Preprocedural Paracetamol Reduces Pain Scores in Patients Undergoing in-Office Laryngeal Procedures.

OBJECTIVE: To investigate the utility of preprocedural paracetamol on reducing pain scores post office-based laryngeal procedures. STUDY DESIGN: Prospective, controlled before-after comparative study. SETTING: Controlled prospective before-after study. METHODS: A retrospective analysis was performed of 100 patients who underwent office-based laryngeal procedures without preprocedural analgesia at our center to establish a control group. Age, sex, procedure type, and amount of substance used were documented as well as postprocedural pain score. Pain scores were recorded every 5 minutes for 30 minutes following office-based laryngeal procedures. A prospective arm of this study was then performed in which every patient undergoing office-based laryngeal procedures at our center between September 2019 and December 2020 was administered 1000 mg of paracetamol prior to their procedure. The postprocedure pain scores of the 2 groups were then compared. RESULTS: A hundred patients were included in the retrospective arm and 75 patients were included in the prospective arm, receiving 1000 mg of paracetamol a median of 45 (interquartile range: 30-53) minutes prior to their procedure. The 2 groups were matched for age, sex, and type of laryngeal procedure. Both nonanalgesia and analgesia groups demonstrated a similar proportion of patients who experienced any pain (47% and 48%, respectively) postprocedurally. The prospective arm of this study however reported a statistically significant reduction in the magnitude of their pain scores at all points postprocedurally (P = .005). CONCLUSION: Paracetamol preprocedurally reduces the severity of pain in office-based laryngeal procedures and would be a useful consideration for patients who are likely to experience significant postprocedural pain. LEVEL OF EVIDENCE: Level 3.

Self-dilatation of benign oesophageal strictures: a literature review.

BACKGROUND: Benign oesophageal strictures can have several aetiologies and often require serial endoscopic dilatation. The aim of this study was to review the existing literature regarding the efficacy of self-dilatation for benign oesophageal strictures. METHODS: This study presents the results of a systematic review that was performed on the available literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text articles from Medline, PubMed and Embase were used, as well as associated reference lists. This study systematically reviews the literature to present the efficacy and different outcome measurements associated with self-dilatation of benign oesophageal strictures. RESULTS: This study identified 13 articles with 274 participants. CONCLUSION: Self-dilatation for refractory benign oesophageal strictures is effective regardless of aetiology. It is well tolerated, safe and leads to lasting symptom resolution in the majority of patients.

The Role of Laparoscopic Cholecystectomy After Severe and/or Necrotic Pancreatitis in the Setting of Modern Minimally Invasive Management of Pancreatic Necrosis.

OBJECTIVES: The trend toward minimally invasive procedures (MIP) in necrotizing pancreatitis is increasing. The optimal timing and technique of cholecystectomy in severe/necrotizing pancreatitis is unclear. This study aims to determine the role of laparoscopic cholecystectomy after severe/necrotizing pancreatitis in the context of MIP. METHODS: Retrospective analysis of a prospective database was performed for consecutive patients after cholecystectomy for gallstone pancreatitis between January 2011 and January 2018 at Monash Health, Melbourne, Australia. RESULTS: Three hundred fifty-five patients with gallstone pancreatitis underwent laparoscopic cholecystectomy with 2 conversions. Patients with severe pancreatitis were older (P = 0.002), with a more even sex distribution when compared with mild pancreatitis. Females predominated in the mild pancreatitis group.Patients with moderate/severe pancreatitis (P = 0.002) and necrosis (P > 0.001) were more likely to have delayed cholecystectomy compared with mild pancreatitis. There was no increase in biliary presentations while awaiting cholecystectomy. Length of stay for patients with severe/necrotizing pancreatitis (P = 0.001) was increased, surgical complications appeared similar. CONCLUSIONS: Laparoscopic cholecystectomy can be performed safely and effectively for pancreatitis, irrespective of severity. The paradigm shift in the management of severe necrotizing pancreatitis away from open necrosectomy toward MIP can be extended to encompass laparoscopic cholecystectomy.

Unilateral permanent sudden sensorineural hearing loss after spina-epidural anaesthesia for caesarean section: a case report.

Sudden sensorineural hearing loss (SSNHL) after spinal-epidural anaesthesia is a very rare complication. The patient is a 25-year-old female who developed right-sided hearing loss, unbalance, a sensation of aural fullness and tinnitus 2 days post uncomplicated spinal-epidural anaesthesia for an emergency caesarean section. Initial management by her primary care physician for suspected eustachian tube dysfunction did not relieve symptoms, and 2 weeks subsequently, audiological assessment demonstrated right Sensorineural hearing loss (SNHL). Specialist consultation was sought, and the patient was commenced on systemic corticosteroids. Microscope otoscopy and posterior fossa magnetic resonance imaging were normal. High-resolution computed tomography scan demonstrated an enlarged right cochlear aqueduct. Repeat audiology after 2 weeks revealed unchanged hearing levels and improved speech discrimination scores in the right ear (from 53 to 90%). Repeat audiogram at 4 months and at 10 months showed no further improvement. Possible physiopathology of this complication, diagnostic dilemma and review of treatment options are discussed.

Hearing Improvement Following Middle Cranial Fossa Floor Defect Repair Utilizing a Modified Middle Fossa Approach and Reconstructive Techniques.

BACKGROUND: Few studies report hearing preservation following middle cranial fossa (MCF) floor defect repair. OBJECTIVE: To investigate audiological outcomes following MCF floor defect repair using a modified MCF suprapetrous approach. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS: Eleven patients, with MCF floor defects. INTERVENTIONS: MCF floor defect surgical repairs with either fascia or fascia and bone graft. MAIN OUTCOME MEASURED: Hearing outcomes. RESULTS: Eleven patients (two men) aged 34 to 82 years (median, 62 yrs) were identified. All patients were operated on by the same two senior surgeons (M.P. and M.G.). One patient with conductive hearing loss (based on tuning fork test) was excluded from the analysis due to missing preoperative audiogram data. All patients had middle fossa plate defects leading to cerebrospinal fluid (CSF) otorrhoea, rhinorrhoea, or meningitis. Nine patients had retrieval of herniated contents from the defect. Five patients had repair with temporalis fascia and split calvarial bone graft, and six patients had repair with fascia only. Follow up audiogram was performed at a mean 7.5 months (range, 0.5-24 mo). There was no recurrent CSF leak during the follow up period. The 10 patients (90.9%, 95% confidence interval [CI] 60.1-100.6) who had complete audiologic data sets demonstrated a mean improvement of 18.86 dB (range, -7.5 to 33.75 dB) in hearing postoperatively. One of these patients acquired a 7.5 dB reduction in postoperative hearing due to post-procedural middle ear effusion which subsequently resolved. Hearing improvement following fascial graft alone versus fascial graft with bone was 12.5 and 26.5 dB, respectively (p < 0.01). CONCLUSION: Middle fossa craniotomy with or without retrieval of herniated contents and floor reconstruction with fascia and bone is associated with improved hearing. Clinical efficacy of this technique, however, can be only fully established when a statistically meaningful number of cases have been performed.

Duration of therapy recommended for bacteraemic illness varies widely amongst clinicians.

The optimum duration of antimicrobial therapy would eradicate infection whilst minimising potential adverse drug effects to the patient. Australian and New Zealand infectious diseases (ID) and ICU specialists were surveyed regarding their recommended duration of antibiotic treatment for five common bacteraemic syndromes. A total of 239 clinicians responded to the survey (15.5% ICU and 84.5% ID). Overall, the most common reported durations were 7 (33.7%), 10 (25.9%) and 14 (26.0%) days, with 46% of responses recommending ≤7 days. Most respondents (>75% for each characteristic) would not modify duration based on host characteristics such as patient age or co-morbidities. ID physicians recommended longer durations than ICU physicians for all five syndromes (ID, median 10, IQR 7-14, range 1-28 days; ICU, median 7, IQR 5-10, range 2-21 days). Across all respondents, the median (IQR) duration for each syndrome was: CVC-BSI, 7 (7-10) days; bacteraemic pneumonia, 7 (7-10) days; bacteraemic UTI, 10 (7-14) days; bacteraemic IAI, 7 (7-12) days; and bacteraemic SSTI, 10 (7-14) days. Marked variation exists amongst clinicians' recommended duration of antibiotic treatment for BSI. A proportion of clinicians recommend therapy of ≤7 days at present (33.3-59.7% across scenarios). Patient characteristics are not strongly considered in the decision on therapy duration. This survey was undertaken as preparatory work for initiation of the BALANCE study, an ongoing randomised trial comparing 7 days with 14 days of therapy for BSI, providing an evidence base to inform best clinical treatment for this patient population.

Prevalence of glaucoma in the Australian National Eye Health Survey.

AIM: To estimate the prevalence of glaucoma in Australia. METHODS: This was a population-based study of 3098 non-Indigenous Australians (50-98 years) and 1738 Indigenous Australians (40-92 years) stratified by remoteness. Each participant underwent a standard examination that included visual field assessment, tonometry and non-mydriatic fundus photography. Two fellowship-trained glaucoma specialists independently assessed relevant case notes (past ocular history, best-corrected visual acuity, frequency doubling technology visual fields, Van Herick grade, intraocular pressure and optic disc-centred photographs) and assigned a diagnosis ranked on a scale of certainty: none, possible, probable or definite glaucoma. RESULTS: A total of 4792 (99.1%, 3062 non-Indigenous and 1730 Indigenous) participants had retinal photographs in at least one eye that were gradable for glaucoma. The weighted prevalence of glaucoma (definite) in non-Indigenous Australians and Indigenous Australians was 1.5% (95% CI 1.0 to 2.2) and 0.6% (95% CI 0.4 to 1.1), respectively. When definite and probable cases of glaucoma were combined, rates were 3.4% (95% CI 2.7 to 4.3) among non-Indigenous and 1.6% (95% CI 1.1 to 2.3) in Indigenous Australians. Only 52.4% of non-Indigenous Australians and 28.0% of Indigenous Australians with glaucoma self-reported a known history of glaucoma. CONCLUSION: We estimate that 198 923 non-Indigenous Australians aged 50 years and over and 2139 Indigenous Australians aged 40 years and over have glaucoma. Given the high rates of undiagnosed glaucoma coupled with a significant ageing of the Australian population, improvements in case detection and access to low vision rehabilitation services may be required to cope with the growing burden of glaucoma.

Emerging ocular biomarkers of Alzheimer disease.

Interest in reliable biomarkers of Alzheimer disease, the leading cause of dementia, has been fuelled by challenges in diagnosing the disease and monitoring disease progression as well as the response to therapy. A range of ocular manifestations of Alzheimer disease, including retinal and lens amyloid-beta accumulation, retinal nerve fiber layer loss, and retinal vascular changes, have been proposed as potential biomarkers of the disease. Herein, we examine the evidence regarding the potential value of these ocular biomarkers of Alzheimer disease.