Search

Joint Voice clinics run by an ENT surgeon (Laryngologist) and Voice therapist avoid repetition of clinical assessment, better planning of patient management and early initiation of treatment. Although is perceived as optimal management of voice patients it is perhaps not necessary for all patients as it is time consuming for the clinicians involved. The aim of this study was to investigate whether it was possible to identify any subgroup of patients that could potentially be seen in a Voice therapist-led new patient clinic by reviewing the outcome of 96 patients referred to a Joint Voice clinic. Forty-four patients were referred for voice therapy out of which 13 (30%) were teachers or lecturers (total number: 16 (81%)). Two others in this subgroup required medical treatment and the other surgery. The most common aetiology in these professional voice users was muscle tension dysphonia (10 patients, 63%). It is concluded that experienced Voice therapists appropriately trained in laryngostroboscopic assessment could potentially receive and manage direct referrals from primary care physicians. They should however work as part of a multiprofessional Voice Disorders Team where the patients could be reviewed by an ENT surgeon if necessary. This would significantly improve the patient pathway for these patients, be cost-effective and make the best use of therapist's and ENT surgeon's time. [ABSTRACT FROM AUTHOR]

AbstractBackgroundAimsMethodsResultsConclusionRecurrence rate of necrotising otitis externa (NOE) after treatment is 15-20%. This is mainly due to a lack of reliable clinical indicator for the resolution of disease.We aim to assess the predictability of the otalgia, otorrhoea and C-reactive protein (CRP) levels in a large cohort of sixty-two patients for treatment outcome.Consecutive patients treated for NOE in our Nottingham tertiary ENT referral unit were retrospectively reviewed from January 2017 to June 2020. Diagnoses were made based on clinical findings and imaging. Good response to treatment was defined as those who required treatment of not longer than the standard six weeks of systemic antibiotics.Average age at presentation was 78.4 years. 75.8% of patients were male. 62.9% had diabetes. Ten patients received more than the standard six weeks of systemic antibiotics. Complications from disease progression included cranial nerve neuropathies (14.5%), meningitis (3.2%), and sigmoid sinus thrombosis (3.2%). Two patients had recurrent or persistent NOE and died while on treatment. Delays in normalization of CRP (p = 0.015) and resolution of otorrhoea (p = 0.014) were associated with an increased need for prolonged antibiotic treatment.Normalisation of CRP and resolution of otorrhea can assist in identifying patients who will likely benefit from a prolonged course of systemic antibiotics. [ABSTRACT FROM AUTHOR]

Objectives: Otosclerosis is a disease process that usually starts around the oval window, causing fixation of the stapes, resulting in conductive hearing loss. Treatment of the conductive hearing loss caused by otosclerosis consists of either rehabilitation with hearing aids or performing surgery. Given the risks of hearing impairment and vertigo associated with the surgery, there has been a desire to advance the practice to minimize the complications. The so-called "non-contact" or "no touch" techniques with the use of various lasers are in current practice. This review article will cover the surgical aspects, the theory behind laser and the various types used in stapes surgery. It will also review the evidence of laser versus conventional stapes surgery and the comparison of different laser types. Methods: A literature search up to December 2019 was performed using Pubmed and a nonsystematic review of appropriate articles was undertaken. Keywords used were stapes, surgery, laser, stapedectomy, and stapedotomy. Results: Overall, there is no evidence to say laser fenestration is better than conventional fenestration techniques; however, with the micro drill, there is an increased risk of footplate fracture and sensorineural hearing loss. There is an increased risk of tinnitus with the laser compared to conventional techniques. Studies have favored the CO2 laser over potassium titanyl phosphate (KTP) and erbium-doped yttrium aluminium garnet (Erbium-YAG) lasers for postoperative closure of the air-bone gap; and KTP laser has less thermal, mechanical, and sound effects compared with the thulium and carbon dioxide (CO2) lasers. There is an increased risk if inner ear complications with the thulium laser. Conclusions: It can be deduced that theoretically and practically, the thulium laser is less safe compared to the KTP and CO2 lasers. The choice of laser used depends on the surgeon's preference, as well as availability, cost, side effects profile, as well as ease of use. [ABSTRACT FROM AUTHOR]

The article evaluates the effectiveness of nasal strips in improving nasal airflow. Research findings show that the addition of splint increases peak respiratory flow. The results of the comparative study on peak inspiratory flow rates of the subject patients using splints before and after physical activity are presented.

Abstract: Objective: UK National Institute of Clinical Excellence (NICE) guidelines on surgical management of otitis media with effusion (OME) in children call for an initial 3 month period of observation, with ventilation tube (VT) insertion considered for children with persistent bilateral OME with a hearing level in better ear of 25–30dB HL or worse (“core criteria”), or for children not meeting those audiologic criteria but when OME has significant impact on developmental, social or educational status (exceptional circumstances). We aimed to establish whether guidelines are followed and whether they have changed clinical practice. Methods: Retrospective case-notes review in five different centres, analysing practice in accordance with guidelines in all children having first VT insertion before (July–December 06) and after (July–December 08) guidelines introduction. Results: Records of 319 children were studied, 173 before and 146 after guidelines introduction. There were no significant differences in practice according to guidelines before and after their introduction with respect to having 2 audiograms 3 months apart (57.8 vs. 54.8%), OME persisting at least 3 months (94.8 vs. 92.5%), or fulfilment of the 25dB audiometric criteria (68.2 vs. 61.0%). Practice in accordance with the core criteria fell significantly from 43.9 to 32.2% (Chi squared p =0.032). However, if the exceptional cases were included there was no significant difference (85.5 vs. 87.0%), as the proportion of exceptional cases rose from 48.3 to 62.2% (Chi squared p =0.021). Conclusion: This study shows that 87.0% of children have VTs inserted in accordance with NICE guidelines providing exceptional cases are included, but only 32.2% comply with the core criteria. A significant number have surgery due to the invoking of exceptional criteria, suggesting that clinicians are personalising the treatment to each individual child. [Copyright &y& Elsevier]