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OBJECTIVES: Insufficient training and the absence of guidelines increase the risk of retraumatisation in torture survivors during surgical procedures. This study aims to develop guidelines to mitigate this risk and gather healthcare professionals' experiences treating torture survivors and insights on the guideline's feasibility and acceptability. DESIGN: The study was conducted in two phases. Phase 'a' involved developing guidelines based on reviews of torture survivors' encounters in somatic care and potential retraumatisation triggers, as well as a qualitative study on survivors' experiences during surgical interventions. The development process adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles and the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument for methodological rigour. Phase 'b' involved focus groups and individual interviews with healthcare professionals to explore challenges in caring for torture survivors and to evaluate the guidelines. SETTING: The study, conducted from May to August 2023, involved participants from surgical departments in three hospitals in southern and southeastern Norway. PARTICIPANTS: Twenty-one healthcare professionals, including surgeons, anaesthesiologists, nurses and a dentist, participated in the study. Both focus group interviews and individual interviews were conducted. RESULTS: Phase 'a': guidelines comprising six sections were developed: an introduction, general guidelines and four sections covering the preoperative, perioperative and postoperative surgical stages. Phase 'b': healthcare professionals struggled to understand torture's complexities and identify survivors' unique needs. They faced challenges using interpreters and assisting patients with strong reactions. While the guidelines were viewed as practical and useful for raising awareness, their length was questioned. CONCLUSIONS: We provide recommendations for preventing retraumatisation in torture survivors undergoing surgical treatment. The guidelines may serve as a starting point for offering safe and individualised care to torture survivors. Teaching institutions and hospitals may incorporate the guidelines into healthcare professionals' education.
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Grupos Focales , Personal de Salud , Investigación Cualitativa , Sobrevivientes , Tortura , Humanos , Sobrevivientes/psicología , Personal de Salud/psicología , Masculino , Femenino , Noruega , Guías de Práctica Clínica como Asunto , Adulto , Procedimientos Quirúrgicos Operativos , Actitud del Personal de SaludRESUMEN
OBJECTIVE: To investigate the microbial changes of long-term hearing aid use culture independently. STUDY DESIGN: Cross-sectional study. PATIENTS: Fifty long-term hearing aid users and 80 volunteer controls with asymptomatic ears. INTERVENTION: External auditory canal (EAC) sampling with DNA-free swabs. MAIN OUTCOME MEASURES: Microbial communities in the samples were investigated with amplicon sequencing of the 16S rRNA gene. RESULTS: The final analysis contained 48 hearing aid users, 59 controls. Twenty-four samples were excluded because of low sequence count, recent use of antimicrobials and/or corticosteroids, recent cold, or missing health status. The groups showed significant differences in bacterial diversity (beta div., p = 0.011), and hearing aid users showed lower species richness than the control group (alpha div., p < 0.01). The most frequent findings in both groups were Staphylococcus auricularis , Alloiococcus otitis , Cutibacterium acnes , Corynebacterium otitidis , and Staphylococcus unclassified sp. Hearing aid users' samples presented more Corynebacterium tuberculostearicum than the control samples. Common EAC pathogens, such as Staphylococcus aureus or Pseudomonas aeruginosa were rare. CONCLUSION: Long-term hearing aid use lowers bacterial diversity and modulates the EAC microbiome. The changes mostly affect commensals. Lowered diversity may predispose individuals to EAC conditions and needs more research.
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Conducto Auditivo Externo , Audífonos , Microbiota , Humanos , Masculino , Conducto Auditivo Externo/microbiología , Anciano , Femenino , Persona de Mediana Edad , Estudios Transversales , ARN Ribosómico 16S/genética , Anciano de 80 o más Años , Adulto , Bacterias/genética , Bacterias/aislamiento & purificaciónRESUMEN
OBJECTIVE: The study's objective was to identify consonant and vowel confusions in cochlear implant (CI) users, using a nonsense syllable repetition test. DESIGN: In this cross-sectional study, participants repeated recorded mono- and bisyllabic nonsense words and real-word monosyllables in an open-set design. STUDY SAMPLE: Twenty-eight Norwegian-speaking, well-performing adult CI users (13 unilateral and 15 bilateral), using implants from Cochlear, Med-El and Advanced Bionics, and a reference group of 20 listeners with normal hearing participated. RESULTS: For the CI users, consonants were confused more often than vowels (58% versus 71% correct). Voiced consonants were confused more often than unvoiced (54% versus 64% correct). Voiced stops were often repeated as unvoiced, whereas unvoiced stops were never repeated as voiced. The nasals were repeated correctly in one third of the cases and confused with other nasals in one third of the cases. The real-word monosyllable score was significantly higher than the nonsense syllable score (76% versus 63% correct). CONCLUSIONS: The study revealed a general devoicing bias for the stops and a high confusion rate of nasals with other nasals, which suggests that the low-frequency coding in CIs is insufficient. Furthermore, the nonsense syllable test exposed more perception errors than the real word test.
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Implantes Cocleares , Percepción del Habla , Adulto , Humanos , Estudios Transversales , Estimulación Acústica , FonéticaRESUMEN
PURPOSE: Chronic obstructive Eustachian tube dysfunction (OETD) can lead to tympanic membrane (TM) retraction and middle ear effusion (MEE) which can cause conductive hearing impairment, which among other ear symptoms can lower the quality of life (QoL). In this prospective study we assess hearing results and subjective changes in QoL following balloon Eustachian tuboplasty (BET) in treatment of OETD. METHODS: Totally 25 ears with TM retraction and 18 ears with MEE due to chronic OETD underwent BET as the sole intervention. Outcomes including otoscopy, ability to perform the Valsalva maneuver, tympanometry, audiometry, Eustachian tube inflammation scale and the Glasgow Benefit Inventory questionnaire (GBI) were obtained on all patients preoperatively and 6 months postoperatively. RESULTS: Hearing thresholds improved statistically significantly (p < 0.05) with means of 3 dB in the TM retraction group and 9 dB in the MEE group. Total GBI results indicated a positive influence on patients' QoL. Valsalva success rate was 80% in patients with TM retraction and 67% in patients with MEE. Tympanometry results improved in 50% of TM retraction patients and in 33% of MEE patients. CONCLUSIONS: Here we demonstrated that the BET has a positive impact on patients' conductive hearing loss and QoL in patients with TM retraction or MEE. Results were better in TM retraction group than in MEE group.
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Enfermedades del Oído , Trompa Auditiva , Otitis Media con Derrame , Humanos , Calidad de Vida , Trompa Auditiva/cirugía , Estudios Prospectivos , Dilatación/métodos , Enfermedades del Oído/cirugía , Otitis Media con Derrame/complicaciones , Otitis Media con Derrame/cirugía , Otitis Media con Derrame/diagnóstico , Pruebas de Impedancia Acústica , Audición , Pérdida Auditiva Conductiva/etiología , Pérdida Auditiva Conductiva/cirugía , Resultado del TratamientoRESUMEN
Due to the invasive nature of surgical procedures and the involvement of medical personnel, torture survivors may experience re-traumatization during surgical treatment. This study aimed to explore torture survivors' experiences of re-traumatization during surgical treatment as well as the process by which trauma-related emotions and responses are evoked during surgical treatment for torture survivors. Eight men, aged 45 to 72, from four different countries, who have lived in Norway for 6-40 years, were recruited. We assessed torture and surgical care experiences through in-depth interviews, and the data were analyzed using thematic analysis, resulting in five themes: (1) Interactions with healthcare providers, (2) Reactions during treatment, (3) Triggers causing re-experiences, (4) Avoidance, and (5) Suggestions to healthcare providers. In this study, survivors reported challenges receiving surgical treatment, indicating re-traumatization and difficulty returning to daily life following treatment. Participants reported little collaboration in care-related decision-making processes, lack of recognition of torture by healthcare providers involved in surgical care and experiencing healthcare professionals' attitudes as a source of perplexity, frustration, and despair. Exacerbation of torture memories throughout treatment and re-experiencing of trauma symptoms aggravated these difficulties. Our findings suggest that surgical treatment can remind torture survivors of the traumatic aspects of torture, eliciting strong reactions and feelings like those experienced during torture.
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Refugiados , Trastornos por Estrés Postraumático , Tortura , Masculino , Humanos , Trastornos por Estrés Postraumático/psicología , Tortura/psicología , Emociones , Sobrevivientes/psicología , Frustación , Refugiados/psicologíaAsunto(s)
Antiinfecciosos , Erisipela , Otitis Externa , Humanos , Otitis Externa/tratamiento farmacológico , Otitis Externa/microbiología , Centros de Atención Terciaria , Pruebas de Sensibilidad Microbiana , Enfermedad Aguda , Antiinfecciosos/uso terapéutico , Antibacterianos/farmacología , Antibacterianos/uso terapéuticoRESUMEN
RATIONALE: The number of torture survivors is on the rise, posing issues for their care in healthcare settings. Even healthcare experts with training in refugee care are unaware of the health difficulties faced by torture survivors. Any medical evaluation or treatment has the potential to re-traumatize torture survivors, thereby reactivating trauma symptoms without applicable guidelines to prevent re-traumatization. OBJECTIVE: Our objective was to identify, characterize, evaluate, and organize current, available evidence presenting existing recommendations and suggestions to prevent re-traumatization during the treatment of torture survivors' physical diseases in healthcare services. METHODS: A comprehensive search of electronic databases was conducted. Gray literature coverage was obtained by searching for publications from relevant associations and healthcare organizations focusing on torture survivors. Clinical practice guidelines (CPGs) and research focusing on somatic healthcare services for adult torture survivors, regardless of study design, were eligible for review. Studies that concentrated on psychiatric departments were excluded. To conduct an overview of the available research and describe the scope and distribution of evidence, a mapping review methodology was used. RESULTS: Forty out of 13,111 initial citations met our criteria. There were two guidelines, and text and opinion statements predominated. Two authors independently assessed the risk of bias in each primary research study using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for the research design. CONCLUSIONS: This mapping review identifies triggers that may re-traumatize torture survivors during treatment and makes recommendations for prevention. Only a few studies have considered torture survivors' perspectives on treatment and re-traumatization. According to the findings of the mapping review, healthcare providers should consider survivors' biopsychosocial situations, demonstrate cultural sensitivity, and change theirpersonal attitudes . They must also identify tortured patients and determine when professional interpreters should be used.
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Refugiados , Trastornos por Estrés Postraumático , Tortura , Adulto , Humanos , Tortura/psicología , Servicios de Salud , Personal de Salud , Sobrevivientes/psicología , Atención a la Salud , Refugiados/psicología , Trastornos por Estrés Postraumático/prevención & control , Trastornos por Estrés Postraumático/psicologíaRESUMEN
OBJECTIVES: To investigate tympanostomy tube (TT) treatment in young children, with special interest in bloodless surgical methods (laser and radiofrequency), myringosclerosis formation and tympanometric testing. METHODS: This prospective study includes 76 children whose 121 ears with middle ear effusion were treated with tympanostomy tubes. Myringotomy was performed with CO2 laser in 37, radiofrequency in 40 and myringotomy knife in 44 ears. The ears were evaluated with otomicroscopy and tympanometry preoperatively and postoperatively every 3-4 months until spontaneous tube extrusion. RESULTS: All tubes extruded spontaneously (mean 12.8 months, range 3-36 months), with no persistent perforations or cholesteatomas. CO2 laser and radiofrequency inserted tympanostomy tubes extruded faster (mean 11 months) compared to incisional myringotomy (mean 15 months, p = 0.002). Myringosclerosis was noted in 25 (21%) ears after treatment. There was a tendency to less myringosclerosis with bloodless techniques, but the difference was not significant. Flat tympanograms on the day of procedure predicted continuation of ventilation problems also after TT treatment (p = 0.003). Ears with preoperative type B tympanogram had significantly more myringosclerosis 21/75 (28%) compared with type A and C tympanograms 4/41 (10%) (p = 0.032). CONCLUSIONS: While all myringotomy methods were effective and safe, the traditional incisional myringotomy with a tympanostomy knife is still a good, feasible and cost-effective myringotomy method. No surgical removal of tympanostomy tubes is needed before 3 years of uncomplicated tympanostomy treatment. Tympanometry turned out to be a useful tool in prediction of post TT treatment ventilation problems of the middle ear.
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Miringoesclerosis , Otitis Media con Derrame , Niño , Humanos , Preescolar , Pruebas de Impedancia Acústica , Ventilación del Oído Medio/efectos adversos , Ventilación del Oído Medio/métodos , Estudios Prospectivos , Dióxido de Carbono , Membrana Timpánica/cirugía , Otitis Media con Derrame/diagnóstico , Otitis Media con Derrame/cirugía , Otitis Media con Derrame/complicaciones , Rayos LáserRESUMEN
The study aimed to evaluate the antibacterial efficacy of Lugol's solution 5% and Gentian violet 1% against methicillin-resistant Staphylococcus aureus (MRSA) biofilm in vivo. The bactericidal efficacy for treatment of MRSA-biofilm skin wound infection was tested in a murine model. Luciferase-tagged S. aureus Xen31, a MRSA-strain derived from S. aureus ATCC-3359130, was used for infection. Wounds were made in the skin of mice and infected with MRSA. The mice were treated with Lugol's solution and Gentian violet. Application of the antimicrobial agents started 24 hours post infection and was repeated daily for five-days. The antimicrobial effect on the biofilm bacteria was evaluated by measuring bioluminescence from MRSA daily for seven-days. Lugol's solution and Gentian violet showed a significant reduction in luminescent signals from the first assessment day to all subsequent days (P < .001). Lugol's solution and Gentian violet effectively eradicated MRSA in biofilm in vivo and could be alternatives or in addition to topical antibiotics when MRSA-biofilm wound infection is suspected.
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Staphylococcus aureus Resistente a Meticilina , Enfermedades Cutáneas Infecciosas , Traumatismos de los Tejidos Blandos , Infección de Heridas , Animales , Ratones , Violeta de Genciana/uso terapéutico , Staphylococcus aureus , Antibacterianos/uso terapéutico , Infección de Heridas/tratamiento farmacológico , Traumatismos de los Tejidos Blandos/tratamiento farmacológico , BiopelículasRESUMEN
Superior semicircular canal dehiscence syndrome is a condition with troubling ear symptoms and vertigo caused by a defect in the bone between the inner ear and the middle cranial fossa. The disease is not dangerous, and for many patients it is sufficient to provide a thorough explanation for the symptoms and advice about coping strategies, balance exercises and, if necessary, use of assisted hearing devices. Surgical treatment may be appropriate for patients with severe symptoms.
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Dehiscencia del Canal Semicircular , Humanos , Canales Semicirculares/diagnóstico por imagen , Síndrome , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Healthcare professionals working in somatic departments are not trained to recognise signs of torture or provide appropriate healthcare to torture survivors, which may result in retraumatisation during surgical treatment. METHODS AND ANALYSIS: This protocol outlines a four-stage qualitative-method strategy for the development and evaluation of guidelines for prevention of retraumatisation of torture survivors during surgical care. The systematic search for literature review in stages 1 and 2 was conducted in August 2019 and March 2021, respectively, using nine databases. The search strategies employed in stage 1, without imposing any date limits, resulted in the inclusion of eight studies that addressed inadequate healthcare strategies associated with retraumatisation. The clinical guidelines review in stage 2 will include publications from 2000 onwards, which will be appraised using the Appraisal of Guidelines Research and Evaluation Version II instrument. Following multi-institutional recruitment in Norway, stage 3 will explore survivors' experiences of receiving surgical treatment using indepth interviews (n=8-12), which will be audio-recorded, transcribed verbatim and analysed using the interpretative phenomenological analysis approach. In stage 4a, based on the findings from stages 1, 2 and 3, a set of clinical guidelines for preventing retraumatisation during surgical treatment will be developed. Next, the feasibility and acceptability of the guidelines will be assessed in stage 4b in three interdisciplinary focus group interviews (n=5 per group) and text condensation analyses. ETHICS AND DISSEMINATION: The Regional (South-East C) Committee for Medical and Health Research Ethics approved the study in May 2021 (#227624). In stages 3 and 4, an informational letter and an informed consent form will be distributed to the participants to sign before the interview. The study results will be disseminated through publications, conference presentations, and national and local public forums to healthcare professionals, service managers, policymakers and refugee-supporting agencies.
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Refugiados , Tortura , Personal de Salud , Humanos , Guías de Práctica Clínica como Asunto , Investigación Cualitativa , SobrevivientesRESUMEN
PURPOSE: An important outcome measure of patient care is the impact on the patient's health-related quality of life (HRQoL). Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms, hearing problems, psychosocial impact, and the need for care. The optimal length of the recall period has not been studied. For these reasons, a new survey is needed that would cover most chronic ear diseases. METHODS: A preliminary 24-item survey (EOS-24) was created. Untreated adult patients (included n = 186) with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument. The recruiting otologists evaluated the severity of the disease and the disability caused by it. A control group was recruited. Based on the patients' responses in different diagnosis groups, the items were reduced according to pre-defined criteria. The resulting survey was validated using a thorough statistical analysis. RESULTS: The relevance and necessity of the original 24 items were thoroughly investigated, leading to the exclusion of 8 items and the modification of 1. The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups, thus constituting the final instrument, EOS-16. The most suitable recall period was three months. CONCLUSIONS: EOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population. The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.
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OBJECTIVE: To investigate the microbiota of the healthy external auditory canal (EAC) culture-independently and to evaluate the usefulness of the swabbing method in collecting EAC microbiota samples. STUDY DESIGN: Cohort study. PATIENTS: Fifty healthy asymptomatic working-age volunteers. INTERVENTION: Samples were harvested with DNA-free swabs from the volunteers' EACs. MAIN OUTCOME MEASURES: Amplicon sequencing of the 16S rRNA gene was used to characterize the microbial communities in the samples. RESULTS: The swabbing method is feasible for EAC microbiota sample collection. The analyzed 41 samples came from 27 female and 14 male subjects; 4 samples were excluded due to recent antimicrobial treatment and 5 because of low sequence count or suspected contaminant microbes. The four most frequent amplicon sequence variants in the microbiota data were Staphylococcus auricularis, Propionibacterium acnes, Alloiococcus otitis, and Turicella otitidis. Typically, the dominant amplicon sequence variant in a sample was one of the most frequent bacteria, but there were also subjects where the dominant species was not among the most frequent ones. The genus Alloiococcus was least common in females who reported cleaning their ears. Subjects with a high relative abundance of Alloiococcus typically had a low abundance of Staphylococcus, which may be a sign of the two being competing members of the microbial community. CONCLUSIONS: The most common bacteria in the microbiome of the healthy EAC were Staphylococcus auricularis, Propionibacterium acnes, Alloiococcus otitis, and Turicella otitidis. The EAC microbiota seems more diverse and individualized than previously thought. Also, ear cleaning habits seem to alter the EAC microbiome.
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Microbiota , Otitis Media con Derrame , Carnobacteriaceae , Estudios de Cohortes , Corynebacterium , Conducto Auditivo Externo , Oído Medio , Femenino , Humanos , Masculino , ARN Ribosómico 16S/genética , StaphylococcusRESUMEN
Background: Increasing antimicrobial resistance to antibiotics is a substantial health threat. Bioactive glass S53P4 (BAG) has an antimicrobial effect that can reduce the use of antibiotics. The aim of this study was to evaluate the antimicrobial efficacy of BAG in vitro on staphylococci in biofilm and in planktonic form. Secondary aims were to investigate whether supernatant fluid primed from BAG retains the antibacterial capacity and if ciprofloxacin enhances the effect.Methods: BAG-S53P4 granules, <45 µm, primed in tryptic soy broth (TSB) were investigated with granules present in TSB (100 mg/mL) and after removal of granules (100, 200, and 400 mg/mL). The efficacy of BAG to eradicate Staphylococcus aureus biofilm in vitro was tested using 10 different clinical strains and 1 reference strain in three test systems: the biofilm-oriented antiseptic test based on metabolic activity, the biofilm bactericidal test based on culturing surviving bacteria, and confocal laser scanning microscopy (CLSM) combined with LIVE/DEAD staining.Results: Exposure to 48 h primed BAG granules (100 mg/mL) produced bactericidal effects in 11/11 strains (p = 0.001), and CLSM showed reduction of viable bacteria in biofilm (p = 0.001). Supernatant primed 14 days, 400 mg/mL, reduced metabolic activity (p < 0.001), showed bactericidal effects for 11/11 strains (p = 0.001), and CLSM showed fewer viable bacteria (p = 0.001). The supernatant primed for 48 h, or in concentrations lower than 400 mg/mL at 14 days, did not completely eradicate biofilm.Conclusion: Direct exposure to BAG granules, or primed supernatant fluid, effectively eradicated S. aureus in biofilm. The anti-biofilm effect is time- and concentration-dependent. When BAG had reached its full antimicrobial effect, ciprofloxacin had no additional effect.
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Biopelículas/efectos de los fármacos , Vidrio , Plancton/efectos de los fármacos , Staphylococcus aureus/efectos de los fármacos , Pruebas de Sensibilidad MicrobianaRESUMEN
OBJECTIVES: Analyze reasons for unilateral conductive hearing loss (CHL) with unknown etiology in children. INTRODUCTION: Unilateral conductive hearing loss (HL) without known etiology can be undiagnosed despite of hearing screening programs. It can be difficult to find the reason for HL and to make a treatment plan. Middle ear endoscopy gives hard-evidence diagnosis and basis for an individual treatment plan. METHODS AND MATERIAL: Prospective clinical follow-up study for a cohort of generally healthy elementary school age children with unilateral conductive HL with unknown etiology. The study population was 192 children, of which 46 had a HL of at least 25 dB with more than 10 dB conductive component. Mean age was 8.7 years. Preoperative tests included otomicroscopy, bone- and air-conduction audiogram, tympanometry, stapes reflex tests, Rinne and Weber test and Otoacoustic emissions. The children underwent endoscopy of the middle ear with an individual treatment plan and long-term follow-up. The aim was to explore etiology and to give a treatment plan for hearing loss. Follow-up included air- and bone conduction hearing tests annually or every other year. Mean follow-up was 5.2 years. RESULTS: A clear etiological finding was found in 36 (78%) ears, stapes anomaly (23) as the most common (64%) finding. Other findings were two cholesteatomas, 2 status after trauma, 5 middle ear anomalies, 5 incus fixations and one incus erosion. Air conduction hearing improved spontaneously during follow-up in 81% (17/21, 2 dropouts) of the stapes anomaly ears (mean 11,3 dB, range 4-32 dB), and none of these ears showed hearing deterioration. In the incus fixation group, one ear showed hearing deterioration. There were no major complications for exploration, and 5 minor postoperative infections. CONCLUSIONS: The most common reason for pediatric unilateral conductive hearing loss was stapes anomaly/fixation. The HL does not deteriorate. Hearing loss in stapes anomalies shows a tendency for spontaneous recovery. Stapes surgery can be postponed or avoided.
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Endoscopía , Pérdida Auditiva Conductiva/diagnóstico , Pérdida Auditiva Conductiva/etiología , Pérdida Auditiva Unilateral/diagnóstico , Pérdida Auditiva Unilateral/etiología , Adolescente , Audiometría , Niño , Preescolar , Estudios de Cohortes , Oído Medio/cirugía , Femenino , Pérdida Auditiva Conductiva/cirugía , Pérdida Auditiva Unilateral/cirugía , Humanos , Yunque/cirugía , Masculino , Estribo/anomalíasRESUMEN
Several methods of imaging the Eustachian tube have been tested in the last century, although neither has led to an established method. The introduction of balloon Eustachian tuboplasty (BET) has revived the request for Eustachian tube (ET) visualization in patients with chronic Eustachian tube dysfunction. Many institutions perform preoperative computed tomography (CT) scans of the temporal bone and epipharynx before BET. Purpose We hypothesize that the injection of a contrast medium into the tympanic cavity is safe and feasible and can evolve the CT scan by visualizing the ET lumen and, potentially, the level of obstruction. This study is the initial feasibility study for such a human application. Material and Methods Ten minutes before a CT scan, diluted iodixanol was injected into the middle ear in 18 patients planned for BET due to otitis media with effusion. Five patients with Meniere's disease were controls. Any immediate or delayed adverse events were recorded. Masking of adjacent bony structures in the middle ear on the CT images was evaluated and the most caudally visible contrast medium between the middle ear and epipharynx recorded. Results There were no serious adverse events. One patient reported transitory vertigo. The contrast medium did not mask middle ear structures, apart from the tympanic membrane. The level of contrast medium passage could be assessed. Conclusion Visualizing the ET lumen in humans using intratympanic contrast medium is feasible and safe and does not obscure other valuable image information in a preoperative CT scan.
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BACKGROUND: A significant number of adults suffer from conductive hearing loss due to chronic otitis media, otosclerosis, or other pathologies. An objective measurement of ossicular mobility is needed to avoid unnecessarily invasive middle ear surgery and to improve hearing outcomes. METHODS: Minimally invasive intraoperative laser vibrometry provides a method that is compatible with middle ear surgery, where the tympanic membrane is elevated. The ossicles were driven by a floating mass transducer and their mobility was measured using a laser Doppler vibrometer. Utilising this method, we assessed both the absolute velocities of the umbo and incus long process as well as the incus-to-umbo velocity ratio during artificial fixation of the incus alone or incus and malleus together. RESULTS: The reduction of absolute velocities was 8âdB greater at the umbo and 17âdB at the incus long process for incus-malleus fixations when compared with incus fixation alone. Incus fixation alone resulted in no change to the incus-to-umbo velocity ratio where incus-malleus fixations reduced this ratio (-11âdB). The change in incus velocity was shown to be the most suitable parameter to distinguish between incus fixation and incus-malleus fixation. When the whole frequency range was analyzed, one could also differentiate these two fixations from previously published stapes fixation, where the higher frequencies were less affected. CONCLUSION: Minimally invasive intraoperative laser vibrometry provides a promising objective analysis of ossicular mobility that would be useful intraoperatively.
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Osículos del Oído , Pérdida Auditiva Conductiva/cirugía , Rayos Láser , Procedimientos Quirúrgicos Otológicos/métodos , Vibración , Adulto , Osículos del Oído/patología , Osículos del Oído/cirugía , Femenino , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Modelos AnatómicosRESUMEN
There is no unanimous consensus for indications of eustachian tube balloon dilation (ETBD). Nordic countries have relatively similar hospital organizations and treatment guidelines. Therefore, it was logical to organize a consensus meeting of ETBD. The symposium: Nordic Experiences on Eustachian Tube Balloon Dilation, in Copenhagen, 30-31 March, 2017. The panellists from Denmark, Finland, Norway and Sweden and the attendees of the meeting agreed a consensus on the following issues: Candidates, Definition of Eustachian Tube Dysfunction, Diagnostic Work up, Differential Diagnosis, Contraindications, ETBD Procedure, Complications, Follow-up, and Outcomes. The article also presents the status for ETBD in each of these countries. Thereafter the consensus statement has been discussed in the national societies and meetings for ear surgeons in each of these countries. It can be assumed that surgeons in the hospitals of these Nordic countries generally follow the recommendations from the consensus meeting.
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Although the majority of early implanted, profoundly deaf children with cochlear implants (CIs), will develop correct pronunciation if they receive adequate oral language stimulation, many of them have difficulties with perceiving minute details of speech. The main aim of this study is to measure the confusion of consonants and vowels in well-performing children and adolescents with CIs. The study also aims to investigate how age at onset of severe to profound deafness influences perception. The participants are 36 children and adolescents with CIs (18 girls), with a mean (SD) age of 11.6 (3.0) years (range: 5.9-16.0 years). Twenty-nine of them are prelingually deaf and seven are postlingually deaf. Two reference groups of normal-hearing (NH) 6- and 13-year-olds are included. Consonant and vowel perception is measured by repetition of 16 bisyllabic vowel-consonant-vowel nonsense words and nine monosyllabic consonant-vowel-consonant nonsense words in an open-set design. For the participants with CIs, consonants were mostly confused with consonants with the same voicing and manner, and the mean (SD) voiced consonant repetition score, 63.9 (10.6)%, was considerably lower than the mean (SD) unvoiced consonant score, 76.9 (9.3)%. There was a devoicing bias for the stops; unvoiced stops were confused with other unvoiced stops and not with voiced stops, and voiced stops were confused with both unvoiced stops and other voiced stops. The mean (SD) vowel repetition score was 85.2 (10.6)% and there was a bias in the confusions of [i:] and [y:]; [y:] was perceived as [i:] twice as often as [y:] was repeated correctly. Subgroup analyses showed no statistically significant differences between the consonant scores for pre- and postlingually deaf participants. For the NH participants, the consonant repetition scores were substantially higher and the difference between voiced and unvoiced consonant repetition scores considerably lower than for the participants with CIs. The participants with CIs obtained scores close to ceiling on vowels and real-word monosyllables, but their perception was substantially lower for voiced consonants. This may partly be related to limitations in the CI technology for the transmission of low-frequency sounds, such as insertion depth of the electrode and ability to convey temporal information.