The introduction of DRG payment resulted in significantly reduced examination fee, slightly decreased medical costs without significant difference in several detailed items, a reduced number of GA cases without statistical significance, and more patients receiving additional operations. The possible solution to make a profit under the DRG payment scheme is to curtail the costs of radiological images and medication, lower GA percentage, perform fewer additional operations, and correct recording of complications or comorbidities.
Using the modified Siegel's criteria, we report the hearing recovery outcomes with matched pretreatment hearing grades of patients with SSNHL treated with combined intra-tympanic steroid therapy. Our results show the prognostic significance of pretreatment hearing grades in patients with SSNHL.
Fifty-five patients hospitalized for osteomyelitis of the temporal bone between 1990 and 2011 were divided into two study groups: group 1 was patients collected from 1990 to 2001 and group 2 was composed of patients between 2002 and 2011. Clinical diagnostic criteria and epidemiologic data were analyzed to illustrate the altering features of osteomyelitis of the temporal bone. Group 1 patients were characterized by high prevalence of diabetes and more commonly suffered from otalgia, otitis externa and granulation tissue in the external auditory canal and higher positive culture for Pseudomonas aeruginosa. Noticeable changing trends were found between both groups, including declining prevalence of diabetes, fewer patients complaining of pain or presenting with otitis externa, and canal granulation, and increased variety of pathogens in group 2. We should highlight the index of clinical suspicion for osteomyelitis of the temporal bone, even in nondiabetic or immunocompetent patients. Painless otorrhea patients were also at risk of osteomyelitis of the temporal bone, especially patients with previous otologic operation. Increased multiplicity of pathogens amplified the difficulty of diagnosis for osteomyelitis of the temporal bone.
NTM otomastoiditis should be suspected if a patient has chronic refractory otorrhea and ear granulation tissue. Surgery, which is the mainstay of treatment, should be complemented with antibiotics. In those without temporal bone osteomyelitis, antibiotic treatment can be stopped after a dry ear is achieved.
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