Tinnitus after Blast Injury; a Prospective Study in Basrah, Iraq.

BACKGROUND: There is many civilians and soldiers who exposed to explosions in Iraq each month and they need an otolaryngological and audiological assessment. OBJECTIVE: To recognize the possible auditory insults and the recovery period of the acquired damages that may resulted from explosion and help for planning of optimal management strategies of otological manifestations and prevent undesirable consequences. PATIENTS AND METHODS: A prospective, descriptive study included forty-seven patients who were exposed to blast injuries within two weeks came to otolaryngology unit in Basrah Teaching Hospital complaining from otological symptoms from July 2017 tell January 2019. Three periodic assessments were done for each patient. An initial evaluation was done in the 1st visit included a detailed history and examination to evaluate the symptoms and assess the associated non-otological injury. An otological examination were done for all patients in the three visits, included microscopic ear examination, photos for the perforated tympanic membrane were taken to grade the perforations depending on their surface area, Pure tone audiometry and tympanometry. Thirty-eight patients were available to follow up in the 2nd and 3rd visits. RESULTS: All of the 47 patients were young and middle age male, hearing loss and tinnitus were the most presenting symptoms, which improved with time. Hearing impairment mostly in the high frequencies however there was improvement in the subsequent visits. The majority of patients (93.6%) presented with tympanic membrane perforation mostly grade I which usually healed spontaneously. There was a statistically significant associations between the degree of tympanic membrane perforation and associated nonotological injuries and with the explosions if occurred in closed space. CONCLUSION: Blast related otological injury constitute the main cause of morbidity as the ear is the most sensitive organ to explosive blast injury. Hearing loss was the dominant symptoms at presentation mainly in high frequencies, but fortunately most of patients improved with time. Tympanic membrane perforation constituted the mostly seen sign, however spontaneous healing can be expected in the majority of cases.

Costs and Charges for Pediatric Tonsillectomy in New York State.

Objective In this study, we aimed to determine the correlation between costs/charges related to admissions for pediatric tonsillectomy in New York State (NYS) and variables including discharge year, All Patient Refined (APR) severity of illness, length of hospital stay, payment typology, location, race, and institutional factors during 2009-2017. Methods Data were extracted from the Statewide Planning and Research Cooperative System (SPARCS) Hospital Inpatient Discharges database developed by the NYS Department of Health. Statistical analysis was employed to determine multiple linear regression coefficients with the costs and charges set as the dependent variable. Results Costs increased by an estimated $230.73 (p<.001) each year, and charges increased by an estimated $1,231.41 (p<.001) annually. For each categorical increase in severity of illness, costs increased by $1,019.21 (p<.001), and charges increased by $3,088.41 (p<.001). For each day spent in the hospital, costs increased by $3,539.23 (p<.001), and charges increased by $8,908.01 (p<.001). Unspecified managed care had the highest mean costs and charges (p<.001). Bronx County had the highest costs, and Queens County had the highest charges. Queens County demonstrated the largest gap between costs and charges. Conclusion This study revealed that the costs and charges related to admissions for elective tonsillectomy had risen from 2009 to 2017, and these changes were not accounted for by inflation alone. We found that the costs and charges for inpatient pediatric tonsillectomy were significantly correlated with discharge year, APR severity of illness, length of hospital stay, location of the hospital, and primary payer.

Sensorineural hearing loss in patients with chronic renal failure on hemodialysis in Basrah, Iraq.

OBJECTIVES: The objective of this study is to determine the effect of hemodialysis on the hearing threshold in patients with chronic renal failure (CRF). MATERIALS AND METHODS: Fifty-nine patients with CRF on regular hemodialysis were followed up for 1 year with a pure-tone audiometric examination every 6 months. RESULTS: The mean age of the patients was 41.8 ± 9.2 years (range: 17-50 years). At the beginning of the study, 39 patients (66.1%) had sensorineural hearing loss (SNHL). During the 12-month follow-up, 6 more patients developed SNHL giving a point prevalence rate of 76.3% at the end of the study. The hearing loss was more evident in the higher frequencies. Of the studied patients, 64.4% showed deterioration of the hearing threshold. The mean hearing threshold at the beginning of the study was 29.2 ± 21.1 dB versus 36.9 ± 17.3 dB at the end of the study (P < 0.001). No significant relation was found between age, sex, serum electrolytes, blood urea, and duration of CRF and hearing loss. Multivariate analysis showed that the duration of hemodialysis was the only significant independent predictor of SNHL. CONCLUSION: SNHL is common in patients with CRF on hemodialysis. It was mild to moderate in the majority of patients. Hearing impairment was most obvious at the high frequencies. Most of the patients showed further deterioration in the hearing threshold with the duration of dialysis.

Length of stay for psychiatric inpatient services: a comparison of admissions of people with and without developmental disabilities.

This study investigated associations between the presence of developmental disabilities and length of inpatient stay for mental health care. All psychiatric admissions of people with developmental disabilities over a 5-year period were selected (n = 294), and were compared using survival analysis to a random sample of admissions from the general psychiatric population (n = 287). Overall, people with developmental disabilities stayed in hospital longer than those without developmental disabilities, and this extra stay was partially attributed to casemix differences between the cohorts. Subanalysis in both cohorts showed that those going back to their usual living arrangement stayed a shorter period than those who were discharged elsewhere, and that people with developmental disabilities were less likely to be discharged to their usual living arrangement than were people without the disability. This study highlighted the importance of specialized residential and personal supports for people with developmental disabilities and a coexisting mental disorder.

Acute psychiatric inpatient care for people with a dual diagnosis: patient profiles and lengths of stay.

OBJECTIVE: This study describes characteristics of psychiatry inpatients with developmental disabilities (DD) and their admissions to psychiatry wards in 2 acute care hospitals. It also compares differences in lengths of stay between admissions of this group with a comparison sample of inpatient admissions without DD. METHOD: A retrospective chart review was conducted on all individuals with DD who were psychiatric inpatients at 2 Kingston, Ontario, general hospitals, within a 4-year period (1994 to 1998). A comparison sample of admissions of patients without DD was chosen. Frequency tables were used to describe the inpatients with DD and to describe the 2 samples of admissions. Nonparametric statistics were used to compare the median length of stay between the 2 samples. Associations between length of stay and other covariates were explored within the sample of patient admissions with DD. RESULTS: The 62 individuals with DD had 101 admissions over the study period. Suicidal ideation was the most common admission reason (46%), and mood disorder was the most common discharge diagnosis (29%). The median length of stay for patients with DD was 8 days, which did not differ meaningfully from the comparison sample. Variables that were significantly associated with length of stay among individuals with DD included sex, referral source, and diagnosis. CONCLUSION: When individuals with DD are psychiatric inpatients, their length of stay is affected by some factors that have been identified in previous studies not specific to DD (for example, referral source and diagnosis). Our finding that male patients with DD have longer lengths of stay than do female patients in the same sample has not been reported in previous research.