Pub Date : 2022-06-15DOI: 10.1017/S002221512200130X
A. Mudry, J. Young
Abstract Background Politzer's tuning fork test is a little-known special examination with a chequered history. Objective This paper gives Politzer's original description, and explains how he intended it to be used. Methods The historiographical research in this study is based on primary references. Secondary documentation is only cited when it is necessary to substantiate any historical argument. Results and conclusion After the apparent disappearance of Politzer's tuning fork test from the otological scene in the 1950s, its consequent resurrection was not what it seemed. This story underlines the need for a standardisation of otological nomenclature, particularly when eponyms are used.
{"title":"Politzer's test – but which one? A plea for standardisation of terms in otology","authors":"A. Mudry, J. Young","doi":"10.1017/S002221512200130X","DOIUrl":"https://doi.org/10.1017/S002221512200130X","url":null,"abstract":"Abstract Background Politzer's tuning fork test is a little-known special examination with a chequered history. Objective This paper gives Politzer's original description, and explains how he intended it to be used. Methods The historiographical research in this study is based on primary references. Secondary documentation is only cited when it is necessary to substantiate any historical argument. Results and conclusion After the apparent disappearance of Politzer's tuning fork test from the otological scene in the 1950s, its consequent resurrection was not what it seemed. This story underlines the need for a standardisation of otological nomenclature, particularly when eponyms are used.","PeriodicalId":22757,"journal":{"name":"The Journal of Laryngology & Otology","volume":"25 1","pages":"1023 - 1026"},"PeriodicalIF":0.0,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86389412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-14DOI: 10.1017/S0022215122001402
Z. Shaikh, S. Sarkar, R. Biswas, A. Adhikari, V. Hallur, P. Parida, C. Preetam, P. Pradhan, D. Samal, A. Nayak, S. Chadaram, K. K. Das, S. Chakraborty, P. Sharma, A. K. Veeti, V. Karakkandy, Anshuman Mishra, Y. Mittal, K. Chithambaram, A. Swarup, S. Chenniappan, Aashaq Shah
Abstract Objective Rhino-orbito-cerebral mucormycosis is a rapidly progressive disease with high mortality rates of about 60 per cent. The increasing incidence of rhino-orbito-cerebral mucormycosis in coronavirus disease 2019 patients in India and worldwide has become a matter of concern owing to the case fatality rate. This study explored the use of low dose aspirin in decreasing the mortality rate of coronavirus disease 2019 associated mucormycosis. Method This was a retrospective observational study. Patients suffering from post-coronavirus disease 2019 mucormycosis were included in the study. Each patient was treated with surgical debridement and systemic amphotericin B. Low dose aspirin was added, and mortality rates were compared with the patients who did not receive aspirin. Results The demographic data and rhino-orbito-cerebral mucormycosis staging between the two groups were not significantly different. There was a statistically significant difference in mortality outcomes between the two groups (p = 0.029) and a 1.77 times higher risk of dying for patients not receiving aspirin. Kaplan–Meier survival indicated that patients receiving aspirin had better survival rates (p = 0.04). Conclusion Low dose aspirin improves survival rates in coronavirus disease 2019 associated mucormycosis.
{"title":"Decreased mortality in coronavirus disease 2019 associated mucormycosis with aspirin use: a retrospective cohort study","authors":"Z. Shaikh, S. Sarkar, R. Biswas, A. Adhikari, V. Hallur, P. Parida, C. Preetam, P. Pradhan, D. Samal, A. Nayak, S. Chadaram, K. K. Das, S. Chakraborty, P. Sharma, A. K. Veeti, V. Karakkandy, Anshuman Mishra, Y. Mittal, K. Chithambaram, A. Swarup, S. Chenniappan, Aashaq Shah","doi":"10.1017/S0022215122001402","DOIUrl":"https://doi.org/10.1017/S0022215122001402","url":null,"abstract":"Abstract Objective Rhino-orbito-cerebral mucormycosis is a rapidly progressive disease with high mortality rates of about 60 per cent. The increasing incidence of rhino-orbito-cerebral mucormycosis in coronavirus disease 2019 patients in India and worldwide has become a matter of concern owing to the case fatality rate. This study explored the use of low dose aspirin in decreasing the mortality rate of coronavirus disease 2019 associated mucormycosis. Method This was a retrospective observational study. Patients suffering from post-coronavirus disease 2019 mucormycosis were included in the study. Each patient was treated with surgical debridement and systemic amphotericin B. Low dose aspirin was added, and mortality rates were compared with the patients who did not receive aspirin. Results The demographic data and rhino-orbito-cerebral mucormycosis staging between the two groups were not significantly different. There was a statistically significant difference in mortality outcomes between the two groups (p = 0.029) and a 1.77 times higher risk of dying for patients not receiving aspirin. Kaplan–Meier survival indicated that patients receiving aspirin had better survival rates (p = 0.04). Conclusion Low dose aspirin improves survival rates in coronavirus disease 2019 associated mucormycosis.","PeriodicalId":22757,"journal":{"name":"The Journal of Laryngology & Otology","volume":"12 1","pages":"1309 - 1313"},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82130245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-26DOI: 10.1017/S0022215122001207
E. Fisher, D. Sandler
The demographics of the developed world have changed during the late twentieth and early twenty-first centuries such that the care of older adults has assumed ever more importance. In the UK in 2016, there were 11.8 million residents aged 65 years and over, representing 18 per cent of the total population; 25 years before, there were 9.1 million, accounting for 15.8 per cent of the population. The projection is that by 2066, this will have risen to 26 per cent of the population. Not only are adults living longer, but they have longer ‘active’ lives and are often also economically productive. The reasons for this are numerous and well documented: better nutrition, medical care and fewer wars; a rise in retirement ages well beyond 60 years for both men and women in most Western countries; young families with two working parents; a reduced proportion of young adults in the population compared to older adults; economic barriers to the provision of adequate pensions; and both older adult and child care provision, with the potential this brings for intergenerational conflict. The result is that the later period in a person’s life is unlikely to be spent principally in gardening (‘growing cabbages’, as a retired Roman Emperor was described). An ‘elderly’ person will spend some of their time in the world of work, whether paid or voluntary, and have an important role in caring for spouses, children or grandchildren, and friends, often in combination with work. These activities require a fully functioning physiology. Therefore, specialties such as ENT and the healthcare of older adults must strive to limit or ideally abolish disability and handicap in older patients, to allow them to function in these important roles. Both specialties are as much involved in improving quality of life as in extending the lifespan of their patients.
{"title":"Virtual issue: ENT care of older adults","authors":"E. Fisher, D. Sandler","doi":"10.1017/S0022215122001207","DOIUrl":"https://doi.org/10.1017/S0022215122001207","url":null,"abstract":"The demographics of the developed world have changed during the late twentieth and early twenty-first centuries such that the care of older adults has assumed ever more importance. In the UK in 2016, there were 11.8 million residents aged 65 years and over, representing 18 per cent of the total population; 25 years before, there were 9.1 million, accounting for 15.8 per cent of the population. The projection is that by 2066, this will have risen to 26 per cent of the population. Not only are adults living longer, but they have longer ‘active’ lives and are often also economically productive. The reasons for this are numerous and well documented: better nutrition, medical care and fewer wars; a rise in retirement ages well beyond 60 years for both men and women in most Western countries; young families with two working parents; a reduced proportion of young adults in the population compared to older adults; economic barriers to the provision of adequate pensions; and both older adult and child care provision, with the potential this brings for intergenerational conflict. The result is that the later period in a person’s life is unlikely to be spent principally in gardening (‘growing cabbages’, as a retired Roman Emperor was described). An ‘elderly’ person will spend some of their time in the world of work, whether paid or voluntary, and have an important role in caring for spouses, children or grandchildren, and friends, often in combination with work. These activities require a fully functioning physiology. Therefore, specialties such as ENT and the healthcare of older adults must strive to limit or ideally abolish disability and handicap in older patients, to allow them to function in these important roles. Both specialties are as much involved in improving quality of life as in extending the lifespan of their patients.","PeriodicalId":22757,"journal":{"name":"The Journal of Laryngology & Otology","volume":"41 1","pages":"785 - 787"},"PeriodicalIF":0.0,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75804690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-26DOI: 10.1017/S0022215122000767
H. Jones, A. Gendre, Alison McHugh, J. Hintze, Barry O'Sullivan, F. Martin, R. Mcconn-Walsh, James Paul O'Neill, Neville Shine
Abstract Objective The Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (‘P-POSSUM’) is a two-part scoring system that includes a physiological assessment and a measure of operative severity. This study sought to determine whether risk estimates for this scoring system could be used in major head and neck reconstructive surgery. Method A retrospective review was performed of patients undergoing resection for a temporal bone malignancy in a single head and neck centre in Dublin, Ireland, from 2002 to 2021. Results The mean ± standard deviation morbidity estimate calculated using the scoring system was 47.6 per cent ± 19.5 per cent. The actual rate of complications was 47 per cent. The optimal cut-off for the scoring system was calculated using the Youden index from the receiver operating characteristic curve, which was 40.5 per cent in this case. Conclusion The study indicates that the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity is a useful tool for predicting morbidity risk in patients undergoing head and neck resection with reconstruction for temporal bone malignancies.
{"title":"Use of the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (‘P-POSSUM’) to predict morbidity in patients undergoing surgery with reconstruction for temporal bone malignancy","authors":"H. Jones, A. Gendre, Alison McHugh, J. Hintze, Barry O'Sullivan, F. Martin, R. Mcconn-Walsh, James Paul O'Neill, Neville Shine","doi":"10.1017/S0022215122000767","DOIUrl":"https://doi.org/10.1017/S0022215122000767","url":null,"abstract":"Abstract Objective The Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (‘P-POSSUM’) is a two-part scoring system that includes a physiological assessment and a measure of operative severity. This study sought to determine whether risk estimates for this scoring system could be used in major head and neck reconstructive surgery. Method A retrospective review was performed of patients undergoing resection for a temporal bone malignancy in a single head and neck centre in Dublin, Ireland, from 2002 to 2021. Results The mean ± standard deviation morbidity estimate calculated using the scoring system was 47.6 per cent ± 19.5 per cent. The actual rate of complications was 47 per cent. The optimal cut-off for the scoring system was calculated using the Youden index from the receiver operating characteristic curve, which was 40.5 per cent in this case. Conclusion The study indicates that the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity is a useful tool for predicting morbidity risk in patients undergoing head and neck resection with reconstruction for temporal bone malignancies.","PeriodicalId":22757,"journal":{"name":"The Journal of Laryngology & Otology","volume":"47 1","pages":"1271 - 1274"},"PeriodicalIF":0.0,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87381496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-24DOI: 10.1017/S0022215122001190
T. Bright, R. Youngs, Y. Faal, A. Hydara, J. Yip, I. Mactaggart, S. Polack
Abstract Objective This study aimed to determine the implications of including tympanometry in the Rapid Assessment of Hearing Loss survey protocol. A comparative study design was employed, with findings from otoscopy compared with the results of tympanometry. Method A population-based survey of the prevalence and causes of hearing loss among adults aged over 35 years in The Gambia was conducted. Clinical assessments included air conduction audiometry, otoscopy and clinical history. Otoscopy outcome was recorded and for those with hearing loss, a probable cause was assigned. Following otoscopy, tympanometry was completed. Otoscopy outcome was not changed as a result of tympanometry. Clinician assigned cause was compared to the results of tympanometry. The proportion of causes potentially misclassified by excluding tympanometry was determined. Results Among people with hearing loss, including tympanometry led to a higher proportion diagnosed with middle-ear conditions. Conclusion The value of adding tympanometry to population-based survey protocols is a higher estimated proportion of hearing loss being attributed to middle-ear disease rather than sensorineural causes. This can inform service needs as more people will be classified as needing medical or surgical services, and a slightly lower number will need rehabilitative services, such as hearing assistive devices. It is highly recommended that tympanometry is included in the protocol.
{"title":"Evaluating the inclusion of tympanometry in population-based surveys of hearing loss","authors":"T. Bright, R. Youngs, Y. Faal, A. Hydara, J. Yip, I. Mactaggart, S. Polack","doi":"10.1017/S0022215122001190","DOIUrl":"https://doi.org/10.1017/S0022215122001190","url":null,"abstract":"Abstract Objective This study aimed to determine the implications of including tympanometry in the Rapid Assessment of Hearing Loss survey protocol. A comparative study design was employed, with findings from otoscopy compared with the results of tympanometry. Method A population-based survey of the prevalence and causes of hearing loss among adults aged over 35 years in The Gambia was conducted. Clinical assessments included air conduction audiometry, otoscopy and clinical history. Otoscopy outcome was recorded and for those with hearing loss, a probable cause was assigned. Following otoscopy, tympanometry was completed. Otoscopy outcome was not changed as a result of tympanometry. Clinician assigned cause was compared to the results of tympanometry. The proportion of causes potentially misclassified by excluding tympanometry was determined. Results Among people with hearing loss, including tympanometry led to a higher proportion diagnosed with middle-ear conditions. Conclusion The value of adding tympanometry to population-based survey protocols is a higher estimated proportion of hearing loss being attributed to middle-ear disease rather than sensorineural causes. This can inform service needs as more people will be classified as needing medical or surgical services, and a slightly lower number will need rehabilitative services, such as hearing assistive devices. It is highly recommended that tympanometry is included in the protocol.","PeriodicalId":22757,"journal":{"name":"The Journal of Laryngology & Otology","volume":"1 1","pages":"839 - 847"},"PeriodicalIF":0.0,"publicationDate":"2022-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76006733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-20DOI: 10.1017/S0022215122001128
E. Fisher, J. Fishman
A common otological problem in primary and secondary care is otitis externa, and it is remarkable that there are so many problems in management associated with this condition. There appears to be a confusing mismatch between guidelines, routine specialist advice and what actually happens day to day in primary care. This issue’s ‘paper of the month’ is a study from Newcastle upon Tyne, which spells out the nature of these difficulties in no uncertain terms and should be widely read. The ‘price’ paid for the misuse of oral antibiotic therapy in the wider population administered for this condition could be considerable, and not just in terms of (wasted) money paid out; it also includes difficulties with the antimicrobial management of infections affecting other parts of the body, as well as the most lethal form of otitis externa, necrotising (‘malignant’) otitis externa, which has been the topic of many recent articles in The Journal of Laryngology & Otology, including guidelines from 2020. Surgery of the nasal septum has historically been over-used. In addition, outcome discussions during conversations with patients for pre-operative consent can often leave something to be desired, and have a tinge of optimism. The Journal has previously published articles on this topic. The current issue includes a study from Norway, in which a large cohort of septoplasty patients were reviewed using a questionnaire completed at 6–12 months and at 3–4 years. The validity of such questionnaires has previously been established. The results showed a significant, although not radical, fall-off in positive outcomes between the two assessments, somewhat less than other studies have shown, and may reflect careful pre-operative patient selection by the clinicians involved. One interesting finding was that the change in outcomes over time was not significantly affected by whether or not turbinate surgery was included with septoplasty. The conclusion that outcomes are better in patients whose noses are more blocked before surgery chimes with previous studies. Laryngeal dysplasia is a condition with a considerable propensity to transform to invasive squamous carcinoma, and the monitoring and treatment of this condition occupies much of a laryngologist’s time. A study from Belfast, Northern Ireland, examined a large cohort of affected patients, and found a malignant transformation rate of 21.8 per cent, slightly higher than some estimates. One important point in the authors’ conclusions is that each of the severity types (mild, moderate and severe) behave as distinct entities in relation to prognosis and malignant transformation, with moderate dysplasia having a higher rate of malignant transformation in this series than had been expected. Sleep-disordered breathing in children has a considerable effect on the quality of life of the child and family. Furthermore, it creates much anxiety in parents, and is increasing in prevalence along with increasing childhood obesity, but i
{"title":"Otitis externa management, septal surgery outcomes, laryngeal dysplasia and paediatric sleep-disordered breathing","authors":"E. Fisher, J. Fishman","doi":"10.1017/S0022215122001128","DOIUrl":"https://doi.org/10.1017/S0022215122001128","url":null,"abstract":"A common otological problem in primary and secondary care is otitis externa, and it is remarkable that there are so many problems in management associated with this condition. There appears to be a confusing mismatch between guidelines, routine specialist advice and what actually happens day to day in primary care. This issue’s ‘paper of the month’ is a study from Newcastle upon Tyne, which spells out the nature of these difficulties in no uncertain terms and should be widely read. The ‘price’ paid for the misuse of oral antibiotic therapy in the wider population administered for this condition could be considerable, and not just in terms of (wasted) money paid out; it also includes difficulties with the antimicrobial management of infections affecting other parts of the body, as well as the most lethal form of otitis externa, necrotising (‘malignant’) otitis externa, which has been the topic of many recent articles in The Journal of Laryngology & Otology, including guidelines from 2020. Surgery of the nasal septum has historically been over-used. In addition, outcome discussions during conversations with patients for pre-operative consent can often leave something to be desired, and have a tinge of optimism. The Journal has previously published articles on this topic. The current issue includes a study from Norway, in which a large cohort of septoplasty patients were reviewed using a questionnaire completed at 6–12 months and at 3–4 years. The validity of such questionnaires has previously been established. The results showed a significant, although not radical, fall-off in positive outcomes between the two assessments, somewhat less than other studies have shown, and may reflect careful pre-operative patient selection by the clinicians involved. One interesting finding was that the change in outcomes over time was not significantly affected by whether or not turbinate surgery was included with septoplasty. The conclusion that outcomes are better in patients whose noses are more blocked before surgery chimes with previous studies. Laryngeal dysplasia is a condition with a considerable propensity to transform to invasive squamous carcinoma, and the monitoring and treatment of this condition occupies much of a laryngologist’s time. A study from Belfast, Northern Ireland, examined a large cohort of affected patients, and found a malignant transformation rate of 21.8 per cent, slightly higher than some estimates. One important point in the authors’ conclusions is that each of the severity types (mild, moderate and severe) behave as distinct entities in relation to prognosis and malignant transformation, with moderate dysplasia having a higher rate of malignant transformation in this series than had been expected. Sleep-disordered breathing in children has a considerable effect on the quality of life of the child and family. Furthermore, it creates much anxiety in parents, and is increasing in prevalence along with increasing childhood obesity, but i","PeriodicalId":22757,"journal":{"name":"The Journal of Laryngology & Otology","volume":"97 1","pages":"471 - 472"},"PeriodicalIF":0.0,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89108113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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