Sustainable equipment donation in otolaryngology in low-resource settings.

PURPOSE OF REVIEW: The purpose of this review is to examine current practices in surgical equipment donation to lower- and middle-income countries (LMICs) with a particular focus on otolaryngology-head and neck surgery (OHNS). This is designed as a pragmatic review to guide potential donor communities to implement sustainable OHNS equipment donation in LMICs. RECENT FINDINGS: LMICs are increasingly reliant on international equipment donation. In terms of OHNS services, global OHNS have compiled a list of essential equipment for baseline care in LMICs. Especially in terms of audiology, OHNS equipment donation has the potential to have a significant impact on populational health. However, there is a scarcity of research on donated equipment in OHNS. A suggested blueprint for sustainable equipment donation follows these steps: establish partnerships, assess needs, source equipment, and follow-up and evaluate the intervention. Key further considerations for sustainability include remanufacturing and repurposing methods, maintenance, and contextual understanding. SUMMARY: Sustainable equipment donation in otolaryngology is an important part of global health equity and healthcare delivery in low-resource settings. Despite the good intentions behind medical equipment donations, there are many challenges; donors and recipients should engage in collaborative, needs-based planning processes that result in long-term sustainability, local capacity building, and community participation.

A Multicenter Validity Study of Four Smartphone Hearing Test Apps in Optimized and Home Environments.

OBJECTIVE: Pure tone audiometry (PTA) is the gold standard for hearing assessment. However, it requires access to specialized equipment. Smartphone audiometry applications (apps) have been developed to perform automated threshold audiometry and could allow patients to perform self-administered screening or monitoring. This study aimed to assess the validity and feasibility of patients using apps to self-assess hearing thresholds at home, with comparison to PTA. METHODS: A multi-center, prospective randomized study was conducted amongst patients undergoing PTA in clinics. Participants were randomly allocated to one of four publicly-available apps designed to measure pure tone thresholds. Participants used an app once in optimal sound-treated conditions and a further three times at home. Ear-specific frequency-specific thresholds and pure tone average were compared using Pearson correlation coefficient. The percentage of app hearing tests with results within ±10 dB of PTA was calculated. Patient acceptability was assessed via an online survey. RESULTS: One hundred thirty-nine participants submitted data. The results of two at-home automated smartphone apps correlated strongly/very strongly with PTA average and their frequency-specific median was within ±10 dB accuracy. Smartphone audiometry performed in sound-treated and home conditions were very strongly correlated. The apps were rated as easy/very easy to use by 90% of participants and 90% would be happy/very happy to use an app to monitor their hearing. CONCLUSION: Judicious use of self-performed smartphone audiometry was both valid and feasible for two of four apps. It could provide frequency-specific threshold estimates at home, potentially allowing assessments of patients remotely or monitoring of fluctuating hearing loss. LEVEL OF EVIDENCE: 2 Laryngoscope, 134:2864-2870, 2024.

Trial of Affordable Bone Conduction Headphones to Support a Deaf Child's Education in Malawi.

A 13-year-old child with hearing loss secondary to chronic serous otitis media and bilateral tympanic perforations had been unable to hear the teacher at school and unable to pass end-of-year exams. In 2020, she trialed a bone conduction headset paired by Bluetooth to a remote microphone and used this to support her hearing at school, socializing with friends and in the family home. Due to the COVID (COronaVIrus Disease) pandemic and a cholera epidemic, she was followed up 3 years later. The child (now 16 years old) reported using the headset every day for 3 years. Able to hear the teacher, she reported having passed school exams every year since using the device, and now had ambitions to study medicine.

Validating a Simulated Emergency Course for Nurses Working in ENT.

OBJECTIVES: Nurses are increasingly providing routine and emergency ENT care; yet there are often limited training opportunities. The aim of this study was to validate an intensive 1-day ENT emergency simulation course for nurses. METHODS: The course included short lectures, practical skills stations and mannequin simulation scenarios. Sixteen nurse participants were video-recorded managing simulated scenarios before and after the course. Two assessors scored individual participant performance on a 15-point competency grid (maximum score 30), blinded to the timing of the recording. Participants also rated their confidence and skill before and immediately following the course across 11 items using a 5-point Likert score (maximum score 55). RESULTS: Blinded assessor ratings for performance were significantly improved after the course compared to baseline (overall score 12 vs 7, respectively; P = .015). There was strong assessor inter-rater reliability (R = 0.965). Self-rated skills and confidence also increased following the course (46.7 vs 24.4 at baseline; P < .01). CONCLUSION: Simulation-based training is an effective and desirable method of teaching ENT emergency management to nurses, with greatest impact on participant confidence. Future courses need to refine the content and increase the validation sample size using a nurse-specific scoring system.

Skull Base Parachordoma/Myoepithelioma.

Parachordoma is a rare soft tissue mixed tumor, associated with soft tissue myoepithelioma. It is typically growing slowly and considered less aggressive than other similar soft tissue tumors. However, it does recur sporadically, and on rare occasions, it has demonstrated the ability to metastasize. Although imaging is important, definitive diagnosis is achieved by histology, and it is typically treated by a wide local excision. We present the first reported case of a skull base parachordoma in a 15-year-old boy, managed with a wide local excision and with no signs of recurrence or metastases after 24 months of follow-up.

Management of Hypertensive Patients With Multiple Drug Intolerances: A Single-Center Experience of a Novel Treatment Algorithm.

Multiple drug intolerance to antihypertensive medications (MDI-HTN) is an overlooked cause of nonadherence. In this study, 55 patients with MDI-HTN were managed with a novel treatment algorithm utilizing sequentially initiated monotherapies or combinations of maximally tolerated doses of fractional tablet doses, liquid formulations, transdermal preparations, and off-label tablet medications. A total of 10% of referred patients had MDI-HTN, resulting in insufficient pharmacotherapy and baseline office blood pressure (OBP) of 178±24/94±15 mm Hg. At baseline, patients were intolerant to 7.6±3.6 antihypertensives; they were receiving 1.4±1.1 medications. After 6 months on the novel MDI-HTN treatment algorithm, both OBP and home blood pressure (HBP) were significantly reduced, with patients receiving 2.0±1.2 medications. At 12 months, OBP was reduced from baseline by 17±5/9±3 mm Hg (P<.01, P<.05) and HBP was reduced by 11±5/12±3 mm Hg (P<.01 for both) while patients were receiving 1.9±1.1 medications. Application of a stratified medicine approach allowed patients to tolerate increased numbers of medications and achieved significant long-term lowering of blood pressure.

Vertical transmission of fungal endophytes is widespread in forbs.

To date, it has been thought that endophytic fungi in forbs infect the leaves of their hosts most commonly by air-borne spores (termed "horizontal transmission"). Here, we show that vertical transmission from mother plant to offspring, via seeds, occurs in six forb species (Centaurea cyanus, C. nigra,Papaver rhoeas,Plantago lanceolata,Rumex acetosa, and Senecio vulgaris), suggesting that this may be a widespread phenomenon. Mature seeds were collected from field-grown plants and endophytes isolated from these, and from subsequent cotyledons and true leaves of seedlings, grown in sterile conditions. Most seeds contain one species of fungus, although the identity of the endophyte differs between plant species. Strong evidence for vertical transmission was found for two endophyte species, Alternaria alternata and Cladosporium sphaerospermum. These fungi were recovered from within seeds, cotyledons, and true leaves, although the plant species they were associated with differed. Vertical transmission appears to be an imperfect process, and germination seems to present a bottleneck for fungal growth. We also found that A. alternata and C. sphaerospermum occur on, and within pollen grains, showing that endophyte transmission can be both within and between plant generations. Fungal growth with the pollen tube is likely to be the way in which endophytes enter the developing seed. The fact that true vertical transmission seems common suggests a more mutualistic association between these fungi and their hosts than has previously been thought, and possession of endophytes by seedling plants could have far-reaching ecological consequences. Seedlings may have different growth rates and be better protected against herbivores and pathogens, dependent on the fungi that were present in the mother plant. This would represent a novel case of trans-generational resistance in plants.