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The Journal of laryngology and otology [journal]
- Investigation of demodex species frequency in patients with a persistent itchy ear canal treated with a local steroid. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Jul 17.:1-4.
Objective: To investigate the frequency of demodex species in the external acoustic meatus in patients with an itchy ear canal. Methods: Patients were assigned to one of three groups. Group one consisted of 54 patients with an itchy ear canal who were using a local agent, while group two was composed of 51 patients with an itchy ear canal who were not using a local agent. Group three consisted of 50 healthy individuals without an itchy ear canal. Results: Demodex species test results were positive in nine (5.8 per cent) of the cases. Six of these positive cases were in group one, two in group two and one in group three. The frequency of demodex species in the external acoustic meatus was similar between those patients with an itchy ear canal who did not use a local agent and the healthy individuals (p = 0.571), but it was significantly higher in those using a local steroid compared with those not using a local agent (p = 0.046). Conclusion: Although demodex species was not significantly higher in patients with an itchy ear canal compared with the control group, use of a local steroid increased the parasite frequency in the external ear canal of affected patients.
- Tinnitus and its association with psychiatric disorders: systematic review. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Jul 17.:1-5.
Objectives: To systematically review the literature on the occurrence of psychiatric diagnoses in a tinnitus-affected population, and correlate the presence of psychiatric disorders with tinnitus-related annoyance and severity. Method: A systematic review of the literature published between January 2000 and December 2012 was performed using PubMed, ISI Web of Science and SciELO databases. Original articles in English and Portuguese that focused on the diagnosis of mental disorders associated with tinnitus, especially anxiety and depression, were identified. Results: A total of 153 articles were found and 16 were selected. Fifteen articles showed a high prevalence of psychiatric disorders in tinnitus-affected patients, and nine showed a high correlation between the presence of a psychiatric disorder and tinnitus-related annoyance and severity. Conclusion: The prevalence of psychiatric disorders, especially anxiety and depression, is high in tinnitus patients, and the presence of these disorders correlates with tinnitus-related annoyance and severity.
- Audiological evaluation in patients with Behçet's disease. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Jul 17.:1-4.
Objective: This study aimed to determine the characteristics of hearing loss in patients with Behçet's disease. Methods: Twenty-six consecutive patients with Behçet's disease and a control group consisting of 25 age-matched healthy subjects were prospectively included in this study. Pure tone and speech audiometry, tympanometry, distortion product otoacoustic emission testing, and auditory brainstem-evoked response assessment were performed in the patients and controls. Results: The pure tone audiograms and the results of distortion product otoacoustic emission testing showed statistically significant hearing loss in the Behçet's disease patients (p < 0.05). Auditory brainstem-evoked response results were not significantly different between the patients and controls (p > 0.05). Conclusion: The findings of the present study demonstrated that audiological involvement is more frequent in patients with Behçet's disease than in healthy controls. Therefore, all patients with Behçet's disease should be regularly monitored by an otolaryngologist and be given information about the possibility of inner-ear involvement.
- Authors’ reply. [Comment, Letter]
- J Laryngol Otol 2014 May; 128(5):482-3.
- Pectoralis major myofascial flap in salvage laryngectomy. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Jul 15.:1-6.
Objective: The main purpose of this study was to evaluate the effect of the pectoralis major myofascial flap on pharyngocutaneous fistula formation and time to oral feeding. Methods: This retrospective study reviewed 155 total laryngectomies. Patients were divided into two main groups. Group 1 included 110 patients who were treated primarily by total laryngectomy and group 2 comprised 45 patients who were treated by salvage laryngectomy with or without a pectoralis major myofascial flap. Results: The use of a pectoralis major myofascial flap did not have a significant effect on pharyngocutaneous fistula formation in the salvage group (p = 0.376). When comparing the oral feeding day of patients with pharyngocutaneous fistula, a significant difference was observed between the salvage group with pectoralis major myofascial flap reinforcement and the salvage group without pectoralis major myofascial flap reinforcement (p = 0.004). Discussion: Our study demonstrated that pectoralis major myofascial flap reinforcement did not decrease the rate of pharyngocutaneous fistula formation. Instead, it prevented the formation of large fistulas that would require surgical management, and showed a similar time to oral feeding and length of hospital stay to primary laryngectomy.
- Use of the nine-step inflation/deflation test and resting middle-ear pressure range as predictors of middle-ear barotrauma in aircrew members. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Jul 14.:1-6.
Objective: To explore the role of the nine-step inflation/deflation tympanometric test and resting middle-ear pressure range as predictors of barotrauma in aircrew members. Methods: A prospective, non-randomised study was conducted on 100 aircrew members. Resting middle-ear pressure was measured and the nine-step inflation/deflation test performed on all subjects before flights. Subjects were allocated to two groups according to resting middle-ear pressure range (group A, within the range of +26 to +100 and -26 to -100 mmH2O; group B, -25 to +25 mmH2O). All aircrew members were assessed after flights regarding the presence and the grade of barotrauma. Results: In both groups, the sensitivity and specificity values of the entire post-inflation/deflation test were close to those of the post-deflation part of the test. The post-deflation test had a higher negative predictive value than the post-inflation test. Ears with resting middle-ear pressure lower than -55 mmH2O experienced barotrauma, regardless of good or poor post-inflation or post-deflation test results. Conclusion: In an aircrew member, a resting middle-ear pressure within the range of -55 and +50 mmH2O, together with good post-deflation test results, are considered reliable predictors for fitness to fly.
- Immunisations and antibiotics in patients with anterior skull base cerebrospinal fluid leaks. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Jul 14.:1-4.
Objective: There are no UK guidelines for the use of antibiotics and/or immunisations in patients with an active anterior skull base cerebrospinal fluid leak. This study aimed to define current UK practice in this area and inform appropriate guidelines for ENT surgeons. Method: A web-based survey of all members of the British Rhinological Society was carried out and the literature in this area was reviewed. Results: Of those who responded to the survey, 14 per cent routinely give prophylactic antibiotics to patients with cerebrospinal fluid leaks, and 34.9 per cent recommend immunisation against at least one organism, most commonly Streptococcus pneumoniae (86.7 per cent). Conclusion: There is no evidence to support the use of antibiotic prophylaxis in patients with a cerebrospinal fluid leak. We propose that all such patients are advised to seek immunisation against pneumococcus, meningococcus and haemophilus.
- Measurement of the sound intensity during suction of middle-ear fluid following myringotomy. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Jul 14.:1-8.
Objective: To determine noise intensity during middle-ear aspiration in order to evaluate whether levels can be potentially harmful. Methods: In this prospective, observational study, middle-ear effusion was aspirated following myringotomy using a suction instrument with a probe tube microphone. Sound pressure levels and duration were measured, and frequency domain analysis was performed. Results: Forty-four ears were analysed, consisting of 20 with mucoid effusion, 11 with serous effusion and 13 with no effusion. Maximum peak sound intensity ranged from 84 to 157 dB. Half of the ears (50 per cent) were exposed to greater than 140 dB; of these, 82 per cent were exposed for longer than 0.2 ms (range, 0.05-14 ms). There was no significant difference in sound pressure level between ears with mucoid and serous effusion; however, ears with mucoid effusion required longer suction times (p < 0.0030). In addition, peak intensity was greater for ears with mucoid effusion versus those with serous or no effusion (p < 0.0001). Conclusion: Middle-ear aspiration during myringotomy caused noise levels within a potentially harmful range.
- Tranexamic acid - a useful drug in ENT surgery? [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Jul 14.:1-6.
Background: Tranexamic acid is a synthetic antifibrinolytic drug. It has been widely available for over 40 years, but only recently has it started to be used routinely in many surgical disciplines. For ENT surgeons, epistaxis and post-tonsillectomy bleeding contribute a significant proportion of the morbidity and emergency workload in a general ENT department. Published evidence indicates a potentially helpful role for tranexamic acid in managing epistaxis. Results and conclusion: To date, the benefits of tranexamic acid as a prophylactic treatment to reduce the rate and severity of post-tonsillectomy bleeding are less certain. Two recently published pilot studies looking at primary haemorrhage in children and secondary haemorrhage in adults following tonsillectomy suggest that further large, randomised trials should explore the efficacy of tranexamic acid in routine ENT surgery. There are potential reductions in patient morbidity and cost savings if tranexamic acid is found to be efficacious in larger trials.
- Aural microsuction for wax impaction: survey of efficacy and patient perception. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Jul 14.:1-5.
Objective: Cerumen impaction is a common problem, and aural microsuction is a technique frequently employed for its management. This study aimed to quantify the patient perception, safety and efficacy of this procedure. Methods: Patients were asked to complete a questionnaire following cerumen clearance by microsuction. The perceived severity of pain, noise-related discomfort and vertigo was scored on a scale of 1 to 10. Patients with mastoid cavities and those who had used a cerumenolytic agent in the preceding week were analysed separately. Results: A total of 159 questionnaires were returned. Mean scores (95 per cent confidence intervals) were: pain, 2.34 (2.06-2.62); noise discomfort, 3.03 (2.71-3.35); and vertigo, 1.95 (1.66-2.25). There was successful clearance (i.e. sufficient to view the tympanic membrane) in 91 per cent of cases. Patients who had used cerumenolytics reported significantly less pain and vertigo (p = 0.008 and p < 0.001, respectively) compared with those who had not, whilst patients with mastoid cavities reported greater levels of vertigo (p < 0.001) than those without. Conclusion: Aural microsuction is well tolerated. Side effects are mild, and the prior use of cerumenolytics appears to further reduce their severity.