Julian Savage

Allergic rhinitis: an update:

Allergic rhinitis is extremely common and a global health problem. One study has quoted a prevalence of 16% and, as with asthma, it seems to be increasing. This increase and association with asthma have raised concerns about appropriate treatment. Fortunately, with new knowledge of the pathophysiologic mechanisms, newer and better treatment strategies have been developed. This short review of allergic rhinitis highlights its prevalence, pathophysiology, clinical presentation, investigation and management. A new classification and recommendations by the World Health Organizationís guidelines ëAllergic Rhinitis and its Impact on Asthmaí are also discussed.

Effects of tensor tympani muscle contraction on the middle ear and markers of a contracted muscle

Many otologic disorders have been attributed to dysfunction of the tensor tympani muscle, including tinnitus, otalgia, Menieres disease and sensorineural hearing loss. The objective of this study was to determine adequate stimuli for tensor tympani contraction in humans and determine markers of the hypercontracted state that could be used to detect this process in otologic disease.

The Role of Vestibular Caloric Tests in Cochlear Implantation

Objective Vestibular function tests are often undertaken before cochlear implantation, in part to help select the side of surgery. The authors aim to determine whether implantation on the side of better vestibular function leads to greater perception of dizziness by patients than implantation on the side of worse or similar function. Study Design Historical cohort study. Setting Tertiary cochlear implantation center. Subjects and Methods The records of 177 adult recipients of a unilateral cochlear implant were reviewed retrospectively in 2 groups. Group A included patients with an implant in the ear with worse or similar caloric responses. Group B included patients with an implant in the ear with the stronger caloric response. All patients underwent preoperative bithermal caloric testing: a clinically significant difference was defined by a 20% lateral canal paresis. They were assessed postoperatively by the Dizziness Handicap Inventory and supplementary questions. Results Fifty-seven percent of both groups reported dizziness in the first 7 days postoperatively. At 2 months, 20% of group A and 34% of group B experienced some dizziness. Fourteen percent of group A and 10% of group B felt that cochlear implantation had resulted in impaired balance. The Dizziness Handicap Inventory scores of 86% of group A (median score 0) and 76% of group B (median score 10) corresponded with low handicap. None of these results differed significantly between groups A and B. Conclusion Although cochlear implantation may result in dizziness, it is almost always short-lived and mild, even when the ear with the stronger caloric response is implanted.

Listening to the Cochlea With High-Frequency Ultrasound

We have developed a high-frequency pulsed-wave Doppler ultrasound probe as a promising minimally-invasive technique for measuring intracochlear mechanics without damaging the cochlea. Using a custom high-frequency ultrasound system, we have measured dynamic motion of intracochlear structures by recording the pulsed-wave Doppler signal resulting from the vibration of the basilar and round window membranes. A 45 MHz needle-mounted Doppler probe was fabricated and placed against the round window membranes of eight different fresh human temporal bones. Pulsed-wave ultrasonic Doppler measurements were performed on the basilar membrane and round window membrane during the application of pure tones to the external ear canal. Doppler vibrational information for acoustic input frequencies ranging from 100-2000 Hz was collected and normalized to the sound pressure in the ear canal. The middle ear resonance, located at approximately 1000 Hz, could be characterized from the membrane velocities, which agreed well with literature values. The maximum normalized mean velocity of the round window and the basilar membrane were 180 μm/s/Pa and 27 μm/s/Pa at 800 Hz. The mean phase difference between the membrane displacements and the applied ear canal sound pressure showed a flat response almost up to 500 Hz where it began to accumulate. This is the first study that reports the application of high frequency pulsed wave Doppler ultrasound for measuring the vibration of basilar membrane through the round window. Since it is not required to open or damage the cochlea, this technique might be applicable for investigating cochlear dynamics, in vivo.

Antiplatelet drugs in elective ENT surgery

INTRODUCTION Oral antiplatelet drugs are increasingly being encountered in patients scheduled for elective ENT surgery. Their pre-operative cessation can have potentially serious complications in some patients, particularly those with intracoronary stents. METHODS In order to gain an impression of current peri-operative management of patients taking antiplatelet drugs, an online survey was distributed to the Expert Panel of ENT UK, the British Association of Otolaryngologists Head and Neck Surgeons, between 13 January and 15 February 2011. RESULTS Three hundred and three members were contacted. The response rate was 55 per cent (167 replies); 78 per cent of respondents were consultants. Results are presented in the main text. CONCLUSION AND RECOMMENDATIONS Patients can be categorised as high or low risk, depending on their indication for taking antiplatelet drugs. Recommendations taken from the literature are given on how best to manage these two groups.

Mental practice in postgraduate training: a randomized controlled trial in mastoidectomy skills

BackgroundMental practice, the cognitive rehearsal of a task in the absence of overt physical movement, has been successfully used in teaching complex psychomotor tasks including sports and music, and recently, surgical skills.The objectives of this study were, 1) To develop and evaluate a mental practice protocol for mastoidectomy 2) To assess the immediate impact of mental practice on a mastoidectomy surgical task among senior Otolaryngology─Head & Neck Surgery (OHNS) residents.MethodThree expert surgeons were interviewed using verbal protocol analysis to develop a mastoidectomy mental practice script. Twelve senior Residents from Canadian training programs were randomized into two groups. All Residents were video-recorded performing a baseline mastoidectomy in a temporal bone lab. The intervention group received mental practice training, while the control group undertook self-directed textbook study. All subjects were then video-recorded performing a second mastoidectomy. Changes in pre- and post-test scores using validated expert ratings, the Task Specific Evaluation of Mastoidectomy and the Global Evaluation of Mastoidectomy, were statistically analyzed.ResultsA mental practice script was successfully developed based on interviews of three expert surgeon-educators. Task Specific Evaluation and Global Evaluation scores increased in both the mental practice and textbook study groups; there was no significant difference between the two groups in the change in scores post-intervention. There was a high and statistically signficant correlation between evaluators on the outcome measures.ConclusionsWe were not able to demonstrate a significant difference for the benefits of mental practice in mastoidectomy, possibly due to the sample size. However, mental practice is a surgical education tool which is portable, accessible, inexpensive and safe.

Is Hospitalization Necessary after Ear Surgery? A National Survey and Retrospective Review of Postoperative Events

Objective First, to survey our national otolaryngology colleagues on their postoperative care habits (hospitalization vs day surgery) after elective middle ear surgery. Second, to evaluate the necessity of hospitalization and safety of day surgery after these procedures. Methods A national survey regarding postoperative habits after elective middle ear surgery was launched. Then, the cases of all patients having undergone these surgical procedures at our center between 2010 and 2016 were reviewed. They were divided into 2 groups: hospitalization and day surgery. Postoperative events during hospitalization and rate of consultation/readmission for day surgery were recorded. Results Heterogeneity in postoperative habits for most elective otologic surgery exists among otolaryngologists. For tympanoplasty, however, day surgery was uniformly favored. At our institution, 88.6% of hospitalization patients had no complications during their stay. Complications noted for others were nausea (7.2%), bleeding (3.1%), hematoma (0.5%), and sensorineural hearing loss (0.5%). In the day surgery group, 3.0% consulted within 48 hours following their procedure, and the readmission rate was 1.3%. Nausea was the only cause for readmission, and stapes surgery accounted for 100% of readmissions. Discussion Most elective middle ear surgery can be safely performed as day care. Hospitalization does not provide care that could not have been provided at home in the majority of cases. Overnight hospital stay may be considered for stapes surgery. Implications for Practice Day surgery for elective middle ear surgery is sufficient for most cases. Transferring these cases to day care should lower costs to our health care system and increase bed availability.

High‐frequency ultrasound Doppler velocimetry measurements of intra‐cochlear structures in human temporal bones.

Hearing loss is one of the most prevalent, chronic, and fast growing disorders, affecting approximately one‐tenth of the population. Diagnostic imaging tools currently used in this field such as CT and MRI do not have sufficient spatial/temporal resolution to properly diagnose most of the underlying causes of hearing loss. In this work, we present the first high‐resolution velocimetry measurements of intra‐cochlear structures using high‐frequency (40 MHz) pulsed‐wave Doppler ultrasound. A 40‐MHz single‐element transducer based on PMN‐PT single‐crystal piezoelectric was fabricated in‐house and mounted onto the tip of a needle. The transducer was a side‐looking circular disk with a 1 mm outer diameter. A custom data acquisition system was developed in order to perform pulsed‐wave Doppler and was synchronized with an acoustic stimulus. Velocimetry measurements were performed on the basilar membrane located inside the cochlea of fresh temporal bones by imaging across the round window membrane and stimulating ...

A new combined approach to the nasopharynx in head and neck plastic surgery: technique and application

This article presents a combined approach to the nasopharynx, which has not been previously described. The technique is applicable to cases of recurrent nasopharyngeal carcinoma which exhibit lateral extension. We describe the technique and report a case in which it was used. A review is presented of all other techniques currently described. The authors would not advocate the use of a combined approach to the nasopharynx in all cases, but there certainly appears to be a place for this technique.