ABSTRACT
Objectives: Middle ear barotrauma is a common complication of hyperbaric oxygen therapy (HBOT). Tympanostomy tube placement prevents barotrauma by facilitating middle ear equalization. We describe variations on techniques published by Mooney et al and Zhang et al for placing modified peripheral intravenous cannula (PIVC) ventilation tubes, which can be performed at the bedside under topical anesthesia. We aim to evaluate the safety and efficacy of this technique when performed to prevent otic barotrauma in patients undergoing HBOT. Methods: We performed an analytical observational study at a tertiary metropolitan Australian hospital with a state-wide adult hyperbaric service between 2018 and 2022. Patients were identified via unit audits. Patient, HBOT, and procedural factors were analyzed against complications using Fisher's exact test with Bonferroni correction and simple logistic regression. Results: Over 4 years, 112 patients (220 ears) underwent modified PIVC ventilation tube insertion. Mean age was 58.6 years (95% CI: 55.7-61.6, SD: 15.9). Thirty-eight patients (33.9%) were female, 74 (66.1%) were male. Thirty-four ears (15.5%) had preexisting barotrauma at the time of tympanostomy tube insertion. Patients underwent a mean of 11.5 dives (95% CI: 9.0-14.0, SD: 13.4), with ventilation tubes being required for a mean of 15.0 days (95% CI: 9.0-14.0, SD: 24.0) to complete HBOT. Fourteen ventilation tubes (6.4%) developed blockage during HBOT, and 12 (5.5%) prematurely extruded. Sixteen ears (7.3%) required reinsertion of ventilation tubes. Nine ears (4.1%) suffered barotrauma despite ventilation tube insertion. Conclusions: Otic barotrauma prophylaxis is paramount for safety during HBOT. We describe a safe, effective, and convenient technique for barotrauma prevention using modified PIVCs.
ABSTRACT
Objective: The aim of the study is to investigate improvements in lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH) treated with prostatic Aquablation. Materials and methods: We performed a literature search of clinical trials using the MEDLINE, Embase, and Cochrane Library databases and retrieved published works on Aquablation for the treatment of BPH up to August 2021. Unpublished works, case reports, conference proceedings, editorial comments, and letters were excluded. Risk of bias was assessed using the ROBINS-I tool. Raw means and mean differences were meta-analyzed to produce summary estimates for pre- versus post-International Prostate Symptom Scores, maximum flow rate, and male sexual health questionnaire value changes. An inverse-variance weighted random effects model was used. Results: Seven studies were included in this review (n = 551 patients) that evaluated various urological parameters. At 3 months, the International Prostate Symptom Scores raw mean difference from baseline was -16.475 (95% confidence interval [CI], -15.264 to -17.686; p < 0.001), with improvements sustained for 12 months. Similarly, maximum flow rate improved by +1.96 (95% CI, 10.015 to 11.878; p < 0.001) from pre to 3 months postoperatively. In addition, the male sexual health questionnaire change pooled effect size was -0.55 (95% CI, -1.621 to 0.531; p = 0.321) from preintervention to postintervention at 3 months. Meta-analyses of some outcomes showed large statistical heterogeneity or evidence of publication bias. Conclusions: Aquablation seems to improve lower urinary tract symptoms in men with BPH while providing relatively preserved sexual function. Further research is required to confirm these preliminary results.
ABSTRACT
INTRODUCTION: There exist a cohort of transmasculine patients who remain dissatisfied with vocal function following testosterone therapy and voice training. AIM: The objective of this case report was to describe the use of injection laryngoplasty in this cohort as an alternative to laryngeal framework surgery. METHOD: A case report and literature review was undertaken. RESULTS: Our case describes a 45-year-old transmasculine patient who remained unsatisfied with vocal pitch despite testosterone therapy and voice training. On initial presentation, the patient had fundamental frequency (fo) ranging from 70-344 Hz with a mean of approximately 135 Hz on reading, and 146 Hz in monologue. Injection augmentation of the vocal folds under local anesthesia with an injectable carboxymethylcellulose gel (prolaryn) was trialed. Following re-absorption of this, further injection was performed using autologous fat and subsequently a longer acting Calcium Hydroxyapatite injectable (Prolaryn Plus). This was followed by re-injection 1 year later. Patient satisfaction has been sustained throughout this period. Repeat acoustic evaluation in 2019 revealed a mean fo of 108 Hz on reading, 100 Hz in monologue, and a fo range of 85-134 Hz across these tasks. CONCLUSION: This case report presents an alternative surgical intervention to supplement testosterone and voice training in transmasculine patients unsatisfied with vocal function.