Rigid bronchoscopy: a consultant survey.

INTRODUCTION: Inhalation of foreign bodies represents a potentially fatal emergency in both adults and children. Chest x-ray, in isolation, is neither sensitive nor specific. Rigid bronchoscopy represents the gold standard to diagnose and retrieve paediatric foreign bodies. Cases are encountered infrequently, creating anxieties about their management. Little is known about the confidence in, and maintenance of, rigid bronchoscopy skills by ear, nose and throat teams. METHODS: A 15-question survey was completed by 50 practising otolaryngology consultants in England. RESULTS: Results show that almost 40% of otolaryngology consultants covering rigid bronchoscopy have not performed bronchoscopy in more than 5 years. Consultants raised concerns about the anaesthetic support and the speed of equipment assembly. Questions on clinical practice showed disparities in practice in the same scenario. CONCLUSIONS: The authors advocate addressing many of the issues raised by the study with a greater availability of simulation courses and regular scheduled intradepartmental teaching days for all professionals involved. National guidelines on criteria for transfer to tertiary centres would improve the consistency of practice.

Bedside open tracheostomy in COVID-19 patients - a safe and swift approach.

BACKGROUND: Tracheostomy can be performed as an open surgical procedure, percutaneous, or hybrid and forms an important step in the management of patients infected with coronavirus disease 2019 (COVID-19) requiring weaning from mechanical ventilation. The purpose of this article is to share our experience to performing bedside surgical tracheostomy in COVID-19 patients in a safe and effective manner, whilst minimising the risk of viral transmission, to optimise patient outcomes and reduce risk to healthcare professionals. MATERIAL AND METHODS: As recommended by ENT UK, we prospectively established a COVID Airway Team within the ENT department at Birmingham Heartlands Hospital, consisting of four head and neck consultant surgeons to perform either open-bedside, open-theatre or percutaneous tracheostomy in COVID-19 patients. A specific stepwise method for bedside open surgical tracheostomy was based on ENT UK and British Laryngological Society recommendations. RESULTS: Thirty patients underwent tracheostomy during the study period (14 bedside-open, 5 open-theatre, 11 percutaneous). Mean duration of mechanical intubation prior to bedside-open tracheostomy was 14.5 days. The average time for open-bedside tracheostomy was 9 minutes compared to 31 minutes for open-theatre. There were no significant tracheostomy related complications with bedside-open tracheostomy. No healthcare professional involved reported acute COVID-19 infection. CONCLUSIONS: We describe our effective, safe and swift approach to bedside open tracheostomy during the COVID-19 pandemic. Our experience demonstrated a short mean procedural time, with no tracheostomy-related complications and no reported viral transmission amongst the healthcare members involved.

Ambulatory management of common ENT emergencies - what's the evidence?

OBJECTIVES: The global pandemic of coronavirus disease 2019 has necessitated changes to 'usual' ways of practice in otolaryngology, with a view towards out-patient or ambulatory management of appropriate conditions. This paper reviews the available evidence for out-patient management of three of the most common causes for emergency referral to the otolaryngology team: tonsillitis, peri-tonsillar abscess and epistaxis. METHODS: A literature review was performed, searching all available online databases and resources. The Medical Subject Headings 'tonsillitis', 'pharyngotonsillitis', 'quinsy', 'peritonsillar abscess' and 'epistaxis' were used. Papers discussing out-patient management were reviewed by the authors. RESULTS: Out-patient and ambulatory pathways for tonsillitis and peritonsillar abscess are well described for patients meeting appropriate criteria. Safe discharge of select patients is safe and should be encouraged in the current clinical climate. Safe discharge of patients with epistaxis who have bleeding controlled is also well described. CONCLUSION: In select cases, tonsillitis, quinsy and epistaxis patients can be safely managed out of hospital, with low re-admission rates.

Efficacy of directional microphone hearing aids: a meta-analytic perspective.

The literature suggests that directional microphone hearing aids (DMHAs) are a viable means for improving the signal-to-noise ratio (SNR) for hearing-impaired listeners. The amount of directional advantage they provide, however, remains relatively unclear because of variability observed among individual studies. The present investigation was undertaken in an attempt to establish the degree of advantage provided by DMHAs. Data were synthesized from 72 and 74 experiments, respectively, on omnidirectional hearing aids and DMHAs representing both favorable and unfavorable outcomes. Using a meta-analytic approach, 138 weighted averages were derived for a variety of comparable independent and dependent variables. Comparisons were made for hearing-impaired and normal-hearing listeners. Findings are discussed with regard to their clinical and research implications.

Paired-comparison hearing aid preferences: evaluation of an unforced-choice paradigm.

Fifteen normal-hearing listeners compared nine frequency-response slopes in a round-robin paired-comparison tournament as they listened to passages of connected discourse against a competing noise background at a +3-dB signal-to-noise ratio. All participants listened in an AB paradigm, in which they were forced to choose which of two signals (A or B) produced better speech intelligibility, and an ABN paradigm, in which they were allowed a third choice of No Preference (N). For both paradigms, listeners generally preferred frequency shaping that either cut low frequencies or boosted high frequencies, and intra- and intersession reliability was high overall. Although listeners' most-preferred responses tended to converge on the same frequency-response slope in the two paradigms, the reliability of these responses was significantly higher for ABN than for AB. The use of the ABN paired-comparison paradigm deserves further study, therefore, as a method to fit multimemory hearing aids.

Loudness discrimination of speech signals spectrally shaped by a simulated hearing aid.

A discrimination task was used to assess changes in the loudness of speech that accompanied changes in the spectral tilt of a simulated hearing aid's frequency response. Band-limited (0.25-4 kHz) spondaic words were spectrally shaped at comparison tilt-factor values of -6, 0, and +6 dB per octave and delivered monaurally via insert earphone to each of 10 listeners with normal hearing (NH) and 15 listeners with mild-to-moderate sensorineural hearing impairment (HI). Results for the NH listeners indicated that loudness differences among the tilt factors were generally perceptible and that loudness judgments were highly transitive across different tilt-factor comparisons. Loudness differences were also perceptible to many of the HI listeners when they switched among tilt factors. The HI listeners' data showed some evidence of transitivity, but not so much as was shown by the NH listeners. Intersubject variability in the loudness judgments was found to be comparable for the two subject groups. Results of the study are discussed with regard to their implications for hearing aid fitting, with particular emphasis on the "parameter adjustment and selection" fitting procedure (J. Punch & R. Robb, 1992).