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OBJECTIVE: This study aimed to analyse social, health and environmental factors associated with the development of chronic otitis media by age nine. METHOD: This was a prospective, longitudinal, birth cohort study of 6560 children, reviewed at age nine. Chronic otitis media defined as previous surgical history or video-otoscopic changes of tympanic membrane retraction, perforation or cholesteatoma. Non-affected children were used as the control group. RESULTS: Univariate analysis demonstrated an association between chronic otitis media and otorrhoea, snoring, grommet insertion, adenoidectomy, tonsillectomy, hearing loss, abnormal tympanograms and preterm birth. Multivariate analysis suggests many of these factors may be interrelated. CONCLUSION: The association between chronic otitis media and otorrhoea, abnormal tympanograms and grommets supports the role of the Eustachian tube and otitis media (with effusion or acute) in the pathogenesis of chronic otitis media. The role of snoring, adenoidectomy and tonsillectomy is unclear. Associations suggested by previous studies (sex, socioeconomic group, parental smoking, maternal education, childcare, crowding and siblings) were not found to be significant predictors in this analysis.
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OBJECTIVE: Mastoidectomy is considered an aerosol-generating procedure. This study examined the effect of wearing personal protective equipment on the view achieved using the operating microscope. METHODS: ENT surgeons assessed the area of a calibrated target visible through an operating microscope whilst wearing a range of personal protective equipment, with prescription glasses when required. The distance between the surgeon's eye and the microscope was measured in each personal protective equipment condition. RESULTS: Eleven surgeons participated. The distance from the eye to the microscope inversely correlated with the diameter and area visible (p < 0.001). The median area visible while wearing the filtering facepiece code 3 mask and full-face visor was 4 per cent (range, 4-16 per cent). CONCLUSION: The full-face visor is incompatible with the operating microscope. Solutions offering adequate eye protection for aerosol-generating procedures that require the microscope, including mastoidectomy, are urgently needed. Low-profile safety goggles should have a working distance of less than 20 mm and be compatible with prescription lenses.
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Mastoidectomía/instrumentación , Microcirugia/instrumentación , Procedimientos Quirúrgicos Otorrinolaringológicos/instrumentación , Equipo de Protección Personal/efectos adversos , Aerosoles , Betacoronavirus/aislamiento & purificación , Líquidos Corporales/virología , COVID-19 , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Humanos , Control de Infecciones/métodos , Mastoidectomía/tendencias , Microscopía/instrumentación , Microcirugia/tendencias , Otorrinolaringólogos/estadística & datos numéricos , Procedimientos Quirúrgicos Otorrinolaringológicos/estadística & datos numéricos , Pandemias , Equipo de Protección Personal/normas , Equipo de Protección Personal/virología , Neumonía Viral/epidemiología , Neumonía Viral/virología , SARS-CoV-2 , Cirujanos/estadística & datos numéricosRESUMEN
OBJECTIVE: Visual communication aids, such as handwriting or typing, are often used to communicate with deaf patients in the clinic. This study aimed to establish the feasibility of communicating through smartphone speech recognition software compared with writing or typing. METHOD: Thirty doctors and medical students were timed writing, typing and dictating a standard set of six sentences appropriate for a post-operative consultation, and the results were assessed for accuracy and legibility. RESULTS: The mean time for smartphone dictation (17.8 seconds, 95 per cent confidence interval = 17.0-18.7) was significantly faster than writing (59.2 seconds, 95 per cent confidence interval = 56.6-61.7) or typing (44 seconds, 95 per cent confidence interval = 41.0-47.1) (p < 0.001). Speech recognition was slightly less accurate, but accuracy increased with time spent dictating. CONCLUSION: Smartphone dictation is a feasible alternative to typing and handwriting. Slow speech may improve accuracy. Early clinical experience has been promising.
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Sordera/rehabilitación , Teléfono Inteligente , Software de Reconocimiento del Habla , Envío de Mensajes de Texto , Equipos de Comunicación para Personas con Discapacidad , Estudios de Factibilidad , Humanos , Médicos/normas , Médicos/estadística & datos numéricos , Estudios Prospectivos , Habla , Estudiantes/estadística & datos numéricos , Factores de TiempoRESUMEN
During airway surgery, the anaesthetist may be required to manipulate or withdraw the endotracheal tube. Traditional surgical head drapes often make access to the tube difficult, therefore limiting control of the airway and risking de-sterilisation of the surgical field. We report a new method of draping for major neck operations that permits easy access to the endotracheal tube while maintaining sterility of the operative field.
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Cuidados Intraoperatorios/métodos , Intubación Intratraqueal/métodos , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Paños Quirúrgicos , Humanos , Cuello/cirugíaRESUMEN
OBJECTIVE: We present a case report and systematic review of acute mastoiditis caused by metastatic lung cancer. CASE REPORT: A 62-year-old woman developed acute mastoiditis as a complication of otitis media. Cortical mastoidectomy revealed deposits of metastatic non-small cell lung carcinoma around the sigmoid sinus. The patient had previously received treatment for lung cancer, but was thought to be in remission. DISCUSSION: A literature review confirmed that this is the first reported case of mastoiditis caused by metastatic lung cancer. Only four similar case reports were identified: two caused by breast carcinoma, one by renal cell carcinoma and one by cholangiocarcinoma. Post-mortem histopathological studies suggest that temporal bone metastasis occurs in 22 per cent of oncology cases. CONCLUSION: This is the first reported case of mastoiditis caused by metastatic lung cancer. Metastasis to the temporal bone is not uncommon, but rarely causes mastoiditis.
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Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/patología , Apófisis Mastoides/patología , Mastoiditis/diagnóstico , Otitis Media con Derrame/complicaciones , Neoplasias Craneales/secundario , Biopsia , Dolor de Oído/diagnóstico , Femenino , Humanos , Imagen por Resonancia Magnética , Apófisis Mastoides/cirugía , Mastoiditis/etiología , Mastoiditis/terapia , Persona de Mediana Edad , Ventilación del Oído Medio , Necrosis , Otitis Media con Derrame/tratamiento farmacológico , Neoplasias Craneales/diagnóstico , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
INTRODUCTION: In September 2007, the Department of Health published Uniforms and Workwear: an Evidence Base for Guiding Local Policy. Following this, most National Health Service trusts imposed a 'bare below the elbow' dress code policy, with clinical staff asked to remove ties, wristwatches and hand jewellery and to wear short-sleeved tops. There is currently no evidence linking dress code to the transmission of hospital-acquired infection. We designed the current survey to assess patients' perceptions of doctors' appearance, with specific reference to the 'bare below the elbow' policy. MATERIALS AND METHODS: A questionnaire showing photographs of a doctor in three different types of attire ('scrubs', formal attire and 'bare below the elbow') were used to gather responses from 80 in-patients and 80 out-patients in the ENT department. Patients were asked which outfit they felt was the most hygienic, the most professional and the easiest identification of the person as a doctor. They were also asked to indicate their overall preference. RESULTS AND ANALYSIS: Formal attire was considered most professional and the easiest identification that the person was a doctor. Scrubs were considered most hygienic. Respondents' overall preference was divided between scrubs and formal clothes. 'Bare below the elbow' attire received the lowest votes in all categories. DISCUSSION: This finding raises significant questions about the Department of Health policy in question. The authors suggest that an alternative policy should be considered, with scrubs worn for in-patient situations and formal attire during out-patient encounters.
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Vestuario/psicología , Control de Infecciones/métodos , Política Organizacional , Satisfacción del Paciente/estadística & datos numéricos , Relaciones Médico-Paciente , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Vestuario/normas , Infección Hospitalaria/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reino Unido , Adulto JovenRESUMEN
UNLABELLED: The National Health Service Plan of 2000 proposed that patients should receive a copy of all correspondence regarding their care. There is concern that the readability of patients' letters may not be appropriate for many patients. MATERIALS AND METHODS: This study determined readability scores for sequential letters written to general practitioners and copied to patients, following ENT consultations at the Royal United Hospital in Bath. Intervention involved educating clinicians in techniques to improve readability. RESULTS AND ANALYSIS: A total of 295 letters from eight clinicians were assessed in the pre-intervention phase. The mean Flesch reading ease score was 61.8 (standard deviation 8.7) and the mean Flesch-Kincaid reading grade was 9.0 (standard deviation 1.7). Re-audit analysed a further 301 letters. There was no significant change in the readability of the letters post-intervention. DISCUSSION: It may not be feasible to present medical information intended for general practitioners in a way that is readable to most of the UK adult population.
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Comprensión , Correspondencia como Asunto , Medicina Familiar y Comunitaria , Registros Médicos/normas , Otolaringología , Adulto , Educación Continua , Escolaridad , Humanos , Relaciones Interprofesionales , Servicio Ambulatorio en Hospital/normas , Educación del Paciente como Asunto , Satisfacción del Paciente , Relaciones Médico-Paciente , Proyectos Piloto , LecturaRESUMEN
OBJECTIVE: To determine the expansile and absorptive properties of the expandable ear wick when tested with commonly prescribed ear drop preparations. DESIGN: This in vitro study assessed wick expansion and absorption of drops when different ear drop preparations were applied. Nine commonly used ear drop preparations were tested (Gentisone HC, Sofradex, Otomize, Betnesol, Exocin, Canesten, Locorten-Vioform, EarCalm and ichthammol glycerin) with a standard expandable ear wick. MAIN OUTCOME MEASURES: Weight, length and width of otowick following exposure to ear drops. RESULTS: There was a marked difference in the absorption and expansion of the otowick when different drops were used. This corresponded to the aqueous or oil base of each preparation. All aqueous ear drop preparations (i.e. Gentisone HC, Sofradex, Otomize, Betnesol, Exocin and EarCalm) produced similar rates of absorption into, and expansion of, the otowick. The oil-based ear drop preparations (i.e. Canesten, Locorten-Vioform and ichthammol glycerin) failed to expand the wick and showed poor rates of absorption into the wick. CONCLUSION: Expandable ear wicks should only be used in conjunction with aqueous ear drops. When using expandable otowicks as an adjunct to treating fungal otitis externa, acetic acid ear drops should be prescribed, as all other anti-fungal drops are oil-based.
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Enfermedades del Oído/tratamiento farmacológico , Otitis Externa/tratamiento farmacológico , Tampones Quirúrgicos , Antibacterianos/administración & dosificación , Dexametasona/administración & dosificación , Combinación de Medicamentos , Diseño de Equipo/normas , Framicetina/administración & dosificación , Gentamicinas/administración & dosificación , Gramicidina/administración & dosificación , Humanos , Hidrocortisona/administración & dosificación , Instilación de Medicamentos , Neomicina/administración & dosificación , Resultado del TratamientoRESUMEN
A postal survey of 500 general practitioners (GPs) in south-west England was undertaken to evaluate the levels of undergraduate and postgraduate otolaryngology training and/or experience received by GPs in that area. Most GPs had received two weeks of undergraduate training in ENT, which had involved no formal assessment. Three-quarters of GPs considered this inadequate. A quarter of GPs had completed a hospital post in ENT prior to entering general practice, most of which lasted three months. Sixty-one per cent of GPs had received some formal postgraduate training in ENT, in the form of courses, lectures or hospital training sessions. Almost half of the GPs considered this inadequate. Seventy-five per cent of GPs stated they would like further training in ENT. Subjective estimates of referral rates to hospital ENT specialist clinics varied considerably. This study illustrates the variability and level of dissatisfaction regarding ENT training amongst GPs at both undergraduate and postgraduate levels.
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Medicina Familiar y Comunitaria/educación , Otolaringología/educación , Derivación y Consulta/estadística & datos numéricos , Encuestas y Cuestionarios , Educación de Pregrado en Medicina , Humanos , Reino UnidoRESUMEN
The NHS Connecting for Health agency continues to implement the national programme for information technology within the National Health Service (NHS). In preparation, NHS employees are being encouraged to develop their information technology skills via the European computer driving licence training course. A postal survey of British Association of Otorhinolaryngologists members was undertaken to evaluate their levels of information technology training, competency and knowledge. Three hundred and thirty-six surgeons responded. Most respondents had received no formal information technology training. Only 3.9 per cent had taken the European computer driving licence course. Most surgeons felt comfortable using word processing and presentation software but were less comfortable with other applications. Junior surgeons were more confident in all areas of information technology application than senior surgeons. Seventy-two per cent of surgeons wanted more information technology training. Most felt that such training should be routine at undergraduate and postgraduate level. With the national programme committed to improving information technology infrastructure within the NHS, more formal training should be provided to ensure a basic standard of information technology competency amongst ENT surgeons.
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Actitud hacia los Computadores , Alfabetización Digital , Capacitación de Usuario de Computador/normas , Capacitación en Servicio/organización & administración , Cuerpo Médico de Hospitales/educación , Otolaringología/educación , Adulto , Anciano , Anciano de 80 o más Años , Capacitación de Usuario de Computador/estadística & datos numéricos , Instrucción por Computador/métodos , Femenino , Humanos , Capacitación en Servicio/estadística & datos numéricos , Masculino , Cuerpo Médico de Hospitales/estadística & datos numéricos , Persona de Mediana Edad , Medicina Estatal , Encuestas y Cuestionarios , Reino UnidoRESUMEN
Among the neuropathological effects of prenatal exposure to ethanol is the disruption of neuromorphogenesis. The effects of ethanol on early events in the development of axons and dendrites were studied using cultured embryonic rat hippocampal neurons, which develop in vitro in a stereotypical sequence of events that mimics their development in vivo. During the first 24 hr in culture, hippocampal neurons attach to the substrate and develop into one of three stages identified by phase-contrast microscopy: (i) neurons having lamellipodia and no processes (stage 1); (ii) neurons developing minor processes (<40 microm) that subsequently become the cell's axon or dendrites (stage 2); or (iii) polarized neurons with at least one axon (process with length > or =40 microm) (stage 3). Exposure to ethanol (300 mg/dl or 800 mg/dl) in the culture medium resulted in an increase in both the number of minor processes per neuron and the number of stage 3 neurons having more than the typical single axon. In addition, ethanol exposure significantly altered the proportion of neurons in the three early stages of development at 18 to 24 hr in vitro, without affecting overall neuron survival. With ethanol, there was a smaller proportion of neurons in the first stage of development, and a greater proportion of polarized stage 3 neurons. These findings suggest that ethanol alters the normal establishment of neuronal polarity, disrupting mechanisms that ensure the formation of the appropriate number of processes and that regulate the timing of process outgrowth.
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Polaridad Celular/efectos de los fármacos , Etanol/toxicidad , Trastornos del Espectro Alcohólico Fetal/embriología , Células Piramidales/efectos de los fármacos , Animales , Axones/efectos de los fármacos , Axones/patología , Dendritas/efectos de los fármacos , Dendritas/patología , Femenino , Trastornos del Espectro Alcohólico Fetal/patología , Técnicas In Vitro , Masculino , Microscopía de Contraste de Fase , Embarazo , Células Piramidales/patología , RatasRESUMEN
A five-point linkage map has been established between the loci encoding liver/bone/kidney alkaline phosphatase (ALPL), enolase 1-alpha (ENO1), glucose-phosphate isomerase (GPI), phosphogluconate dehydrogenase (PGD), and transforming growth factor beta 1 (TGFB1) in swine. Linkage analysis was performed using the Meishan x Yorkshire three-generation reference pedigree at the University of Illinois (n = 91). Previously ENO1, GPI, PGD, and TGFB1 were mapped to porcine chromosome 6q by in situ hybridization but the linkage relations of TGFB1 and ENO1 with other loci in this group were not investigated. Based on mapping data from human chromosomes 1 and 19 and mouse chromosomes 4 and 7, it was postulated that ALPL should reside among or near these loci. Restriction fragment length polymorphisms were identified for ALPL, ENO1, and TGFB1. GPI (EC 5.3.1.9) and PGD (EC 1.1.1.44) phenotypes were determined by agarose gel electrophoresis of isozymes. Marker data were analyzed using the MLINK (two locus) and ILINK (multilocus) programs from LINKAGE (version 5.10). The most likely locus order between GPI-TGFB1-(PGD-ENO1)-ALPL with recombination rates of 0.049, 0.044, 0.000, and 0.156, respectively, could not be significantly determined. The maximum five-point lod score was the same to four decimal places irrespective of the order of ENO1 and PGD. This indicates that ENO1 and PGD are very closely linked and that ALPL is located telomeric to the established linkage group on pig chromosome 6.