Transdermal lidocaine as treatment for chronic subjective tinnitus: A pilot study.

OBJECTIVE: To assess the efficacy of transdermal lidocaine as a treatment for chronic subjective tinnitus as measured by the Tinnitus Functional Index (TFI). STUDY DESIGN: Pilot, prospective efficacy trial. SETTING: Tertiary care hospital. PATIENTS: Men and women, over the age of 18 with chronic subjective tinnitus for >6 months. INTERVENTION: Daily application of commercially available transdermal lidocaine patch. OUTCOME MEASURE: Change in the TFI. RESULTS: The average pre-treatment TFI score was 56.2. After 1 month the average TFI decreased to 41 (p < 0.05). The scores dropped to 34 and 35 after 2 and 3 months of treatment respectively. Despite improvement in symptoms of tinnitus, most patients did not continue the study after the first month, dropping out due to the size, discomfort, and appearance of the lidocaine patch, failure to follow-up and lack of perceived benefit from treatment. CONCLUSIONS: In this preliminary study, 5% transdermal lidocaine appears to be a potential treatment for chronic subjective tinnitus. The majority of subjects who completed 1 month of treatment had clinically significantly improved tinnitus. These findings are confounded however by the small sample size and significant drop out rate.

Dog bites of the head and neck: an evaluation of a common pediatric trauma and associated treatment.

PURPOSE: To identify which patients and canines are involved in dog bites of the head and neck, and how they impact health systems. MATERIALS AND METHODS: This is a single center, retrospective cohort study conducted from January 2012 to June 2013 in an academic, tertiary care center situated between multiple suburban and urban communities. Patients were identified by queried search for all bite-related diagnoses codes. RESULTS: 334 unique dog bites were identified, of which 101 involved the head and neck. The mean patient age was 15.1±18.1years. Of the more than 8 different breeds identified, one-third were caused by pit bull terriers and resulted in the highest rate of consultation (94%) and had 5 times the relative rate of surgical intervention. Unlike all other breeds, pit bull terriers were relatively more likely to attack an unknown individual (+31%), and without provocation (+48%). Injuries of the head and neck had an average follow-up of 1.26±2.4 visits, and average specialty follow-up of 3.1±3.5 visits. CONCLUSIONS: The patients most likely to suffer dog bite injuries of the head and neck are children. Although a number of dog breeds were identified, the largest group were pit bull terriers, whose resultant injuries were more severe and resulted from unprovoked, unknown dogs. More severe injuries required a greater number of interventions, a greater number of inpatient physicians, and more outpatient follow-up encounters. Healthcare utilization and costs associated with dog bites warrant further investigation.

A Multicenter, Cross-Sectional Assessment of Otolaryngology Knowledge Among Primary Care Trainees.

OBJECTIVES: (1) Identify knowledge deficits in this cohort regarding basic conditions treated by an otolaryngologist. (2) Determine the training needs of these physicians regarding the care of the head and neck patient. METHODS: This cross-sectional assessment used a 10-question, multiple-choice assessment administered to medical students and resident physicians at the University of California, Davis, University of California, San Francisco, and University of West Virginia in the departments of emergency medicine, family medicine, internal medicine, and otolaryngology. RESULTS: The otolaryngology cohort scored an average of 93%, while all others scored 56%. There was no statistical difference in the results between fourth-year medical students and non-otolaryngology residents of any year. Only 16% of the primary care providers and students assessed felt comfortable with these conditions, and 86% (321/372) of the respondents desired increased education on these topics. CONCLUSION: This study identified significant knowledge gaps among non-otolaryngologists in the diagnosis and treatment of basic head and neck conditions. As a specialty, a greater focus should be placed on improving the familiarity of our primary care colleagues on these conditions.

Cochlear implantation in single-sided deafness for enhancement of sound localization and speech perception.

PURPOSE OF REVIEW: To examine the current literature regarding application of cochlear implantation in patients with single-sided deafness for improvement in sound localization. RECENT FINDINGS: As familiarity of the technical and biological capabilities of cochlear implantation improves and criteria for use broaden, investigators have begun examining usage of cochlear implantation in patients with single-sided deafness as a viable solution in attempts to improve sound localization and speech perception. Although studies of such application are limited, from the available published literature, modest benefits have been described in both sound localization and speech perception. Patients consistently report improvement in quality of life after cochlear implantation for single-sided deafness. SUMMARY: Although single-sided deafness is not a currently approved indication for cochlear implantation, limited investigational studies to date have demonstrated patient improvement in both sound localization and speech perception.