Photodynamic Therapy as a New Treatment for Chronic Rhinosinusitis - A Systematic Review.

This review examines the latest evidence for photodynamic therapy (PDT) in treating chronic rhinosinusitis. MedLine, EMBASE and TRIP Database searches were conducted using the terms: "photodynamic" or "phototherapy" or "photo" and "sinusitis" or "rhinosinusitis," date range January 2000 to May 2020. A total of 192 records were initially identified, after duplicates and exclusions, 9 full papers and 3 abstracts were included. All study types including in-vitro, animal and human studies were evaluated. Whilst there is in-vitro evidence for the efficacy of PDT's bactericidal effect on drug resistant bacteria and biofilm viability, there are few clinical studies. PDT is a promising area of research, but larger, focused studies looking at the safety, delivery, efficacy, and patient selection are required before it can be considered a viable treatment for CRS.

Examining cognitive functioning of adult acute psychiatric inpatients through a brief screening assessment.

OBJECTIVE: Psychiatric inpatients present with multiple difficulties, including comorbid diagnoses, social problems, trauma, and high levels of psychiatric medication use. All of these factors have been associated with poorer cognitive functioning, which is rarely assessed. The aim of this study was to examine the acceptability of a brief cognitive screening assessment, and identify the cognitive and psychological profile of current psychiatric inpatients. METHOD: A cross-sectional design was adopted. Participants (N = 75) were administered brief measures of cognitive functioning, the Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005), and psychological global distress, Clinical Outcomes of Routine Evaluation-Outcome Measure, (CORE-OM; Evans et al., 2002) within the first 4 weeks of their hospital admissions. RESULTS: The MoCA was identified as acceptable for the inpatient environment. Most of the participants (79%) met the cut-off for mild cognitive impairment. No significant differences were found across diagnoses in regard to cognitive functioning, but participants with diagnoses of personality disorder experienced the most psychological global distress. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Acute psychiatric inpatient wards should consider mild cognitive impairments when assessing and treating people with serious mental illness and make appropriate adaptations to their care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Laryngeal mask airways and use of a Boyle-Davis gag in ENT surgery: is there a learning curve? A prospective analysis.

OBJECTIVES: The objective was to identify whether the experience of the operating surgeon was relevant to the frequency of the laryngeal mask airway (LMA) airway obstruction or change to an endotracheal tube during ear, nose, and throat surgery. METHODS: Data were prospectively collected for 186 patients undergoing a procedure with the use of a Boyle-Davis gag and LMA over 12 months in a district-general hospital in the United Kingdom. patient demographics (age, mallampati grade), grade of surgeon, grade of anesthetist, LMA size inserted, and any intraoperative adjustments needed were recorded. RESULTS: There was an overall intraoperative airway intervention rate of 21%. The experience of the surgeon affected the rate of intraoperative airway interventions encountered, reflected by the significantly lower rate of airway complications (ie, 10%) seen when associate specialists perform these types of procedures compared to other grades of surgeon (Fisher's exact test 2-tailed P value = .04). A significant complication rate of 50% was seen with core surgical trainees compared to other grades of surgeon (Fisher's exact test 2-tailed P value = .002). CONCLUSIONS: The results of this study suggest there may be a learning curve for otolaryngology trainees when using a LMA. However, larger studies and further subanalyses are essential before further conclusions can be made.

A study to determine the benefits of bilateral versus unilateral nasal packing with Rapid Rhino ® packs.

There is little evidence to suggest that bilateral nasal packing increases intra-nasal pressures compared to a single pack (or is well tolerated) for uncontrolled unilateral epistaxis, but it is often performed and justified on those grounds. 15 volunteers were recruited according to strict criteria. Rapid Rhino(®) 5.5 cm anterior packs were inserted bilaterally following topical nasal preparation with co-phenylcaine. The first pack was inflated to a pre-determined pressure. The contralateral pack was inflated to match, and any intra-nasal pressure change on the first side was measured. The subject's level of discomfort was scored on a visual analogue scale. This procedure was repeated at incremental pressures. Higher ipsilateral intra-nasal pressures are achieved when additional contralateral nasal packs are inflated. This change in ipsilateral intra-nasal pressure is greater at higher total inflation pressures. At higher pressures, the subjects reported lower mean pain scores when bilateral packs were used compared to unilateral. This effect was only statistically significant at intra-nasal pressures of 140 mmHg and above (Wilcoxon Signed-Rank test, p < 0.02). It is possible to increase the ipsilateral nasal cavity pressure by inserting a contralateral nasal pack. Although this extra pressure may be enough to tamponade further venous bleeding without significantly increasing a subject's discomfort, the high levels of pack pressure required, make this unlikely to be of significant use in the clinical setting.

Superhydrophobic surfaces as an on-chip microfluidic toolkit for total droplet control.

We propose and outline a novel technique designed to utilize the unique surface repulsion present between aqueous droplets and customizable superhydrophobic surfaces for the on-chip spatial and temporal manipulation of droplets within microfluidic architectures. Through the integration of carefully designed and prepatterned superhydrophobic surfaces into polymer microfluidic chipsets, it is possible to take advantage of this enhanced surface repulsion to passively manipulate droplets on the microscale for a wide range of droplet operations, including but not limited to acceleration, deceleration, merging, and path control. This work aims to help fulfill and stimulate development based around current requirements for additional passive analytical manipulation and detection techniques in order to enable a reduction in experimental design complexity with the goal of facilitating and improving portability for Lab-on-a-chip devices.

Nasal pemphigoid: a diagnostic dilemma.

Cicatricial pemphigoid is a chronic, systemic, immunobullous disorder affecting mucous membranes. Nasal manifestations of cicatricial pemphigoid are less common than in the rest of the upper aero-digestive tract, and may prove difficult to diagnose and manage effectively. We report one such case presenting with isolated nasal symptoms, in which diagnosis, treatment and ongoing management of the underlying cause was particularly challenging. A literature review was performed to ascertain the incidence of cicatricial pemphigoid and to establish the best evidence-based investigation and treatment.

Compartmentalization of electrophoretically separated analytes in a multiphase microfluidic platform.

Herein, we describe the monolithic integration of a multiphase microfluidic system to a microcapillary gel electrophoresis (µCGE) architecture for the complete isolation and storage of separated analyte bands. Within this platform, analyte molecules are separated using microchannel gel electrophoresis, and the eluted bands are stored in a sequence of approximately 40-600 encapsulating microdroplets. Importantly, employing such a system allows for total control of droplet size, shape, and composition. This approach is utilized to separate, optically detect, and encapsulate two fluorescent analytes from a composite sample mixture. Further to this, we subsequently investigate the potential of the system to be used as a concentration gradient generator through analysis of the segmented analyte bands and droplet composition.

The middle ear mass: a rare but important diagnosis.

The authors report a rare case of primary intracranial meningioma presenting as a middle ear mass with conductive hearing loss. The authors aim to highlight the importance of diagnosing a middle ear mass, which although rare, may have a substantial impact on ongoing patient management. A discussion of other middle ear pathologies is made in order to demonstrate the subtle differences in presentation.

A rare cause of upper airway obstruction: spontaneous synchronous sublingual and laryngeal haematomas.

Anticoagulation with warfarin is commonly used for prevention of thromboembolic events in patients with atrial fibrillation. Bleeding is the main side effect of anticoagulation. We report the case of a 66-year-old man who developed two spontaneous synchronous upper airway haematomas while on warfarin therapy. To our knowledge, this is the first reported case of a sublingual haematoma presenting simultaneously with supraglottic laryngeal haematomas. Upper airway haematomas are rare in the absence of a history of trauma but need to be urgently assessed due to their life-threatening potential. Clinicians should be aware of the possibility of haematomas involving the upper airway in patients on anticoagulant therapy, particularly if complaining of red flag symptoms such as acute onset dysphonia, odynophagia or airway/breathing difficulties.

Prospective, randomized, single-blinded study comparing the use of a flexible nasendoscope and a rigid laryngoscope in outpatient laryngeal and pharyngeal examinations.

OBJECTIVE: To compare the quality of the image obtained using a flexible nasendoscope and a rigid laryngoscope when visualizing laryngeal and pharyngeal structures in an outpatient setting. DESIGN: Prospective, randomized, single-blinded study. SETTING: Otolaryngology outpatient clinic. PARTICIPANTS: Patients referred to the otolaryngology clinic with laryngeal symptoms were prospectively recruited and subjected to laryngeal investigation using both the flexible nasendoscope and the rigid laryngoscope. The order of both instruments was randomized, and the investigations were recorded and scored according to a set protocol. MAIN OUTCOME MEASURES: Primary: score of each instrument at visualizing laryngeal structures. Secondary: tolerability of each instrument. RESULTS: Thirty patients (12 males vs 18 females) were recruited, with a median age of 43.5 years. No statistical difference was noted in terms of the tolerability of each instrument (p = .885). Both instruments were similar in terms of the structures identified. The quality of the image was better when using the rigid laryngoscope (p = .009). CONCLUSION: The flexible nasendoscope and the rigid laryngoscope were equally tolerated. The flexible nasendoscope was slightly better at visualizing the laryngeal structures, whereas the rigid laryngoscope provided better image quality.

To "EE" or not to "EE".

OBJECTIVE: To assess whether /i:/ ("ee") is the best sound to use during indirect laryngoscopy to produce the optimal view of the larynx. DESIGN: Prospective study. SETTING: District general hospital otolaryngology outpatient clinic. PATIENTS: Eighty-seven patients from a general otolaryngology clinic with no laryngeal or pharyngeal symptoms or pathology. MAIN OUTCOME MEASURES: The views obtained during indirect laryngoscopy and vocalization of /i:/ ("ee"), /ei/ ("ay"), /[see text]/ ("err"), /a:/ ("ah"), and /ea/ ("air") were graded according to a laryngoscopy grading system. RESULTS: The greatest number of adequate views of the larynx was achieved by using the sounds /i:/ and /[see text]/. There was no significant difference between /i:/ and /[see text]/ (p = .740), but there were significant differences between /i:/ and /ei/ (p = .019), /i:/ and /a:/ (p = .00000), and /i:/ and /ea/ (p = .00013). CONCLUSION: For the optimal view of the larynx during indirect laryngoscopy, we recommend the use of the sounds /i:/ ("ee") and /[see text]/ ("err").

Change in health status after rhinoplasty.

OBJECTIVE: To assess the change in health status of patients undergoing rhinoplasty. DESIGN: Retrospective mail-based questionnaire study using a validated post-intervention questionnaire specifically designed for otolaryngology surgery. SETTING: District general hospital otolaryngology department. PATIENTS: All patients (78 in total) undergoing rhinoplasty surgery between October 1998 and November 2003 were included in the study. MAIN OUTCOME MEASURE: Glasgow Benefit Inventory, a validated post-intervention questionnaire specifically designed for otolaryngologic surgery. RESULTS: The mean total Glasgow Benefit Inventory score was +20.0 (95% confidence interval [CI] 14.2-25.9), and the mean general, social, and physical subscale scores were +25.0 (95% CI 17.3-32.7), +10.2 (95% CI 4.4-16.0), and +9.9 (95% CI 2.7-17.0), respectively. CONCLUSIONS: Our results show that the health status of patients undergoing rhinoplasty improved overall and according to each of the subscales used.

Endoscopic dacryocystorhinostomy in warfarinized patients.

PURPOSE: To report the results of endoscopic dacryocystorhinotomy (EDCR) in anticoagulated patients who did not interrupt their anticoagulant regimen for the procedure. MATERIALS AND METHODS: A case note review was made of all 9 patients taking warfarin who had EDCR at Ipswich Hospital from May 1998 to October 2003. Age, gender, indications for surgery, complications, and outcome were analyzed, and the results were compared to EDCRs in nonwarfarinized patients. RESULTS: Of the 9 patients, 7 had complete relief of epiphora. Two patients had a persistent watering eye. One of them had blockage of upper, lower, and common canaliculi, and the other was found to have adhesions between the lateral nasal wall and middle turbinate. A total of 6 patients had no postoperative complications; 2 had minor periorbital bruising that did not delay discharge, and only 1 patient had ooze through a Kaltostat nasal pack and was kept in the hospital for 2 days. None required readmission. CONCLUSIONS: EDCR is a safe and efficacious treatment in patients with distal nasolacrimal obstruction in anticoagulated patients and does not require stopping the warfarin perioperatively.

A prospective randomised controlled trial comparing Merocel and Rapid Rhino nasal tampons in the treatment of epistaxis.

A prospective study was performed to compare the efficacy and patient tolerance of Merocel and Rapid Rhino nasal tampons in the treatment of epistaxis. A total of 42 patients were studied. There was no significant difference between the two types of pack in efficacy or patient discomfort with pack in situ. Rapid Rhino produced significantly lower scores for subjective patient discomfort during insertion and removal of pack.