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Introduction: 4.1 million people in England and Wales do not speak English as a first language.1 Whilst representing only 7.1% of the population, data suggests this cohort face greater barriers to effective healthcare than native English speakers. One study found they experience twice the rate of medication errors.2 One solution is the use of translation services in healthcare settings. However, national evidence shows service underutilisation.2 Research cites long waiting times, loss of phone connection and translator lack of familiarity with National Health Service (NHS) as contributors.3 Anecdotal data suggests underutilisation of services at Oxford Road Campus (ORC) of Manchester University Foundation Trust (MFT). 18% of ORC patients are not native English speakers, meaning there is a potential risk to patient outcomes if translation services are underutilised. Aim: To explore the barriers pharmacy staff at ORC of MFT face when accessing the local translation service for patients; where its use would be appropriate and/or beneficial. Methods: A literature search was conducted regarding use of translation services by healthcare staff and existing barriers to use. An interview proforma was formulated using the literature findings, existing questionnaires, discussions with a University of Manchester research Pharmacist and the group's aims and objectives. The questions were formulated into the Qualtrics XMTM software. Data was collected using structured interviews to increase capture of qualitative data. The target audience was Trust pharmacy staff with patient contact. The sampling technique was opportunistic and captured 45 respondents. Quantitative data was analysed through Microsoft Excel, whilst qualitative data was analysed using thematic grouping. No ethical approval was required as this was a service evaluation. Results: 97.8% of respondents had encountered at least one patient without English as a first language. Of these, 100% were aware of trust translation services, despite only 7% of staff having received training. Only 25% of participants reported the trust translation service was their primary method for translation. Preferred methods of overcoming language barriers were use of relatives/next of kin or a multilingual staff member. The most reported barriers in order of frequency were time, ease of access and preferring alternative methods. Some participants who had never used the service reported concerns over the accuracy of translation and high costs of the service. 78% of respondents indicated that they would use the service if barriers were rectified. When asked about features of an ideal service, exact waiting times, use without a PIN and dedicated ward phones were the most popular responses. Discussion/Conclusion: Results obtained show numerous barriers to service use and accessibility. Of note, several staff who reported barriers had never used the service. These perceived barriers often related to factually incorrect views of the service such as cost and accuracy of translation. Thus, training for staff in conjunction with improvements to the service would increase utilisation of the translation service and therefore patient safety. One imitation of our project was that no data exists on number of patient facing staff so it is not possible to quantify the percentage of staff captured. References: 1. Office for National Statistics. Census 2021. [Internet]. 2021 [cited 2023 Mar 14]. Available from: https://census.gov.uk/census-2021-results 2. Bajramovic Fejzic J, Tett SE, Medication management reviews for people from the former Yugoslavia now resident in Australia, Pharm World Sci, 2004 [cited 2023 Mar 14];26(5):271-6. Available from: https://pubmed.ncbi.nlm.nih.gov/15598068/ 3. Lehane D, Campion P, Interpreters: why should the NHS provide them?, Br J Gen Pract, 2018 [cited 2023 Mar 14]. p. 564-5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255215/ [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is the the most common disease-specific cause of adult emergency hospital admissions in Ireland. Preliminary groundwork indicated that treatment of acute exacerbations of COPD (AECOPD) in Ireland is not standardised between public hospitals. Applying Institute for Healthcare Improvement Breakthrough Series and Model for Improvement methodologies, Royal College of Physicians of Ireland designed and conducted a novel flexible and adaptive quality improvement (QI) collaborative which, using embedded evaluation, aimed to deliver QI teaching to enable teams to implement bespoke, locally applicable changes to improve and standardise acute COPD care at presentation, admission and discharge stages within their hospitals., Methods: Eighteen teams from 19 hospitals across Ireland participated over 13 months. QI teaching was facilitated through inperson learning sessions, site visits, programme manager and coaching support. Teams submitted monthly anonymised patient data (n=10) for 22 measures of AECOPD care for ongoing QI evaluation. A mixed-methods survey was administered at the final learning session to retrospectively evaluate participants' experiences of QI learning and patient care changes., Results: Participants reported that they learnt QI and improved patient care during the collaborative. Barriers included increased workload and lack of stakeholder buy-in. Statistically significant improvements (mean±SD) were seen for 'documented dyspnoea, eosinopenia, consolidation, acidaemia and atrial Fibrillation (DECAF) assessment' (7.3 (±14.4)% month(M)1 (n=15 sites); 49.6 (±37.7)% M13 (n=16 sites); p<0.001, 95% CI (14.3 to 66.7)), 'Documented diagnosis - spirometry' (42.5 (± 30.0)% M1 (n=16 sites); 69.1 (±29.9)% M13 (n=16 sites); p=0.0176, 95% CI 5.0 to 48.2) and 'inhaler technique review completed' (45.6 (± 34.1)% M1 (n=16 sites); 76.3 (±33.7)% M13 (n=16 sites); p=0.0131, 95% CI 10.0 to 65.0). 'First respiratory review' demonstrated improved standardisation., Conclusion: This flexible QI collaborative provided adaptive collaborative learning that facilitated participating teams to improve AECOPD patient care based on the unique context of their own hospitals. Findings indicate that involvement in the QI collaborative facilitated teams in achieving their improvements., Competing Interests: Competing interests: JB is a general practitioner. TJMcD, RWC and BC are hospital respiratory consultants. All have made all efforts to ensure their input has not been biased by their own clinical practice. TJMcD was the (retired) clinical lead for the National Clinical Programme for COPD (now the NCPR)., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

BackgroundSerosurveys for SARS-CoV-2 aim to estimate the proportion of the population that has been infected.AimThis observational study assesses the seroprevalence of SARS-CoV-2 antibodies in Ontario, Canada during the first pandemic wave.MethodsUsing an orthogonal approach, we tested 8,902 residual specimens from the Public Health Ontario laboratory over three time periods during March-June 2020 and stratified results by age group, sex and region. We adjusted for antibody test sensitivity/specificity and compared with reported PCR-confirmed COVID-19 cases.ResultsAdjusted seroprevalence was 0.5% (95% confidence interval (CI): 0.1-1.5) from 27 March-30 April, 1.5% (95% CI: 0.7-2.2) from 26-31 May, and 1.1% (95% CI: 0.8-1.3) from 5-30 June 2020. Adjusted estimates were highest in individuals aged ≥ 60 years in March-April (1.3%; 95% CI: 0.2-4.6), in those aged 20-59 years in May (2.1%; 95% CI: 0.8-3.4) and in those aged ≥ 60 years in June (1.6%; 95% CI: 1.1-2.1). Regional seroprevalence varied, and was highest for Toronto in March-April (0.9%; 95% CI: 0.1-3.1), for Toronto in May (3.2%; 95% CI: 1.0-5.3) and for Toronto (1.5%; 95% CI: 0.9-2.1) and Central East in June (1.5%; 95% CI: 1.0-2.0). We estimate that COVID-19 cases detected by PCR in Ontario underestimated SARS-CoV-2 infections by a factor of 4.9.ConclusionsOur results indicate low population seroprevalence in Ontario, suggesting that public health measures were effective at limiting the spread of SARS-CoV-2 during the first pandemic wave.

This paper explores the affective formation of health and space/place through an examination of the affective and bodily practices of marathon runners in China. By elaborating the idea of "affective spaces of health", we investigate not only how the affective potential of running bodies enables a therapeutic and individualised form of selfhood in response to China's post-socialist transformation, but also how affective atmospheres might condition and discipline runners' affective capacities for health. The paper therefore questions the simplistic association of health with particular qualities of place, and calls for research to focus on the affective, dispersed and fluid spaces of health instead., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

This paper explores how the intersection of masculinity and religion shapes workplace well-being by focusing on Christianity and the social construction of masculinity among factory workers in a city in China. While existing work on public and occupational health has respectively acknowledged masculinity's influences on health and the religious and spiritual dimensions of well-being, there have been limited efforts to examine how variegated, and especially religious, masculinities influence people's well-being in the workplace. Drawing on ethnography and in-depth interviews with 52 factory workers and 8 church leaders and factory managers, we found that: (1) Variegated masculinities were integrated into the factory labor regime to produce docile and productive bodies of workers. In particular, the militarized and masculine cultures in China's factories largely deprived workers of their dignity and undermined their well-being. These toxic masculinities were associated with workers' depression and suicidal behavior. (2) Christianity not only provided social and spiritual support for vulnerable factory workers, but also enabled them to construct a morally superior Christian manhood that phytologically empowered them and enhanced their resilience to exploitation. This paper highlights not only the gender mechanism of well-being, but also the ways religion mediates the social-psychological construction of masculinity.

Background: Use of videos of surgical and medical techniques for educational purposes has grown over the last years. To our knowledge, there is no validated tool to specifically assess the quality of these types of videos. Our goal was to create an evaluation tool and study its intrarater and interrater reliability and its acceptability. We named our tool UM-OSCAARS (Université de Montréal Objective and Structured Checklist for Assessment of Audiovisual Recordings of Surgeries/techniques)., Methods: UM-OSCAARS is a grid containing 10 criteria, each of which is graded on an ordinal Likert-type scale of 1 to 5 points. We tested the grid with the help of 4 voluntary otolaryngology - head and neck surgery specialists who individually viewed 10 preselected videos. The evaluators graded each criterion for each video. To evaluate intrarater reliability, the evaluation took place in 2 different phases separated by 4 weeks. Interrater reliability was assessed by comparing the 4 topranked videos of each evaluator., Results: There was almost-perfect agreement among the evaluators regarding the 4 videos that received the highest scores from the evaluators, demonstrating that the tool has excellent interrater reliability. There was excellent test-retest correlation, demonstrating the tool's intrarater reliability., Conclusion: The UM-OSCAARS has proven to be reliable and acceptable to use, but its validity needs to be more thoroughly assessed. We hope this tool will lead to an improvement in the quality of technical videos used for educational purposes., Competing Interests: None declared., (© 2021 Joule Inc. or its licensors.)

Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that may be punctuated by episodes of worsening symptoms, called exacerbations. Acute exacerbations of COPD (AECOPD) are detrimental to clinical outcomes, reduce patient quality of life and often result in hospitalisation and cost for the health system. Improved diagnosis and management of COPD may reduce the incidence of hospitalisation and death among this population. This scoping review aims to identify improvement interventions designed to standardise the hospital care of patients with AECOPD at presentation, admission and discharge, and/or aim to reduce unnecessary admissions/readmissions., Methods: The review followed a published protocol based on methodology set out by Arksey and O'Malley and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic database searches for peer-reviewed primary evidence were conducted in Web of Science, EMBASE (Elsevier) and PubMed. Abstract, full-text screening and data extraction were completed independently by a panel of expert reviewers. Data on type of intervention, implementation supports and clinical outcomes were extracted. Findings were grouped by theme and are presented descriptively., Results: 21 articles met the inclusion criteria. Eight implemented a clinical intervention bundle at admission and/or discharge; six used a multidisciplinary care pathway; five used coordinated case management and two ran a health coaching intervention with patients., Conclusion: The findings indicate that when executed reliably, improvement initiatives are associated with positive outcomes, such as reduction in length of stay, readmissions or use of health resources. Most of the studies reported an improvement in staff compliance with the initiatives and in the patient's understanding of their disease. Implementation supports varied and included quality improvement methodology, multidisciplinary team engagement, staff education and development of written or in-person delivery of patient information. Consideration of the implementation strategy and methods of support will be necessary to enhance the likelihood of success in any future intervention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Eight new cases of chronic otomastoiditis due to nontuberculous mycobacteria were reported at Center Hospitalier Universitaire Sainte-Justine (CHUSJ) between 2008 and 2018. In the literature, only 89 cases have been described since 1972. This case series aims to define the clinical presentation, infectious pathogens, as well as diagnostic and therapeutic means employed in cases of nontuberculous mycobacteria otitis media encountered in our tertiary pediatric reference center., Methods: All cases of otitis media caused by nontuberculous mycobacteria diagnosed at Sainte-Justine between 2008 and 2018 were reviewed. Species identification was retrieved from the Laboratoire de Santé Publique du Québec, Quebec's provincial public health and reference laboratory., Results: All 8 cases occurred in immunocompetent children. Clinical features on presentation were chronic tympanostomy tube otorrhea with abundant granulation tissue in 7 cases. CT scan demonstrated coalescent mastoiditis in 3 cases. The median delay between initial presentation and identification of nontuberculous mycobacteria was 81 days. Seven patients had a Mycobacterium (M.) abscessus complex infection. Treatment consisted of weekly microscopic granulation debridement, a combined systemic antibiotic therapy for an average duration of 21 weeks, as well as instillation of boric acid into the middle ear. While 3 cases required at least one mastoidectomy, 2 cases were treated only medically., Conclusion: Nontuberculous mycobacteria otitis media is a rare clinical entity, for which high clinical suspicion and specific microbiological analyses could minimize diagnostic delay. The use of boric acid as a desiccating agent may allow for a better local control., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Aim: This scoping review will gather existing evidence on specific interventions at presentation and discharge which aim to standardize care and/or reduce unnecessary admissions and/or readmissions to hospital for patients presenting with acute exacerbation of chronic obstructive pulmonary (airways) disease., Design: Scoping review of relevant literature from January 2000-March 2019., Methods: Database searches for primary evidence in peer-reviewed journals will be conducted electronically using Web of Science, EMBASE (Elsevier) and PUBMED. Eligibility criteria will include hospital-based interventions for presentations of acute exacerbation of chronic obstructive pulmonary disease with outcomes specific to standardizing care or reducing unnecessary admissions or readmissions. Abstract, full-text screening and data extraction will be completed independently by a panel of expert reviewers., Results: We aim to identify current interventions and improvement approaches in acute exacerbation of chronic obstructive pulmonary (airways) disease care that have an impact on admission and discharge processes or readmissions. Recommendations as a result of this review will aid the design and development of future improvement intervention., Competing Interests: Rachel MacDonell is employed by Royal College of Physicians of Ireland as Programme Manager with responsibility for a COPD Improvement Collaborative in Ireland. Orla Woods and Lucia Prihodova are employed by the Research Department of Royal College of Physicians of Ireland. As such, none of the authors have any conflict of interest to declare., (© 2019 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Around the world, smart technologies are being embraced as a cost-efficient means of enabling the elderly to be cared for in new, more non-proximate ways. They can facilitate ageing-in-place, and have the potential to relieve pressure on the providers of care. Yet, the fact is that the interface of technology and society is a negotiated one. These negotiations are most acutely felt when technology is used to supplement the hitherto human-centred process of caregiving, especially amongst "marginalised" societal cohorts, like the elderly. With this, there is a need to better understand the ways in which smart eldercare technologies are used, misused, or not used by those that they are designed to benefit. Drawing on qualitative data derived from triallists of three smart eldercare technologies in Singapore, this paper explores how the lived experience of smart eldercare can cause agentic and apathetic behaviours towards technology to manifest. Specifically, we identify four expectations - of understanding, response, compliance and appreciation - that undermine the potential beneficence of smart eldercare. To conclude, we emphasise the need for more collaborative, and more contextually-sensitive, approaches to the design, development and implementation of smart eldercare solutions., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background and Objectives: Locacorten Vioform (Novartis UK) is frequently prescribed for otomycosis. Its component, Clioquinol, also has anti-bacterial properties. Up to this point, its ototoxic potential has not been evaluated. Our objective aims to evaluate Locacorten Vioform's potential ototoxicity when applied directly to the middle ear cavity., Materials and Methods: We performed an experimental prospective animal study in our animal research center with 20 Hartley guinea pigs divided into 2 groups. The first group (experimental) was treated with Locacorten Vioform in one ear and with a physiologic saline solution in the other. The second group (positive control) was treated with concentrated gentamycin in one ear and physiologic saline in the other. Auditory brainstem response measurements were obtained before and after three sets of injections. Statistics were analyzed using a variance analysis with repeated measures. The histological state of cochlear outer hair cells was compared between the two groups using scanning electron microscopy., Results: Average hearing loss in ears treated with Locacorten Vioform was 32.1 dB, compared with a 2.5 dB average loss in the saline-treated ears. Ears treated with gentamycin lost an average of 33.0 dB. There were clinically and statistically significant differences between the two ears of the guinea pigs in both groups ( p <0.001). Scanning electron microscopy revealed severe pericochlear and cochlear inflammation and ossification in the Locacorten Vioform-treated ears. Gentamycin caused significant destruction of outer hair cell architecture., Conclusions: Locacorten Vioform induces a hearing loss similar to that caused by gentamycin when applied directly to the middle ear of a guinea pig model. Electron microscopy indicates a pericochlear and cochlear inflammatory reaction with ossification.

Objective: To develop a three-dimensional study tool of the membranous labyrinth in order to study the pathophysiology, diagnostic workup and treatment of benign paroxysmal positional vertigo (BPPV). BPPV is the most common cause of peripheral vertigo. Its diagnosis and treatment depend on an understanding of the anatomy of the vestibular labyrinth and its position relative to the head. To date, many illustrations have been made to explain principals of diagnosis and treatment of BPPV, but few have been based on anatomical studies of the membranous labyrinth., Methods: A cadaveric human membranous labyrinth was axially sectioned at 20 μm resolution, stained and segmented to create a high-resolution digital model. The model was cloned to create an enantiomeric pair of labyrinths. These were associated a 3D model of a human skull, segmented from MRI data, and were oriented according to established anatomic norms. Canal markers representing otoliths were created to mark canalith position during movement of the model within the 3D environment., Results: The model allows visualization of true membranous labyrinth anatomy in both ears simultaneously. The dependent portion of each semicircular duct and of the utricle can easily be visualized in any head position. Moveable markers can mark the expected progress of otolith debris with changes in head position and images can be captured to document simulations. The model can be used to simulate pathology as well as diagnostic maneuvers and treatment procedures used for BPPV. The model has great potential as a teaching tool., Conclusion: A simple model based on human anatomy has been created to allow careful study of BPPV pathophysiology and treatment. Going forward, this tool could offer insights that may lead to more accurate diagnosis and treatment of BPPV.

Nystatin is a topical antifungal agent. Its wide spectrum of action and low cost make it a treatment of choice. Though it is safe for external ear use, no study has proven its safety in cases of tympanic membrane perforation (TMP). We aim to test the safety of Nystatin when applied directly to the middle ear of a Guinea Pig model. We performed an experimental study with 18 Hartley Guinea Pigs that were divided into two groups. All tympanic membranes were perforated at the beginning of the study. Exposing one group to Nystatin and the other to the ototoxic Neomycin, we compared results of auditory brainstem response testing at three intervals. Each animals' contralateral ear was used as a negative control. At the end, we performed a histological analysis of the animals' cochleae using a scanning electron microscope (SEM). Average hearing loss in the Nystatin group was 13.0 dB which was similar to the results obtained in the negative control group (13.1 dB). Average hearing loss in the Neomycin group was 39.3 dB, which represents a statistically significant difference (P < 0.001). SEM evaluation revealed intact cochlear hair cell architecture in the Nystatin and normal saline groups, whereas significant hair cell losses were noted in the Neomycin group was noted. Nystatin does not cause hearing impairment or cochlear hair cell damage when exposed directly to the middle ear of a Guinea Pig model. It is therefore a safe treatment option for otomycosis with presence of TMP.

In an investigation of 4-amino-3,4-dihydronaphthalen-1(2H)-ones as novel modulators of allergic and inflammatory phenomena, we have investigated a series of cyclic analogues. Tertiary amines of structural types 9, 10, 20 and 21 were synthesised and evaluated for mast cell stabilising activity. In vitro and in vivo studies showed that of these compounds, the cyclohexenylamino derivatives of tetralone and benzosuberone of series 20 and 21 exhibited interesting activity both in vitro and in vivo.

In a continuation of our studies into indan and tetralin systems as novel modulators of allergic and inflammatory phenomena, we have extended our work to include dimers linked via C-C bonds. Of these compounds, 2-Benzyl-2-[2-phenyl-1-ethenyl]-1,2,3,4-tetrahydro-1-naphthalenol 12 exhibited most promising activity both in vitro and in vivo., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objective: To perform a literature review of intra-parotid neurofibromas. These tumours present a challenge because of their risk of malignant transformation and their high probability of operative facial nerve compromise., Design: A description of one case of intraparotid neurofibroma. A systematic MEDLINE review was performed to document all reported cases., Setting: Pediatric tertiary care centre., Methods: An 14-month-old boy was referred with a nontender right-sided 4 × 2.5 cm preauricular mass, which was slowly increasing in size for 8 months. No facial nerve compromise was present., Main Outcome Measures: During superficial parotidectomy, the mass was found to involve the facial nerve and complete resection was performed, on which a cerebrospinal fluid (CSF) leak originating from the stylomastoid foramen occurred. Mastoidectomy revealed an intramastoid division of the facial nerve. The leak coming from the facial nerve was successfully controlled with anastomosis of the major division with the distal nerves., Results: Histopathologic analysis revealed a diffuse neurofibroma. Twenty-two previous cases of intraparotid neurofibroma have been described, although this is the first reported case of the diffuse subtype. Preoperative fine-needle aspiration was inconclusive, and incisional biopsy was dangerous., Conclusion: It seems prudent to delay surgery for asymptomatic pediatric patients with facial neurofibroma. Surgery with primary facial nerve grafting is an effective option for patients with facial function of grade III or worse or when the tumour is large, disfiguring, and aggressive. Potential complications of treatment vary depending on the location of the tumour. These include disease recurrence, facial nerve compromise, and CSF leak.

Objectives: Hyaluronic acid fat graft myringoplasty (HAFGM) is a new technique for tympanic membrane perforation (TMP) treatment. It is simple, inexpensive, and performed under local anesthesia at the outpatient office department. We aim to evaluate the HAFGM on different TMP sizes, to compare the success rate of HAFGM with the underlay and overlay techniques, and to assess the hearing improvement at one year postoperatively., Study Design: Prospective study., Methods: Patients were divided into three groups depending on the patient's choice of technique: HAFGM (group I), underlay technique (group II), and overlay technique (group III). Perforations were classified into four grades. Postoperatively, the status of the eardrum, the improvement of hearing, and the incidence of complications were the main criteria for measuring outcome., Results: Distribution of TMP was 131, 63, and 52 in group I, II, and III, respectively. Global successful rate and successful closure of the grade I, II, III, and IV were the same for the three groups. Postoperatively, no worsening of bone conduction threshold was noted. Air-bone gap (ABG) was statistically similar for the three groups. No complications were noted for group I. The mean duration of the operative procedures was 16, 65, and 74 minutes for group I, II, and III, respectively (P = .02). The mean postoperative follow-up was 18.7, 20.6, and 15.5 months for groups I, II, and III, respectively., Conclusions: HAFGM success rate is comparable to that of the underlay and overlay techniques. Furthermore, it requires no hospitalization and avoids the difficulty of overlay and underlay tympanoplasty., (Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.)

Objective: To evaluate audiometric and clinical results of children fitted with a bone-anchored hearing aid with specific emphasis on speech discrimination in different sound environments after one year of use., Methods: We performed a prospective longitudinal study. Seventeen patients between the ages of 5 and 18 years old were included. All patients underwent a complete tonal and vocal evaluation at four pre-determined intervals between the pre-operative period and one-year of bone-anchored hearing aid (BAHA) use. Basic pure-tone average and speech reception threshold were measured in different sound environments. Speech discrimination improvement was tested with the voice originating from the side of the BAHA-fitted ear and with the voice originating from a source directly in front of the patient. These measures were repeated with confounding noise facing the patient then from the side of the affected ear. All tonal and vocal evaluations were performed pre-operatively, the day of processor insertion, 6 months and 12 months after processor insertion. A variance analysis was performed to compare differences in hearing gain with BAHA over time., Results: Hearing gain with BAHA was clinically and statistically significant at all intervals. Conventional tonal evaluation revealed significantly improved hearing gain after BAHA insertion compared with pre-operative testing with BAHA (26.3 dB vs. 17.3 dB), and this improvement was maintained at one year (27.9 dB). Speech discrimination gain at one year was better than immediately post-insertion (21.9% vs. 11.7%). Maximal gain with BAHA was found with the voice originating from the side of the affected ear and with confounding noise facing the patient (27.1% at one year), whereas the least gain was found in a silent room with the voice coming from straight ahead (11.9% at one year)., Conclusions: Pure-tone average gain at one year post-insertion was similar to immediate post-insertion gain. BAHA aids speech discrimination most when the voice originates from the side of the affected ear with confounding noise facing the patient. Speech discrimination gain improves with time, suggesting an underlying learning process. The best BAHA gain in speech discrimination occurred with background noise., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

Objectives: The main purpose of this study is to compare audiological outcomes of incus reconstruction, Xomed Medtronic universal titanium partial ossicular replacement prosthesis (PORP) and total ossicular replacement prosthesis (TORP). We also compared results based on surgical technique, history of previous surgery, form of the prosthesis head, pathology and frequency., Methods: A chart review was performed and included reconstructions performed between June 2003 and December 2006. Results were based on air-bone gap and pure tone average., Results: Postoperative mean air-bone gap and mean pure tone average are significantly lower using incus reconstruction compared with the titanium prosthesis groups. PORP and TORP groups yielded similar outcomes. Closure of ABG is similar in all three groups. Postoperative results were better using an intact canal wall mastoidectomy compared with a canal wall down technique, but ABG closure was similar in both groups. Primary surgeries gave better results than revisions of reconstructions performed by the senior author or elsewhere., Conclusion: Though Xomed Medtronic titanium prostheses are effective in ossicular reconstruction, incus reconstruction is at least as effective when feasible. Canal wall down mastoidectomy should be reserved for cases where preservation of the canal wall is contraindicated. Previous same ear surgery is a poor prognostic factor for successful outcome. Preliminary results indicate that round head PORPs may be superior to their oval head counterparts.