Effect of the coronavirus disease 2019 pandemic on paediatric bilateral myringotomy and tube insertion rates in New Brunswick, Canada.

OBJECTIVE: To assess the effect of the coronavirus disease 2019 pandemic on paediatric bilateral myringotomy and tube insertion rates in New Brunswick, Canada. METHODS: All paediatric bilateral myringotomy and tube insertion cases from 1 July 2015 through 30 June 2021 were provided by New Brunswick Medicare. The numbers of otolaryngologists, cataract surgical procedures, total hip arthroplasties and thyroidectomies were collected to assess the availability of operating theatres and otolaryngologists. Negative binomial logarithmic regressions were used for analyses. RESULTS: Of the 5175 paediatric bilateral myringotomy and tube insertion cases that were included, the bilateral myringotomy and tube insertion rate significantly decreased by 2.9 times (p < 0.001) during the pandemic. Thyroidectomies, cataract surgical procedures and total hip arthroplasties did not significantly decrease. The number of otolaryngologists increased (20 vs 16-17). CONCLUSION: Paediatric bilateral myringotomy and tube insertion rates significantly decreased during the pandemic. This cannot be accounted for by reduced otolaryngologists or operating theatre availability. The paediatric bilateral myringotomy and tube insertion rate decrease is likely due to public health measures reducing the transmission of upper respiratory tract infections, resulting in fewer indications for paediatric bilateral myringotomy and tube insertion.

Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis.

BACKGROUND: Recent evidence suggests that biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of chronic rhinosinusitis with nasal polyposis (CRSwNP). There remains a population in CRSwNP that despite medical therapy and endoscopic sinus surgery have persistent signs and symptoms of disease. Therefore, biologics, monoclonal antibody agents, could be beneficial therapeutic treatments for these patients. There have been eight randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL-5R, IL-33, and immunoglobulin (Ig)E. However, there are no formal recommendations for the optimal use of biologics in managing Chronic Rhinosinusitis (CRS) within the Canadian health care environment. METHODS: A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. 17 fellowship trained rhinologists across Canada evaluated the 28 original statements on a scale of 1-10 and provided comments. A rating within 1-3 indicated disagreement, 8-10 demonstrated agreement and 4-7 represented being neutral towards a statement. All ratings were quantitively reviewed by mean, median, mode, range and standard deviation. Consensus was defined by removing the highest and lowest of the scores and using the "3 point relaxed system". RESULTS: After three rounds, a total of 11 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with CRS. CONCLUSION: This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of patients with CRS, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years.

[Clinical evaluation of aggressive nutritional care to head and neck cancer patients during radiation therapy].

Anorexia, dysphagia, and dysgeusia are the most prevalent symptoms in head and neck cancer patients during radiation therapy. The patients, who were in poor general condition, suffered marked loss of body weight and consequently were unable to tolerate further anti-cancer treatments. Aggressive nutritional support to the head and neck cancer patients was started in April, 1986 to improve the general condition of these patients in our hospital. The physiological condition of 152 patients who underwent nutritional support were evaluated as a study group (Group I) between August 1986 and May 1987. Group II, 165 patients without nutritional care were evaluated as a control group between August 1985 and May 1986. In Group I, oral supplementary diets or enteral feedings were provided as nutritional support to all of the anorectic patients. Anthropometric measurement and laboratory data were collected in both groups at the several time points. An average of 1.1 kilogram (Kg) and 3.5Kg body weight loss was observed in Group I and Group II, respectively (P less than 0.005). In patients diagnosed with nasopharyngeal carcinoma, the average duration of radiation treatment was 11 days shorter in Group I than that in Group II (42 vs 53 days). In conclusion, aggressive nutritional care performed by a group of clinical staff, which included doctors (radiation oncologist), dietitians and oncologic nurses, was sufficient to improve the general condition of the head and neck cancer patients during radiation therapy and to therefore increase the recovery rate of these patients after radiation treatments.(ABSTRACT TRUNCATED AT 250 WORDS)