Migration and other electrode complications following cochlear implantation.

OBJECTIVES: To investigate migration and other electrode-related complications in cochlear implant surgery. METHODS: Retrospective review of all patients (adult and paediatric) undergoing cochlear implantation at a tertiary referral centre in England, between April 2019 and December 2021. Split arrays and patients who did not have post-op imaging were excluded. RESULTS: Two hundred and ninety-nine cochlear implants were performed including 90% primary and 10% revision surgeries. Two hundred and forty-eight (86%) of electrodes implanted were straight arrays.Twenty-seven (9%) demonstrated suboptimal position on post-operative imaging. Three (11%) were true migration, 4 (15%) possible migration, 15 (56%) had two or less extra-cochlear electrodes, 3 (11%) expected partial insertion and 2 (7%) demonstrated tip fold-overs. Twenty (74%) of arrays within the suboptimal insertion group were in primary surgeries. Six patients required re-implantation. The most common reason for re-implantation was migration. DISCUSSION: Electrode migration after cochlear implantation may be more common than previously thought. We demonstrate rates of migration congruous with current literature; this is despite robust and varied fixation techniques. Notable in our series is that all true captured migrations were seen exclusively in straight arrays. The majority of patients in the possible and confirmed migration group had normal inner ear anatomy. CONCLUSION: Suboptimal electrode position following cochlear implant surgery is a recognized complication and can affect implant performance. Reporting may increase with more widespread use of sophisticated post-operative imaging. Use of a pre-curved electrode and routine use of appropriate fixation techniques may reduce migration rates.

Defying Deafness: Remembering Jack Ashley.

After he sustained a profound hearing loss in his only hearing ear following a routine myringoplasty, Jack Ashley became Britain's first deaf politician. His story is an inspiring one, converting a postoperative complication into a driver for success and change in the lives of millions of deaf and disabled people around the world.

Preoperative and postoperative optimisation of patients undergoing thyroid surgery: a multicentre quality improvement project at Barts Health NHS Trust.

Hypocalcaemia following thyroid surgery can occur in up to 38% of patients. With over 7100 thyroid surgeries performed in 2018 in the UK, this is a common postoperative complication. Undertreated hypocalcaemia can result in cardiac arrhythmias and death. Preventing adverse events from hypocalcaemia requires preoperative identification and treatment of at-risk patients with vitamin D deficiency, timely recognition of postoperative hypocalcaemia and prompt appropriate treatment with calcium supplementation. This project aimed to design and implement a perioperative protocol for prevention, detection and management of post-thyroidectomy hypocalcaemia. A retrospective audit of thyroid surgeries (n=67; October 2017 to June 2018) was undertaken to establish baseline practice of (1) preoperative vitamin D levels assessment, (2) postoperative calcium checks and incidence of postoperative hypocalcaemia and (3) management of postoperative hypocalcaemia. A multidisciplinary team approach following quality improvement principles was then used to design a perioperative management protocol with all relevant stakeholders involved. After dissemination and implementation, the above measures were reassessed prospectively (n=23; April-July 2019). The percentage of patients having their preoperative vitamin D measured increased from 40.3% to 65.2%. Postoperative day-of-surgery calcium checks increased from 76.1% to 87.0%. Hypocalcaemia was detected in 26.8% of patients before and 30.43% of patients after protocol implementation. The postoperative component of the protocol was followed in 78.3% of patients. Limitations include low number of patients which precluded from analysis of the impact of the protocol on length of stay. Our protocol provides a foundation for preoperative risk stratification and prevention, early detection and subsequent management of hypocalcaemia in thyroidectomy patients. This aligns with enhanced recovery protocols. Moreover, we offer suggestions for others to build on this quality improvement project with the aim to further advance the perioperative care of thyroidectomy patients.

Recurrent Swelling in Pediatric Cochlear Implant Patients.

OBJECTIVE: To determine the prevalence, characteristics, and outcomes of pediatric patients with recurrent swelling over their cochlear implant receiver package. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: A total of 332 bilateral cochlear implant patients under the age of 18 years were reviewed. Twelve patients with more than one episode of swelling around their cochlear implant receiver package were isolated. Patients with clinical evidence of infection were excluded from the study. The etiology of hearing loss was heterogeneous. INTERVENTION: Three patients underwent ultrasound, and three patients underwent bedside aspiration. Most patients were treated with 7 days of oral broad-spectrum antibiotics. MAIN OUTCOME MEASURE: Incidence, frequency, and course of recurrent swelling around cochlear implant receiver packages. RESULTS: The first swelling appeared between 0.86 and 9.95 years after surgery (mean, 3.38), and the occurrence of the last episode ranged from 0.06 to 3.42 years from the current date (mean, 1.04). The total number of episodes ranged from 2 to 18 (mean, 6). Seven patients had unilateral swellings, and five had bilateral swellings. Swellings were associated with upper respiratory tract infection or minor trauma, or had no identifiable cause. Aspiration in three cases showed evidence of altered blood. CONCLUSIONS: Recurrent otherwise asymptomatic swelling over cochlear implant receiver packages in children is more common than initially thought. Possible causes include hematoma and seroma secondary to upper respiratory tract infection. The incidence and the timing of swelling are variable. There were no swelling-related device failures or reimplantations so patients and parents can be reassured about the long-term outcome.

Enhanced recovery after laryngectomy: A feasibility study in 25 patients.

PURPOSE: To describe the development and implementation of an enhanced recovery programme for patients undergoing total laryngectomy. METHODS: A feasibility study set in a tertiary head and neck unit in London, United Kingdom. The programme was developed based on Enhanced Recovery After Surgery (ERAS) Society guidelines for head and neck cancer surgery and local expert group consensus. An ERAS 'booklet' was devised which accompanied all laryngectomy patients during their inpatient stay. Contributors included otolaryngologists, anaesthetists, dieticians, physiotherapists, speech and language therapists and nurses. A 12-month pilot study was undertaken. The main outcome measures were feasibility and adherence. RESULTS: An enhanced recovery programme for 25 people undergoing total laryngectomy was successfully piloted in a tertiary referral head and neck unit. Median length of stay was reduced in the post-ERAS group by 1.5 days. No statistically significant difference in length of stay, time to first gastrografin swallow, rate of fistula nor postoperative normalcy of eating between the pre and post-ERAS patients who underwent laryngectomy was observed. Clavien-Dindo-grouped complication rates were significantly higher in the post-ERAS group. CONCLUSION: This enhanced recovery programme for patients undergoing laryngectomy is the first of its kind in the literature. Implementation has been demonstrated feasible. Further longitudinal studies are required to reliably inform us on ERAS programmes' effects on laryngectomy outcomes.

Use of narrow band imaging and 4K technology in otology and neuro-otology: preliminary experience and feasibility study.

The advent of the endoscope has facilitated otological surgery in recent years. Advances in optical technology have led to the development of high definition visualisation, such as 4K magnification. Narrow band imaging (NBI) has been shown to improve visualisation of tissue based on varying degrees of vascularity. This is a feasibility study, the first of its kind, aiming to investigate the appearances of middle ear anatomy and pathology (tympanic membrane, tympanosclerosis, cholesteatoma, granulation, endolymphatic sac hydrops, otosclerosis) under the NBI filter, using a high definition 4K endoscope. Qualitative analysis of image detail and operating time in minutes were recorded. The study demonstrates that these two technologies can be implemented with ease into practice, and show a clear differentiation between pathology and normal anatomy. NBI and 4K magnification prove to be useful adjuncts to the surgeon during endoscopic ear surgery.

Day case hemithyroidectomy is safe and feasible: experience in Scotland.

BACKGROUND AND AIMS: We aimed to analyse the safety and feasibility of day case hemithyroidectomy. METHODS AND RESULTS: We reviewed all hemithyroidectomies led by two surgeons across two sites between 2010 and the end of 2013. Patients were divided into 'planned inpatient' or 'planned day case'. RESULTS: Day of discharge, conversion to inpatient procedure, intraoperative and postoperative complications and postoperative presentations or readmission to hospital were analysed. Age, gender, American Society of Anaesthesiologists score and indication for surgery were also recorded. One-hundred and eighty hemithyroidectomy cases were analysed, 35 (19.5%) were planned as inpatient procedures. Of the remaining 145 (80.5%) planned day case: 106 (73.1%) were successfully discharged on the same day and 39 (26.9%) were not; 11 (7.6%) were converted to inpatient procedures perioperatively; 8 (5.5%) had additional procedures; 6 (4.1%) had wound infections; 7 (4.8%) presented to ER; 1 (0.7%) of which required readmission to hospital for a reason unrelated to the surgery. None had laryngeal nerve palsy, compressive haematoma or symptomatic hypocalcaemia. CONCLUSION: This study showed that hemithyroidectomy by experienced surgeons can be performed safely as a day surgery. No 'planned day case patients' in this study developed laryngeal nerve palsy, compressive haematoma or symptomatic hypocalcaemia.

UK foundation-year 1 doctors--a survey uncovering infrequent theater experience regardless of time, place, or surgical specialty.

INTRODUCTION: Doctors in the United Kingdom are expected to choose a broad career path after approximately 16 months of finishing medical school. We aim to investigate how much surgical exposure foundation-year (FY)1 doctors would have by the end of their first year after finishing medical school and whether this is sufficient to make an informed decision on a career in surgery. METHOD: Cross-sectional survey via a 10-part questionnaire sent to 1341 FY1 doctors at the end of their first clinical year across secondary and tertiary hospitals within 9 foundation schools in the United Kingdom. RESULTS: A total of 389 FY1 doctors responded. More than half (52.2%) of the FY1 doctors were unable to attend theater more than 5 times during their rotation. Length of surgical rotation, surgical specialty, type of hospital, and prior interest in surgery had no significant effect on theater attendance (p > 0.05). More than half (50.9%) of the FY1 doctors did not feel like they had had sufficient experience to make an informed decision about a career in surgery. DISCUSSION: Poor theater attendance is common among FY1 doctors, which may lead to ill-informed specialty career decisions. The Modernising Medical Careers program and European Working Time Directive are likely contributing to this lack of exposure. Protected and logged theater sessions for all FY1 doctors could ensure sufficient exposure. New initiatives need to be employed to increase surgical exposure among FY1 doctors to ensure that specialty choices in their second FY are informed ones. The proposed changes to the United Kingdom's junior doctor's training in the "Shape of Training" report may mean that changes in exposure in the early years are even more pertinent.

Desire for post bariatric body contouring in South East Scotland.

The past 20 years has seen a doubling in the worldwide prevalence of morbid obesity (usually defined as a body mass index BMI, >40 kg/m(2)). Scotland has one of the worst obesity records amongst developed countries. In 2010, 65.1% of all adults aged 16 and over were overweight or obese. Morbid obesity rates (BMI 40 kg/m(2) or more) increased from 1.2% in 1995 to 2.7% in 2003, and fluctuated between 2.2% and 2.7% between 2008 and 2010 (Figure 1). Morbid obesity is associated with twice the mortality compared with the general population. The National Audit Office (NAO) estimated that in 1998 over 30,000 deaths a year in England were attributable to obesity, approximately 6% of all deaths in that year. Obesity is associated and with other conditions such as hypertension, type 2 diabetes, cardiovascular disease, osteoarthritis and cancer, as well as increased rates of psychiatric illness.

The Lacemaker: helping clinicians identify the depression-prone profile.

Claude Gorretta's film, The Lacemaker, centres around Beatrice, a girl who becomes depressed after having her heart broken by a boyfriend. As Beatrice's depressive reaction was predictable from her family background and personality, this film could be used as an educative tool to sensitize clinicians to patients susceptible to depression.