Modified Intravenous Cannula Ventilation Tubes for Otic Barotrauma Prevention.

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.

A rare finding of bilateral facial canal meningoceles involving the tympanic segment in suspected idiopathic intracranial hypertension.

Meningoceles are a common radiological feature found in cases of idiopathic intracranial hypertension (IIH). Rarely, they can affect the facial canal within the petrous temporal bone, leading to symptoms such as facial nerve palsy, hearing loss or meningitis. This is the first case report that describes bilateral facial canal meningoceles involving the tympanic segment of the canal. Prominent Meckel's caves were also seen on MRI, a feature commonly associated with IIH.

Diagnostic approach to patients at risk of otogenic skull base osteomyelitis.

BACKGROUND: Otogenic skull base osteomyelitis (OSBO) is rare and potentially fatal sequelae of otitis externa. Accurate and timely diagnosis is important due to rising incidence, morbidity and costs associated with treatment. Consensus on the diagnostic approach for OSBO has yet to be reached, in particular the utility of imaging modalities. AIMS/OBJECTIVES: This study reviews a single institution's high-volume experience of OSBO, with the aim of analysing clinicopathologic features and imaging studies to develop a diagnostic algorithm. MATERIAL AND METHODS: A retrospective review of patients admitted with OSBO from 2009 to 2019, was performed. After applying inclusion and exclusion criteria, 103 patients with 106 unique episodes of suspected OSBO were selected. De-identified information including patient demographics, clinicopathologic features and imaging outcomes was recorded and analysed. RESULTS: HbA1c ≥ 7% significantly predicted for OSBO in univariate (OR 7.83, 95% CI 1.85-33.16, p = 0.01) and multivariate analyses (OR 5.21, 95% CI 1.05-25.81, p = 0.04). The CT/technetium-99m/gallium-67 combination produced better diagnostic accuracy for OSBO (AUROC 0.96, 95% CI 0.92-1), when compared to a CT/MRI combination (AUROC 0.86, 95% CI 0.79-0.93). CONCLUSIONS AND SIGNIFICANCE: Once there is a clinical suspicion for OSBO, diagnosis is established by synthesising results from clinical assessment, pathologic investigations and imaging modalities. The imaging utilised to diagnose OSBO should vary according to the clinical situation and limitations of each modality.

Cochlear Patency After Translabyrinthine Vestibular Schwannoma Surgery.

OBJECTIVES: To determine the temporal occurrence of fluid signal changes on T2-weighted magnetic resonance imaging (T2MRI) that occur in the cochlear lumen after translabyrinthine surgery. STUDY DESIGN: Retrospective case control study. SETTING: Tertiary referral neurotology center. SUBJECTS AND METHODS: Seventy-one patients were identified who underwent translabyrinthine removal of a vestibular schwannoma between 2010 and 2014; of these 49 were included as they had postoperative T2 MRI at 6, 18, and 48 months available postsurgery. Magnetic resonance imaging scans were scored base on fluid signal changes within the cochlea. RESULTS: In total, 147 magnetic resonance imaging scans were reviewed on 49 patients. In the cohort analysis 86% of patients showed evidence of fluid signal changes 48 months postoperatively. Ninety-five percent of patients who went on to demonstrate loss of fluid signal at 48 months had already shown changes at 6 months postsurgery. The majority of cochlea signal changes identified at 6 months were minor (72% Grade 1) while at 48 months this had progressed to severe (71% Grade 2 or 3). Of the patients with a normal cochlea at 6 months 78% maintained a normal cochlea to the 48-month scan. CONCLUSION: Cochlear signal changes suggestive of fibrosis occurred in most patients following translabyrinthine removal of vestibular schwannoma. Given the early onset of cochlear fluid signal changes on T2MRI, and the progression of these changes on subsequence imaging, cochlear implantation would ideally need to be performed either simultaneous to translabyrinthine surgery or as an early second-stage procedure to maximize the chance of a successful electrode insertion, or one can consider a placeholder as well.

Diagnostic Accuracy of the Modified Evan's Blue Dye Test in Detecting Aspiration in Patients with Tracheostomy: A Systematic Review of the Evidence.

Oropharyngeal aspiration (OPA) is a common occurrence in patients with tracheostomy. The modified Evan's blue dye test (MEBDT) is an easily administered bedside procedure for the assessment of tracheostomised patients. However, studies evaluating the diagnostic accuracy of the MEBDT reach conflicting results. Therefore, we conducted a systematic review to determine the overall accuracy of the MEBDT in detecting OPA in adults with tracheostomy. The search strategy incorporated searching electronic databases, checking reference lists and citations and retrieving unpublished data. Data of primary studies were extracted and examined by three independent reviewers. The assessment of the methodological quality of included studies was performed using the QUADAS-2 tool. Six studies met the inclusion criteria for this systematic review. The studies presented significant disparities in study design and patient characteristics. Furthermore, high discrepancies in the administration of MEBDT across studies were noted. Therefore, a meta-analysis was not considered appropriate. Sensitivity estimates varied widely across the studies (38-95 %), indicating that the MEBDT is unreliable in detecting OPA. However, the studies emerge with overall high specificity values, ranging from 79 to 100 %. This true negative rate suggests that the MEBDT correctly identifies patients without OPA. This review highlights the need for further research studies assessing the accuracy of the MEBDT in detecting aspiration in patients with tracheostomy, using a standardised and reliable procedure. Outcomes from such studies will update the current level of evidence in relation to the MEBDT and consequently define best clinical practice.

Hormesis results in trade-offs with immunity.

Many have argued that we may be able to extend life and improve human health through hormesis, the beneficial effects of low-level toxins and other stressors. But, studies of hormesis in model systems have not yet established whether stress-induced benefits are cost free, artifacts of inbreeding, or come with deleterious side effects. Here, we provide evidence that hormesis results in trade-offs with immunity. We find that a single topical dose of dead spores of the entomopathogenic fungus, Metarhizium robertsii, increases the longevity of the fruit fly, Drosophila melanogaster, without significant decreases in fecundity. We find that hormetic benefits of pathogen challenge are greater in lines that lack key components of antifungal immunity (Dif and Turandot M). And, in outbred fly lines, we find that topical pathogen challenge enhances both survival and fecundity, but reduces ability to fight off live infections. The results provide evidence that hormesis is manifested by stress-induced trade-offs with immunity, not cost-free benefits or artifacts of inbreeding. Our findings illuminate mechanisms underlying pathogen-induced life-history trade-offs, and indicate that reduced immune function may be an ironic side effect of the "elixirs of life."

Descriptive investigation of the recording of influenza vaccination details on The Health Information Network database.

BACKGROUND: The UK primary care databases are used in pharmacoepidemiology studies of vaccination type. We investigated vaccine recording and whether, and how, exposure to specific brands and batches can be identified. METHODS: Details of influenza vaccinations given in the 2010-2011 or 2011-2012 seasons were identified from coded and text fields in The Health Information Network UK primary care database. The proportion of people over 64 years of age vaccinated against influenza was compared with published regional rates. Searches for Fluvirin (Novartis Vaccines and Diagnostics GmbH, Marburg, Germany) batch numbers and name identified exposure to this specific vaccine. The recording of any brand name and batch number was described for a sample of 1000 vaccinations across 472 practices. RESULTS: A total of 767 904 influenza vaccinations were identified during the 2010-2011 season and 784 518 in 2011-2012. Vaccination rates for people aged over 64 years were 75.6%, 80.9%, 78.4% and 71.9% in England, Northern Ireland, Scotland and Wales, respectively (2011-2012 season), compared with published figures of 74.0%, 77.0%, 76.2% and 67.7%. Rates were slightly lower in 2010-2011 in both data sources. A Fluvirin brand was identified for 3.6% of all UK vaccinations but 26.2% of those in Scottish practices. Vaccination brand could be identified for 94.3% of the sample, 93.6% with a batch number. Batch number (98.5%) and brand name (50.3%) were most frequently recorded in an immunisation 'batch' text field. CONCLUSION: Patients exposed to an influenza vaccine in primary care can be identified from The Health Information Network. Identification of brand or batch number requires a text search. Regional variation in brand of vaccine should be considered when estimating sample size.

Reliability of the Clinical Dementia Rating with a traumatic brain injury population: a preliminary study.

This study examined the inter-rater reliability (IRR) of the Clinical Dementia Rating (CDR) for patients with traumatic brain injury (TBI). The CDR is a commonly used rating of impairment, but there has been no research examining its utility in patients with TBI. It was hypothesized that the CDR would have good IRR when used with patients with TBI. Two hundred and fifty U.S. neuropsychologists were randomly selected from the National Academy of Neuropsychology's membership list and were mailed packets of information (e.g., CDR, patient vignette, mental status, neuropsychological test information, and history). Professionals were asked to complete the CDR for the described patient and return the information. IRR was calculated for the Global CDR score and each of the six CDR domains. Of those packets mailed, 53 were returned and completed as instructed (21.2% response rate). Clinician experience varied from 0 to 31 years. Global CDR score IRR was 73.6%. Domain IRRs were as follows: Orientation, 79.2%; Home and Hobbies, 71.7%; Personal Care, 71.7%; Memory, 56.6%; Judgment and Problem Solving, 49.1%; and Community Affairs, 54.7%. Results suggest the CDR Global score has acceptable IRR (>.70). Overall concordance (W = .527) among raters was significant with moderate-to-strong agreement. Further research to improve the utility of this instrument is discussed.

Progressive dysphagia in limb-girdle muscular dystrophy type 2B.

Dysphagia has not been reported in genetically confirmed limb-girdle muscular dystrophy type 2B (LGMD2B). A 40-year-old woman reported exercise-induced calf pain at age 34, followed by progressive lower and upper limb weakness. At age 38, progressive dysphagia for solids, and subsequently liquids, ensued. Endoscopic and videofluoroscopic-radiological findings indicated a myopathic swallowing disorder. Molecular genetic analysis confirmed two dysferlin gene mutations consistent with a compound heterozygote state. Progressive dysphagia should be considered as part of the expanding dysferlinopathy phenotype.

Bisensory augmentation: A speechreading advantage when speech is clearly audible and intact.

Reisberg, McLean, and Goldfield (1987) have shown that vision plays a part in the perception of speech even when the auditory signal is clearly audible and intact. Using an alternative method the present study replicated their finding. Clearly audible spoken messages were presented in audio-only and audio-visual conditions, and the adult participants' resulting comprehension was measured. Stories were presented in French (Expt 1), in a Glaswegian accent (Expt 2), and by presenting spoken information that was semantically and syntactically complex (Experiment 3). Three separate groups of 16 adult female participants aged 19-21 participated in the three experiments. In all three experiments, comprehension improved significantly when the speaker's face was visible.