A retrospective cohort study of telephone versus face-to-face clinics for the management of new otology referrals.

PURPOSE: To compare outcomes of telephone and face-to-face consultations for new otology referrals and discuss the wider use of telemedicine in otology. METHODS: Retrospective cohort study including new adult otology referrals to our unit, sampled consecutively between March 2021 and May 2021, seen in either a face-to-face or telephone clinic. Primary outcome measure was the proportion of patients with a definitive management outcome (discharged or added to waiting list for treatment) versus the proportion of patients requiring follow-up for further assessment or review. RESULTS: 150 new patients referred for a routine otology consultation (75 telephone, 75 face-to-face) were included. 53/75 patients (71%) undergoing a face-to-face consultation received a definitive outcome following initial review, versus 22/75 (29%) telephone patients (χ2 < 0.001, OR 5.8). 52/75 (69%) telephone patients were followed up face-to-face for examination. The mean (SD) number of appointments required to reach a definitive outcome was 1.22 (0.58) and 1.75 (0.73) in the face-to-face and telephone cohorts, respectively (p < 0.001). CONCLUSIONS: Telephone clinics in otology have played an important role as part of the COVID19 response. However, they are currently limited by a lack of clinical examination and audiometry. Remote assessment pathways in otology that incorporate asynchronous review of recorded examinations alongside audiometry, either conventional or boothless, may mitigate this problem; however, further research is required.

Cochlear implantation under local anesthetic: A systematic review and meta-analysis.

OBJECTIVES: As the population ages and implantation criteria are relaxed, more patients with complex comorbidities are becoming eligible for cochlear implantation (CI). These patients have higher risks associated with general anesthesia. This systematic review assesses outcomes and complications following CI under local anesthetic to examine utility for patients deemed not suitable or at high risk for general anesthesia. METHODS: A systematic review and meta-analysis performed according to the 2020 PRISMA guidelines. Databases searched were MEDLINE, PubMed, EMBASE, CINAHL, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. There were no limitations on year of publication or language. RESULTS: Then, 132 unique were identified. After screening abstracts and full texts for eligibility criteria a total of 18 articles were included. In the nine studies where audiological data were reported, all patients demonstrated improvement in audiological outcomes following implantation under local anesthetic (LA). Only minor complications of transient vertigo, wound infection, facial nerve paralysis, confusion, and tinnitus were reported but all were transient. Meta-analysis showed surgical time was significantly shorter under LA. CONCLUSIONS: CI under LA is safe for patients with comorbidities which preclude them from general anesthesia, with minimal complications and an improved cost-effectiveness profile. However, larger scale, robust trials are required to assess this further.

Early versus late oral feeding following total (pharyngo)laryngectomy: Systematic review and meta-analysis.

Timing of oral feeding following total laryngectomy is a contentious issue with highly varied practices. Multiple database search was performed to identify studies comparing outcomes of early (≤5 days) versus late (>5 days) oral feeding. Bias assessment was carried out using Cochrane bias tool. Random-effects meta-analysis was used. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The rate of pharyngocutaneous fistula (PCF) in randomized control trials (RCTs) in early versus late feeding was 15.2% versus 11.7% (RR 1.35, 95%CI [0.68-2.7], p = 0.40). The rate of PCF in the cohort studies was 14.1% versus 20.5% (RR 1.0, 95%CI [0.76-1.3], p = 0.98). The length of hospital stay was significantly shorter in the early feeding group (mean difference (days) -4.68 (-6.2 to -3.1, p < 0.0001). Early oral feeding appears to be safe and is associated with shorter hospital stay. However, the quality of evidence is low and the patient characteristics are not representative of current practices.

Outcomes and prognosticators in regionally recurrent cutaneous squamous cell carcinoma of the head and neck.

INTRODUCTION: Data regarding regionally metastatic cutaneous squamous cell carcinoma of the head and neck (cSCCHN) is limited and derived almost exclusively from Australian and United States (US) institutions. We report the first United Kingdom perspective, with the aims of benchmarking survival outcomes and identifying clinically relevant prognosticators. MATERIALS AND METHODS: Ninety-one patients with regionally recurrent cSCCHN treated with curative intent over a ten-year period (2009-2018) were studied retrospectively. Time-to-event analyses were used to estimate oncological outcomes, and log-rank statistics and Cox proportional hazards models used to examine potential prognosticators. Receiver operating characteristics were also used to analyse the influence of nodal disease burden. RESULTS: Parotid involvement (with or without neck involvement) was most common (79.2%), and time to recurrence in those with parotid disease alone significantly shorter than for any other disease distribution (p = 0.034). Respective five-year overall, disease-specific, and disease-free survival estimates were 43.8%, 63.8%, and 36.2%. Extracapsular spread (ECS) portended reduced DFS and DSS (p = 0.012 and p = 0.005 respectively). Increasing nodal burden (≥4 involved nodes) also reduced DSS (p = 0.020), while parotid disease alone predicted more favourable DSS (p = 0.008). ECS and isolated parotid involvement remained significant on multi-variate analysis (p = 0.014 and p = 0.028 respectively). CONCLUSIONS: Oncological outcomes were unfavourable but broadly consistent with previous reports, notionally lending support to a more proactive approach in managing the clinically node negative neck/parotid in selected high-risk cases. Our data also support distinct parotid classification and consideration of involved lymph node number in future staging systems.

Novel Minimal Access Bone Anchored Hearing Implant Surgery and a New Surface Modified Titanium Implant, the Birmingham Experience.

BACKGROUND: Bone anchored hearing implants (BAHI) are widely used and highly successful, accompanied with a high level of patient satisfaction across most techniques. A large UK teaching hospital switched from the previously used wide diameter titanium fixture and drilling system to the novel minimally invasive technique and laser ablated titanium implant. Before this change the rates of fixture failure and skin problems necessitating abutment change were 1% each. METHODS: Retrospective case note review of consecutive BAHI patients drawn from an electronic database between January 2015 and October 2016. RESULTS: Data from a total of 118 procedures were reviewed, with different combinations of surgical techniques and implant types. Sixty procedures were performed via the novel minimally invasive technique with 21 failures (35%). Fourty-eight modified minimally invasive technique procedures were performed with seven failures. In 64 of the procedures, laser ablated titanium fixtures were placed with 21 failures (32.8%). In 54 procedures wide diameter titanium fixtures were placed with eight failures (5%). CONCLUSION: Initial experience with the novel minimally invasive technique and laser ablated titanium fixture showed significantly higher failure rates than expected. This prompted a change to an open technique and subsequent abandonment of the laser ablated titanium fixture and custom drilling solution in our institution.

Inter-rater Reliability and Validity of Holgers Scores for the Assessment of Bone-anchored Hearing Implant Images.

OBJECTIVES: This study aims to review the utility and interassessor reliability of Holgers classification by simultaneously testing various professionals of the bone-anchored implant team for their impression of a series of randomized images. STUDY DESIGN: Retrospective review of a randomized series of bone-anchored implant fixture clinical photographs from the database at a tertiary referral university hospital. Raters were blinded to the contemporaneous Holgers grading assigned by the Clinical Nurse Specialist at initial assessment. Multivariate analysis was performed for correlation between scores for assessors and between grades of assessor. SETTING: Queen Elizabeth Hospital, Birmingham, UK a tertiary center for BAHIs. PATIENTS: Patients implanted from May 2012 until November 2014. MAIN OUTCOME MEASURE: Photographs of fixture sites of adult patients were taken following bone-anchored hearing implant surgery using either a tissue reduction (a split skin graft or linear incision technique was used) or tissue preservation approach, at 1 week, 6 months, and 12 months postoperatively. On a single occasion 263 images were reviewed by 10 assessors (2 consultants, 2 higher surgical trainees, 3 junior doctors, and 3 audiologists). Images were displayed at 10-second intervals and were scored by each assessor. Assessors were blinded to patient identity, time points and to each other's scores. Results were then compared against the real-time scoring of Holgers grades done by the BAHI specialist nurse to compare scores. RESULTS: Overall 227 (86.2%) images were with tissue reduction technique of which 110 (41.8%) were with linear incision and 117 (44.4%) were with a split skin graft (SSG); and 36 (13.6%) were with tissue preservation technique. Of these 263 images, 104 were at 1 week (39.5%), 70 were at 6 months (26.6%), and 89 were at 12 months (33.9%). The cumulative scores for each grade scored by blinding the time points were: 0 = 1132 (43.04%), total 1 = 995 (37.83%), total 2 = 346 (13.15%), total 3 = 141 (5.36%), total 4 = 16 (0.6%). 2630 data points had a variance of only 0.6415 for each nominal. Multivariate correlation between all assessors was r =0.7230 (Pearson's R). Correlations between consultants r=0.6317, higher surgical trainees r=0.7351, junior doctors r=0.7599, and audiologists r=0.7981.There is a good correlation (r=0.89) with no statistically significant differences between the SSG and linear incision groups (p>0.05), possibly suggesting Holgers score is comparable within both these tissue reduction techniques.There is a moderate correlation (r=0.58) with statistically significant differences between tissue preservation versus tissue reduction groups (p<0.05), possibly suggesting tissue preservation gives better results with lower Holgers scores than tissue reduction. CONCLUSION: Holgers scoring system is a reliable tool with respect to inter-rater variability across all levels of experience. Correlation was closer with audiologists and lesser experienced assessors.

Can Preoperative High Resolution Computed Tomography Be Rationalized in Adult Cochlear Implant Candidates?

OBJECTIVE: To establish whether criteria can be used to identify patients who do not need high resolution computed tomography (HRCT) scans before cochlear implant operations, by retrospectively applying a preoperative selection pathway, the Cambridge Cochlear Implant Protocol (CCIP). STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center, Queen Elizabeth Hospital, Birmingham, UK (QEHB). PATIENTS: One hundred adult patients receiving primary cochlear implantation (CI) operations from April 2015 to July 2016 performed at the QEHB who received preoperative HRCTs. MAIN OUTCOME MEASURES: Etiology of hearing loss and anatomical abnormalities were collected by reanalyzing HRCT scans. Patients were retrospectively grouped according to criteria to restrict HRCT use derived from the Cambridge Cochlear Implant Programme (CCIP). The two main outcomes, recorded management change and significant abnormalities, were compared between the two CCIP groups, scanned and not scanned. RESULTS: Twenty-six patients had significant abnormalities detected on imaging, 16 in the scanned group and 10 in the not scanned group (p = 0.152). Five patients had a recorded management change as a result of HRCT scan, four scanned group, one not scanned group (p = 0.107). Significant abnormalities and recorded management change were seen across all etiological subgroups of hearing loss. CONCLUSION: The anatomy within the temporal bone is variable amongst CI recipients. Recorded management change and significant abnormalities occurred in both CCIP groups and across many etiologies of hearing loss patients. No specific group, based on the etiology of their hearing loss could be identified that do not require preoperative HRCT. Therefore, it is recommended that all CI patients should continue to receive preoperative HRCT imaging.

Decoration of graphitic surfaces with Sn nanoparticles through surface functionalization using diazonium chemistry.

Composites of tin nanoparticles (Sn NP) and graphene are candidate materials for high capacity and mechanically stable negative electrodes in rechargeable Li ion batteries. A uniform dispersion of Sn NP with controlled size is necessary to obtain high electrochemical performance. We show that the nucleation of Sn particles on highly ordered pyrolitic graphite (HOPG) from solution can be controlled by functionalizing the HOPG surface by aryl groups prior to Sn deposition. On the contrary, we observe heterogeneous deposition of micrometer sized Sn islands on HOPG subjected to oxidation prior to deposition in the same conditions. We demonstrate that functional groups act as nucleation sites for Sn NP nucleation, and that homogeneous nucleation of small particles can be achieved by combining surface functionalization with diazonium chemistry and appropriate stabilizers in solution.

High spatial resolution ellipsometer for characterization of epitaxial graphene.

An ellipsometer with 3µm×5µm spot size constructed with a single focusing and imaging element is used to measure the layer number of exfoliated graphene on glass and expitaxial graphene on SiC. Ellipsometric sensitivity to graphene layer number increases with decreasing layer number and decreasing substrate refractive index. Single-atomic-layer sensitivity has been achieved. High spatial resolution imaging and ellipsometry is useful for rapid characterization of epitaxially grown graphene films.

An open-source, extensible system for laboratory timing and control.

We describe a simple system for timing and control, which provides control of analog, digital, and radio-frequency signals. Our system differs from most common laboratory setups in that it is open source, built from off-the-shelf components, synchronized to a common and accurate clock, and connected over an Ethernet network. A simple bus architecture facilitates creating new and specialized devices with only moderate experience in circuit design. Each device operates independently, requiring only an Ethernet network connection to the controlling computer, a clock signal, and a trigger signal. This makes the system highly robust and scalable. The devices can all be connected to a single external clock, allowing synchronous operation of a large number of devices for situations requiring precise timing of many parallel control and acquisition channels. Provided an accurate enough clock, these devices are capable of triggering events separated by one day with near-microsecond precision. We have achieved precisions of approximately 0.1 ppb (parts per 10(9)) over 16 s.