Audiologic and surgical outcomes of a novel, nonpercutaneous, bone conducting hearing implant.

OBJECTIVE: To assess the selection criteria, surgical technique, audiologic, and quality of life outcomes for a novel, nonpercutaneous bone conductor hearing aid. STUDY DESIGN: Retrospective case review. SETTING: Secondary otology practice. PATIENTS: Eighteen patients (16 adults and 2 children). INTERVENTION: Implantation of unilateral (n = 16) or bilateral (n = 2) devices. MAIN OUTCOME MEASURES: Mean preoperative and postoperative air conduction and bone conduction free-field testing, BKB-SIN aided and unaided at 0-degree 70 dB SPL, Speech, Spatial, and Qualities of Hearing Scale (SSQ), aided and unaided measures of localization and discrimination in single-sided deafness (SSD), surgical complications. RESULTS: Implants have been fixed under general or local anesthesia without perioperative complications. Two patients noted minor skin irritation only. Audiologic gain was greatest for those with bilateral conductive loss (21.9 ± 10.4 dB HL). For those with bilateral and unilateral mixed loss, gain was 6.2 ± 5.3 dB HL and 5.5 ± 6.5 dB HL, respectively. A greater improvement was seen with BKB-SIN at 70 dB SPL at 0 with all groups except for SSD, gaining statistically significant benefit. Localization and discrimination studies in patients with SSD or unilateral conductive loss failed to detect benefit from aiding. SSQ scores show an improvement in all domains for each patient group. CONCLUSION: The surgical procedure requires no specialized equipment and can be performed as a day case. This device complements treatment for patients requiring bone conduction aids and presents as an alternative to conventional percutaneous bone-anchored implants.

Maximal medical therapy for chronic rhinosinusitis: a survey of otolaryngology consultants in the United Kingdom.

BACKGROUND: The management of chronic rhinosinusitis is based on a trial of "maximal medical therapy" before surgery is considered. Ear-Nose-Throat (ENT) UK consultant members were surveyed to determine the role and variability of UK-wide practices. METHODS: A survey was posted to all ENT UK consultant members (n = 603). This assessed the frequency of prescription, duration, and type of oral antibiotics, steroids, and antihistamines for chronic rhinosinusitis. RESULTS: A total of 158 questionnaires (26.3%) were returned. Of these, 61% were primarily rhinologists. The use of decongestants, antifungals, and immunotherapy was generally limited. Oral antibiotics were often used, with clarithromycin of <5 weeks duration being the preferred choice. Sixty-one percent of consultants always prescribe a steroid spray, most commonly mometasone furoate (75%). CONCLUSION: Although most respondents use triple therapy of oral antibiotics, steroid nasal spray, and saline douching to some extent, "maximal medical therapy" for chronic rhinosinusitis seems to vary greatly among consultants and frequently does not reflect recent guidelines.

Chronic cough, reflux, postnasal drip syndrome, and the otolaryngologist.

Objectives. Chronic cough is a multifactorial symptom that requires multidisciplinary approach. Over the last years, general practitioners refer increasingly more chronic cough patients directly to the otolaryngologist. The aim of this paper is to highlight the issues in diagnosis and management of chronic cough patients from the otolaryngologist perspective. Design. Literature review. Results. Gastroesophageal reflux and postnasal drip syndrome remain one of the most common causes of chronic cough. Better diagnostic modalities, noninvasive tests, and high technology radiological and endoscopic innovations have made diagnosis of these difficult-to-treat patients relatively easier. Multidisciplinary assessment has also meant that at least some of these cases can be dealt with confidently in one stop clinics. Conclusions. As the number of referrals of chronic cough patients to an Ear Nose Throat Clinic increases, the otolaryngologist plays a pivotal role in managing these difficult cases.

A microfluidic system for testing the responses of head and neck squamous cell carcinoma tissue biopsies to treatment with chemotherapy drugs.

Tumors are heterogeneous masses of cells characterized pathologically by their size and spread. Their chaotic biology makes treatment of malignancies hard to generalize. We present a robust and reproducible glass microfluidic system, for the maintenance and "interrogation" of head and neck squamous cell carcinoma (HNSCC) tumor biopsies, which enables continuous media perfusion and waste removal, recreating in vivo laminar flow and diffusion-driven conditions. Primary HNSCC or metastatic lymph samples were subsequently treated with 5-fluorouracil and cisplatin, alone and in combination, and were monitored for viability and apoptotic biomarker release 'off-chip' over 7 days. The concentration of lactate dehydrogenase was initially high but rapidly dropped to minimally detectable levels in all tumor samples; conversely, effluent concentration of WST-1 (cell proliferation) increased over 7 days: both factors demonstrating cell viability. Addition of cell lysis reagent resulted in increased cell death and reduction in cell proliferation. An apoptotic biomarker, cytochrome c, was analyzed and all the treated samples showed higher levels than the control, with the combination therapy showing the greatest effect. Hematoxylin- and Eosin-stained sections from the biopsy, before and after maintenance, demonstrated the preservation of tissue architecture. This device offers a novel method of studying the tumor environment, and offers a pre-clinical model for creating personalized treatment regimens.

The Isadora syndrome: a case report of cervical, oesophageal and tracheal transection in a go-karting accident.

We report a case of cervical spine, tracheal and oesophageal trauma from a go-karting injury caused by the patient's scarf catching in the vehicle's wheel. We discuss the significance of the pre-hospital and operative management of this potentially life-threatening injury by a multi-specialty surgical team. The importance of health and safety issues in recreational sports is highlighted in view of the increasing incidence of cervical spine trauma over past two decades.

Predicting thyroxine requirements following total thyroidectomy.

OBJECTIVE: Optimal thyroxine replacement following total thyroidectomy is critical to avoid symptoms of hypothyroidism. The aim of this study was to determine the best formula to determine the initiated replacement dose of levothyroxine immediately following total thyroidectomy. DESIGN: Prospective study. All patients were initiated on 100 µg levothyroxine and titrated to within the reference range for TSH and free T4. Correlations to height, weight, age, lean body mass (LBM), body surface area (BSA) and body mass index (BMI) were calculated. PATIENTS: One hundred consecutive adult patients underwent total thyroidectomy for non-malignant disease. MEASUREMENTS: Comparison between three methods of levothyroxine dose prediction, aiming for a levothyroxine dose correct to within 25 µg of actual dose required. RESULTS: Correlations were seen between levothyroxine dose and patient age (r=-0.346, P<0.01), bodyweight (r=0.296, P<0.01), LBM (r=0.312, P<0.01), BSA (r=0.319, P<0.01) and BMI (r=0.172, P<0.05). A regression equation was calculated (predicted levothyroxine dose=[0·943 × bodyweight] + [-1.165 × age] + 125.8), simplified to (levothyroxine dose= bodyweight - age + 125) pragmatically. Initiating patients empirically on 100 µg post-operatively showed that 40% of patients achieved target within 25 µg of their required dose; this increased to 59% when using a weight-only dose calculation (1.6 µg/kg) and to 72% using the simplified regression equation. CONCLUSIONS: A simple calculated regression equation gives a more accurate prediction of initiated levothyroxine dose following total thyroidectomy, reducing the need for outpatient attendance for dose titration.