Innovative dual-function protective scope mask and filtration system for aerosol generating ENT scope procedures.

Background: Aerosol-generating procedures (AGPs), such as nasoendoscopy, are considered high-risk during the COVID-19 pandemic due to risk of virus aerosol transmission. We aim to evaluate the efficacy of an innovative system in reduction of aerosol contamination. Methods: Pilot study involving 15 healthy volunteers performing aerosol-generating activities with the prototype, compared with and without a standard surgical mask. Results: We found an increased frequency of smaller-sized particle emissions for all four expiratory activities. The particle emission rate with the prototype mask was significantly slower over time for the smallest sized particle (0.3 µm) during breathing, speaking and singing compared with similar activities without the mask (p < .05). We found similar trends for coughing for larger particles but that did not reach statistical significance. Conclusion: The innovation offers good protection against aerosol transmission through the physical barrier of the mask, the negative pressure environment within the mask, and the unit's dual filtration function. Level of evidence: Level 2b.

Longus colli tendinitis: acute neck pain with retropharyngeal swelling.

Longus colli tendinitis (LCT) has been described in several case reports, and is likely underdiagnosed due to its non-specific symptoms and self-limiting nature. It usually presents as acute neck pain with retropharyngeal swelling seen on nasoendoscopy and imaging studies. This may lead to unnecessary invasive interventions if physicians are unaware of the disease course. We discuss a case of LCT in a young woman who was treated at our institution, with recommendations on how to identify and treat such cases accurately without overtreatment.

Changing patient profile, hearing aid use and disability among first-time hearing aid users in Singapore over a decade.

OBJECTIVES: To examine the time trends in demographics, hearing characteristics, hearing aid (HA) choices, usage and patient-reported disability among first-time HA users in Singapore over a decade. DESIGN: Cross-sectional study. Study sample: 1052 subjects issued with HAs at a tertiary hospital from 2004 to 2013. RESULTS: An increase in number of first time HA users were seen from 2004 to 2013. Although mean age did not change significantly, the proportion of older adults (>80 years) being fitted increased (p for trend = 0.033). Inflation adjusted cost of HAs rose over time (p < 0.001 for trend). Bilateral HA uptake increased (adjusted odds ratio [AOR] = 1.58 (95% Confidence Interval [CI] 1.35-1.85) while use of customisable HAs decreased (AOR = 0.74, 95% CI 0.66-0.84) over the period. A decrease in the proportion of subjects reporting 5 or more disabilities (AOR = 0.45, 95% CI 0.34-0.59) and using their HAs >7 hours daily (AOR = 0.45, 95% CI 0.34-0.59) was seen. CONCLUSION: From 2004 to 2013, there was a positive trend towards HA uptake in Singapore. Bilateral HA uptake increased while customisable in ear type of HA use decreased. While hearing disability showed a decreasing trend, HA usage remained suboptimal.

Performance of Digital Contact Tracing Tools for COVID-19 Response in Singapore: Cross-Sectional Study.

BACKGROUND: Effective contact tracing is labor intensive and time sensitive during the COVID-19 pandemic, but also essential in the absence of effective treatment and vaccines. Singapore launched the first Bluetooth-based contact tracing app-TraceTogether-in March 2020 to augment Singapore's contact tracing capabilities. OBJECTIVE: This study aims to compare the performance of the contact tracing app-TraceTogether-with that of a wearable tag-based real-time locating system (RTLS) and to validate them against the electronic medical records at the National Centre for Infectious Diseases (NCID), the national referral center for COVID-19 screening. METHODS: All patients and physicians in the NCID screening center were issued RTLS tags (CADI Scientific) for contact tracing. In total, 18 physicians were deployed to the NCID screening center from May 10 to May 20, 2020. The physicians activated the TraceTogether app (version 1.6; GovTech) on their smartphones during shifts and urged their patients to use the app. We compared patient contacts identified by TraceTogether and those identified by RTLS tags within the NCID vicinity during physicians' 10-day posting. We also validated both digital contact tracing tools by verifying the physician-patient contacts with the electronic medical records of 156 patients who attended the NCID screening center over a 24-hour time frame within the study period. RESULTS: RTLS tags had a high sensitivity of 95.3% for detecting patient contacts identified either by the system or TraceTogether while TraceTogether had an overall sensitivity of 6.5% and performed significantly better on Android phones than iPhones (Android: 9.7%, iPhone: 2.7%; P<.001). When validated against the electronic medical records, RTLS tags had a sensitivity of 96.9% and specificity of 83.1%, while TraceTogether only detected 2 patient contacts with physicians who did not attend to them. CONCLUSIONS: TraceTogether had a much lower sensitivity than RTLS tags for identifying patient contacts in a clinical setting. Although the tag-based RTLS performed well for contact tracing in a clinical setting, its implementation in the community would be more challenging than TraceTogether. Given the uncertainty of the adoption and capabilities of contact tracing apps, policy makers should be cautioned against overreliance on such apps for contact tracing. Nonetheless, leveraging technology to augment conventional manual contact tracing is a necessary move for returning some normalcy to life during the long haul of the COVID-19 pandemic.

Factors Influencing Hearing Disability and Reduction in Disability among First-time Hearing Aid Users in Singapore.

INTRODUCTION: This study aims to examine the factors associated with self-reported hearing disability and early reduction in disability after first-time hearing aid (HA) fitting in Singapore. METHODS: Retrospective record review of 1,068 subjects issued with HAs at a tertiary hospital from 2001 to 2013. RESULTS: Subjects reporting ≥5 disabilities reduced from 90% to 24% after HA fitting. 'Difficulty hearing in noise' was the commonest disability before and after HA fitting, while 'needs to increase volume of TV/radio' was the disability with most improvement after fitting. In multivariable models, having worse pure tone audiometry (PTA) thresholds of the better hearing ear and being ethnically Chinese were associated with subjects reporting more hearing disabilities. A higher proportion of subjects reported a reduction rather than an absence of disability after HA fitting. In multivariable models, daily HA usage for ≥4 hours, sensorineural hearing loss (HL) and worse PTA thresholds of the better hearing ear were associated with reduction in more disabilities after HA fitting. CONCLUSION: Hearing disability is high among first-time HA users in Singapore. Ethnicity and PTA thresholds were associated with self-reported hearing disability. After HA fitting, higher daily HA usage, sensorineural HL, and worse PTA thresholds of the better hearing ear were associated with early reduction in disability. Patient counselling on the benefits of HL rehabilitation could focus on hearing disability rather than PTA thresholds. The management of patients' expectations could focus on reducing rather than eliminating disability.

Factors influencing degree of hearing loss at presentation, hearing aid choice, and usage in first time hearing aid users in Singapore.

OBJECTIVE: To examine the factors associated with late presentation at first hearing aid (HA) fitting, HA choice and usage among users in Singapore. DESIGN: Retrospective cross-sectional study. STUDY SAMPLE: 1068 subjects issued with HAs at a tertiary hospital from 2001 to 2013. RESULTS: Half of the subjects presented with more severe (>55 dB) hearing loss (HL) in their better ear. In multivariable analysis, older age, Malay ethnicity, conductive and mixed HL, and combination type of HL were associated with more severe HL at first presentation. Over 70% of subjects were older than 65 years. Worse pure tone audiometry (PTA) thresholds of the better ear, gradual onset and sensorineural HL were associated with older age presentation. For unilaterally fitted subjects, PTA thresholds were the only determinant of having the better ear aided. Better PTA thresholds, younger age and sensorineural HL were associated with choosing in ear compared to behind the ear HAs. Younger age and worse PTA of the better ear were associated with ≥4 h of daily HA usage. CONCLUSIONS: Age, ethnicity and type of HL were important determinants for more severe HL at first HA fitting. Older patients and those with better hearing were less likely to use their HAs regularly.

Hearing impairment and hearing aid usage in Singapore.

OBJECTIVE: To examine the epidemiological and audiological profile, pattern of hearing aid (HA) fitting and usage among HA users in Singapore. DESIGN: Retrospective cross-sectional study. STUDY SAMPLE: Cohort of 1068 subjects issued with HAs at a tertiary hospital between 2001 and 2013. RESULTS: Mean age was 70 years with 50.8% male. Mean hearing loss (HL) was 63.1 dB and 69.5% had at least moderate-severe HL. Sensorineural HL was present in 66.4% and 69.8% had symmetrical HL. "Behind-the-Ear" HAs were cheaper than "In-Ear" HAs. Standard "Behind-The-Ear" HAs were also cheaper than "Receiver-in-Canal" HAs. Among In-Ear HAs, "In-the-Canal" and "Completely-in-Canal" were more popular than "In-the-Ear" HAs despite costing more. HA was used ≥4 days/week by 85.6% but >7 h per day by only 35.7%. Only 18% received bilateral first HA fitting. In multivariate analysis, younger age and symmetrical HL were predictors of bilateral HA uptake while better Pure-Tone-Audiometry of aided ear and >7 h of daily HA usage were predictors of successive HA fitting. CONCLUSIONS: HA users in Singapore were elderly and presented with advanced HL. Bilateral HA adoption and average daily use were low compared to other developed countries. Future research on understanding the suboptimal HA usage should explore patients' motivation, hearing disability, and HA effectiveness.

Contralateral deafness post head injury without temporal bone fractures.

We report an unusual case of contralateral deafness in a 31-year-old man after an uncomplicated blunt force head injury. The patient was presented with a left-sided head injury and complained of profound deafness in his right ear, dysequilibrium, and vertigo. Pure tone audiogram revealed total sensorineural deafness in the right ear. A high-definition computed tomography scan demonstrated no radiological evidence of bony injuries or a fistula. His dysequilibrium had improved 2 months later, but his vertigo and hearing loss persisted. We will discuss several possible mechanisms of injury that may result in deafness after head injury without bony fractures. The literature has been reviewed. Although deafness is not an uncommon complication of head injuries, its presentation in the contralateral ear in the absence of temporal bone fractures following head injury has not been reported before in the medical literature.

Ear microbiology reports: a need for better communication with the microbiologists.

Most ENT surgeons treat discharging ears with topical antibiotics but many may not routinely utilise ear microbiology specimens. One reason could be that ear microbiology reports may not reflect their usual therapeutic options. This paper explores how microbiology departments in England process ear swabs. We carried out a telephone questionnaire of 104 microbiology departments in England. Results were obtained from 95 hospitals. Various culture methods are used, with sensitivity testing for up to 51 different antibiotics. Only five are licensed for topical use. Systemic antibiotics seemed to be preferentially tested for over topical antibiotics. Anaerobes and fungus are routinely tested. Many microbiology departments do not routinely report on all sensitivities tested. Antibiotic sensitivity testing for various micro-organisms cultured from ear swabs seemed to be guided by protocols for systemic infections. Microbiologists may not fully appreciate ENT surgeons' preferential usage of topical antibiotics in treating discharging ears, albeit there are other factors in their consideration for antibiotics to test. To gain better guidance from swab results, and to reduce needless lab costs, discussion with the microbiologists may be of benefit.

Teaching arms and screens for microscope and fibreoptic nasendoscope: are they effective teaching devices and are we utilising them?

With training time for junior doctors now reduced, it is crucial to optimise training opportunities during elective clinical activities. Teaching ENT examination skills presents unique challenges as often, only the examiner can observe what's going on. We set out to explore the utilisation of microscope and nasendoscope teaching devices for ENT junior doctors. Telephonic survey of 102 English ENT units. ENT junior doctors spent an average of 7 h per week in elective ENT outpatient clinics. 92% of them felt that spending time in outpatient clinics helped improve their confidence in patients' management. 81% of ENT junior doctors stated that being able to observe others or being observed themselves would help to improve their clinical abilities. The availability and utilisation of nasendoscopy and microscopy teaching tools are currently suboptimal. Doctors working in departments that utilised the teaching tools stated that their educational needs were more likely to be met. Most ENT junior doctors found it beneficial to attend elective outpatient clinics although their learning needs were more likely to be met should ENT teaching devices be available. The availability and utilisation of ENT teaching devices are currently suboptimal and needs addressing.

Bilateral Bone-anchored Hearing Aid: impact on quality of life measured with the Glasgow Benefit Inventory.

OBJECTIVE: To investigate whether the fitting of bilateral Bone-anchored Hearing Aid (BAHA) would result in any additional improvement in patients' quality of life (QOL) over and above what we would experience from the fitting of a single-sided BAHA. STUDY DESIGN: Retrospective, anonymized, cross-sectional postal survey using the Glasgow Benefit Inventory (GBI). SETTING: Tertiary referral center. PATIENTS: All 93 adult patients who had been using bilateral BAHA for more than 6 months. INTERVENTION(S): Hearing rehabilitation using bilateral BAHA. MAIN OUTCOME MEASURE(S): These include the GBI benefit scores across the following domains: "overall benefit," "general health benefit," "physical health benefit," and "social benefit." Comparison of GBI scores against other otological interventions including single-sided BAHA. RESULTS: Response rate was 76%. Ninety-two percent of patients reported improvement in QOL. Positive QOL improvement scores were reported across all domains. Overall GBI benefit score was +ve 38. This is higher than the benefit scores reported by patients with single-sided BAHA, although this may not be statistically significant. CONCLUSION: After fitting the second BAHA, patients may report additional improvement in their QOL (of a smaller magnitude) over and above the initial improvement in their QOL after fitting of their first BAHA. In fact, the overall benefit score for bilateral BAHA seem to be close to that for cochlear implantation.

Bone-Anchored Hearing Aid: patient satisfaction with the Cordelle device.

OBJECTIVE: To assess patient satisfaction with the Bone-Anchored Hearing Aid (BAHA) Cordelle device and to identify any user- and device-related issues. STUDY DESIGN: Retrospective, anonymized, cross-sectional postal survey using the Entific Medical Systems questionnaire. SETTING: Tertiary referral center. PATIENTS: Fifty adult patients who had been using the BAHA Cordelle for more than 6 months. INTERVENTION: Hearing rehabilitation using BAHA Cordelle. MAIN OUTCOME MEASURES: Patients' satisfaction with the BAHA Cordelle in a variety of real-life hearing scenarios, their actual use of the device, and other issues with the device. RESULTS: Response rate was 66%. Responders were happy with their Cordelle in quiet situations and 1-to-1 conversations but less so in noisy or in group situations.However, approximately 80% of Cordelle users will use their device everyday for more than 8 h/d, and the overall satisfaction level is high. Compared with ear-level BAHA patients, Cordelle users are older and have mixed hearing loss with poorer sensorineural reserve, making hearing rehabilitation more challenging. CONCLUSION: The findings of this study support the use of the BAHA Cordelle as a viable, safe, low-morbidity hearing rehabilitation option in patients with mixed hearing loss with poor sensorineural reserve. Patients should be counseled appropriately to help manage their expectations.

Experience with the longer (8.5 mm) abutment for Bone-Anchored Hearing Aid.

BACKGROUND: Use of the longer (8.5 mm) abutment for a Bone-Anchored Hearing Aid has been helpful for a certain group of patients. The most common reason for its use is soft tissue problems with tissue overgrowth interfering with device function. The longer abutment has been used in our institution, a tertiary referral center, on a named patient basis since 2002, and more than 100 patients have received it. OBJECTIVES: This paper will review this subgroup of patients and describe their demographics. Comorbidity, smoking history, graft failure, infection, and index of deprivation will be looked at as contributing factors for this group with soft tissue problems. PATIENTS: We identified 111 patients who had longer abutments ordered for them, and a retrospective case review was performed. RESULTS: Eighty-one patients required soft tissue reduction surgery because of overgrowth, and all but one (80/81 [98.8%]) of these patients required no further surgery after having their 5.5-mm abutment changed to the 8.5-mm version. One patient underwent further surgery 10 months after the longer abutment was inserted but has been problem-free for 16 months since then. Length of follow-up ranged from 6 months to 5 years after converting to the longer abutment. CONCLUSION: We have found the longer abutment to be very successful for the small proportion of patients with troublesome soft tissue overgrowth. We would advocate its use when topical management and surgical intervention have failed to control the skin reaction.

Unexpected exit of a cochlear implant electrode through the wall of the basal turn of the cochlea - a report on two patients.

We describe the unusual complication of the cochlear implant electrode eroding through the lateral bony wall of the cochlear basal turn in 2 different patients. This complication, occurring during life, has not been previously described in the literature. Radiological investigations were vital in making this diagnosis. We also discuss the likely pathophysiology behind this complication.

Partial middle turbinectomy by nasotracheal intubation.

Partial middle turbinate avulsion is a rare complication of nasotracheal intubation. Patients usually experience a brisk hemorrhage at the time of injury. Postoperatively, some patients develop a unilateral nasal obstruction, while others are asymptomatic. We present an unusual case in which a patient became symptomatic many years after the incident. We hope to raise awareness that a traumatic disruption of the turbinates secondary to nasotracheal intubation might lead to the development of an abnormal nasopharyngeal mass.

Tracheal ring fracture and early tracheomalacia following percutaneous dilatational tracheostomy.

BACKGROUND: Percutaneous dilatational tracheostomy (PDT) is increasingly popular within intensive care units for patients who need prolonged ventilatory support. Significant complications are rare. CASE PRESENTATION: Our patient suffered tracheal ring fracture and early tracheomalacia following this procedure. These complications are demonstrated in our accompanying video. CONCLUSION: Contrary to common beliefs, tracheal rings are commonly fractured during the PDT procedure. The consequent granulation can lead to tracheal stenosis and tracheomalacia.