include bilateral cochlea or CN aplasia (Group A), and relative indications for ABI include bilateral cochlea or CN hypoplasia (Group B). Data was subsequently correlated to the US Census Bureau, the National Health Interview Survey, and the Gallaudet Research Institute to provide an estimation of pediatric ABI candidates. RESULTS Eleven studies documented rates of bilateral findings. Bilateral cochlea aplasia was identified in 0-8.7% of patients and bilateral CN aplasia in 0-4.8% of patients (Group A). Bilateral cochlea hypoplasia was identified in 0-8.7% of patients and bilateral CN hypoplasia in 0-5.4% of patients (Group B). Using population-level sensorineural hearing loss data, we roughly estimate 2.1% of potential implant candidates meet absolute indications for an ABI in the United States. CONCLUSION Congenital cochlear and cochlear nerve anomalies are exceedingly rare. This study provides the first preliminary estimate of cochlea and CN aplasia/hypoplasia at the population level albeit with limitations based on available data. These data suggest the need for dedicated ABI centers to focus expertise and management.
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