Digital otoscopy in remote consultations.

Introduction: Otoscopes and otomicroscopes are the most commonly used instruments for visualizing the ear. Digital otoscopy (DO) could be used to improve diagnostics in primary health care by utilizing image enlargement. The aim of the study was to explore the possibilities of DO in remote consultations. Materials and Methods: Based on real-life referrals, 45 otologic outpatients were recruited. DO was performed followed by an attending otologist's appointment, serving as the gold standard. Twenty-four patient cases were analyzed on a digital platform as remote consultation cases containing the given referral information supplemented with DO videos (DOVs). A total of 71 evaluations were performed by five otologists. The quality of the DOVs, their suitability for remote consultations, the accuracy of diagnoses and the usefulness of remote consultations were determined. Results: The average DOV quality was judged to be 7.4 ± 0.3 (mean ± standard error of the mean; scale of 1-10). The diagnosis was correct in 79% of the cases. In 59% of the patients, the otologists considered that remote consultation could have replaced an in-person visit. Conclusions: In our simulated remote consultation setup, DOV quality was sufficient for diagnostic purposes, DO improved diagnostics and treatment planning in most cases and could be used to reduce the need for in-person visits. DO-aided remote consultation may improve diagnostics and access to care.Level of evidence: 3.

[How and when is topical treatment applied into the ear?]. / Miten ja milloin käytän korvaan tippoja?

Topical treatment is the first-line treatment for inflammation of the external auditory canal and chronic otitis media, without the need of systemic antimicrobial drug therapy. The ear canal is cleaned mechanically, by rinsing with saline, and finally dried by suction. A bacterial or fungal culture specimen should be taken, if the inflammation does not heal with the first treatment or recurs rapidly. High local drug levels without systemic adverse effects are achieved with ear drops. A combinatorial broad-spectrum antibiotic/corticosteroid ear drop is the most effective remedy for bacterial inflammation, whereas the most important therapeutic procedure in fungal infections is cleaning and topical medication.

Acquired jugular vein aneurysm.

Venous malformations of the jugular veins are rare findings. Aneurysms and phlebectasias are the lesions most often reported. We report on an adult patient with an abruptly appearing large tumorous mass on the left side of the neck identified as a jugular vein aneurysm. Upon clinical examination with ultrasound, a lateral neck cyst was primarily suspected. Surgery revealed a saccular aneurysm in intimate connection with the internal jugular vein. Histology showed an organized hematoma inside the aneurysmal sac, which had a focally thinned muscular layer. The terminology and the treatment guidelines of venous dilatation lesions are discussed. For phlebectasias, conservative treatment is usually recommended, whereas for saccular aneurysms, surgical resection is the treatment of choice. While an exact classification based on etiology and pathophysiology is not possible, a more uniform taxonomy would clarify the guidelines for different therapeutic modalities for venous dilatation lesions.

Idiopathic inflammatory medial meatal fibrotizing otitis presenting in children.

OBJECTIVE: Acquired atresia of the ear canal presents rarely in children. Idiopathic inflammatory medial meatal fibrotizing otitis (IMFO) evidently has its own distinct etiopathologic findings causing acquired ear canal atresia. PATIENTS: Two IMFO children treated and followed-up at the Department of Otorhinolaryngology of Helsinki University Hospital. INTERVENTIONS: Clinical and radiologic evaluation of 2 children with IMFO solely affecting the glabrous skin over the osseous part of the ear canal and the tympanic membrane. MAIN OUTCOME MEASURE: Review of identical cases of the acquired postinflammatory or inflammatory medial meatal atresia in children reported in association with literature. RESULT: Idiopathic inflammatory medial meatal fibrotizing otitis, affecting solely the glabrous skin on the tympanic membrane and the osseous part of the external ear canals, is manifesting in 2 children without ongoing chronic middle ear infection. CONCLUSION: The etiopathologic findings or pathophysiology of IMFO is speculative. The success of surgical correction of the already-formed fibrous atresia has not been established.

Labyrinthine malformation in the 22q11.2 deletion syndrome.

Velocardiofacial syndrome and DiGeorge syndrome, integrating to form the 22q11.2 deletion syndrome, manifest frequently with hearing loss. Instead, a labyrinthine anomaly is only occasionally described in velocardiofacial syndrome/DiGeorge syndrome. We report a vestibular labyrinthine malformation demonstrated with computed tomographic scan in a patient with a palatal cleft and a 22q11.2 deletion presenting as velocardiofacial syndrome.

Progressive stapedial fixation in Beckwith-Wiedemann syndrome.

Beckwith-Wiedemann syndrome is a genetic fetal overgrowth disturbance characterized by organomegaly, abdominal wall defects, postnatal hypoglycemia, and increased frequency of embryonic and postnatal tumors. Hearing loss in connection with this syndrome is rare. We describe a patient with Beckwith-Wiedemann syndrome having a progressive conductive hearing loss caused by a stapedial footplate fixation occurring during preschool age. We studied progression of the hearing impairment audiometrically from the patient's fourth year of life until age 19. In the right ear, it progressed from a mean pure-tone hearing level of 10 dB to 70 dB, with a perceptive component of 30 dB. The hearing level of the left ear remained at 25 dB. An exploratory tympanotomy disclosed stapedial fixation, and a partial stapedectomy improved the hearing level in the right ear to 30 to 35 dB. In patients with Beckwith-Wiedemann syndrome, a progressive conductive hearing loss, caused by stapedial footplate fixation, may develop after birth. Clinically, the fixation is identical to otosclerosis, but the typical family history of otosclerosis is lacking.

Long-term hearing results after stapes surgery: a 20-year follow-up.

OBJECTIVE: The aim of this study was to evaluate the results of stapes surgery after 20 years of follow-up and to compare the results between large fenestra versus small fenestra stapedotomy. STUDY DESIGN: Retrospective clinical study. SETTING: Tertiary referral center (university hospital). PATIENTS: One hundred forty-two patients with otosclerosis treated by surgery. INTERVENTION: Eighty patients had a total stapedectomy with House-wire prosthesis and 62 patients a stapedotomy with Teflon-piston prosthesis. MAIN OUTCOME MEASURES: Preoperative, postoperative, and long-term hearing thresholds were compared. Patients filled in a questionnaire about the impact of surgery on the quality of life and postoperative symptoms. RESULTS: The long-term pure tone average improvement did not differ significantly between the techniques compared with the preoperative values. The air-bone gap tended to enlarge as a function of time. The change in the pure tone average was 0.9 dB per year for both techniques. In the questionnaire, some patients reported vertigo, tinnitus, loud noise intolerance, and taste disturbances. Loud noise intolerance seemed to persist in the long term. Surgery had no effect on preoperative tinnitus. CONCLUSIONS: There were no statistically significant differences between the techniques regarding hearing results. Over the long term, both techniques are safe and effective in restoring hearing and improving quality of life.

Idiopathic inflammatory medial meatal fibrotizing otitis.

BACKGROUND: Idiopathic inflammatory medial meatal fibrotizing otitis (IMFO) is rare. Only a few cases with unknown cause have been reported. OBJECTIVE: To report 3 cases of IMFO as a specific diagnostic entity. PATIENTS AND METHODS: Two adults and 1 child with bilateral IMFO were observed for several years at the Department of Otorhinolaryngology of Helsinki University Hospital, Helsinki, Finland. RESULTS: Only the osseous part of the external ear canals was affected by IMFO. The skin and skin organs over the lateral cartilage of the ear canals remained rigorously and constantly uninflamed through the active, relentless progression of the disease over several years, resulting in the formation of a fibrous plug of the medial meatal canal. The middle ears and mastoid air cells were not affected during the active inflammatory phase. CONCLUSION: IMFO has its own specific pathophysiologic characteristics, and perhaps also etiopathologic characteristics, which are still unknown.