Journal of Laryngology and Otology 2021-02-10

Acute ENT care, cochlear implantation and otitis media in the pandemic, and ENT post-graduate education

Fisher, Edward W,Fishman, Jonathan

Publication date 10-02-2021


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The prevalence of tinnitus in China: a systematic review of the literature

Zhang, D,Xu, Q,Caimino, C,Baguley, D M

Publication date 22-01-2021


Objective The aim of the present study was to identify reports of the prevalence of tinnitus in China and to present these findings in a review format.
Method This study assessed and collated published prevalence estimates of tinnitus and tinnitus severity, creating a narrative synthesis of the data from publications identified from a combination of Chinese and English language databases.
ResultsA total of 23 studies were included. Tinnitus prevalence ranged from 4.3 per cent to 51.33 per cent but varied with age and gender. The highest increase in prevalence from previous decade in age occurs during the fifth and sixth decades, and the highest prevalence was in the seventh decade at 32.47 per cent. There is also evidence that tinnitus prevalence is related to certain risk factors including comorbid disorders.
Conclusion The prevalence of tinnitus in mainland China in this study is consistent with global data. With increasing awareness of the prevalence of tinnitus in China, the development of epidemiological standards is a priority.

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Otitis media in coronavirus disease 2019: a case series

Raad, N,Ghorbani, J,Mikaniki, N,Haseli, S,Karimi-Galougahi, M

Publication date 07-01-2021


Background Manifestations of the coronavirus disease 2019 in ENT include sore throat, rhinorrhoea, anosmia and dysgeusia. Whether coronavirus disease 2019 causes otitis media is not known.
Objective To assess the presence of otitis media in a series of patients with confirmed coronavirus disease 2019 and ENT symptoms.
Methods The study included patients with coronavirus disease 2019, confirmed on polymerase chain reaction assay, who had otological (e.g. otalgia, otorrhoea, hearing loss) or other ENT (e.g. anosmia, dysgeusia) manifestations of coronavirus disease 2019, in two tertiary referral hospitals in Iran. Patients were excluded if they had a background of otological problems including previous acute otitis media, chronic otitis media, otological surgery, and trauma or radiotherapy to the head and neck.
Results Otitis media was found in eight patients with coronavirus disease 2019 and no background of otological problems. Six patients had middle-ear effusion, three had typical signs of acute otitis media, and one had a tympanic membrane perforation. Most patients had hearing loss; conductive hearing loss and mild sensorineural hearing loss at high frequencies were the underlying mechanisms.
Conclusion Otitis media should be considered a manifestation or associated symptom of coronavirus disease 2019 during the current pandemic.

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An audit of UK audiological practice in specialist paediatric oncology centres regarding hearing assessment of children at risk of ototoxicity due to chemotherapy

Brown, E C M,Caimino, C,Benton, C L,Baguley, D M

Publication date 25-01-2021


Objective Platinum-based chemotherapy drugs are associated with substantial ototoxicity. The hearing of children treated with these drugs should be closely monitored.
MethodA questionnaire was sent out to the 19 audiology departments associated with national paediatric cancer specialist centres in the UK looking at current practice in ototoxicity monitoring.
Results Responses were received from 17 of 19 centres (89 per cent). All offered some form of audiometric monitoring service. Extended high-frequency testing (9–20 k Hz) was only utilised by 7 services (29 per cent). A majority of respondents were reluctant to consider self-test devices in paediatric ototoxicity monitoring (n = 9; 53 per cent). Provision of long-term audiological follow up is sporadic with only 4 (23 per cent) respondents keeping all children with normal hearing under review once treatment is completed.
Conclusion While some good practice in paediatric ototoxicity was identified, opportunities exist to improve clinical practice and protocols, promote multidisciplinary team working and to utilise technologies such as extended high frequency and self-test audiometry.

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A prospective study on the feasibility of cochlear implantation during the coronavirus disease 2019 crisis and trends of assessment: experience in a UK centre

Mohammed, H,Kennedy, L,Whitehead, D,Ahmad, N,Banerjee, A

Publication date 13-01-2021


Objectives To demonstrate the feasibility of continuing cochlear implantation during the coronavirus disease 2019 crisis and to report on trends of referrals via the neonatal hearing screening programme.
MethodsA prospective case series was conducted on children who underwent cochlear implantation during the coronavirus disease 2019 crisis in the UK and a sample of referrals via the neonatal hearing screening programme. A step-by-step description of peri-operative management is included.
Results Regionally, between February and May 2020, 106 babies were referred via the neonatal hearing screening programme to paediatric audiology. Eleven children were operated on during the coronavirus disease 2019 study period. None of the 11 children developed coronavirus symptoms.
Discussion It is widely recognised that the demands of managing the current pandemic may compromise screening, clinical assessment and elective surgery. Time-sensitive issues such as cancer management have gained prominence, but a similar need exists for timely paediatric cochlear implantation.
Conclusion Implantation in the paediatric population during the coronavirus disease 2019 pandemic is feasible with careful planning.

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Hearing results after stapedotomy for otosclerosis: comparison of prosthesis variables

Odat, H,Kanaan, Y,Alali, M,Al-Qudah, M

Publication date 22-01-2021


Objective To evaluate the influence of different piston variables on hearing following stapedotomy.
Methods Data were analysed in groups according to: piston material (titanium vs fluoroplastic), shaft diameter (0.4 mm vs 0.5 mm) and crimping style (manual crimping vs self-crimping). Pre- and post-operative average air–bone gap, air–bone gap difference, success rate and operative time were evaluated.
Results and conclusion Fifty-one patients (58 ears) were included. A post-operative air–bone gap of 10 dB or lower was achieved in 44 cases, with a success rate of 75.9 per cent; 52 cases (89.7 per cent) had an air–bone gap of 20 dB or lower. The success rate was higher, but not significantly, in fluoroplastic than in titanium pistons (85 per cent vs 70 per cent). Pistons with shaft diameters of 0.5 mm and 0.4 mm had success rates of 79 per cent and 72 per cent, respectively. No significant differences were found for any audiometric parameters. There were no significant differences between manual crimping and self-crimping pistons in terms of audiometric results or success rate.

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Efficacy of diluted vinegar in treating granular myringitis: a randomised controlled trial

Prakairungthong, S,Ungchoomchoke, P,Limviriyakul, S,Suvarnsit, K,Atipas, S,Thongyai, K

Publication date 25-01-2021


Objective This study aimed to evaluate the outcome of granular myringitis treatment of 1 per cent diluted vinegar ear drops or 1 per cent chloramphenicol ear drops and to assess the side effects of 1 per cent diluted vinegar.
Method Twenty-four patients aged over 18 years and diagnosed with granular myringitis grade I or II within 90 days of symptom onset were included. Patients were equally randomised into either the 1 per cent diluted vinegar group or the 1 per cent chloramphenicol group. Outcome of treatment and side effects were compared between groups. The main outcome measure was completely epithelialised tympanic membrane at the eight-week period.
Results Eleven of 12 patients treated with 1 per cent diluted vinegar had complete recovery. In the 1 per cent chloramphenicol group, 8 of 12 patients recovered. The difference between groups was not statistically significant (p = 0.156). The observed side effects of diluted vinegar included dizziness and mild external auditory canal irritation.
Conclusion One per cent diluted vinegar is an interesting option for granular myringitis. Other comparative advantages of 1 per cent diluted vinegar include its low price and no induction of antimicrobial resistance.

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Endoscopic epitympanic exploration in mucosal chronic otitis media: is canal wall up mastoidectomy really needed?

Das, A,Mitra, S,Hazra, S,Sengupta, A

Publication date 25-01-2021


Objective To compare endoscopic epitympanic exploration with conventional canal wall up (cortical) mastoidectomy for mucosal chronic otitis media in terms of post-operative outcomes.
Methods Seventy-six patients diagnosed with chronic otitis media (mucosal variety) were randomly assigned to two treatment groups: endoscopic epitympanic exploration and conventional canal wall up (cortical) mastoidectomy.
The groups were compared in terms of: post-operative anatomical outcomes (graft uptake), middle-ear physiological outcomes (post-operative tympanometry), audiological outcomes (air–bone gap), surgical time, post-operative pain, vertigo, and long-term complications such as retraction pocket and re-perforation.
Results There was a statistically significant difference between the groups in terms of mean air–bone gap at 12 months, surgical time, and median post-operative pain measured at 6 hours (p < 0.05).
No statistically significant differences were noted in terms of: graft uptake at 1, 3 and 6 months, mean air–bone gap at 3 and 6 months, tympanometry at 3, 6 and 12 months, vertigo at 1 week, or long-term complications.
Conclusion Endoscopic epitympanic exploration resulted in significantly better long-term audiological outcomes, shorter operating time and less pain compared with conventional canal wall up (cortical) mastoidectomy.

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The relation between serum D-dimer, ferritin and vitamin D levels, and dysgeusia symptoms, in patients with coronavirus disease 2019

Elibol, E,Baran, H

Publication date 07-01-2021


Objective This study aimed to evaluate the association between serum D-dimer, ferritin and vitamin D levels, and dysgeusia symptoms, in patients with coronavirus disease 2019.
Methods The present study was conducted with the medical records of 300 patients positive for coronavirus disease 2019, hospitalised between 28 March and 15 August 2020. The patients were divided into two groups regarding the presence or absence of dysgeusia symptoms.
Results Fever and sore throat rates, and the mean D-dimer level, were considerably higher in the dysgeusia group than in the non-dysgeusia group (32.1 vs 21.6 per cent, p = 0.04; 43.6 vs 20.7 per cent, p < 0.001; and 0.54 ± 0.32 vs 0.49 ± 0.51 mg/l FEU, p = 0.008, respectively). The mean age was significantly lower in the dysgeusia group than in the non-dysgeusia group (42.83 ± 12.31 vs 50.51 ± 13.67 years, p < 0.001).
Conclusion Younger age, fever and shortness of breath could be observed in patients with dysgeusia symptoms. In addition, the D-dimer level was significantly higher in the dysgeusia group.

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Does the radioactive iodine dose affect smell, taste sensation and nose function?

Tutar, B,Özülker, T,Berkiten, G,Karaketir, S,Ekincioğlu, M E,Saltürk, Z,Onaran, Ö,Gürpınar, B,Karaketir, Ş,Kumral, T L,Uyar, Y

Publication date 22-01-2021


Objective To detect whether the adverse effects of post-operative radioactive iodine therapy following differentiated thyroid cancer on smell, taste and nasal functions were associated with radioactive iodine dose.
Methods Fifty-one patients who had undergone total thyroidectomy because of differentiated thyroid cancer were divided into two groups depending on the post-operative radioactive iodine therapy dose: low dose group (50 m Ci; 21 patients) and high dose group (100–150 m Ci; 30 patients). The Sniffin’ Sticks smell test, the Taste Strips test and the 22-item Sino-Nasal Outcome Test were performed on all patients one week before therapy, and at two months and one year following therapy.
Results Statistically significant differences were detected in the Sniffin’ Sticks test results, total odour scores, total taste scores and Sino-Nasal Outcome Test results between the assessment time points. There was no statistically significant difference between the low and high dose groups in terms of odour, taste or Sino-Nasal Outcome Test scores either before or after therapy.
Conclusion Radioactive iodine therapy has some short- and long-term adverse effects on nasal functions and taste and odour sensations, which affect quality of life. These effects are not dose-dependent.

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Revision cricotracheal resection: our experience

Ebada, H A,El-Fattah, A M A,Tawfik, A

Publication date 25-01-2021


Objective The incidence of recurrent stenosis after cricotracheal resection is 3–9.5 per cent. Management of such patients is challenging. This study aimed to review our experience in revision cricotracheal resection.
Methods The study was conducted in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt, on nine patients with recurrent stenosis following cricotracheal resection. Revision cricotracheal resection was performed in all patients. Surgiflo was applied on the site of anastomosis to enhance healing.
Results No intra-operative complications were recorded. Minor post-operative complications occurred in two patients (surgical emphysema and temporary choking); no major complications were reported. Re-stenosis occurred in one patient. Successful decannulation was achieved in eight of the nine patients.
Conclusion Revision cricotracheal resection is the definitive curative treatment for recurrent stenosis after previous unsuccessful resection. It has high success rates, provided that careful pre-operative assessment and meticulous operative technique are performed.

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Antibiotics in treatment of peritonsillar infection: clindamycin versus penicillin

Hallgren, F,Lindell, E,Nilsson-Helger, B,Lundqvist, A

Publication date 22-01-2021


Objective This study aimed to compare antibiotic treatment with clindamycin versus penicillin V or G in terms of time to recovery and recurrence in patients with peritonsillar infection, including both peritonsillar cellulitis and peritonsillar abscess.
Method This retrospective cohort study examined the records of 296 patients diagnosed with peritonsillar infection. Based on the ENT doctors choice of antibiotics, patients were divided into clindamycin and penicillin groups.
Results Mean number of days in follow up was 3.5 days in the clindamycin group and 3.4 days in the penicillin group. The recurrence rate within 2 months was 7 per cent in the clindamycin group and 4 per cent in the penicillin group.
Conclusion This study found no significant differences in either recovery or recurrence between the groups. This supports the use of penicillin as a first-line treatment, considering the greater frequency of adverse effects of clindamycin shown in previous studies, as well as its profound collateral damage on the intestinal microbiota, resulting in antibiotic resistance.

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What still presents urgently to ENT during a pandemic? Experience of an ENT rapid access clinic during the coronavirus disease 2019 pandemic

Stubington, T J,Morrison, B,Sevilla, C,Judd, O

Publication date 07-01-2021


Objectives This study sought to determine the conditions that still present to ENT despite government advice to avoid unnecessary travel. It also assessed the impact of social distancing on pathologies presenting to ENT and reviewed the usefulness of telephone consultations in semi-urgent presentations.
MethodA retrospective review was conducted of 97 instances of patient care carried out in the rapid access ENT clinic at a large district general hospital.
Results Otitis externa and foreign bodies represented 25 per cent and 13 per cent of consultations respectively. Tonsillitis and peritonsillar abscess were uncommon, representing 6 per cent of total consultations. Telephone appointments represented only 28 per cent of total consultations; however, they appeared to reduce the number of physical appointments required.
Conclusion Otitis externa and foreign bodies continue to be common during the pandemic. Social distancing measures reduced the number of tonsillitis and quinsy presentations. Telephone consultations are effective for certain urgent presentations to ENT, most noticeably nasal trauma and follow up of non-serious pathologies.

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The ENT run through pilot: a questionnaire survey of 23 trainees

Heward, E,Kumar, B N

Publication date 22-01-2021


Objective The ENT run through pilot was introduced in 2018 to improve early recruitment to the specialty. This study aimed to understand what makes a successful interview applicant and the experience of the run through trainees during the specialty trainee one and specialty trainee two years.
MethodA questionnaire survey was sent to all ENT run through trainees.
Results Twenty-three trainees responded. Of the successful candidates, 74 per cent held additional degrees prior to application. The median core surgical interview rank was 27 (range: 3–174). Trainees felt that being on the run through pilot had increased ENT trainer engagement.
Conclusion The ENT run through posts are highly competitive, and holding an additional degree may improve applicant success. The pilot programme has been successful by increasing trainer engagement at this critical stage of training. These results will enable development of the pilot programme and provide valuable information for those applying to an ENT run through post.

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Use of lidocaine with phenylephrine (Co-phenylcaine) spray for anaesthesia of the external auditory canal

Lim, A E,Alatsatianos, A,Wardrop, P

Publication date 22-01-2021


ObjectiveA method is described for topical local anaesthesia of the tympanic membrane and ear canal using lidocaine and phenylephrine (Co-phenylcaine) spray and soaked micropatties.
Discussion The advantages of this method are discussed in comparison to existing methods.

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A novel technique for protecting staff during microlaryngoscopy procedures

Zoabi, T,Ronen, O

Publication date 08-01-2021


Objective Microlaryngoscopy is an aerosol-generating procedure. This paper presents a novel approach for better protecting staff during microlaryngoscopy.
MethodsA clear plastic microscope drape is attached to the objective lens. Instead of using the drape to cover the microscope, it is pulled down to cover the patients head and torso. The holes designated for the binoculars of the microscope are used for the surgeon hands, forming protective clear plastic sleeves.
Conclusion The proposed technique, which is simple, relatively inexpensive and technically feasible for any hospital to perform during microlaryngoscopy procedures, can increase safety and minimise droplet and aerosol exposure in the operating theatre.

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Transnasal humidified rapid-insufflation ventilatory exchange (‘THRIVE’) in the coronavirus disease 2019 pandemic

Hey, S Y,Milligan, P,Adamson, R M,Nixon, I J,McNarry, A F

Publication date 07-01-2021


Background Since the start of the coronavirus disease 2019 pandemic, transnasal humidified rapid-insufflation ventilatory exchange (‘THRIVE’) has been classified as a high-risk aerosol-generating procedure and is strongly discouraged, despite a lack of conclusive evidence on its safety.
Methods This study aimed to investigate the safety of transnasal humidified rapid-insufflation ventilatory exchange usage and its impact on staff members. A prospective study was conducted on all transnasal humidified rapid-insufflation ventilatory exchange cases performed in our unit between March and July 2020.
Results During the study period, 18 patients with a variety of airway pathologies were successfully managed with transnasal humidified rapid-insufflation ventilatory exchange. For each case, 7–10 staff members were present. Appropriate personal protective equipment protocols were strictly implemented and adhered to. None of the staff involved reported symptoms or tested positive for coronavirus disease 2019, up to at least a month following their exposure to transnasal humidified rapid-insufflation ventilatory exchange.
Conclusion With strictly correct personal protective equipment use, transnasal humidified rapid-insufflation ventilatory exchange can be safely employed for carefully selected patients in the current pandemic, without jeopardising the health and safety of the ENT and anaesthetic workforce.

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Facial nerve baroparesis during airflight: a case report and literature review

Alwan, M,Gordan, M

Publication date 09-12-2020


Background Facial nerve baroparesis is a rare phenomenon which has been reported during flight. It is thought to occur due to ischaemic neuropraxia on the facial nerve as middle-ear pressure increases in the presence of Eustachian tube dysfunction and force is transmitted through a dehiscent facial nerve canal.
Method This study presents an aviation-associated, right-sided facial nerve palsy as well as presenting the results of a systematic review that was performed on the available literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text articles from Medline, Pub Med and Embase were used, as well as associated reference lists. This study systematically reviews the literature to discuss presentation, investigations performed and an approach to management of this rare condition.
Results This study identified 23 cases in the literature (including the case presented in this study) of facial nerve baroparesis.
Conclusion Facial nerve baroparesis is a mostly temporary rare phenomenon that can be managed effectively with ventilation tube insertion. In the event of long-standing facial nerve palsy after descent of the aircraft, urgent myringotomy should be performed to prevent permanent facial nerve damage.

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Diagnostic Vestibular Pocket Guide: Evaluation of Dizziness, Vertigo, and Imbalance J A Honaker Plural Publishing, 2020 ISBN 978 1 63550 312 8 pp 288 Price €54.99 US$79.95

Flood, L M

Publication date 21-01-2021


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The Coordination of Clinical Research: A Handbook for Research Coordinators M Bhandari, E M M Van Lieshout Thieme, 2020 ISBN 978 3 13242 229 2 pp 320 Price £84.00 €(D)179.99

Flood, L M

Publication date 22-01-2021


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JLO volume 135 issue 1 Cover and Front matter

Publication date 10-02-2021


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JLO volume 135 issue 1 Cover and Back matter

Publication date 10-02-2021


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