Literature Review: A Roundup of Important Recent Studies

Bottom line: Because there is a relatively high rate of hearing loss progression in unilateral EVA patients, otolaryngologists should consider offering patients close audiometric monitoring and SLC26A4 genetic testing.

Citation: Greinwald J, deAlarcon A, Cohen A, et al. Significance of unilateral enlarged vestibular aqueduct. Laryngoscope. 2013;123:1537-1546.

—Reviewed by Amy Eckner

Patients with VFP After Thyroidectomy Incur High Cost of Care

Do patients with vocal fold paralysis (VFP) after thyroid surgery incur higher health care costs than those without and, if so, how much?

Background: Thyroidectomies are common in the United States, with bilateral and unilateral VFP occurring at a rate as high as 18.6 percent. The additional treatment that is required incurs a higher cost for patients and insurers that could be avoided without VFP. Actual figures for this cost have not been previously reported.

Study design: Retrospective cohort study of 76 VFP patients and 238 control patients without paralysis through December 2010. Charge analysis ended at 90 days post-operative. Only medical group medical records were used to record charges rather than actual amounts paid.

Setting: Henry Ford Health System, Detroit, Michigan.

Synopsis: Mean tumor weight and

average BMI were not statistically different between VFP and control patients. Proportionally, more VFP patients (8/76) received revision surgeries than control patients (10/238). Serious post-operative morbidity markers (post-operative intubation, tracheotomy, indwelling feeding tube placement, respiratory failure, swallowing study/seophagram) were more common in VFP patients. Length of stay was significantly longer for VFP patients (6.33 days/3.12 days in ICU vs. 2.80 days/0.87 days in ICU). The geometric mean charge for hospitalization for VFP patients was $34,200, compared with $21,600 for the control group, with VFP patients accruing more charges in follow-up costs. Bilateral VFP patients had significantly higher charges than those for unilateral VFP patients only at the 30-day mark. The most expensive hospitalization among VFP patients was $259,480. There were some very expensive charges in the control group but only three bills higher than $100,000. Study limitations included the fact that charge data ended at post-operative day 90 (most surgery related to VFP took place much later), a possibility of coding errors and likely underreporting of transient VFP.

Bottom line: VFP patients incurred a much greater cost for health care in the first 90 days after surgery than those without VFP. The likelihood of VFP was not related to malignancy, BMI or gland weight in this study.