Hyperbaric oxygen therapy for nonhealing wounds: Treatment results of a single center.

The present article evaluates the results of the treatment with adjuvant hyperbaric oxygen therapy (HBOT) of patients with nonhealing, chronic wounds. In the period 2013 to 2016, 248 patients were referred from various hospitals because of chronic wounds that were recalcitrant in healing despite standard wound care as described in national and international guidelines. After inclusion, all patients were treated with HBOT and subjected to a weekly standard wound care treatment. During each HBOT session, 100% O2 was administered for 75 minutes under increased pressure of 2.4 ATA. Wounds and quality of life were assessed before and after the total treatment period. A total of 248 patients have been evaluated. Diabetic foot ulcers were present in 134 patients, the remainder (114 patients) showed a variety of wound locations and etiologies. The number of HBOT treatments amounted to an average of 48 (range 20-68) sessions. Before referral to our clinic, 31% of all wounds had existed for at least 18 months (72 patients). After HBOT, 81% of all wounds were near complete healing or completely healed, in 13% of the cases the wound was stable, and in 2% minor or major amputation had to be carried out. The mean treatment time for wounds pre-existing fewer than 6 weeks ("early referrals") was 67 days, and 119 days for wounds pre-existing more than 18 months ("late referrals"). A majority of the patients in our study referred with nonhealing wounds clinically improved when adjuvant HBOT was added to standard wound care protocols. No differences in success rate were seen between diabetic and nondiabetic wounds. It showed that HBOT is a well-tolerated treatment.

Hyperbaric oxygen therapy for late radiation-induced tissue toxicity: prospectively patient-reported outcome measures in breast cancer patients.

INTRODUCTION: This study examines patient reported outcome measures of women undergoing hyperbaric oxygen treatment (HBOT) after breast-conserving therapy. METHOD: Included were 57 women treated with HBOT for late radiation-induced tissue toxicity (LRITT) referred in the period January 2014-December 2015. HBOT consisted of (on average) 47 sessions. In total, 80 min of 100 % O2 was administered under increased pressure of 2.4 ATA. Quality of life was assessed before and after treatment using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR23, and a NRS pain score. RESULTS: Fifty-seven women were available for evaluation before and after treatment. Before HBOT, patients had severe complaints of pain in the arm/shoulder (46 %), swollen arm/hand (14 %), difficulty to raise arm or move it sideways (45 %), pain in the area of the affected breast (67 %), swollen area of the affected breast (45 %), oversensitivity of the affected breast (54 %), and skin problems on/in the area of the affected breast (32 %); post HBOT, severe complaints were still experienced in 17, 7, 22, 15, 13, 15, and 11 % of the women, respectively. Differences were all significant. The NRS pain score improved at least 1 point (range 0-10) in 81 % of the patients (p < 0.05). CONCLUSION: In these breast cancer patients treated with HBOT for LRITT, the patient-reported outcomes were positive and improvements were observed. HBOT was a well-tolerated treatment for LRITT and its side-effects were both minimal and reversible.

Using the Digits-In-Noise Test to Estimate Age-Related Hearing Loss.

OBJECTIVE: Age-related hearing loss is common in the elderly population. Timely detection and targeted counseling can lead to adequate treatment with hearing aids. The Digits-In-Noise (DIN) test was developed as a relatively simple test to assess hearing acuity. It is a potentially powerful test for the screening of large populations, including the elderly. However, until to date, no sensitivity or specificity rates for detecting hearing loss were reported in a general elderly population. The purpose of this study was to evaluate the ability of the DIN test to screen for mild and moderate hearing loss in the elderly. DESIGN: Data of pure-tone audiometry and the DIN test were collected from 3327 adults ages above 50 (mean: 65), as part of the Rotterdam Study, a large population-based cohort study. Sensitivity and specificity of the DIN test for detecting hearing loss were calculated by comparing speech reception threshold (SRT) with pure-tone average threshold at 0.5, 1, 2, and 4 kHz (PTA0.5,1,2,4). Receiver operating characteristics were calculated for detecting >20 and >35 dB HL average hearing loss at the best ear. RESULTS: Hearing loss varied greatly between subjects and, as expected, increased with age. High frequencies and men were more severely affected. A strong correlation (R = 0.80, p < 0.001) was found between SRTs and PTA0.5,1,2,4. Moreover, 65% of variance in SRT could be explained by pure-tone thresholds. For detecting mild or moderate hearing loss, receiver operating characteristics showed areas under the curve of 0.86 and 0.98, respectively. CONCLUSIONS: This study demonstrates that the DIN test has excellent test characteristics when screening for moderate hearing loss (or more) in an elderly population. It is less suited to screen for mild hearing loss. The test is easy to complete and should be suitable for implementation as an automated self-test in hearing screening programs. Ultimately, when combined with active counseling, hearing screening could lead to higher hearing aid coverage in the hearing impaired elderly.