Previous studies have suggested that musculoskeletal symptoms are common among practicing otolaryngologists. Early training can be the ideal time to foster knowledge of ergonomics and develop safe work habits, however, little data exists regarding musculoskeletal symptoms in residents. The purpose of this study was to identify and characterize musculoskeletal symptoms in a preliminary sample of otolaryngology residents.
http://ift.tt/2jEkBf3
A case of nasal septal perforation secondary to systemic bevacizumab therapy for ovarian cancer is reported. Bevacizumab is a vascular endothelial growth factor A (VEGF-A) inhibitor that is becoming more widely utilized in the oncologic community. There is only one prior report of septal perforation secondary to bevacizumab in the Otolaryngology specific literature. The purpose of this report is: 1) to raise awareness and discuss the literature surrounding the sinonasal complications of bevacizumab and 2) provide workup and treatment recommendations based on the sum of the available literature.
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To evaluate the long-term efficacy of endolymphatic sac shunt techniques with and without local steroid administration.
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To quantify the potential effectiveness of cochlear implantation for tinnitus suppression in patients with single-sided deafness using the Tinnitus Handicap Inventory.
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Cochlear implant is a viable rehabilitation option for sensorineural hearing loss in post-irradiated patients [1,2]. The retro-cochlear auditory pathways appear to remain functionally intact in the long term in patients who have had irradiation for nasopharyngeal carcinoma, [3] and the overall hearing outcomes post-cochlear implant were similar in post-irradiated patients and patients who had no prior irradiation [4].
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Unilateral sphenoid sinus opacification (SSO) on imaging is a common incidental radiologic finding. Inflammatory sinus disease is rarely isolated to one sinus cavity therefore SSO raises the potential for neoplastic etiology. The clinical significance of SSO was evaluated and compared to maxillary sinus opacification (MSO).
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Many head and neck surgical procedures are considered clean-contaminated wounds and antibiotic prophylaxis is recommended. Despite prophylaxis, the incidence of surgical site infections remains significant – especially in the setting of free tissue transfer. The antibiotic course is often of a longer duration after free tissue transfer than the recommended 24 hours post-operatively. Currently, there is no consensus on appropriate antibiotic regimen or duration at this time. This study investigates the outcomes of a 7-day perioperative antibiotic regimen after microvascular reconstruction of the head and neck at our institution.
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To explore surgical timing of facial paralysis after temporal bone trauma.
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A 40-year-old woman with a history of 2 episodes of corticosteroid-responsive angioedema without urticaria presented to the allergy clinic for evaluation of recurrent angioedema after a third episode. Her medical history was significant for papillary thyroid carcinoma that required anterior neck dissection and radiation as well as epithelioid hemangioendothelioma of the right internal jugular vein that required resection and graft placement. Her first episode of laryngeal edema occurred while she was completing radiation treatment 10 months earlier and was accompanied by 1 day of shortness of breath and stridor that required admission to the intensive care unit.
http://ift.tt/2iQ83wR
Chronic urticaria and angioedema are skin diseases marked by the daily or almost daily occurrence of urticaria and/or angioedema for longer than 6 weeks. Although drug, food, aeroallergen, contact allergen, thyroid autoimmunity, and vitamin D associations and autoantibodies to the high affinity immunoglobulin E (IgE) receptor or free IgE might be discovered, in most cases the etiology remains idiopathic.1,2 Women represent most cases of chronic urticaria.
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Adolescents with asthma are at risk of poor outcomes and are traditionally difficult to reach.
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Vivienne Woo | Theresa Alenghat
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A significant proportion of patients with American Joint Committee on Cancer (AJCC)-defined early-stage cutaneous melanoma have disease recurrence and die. A 31-gene expression profile (GEP) that accurately assesses metastatic risk associated with primary cutaneous melanomas has been described.
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Publication date: Available online 18 January 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Mokhtar Abdel Khalek Bassiouni, Mohamed Bassiouni Atalla, Ahmed Amin Omran, Mohamed Eid Ibrahim, Iman Mamdouh Talaat, Al Nagy Ibreak Abdel Kader
ObjectivesNon-echoplanar imaging (Non-EPI) MRI has been recently introduced to improve the detection of small sized cholesteatoma and decrease different artifacts occurring in the echo-planar diffusion weighted image (EPI DWI) technique. It is a time saving procedure in comparison to the delayed post-contrast imaging. We prospectively assessed the diagnostic accuracy of Non-EPI-DW sequences in the detection of middle ear cleft cholesteatoma.Material and methodsForty patients suspected to have cholesteatoma were collected from the ENT outpatient clinic of a tertiary referral center. Twenty patients underwent primary mastoid surgery, ten patients scheduled for revision mastoid surgery, while the remaining patients underwent second look operation after one year of their first surgery. All patients underwent Non-EPI-DW sequences prior to their planned surgery. Diagnosis of cholesteatoma was based on evidence of a hyperintense lesion on diffusion-weighted images that were correlated with the surgical findings and histopathological examination, which was used as the gold standard for diagnostic confirmation. Sensitivity, specificity and predictive values of MRI were estimated.ResultsDiffusion weighted imaging accurately predicted the presence of cholesteatoma in 88.2% of cases, and it correctly excluded it in 100% of cases. Sensitivity, specificity, positive and negative predictive values were 88.24%, 100%, 100% and 60%, respectively. Non-echo-planar DWI has been shown to have a high sensitivity and specificity for detecting recurrent cholesteatoma.ConclusionsNon-echoplanar DWI is an effective technique in cholesteatoma diagnosis. It is capable of detecting lesions larger than 2mm.
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In a stimulating new Roundtable Discussion, a distinguished panel of leading physicians and clinical researchers highlight the key changes, new topics, and areas of ongoing controversy in the "2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis." The Roundtable Discussion and the American Thyroid Association (ATA) guidelines are available free on the website of Thyroid, the official peer-reviewed journal of the ATA, published by Mary Ann Liebert, Inc., publishers.
Led by Moderator Douglas S. Ross, MD, Harvard Medical School and Massachusetts General Hospital, Boston, the Roundtable features panelists Victor J. Bernet, MD, Mayo Clinic and Mayo Clinic College of Medicine, Jacksonville, FL; David S. Cooper, MD, The Johns Hopkins University School of Medicine, Baltimore, MD; Gilbert Daniels, MD, Harvard Medical School and Massachusetts General Hospital; Jacqueline Jonklaas, MD, PhD, Georgetown University, Washington, DC; John C. Morris, MD, Mayo Clinic, Rochester, MN; Elizabeth N. Pearce, MD, Boston University School of Medicine; Mary Samuels, MD, Oregon Health & Science University, Portland; and Julie Ann Sosa, MD, MA, Duke Cancer Institute and Duke Clinical Research Institute, Duke University, Durham, NC.
The panelists, all members of the American Thyroid Association and some of whom were on the task force that developed the previous management guidelines in 2011, highlighted the major changes in the 2016 guidelines, which included an increase in the number of recommendations from 100 to 124 and an expanded focus on more unusual cases of thyrotoxicosis. The spirited and informative discussion also focused on important changes in the new guidelines, including new paradigms for determining the etiology of thyrotoxicosis, new approaches to monitor response to anti-thyroid drugs such as measures of thyrotropin receptor antibodies, new data supporting the safety of long-term use of anti-thyroid drugs, and new approaches to manage hyperthyroidism in women who want to become pregnant.
"These guidelines provide a significant update compared to the previous version published in 2011 because they integrate recent studies and developments in practice trends. They form a detailed and balanced framework for the diagnosis and management of patients with different etiologies of thyrotoxicosis that is based on the currently available evidence," says Peter A. Kopp, MD, Editor-in-Chief of Thyroid and Professor of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago.
"The updated guidelines have refined several important aspects of diagnosis and management of patients with hyperthyroidism based upon new knowledge and technology. The panel's discussion focused upon several of the more common issues regarding application of new recommendations. I found it to be both simulating and informative." says John C. Morris, MD, President of the American Thyroid Association, Professor of Medicine, Mayo Clinic, Rochester, Minnesota.
The Roundtable was supported by Quidel.
About the Journal
Thyroid, the official journal of the American Thyroid Association, is an authoritative peer-reviewed journal published monthly online with open access options and in print. The Journal publishes original articles and timely reviews that reflect the rapidly advancing changes in our understanding of thyroid physiology and pathology, from the molecular biology of the cell to clinical management of thyroid disorders. Complete tables of content and a sample issue may be viewed on the Thyroid website. The complete Thyroid Journal Program includes the highly valued abstract and commentary publication Clinical Thyroidology, led by Editor-in-Chief Jerome M. Hershman, MD and published monthly, and the groundbreaking videojournal companion VideoEndocrinology, led by Editor Gerard Doherty, MD and published quarterly. Complete tables of content and sample issues may be viewed on the Thyroid website.
About the Society
The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 94th anniversary, the ATA delivers its mission — of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health — through several key endeavors: the publication of highly regarded professional journals, Thyroid, Clinical Thyroidology, and VideoEndocrinology; annual scientific meetings; research grant programs for young investigators, biennial clinical and research symposia; support of online professional, public and patient educational programs; and the development of guidelines for clinical management of thyroid disease and thyroid cancer. The ATA promotes thyroid awareness and information through its online Clinical Thyroidology for the Public (distributed free of charge to over 11,000 patients and public subscribers) and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet.
About the Publisher
Mary Ann Liebert, Inc., publishers is a privately held, fully integrated media company known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research, including Diabetes Technology & Therapeutics, Journal of Women's Health, and Metabolic Syndrome and Related Disorders. Its biotechnology trade magazine, Genetic Engineering & Biotechnology News (GEN), was the first in its field and is today the industry's most widely read publication worldwide. A complete list of the firm's more than 80 journals, books, and newsmagazines is available on the Mary Ann Liebert, Inc., publishers website.
The post American Thyroid Association Experts Debate Benefits and Challenges of New ATA Guidelines for Managing Hyperthyroidism and Thyrotoxicosis appeared first on American Thyroid Association.
<span class="paragraphSection"><span style="font-style:italic;">Surgical Pain Management: A Complete Guide to Implantable and Interventional Pain Therapies</span>, NarangS, WeisheiplA and RossEL (editors). Published by Oxford University Press. Pp. 408. Price $115. ISBN 978-0-19-937737-4</span>
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<span class="paragraphSection"><strong>Background.</strong> Evidence suggests that endothelial dysfunction in the early postoperative period promotes myocardial injury after non-cardiac surgery. The aim of this study was to investigate the impact of colon cancer surgery on endothelial function and the association with the l-arginine-nitric oxide pathway postoperatively.<strong>Methods.</strong> Patients undergoing elective colon cancer surgery (n = 31) were included in this prospective observational cohort study. Endothelial function, as measured using the reactive hyperaemia index (RHI), was assessed non-invasively using digital pulse tonometry. RHI and plasma concentrations of L-arginine, asymmetric dimethylarginine (ADMA), dihydrobiopterin and biopterin metabolites, tetrahydrobiopterin (BH4) and total biopterin were measured before surgery, at four h after surgery and at postoperative day one and two. Cardiac troponin I was measured before surgery and once daily on postoperative days one to four.<strong>Results.</strong> Preoperative RHI was 1.86 (1.64 – 2.11) and decreased significantly during the observation period (linear mixed effects model of serial measurements, <span style="font-style:italic;">P = </span>0.015). Both L-arginine (<span style="font-style:italic;">P</span> < 0.001) and ADMA (<span style="font-style:italic;">P = </span>0.024) decreased during the postoperative period. All biopterin metabolites were significantly decreased after surgery. A significant positive correlation was found between logAUC(l-arginine/ADMA) and logAUC(RHI) (<span style="font-style:italic;">P = </span>0.015) and between logAUC(L-arginine/ADMA) and logAUC(BH4) (<span style="font-style:italic;">P = </span>0.015). None of the patients had cardiac troponin I elevations.<strong>Conclusions.</strong> RHI was attenuated in the first days after colon cancer surgery indicating acute endothelial dysfunction. Endothelial dysfunction correlated with disturbances in the L-arginine – nitric oxide pathway. Our findings provide a rationale for investigating the hypothesized association between acute endothelial dysfunction and cardiovascular complications after non-cardiac surgery.<strong>Clinical trial registration.</strong> NCT02344771.</span>
http://ift.tt/2jEOhIz
<span class="paragraphSection"><span style="font-style:italic;">Advances in Anesthesia</span>. McLoughlinTM, SalinasFV and TorsherL (editors). Published by Elsevier. Pp. 213. Price $175. ISBN 978-0-323-35605-3</span>
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<span class="paragraphSection">The increased popularity of paravertebral block (PVB) can be attributed to its relative safety and comparable efficacy when compared with epidural analgesia. It has thus been recommended for open cholecystectomy and other less painful surgeries such as inguinal herniorraphy and appendectomy. We performed a systematic review of PVB in paediatric abdominal conditions to assess its clinical efficacy and side effects compared with other analgesic therapies.A search of Medline, Embase, and Web of Science and hand-searching references from inception date to May 2016 was done. Relevant studies were randomized clinical trials in patients 0–18 years old comparing PVB (single shot or continuous catheter) with any comparator and analgesic medication. Pain scores, rescue analgesia and adverse events were compared.The systematic reviews identified six trials enrolling 358 paediatric patients. PVB medications included bupivacaine, ropivacaine, lidocaine, and fentanyl. Surgical procedures included inguinal herniorraphy, cholecystectomy, and appendectomy. The standardized mean difference in early pain scores favoured PVB: 0.85 [95% confidence interval (CI) 0.12–1.58] at 4–6 h and 0.64 (95% CI 0.28–1.00) at 24 h. One study reported a reduced length of stay. Parental [odds ratio (OR) 5.12 (95% CI 2.59–10.1)] and surgeon [OR 6.05 (95% CI 2.25–16.3)] satisfaction were higher in those receiving a PVB. No major complications occurred with a PVB.PVB resulted in minimally improved pain scores for up to 24 h after surgery, reduced rescue analgesia requirements, and increased surgeon and parental satisfaction. PVB is a good alternative to caudal and ilioinguinal block in paediatric abdominal surgery.</span>
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<span class="paragraphSection">Dating back at least to the early report of Charles Mayo in 1927, phaeochromocytoma, a catecholamine-secreting tumour of adrenal chromaffin cells, has been considered a surgically curable cause of hypertension.<a href="#aew414-B1" class="reflinks"><sup>1</sup></a> In the first half of the 20th century, however, the provision of anaesthesia for a laparotomy and resection of adrenal phaeochromocytoma and the related paraganglionoma (a tumour of extra-adrenal chromaffin tissue) was one of the greatest challenges faced by members of the fledgling specialty.<a href="#aew414-B2" class="reflinks"><sup>2–4</sup></a> Thirty years ago in the <span style="font-style:italic;">British Journal of Anaesthesia</span>, Hull<a href="#aew414-B5" class="reflinks"><sup>5</sup></a> reflected further back to the early days of phaeochromocytoma surgery when perioperative mortality was as high as 30–45%.</span>
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<span class="paragraphSection"><strong>Background.</strong> Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) was introduced to adult anaesthesia to improve the safety of airway management during apnoea before intubation. The objective of our study was to determine whether THRIVE safely prolongs apnoeic oxygenation in children.<strong>Methods.</strong> This was a randomized controlled trial in 48 healthy children, with normal airways and cardiorespiratory function, in age groups 0–6 and 7–24 months, 2–5 and 6–10 yr old, presenting for elective surgery or imaging under general anaesthesia. All children were induced with sevoflurane, O<sub>2</sub>, and N<sub>2</sub>O, followed by muscle relaxation with rocuronium, and standardized preoxygenation with bag-and-mask ventilation. The control arm received jaw support during apnoea, whereas the THRIVE arm received jaw support during apnoea and age-specific flow rates. The primary outcome was to demonstrate that children allocated to THRIVE maintain transcutaneous haemoglobin saturation at least twice as long as the expected age-dependent apnoea time in the control group.<strong>Results.</strong> Both study arms (each <span style="font-style:italic;">n</span>=24) were similar in age and weight. The apnoea time was significantly shorter in the control arm: average 109.2 (95% CI 28.8) s in the control arm and 192 s in the THRIVE arm (0–6 months), 147.3 (95% CI 18.9) and 237 s (7–24 months), 190.5 (95% CI 15.3) and 320 s (2–5 yr), and 260.8 (95% CI 37.5) and 430 s (6–10 yr), respectively. Average transcutaneous haemoglobin saturation remained at 99.6% (95% CI 0.2) during THRIVE. Transcutaneous CO<sub>2</sub> increased to a similar extent in both arms, with 2.4 (95% CI 0.5) mm Hg min<sup>−1</sup> for the control arm and 2.4 (95% CI 0.4) mm Hg min<sup>−1</sup> for the THRIVE arm.<strong>Conclusion.</strong> Transnasal humidified rapid-insufflation ventilatory exchange prolongs the safe apnoea time in healthy children but has no effect to improve CO<sub>2</sub> clearance.<strong>Clinical trial registration.</strong> ACTRN12615001319561.</span>
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<span class="paragraphSection">Central venous cannulation is a standard practice for any major surgery and intensive care unit admission entailing major haemodynamic effects, blood loss, administration of fluids and vasoactive drugs, and central venous pressure monitoring.<a href="#aew443-B1" class="reflinks"><sup>1</sup></a> The internal jugular vein (IJV) or subclavian vein is the preferred route for this purpose. Hitherto, the practice regarding the length of insertion of the central venous catheter (CVC) has not conformed to any fixed guidelines.<a href="#aew443-B2" class="reflinks"><sup>2</sup></a> One of the dreaded complications of CVC placement is cardiac tamponade as a result of perforation of the vessel or the cardiac chamber, which carries a high mortality.<a href="#aew443-B3" class="reflinks"><sup>3</sup></a><a href="#aew443-B4" class="reflinks"><sup>4</sup></a> The US Food and Drug Administration recommends that the CVC tip should not be located in or allowed to migrate into the heart to avert this catastrophic complication.<a href="#aew443-B5" class="reflinks"><sup>5</sup></a> Owing to this, it is believed that the tip of the catheter should be placed in the middle superior vena cava (SVC), outside the pericardial reflection enveloping the lower SVC. This corresponds to the level of the carina, ∼2 cm above the junction of the SVC and the right atrium (RA).<a href="#aew443-B2" class="reflinks"><sup>2</sup></a><a href="#aew443-B4" class="reflinks"><sup>4</sup></a><a href="#aew443-B6" class="reflinks"><sup>6</sup></a></span>
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<span class="paragraphSection">Editor—We thank Dr Molokhia for his interest in our editorial<a href="#aew454-B1" class="reflinks"><sup>1</sup></a>. We too had acknowledged the limitation of waist circumference (WC) in not being able to differentiate between visceral and subcutaneous fat. Indeed, all anthropometric indices of abdominal adiposity are subject to inaccuracies. This applies to both WC and sagittal abdominal diameter (SAD) owing to the different anatomical locations adopted for measurements<a href="#aew454-B1" class="reflinks"><sup>1</sup></a> and lack of evidence on optimal cut-offs. The intention of our editorial was to highlight some of the drawbacks of BMI and to suggest a suitable alternative that can be of similar practical utility to BMI in the perioperative setting. Waist circumference can be measured with a simple measuring tape rather than needing specialized abdominal callipers or any expensive methods, such as computed tomography or magnetic resonance imaging. In fact, both WC and SAD have been found to be correlated strongly with visceral adipose tissue at the abdominal level<a href="#aew454-B3" class="reflinks"><sup>3</sup></a> and cardiometabolic risk factors.<a href="#aew454-B2" class="reflinks"><sup>2</sup></a> Moreover, another study found no advantage of SAD over other simpler measures, such as WC.<a href="#aew454-B4" class="reflinks"><sup>4</sup></a> Hence, until further large-scale robust research provides conclusive evidence of the superiority of SAD, WC is just as good and simpler than SAD to incorporate in routine perioperative evaluation.</span>
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<span class="paragraphSection">In this issue of the <span style="font-style:italic;">BJA</span>, Humphreys and colleagues<a href="#aew432-B1" class="reflinks"><sup>1</sup></a> present their data on the use of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) (Fisher and Paykel Healthcare, Auckland, New Zealand) in children. THRIVE is a technique that uses rapidly insufflated, heated, humidified gases administered via high flow nasal cannula (HFNC) to achieve apnoeic oxygenation and ventilation. This is the first study to demonstrate that THRIVE is effective in prolonging the safe apnoeic time in children during airway management. The purpose of this editorial is to explore the processes contributing to oxygenation and ventilation achieved through THRIVE, and to discuss future applications for this potentially promising ventilatory technique.</span>
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<span class="paragraphSection"><strong>Background.</strong> Mortality associated with surgery for phaeochromocytoma has dramatically decreased over the last decades. Many factors contributed to the dramatic decline of the mortality rate, and the influence of an α-receptor blockade is unclear and has never been tested in a randomized trial. We evaluated intraoperative haemodynamic conditions and the incidence of complications in patients with and without α-receptor blockade undergoing surgery for catecholamine producing tumours.<strong>Methods.</strong> Haemodynamic conditions and perioperative complications were assessed in 110 patients with (B) and 166 without (N) α-receptor blockade. Data were analysed as a consecutive case series of 303 cases and subsequently via propensity score matching, and presented as mean and confidence interval (CI).<strong>Results.</strong> No difference in maximal intraoperative systolic arterial pressures (B = 178 mm Hg (CI 169-187) <span style="font-style:italic;">vs</span> N = 185 mm Hg (CI 177-193; <span style="font-style:italic;">P</span> = 0.2542) and hypertensive episodes above 250 mm Hg were found (<span style="font-style:italic;">P</span> = 0.7474) for the closed case series. No major complications occurred. Propensity score matching (75 pairs) revealed a significant difference of 17 mm Hg in maximal intraoperative systolic bp for these selected pairs (<span style="font-style:italic;">P</span> = 0.024).<strong>Conclusions.</strong> Only a slight difference in mean maximal systolic arterial pressure was detected between patients with or without an α-receptor blockade. There was no difference in the incidence of excessive hypertensive episodes between groups and no major complications occurred. The basis for the general recommendation of perioperative α- receptor blockade for phaeochromocytoma surgery demands further study.</span>
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<span class="paragraphSection">A number of countries have developed, at national or state level, quality registries that contain individualised data on patient characteristics, health status, medical interventions and outcomes after treatment.<a href="#aew433-B1" class="reflinks"><sup>1</sup></a><a href="#aew433-B2" class="reflinks"><sup>2</sup></a> These registries offer new opportunities to perform large-scale population-based studies in the field of perioperative medicine.</span>
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<span class="paragraphSection"><strong>Background.</strong> The lower superior vena cava (SVC), near its junction with the right atrium (RA), is considered the ideal location for the central venous catheter tip to ensure proper function and prevent injuries. We determined catheter insertion depth with a new formula using the sternoclavicular joint and the carina as radiological landmarks, with a 1.5 cm safety margin. The accuracy of tip positioning with the radiological landmark-based technique (R) and Peres' formula (P) was compared using transoesophageal echocardiography.<strong>Methods.</strong> Real-time ultrasound-guided central venous catheter insertion was done through the right internal jugular or subclavian vein. Patients were randomly assigned to either the P group (<span style="font-style:italic;">n</span>=93) or the R group (<span style="font-style:italic;">n</span>=95). Optimal catheter tip position was considered to be within 2 cm above and 1 cm below the RA–SVC junction. Catheter tip position, abutment, angle to the vascular wall, and flow stream were evaluated on a bicaval view.<strong>Results.</strong> The distance from the skin insertion point to the RA–SVC junction and determined depth of catheter insertion were more strongly correlated in the R group [17.4 (1.2) and 16.7 (1.5) cm; <span style="font-style:italic;">r</span>=0.821, <span style="font-style:italic;">P</span><0.001] than in the P group [17.3 (1.2) and 16.4 (1.1) cm; <span style="font-style:italic;">r</span>=0.517, <span style="font-style:italic;">P</span><0.001], with <span style="font-style:italic;">z</span>=3.96 (<span style="font-style:italic;">P</span><0.001). More tips were correctly positioned in the R group than in the P group (74 <span style="font-style:italic;">vs</span> 93%, <span style="font-style:italic;">P</span>=0.001). Abutment, tip angle to the lateral wall >40°, and disrupted flow stream were comparable.<strong>Conclusions.</strong> Catheter tip position was more accurate with a radiological landmark-based technique than with Peres' formula.<strong>Clinical trial registration.</strong> Clinical Trial Registry of Korea: <a href="http://ift.tt/1JTfppE">http://ift.tt/2jEyARP; KCT0001937.</span>
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<span class="paragraphSection">Patients undergoing ophthalmic procedures, including cataract, glaucoma, and vitreoretinal surgeries, are often elderly with significant co-morbidities. Regional anaesthesia (RA) techniques are commonly used unless general anaesthesia is preferred or specifically indicated. Some of these patients may be receiving antithrombotics for serious medical conditions. Antithrombotics are drugs that reduce blood clot formation, such as aspirin, oral anticoagulants, antiplatelet agents, or novel oral anticoagulants (NOACs). Clinical effects of some antithrombotics with longer half-lifes may take days to wane. Time may not be available to stop these agents if surgery is urgent; therefore, specific measures are undertaken to antagonize their effects.</span>
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<span class="paragraphSection"><strong>Background.</strong> The operating theatre, anaesthesia induction and separation from parents create fear and anxiety in children. Anxiety leads to adverse behavioral changes appearing and sometimes persisting during the postoperative period. Our aim was to compare the effects of midazolam (0.3 mg kg<sup>−</sup><sup>1</sup>: MDZ) for premedication with age-appropriate tablet game apps (TAB) on children anxiety during and after ambulatory surgery.<strong>Methods.</strong> A randomized controlled trial was conducted from May 16th, 2013 to March 25th, 2014 at the Children Hospital of Lyon. The primary outcome of this study was the change in m-YPAS score at the time of anaesthetic mask induction. Anxiety was also assessed in the waiting surgical area, at the time of separation with parents and when back in the ambulatory surgery ward.<strong>Results.</strong> One hundred and eighteen patients aged four-11 yr were recruited, 60 in the TAB Group and 58 in the MDZ Group. Main endpoint was missing for three patients from the MDZ Group. At the time of mask induction, there was no significant difference between MDZ and TAB Group for the m-YPAS score (40.5 (18.6) <span style="font-style:italic;">vs</span> 41.8 (20.7), <span style="font-style:italic;">P</span> = 0.99). There was no significant correlation between m-YPAS score and its evolution over the four period of time between subjects.<strong>Conclusions.</strong> We were not able to show whether TAB is superior to MDZ to blunt anxiety in children undergoing ambulatory surgery. TAB is a non-pharmacological tool which has the capacity in reducing perioperative stress without any sedative effect in this population.<strong>Clinical trial registration.</strong> NCT 02192710</span>
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<span class="paragraphSection">Editor—Effective treatment of perioperative hyperglycaemia has proved difficult.<a href="#aew455-B1" class="reflinks"><sup>1</sup></a> Continuous glucose monitoring (CGM) might improve perioperative treatment without increasing the risk of hypoglycaemia.<a href="#aew455-B2" class="reflinks"><sup>2</sup></a> The reported accuracy of current CGM via central and peripheral venous sampling is 5.6–7.5%.<a href="#aew455-B3" class="reflinks"><sup>3</sup></a><a href="#aew455-B4" class="reflinks"><sup>4</sup></a> In this pilot study, we investigated the efficacy of perioperative CGM via peripheral i.v. sampling in patients with diabetes mellitus (DM) type 2 compared with standard care. We hypothesized that the availability of CGM data during surgery would lower postoperative glucose values.</span>
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<span class="paragraphSection">Editor—Waist circumference is at least as good an indicator of total body fat as BMI<a href="#aew453-B1" class="reflinks"><sup>1</sup></a> or skin fold thicknesses.<a href="#aew453-B2" class="reflinks"><sup>2</sup></a> It does not, however, distinguish visceral from subcutaneous abdominal adipose tissue.<a href="#aew453-B3" class="reflinks"><sup>3</sup></a></span>
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<span class="paragraphSection">Editor—Health-care quality is being measured in ways beyond morbidity and mortality and now includes patient satisfaction. This often difficult-to-define quality is described as the degree to which medical services achieve patient-desired health outcomes consistent with their current medical knowledge.<a href="#aew456-B1" class="reflinks"><sup>1</sup></a> Patient-reported satisfaction data have become a surrogate for determining whether desired health outcomes have been met. As physicians, we strive for positive patient experiences while providing the highest quality of evidence-based care.</span>
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<span class="paragraphSection">Editor—Usually, ketamine is dissolved in saline and administered i.v. or i.m. Alternative routes, such as oral, nasal, and rectal administration, have been described for less resource-consuming and painless administration.<a href="#aew457-B1" class="reflinks"><sup>1</sup></a><a href="#aew457-B2" class="reflinks"><sup>2</sup></a> We explored the safety and feasibility of delivery of ketamine by inhalation. Advantages of this route include rapid delivery and absorption into the systemic circulation and the possibility of ketamine administration outside the hospital setting because no i.v. access line is required. The study was performed in healthy volunteers of either sex (aged 18–40 yr, BMI <30 kg m<sup>−2</sup>) after approval by the local human ethics committee and after receiving written informed consent from participants. The study was registered at the Dutch trial registry (NTR 5358).</span>
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<span class="paragraphSection"><strong>Background.</strong> Dexmedetomidine has been proposed as a perineural local anaesthetic (LA) adjunct to prolong peripheral nerve block duration; however, results from our previous meta-analysis in the setting of brachial plexus block (BPB) did not support its use. Many additional randomized trials have since been published. We thus conducted an updated meta-analysis.<strong>Methods.</strong> Randomized trials investigating the addition of dexmedetomidine to LA compared with LA alone (Control) in BPB for upper extremity surgery were sought. Sensory and motor block duration, onset times, duration of analgesia, analgesic consumption, pain severity, patient satisfaction, and dexmedetomidine-related side-effects were analysed using random-effects modeling. We used ratio-of-means (lower confidence interval [point estimate]) for continuous outcomes.<strong>Results.</strong> We identified 32 trials (2007 patients), and found that dexmedetomidine prolonged sensory block (at least 57%, <span style="font-style:italic;">P</span> < 0.0001), motor block (at least 58%, <span style="font-style:italic;">P</span> < 0.0001), and analgesia (at least 63%, <span style="font-style:italic;">P < </span>0.0001) duration. Dexmedetomidine expedited onset for both sensory (at least 40%, <span style="font-style:italic;">P < </span>0.0001) and motor (at least 39%, <span style="font-style:italic;">P < </span>0.0001) blocks. Dexmedetomidine also reduced postoperative oral morphine consumption by 10.2mg [-15.3, -5.2] (<span style="font-style:italic;">P < </span>0.0001), improved pain control, and enhanced satisfaction. In contrast, dexmedetomidine increased odds of bradycardia (3.3 [0.8, 13.5](<span style="font-style:italic;">P = </span>0.0002)), and hypotension (5.4 [2.7, 11.0] (<span style="font-style:italic;">P < </span>0.0001)). A 50-60µg dexmedetomidine dose maximized sensory block duration while minimizing haemodynamic side-effects. No patients experienced any neurologic sequelae. Evidence quality for sensory block was high according to the GRADE system.<strong>Conclusions.</strong> New evidence now indicates that perineural dexmedetomidine improves BPB onset, quality, and analgesia. However, these benefits should be weighed against increased risks of motor block prolongation and transient bradycardia and hypotension.</span>
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Background: Preservatives are known causes of allergic contact dermatitis. Objective: The aim of this study was to determine the prevalence of preservatives in each product category in the Contact Allergen Management Program and compare prevalence with reported rates of allergic contact dermatitis. Methods: Contact Allergen Management Program product information was queried based on the 53 approved preservatives for cosmetic products by the European Union and Association of Southeast Asian Nations plus 5 additional preservatives used in US products. Results: Phenoxyethanol and parabens were the most common preservatives with 23.9% of products containing phenoxyethanol and 20.75% of products containing parabens. Methylisothiazolinone (MI) was found in 12.9% of products, most commonly in hair care and household products. Preservatives like MI and methylchloroisothiazolinone (MCI) that are both common in products and have a high incidence of allergic contact dermatitis are of greatest concern as contact allergy hazards. Phenoxyethanol and parabens are common and have weak sensitizing power, making them preferred preservatives. Conclusions: Evaluating the prevalence of preservatives provides important information on allergen exposures. Using current positive reaction rates, the risk of sensitization to a given preservative can be more accurately estimated and may affect the use of certain preservatives by industry in the future.
Ecologically sound because they are synthesized from natural and renewable sources, the mild surfactants alkyl glucosides are being rediscovered by the cosmetic industry. They are currently found in rinse-off products such as shampoos, liquid cleansers, and shower gels, but also in leave-on products that include moisturizers, deodorants, and sunscreens. During the past 15 years, numerous cases of allergic contact dermatitis have been published, mostly to lauryl and decyl glucosides, and these compounds are considered emergent allergens. Interestingly, the sunscreen Tinosorb M contains decyl glucoside as a hidden allergen, and most cases of allergic contact dermatitis reported to this sunscreen ingredient are probably due to sensitization to decyl glucoside. This article will review the chemistry of alkyl glucosides, their sources of exposure, as well as their cutaneous adverse effects reported in the literature and encountered in various patch testing centers.
Background: Allergic perineal dermatitis (PD) due to diaper wipes, topical medicaments, or diapers has been reported. Although patch testing is the criterion standard for detection of allergic contact dermatitis in children, this is limited by body surface area, decreased tolerance of the patch testing procedure, and increased false-positive rates due to irritant reactions. Therefore, a targeted patch testing series is necessary to better screen diapered infants for possible allergic PD. Objective: We propose 2 patch test series (PD series 1 and 2) to screen infants with possible allergic PD. Methods: Allergens are chosen using existing sensitization data of common allergens in children, published case reports, and the collective experience of American Contact Dermatitis Society members through an electronic survey. Results: PD series 1 includes 23 potential allergens found in wet wipes and topical diaper preparations. PD series 2 contains 10 potential allergens most commonly found in diapers. Conclusions: We believe that these judiciously chosen patch test series will increase the yield of detecting the causes of allergic PD while not exposing children to an unnecessarily large screening patch test panel.
In this article, some aspects of sandalwood oil, ylang-ylang oil, and jasmine absolute are discussed including their botanical origin, uses of the plants and the oils and absolute, chemical composition, contact allergy to and allergic contact dermatitis from these essential oils and absolute, and their causative allergenic ingredients.
The skin serves as the foremost barrier between the internal body and the external world, providing crucial protection against pathogens and chemical, mechanical, and ultraviolet damages. The skin is a central player in the intricate network of immune, neurologic, and endocrine systems. The endocannabinoid system (ECS) includes an extensive network of bioactive lipid mediators and their receptors, functions to modulate appetite, pain, mood, and memory, and has recently been implicated in skin homeostasis. Disruption of ECS homeostasis is implicated in the pathogenesis of several prevalent skin conditions. In this review, we highlight the role of endocannabinoids in maintaining skin health and homeostasis and discuss evidence on the role of ECS in several eczematous dermatoses including atopic dermatitis, asteatotic eczema, irritant contact dermatitis, allergic contact dermatitis, and chronic pruritus. The compilation of evidence may spark directions for future investigations on how the ECS may be a therapeutic target for dermatologic conditions.
Background: Although there are several case reports of wet wipe–associated contact dermatitis, the prevalence of wipes as a source of allergic contact dermatitis in larger populations and the responsible allergens are largely unknown. Objective: The aim of the study was to determine the prevalence of wet wipes as a source of contact allergy and the most commonly associated allergens in a North American tertiary referral patch test population. Methods: Data collected from 2011 to 2014 by the North American Contact Dermatitis Group was used to conduct a retrospective cross-sectional analysis of patient demographics and patch test results associated with the triple-digit source code for "wet wipe." Results: Of the 9037 patients patch tested during the study period, 79 (0.9%) had a positive patch test reaction to an allergen identified with a wet wipe source. The most commonly associated allergens were preservatives, including the following: methylisothiazolinone (MI) (59.0%), methylchloroisothiazolinone (MCI)/MI (35.6%), bronopol (2-bromo-2-nitropropane-1,3-diol) (27.4%), and iodopropynyl butylcarbamate (12.3%). Fragrance (combined) represented 12.3%. Anal/genital dermatitis was 15 times more likely (P
Background: Patch testing is the most important diagnostic tool for the assessment of allergic contact dermatitis. Objective: This study documents the North American Contact Dermatitis Group (NACDG) patch testing results from January 1, 2013, to December 31, 2014. Methods: At 13 centers in North America, patients were tested in a standardized manner with a screening series of 70 allergens. Data were manually verified and entered into a central database. Descriptive frequencies were calculated, and trends were analyzed using χ2 test. Results: A total of 4871 patients were tested. There were 3255 patients (66.8%) who had at least 1 positive reaction and 2412 patients (49.5%) who were ultimately determined to have a primary diagnosis of allergic contact dermatitis. A total of 434 patients (8.9%) had occupationally related skin disease. There were 9726 positive allergic reactions. Compared with the previous reporting periods (2011–2012 and 2001–2012, including at least three 2-year cycles), positive reaction rates for the top 25 screening allergens statistically increased for 2 allergens: methylchloroisothiazolinone/methylisothiazolinone (6.4%; risk ratios, 1.26 [1.07–1.50] and 2.08 [1.84–2.37]) and hydroxyethyl methacrylate (2.6%; risk ratios, 1.34 [1.02–1.76] and 1.23 [1.00–1.51]). Methylisothiazolinone, which was added to the screening series for this 2013–2014 cycle, had the third highest positive reaction rate of allergens tested (10.9%). Four other newly added allergen preparations—formaldehyde 2% (7%), diphenylguanidine (3.8%), propylene glycol 100% (2.8%), and benzophenone-4 (2.1%)—all had reaction rates greater than 2%. Twenty-one percent of tested patients had at least 1 relevant allergic reaction to an allergen not on the NACDG series; 14.6% of these were occupationally related. The T.R.U.E. TEST (SmartPractice Denmark, Hillerød, Denmark) would have hypothetically missed one quarter to one third of reactions detected by the NACDG screening series. Conclusions: These results confirm that the epidemic of sensitivity to methylisothiazolinone previously documented in Europe is also occurring in North America. Patch testing with allergens beyond a standard screening tray is necessary for the complete evaluation of occupational and nonoccupational allergic contact dermatitis.
Background: There is no clear consensus among orthopedic surgeons concerning metal hypersensitivity screening and orthopedic implants. Objective: This study investigated practices and opinions about metal hypersensitivity and orthopedic implants via a survey administered to practicing orthopedists. Methods: A questionnaire was sent to members of the Pennsylvania Orthopaedic Society electronically. Respondents were asked about preoperative and postoperative screening habits concerning metal hypersensitivity and implants. Results: Forty-four physicians completed the survey. Only 11% of respondents reported that they always or often screen patients for metal hypersensitivity. Fifty percent of respondents stated that they only rarely refer patients for patch testing (and the remainder never do). If, however, patients were found to have a positive patch test, most providers were very likely to use a different implant. Other respondents were skeptical of the relationship between metal hypersensitivity and implant failure. Dermatitis, pain, and loosening were common reasons for postoperative testing. Seventy percent of respondents said that patch testing rarely or never changed their decision making. Conclusions: This study is reflective of the lack of consensus between orthopedists regarding patch testing. It demonstrates the diversity of opinions among orthopedists, the need for additional dialogue between orthopedic and dermatology specialties, and the need for larger studies investigating outcomes and metal hypersensitivity.
Background: Contact dermatoses are common in mechanic and repair occupations. Objectives: This study aimed to (1) estimate the prevalence of occupationally related contact dermatitis among mechanics/repairers patch tested from 1998 to 2014 by the North American Contact Dermatitis Group, (2) characterize responsible allergens and irritants, and their sources, and (3) compare results among 3 occupational subgroups (mechanics, electrical/electronic, and other). Methods: A cross-sectional analysis of patients patch tested by the North American Contact Dermatitis Group between 1998 and 2014. Results: Of 38,784 patients patch tested, 691 (1.8%) were mechanics/repairers. Male sex (93.5%) and hand involvement (59.5%) were common overall. Occupationally related skin disease was more prevalent among vehicle and mobile equipment mechanics/repairers (52.7%) and other mechanics/repairers (41.4%) than electrical/electronic equipment mechanics/repairers (21.3%). Overall, carba mix, thiuram mix, and methylchloroisothiazolone/methylisothiazolone were the most common occupation-related clinically relevant allergens. Gloves, automotive vehicles, solvents, oils, lubricants, and fuels were the most common sources of responsible allergens. Conclusions: Common occupationally related allergens included rubber accelerators and the preservative methylchloroisothiazolone/methylisothiazolone.
No abstract available
Introduction: Corticosteroids may cause delayed hypersensitivity. On the basis of structure, the following 4 groups of corticosteroids are recognized: A, B, C, and D (subdivided into D1 and D2). More recently, a newer classification system subdivides corticosteroids into groups 1, 2, and 3. Cross-reactions are unpredictable. The objective of this study was to describe positive patch test and co-reaction patterns to corticosteroids. Methods and Results: A retrospective analysis of 17,978 patients patch tested by the North American Contact Dermatitis Group between 2007 and 2014 was performed. Corticosteroids tested during this period included the following: tixocortol-21-pivalate 1.0% petroleum (pet), budesonide 0.1% pet, triamcinolone acetonide 1.0% pet, desoximetasone 1.0% pet, clobetasol-17-propionate 1.0% pet, and hydrocortisone-17-butyrate (HC-17-B) 1.0% (pet and alcohol). Overall, 4.12% (n = 741) of patients had 1 or more positive reactions to corticosteroids. Tixocortol-21-pivalate positivity was the most common (2.26%), followed by budesonide (0.87%), HC-17-B (0.43%), clobetasol-17-proprionate (0.32%), and desoximetasone (0.16%). Reaction strength was strong (++ or +++) in almost twice as many tixocortol and budesonide reactions (>64%) as compared with the other 3 corticosteroids (
No abstract availableOxymetazoline hydrochloride 1% cream (Rhofade, Allergan) is indicated for the topical treatment of persistent facial erythema associated with rosacea in adults.
FDA Approvals
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Mit Einführung der flächendeckenden klinisch-epidemiologischen Krebsregistrierung auf Basis des Krebsfrüherkennungs- und -registergesetzes ergeben sich neue Chancen, die Versorgung im Bereich der Krebserkrankungen bevölkerungsbezogen transparent zu machen. Zusätzlich zur Beschreibung der Versorgungslandschaft, wie sie aus der epidemiologischen Berichterstattung bekannt ist, erhalten Fachbereiche und Leistungserbringer in Zukunft einen Überblick über die eigenen Behandlungen sowie die entsprechende Vergleichsdaten. Mit den (klinischen) Krebsregisterdaten lässt sich eine Versorgungsforschung mit Ist-Soll-Vergleichen, Historien-, Leitlinien-, Klinikvergleichen usw., Analysen zur Fehlversorgung, zu sektorenübergreifenden Behandlungspfaden und zur bevölkerungsbezogenen Umsetzung von Therapiekonzepten/Früherkennungsmaßnahmen etablieren. Es entstehen Datenbanken, die der Generierung von Hypothesen dienen können – auch für seltene Krebserkrankungen oder spezielle Subgruppen.
Von der Bevölkerung und von Leistungserbringern geäußerte Erwartungen und Ängste werden angesprochen und erläutert. Die Nutzung von Krebsregisterdaten für die Beurteilung vermeintlicher lokaler Häufungen von Krebserkrankungen wird zusammenfassend erläutert.
Weitere Informationsveranstaltungen und offene Diskussionen über die Vorteile der neuen integrierten Register sind notwendig. Die Möglichkeiten der Nutzung müssen dargelegt werden, um falschen Erwartungen entgegenzuwirken. Die dargestellte Methodik sowie die zugehörige Risikokommunikation können als Ausgangspunkt für künftige klinisch-epidemiologische Aufgaben dienen.
Acute urticaria is the presence of urticaria for
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Integrative medicine, bogus cancer treatment, chelation, low T, and more -- what do you need to know about the proliferation of these clinics in medicine?
Medscape Public Health
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The 'Portsmouth Tonsillitis Protocol' by Bird et al. (October 2013 issue)[1] provides the first published treatment algorithm for use in patients with acute tonsillitis presenting to secondary care. Following introduction of the protocol at their centre the authors demonstrate an improved delivery of tonsillitis treatment as well as a reduction in hospital admission rates and inpatient services leading to significant cost savings. The financial implications are particularly relevant to health services facing economic pressures.
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We present a case of a man aged 20 years who was diagnosed with a major depressive disorder and was started on escitalopram and zopiclone. The patient had a significant response to escitalopram except that he developed severe insomnia which dramatically resolved following discontinuation of zopiclone. The patient was recommenced on low dose of zopiclone and unfortunately redeveloped moderate insomnia. The patient was thoroughly investigated and zopiclone was determined to have paradoxically caused the insomnia.
Gastrointestinal stromal tumours (GISTs) can arise everywhere along the gastrointestinal (GI) tract. Their presentation in unusual locations should always be taken into account. A 74-year-old man referred to the emergency department for small bowel obstruction caused by an incarcerated inguinal hernia. A CT scan showed a mesenchymal tumour originating from the herniated bowel loop and a mass in the ascending colon. Laparoscopic resection of the mass and laparoscopic right hemicolectomy were performed. The histology showed a ruptured GIST arising from the herniated small bowel and a high-grade dysplasia villous adenoma of the right colon. GISTs can present with symptoms spanning from vague abdominal discomfort to surgical urgencies. Strangulated hernia is an extremely rare presentation, with only two cases described in the literature. A safe surgical approach was obtained with laparoscopy, maintaining surgical radicality. The ileal localisation and the pseudocapsule rupture were the main risk factors on prognostic stratification.
Description
A 21-year-old man presented to our institution after a motor vehicle collision. His vitals were normal. He had normal heart sounds with no murmurs.
Electrocardiogram (EKG) showed ST-segment elevations in leads I, AVL.,V1 to V3. Troponin was elevated at 1810 ng/L (<15 ng/L). Chest CT revealed multiple rib fractures and a haematoma in the antero-septum of the left ventricle (LV). An echocardiogram revealed mild LV systolic dysfunction with a severely hypokinetic septum and moderate right ventricular (RV) systolic dysfunction. Coronary angiogram showed no evidence of atherosclerosis. There was a traumatic dissection of the second diagonal artery and septal coronary perforation with shunting into the RV (figure 1, videos 1 and 2).
Figure 1
(A) 3D CT reformat demonstrating haematoma adjacent to LAD. (B) Axial CT demonstrating haematoma adjacent to right ventricle (arrowhead). (C) Resolution of haematoma at 3-month (asterisk). (D) Septal haematoma...
Paraneoplastic neurological disorders are uncommon presentations of head and neck cancers. We present a case of a 68-year-old male patient who presented with dizziness, nausea and memory problems. MRI of his brain showed bilateral cerebellar leptomeningeal enhancing signal abnormality with cervical lymphadenopathy. CT imaging of his neck raised the suspicion of a tonsillar primary, which was later confirmed on biopsy. His poorly differentiated HPV positive squamous cell carcinoma was treated with chemoradiotherapy. Subsequent MRI imaging showed progressive cerebellar atrophy and his presenting symptoms persisted, but he remained disease free 6 months post-treatment for his primary malignancy.
Shrimp and house dust mite (HDM) allergies are common in Canadians. Often, both of these allergies occur in the same patient. This may be due to homology of tropomyosin or other potentially shared proteins. Th...
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Hereditary angioedema (HAE) is a rare but serious condition characterized by recurrent spontaneous attacks of angioedema affecting superficial tissues of upper respiratory and gastrointestinal tracts. The pote...
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Issues of complete disease clearance and hearing preservation in cholesteatoma induced labyrinthine fistula cases has been discussed and updated in this article. Successful disease clearance and hearing preservation in a case of cholesteatoma induced isolated cochlear promontory fistula encouraged us to retrospectively analyse 13 more cases of cholesteatoma induced labyrinthine fistula who presented in emergency service as complicated chronic suppurtive otitis media. Pre-operatively nine patients experienced vertigo, two had profound sensori neural hearing loss and radiology was suggestive of labyrinthine fistula in 12 patients. Lateral semicircular canal was involved in 13 cases. In all cases cholesteatoma matrix was completely removed from the fistula site irrespective of the fistula size and hearing status. Hearing was preserved in 11 out of 12 patients. Gentle and meticulous removal of the matrix and careful repair of labyrinthine fistula delivers significant hearing preservation rate along with a safe and dry ear which avoids a second look surgery.
Normal middle ear volume indicates the well ventilated middle ear and subsequently the normal function of the Eustachian tube. We carried out preoperative assessment of the middle ear volume by tympanometry and scintigraphic evaluation of Eustachian tube patency in patients with unilateral otitis media. We correlated the middle ear volume and Eustachian tube patency in these patients. Prospective. A total of 58 patients with unilateral otitis media were studied. All patients underwent Eustachian tube scintigraphy. We categorized the patients as Group A with patent Eustachian tube and Group B with blocked Eustachian tube (ET). We assessed the equivalent middle ear volume (VeqME) in all patients and correlated it with ET patency. We also correlated the degree of hearing loss and intraoperative middle ear pathology in two groups. There is strong linear correlation between the ET patency and VeqME of the patients. Degree of hearing loss and the middle ear pathology is also found to be severe in patients with blocked ET and low VeqME. Preoperative assessment of patients with chronic otitis media should include the objective evaluation of middle ear volume and ET patency, as it is the reliable predictor of middle ear pathology.
