Patient Use of Low-cost Digital Videoscopes and Smartphones for Remote Ear and Oropharyngeal Examinations.

Importance: During the novel coronavirus disease 2019 pandemic, telehealth has become a vital component of health care delivery. For otolaryngology evaluations, examination of the ear and oropharynx is important but difficult to achieve remotely. Objective: To assess the feasibility of patient use of low-cost digital videoscopes and smartphones for examination of the ear and oropharynx. Design, Setting, and Participants: A prospective quality improvement study was conducted in an academic adult otolaryngology clinic including 23 patients who presented for an in-person appointment and owned a smartphone device. The study was conducted from July 1 to 15, 2020. Interventions: Participants were asked to capture pictures and videos of their ear canals and oropharynx with digital videoscopes and their smartphones under real-time guidance over a telehealth platform. They were then surveyed about their experience. Main Outcomes and Measures: The primary outcomes were ratings by health care clinicians and a blinded otolaryngologist reviewer of image acceptability. Secondary outcomes included participant time to image acquisition and willingness to purchase digital videoscopes for telehealth use. Results: Of the 23 participants included, 14 were women (61%); mean age was 50 years (range, 21 to 80 years). Of the images obtained using the digital otoscope ear examination, 95% were considered acceptable by the health care clinicians and 91% were considered acceptable by the blinded reviewer; 16 participants (70%) reported that the otoscope was easy to use. The mean time to acquire images for both ears was 114 seconds (95% CI, 84-145 seconds). Twenty-one participants (91%) were willing to pay for a digital otoscope for telehealth use. For the oropharyngeal examination, a greater proportion of smartphone video examinations were considered acceptable by clinicians (63% acceptability) and the blinded reviewer (55%) compared with the digital endoscope (clinicians, 40%; blinded reviewer, 14%). The mean time required for the oropharyngeal examination smartphone video capture was shorter at 35 seconds compared with both the digital endoscope (difference, -27 seconds; 95% CI, -7 to -47 seconds) and smartphone photo capture (difference, -53 seconds; 95% CI, -20 to -87 seconds). Conclusions and Relevance: Digital otoscopes and smartphones apparently can facilitate remote head and neck physical examination in telehealth. Digital otoscopes were useful for ear examinations, and smartphone videos appeared to be the most useful for oropharyngeal examinations. Further studies are required to determine specific diagnostic capabilities in various telehealth practice settings.

External auditory exostoses and early Neolithic aquatic resource procurement in Cyprus: Results from Cypro-PPNB Kissonerga-Mylouthkia in regional context.

OBJECTIVE: This research is designed to evaluate the occurrence of external auditory exostoses (EAEs) in skeletal remains from the oldest known water wells in the world (Kissonerga-Mylouthkia, Cyprus, 8,200-7,200 BCE). MATERIALS: Six individuals (MNI = 6), five fragmentary temporalia, two preserved auditory canals. METHODS: Macroscopic and microscopic (up to x30) observation, with illumination; presence, type, side, severity, occlusion, number, and position of bony growths recorded. RESULTS: Bony growths within two auditory canals were discovered. Differential diagnosis includes osteomata and external auditory exostoses, with the latter consistent with the bony growths (Grade 1 EAEs, two adult males, one with single, another with two EAEs). CONCLUSIONS: The emergence of the Neolithic in Southwest Asia is thought to involve increases in dietary breadth among foraging societies (Broad-Spectrum Revolution). EAEs likely indicate maritime activity in this context, given the lack of freshwater bodies, and zooarchaeological evidence points to dietary and other uses of maritime organisms. SIGNIFICANCE: This EAE evidence is the oldest known in maritime contexts in Eastern Mediterranean and the Middle East, and first in Cyprus. It contributes towards understanding the initial colonization events by Neolithic farming communities in the 9th millennium BC, and the emergence of broad-spectrum economies at the dawn of the Neolithic in Southwest Asia, crucial for re-considerations of paradigms on the transition to the Neolithic way of life in the Near East. LIMITATIONS: Only a few skeletal remains from these prehistoric contexts were available for observation. SUGGESTIONS FOR FURTHER RESEARCH: Further intensive review of Cypriot skeletal collections for EAEs is advised.

MRI assessment of internal acoustic canal variations using 3D-FIESTA sequences.

Magnetic resonance imaging (MRI) of the internal acoustic canal is the standard diagnostic tool for a wide range of indications in patients. This study aims to investigate the vascular variations and compression of the cranial nerves (CNs) VII and VIII at the cerebellopontine angle in patients with neuro-otologic symptoms using 3D-fast imaging employing steady-state acquisition (FIESTA) MR imaging. One hundred and eighty-seven patients (374 temporal bones) were examined on a 1.5-T MRI. In addition to conventional MR sequences, a 3D-FIESTA MR imaging was acquired. Magnetic resonance images thus obtained were evaluated with special regard to the presence of vascular contact to the CNs VII and VIII, as well as the presence of the vascular variations of the anterior inferior cerebellar artery (AICA) causing the compression of CNs. The Chi-squared test was used for statistical analysis. No statistically significant differences were found between the presence and absence of the AICA loop and/or vascular contact for the clinical symptoms of patients (P > 0.05). The cisternal and canalicular segments of CNs VII and VIII and adjacent vascular variations are well identified using 3D-FIESTA, especially by determining the relationship of the AICA variations between CNs.

Magnitude of impacted earwax in Oman, its impact on hearing impairment and economic burden of earwax on health services.

BACKGROUND: Wax in ear canal causes a sizeable burden on resources of health services to a country. AIM: The magnitude of impacted wax, its effect in a survey and cost of managing this problem were reviewed in 2002. SETTINGS AND DESIGNS: A study was conducted during 1996 to estimate the magnitude and causes of hearing impairment and ear diseases in Oman. The authors further reviewed the data of community-based prevalence study to assess the role of impacted wax. MATERIALS AND METHODS: Trained physicians used portable audiometers to test the hearing status of each ear. They used otoscopes to examine the ear. Persons suspected to have hearing impairment or ear disease were reexamined by audiologists and otologists to determine the causes of hearing impairment. The resources for managing impacted wax were also calculated. RESULTS: In this survey, 11,402 subjects of all ages were examined. Prevalence of impacted wax was 11.7% (CI 95% 11.1-12.2). Impacted wax was significantly higher in females compared to males [RR = 1.22 (CI 95% 1.10-1.35)]. It was more common in residents of regions with humid environment than those of regions with less humidity [RR = 1.91 (CI 95% 1.67-2.18)]. Impacted wax in ear canal was associated with ear diseases. A total of 181,000 Omani people were estimated to have impacted wax in the ear canal. Managing impacted wax could cost 3.6 million US dollars to the ear care services. CONCLUSIONS: Impacted wax was a hindrance in the hearing survey and countries should plan to deal with earwax in such surveys. Its impact on hearing impairment and resource burden should be considered while formulating policies for ear care.

Assessment of visualization of structures in the middle ear via Tos modified canal wall-up mastoidectomy versus classic canal wall-up and canal wall-down mastoidectomies.

OBJECTIVE: The aim of this prospective study is to evaluate the differences in the ability to view structures in the middle ear between Tos modified canal wall-up mastoidectomy and classic canal wall-up (CWU) and canal wall-down (CWD) mastoidectomies. METHODS: Eighteen temporal bones of 10 cadaver heads were used. Six bones were randomly selected for each surgical technique (Tos' technique, CWU and CWD mastoidectomies) and fixed on an operating table. In the Tos' technique: (1) transmeatal posterior tympanotomy with drilling of the supero-posterior bony annulus, (2) transmeatal atticotomy with preservation of the bony bridge and (3) cortical mastoidectomy were performed. In the classic CWU mastoidectomy, cortical mastoidectomy and posterior atticotympanotomy (facial recess approach) were performed. Incus and posterior half of the tympanic membrane were removed from all temporal bones. An independent specialist performing otologic surgery evaluated all of the temporal bones and approved the proper extent of dissections. Two another independent observers blinded to the purpose of the study were asked to point five anatomic structures and locations (sinus tympani, anterior attic, posterior crus, lateral attic and the Eustachian tube orifice) in two different sessions. Observers were allowed to rotate the operating table as it has been done during otologic surgery, and the line of view for the observers was both transmastoid and transcanal. The ability to view these structures was recorded as "correct/visible" or "incorrect/invisible". These records were also verified after removing the posterior and superior walls of the outer ear canal in temporal bones of the Tos and CWU groups at the end of the study. RESULTS: Significant differences were found in the ability to view middle ear structures between the Tos' technique and CWU mastoidectomy as well as between CWU and CWD mastoidectomies, with the Tos' and CWD techniques almost equally showing superiority to CWU (p<.0001). Of the five locations, sinus tympani and anterior attic were observed more frequently with the Tos' technique versus CWU (p=.001). Sinus tympani (p<.005), anterior attic (p=.001) and posterior crus (p<.05) were observed more frequently with CWD versus CWU. There was no significant difference in the ability to observe lateral attic and the Eustachian tube orifice among the three techniques. In addition, there was no significant difference in the ability to visualize all the five locations between the Tos' and CWD technique. CONCLUSIONS: Statistical analysis showed good reproducibility of this randomised, blinded study. Tos' modified CWU mastoidectomy, in which most part of the canal wall is intact, showed similar advantage of the CWD in viewing structures in the middle ear. The Tos' technique and CWD mastoidectomy provided better visualization of sinus tympani and anterior attic that are the most frequent places of residual cholesteatoma in the classic CWU mastoidectomy.

Canal atresia: "surgery or implantable hearing devices? The expert's question is revisited".

OBJECTIVES: (1) Evaluate hearing results in patients managed with external auditory canal reconstruction; (2) compare results to the expectations from treatment with surgical; placement of an osteo-integrated bone-conduction device (BAHA system); (3) assess complications of both interventions; (4) evaluate the medical cost-effectiveness of each avenue of management at 2005 rates for billings based upon relative value units (RVUs). METHODS: (1) Retrospective chart review for 36 ears in 29 pediatric patients who underwent surgical canal reconstruction at a tertiary-care pediatric hospital in a major urban center with assessment of management techniques and surgical and audiologic outcomes. (2) Retrospective chart review of six pediatric patients who underwent BAHA placement in a major urban center with assessment of management techniques and surgical and audiologic outcomes. (3) Cost reassessment at 2005 billings rates based upon RVUs for canal reconstruction versus BAHA system and comparative analysis. RESULTS: (1) The average post-operative hearing loss in the right ear was 34.3 dB left ear was 31.6 dB. The average gain per ear was 17.3 dB. (2) Twenty-seven (93%) of EAC reconstruction patients required some form of amplification post-operatively. (3) Data available for three of the BAHA patients reflected the predicted average gain in dB (predicted 34.3 dB, observed 31.8 dB). (4) Early complications of canal reconstruction included removal of the packing by the patient, post-operative bleeding and post-operative hematoma. (5) Late complications included recurrent canal stenosis, recurrent otitis externa, canal prolapse and canal cholesteatoma. (6) Uncomplicated external auditory canal reconstruction cost $51,505.98 or $2909.94/dB of hearing gain based upon billings fro RVUs. (7) Uncomplicated two-staged BAHA system placement cost $42,448.85 or $1237.57/dB of hearing gain based upon billings for RVUs. (8) Uncomplicated single-staged BAHA system placement cost $28,341.00 or $826.27/dB of hearing gain based upon billings for RVUs. CONCLUSIONS: Study results indicate that even with significant investments in EAC reconstruction, most patients still required some form of amplification. There are also significant risks of early and late complications from the reconstructive procedure. Studies indicate and our results support that the osteo-integrated bone-conduction device (BAHA system) can achieve truly acceptable hearing (

Pass/fail rates for repeated click-evoked otoacoustic emission and auditory brain stem response screenings in newborns.

The click-evoked otoacoustic emission (EOAE) recording procedure is a simple and quick test to perform. Some suggest that the EOAE is a more efficient newborn hearing screening procedure than the auditory brain stem response (ABR). However, one shortcoming of the EOAE is a high false-positive rate in newborns, which is attributed to ear-canal debris. The purposes of this study were to assess the initial pass/fail rates of ABR and EOAE measurements and the effectiveness of repeated EOAE measurements as a method of reducing the false-positive rate. Fifty healthy, low-risk newborns sequentially underwent ABR, repeated EOAE, otoscopy, EOAE, and ABR if necessary. The initial ABR passing rate was 98%, whereas the EOAE passing rate was 61%. The EOAE passing rate improved with each retest and approximated the ABR rate by the fourth test. EOAE failures and the overall level of the EOAE were found to be significantly related to the amount of ear-canal debris. These results indicate that some newborns will require four or more tests before they eventually pass. Further study is needed to determine the overall cost-effectiveness of the EOAE as compared with the ABR before specific recommendations for a universal hearing screening program are proposed.