Philip Clamp

The Cochlear Baha 4 Attract System – design concepts, surgical technique and early clinical results

Bone conduction implant systems utilize osseointegrated fixtures to transmit sound through the bones of the skull. They allow patients with hearing loss to receive acoustic signals directly to the inner ear, bypassing the outer and middle ear. The new Cochlear™ Baha® Attract System (Cochlear Bone Anchored Solutions AB, Mölnlycke, Sweden) has been designed as a non-skin penetration hearing implant. The system uses magnetic coupling to hold the external sound processor in place and transmit acoustic energy. An implantable magnet is anchored to the skull via a single osseointegrated fixture, maximizing the efficiency of energy sound transfer. The interposed soft tissue is protected by a SoftWear pad that evenly distributes pressure in order to minimize the risk of pressure necrosis. This article summarizes the design features and early clinical results of the Baha 4 Attract System and provides context as to its place in the broader hearing aid market.

Correcting a financial brokerage model for cloud computing: closing the window of opportunity for commercialisation

In April 2012, Rogers and Cliff (R&C) demonstrated a theoretical financial brokerage model for cloud computing that is profitable for the broker, offers reduced costs for cloud users, and generates more predictable demand flow for cloud providers. Relatively cheap, long-term reserved instances (RIs) are bulk-purchased by the broker, and then re-packaged and re-sold as monthly options contracts at a price lower than a user can purchase “on-demand” from the provider. Thus, the broker risks exposure on purchase for margin on sales. R&C’s result has generated significant interest in the cloud computing community and is currently the fifth most accessed research paper of all time in the Journal of Cloud Computing: Advances, Systems and Applications.Here, we perform an independent replication of R&C’s brokerage model using CReST, a discrete event simulation platform for cloud computing developed at the University of Bristol. We identify two implementation problems in R&C’s original work: firstly, the broker buys fewer RIs than the model suggests; and secondly, the broker is undercharged for RIs used. We correct R&C’s results accordingly: while broker’s profits are not as high as R&C suggest, the model still supports the theoretical possibility of a profitable brokerage.However, aggressive competition between cloud providers has reduced the cost of cloud services to users and led to the introduction of new secondary markets where users can buy and sell RIs between themselves. This has squeezed the opportunity for an intermediary brokerage. By recalibrating R&C’s model to fit current market conditions, we conclude that the commercial viability of R&C’s brokerage model has been eradicated. The window of opportunity has now closed.

Smartphone speech-to-text applications for communication with profoundly deaf patients

OBJECTIVE Visual communication aids, such as handwriting or typing, are often used to communicate with deaf patients in the clinic. This study aimed to establish the feasibility of communicating through smartphone speech recognition software compared with writing or typing. METHOD Thirty doctors and medical students were timed writing, typing and dictating a standard set of six sentences appropriate for a post-operative consultation, and the results were assessed for accuracy and legibility. RESULTS The mean time for smartphone dictation (17.8 seconds, 95 per cent confidence interval = 17.0-18.7) was significantly faster than writing (59.2 seconds, 95 per cent confidence interval = 56.6-61.7) or typing (44 seconds, 95 per cent confidence interval = 41.0-47.1) (p < 0.001). Speech recognition was slightly less accurate, but accuracy increased with time spent dictating. CONCLUSION Smartphone dictation is a feasible alternative to typing and handwriting. Slow speech may improve accuracy. Early clinical experience has been promising.

The role of post-operative imaging in cochlear implant surgery: A review of 220 adult cases

Abstract Objectives To determine the incidence of abnormal radiological findings after cochlear implantation and their effect on clinical outcomes. Methods Retrospective review of 220 adult cochlear implants. Clinical records and post-operative plain X-rays were reviewed and compared with pre-operative and 6-month post-operative City University of New York (CUNY) speech scores. Results There were no cases of extra-cochlear array misplacement. Imaging showed 20 cases of incomplete array insertion (9.2%), 3 cases of kinking of the array (1.4%), 2 cases of tip rollover (0.9%), and 1 case of apparent array fracture (0.5%). Patient management was not altered by abnormal imaging. Patients with abnormal radiological findings had slightly minor improvements (median 39 vs. 56%) in City University of New York (CUNY) speech discrimination scores at 6 months (Mann–Whitney U test, P = 0.043). Conclusion All abnormalities on post-operative imaging were minor and did not alter patient management. The future role of post-operative imaging is discussed.

What factors influence patient and parent choice of cochlear implant model for children

Abstract Objectives The West of England Cochlear Implant Programme purchases two makes of cochlear implant (CI) for paediatric use (MED-EL and Cochlear). If the CI team has no preference, the decision regarding which implant to use is made by the patient and family. Families are provided with information about the devices and allowed time to handle dummy implants and ask questions. The aim of this study is to establish how patients make this choice and which factors are considered most important in the decision-making process. Method Patients who received a CI within the past 4 years were sent a postal survey, with reminders issued when patients attended for checkups. Patients were asked to rate certain factors from 0 to 10 depending on their importance in the decision-making process. Results Sixty-four patients replied (response rate 74%). In most cases (83%), the parents and/or children were involved in the decision regarding the choice of implant. Eighty-nine percent of patients received information about the choices of CI from the CI team. Patients also accessed information directly from the manufacturer, from other CI users, and from websites. The most important factor in choosing CI model was robustness and reliability (mean score 9.6), followed by comfort (9.4), size/shape (9.2), and control system/ease of use (8.9). All patients were happy with the choices they made. Discussion In this study, most patients undergoing cochlear implantation were offered a choice of model. Robustness, reliability, comfort, and size/shape of CI are considered the most important factors in this decision.

Mastoiditis secondary to metastatic lung carcinoma: case report and literature review

OBJECTIVE We present a case report and systematic review of acute mastoiditis caused by metastatic lung cancer. CASE REPORT A 62-year-old woman developed acute mastoiditis as a complication of otitis media. Cortical mastoidectomy revealed deposits of metastatic non-small cell lung carcinoma around the sigmoid sinus. The patient had previously received treatment for lung cancer, but was thought to be in remission. DISCUSSION A literature review confirmed that this is the first reported case of mastoiditis caused by metastatic lung cancer. Only four similar case reports were identified: two caused by breast carcinoma, one by renal cell carcinoma and one by cholangiocarcinoma. Post-mortem histopathological studies suggest that temporal bone metastasis occurs in 22 per cent of oncology cases. CONCLUSION This is the first reported case of mastoiditis caused by metastatic lung cancer. Metastasis to the temporal bone is not uncommon, but rarely causes mastoiditis.

Comparative trends in ENT junior doctor pay.

Sir, Post-laryngectomy patients have a laryngectomy stoma as the sole connection between the outside world and the lungs. Hence, obstruction here causes acute respiratory distress. The commonest cause of obstruction is crust formation caused by inadequate humidification. We wish to highlight a readily available instrument Tilley’s dressing forceps (picture-1) that can be used safely and quickly to remove obstruction from a part of the body that is otherwise difficult to gain access to.

Response to Dikkers Letter to the Editor regarding “Systematic review of intralesional cidofovir dosing regimens in the treatment of recurrent respiratory papillomatosis”

Clamp and Saunders provide a nice review of intralesional cidofovir dosing regimens in the treatment of recurrent respiratory papillomatosis (RRP) [1]. They state that it provides a precedent for those that wish to prescribe cidofovir for adjuvant use in the management of RRP. While this may be true, they unfortunately neglect the fact that since January 31, 2011, cidofovir is no longer an alternative for adjuvant treatment of RRP [2]. Recent investigations, initiated after that ban, confirmed clinical safety of cidofovir [3,4]. The manufacturer of cidofovir, Gilead Sciences Inc. (Foster City, CA, USA), has ceased its production since December 2012. Since then, Heritage Pharmaceuticals (Edison, NJ, USA) has been producing cidofovir. Heritage Pharmaceuticals has FDA-approval to sell it in the USA. It is not permitted, and illegal, to export cidofovir to any country outside of the USA. The proposed precedent as published by Clamp and Saunders is therefore only of use to USA-based laryngologists.

Draping for neck surgery requiring endotracheal tube manipulation

During airway surgery, the anaesthetist may be required to manipulate or withdraw the endotracheal tube. Traditional surgical head drapes often make access to the tube difficult, therefore limiting control of the airway and risking de-sterilisation of the surgical field. We report a new method of draping for major neck operations that permits easy access to the endotracheal tube while maintaining sterility of the operative field.