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Silent Type

(7,346 posts)
50. American Academy of Otolarngology differs with your perception of need.
Sun Dec 15, 2024, 01:49 PM
Dec 15

Based on estimates from surveys administered between 2001-2012 (Oehlandt, 2022; Shan, 2019), ETD affects 4-5% of adults. Medical management is frequently used for treatment of associated conditions, but success rates are limited. Established surgical approaches include myringotomy (creating a hole in the eardrum) and tympanostomy (small tubes implanted through a hole in the ear drum). (Tucci, 2019).

In 2019, the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) published a set of consensus statements regarding the use of BDET (Tucci, 2019). The published consensus statements were reached using the Delphi method. This involved the iterative consideration of statements by a panel representing a variety of medical specialty societies until consensus was reached. The target population for the statements was adults 18 years of age or older who had symptoms for 3 months or longer that significantly affected their quality of life or functional health status. The panel reached consensus on the following 18 statements regarding selection of candidates for BDET:

A comprehensive history and physical exam, including otoscopy, are essential parts of the diagnostic evaluation of a candidate for BDET.

Nasal endoscopy is an essential part of the diagnostic evaluation prior to BDET.

BDET is contraindicated for patients diagnosed as having a patulous ETD.

Nasal endoscopy in patients who are candidates for BDET is necessary for assessing the ET lumen and assessing the feasibility of transnasal access to the nasopharynx. A diagnosis of patulous ETD is suggested by symptoms of autophony of voice, audible respirations, pulsatile tinnitus, and/or aural fullness.

The benefit of repeat BDET after a prior ineffective BDET has not been determined.

Symptoms of obstructive ETD can include aural fullness, aural pressure, hearing loss, and otalgia.

Tympanometry is an essential part of the diagnostic evaluation prior to BDET. 8.50 0

Establishing a diagnosis of obstructive ETD requires ruling out other causes of aural fullness such as patulous ETD, temporomandibular joint disorders, extrinsic obstruction of the ET, superior semicircular canal dehiscence, and endolymphatic hydrops.

Patient-reported symptom scores alone are insufficient to establish a diagnosis of obstructive ETD.

Nasal endoscopy is necessary to rule out extrinsic causes of ETD.

Comprehensive audiometry is an essential part of the diagnostic evaluation prior to BDET.

BDET is appropriate in patients with obstructive ETD who have failed medical therapy for identified treatable causes.
Common causes of obstructive ETD that benefit from identification and management are allergic rhinitis, rhinosinusitis, and laryngopharyngeal reflux.

Medical management of known pathology that could affect nasal or ET function is appropriate to perform prior to BDET.
Patients with a history of recurrent baro-challenge, defined as uncomfortable pressure in the ear upon exposure to ambient pressure
changes that cannot be easily relieved, may improve following BDET.

There is no scientifically proven or standard medical therapy for ETD.

Pneumatic otoscopy can identify negative pressure in the middle ear space and can differentiate between adhesive and non-adhesive retractions of the tympanic membrane. . . . . . .

https://www.anthem.com/dam/medpolicies/abcbs/active/guidelines/gl_pw_e002209.html

Recommendations

0 members have recommended this reply (displayed in chronological order):

Medicare would have denied $40k balloon dilation procedure too. It's a 15 minutes procedure Silent Type Dec 14 #1
She tried that. MrsCoffee Dec 14 #2
She tried that and it was painful. So let's spend $35k more because it's uncomfortable for a few minutes. Silent Type Dec 14 #4
I'm sorry but this is peripherally personal. JMCKUSICK Dec 14 #8
My life from the time I was about 12 moniss Dec 15 #53
You are a walking, talking example of insidious discrimination JMCKUSICK Dec 15 #54
Thank you. I can remember moniss Dec 15 #55
Are you fucking kidding me?! Arazi Dec 14 #15
Nope, not one of those because they aren't of questionable clinical value and government plans Silent Type Dec 14 #24
You. Are. Not. A. Medical. Expert. Arazi Dec 15 #26
Well, then, you won't like MFA because any government plan is likely going to do Silent Type Dec 15 #30
She was suicidal and needed medical care Arazi Dec 15 #39
Your lack of empathy is noted. choie Dec 15 #27
Empathy yes. Spending considerably more without looking to see if Medicare/caid guidelines Silent Type Dec 15 #32
You are not in a position to judge someone's pain tolerance Keepthesoulalive Dec 15 #35
I think I'll stick with the judgement of the attending physician.... paleotn Dec 14 #3
You mean the ones who order millions of quack treatments and tests a year to pad their bank account. Silent Type Dec 14 #5
Ah yes. ALL physicians are crooks. Is that what you're saying? paleotn Dec 14 #9
And I told you I'm not. I do work with doctors, and yes many cheat. Shouldn't be surprising Silent Type Dec 14 #11
So answer my question, do people have to die just so we ensure no grifting? paleotn Dec 14 #12
Got citations of people dying because of denials? There are plenty of cases where docs Silent Type Dec 14 #14
Hard to believe I'm having to defend this..... paleotn Dec 14 #17
Looked at Buzzfeed link, Silent Type Dec 14 #20
Words wasted on the wrong people. paleotn Dec 15 #40
Do you have a connection to the for-profit private health insurance industry? (no, not being a customer) Celerity Dec 15 #45
Bullshit choie Dec 15 #28
I work with many doctors Horse with no Name Dec 15 #44
Message auto-removed Name removed Dec 14 #16
I agree with your assessment. choie Dec 15 #29
Medicare would have paid the negotiated rate, not denied the care. Ms. Toad Dec 14 #23
American Academy of Otolarngology differs with your perception of need. Silent Type Dec 15 #50
I'm astounded you're continuing this Arazi Dec 15 #52
First - this has nothing to do with my perception of need. It was her doctor who made that assessment - the doctor Ms. Toad Dec 15 #56
So much effort to explain UHC, amazing. Passages Dec 15 #41
So much criminality is exposed in McNaughton's case. vanessa_ca Dec 15 #47
Absolutely. Passages Dec 15 #48
I just noticed your signature line. I love you lol. eom vanessa_ca Dec 15 #49
This is so painful to read that it leaves me with one question JMCKUSICK Dec 14 #6
As long as healthcare is a profit motivated "industry", the answer is to your question is yes. paleotn Dec 14 #10
Every component of our so-called health system takes a big cut. Heck, UHG donated significantly more to Dems Silent Type Dec 14 #13
As usual JMCKUSICK Dec 14 #18
Once again government failed us. While a big friggin deal, ACA is based totally upon private insurers. Why? Silent Type Dec 14 #22
Because Dems don't fight, they negotiate...with our lives JMCKUSICK Dec 15 #33
That's what I'm saying, Congress has failed us. Silent Type Dec 15 #51
"a million medical victim march on Washington" vanessa_ca Dec 15 #25
I'm sorry I can't hear you. I'm... lame54 Dec 14 #7
I hope she eventually got the surgery Meowmee Dec 14 #19
I wish they would showcase these stories Skittles Dec 14 #21
The Daily Mail? sheshe2 Dec 15 #31
Yes. I have better sources from independent outlets like ProPublica, however vanessa_ca Dec 15 #36
You don't need three OPs. sheshe2 Dec 15 #37
Because I am familiar with those three stories vanessa_ca Dec 15 #38
Since when were doctors not the authority on "medically necessary"? ColinC Dec 15 #34
Since when? Ask a woman who needs an abortion and can't get one. Autumn Dec 15 #42
Yeah, I have an old high school acquaintance, an MD who treats the LGBTQ community primarily Nittersing Dec 15 #43
Ask Greg Abbott, Ken Paxton and a host of other mostly male, GOP officials who are now overlords of the uterus. Vinca Dec 15 #46
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