The Utility of the Maxillary Heuwieser for Oropharyngeal Foreign Body Removal Under Nebulized Local Anesthesia: A Case Series.

We describe a novel and safe use of existing instrumentation in the removal of select foreign bodies in the upper aerodigestive tract to minimize health-care costs. A retrospective review of 4 cases involving visualized upper aerodigestive tract foreign bodies were identified via flexible laryngoscopy and extracted under local anesthesia from 2016 to 2018. All 4 patients were not in any airway distress and underwent successful removal of the foreign body, which included 2 fishbones, a sewing pin, and a wire bristle with a maxillary Heuwieser or giraffe instrument under flexible laryngoscopy visualizing using local anesthesia without complications. No foreign bodies were dislodged. The use of a maxillary Heuwieser and flexible laryngoscopy visualization is safe, allows for removal of otherwise difficult to reach foreign bodies at the bedside, improving patient comfort, obviates the need for general anesthesia to the patient, and minimizes health-care costs.

In vitro efficacy of a consumer-marketed ear cleaning tool.

HYPOTHESIS: The WaxVac ear cleaning device may be a useful adjunct for patients requiring aural toilet. BACKGROUND: Cerumen removal and routine aural toilet is a common complaint that presents to the otolaryngology clinic. We tested this device to make an appropriate recommendation to our patients. METHODS: We conducted in vitro testing of the WaxVac device on an artificial ear canal model and cadaveric temporal bones testing the strength of the suction, noise created by the device, and the ability of the device to remove foreign bodies from the external auditory canal. These foreign bodies included a PE tube, baby powder, a q-tip head, saline, and artificial cerumen. RESULTS: The WaxVac created very little suction as compared with Frazier tip suctions used in clinic. The device produced very little noise in the canal, which was equivalent to a #3 Frazier tip suction. The WaxVac was unable to remove q-tip heads or artificial cerumen from the ear canal model or the cadaveric temporal bones. Very little of the saline could be removed by the WaxVac, and only 20% to 50% of trials demonstrated removal of a PE tube. However, a large amount of the powder was able to be removed by the device. CONCLUSION: Although the concept of this device is good, the actual product does not produce adequate suction to remove cerumen or most common foreign bodies from the external auditory canal. It is unlikely to be useful for aural toilet.

Early tracheotomy in elderly patients results in less ventilator-associated pneumonia.

OBJECTIVES: To determine if the timing of tracheotomy in elderly patients results in less ventilator associated-pneumonia, mortality, and morbidity. STUDY DESIGN: Historical cohort study. SUBJECTS AND METHODS: This study included 158 ICU patients aged >65 who underwent tracheotomy from March 2003 to June 2007. Patient demographics, outcomes, and ventilation data were collected and analyzed. RESULTS: The early tracheotomy group (continuous intubation time <7 days) included 43 patients, and 115 patients were included in the late group. There were no statistically significant differences in the demographics of the two groups. A statistically significant difference in the rate of ventilator-associated pneumonia was noted in the early versus late tracheotomy group (-0.29% VAP, 95% CI: -0.46, -0.12). There were more intubations per patient noted in the early tracheotomy group versus the late tracheotomy group (0.70 intubations, 95% CI: 0.41, 0.99). The early tracheotomy group has a lower total ICU admission time (-9.5 days, 95% CI: -21.81, -2.25) and total hospital admission time (-10 days, 95% CI: -33.69, -2.249). There was no difference in mortality, although there was a trend of lower mortality in the early tracheotomy group (-11.3% mortality, 95% CI: -0.27, -0.05). CONCLUSION: Early tracheotomy in elderly patients is associated with less ventilator-associated pneumonia, more frequent intubations, less total admission time, and a trend toward lower mortality.