An international study to develop the EAR-Q patient-reported outcome measure for children and young adults with ear conditions.

BACKGROUND: There is currently a lack of patient-reported outcome measures for ear reconstruction. We developed the EAR-Q to measure ear appearance and post-operative adverse effects from the patient perspective. METHODS: Field-test data were collected from children and young adults in eight countries between 13 May 2016 and 12 December 2019. Rasch measurement theory (RMT) analysis was used to refine the scales and to examine their psychometric properties. RESULTS: Participants had microtia (n = 607), prominent ears (n = 145) or another ear condition (n = 111), and provided 960 assessments for the Appearance scale (e.g., size, shape, photos), and 137 assessments for the Adverse Effects scale (e.g., itchy, painful, numb). RMT analysis led to the reduction of each scale to 10-items. Data fit the Rasch model for the Appearance (X2(80) = 90.9, p = 0.19) and Adverse Effects (X2(20) = 24.5, p = 0.22) scales. All items in each scale had ordered thresholds and good item fit. There was no evidence of differential item function for the Appearance scale by age, gender, language, or type of ear condition. Reliability was high for the Appearance scale, with person separation index (PSI) and Cronbach alpha values with and without extremes ≥0.92. Reliability for the Adverse Effects scale was adequate (i.e., PSI and Cronbach alpha values ≥0.71). Higher scores (liked appearance more) correlated with higher scores (better) on Psychological, Social and School scales. INTERPRETATION: The EAR-Q can be used in those 8-29 years of age to understand the patient perspective in clinical practice and research, and in addition, can be used to benchmark outcomes for ear reconstruction internationally.

Efficacy of balloon Eustachian tuboplasty on the quality of life in children with Eustachian tube dysfunction.

Background: Balloon Eustachian Tuboplasty (BET) is used as a second-line treatment in cases in which adenoidectomy, paracentesis, and VT have failed. However, studies have not investigated the efficacy of this procedure as a first-line treatment.Objectives: To evaluate the quality of life in children with chronic Eustachian tube dysfunction (ETD) after BET using the Otitis Media-6 (OM-6) questionnaire.Methods: We retrospectively evaluated the data of 62 children with chronic dysfunction ETD and divided patients into the following groups: 30 cases underwent BET (group 1), and 32 cases underwent ventilation tube (VT) insertion from July 2016 to April 2018. The children's parents were instructed to complete the OM-6 questionnaire preoperatively and at 6 weeks and 1 year postoperatively.Results:. The average preoperative scores were higher than the postoperative scores, and the average 6-week postoperative scores were higher than the average 1-year postoperative scores for both groups 1 and 2. Further, the average 6-week postoperative scores from patients in group 2 were significantly higher than those in group 1.Conclusion and significance: Our results demonstrate that BET may be a safe, first-line intervention that positively effects the quality of life in children with chronic ETD.

Surfers' awareness of the preventability of 'surfer's ear' and use of water precautions.

OBJECTIVE: To establish surfers' knowledge of the preventability of external auditory canal exostoses ('surfer's ear'), and their use of water precautions. METHOD: Survey of surfers conducted between December 2009 and March 2010 at beaches in Cornwall, UK. RESULTS: Ninety-two surfers were included (78 males and 14 females, mean age 27 years, standard deviation 7.9 years). Participants were grouped according to their awareness of the preventability of surfer's ear (55 aware, 37 unaware). These groups were comparable in age, surfing history and gender mix (p > 0.05). Surfers aware of the preventability of exostoses (66 per cent) were more likely to use water precautions than those who were not (38 per cent) (p < 0.01). Two surfers used water precautions regularly and 48 used them occasionally. Sixty-one of the 76 surfers who did not use water precautions (ear plugs) suggested they would consider doing so in the future. CONCLUSION: Awareness of the preventability of surfer's ear was associated with greater use of water precautions. Further research should explore reasons for the low uptake of such precautions. Most surfers not already using ear plugs would consider doing so in the future.

[Development and evaluation of a quality of life scale specific to patients with congenital external and middle ear malformation].

OBJECTIVE: To develop a quality of life scale for patients with congenital external and middle ear malformation, and to explore its reliability and validity. METHODS: The initial quality of life scale for patients with congenital external and middle ear malformation was constructed based on quality of life scales from home and abroad. A total of 140 patients with congenital external and middle ear malformation had been recruited in the study. After pretest and item sifting, the quality of life scale was constructed, and its reliability and validity were evaluated. RESULTS: Eighteen-item quality of life scale for patients with congenital external and middle ear malformation was constructed, which included three parts: physiological function, psychological status and social interaction. The retest reliability was 0.878; split-half reliability coefficient and Cronbach's alpha coefficient were 0.927 and 0.899, respectively. The results of factor analysis showed satisfactory construct validity. The reliability and validity of this scale was consistent with the demands of psychometrics. CONCLUSION: Congenital external and middle ear malformation quality of life scale is believable and effective, which can be used for clinical practice.

A comparative study of patient satisfaction with day case and in-patient major ear surgery.

INTRODUCTION: Major ear surgery can be safely performed on a day case basis (i.e. six hour stay). This study aimed to ascertain whether patients had the same level of satisfaction and speed of recovery following major ear surgery when it was performed as a day case compared with performance as an in-patient procedure. METHOD: A cross-sectional survey, by postal questionnaire, of patient satisfaction with day case and in-patient major ear surgery was carried out with 158 patients. Comparisons were made between the responses of the two groups. RESULTS: The response rate was 71 per cent. Patients returned to work significantly sooner following day surgery (p < 0.025) but felt their operation to be of significantly more benefit following in-patient surgery (p < 0.05). CONCLUSIONS: Patient satisfaction following day case major ear surgery is as good as that following in-patient surgery. This has supported the expansion of this service in our unit.

Doenças fictícias em otorrinolaringologia / Factitious disorders in otolaryngology

Os autores estabelecem o conceito de doenças fictícias e comentam sua incidência na área otorrinolaringológica nas formas conscientes, nas psicóticas da síndrome de Münchausen e nas mistas. Criam características para o estabelecimento de um grupo de risco e representam dois casos típicos da doença. Concluem que as doenças fictícias podem ser mais freqüentes do que se pensa, sendo necessário um alto índice de suspeiçäo para seu diagnóstico

Sintomas e sinais otoneurológicos na síndrome de pânico e na agorafobia / Otoneurological symptoms and signs in panic disorder and agoraphobia

Foram examinados 16 casos de Síndrome de Pânico e seis casos de Agorafobia com Crises de Pânico sob o ponto de vista otoneurológico. Foi observada grande incidência de sintomatologia auditiva (hipersensibilidade a sons intensos, tinnitus e hipoacusia) e vestibular (tonturas rotatórias e näo rotatórias náuseas). Ao exame audiológico nenhuma anormalidade auditiva foi encontrada. Ao exame vestibular, importantes alteraçöes pertinentes a pesquisa do nistagmo espontâneo, de posiçäo, per-rotatório e pós-calórico foram identificados, na maioria dos pacientes, em ambas as síndromes psiquiátricas. Esses achados justificam a indicaçäo sistemática do exame otoneurológico nessas síndrome psiquiátricas

Anxiety and endocrine changes in surgical patients.

There is a need for research to identify the relationship between psychological and endocrine responses to surgical operations, and to discover whether these responses differ with variations in practice between different settings. This preliminary study investigated 17 patients undergoing middle ear operations in two hospitals. Measurements included state anxiety, Recovery Inventory, cortisol excretion and noradrenaline excretion. All were made pre-operatively and on three post-operative days. Recovery Inventory correlated (between subjects) with state anxiety, but this relationship was confined to the post-operative days. No correlation between a psychological measure and an endocrine one reached significance. There was a non-significant tendency for pre-operative anxiety to be lower in one ward than another; cortisol levels were significantly higher in the same ward overall. These results do not support a view that anxiety is related to processes mediating physical recovery. Explanations for the difference in cortisol levels are considered. It is suggested that the influence of pre-operative psychological preparation on endocrine responses deserves systematic investigation.