Spontaneous bilateral pneumothorax in a previously healthy COVID-19 patient: A case report

Coronavirus disease 2019 (COVID-19) is commonly linked with mild cough, fever, and shortness of breath symptoms. However, there have been reports of pneumothorax, which particularly occurred at least 1 week following symptom onset in elderly COVID-19 patients. Spontaneous pneumothorax (SP) is an uncommon but possibly fatal complication of COVID-19 pneumonia and is rarely reported in non-intubated patients. We report a case of a healthy, non-smoker 35-year-old young woman who presented with a 7-day cough, fever, and sudden shortness of breath. She was diagnosed with severe COVID-19 pneumonia, experienced a right SP, and developed a second pneumothorax on the contralateral side. She improved gradually following chest tube insertion in the right lung and conservative management for the left pneumothorax.

Surgery for Otitis Media with Effusion: A Survey of Otolaryngologists Who Treat Children in Brazil

Abstract Introduction Myringotomy and ear tube placement (MTP) is the surgical treatment for otitis media with effusion (OME), and it is the most common surgery performed in children. Several guidelines have been developed to assist in the care of patients who become candidates for MTP. Objectives To evaluate the practice of Brazilian otorhinolarynogologists when performing MTP according to the years of clinical experience. Secondarily, we also want to assess if their practice regarding MTP varied according to the percentage of children treated and the location of their practice. Methods A 30-question survey was sent to otolaryngologists affiliated with the Brazilian Academy of Pediatric Otorhinolaryngology (Academia Brasileira de Otorrinolaringologia Pediátrica, ABOPe, in Portuguese) and/or the Scientific Department of Otorhinolaryngology of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP, in Portuguese). The questions included were carefully chosen to provide a profile about the practices adopted in the pre-, peri- and postoperative periods of MTP. Results The questionnaire was sent to 208 otolaryngologists, and there were 124 (59.6%) respondents. Of those, 59.7% use antiseptics before surgery. Only 54 otolaryngologists, less than half of the subjects in this study (43.5%), always place a tube during the procedure. More physicians who practice in small cities recommend water precautions after MTP when compared to other physicians (p < 0.001). Conclusions The present study reveals that many respondents do not follow some of the recommendations of the current guidelines of the American Academy of

Long-term indwelling gastric tube for prevention and treatment of esophageal stricture after endoscopic submucosal dissection for esophageal circumferential superficial cancer / 中华消化内镜杂志

To investigate the effect of long-term indwelling gastric tube on the prevention and treatment of esophageal stenosis after endoscopic submucosal dissection (ESD) for esophageal circumferential superficial cancer, data of patients with esophageal circumferential superficial cancer who underwent ESD in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2021 were retrospectively analyzed. There were 15 patients with gastric tube placement (GTP) after ESD (the GTP group ), and 23 patients without GTP (the non-GTP group). The general information, lesion location, pathological stage, postoperative complications, degree of esophageal stenosis (water intake), pain conditions, number of hospitalizations and medical expenses were compared between the two groups. The results showed that there was no significant difference in age, gender, lesion location or postoperative pathological stage between the two groups ( P>0.05). Compared with the non-GTP group, the rate of water intake in the GTP group was significantly higher (11/15 VS 6/23, P<0.05), the frequency of pain was less in the GTP group (7.3±3.1 times VS 10.7±3.6 times, t=3.00, P<0.05), and the number of hospitalizations and the medical expenses after ESD to before and after stent placement were significantly lower in the GTP group than those in the non-GTP group ( P<0.05). There were no significant differences in the incidence of delayed bleeding and perforation, or time of the first stenosis after ESD between the two groups ( P>0.05). The results of the study initially showed that long-term indwelling gastric tube after ESD can reduce the degree of esophageal stenosis with good safety for esophageal circumferential superficial lesions.

Vertiginous Episodes in Menière Disease following Transmyringeal Ventilation Tube Insertion: A Systematic Review on the Current State of Evidence

Abstract Introduction Menière disease (MD) is a disorder characterized by episodes of vertigo, sensorineural hearing loss, tinnitus and aural fullness. Objectives To assess the effect of ventilation tube insertion (VTI) on vertiginous episodes in patients (≥ 18 years old) with MD. Data Synthesis A systematic literature search on randomized clinical trials (RCTs), nonrandomized trials and other systematic reviews was performed. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to assess the overall certainty of evidence. Two RCTs and four nonrandomized studies were identified. Data extraction was only possible for one RCT. Results showed that the number of patients with no vertigo attacks significantly increased following active treatment (relative risk 1.52; [95% confidence interval: 1.19-1.94]). The quality of evidence was rated as low. None of the nonrandomized trials included a proper control group, which hindered data extraction and quality assessment. Conclusion There are currently no RCTs that specifically assess the efficacy of VTI in patients with MD. Current limited data suggest a considerable positive effect on the number of vertiginous episodes in patients with MD. However, due to poor evidence, a fluctuating course and a substantial placebo-effect associated with MD-treatment, no solid conclusion(s) regarding the efficacy of VTI can be made. There is a need for high-quality RCTs.

Effect of tympanostomy tube insertion or tympanocentesis on transnasal endoscopic adenoidectomy in the treatment of pediatric patients with secretory otitis media / 重庆医学

Objective To discuss the tympanic membrane puncture or tympanostomy tube under endotoscope combined with adenoidectomy under nasal endoscopy on the influence of invalid conservative treatment of pediatric secretory otitis media.Methods A total of 112 cases of secretory otitis media with invalid conservative treatment were selected in the department of otorhinolaryngology of children′s hospital of Nanjing Medical University from July 2013 to August 2015.They were divided into three groups,the group A of 38 cases(68 ears)underwent transnasal endoscopic pure adenoidectomy;the group B of 37 cases(60 ears)underwent transnasal endoscopic adenoidectomy combined with tympanocentesis;the group C of 37 cases(59 ears)underwent tympanostomy tube insertion.The clinical treatment effect,the period of middle ear effusion,postoperative recurrence and complication were observed and compared.Results The total effective rate of the 3 groups was improved after 3 months(P<0.05);the total effective rate in group B and group C at one week and 3 months after operation were higher than those of group A(P<0.05);and the total effective rate in group C at 3 months after operation was significantly higher than that of group B(P<0.05).The level of auditory brainstem evoked potential(ABR)and the latency of ABR wave Ⅰ latency were decreased at 1 year after operation(P<0.05);the ABR changes in group B and group C at 1 week and 1 year after operation were lower than those in group A(P<0.05).The incidence of recurrence rate and the period of middle ear effusion in group C were lower than those in group A and B(P<0.05).The incidence of complication of group A was lower than those of group B and group C(P<0.05).Conclusion Using tympanostomy tube combined with adenoidectomy under endoscope can improve the children with hearing,which not only can shorten the time of the middle ear effusion,but also effectively reduce the recurrence rate.

Success Rates of Multiple Treatments for Ingrown Nails / 대한피부과학회지

BACKGROUND: An ingrown nail is a common condition of inflammation and infection that can occur when nails are clipped too much or pressure is applied by tight shoes. In Korea, a study on the success of tube insertion after nail guttering has been reported, but studies including other treatments are lacking. OBJECTIVE: To evaluate the success rates of three treatments for ingrown nails: 1) nail splinting via a flexible tube; 2) partial nail extraction and electrocautery; or 3) partial nail extraction and phenol cauterization. METHODS: Fifty-one patients who underwent nail splinting via a flexible tube or partial nail extraction followed by either electrocautery or phenol cauterization of the nail matrix over a 6-year period at our hospital were evaluated for treatment outcome. The disease severity was classified using the Heifetz grading scale. We evaluated the success rates of the various treatments according to reduced disease severity. Treatment failure was defined as persistence or re-occurrence of disease symptoms. RESULTS: 1. Out of 51 cases of ingrown nails, 31 (60%) showed no recurrence after treatment. 2. There were conflicting results between the severity grade and success rate. 3. Treatment via partial nail extraction and either electrocautery or phenol cauterization was more effective (success rates of 63% and 60%, respectively) than nail splinting via a flexible tube (56% success rate). However, the results were not statistically significant. CONCLUSION: Selecting the proper therapeutic method is important for successful treatment of an ingrown nail.

The application of GUSS swallowing evaluation as a symbol of pulling out the tube in cerebral hemorrhage patients with indwelling gastric tube / 中国实用护理杂志

Objective To compare the difference between GUSS swallowing evaluation and traditional evaluation as a symbol of pulling out stomach tube.Methods 60 patients with cerebral hemorrhage combined with indwelling tube were divided into two groups,the GUSS group and the traditional group,according to the symbol of pulling out the gastric tube.Each group contained 30 cases.The GUSS score ≥ 15 points was used as the symbol of pulling out the gastric tube in the GUSS group,while being able to eat 200 ml liquid without any trouble in two days was used as the symbol in the traditional group.Then we compared the incidence of gastric tube reinsertion and aspiration pneumonitis between the two groups.Results No gastric tube reinsertion and aspiration pneumonitis occurred in the GUSS group,while 7 cases accepted gastric tube reinsertion and 3 cases diagnosed as aspiration pneumonitis in the traditional group.The incidence of gastric tube reinsertion and aspiration pneumonitis in the GUSS group were obviously lower than those in the traditional group.Conclusions GUSS evaluation score ≥ 15 points could be used as a symbol of pulling out gastric tube.

The Effect of Punctoplasty with Pigtail Probe for Canalicular Intubation in Patients with Punctal Obstruction

PURPOSE: To assess the surgical results of a punctoplasty with insertion of a silicone tube using a pigtail probe for the management of acquired punctal obstruction. METHODS: The medical records of 61 patients who underwent an operation for the management of punctual obstruction were reviewed. After punctal dilation, fluorescein dye disappearance test was performed to evaluate its efficacy. In the case of no functional delay after punctal dilation, three-snip punctoplasty with a silicone tube using a pigtail probe was performed. In the case of a functional delay, three-snip punctoplasty with a silicone tube into the nasolacrimal duct was performed. RESULTS: The surgical success over 1 year was 39.1% in patients who underwent only three-snip punctoplasty, 79.2% in patients who underwent a three-snip punctoplasty with a silicone tube insertion into the nasolacrimal duct, and 85.7% in patients who underwent a three-snip punctoplasty with canalicular intubation using a pigtail probe. CONCLUSIONS: The use of a pigtail probe for canalicular intubation together with a three-snip punctoplasty is useful to prevent the recurrence of punctal obstruction.

Fluoroscopically Guided Three-Tube Insertion for the Treatment of Postoperative Gastroesophageal Anastomotic Leakage

OBJECTIVE: To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). MATERIALS AND METHODS: From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. RESULTS: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 +/- 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 +/- 0.40 g/dL) to post-enteral feeding (3.7 +/- 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). CONCLUSION: Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.

Mupirocin Ointment Prevents Early Post-Tympanostomy Tube Otorrhea: A Preliminary Study

BACKGROUND AND OBJECTIVES: The most common complication of tympanostomy tube (T-tube) insertion is the development of postoperative otorrhea. Post-tympanostomy tube otorrhea (PTTO) is defined as active drainage through an existing T-tube. Many surgeons routinely use topical antibiotics as prophylaxis against early PTTO. Mupirocin calcium ointment is a topical antimicrobial agent with broad-spectrum antimicrobial activity against many Gram-positive organisms. This study evaluated the clinical effectiveness of topical mupirocin ointment in reducing early PTTO. SUBJECTS AND METHODS: The study included 98 ears (67 patients, mean age 32.9 years) that had a T-tube inserted because of chronic middle ear effusion or atelectatic otitis media. A Paparella type-I polyethylene-tube coated with mupirocin was inserted through the tympanostomy. Patients were instructed not to use otic drops or any other medications. All patients were seen by day 14 postoperatively. RESULTS: Early PTTO occurred in one case (1.5%). No early PTTO was seen with a middle ear effusion. Nineteen children were treated under general anesthesia; none developed early PTTO. CONCLUSIONS: Insertion of a T-tube coated with mupirocin ointment could be effective at preventing early PTTO.

Mupirocin Ointment Prevents Early Post-Tympanostomy Tube Otorrhea: A Preliminary Study

BACKGROUND AND OBJECTIVES: The most common complication of tympanostomy tube (T-tube) insertion is the development of postoperative otorrhea. Post-tympanostomy tube otorrhea (PTTO) is defined as active drainage through an existing T-tube. Many surgeons routinely use topical antibiotics as prophylaxis against early PTTO. Mupirocin calcium ointment is a topical antimicrobial agent with broad-spectrum antimicrobial activity against many Gram-positive organisms. This study evaluated the clinical effectiveness of topical mupirocin ointment in reducing early PTTO. SUBJECTS AND METHODS: The study included 98 ears (67 patients, mean age 32.9 years) that had a T-tube inserted because of chronic middle ear effusion or atelectatic otitis media. A Paparella type-I polyethylene-tube coated with mupirocin was inserted through the tympanostomy. Patients were instructed not to use otic drops or any other medications. All patients were seen by day 14 postoperatively. RESULTS: Early PTTO occurred in one case (1.5%). No early PTTO was seen with a middle ear effusion. Nineteen children were treated under general anesthesia; none developed early PTTO. CONCLUSIONS: Insertion of a T-tube coated with mupirocin ointment could be effective at preventing early PTTO.

Eosinophilic Otitis Media 3 Cases Discovered with Recurrent and Sticky Otorrhea after Ventilation Tube Insertion / 대한이비인후과학회지

We studied three patients in whom otorrhea occurred without bacterial infection following ventilation tube (VT) insertion. These patients took oral steroids since the conventional therapy was not effective; however, the oral steroids produced temporal effect since sticky otorrhea occurred when the oral steroids were stopped. We collected ear discharge from each patient and consulted the pathologist about histopathologic findings of it. We identified the predominant eosinophilic infiltration at specimen. We tried to relate this type of otitis media with eosinophilic otitis media (EOM) and treated the patients with intratympanic steroid injection.

Clinical study on the stomach tube insertion in the lateral recumbent position in rescuing the unconscious patients / 中国实用护理杂志

Objective To study the application of stomach tube insertion in the lateral recumbent position in rescuing the unconscious patients,to reduce the discomfort of patients and increase the one-time success rate in the insertion of stomach tube. Methods 100 cases of unconscious patients were divided into the control group and the treatment group with 50 cases in each, they adopted routine tube insertion method and tube insertion in the lateral recumbent position.The success rate of tube insertion and incidence of complications were collected and analyzed in the two groups.Results The experimental group had a higher success rate and less complications compared with the control group.Conclusions The lateral recumbent position for stomach tube insertion is the ideal position for the unconscious patients.

A Case of Focal Reexpansion Pulmonary Edema after Chest Tube Insertion / 결핵및호흡기질환

Reexpansion pulmonary edema is not a common phenomenon after chest tube insertion but some reports from 0% to 14%. There are various resulting complications, including acute respiratory distress syndrome. We report a case of focal reexpansion pulmonary edema after chest tube insertion. A 49-year-old male came to the hospital due to ongoing dyspnea and left chest pain for 3 days. On chest X-ray, the patient had a left pneumothrax. We planned to insert a chest tube for symptom relief. To determine whether or not the chest had expanded as a result of the chest tube insertion, the patient underwent repeated chest X-rays the following day. The patient experienced brief respiratory symptoms upon initial suction; a chest PA showed patchy consolidated infiltration at the inserted site. After 5 days of conservative management, the recovered completely.

Application of gastric tube insertion by left recumbent position for patients with exanimation / 中国实用护理杂志

Objective To explore the practicability and clinical significance of gastric tube insertion by left recumbent position for patients with exanimation. Methods We divided 100 patients with exanimation who needed gastric tube insertion into the routien group and the left-recumbent-position group with 50 cases in each group randomly and adopted routine insertion method and insertion by left recumbent position.The success rate of tube insertion and incidence of complications were observed in the two groups.Results The one-time success rate of insertion was higher while the incidence of complication was lower in the left-recumbent-position group compared with the control group (P<0.05). Conclusion Gastric tube insertion by left recumbent position proved to be a desirable method in that it could increase the onetime success rate of insertion and decrease the complications.So it worth widely applying.

Self-retaining harpoon tympanostonomy tube with applicator

Objective: To describe a novel harpoon design for a low cost, self retaining tympanostomy tube with applicator used in a 38-year-old female for otitis media with effusion. Methods: a. Study design: Instrumental Innovation/Case Report b. Setting: Tertiary Hospital in Metro Manila Results: The tympanostomy tube was inserted under endoscopic guidance within 10 seconds, remained in place for two months with relief of symptoms, and spontaneously extruded by the seventh month of follow-up. Conclusion: The harpoon-designed tube with applicator provided ease of insertion and good anchorage in the tympanic membrane. Maximizing the use of a stylet-needle as both perforator and applicator simplified the tympanostomy and ventilating tube insertion procedures into a single maneuver. (Author)

Grommet Cholesteatoma / 대한이비인후과학회지

There are occasional complications after tympanostomy tube insertion due either to the operative procedure itself or to the anato-mical or physiological effects of the tubes. Hearing loss, persisting perforation, tympanosclerosis, atrophy, atelectasis, and the development of cholesteatoma have all been attributed to the tympanostomy tubes. The development of a secondary cholesteatoma at the site of the tube placement Grommet cholesteatoma- is a very uncommon complication. We report one case of cholesteatoma associated with tympanostomy tube insertion.

Efficacy of Adenoidectomy in Preventing Recurrence of Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Previous studies of the efficacy of adenoidectomy in otitis media with effusion have yielded conflicting results. The aim of this study was to investigate the efficacy of adenoidectomy and influences of other associated risk factors on the recurrence of otitis media with effusion (OME). SUBJECTS AND METHOD: A retrospective analysis was carried out on 441 ears of 266 patients who underwent tympanostomy tube (T-tube) insertions from January 1990 to December 2000. Patients were grouped according to the surgical procedures they underwent; T-tube insertion only, T-tube insertion and adenoidectomy and T-tube insertion and adenotonsillectomy. In addition to the type of surgical procedure, the time elapsed to the extrusion of T-tube, age, paranasal sinusitis, the nature of effusion, and adenoid size were chosen as factors affecting the recurrence of otitis media with effusion. The recurrence of OME, the reinsertion of T-tube, and the number of T-tube insertions during each patients' follow-up period were defined as the dependent variables. Statistical analyses were performed by multiple logistic regression and cumulative multiple logistic regression methods. RESULTS: A significant benefit was observed with adenoidectomy in preventing recurrence of OME (p<0.001), which was not enhanced by tonsillectomy. The effect of adenoidectomy was independent of adenoid size. Earlier extrusion of tympanostomy tubes was strongly correlated with the recurrence of otitis media with effusion (p<0.0001). OME tended to recur if the patients had younger age. CONCLUSION: Performing adenoidectomy at the time of the insertion of tympanostomy tube substantially reduces the recurrence of otitis media with effusion and the likelihood of reinsertion of T-tube.

Effect of Ventilation Tube Insertion on the Quality of Life / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Traditionally, the treatment results after ventilation tube insertion (VTI) in otitis media with effusion (OME) have been reported using the objective measures such as the changes in hearing levels, the recurrence rate of OME and the occurrence rate of tympanic membrane sequelae. This present study was to determine the effect of VTI on the quality of life (QOL) in patients of OME after the surgery. MATERIALS AND METHOD: Sixty-nine children with OME were included. For the measurement of QOL, the study was performed using questionnaires including six items such as physical suffering, hearing loss, speech impairment, emotional distress, activity limitations and care-provider concerns. We questioned the parents of the patiens on these items pre-operatively and at least one month after VTI. Test-retest reliability was determined by reviewing the results of the repeated questionnaires within 7 days in the subgroup of patients with stabilized status. The effect of VTI was determined by the standardized response mean (SRM), which is defined as the mean change score divided by standard deviation. SRM of less than 0.5 was defined as small effectiveness: greater than 0.5 but less than 0.8 as moderate effectiveness; greater than 0.8 as large effectiveness. RESULTS: Individual items of the questionnaire showed excellent test-retest reliability. The median of the preoperative QOL score was 4.1. The median change of the QOL scores after VTI was 2.4, with a SRM of 0.77 (95% confidence interval 0.54-0.99), indicating moderate effectiveness. The QOL scores of the items regarding hearing loss, care-provider concerns and physical suffering showed greater changes after VTI than those of other items. Among the items, those regarding speech impairment showed least change. CONCLUSION: VTI resulted in the improvement of QOL in most patients. Measurement of QOL could be a reliable test to study the effect of VTI in OME patients.

Intranasal Endoscopic Diagnosis and Treatment in Congenital Nasolacrimal Duct Obstruction

This study is to demonstrate the effectiveness of intranasal endoscopy during silicone tube insertion in children with congenital nasolacrimal duct obstruction. Participants were 10 children with symptoms of epiphora since birth. They underwent silicone tube insertion during the period of July 1998 to November 1999. Three were female and seven male. Mean age was 25.8 months, ranging from 15 to 44 months. Probing had been failed in five of them, once in two children and twice in the other three. Silicone tube insertion was done after identifying the cause of probing failure by observing the probe tip with intranasal endoscopy. The cause of tearing confirmed by intranasal endoscopic examination were mucosal obstruction in 5 cases, submucosal passing of the probe in 4 cases and obstruction due to pus collection in one case. In 4 cases in which the probe had passed into submucosal space, probing succeeded in three cases by placing the probe tip medially(nasal direction). There was accompanying abnormal bony structure in the other one case and we had to bend the probe tip with ethmoid forceps into nasal cavity to form the lacrimal pathway. When probing fails or is difficult to do due to poor cooperation, identifying the cause of failure with intranasal endoscopic examination and inserting silicone tube under direct visualization can minimize intranasal trauma and will lead to good outcome.