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Otology/Neurotology

(129) Delays in Time to Treatment for Lateral Skull Base Defects

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • MM

    Maggie M. Mouzourakis, MD

    Resident Physician
    Dartmouth-Hitchcock Section of Otolaryngology
    Lebanon, New Hampshire, United States

    • Co-Author(s)

  • Peter Steinwald, MD

    Resident
    Tufts Medical Center
    Boston, Massachusetts, United States

  • AM

    Anne K. Maxwell, MD

    Assistant Professor
    University of Nebraska Medical Center Department of Otolaryngology-Head and Neck Surgery, Omaha, NE
    Omaha, Nebraska, United States

  • Ari Saravia, MD

    Resident
    University of Alabama Birmingham Department of Otolaryngology - Head and Neck Surgery, LSUHSC School of Medicine
    New Orleans, Louisiana, United States

  • Nicholas Mankowski, MD

    Otolaryngology-Head and Neck Surgery Resident
    Tulane University School of Medicine
    New Orleans, Louisiana, United States

  • AM

    Adam N. Master, MD

    Faculty at Tulane School of Medicine
    Ochsner Medical Center
    Shreveport, Louisiana, USA

    • Senior Author(s)

  • KN

    Kathryn Y. Noonan, MD

    Assistant Professor
    Tufts University School of Medicine, Department of Otolaryngology
    Boston, MA, United States

Disclosure(s):
Maggie M. Mouzourakis, MD: No relevant relationships to disclose.
Peter Steinwald, MD: No relevant relationships to disclose.
Anne K. Maxwell, MD: No relevant relationships to disclose.
Ari Saravia, MD: No relevant relationships to disclose.
Nicholas Mankowski, MD: No relevant relationships to disclose.


Introduction: Lateral skull base defects often pose a diagnostic challenge; however, early recognition and treatment are important to avoid sequelae. This study examines factors associated with time to diagnosis and treatment for patients with lateral skull base defects (LSBD), with attention to known factors that impact health care disparities.

Methods: This is a multi-institutional retrospective cohort study at four US tertiary centers from 2000-2022, examining factors associated with delay in diagnosis and treatment of LSBD. Multivariate regressions were used to analyze how age, sex, race/ethnicity, insurance, language, zip code, distance to medical center, referral patterns, diagnostic work-up and clinical course affected time to diagnosis and treatment.

Results: In 122 patients with LSBD, mean time to treatment of CSF leak or encephalocele was 13.5 months. Fifty-five (45%) people had private insurance. The average travelled distance for care was 61.8 miles. On average, patients waited 10.2 months from initial assessment to diagnosis and saw 2 providers prior to diagnosis. Six patients(5%) had work-ups that spanned over 5 years; median time to diagnosis was 10 months. Approximately 90% (110) of patients had a CT scan, and 74% (90) had an MRI. Imaging did not influence time to treatment. Older age and number of providers seen were associated with delays (P < 0.05). Non-English speakers (5% of 122) encountered significant treatment delays (P < 0.05). Race, insurance status, distance travelled, zip code, imaging, myringotomy, beta-2 transferrin, ED work-up and the COVID-19 pandemic were not found to be significantly associated with time to treatment.

Conclusions: Although travel distance to a neurotologist did not cause delays in management of LSBD, referral patterns did influence care. Language barriers may also contribute to delays in treatment.