A Novel Topical Treatment for Keratosis Obturans.

OBJECTIVE: To present and evaluate the treatment of keratosis obturans (KO) using miconazole/triamcinolone 0.1% crème gauzes. STUDY DESIGN: A retrospective clinical capsule report. PATIENTS: Twelve patients diagnosed with KO between January 2000 and July 2020 visiting our tertiary hospital setting, were retrospectively reviewed. INTERVENTIONS: Either miconazole/triamcinolone 0.1% crème gauzes or periodic microscopic removal of the keratin plug. MAIN OUTCOME MEASURES: No evidence of disease during microscopic inspection of the ear canal. RESULTS: Successful treatment with miconazole/triamcinolone 0.1% gauzes was seen in 4/7 patients (57%) and successful treatment of periodic cleaning of the ear canal was seen in 1/5 patients (20%). CONCLUSIONS: Topical treatment of KO with miconazole/triamcinolone 0.1% crème gauzes in the ear canal could be considered as a treatment option for patients diagnosed with KO.

Success Rate of Tympanic Membrane Closure in the Elderly Compared to Younger Adults.

OBJECTIVE: To assess the effectiveness and safety of tympanoplasty in elderly patients and the effect of frailty on the results. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Thirty-one ears in 30 patients aged 65 years and older were included and matched with 31 controls, based on the type of surgery, of a pool of 133 patients aged 35 to 55 years. INTERVENTION: Therapeutic. MAIN OUTCOME MEASURE: Success was defined as tympanic membrane closure and resolution of presenting complaints. Complications were assessed. Frailty was defined by assessing multimorbidity and polypharmacy. Fisher's exact test was used to compare success and complication rates between the age groups. Linear logistic regression analysis using generalized linear models was performed on success and complication rate. RESULTS: Success rates in both the groups were 84%. Complication rate in the elderly group was 16% versus 6% in the control group. This difference was not statistically significant in the Fisher's exact test. In the generalized linear model analysis age group, multimorbidity and polypharmacy had no significant influence on both success and complication rate. CONCLUSION: There was no difference in success and complication rate in elderly undergoing tympanoplasty compared with younger adults. Having multimorbidity or polypharmacy did not correlate with failure of the tympanic membrane closure or a higher complication rate.

Anxiety levels of patients undergoing coronary procedures in the catheterization laboratory.

BACKGROUND: High levels of anxiety are associated with worse outcomes in coronary artery disease patients. Little is known about anxiety levels in patients undergoing coronary procedures. Our objective is to examine the levels of anxiety in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) during the different phases of hospital stay and to evaluate which patient characteristics are associated with increased anxiety. METHODS: Patients undergoing CAG or PCI between April 2009 and April 2010 were included in this prospective cohort study. Anxiety levels were measured using the self reported Visual Analogue Scale (VAS) of Anxiety, ranging from 0 to 100. VAS anxiety scores were obtained at hospital intake, pre- and post-procedure, and at hospital discharge. Multivariate linear regression analyses were performed to assess correlations between baseline characteristics and anxiety levels at the different time points. RESULTS: In total 2604 patients were included, with 70.4% male participants with a mean age of 65±12years. VAS anxiety scores were highest pre-procedure (44.2±27.0mm). Female patients reported a significantly higher pre procedure VAS anxiety score (50.4±26.5) compared to males (41.5±26.8, p=0.02). Other factors associated with higher levels of anxiety at different time points were age<65years, low level of education and an acute primary PCI. CONCLUSION: In the largest cohort to date, we examined anxiety among patients undergoing PCI or CAG was highest immediately around the procedure, particularly in patients aged <65years, of female gender, undergoing primary PCI, or with a lower level of education. Better pre-procedural information or pharmacological strategies may reduce anxiety in these patients.