Journal of Laryngology and Otology 2020-10-19

Changes to otolaryngological practice in the coronavirus disease 2019 era

Fishman, Jonathan,Fisher, Edward

Publicatie 19-10-2020


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Olfactory disorders in coronavirus disease 2019 patients: a systematic literature review

Fuccillo, E,Saibene, A M,Canevini, M P,Felisati, G

Publicatie 15-09-2020


ObjectiveRecent scientific literature has widely described a possible major role of smell dysfunction as a specific symptom of coronavirus disease 2019. This systematic review may provide a more holistic approach to current knowledge of the disease.MethodsA systematic review was completed using Embase, PubMed and Web of Science databases that considered original articles focused on olfactory evaluation in coronavirus disease 2019 patients, published between March and May 2020, in English language.ResultsFrom the 483 research papers initially identified, 32 original studies were selected, comprising a total of 17 306 subjects with a laboratory confirmed diagnosis of coronavirus disease 2019. Individual study sample sizes ranged from 6 to 6452 patients. This comprehensive analysis confirmed that olfactory disorders represent an important clinical feature in coronavirus disease 2019, with a prevalence of 11–100 per cent in included patients, although there was heterogeneity in terms of assessment tools and population selection criteria.ConclusionThe results indicate that an accurate clinical evaluation should be carried out using structured questionnaires and tests with olfactory substances.

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Differences between primary care physicians and specialised neurotologists in the diagnosis of dizziness and vertigo in Japan

Ito, T,Matsuyama, S,Shiozaki, T,Nishikawa, D,Akioka, H,Yamanaka, T,Kitahara, T

Publicatie 17-09-2020


ObjectiveVertigo and dizziness are frequent symptoms in patients at out-patient services. An accurate diagnosis for vertigo or dizziness is essential for symptom relief; however, it is often challenging. This study aimed to identify differences in diagnoses between primary-care physicians and specialised neurotologists.MethodIn total, 217 patients were enrolled. To compare diagnoses, data was collected from the reference letters of primary-care physicians, medical questionnaires completed by patients and medical records.ResultsIn total, 62.2 per cent and 29.5 per cent of the patients were referred by otorhinolaryngologists and internists, respectively. The cause of vertigo or dizziness and diagnosis was missing in 47.0 per cent of the reference letters. In addition, 67.3 per cent of the diagnoses by previous physicians differed from those reported by specialised neurotologists.ConclusionTo ensure patient satisfaction and high quality of life, an accurate diagnosis for vertigo or dizziness is required; therefore, methods or materials to improve the diagnostic accuracy are needed.

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En Hamac tympanoplasty and canalplasty for optimal type 1 tympanoplasty outcomes

Vandenbroeck, S,Kuhweide, R,Lerut, B

Publicatie 13-08-2020


ObjectiveMultiple tympanoplasty techniques have been developed with numerous differences in grafting and approach. This study aimed to improve type 1 tympanoplasty outcomes by using the ‘en hamac’ technique as well as performing a complete canalplasty for anterior perforations.MethodA retrospective review was performed using the prospective Otology-Neurotology Database tool for otological surgery. All primary type 1 tympanoplasty cases performed for tympanic membrane perforations from 2010 to 2016 were selected for analysis, all performed by one author. Minimal clinical and audiometric follow up was 18 months.ResultsTympanic membrane perforation closure was achieved in 62 of the patients (96.88 per cent). None of the en hamac cases had residual or recurrent perforation (p = 0.02). The mean remaining air–bone gap was 8.50 dB. The remaining air–bone gap was less than 10 dB in 72.55 per cent, 10–20 dB in 25.49 per cent and more than 20 dB in 1.96 per cent.ConclusionUsing the en hamac technique for anterior perforations as well as systematically performing a complete canalplasty provides multiple surgical advantages with excellent post-operative results.

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A comparative study of endoscopic cartilage myringoplasty used to treat wet and dry ears with mucosal-type chronic otitis media

Lou, Z,Li, X

Publicatie 05-08-2020


ObjectiveThe outcomes of dry and wet ears were compared following endoscopic cartilage myringoplasty performed to treat chronic tympanic membrane perforations in patients with mucosal chronic otitis media.MethodsPatients with chronic perforations, and with mucosal chronic otitis media with or without discharge, were recruited; all underwent endoscopic cartilage myringoplasty. The graft success rate and hearing gain were evaluated at six months post-operatively.ResultsThe graft success rates were 85.9 per cent (67 out of 78) in dry ears and 86.2 per cent (25 out of 29) in wet ears; the difference was not significant (p = 0.583). Among the 29 wet ears, the graft success rates were 100 per cent in 11 ears with mucoid discharge and 77.8 per cent in the 18 patients with mucopurulent otorrhoea.ConclusionThe wet or dry status of ears in patients with chronic perforations with mucosal chronic otitis media did not affect graft success rate or hearing gain after endoscopic cartilage myringoplasty. However, ears with mucopurulent discharge were associated with increased failure rates and graft collapse, whereas ears with mucoid discharge were associated with higher graft success rates.

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The outcomes of endoscopic myringoplasty: elevating a tympanomeatal flap or not

Wang, D,Wang, W

Publicatie 28-09-2020


ObjectiveThe aim of this study was to compare the differences between the no tympanomeatal flap approach and the tympanomeatal flap approach in endoscopic myringoplasty.MethodA total of 132 patients with tympanic membrane perforation were randomly divided into two groups: the no tympanomeatal flap approach group (group A, 56 ears) and the tympanomeatal flap approach group (group B, 76 ears). A comparison between the two groups was made.ResultsThe average operation time of group A was 36.00 ± 5.24 minutes, which was significantly shorter than that of group B, which was 43.89 ± 4.57 minutes (p = 0.002). The blood loss of group A was 5.08 ± 1.83 ml, which was significantly less than that of group B (9.67 ± 2.29 ml; p < 0.001). There were no differences in the degree of hearing improvement, the rate of hearing improvement, the dry ear time (when the external auditory canal and the operating cavity were dry) after operation and the success rate of tympanic membrane repair when compared between the two groups.ConclusionCompared with group B, group A (no tympanomeatal flap approach) can achieve the same effect but has the advantages of a shorter operation time and less blood loss during the operation.

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Comparison of gustatory function between mucosal and squamous disease: a randomised controlled study

Anant, A,Lal, P,Pradhan, P

Publicatie 17-08-2020


ObjectiveThe aim of this study was to evaluate and compare the gustatory function between patients with chronic mucosal and squamous diseases before and after the surgery.MethodA total of 33 patients with mucosal diseases and 34 patients with squamous diseases were evaluated for gustatory function both in the pre-operative and post-operative periods. The taste scores were compared between the two groups.ResultsThe gustatory scores in the mucosal disease group were significantly better than the scores in the squamous disease group (p < 0.05). There was no significant correlation detected between the age of the patients or duration of the disease with the taste scores in any of the study groups.ConclusionThe improvement in gustatory score was better in the chronic mucosal disease group than the squamous disease group. There was no significant correlation found between the age of the patients or duration of disease and the taste score in any of the study groups.

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The single-use rhinolaryngoscope: an evaluation and cost comparison

Mistry, R,Russell, R V,Walker, N,Ofo, E

Publicatie 28-09-2020


BackgroundThis study investigated whether the single-use rhinolaryngoscope is clinically and economically comparable to the conventional reusable rhinolaryngoscope within a tertiary otolaryngology centre in the UK.MethodsA non-blinded, prospective and single-arm evaluation was carried out over a 5-day period, in which micro-costing was used to compare single-use rhinolaryngoscopes with reusable rhinolaryngoscopes.ResultsOverall, 68 per cent of the investigators perceived the single-use rhinolaryngoscope to be ‘good’ or ‘very good’, while 85 per cent believed the single-use rhinolaryngoscope could replace the reusable rhinolaryngoscope (n = 59). The incremental costs of reusable rhinolaryngoscope eyepieces and videoscopes in the out-patient clinic, when compared to single-use rhinolaryngoscopes, were £30 and £11, respectively. The incremental costs of reusable rhinolaryngoscope eyepieces and videoscopes in the acute surgical assessment unit, when compared to single-use rhinolaryngoscopes, were −£4 and −£73, respectively.ConclusionThe single-use rhinolaryngoscope provides a clinically comparable, and potentially cost-minimising, alternative to the reusable rhinolaryngoscope for use in the acute surgical assessment unit of our hospital.

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Petrous apex pneumatisation in children: a radiological study

Hardcastle, T,McKay-Davies, I,Neeff, M

Publicatie 24-08-2020


ObjectiveThis study aimed to investigate petrous apex pneumatisation in children, as an understanding of petrous apex pneumatisation is useful in the diagnosis and surgical management of middle-ear disease.MethodsComputed tomography head scans from 1700 patients aged 0–16 years were assessed. Petrous apex bone and air cell volumes were calculated to determine the degree of petrous apex pneumatisation. Scans were analysed for communicating tracts between the middle ear and petrous apex.ResultsPetrous apex pneumatisation was found in 21.0 per cent of patients. Positive relationships were found between age and petrous apex pneumatisation prevalence (rs = 0.990, p < 0.001), and between age and degree of petrous apex pneumatisation (rs = 0.319, p < 0.001). Petrous apex pneumatisation prevalence did not significantly differ by sex or ethnicity. Communicating tracts were identified in 84.3 per cent of patients with petrous apex pneumatisation, most commonly anterior to the otic capsule.ConclusionIn children, the prevalence and degree of petrous apex pneumatisation increases with age, but prevalence is not affected by sex or ethnicity.

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Minimising aerosol spread during endoscopic sinus and skull base surgery. Experimental model evaluation of the efficacy of the microscope drape method

Ioannidis, D,Tsagkovits, A,Rokade, A

Publicatie 14-09-2020


BackgroundEndoscopic sinus and anterior skull base surgery is considered particularly high risk for severe acute respiratory syndrome coronavirus-2 transmission in the operating theatre setting. In this context, the use of a microscope drape method is proposed, to minimise aerosol spread in the wider operating theatre environment.MethodsThe efficacy of the method is assessed with a simulation model, using a CMI Concept Air Trace MK2 smoke generator for aerosol generation and a Fluke 985 air particle counter to measure air particles sized 0.3–10 μm in the operating theatre environment.ResultsAerosol spread was contained almost to baseline levels with the application of the drape barrier and the negative pressure created using suction within the drape.ConclusionThe method is an efficient adjunct that could reduce the risk of aerosol shedding and viral transmission to the operating theatre team. It potentially allows faster operating theatre turnover and more liberal use of powered instruments during endonasal surgery.

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Should adults with isolated serous otitis media be undergoing routine biopsies of the post-nasal space?

Cunniffe, H A,Gona, A K,Phillips, J S

Publicatie 10-09-2020


BackgroundSerous otitis media is a recognised presentation of Eustachian tube dysfunction secondary to post-nasal space pathology. Post-nasal space biopsies are commonly taken in patients with isolated serous otitis media, despite normal nasendoscopy findings, without robust evidence for doing so. This study examined cases of unilateral serous otitis media with effusion in adults. It is the largest known retrospective study to investigate whether post-nasal space biopsies are indicated in non-endemic regions.MethodsA retrospective analysis was performed of 119 patients who underwent post-nasal space biopsy because of isolated serous otitis media, in a tertiary referral centre, from 2007 to 2017. Endoscopic examination and final histological report findings were reviewed.ResultsOf the 119 patients identified, 6 (5.0 per cent) were found to have abnormal histology. In all six cases, suspicious clinical findings had been noted on nasendoscopic examination prior to biopsy.ConclusionSuspicious findings pre-operatively predict sinister pathology. Biopsies are not recommended in cases of adult serous otitis media with normal nasendoscopy findings if no other risk factors exist. A UK-wide retrospective study or prospective study over the next 10 years will help provide the evidence necessary to support this guidance.

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Horizontal sound localisation and speech perception in Bonebridge-implanted single-sided deafness patients

Zhao, C,Yang, J,Liu, Y,Gao, M,Chen, P,Zheng, J,Zhao, S

Publicatie 16-09-2020


ObjectiveThis study aimed to investigate the benefit of Bonebridge devices in patients with single-sided deafness.MethodFive patients with single-sided deafness who were implanted with Bonebridge devices were recruited in a single-centre study. Participants’ speech perception and horizontal sound localisation abilities were assessed at 6 and 12 months post-operatively. Speech intelligibility in noisy environments was measured in three different testing conditions (speech and noise presented from the front, speech and noise presented from the front and contralateral (normal ear) side separately, and speech presented from the ipsilateral (implanted Bonebridge) side and noise from the contralateral side). Sound localisation was evaluated in Bonebridge-aided and Bonebridge-unaided conditions at different stimuli levels (65, 70 and 75 dB SPL).ResultsAll participants showed a better capacity for speech intelligibility in quiet environments with the Bonebridge device. The speech recognition threshold with the Bonebridge device was significantly decreased at both short- and long-term follow up in the speech presented from the ipsilateral (implanted Bonebridge) side and noise from the contralateral side condition (p < 0.05). Additionally, participants maintained similar levels of sound localisation between the Bonebridge-aided and unaided conditions (p > 0.05). However, the accuracy of localisation showed some improvement at 70 dB SPL and 75 dB SPL post-operatively.ConclusionThe Bonebridge device provides the benefit of improved speech perception performance in patients with single-sided deafness. Sound localisation abilities were neither improved nor worsened with Bonebridge implantation at the follow-up assessments.

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Potential association between recurrent facial nerve palsy and migraines

Kontorinis, G,Tyagi, A

Publicatie 17-09-2020


ObjectiveThis study aimed to investigate the possible association between recurrent facial nerve palsy and migraines.MethodThis study was a prospective case series with a two-year follow-up at an academic, tertiary referral centre and included patients with at least four episodes of recurrent lower motor neuron facial nerve palsy. All patients underwent standardised diagnostic tests.ResultsFour patients fulfilled the inclusion criteria. The patients were all female with an average age at presentation of 40.75 years (range, 33–60 years) and an average age at the initial episode of 14 years (range, 12–16 years). The number of episodes varied between six and nine. All patients had at least one episode of facial nerve palsy on the contralateral side. Two patients were diagnosed and treated for migraine with aura remaining asymptomatic following prophylactic medication for migraines.ConclusionThe results raise the possibility of an association between recurrent facial nerve palsy and migraines. Prospective studies in patients with even fewer episodes of facial nerve palsy could shed more light on this association.

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Single-use lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical spray; can it now be employed as a multi-use atomiser?

Jog, M,Zudovaite, I,"ODwyer, M",Saeed, K,Singh, T

Publicatie 17-09-2020


ObjectiveThis study investigated the risk of contamination of lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical solution after modification of the application technique.MethodsThis paper reports a prospective basic sciences study involving 22 study samples and 1 control sample of the lidocaine hydrochloride and phenylephrine hydrochloride topical anaesthetic spray. The samples were assessed for microbiological contamination after a single use on patients using a modified application technique. The modification involves keeping the nozzle (actuator) pressed down whilst withdrawing the spray to at least 30 cm (1 ft) from the patient, before releasing the nozzle (actuator) and subsequently reapplying the spray.ResultsThree of the 23 samples confirmed bacterial growth in the bottle contents, but there was no growth in any of the samples from the pump. These bacteria are considered to be contaminants.ConclusionThere is a potential to use the lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical solution as a multi-use spray by changing the actuator between patients. This would have significant beneficial cost implications without the attendant infection control risk.

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The role of transoral fine needle aspiration in expediting diagnosis and reducing risk in head and neck cancer patients in the coronavirus disease 2019 era: a single-institution experience

Touska, P,Oikonomou, G,Ngu, R,Chandra, A,Malhotra, A,Fry, A,Oakley, R,Arora, A,Jeannon, J-P,Simo, R

Publicatie 02-09-2020


ObjectiveThe global coronavirus disease 2019 (COVID-19) pandemic has necessitated rapid alterations to diagnostic pathways for head and neck cancer patients that aim to reduce risk to patients (exposure to the hospital environment) and staff (aerosol-generating procedures). Transoral fine needle aspiration cytology offers a low-risk means of rapidly diagnosing patients with oral cavity or oropharyngeal lesions. The technique was utilised in selected patients at our institution during the pandemic. The outcomes are considered in this study.MethodDiagnostic outcomes were retrospectively evaluated for a series of patients undergoing transoral fine needle aspiration cytology of oral cavity and oropharyngeal lesions during the COVID-19 pandemic.ResultsFive patients underwent transoral fine needle aspiration cytology, yielding lesional material in 100 per cent, with cell blocks providing additional information. In one case, excision biopsy of a lymphoproliferative lesion was required for final diagnosis.ConclusionTransoral fine needle aspiration cytology can provide rapid diagnosis in patients with oral cavity and oropharyngeal lesions. Whilst limitations exist (including tolerability and lesion location), the technique offers significant advantages pertinent to the COVID-19 era, and could be employed in the future to obviate diagnostic surgery in selected patients.

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Improving peri-operative psychosocial interventions for children with autism spectrum disorder undergoing ENT procedures

Fahy, R,Corbett, M,Keogh, I

Publicatie 30-09-2020


ObjectivesChildren with autism spectrum disorder face a broad range of communication and sensory challenges. Many of these children also have chronic ENT issues. This study aims to better understand these challenges and improve our services for children with autism spectrum disorder.MethodsQuestionnaires and semi-structured interviews were carried out with parents of children with autism spectrum disorder.ResultsThirty-four individuals participated, comprising 9 caregivers and 25 staff members. All parents recognised their critical roles in understanding their childrens special needs and sensitivities. Parents and staff stressed the importance of a partnership role that inquired about unique needs, leading to environmental modifications for individual children.ConclusionThe importance of listening to and involving caregivers is a fundamental tenet; parents must be recognised as the experts. Uncertainty must be kept to a minimum, with clear communication in a structured, low-arousal environment for these children. We have listened to parents and staff, and developed a social story.

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Cochlear Implants: From Principles to Practice D S Haynes, R H Gifford, G B Wanna, A C Rivas Jaypee Bros Medical, 2020 ISBN 978 1 78779 119 0 pp 264 Price £66.00

Banerjee, Anirvan

Publicatie 07-09-2020


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Oculoplastic Surgery, 3rd edn B Leatherbarrow Thieme, 2020 ISBN 978 1 62623 689 9 pp 716 Price £231.71 €269.99 $299.99

Ullas, G

Publicatie 17-09-2020


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JLO volume 134 issue 9 Cover and Front matter

Publicatie 19-10-2020


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JLO volume 134 issue 9 Cover and Back matter

Publicatie 19-10-2020


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