Cerumen Impaction Removal in General Practices: A Comparison of Approved Standard Products.

BACKGROUND: Ear irrigation is a commonly used method for removing earwax in general practice. There is no firm evidence if no pre-treatment is as good as pre-treatment with various standard preparations. AIM: To assess the effectiveness of no pre-treatment compared to pre-treatment with commercially available cerumenolytics and to assess which preparation is best suited for pre-treatment. METHODS: This is a pragmatic observational study of patients with cerumen treated from a single GP with 3 different preparations or no preparation prior to standardized ear irrigation. Generalized linear mixed models with logit link function were performed to assess the effectiveness of pre-treatment with different preparations and no pre-treatment. The models were adjusted for age group (<70, ≥70) and sex. RESULTS: A total of 168 patients (298 ears, 58 % female, median age 65 years) consulted for obstructive cerumen, some of them several times. The cerumen was successfully removed in 70% (208/298). Comparing any preparation to no preparation (aggregated comparison), the odds ratio for complete clearance was 1.35 (95%confidence interval: 0.69-2.65). Comparing the preparations individually, the odds ratio of the docusate-sodium-based preparation was 1.87 (95% CI: 0.79-4.42) indicating a higher effectiveness. Although, not statistically significant. Ear irrigation was less successful for patients aged ≥ 70 years (OR = 0.48, 95% CI: 0.23-0.98). CONCLUSIONS: The aggregated comparison indicates a slight trend toward a higher effectiveness of any pre-treatment compared to no pre-treatment. The effect-size of docusate-sodium-based pre-treatment indicates a higher effectiveness of cerumen impaction removal. Nevertheless, superiority could not be shown conclusively according to the statistical significance given the restricted sample size.

Evaluation of patient satisfaction after therapy of unilateral clefts of lip, alveolus and palate.

INTRODUCTION: Cleft lip, alveolus and palate (CLAP) is a craniofacial abnormality and is one of the most frequent human developmental anomalies. Therapy of clefts does not only comprise surgical closure of the cleft, but rather aims at an aesthetically and functionally optimal result at adult age. MATERIAL AND METHODS: Thirty-three cleft patients with total clefts of lip, alveolus and palate were enrolled in this study. Osseous bridging of the alveolar cleft (osteoplasty) was performed in all patients followed by different types of subsequent treatment. All patients answered a questionnaire to assess their satisfaction with the treatment result and their facial appearance. Patient satisfaction was correlated to the type of alveolar cleft repair. RESULTS: The returned questionnaires revealed varying patient satisfaction with their appearance, occlusal conditions, and dental aesthetics depending on the type of dental treatment in the alveolar cleft area. Questionnaire analysis by gender revealed clear gender-dependent differences in self-rated satisfaction. CONCLUSION: Aesthetics gain increasing importance for self-perception. Therefore, patient satisfaction with her facial appearance should move even more into focus of therapy of clefts.

[Oversized patient arms: a problem with blood pressure measurements]. / Patientenarm in Ubergrösse: Ein Problemfall bei der Blutdruckmessung.

The increase in the worldwide prevalence of obesity systematically leads to a higher number of individuals who may be wrongly diagnosed as hypertensive because their arms are too large for standard blood pressure cuffs, which are ordinarily appropriate in patients with normal sized arms. The aim was to gain real data of upper arm and wrist circumferences in 327 elected subjects with larger arms (upper arm circumference >32.5 cm) from two Bavarian general practices. We found that 93.9% of all patients had an upper arm circumference of a maximum of 41.0 cm and a wrist circumference of at most 20.5 cm. These data were then compared with the approved size ranges of six wrist blood pressure measurement devices, one special three-in-one cuff for different sizes and the two large adult cuffs recommended by the German Hypertension Society. Availability of one large cuff and one wrist blood measurement device (either used at the upper arm or at the wrist depending on patient dimensions) seems to be sufficient. This should allow for true blood pressure readings to be obtained in at least 96% of all patients with arms of more than normal circumference.

[Oversized patient arms: a problem with blood pressure measurements in the ENT-practice]. / Problemfälle bei der Blutdruckmessung in der HNO-Praxis: Patienten mit zu dickem Arm.

The increase in the worldwide prevalence of obesity systematically leads to a higher number of individuals who may be wrongly diagnosed as hypertensive because their arms are too large for standard blood pressure cuffs, which are ordinarily appropriate in patients with normal sized arms. We found however, that 97,8% of patients with an oversized upper arm had a normal sized wrist, appropriate to the most wrist blood measurement devices. The availability of a wrist blood measurement device seems therefore a good recommendation for every practice, to grant correct blood pressure readings also in patients with oversized arms. Blood pressure measurement, large arm circumference, wrist blood measurement devices.