Objective The objective of our study was to review the current literature pertaining to perioperative opioids in sinus surgery and to determine the effects of implementing opioid stewardship recommendations in the setting of endoscopic sinonasal surgery. Study Design Single-institution retrospective case-control study. Setting Academic medical center outpatient area. Methods This retrospective review comprised 163 patients who underwent routine functional endoscopic sinus surgery, septoplasty, and/or inferior turbinate reduction before and after implementation of a standardized pain control regimen based on published opioid stewardship recommendations. The regimen consisted of an oral dose of gabapentin (400 mg) and acetaminophen (1000 mg) at least 30 minutes prior to surgery, absorbable nasal packing soaked in 0.5% tetracaine intraoperatively, and a postoperative regimen of acetaminophen and nonsteroidal anti-inflammatory medications. Tramadol tablets (50 mg) were prescribed postoperatively for breakthrough pain. The primary outcome measure for the study was the average number of hydrocodone equivalents (5 mg) prescribed before and after the new protocol. Results The average number of opioid medications prescribed, measured as hydrocodone equivalents (5 mg), decreased from 24.59 preprotocol to 18.08 after the initiation of the new perioperative regimen ( P < .001). There was no significant difference between the periods ( P > .05) in number of postoperative phone calls regarding pain or in patient satisfaction scores. Conclusion Opioid stewardship recommendations can be instituted for sinonasal surgery, including multimodal perioperative pain management and substitution of tramadol for breakthrough pain, as a method to decrease the volume of opioids prescribed, without increasing patient phone calls or affecting the likelihood of physician recommendation Press Ganey scores.

Background The United States Preventative Service Taskforce recently determined that there was insufficient evidence to recommend hearing screening in adults. Purpose To determine the age to screen adults in the U.S. for hearing loss and identify factors related to increased odds of hearing loss. Research Design Epidemiological Cross-Sectional Study. Study Sample Data from 3,409 individuals aged 20–69 years(y) were analyzed from the 1999–2000 and 2000–2002 cycles of the National Health and Nutrition Examination Survey (NHANES). Data Collection and Analysis Hearing sensitivity from 0.5–8 kHz was assessed and hearing loss was defined as pure tone average 0.5, 1, 2, 4 kHz (PTA4) > 15 dBHL for the worse ear. Thresholds were examined separately for men and women in 2-year intervals. A multivariate ordinal regression model adjusting for age, sex, race/ethnicity, and education was used to examine relationship to determinants. Results Slight (>15 dBHL) hearing loss based on threshold at a single audiometric frequency was first evident in males aged 28–29y. For females, this occurred at age 34–35y. The age at which average PTA4 increased above 15 dBHL (slight hearing loss) was 46–47y for males and 56–57y for females. Multivariate ordinal regression revealed the following “high risk” factors: increased age, male sex, tinnitus, perceived hearing loss, and diabetes. Conclusions For the function of primary prevention, these data suggest screening should initiate at ∼30y for males and 35y for females, the ages when average hearing thresholds at a single frequency can be classified as slight hearing loss. For secondary prevention, the recommended screening ages are higher – 45y for males and 55y for females. Hearing screening is recommended for asymptomatic adults, especially those with high risk factors. Our results also highlight the limitations of PTA4 in identifying early indices of hearing loss.

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