Clinical Otolaryngology最新文献

Introduction: In Australia, older Aboriginal and Torres Strait Islander people have the highest prevalence of hearing loss, for which dedicated audiological services are available. However, there is limited research on the experiences older Aboriginal and Torres Strait Islander people have with hearing loss and audiological services. Therefore, this study aimed to consolidate existing literature with a scoping review, specifically on the above to identify gaps and guide future research.

Method: Ten databases, including electronic journal databases and government databases, were systematically searched. Additional studies were sought from article reference lists, review articles, conference abstracts and Google Scholar. We identified 540 records and 22 of them met our inclusion criteria. Our inclusion criteria constituted research of any design on the experiences of older Aboriginal and Torres Strait Islander people (aged 45+ years) with hearing loss and audiological services.

Results: Seventeen studies reported on experiences with hearing loss, four studies reported on experiences with audiological services and one study reported on both experiences. Prevalence of hearing loss was estimated to be 20%-34% in older Aboriginal and Torres Strait Islander people; a discrepancy between self-reported and objective hearing difficulties was also identified. Audiological services currently available to older Aboriginal and Torres Strait Islander people were also underutilised.

Conclusions: Future research on older Aboriginal and Torres Strait Islander people is required to uncover: (1) the reasons for underreported hearing loss; (2) types of hearing loss experienced; (3) barriers to accessing audiological services; and (4) best hearing-loss management and rehabilitation practices.

Objective: Apparent diffusion coefficient (ADC) value helps in differentiating infections from neoplasms on magnetic resonance imaging (MRI). We investigate the diffusion-weighted images in skull base osteomyelitis (SBO) to evaluate if ADC values can differentiate fungal and bacterial SBO and to analyse the microbiology of all SBO patients.

Design: Retrospective observational study.

Setting: Quaternary care referral centre.

Participants: A retrospective review of 142 patients diagnosed and treated for SBO patients from January 2010 to May 2023 was done.

Main outcome measure: Chi-square or Fisher's exact test was used to compare ADC values of bacterial and fungal SBO.

Results: The most common pathogens isolated were Pseudomonas (42.2%), Aspergillus (30.98%), and S. aureus (23.94%). The average ADC value of affected soft tissues among patients was 1.13 ± 0.26 × 10^-3 mm2/s compared to the average ADC value of normal soft tissue, 1.34 ± 0.31 × 10^-3 mm2/s. There was no statistical significance when comparing the average ADC values of bacterial and fungal SBO patients (p value = 0.142).

Conclusion: This study suggests that though infection due to Pseudomonas was the commonest, it was detected only in 42.2% of patients. More than half of the cases had organisms other than Pseudomonas, demanding the clinician to obtain deeper biopsies early in the course of the disease for microbiological analysis. DWI does not help differentiate bacterial and fungal SBO, again emphasising the need for deeper tissue biopsies in all these patients to assist in the early identification of the pathogen.

Objective: It is often recommended that, in children with bilateral epistaxis, only one side of the nasal septum should be cauterised at a time in order to reduce the risk of septal perforation. This advice may have been reasonable when hot wire electrocautery was in common use. The risk of septal perforation after silver nitrate cautery is unknown but probably low.

Methods: Retrospective case note review of children attending the nurse-led epistaxis clinic between 2019 and 2022.

Results: Nine hundred and twenty children were seen in the nurse-led clinic between January 2019 and December 2022. Six hundred and one children (79%) underwent nasal cautery. Simultaneous bilateral nasal cautery was carried out in 176 (29%) children. Our follow up period ranged between 303 and 1744 days, with a median of 809.5 days. No child presented to emergency or ENT services with septal perforation or any other complication of simultaneous bilateral nasal cautery.

Conclusion: To the author's knowledge, this is the largest study assessing the safety of simultaneous bilateral nasal cautery with silver nitrate in children. No adverse results have been found after cauterising both sides of the septum at the same sitting, and doing so potentially saves time and money for patients and the health service.

Background: The use of the 3D exoscope in cervicofacial reconstruction has demonstrated its effectiveness, yet few studies have compared its utility to that of the microscope.

Objective: To compare the reliability of microanastomoses performed with both tools, along with postoperative outcomes and user experience.

Patients and methods: This was a retrospective single-center study that included all cases of microanastomosed forearm or fibula free flap reconstructions performed between June 2019 and June 2022. For each procedure, microsurgical characteristics were collected and compared. The primary outcome measure was the reliability of anastomoses (lack of intraoperative events and absence of early surgical revisions). Secondary outcome measures pertained to postoperative evolution.

Results: Forty patients underwent microanastomosed flap reconstruction (20 forearm flaps, 20 fibula flaps) using either a microscope (n = 10 in each group) or a 3D exoscope (n = 10 in each group). Patient characteristics were comparable between the two groups. No significant difference was observed between the use of the microscope and the 3D exoscope in terms of anastomosis reliability; OR = 2.07 [0.09-130.88], p = 1. No differences were noted between the two groups in postoperative outcomes except for a shorter hospitalization period for patients undergoing forearm flap reconstruction with the exoscope compared to the microscope (p = 0.03).

Conclusion: The use of the 3D exoscope appears to be an interesting alternative to the microscope in cervicofacial reconstruction due to similar microsurgical results, good ergonomics and significant pedagogical appeal.

Objectives: We aimed to assess the outcomes of fat graft myringoplasty augmented with hyaluronic acid in closing large-sized eardrum perforations compared to the traditional underlay cartilage-perichondrium composite myringoplasty (CPCM).

Study design: It was a prospective randomised comparative study.

Settings: It was held in tertiary referral institutions between May 2020 and April 2022.

Participants: We included 100 patients with a large-sized eardrum perforation (50%-75% of the eardrum surface area). Using the endoscopic transcanal approach, 50 patients were managed by fat graft myringoplasty augmented with hyaluronic acid, while CPCM managed the other 50 patients.

Main outcome measures: We evaluated the closure rates 1, 6 months and 1 year after surgery. Also, we assessed the audiological performance of the patients with a successful closure before and 1 year after the operation.

Results: Fat graft myringoplasty operation was statistically shorter than the CPCM. The closure rate 1 year after surgery was 92% in the first group and 86% in the second group, without a statistically significant difference between both groups. Successful air-bone gap closure to less than 10 dB occurred in 93.5% of group A and 81.4% of group B without a statistically significant difference. The mean postoperative air-bone gap was 5.3 ± 3.95 dB in the first group and 7.95 ± 5.17 dB in the second group, with a statistically significant difference.

Conclusions: Fat graft myringoplasty augmented with hyaluronic acid was a reliable, safe, simple, and effective manoeuvre to close large-sized eardrum perforations compared to the conventional CPCM.