A comparative examination of healthcare use related to hearing impairment in europe

Introduction: The economic burden of hearing impairment is an area of increased interest. In this paper we examine the relationship between hearing impairment and service use in 14 European countries. Methods: Based on the Survey of Health Ageing and Retirement in Europe (SHARE) undertaken in 2013, Poisson regression models are used to analyse the relationship between the number of visits/number of nights in hospital, and hearing impairment controlling for a number of covariates. Results: We find that hearing impairment is generally associated with increased use of primary and secondary healthcare services when other aspects of health have been controlled. Comparative analysis revealed that where access to hearing assistive technology was greatest the additional use of services was least. Conclusions: The comparative analysis suggests that variations exist across countries in respect of the additional healthcare use occasioned by hearing impairment. They may also provide valuable insights into how the burden of illness might be reduced

Allografts Use in Nasal Reconstruction

The outcomes of destructive processes of the nasal structure such as infection, chronic inflammation, or resective procedures can lead to the need of complex reconstruction of the nasal framework [1]. Various types of grafts and implants have been employed [2]. When dealing with a nasal reconstruction of whatever kind, the surgeon is faced by a clinical dilemma: which is the best material for reconstructive purposes in that patient? The materials used for augmentation are therefore an important issue among reconstructive rhinoplasty surgeons [3, 4]. A basic differentiation must be outlined between the terms of grafts and implants: a graft is made of tissue either from the same patient (autograft) or from a member of the same species (homograft). Implants are synthetic and if implantable are called alloplasts [5]. Alloplastic material is deemed desirable if noncarcinogenic, nonallergenic, readily available, resistant to mechanical strain, and entirely reabsorbable and still reliable. It is commonly perceived that autologous grafts are the first choice for augmenting the nose; unfortunately, this material is not always available or sufficient in cases of atrophic changes of the nose of whatever cause to fulfill the needs. However, limited availability, unpredictable resorption rates, difficulty of handling, and donor-site morbidity are possible drawbacks. In such instances, other choices must be considered, and alloplastic materials can represent an attractive alternative tool to take into account [6]. On the other hand, their efficacy complications and limited usage are 192 debated, such not uniform feelings and disputed possibilities have given rise to the development of different technologies to possibly reach ideal grafting substance (Fig. 16.1). In Western countries, surgeons prefer costal or auricular cartilage when septal cartilage is not available or insufficient, whereas alloplastic materials are more widely used in Asia [7]. Since the very beginning of the rhinoplasty history, many efforts have been made over time to use implants such as gold, iron, ivory, paraffin, celluloid, glass, and cork, eventually discorded due to unsurpassable troubles [8] (Figs. 16.2 and 16.3). Today, commonly used alloplastic materials are silicon, Gore-Tex® (Surgiform Technology, SC, USA), Medpor® (Stryker Corporate, a b c d Fig. 16.1 (a) CT scan and pathology specimen showing foreign body cystic reaction. Fibrous capsule with implant inside. (b) Latex implant of the dorsum (implanted 10 years previously), at moment inflamed, cistic and mobile, removed. (c) The removing of latex implant. (d) A fibrous capsule with implant inside P. G. Giacomini et al. 193 a b Fig. 16.2 (a) Kirschner steel wire and preserved costal cartilage implant of dorsum (10 years previously), for cocaine abuse outcomes. (b) Picture 6 months after removal a b Fig. 16.3 (a) CT scan, showing implant and the infected. (b) Mobile dorsal implant 16 Allografts Use in Nasal Reconstruction 194 MI, USA), and polydioxanone plate (PDS Flexible Plate, Johnson & Johnson Company, Langhorne, Pennsylvania, USA) [9]. An overview of their pros and cons will be conducted on the basis of the literature data and personal experience to highlight their possible use in case of atrophic nose outcomes that require surgical correction. Some exemplificative clinical cases of patients treated at the ENT Dept., School of Medicine, University of Rome Tor Vergata, at Nose Plastic Surgery Clinic in the past 10 years for complications associated with alloplastic materials used in atrophic rhinitis of various etiologies are reported. Clinical profiles: eight cocaine abuse, one purulent chronic infection, two outcomes of facial trauma, and one previous nasal surgery. M/F ratio: 1:4. The patients’ age ranged from 42 to 81 years (mean: 49 years). The follow-up period was 3–15 years (mean: 4.2 years). All had been treated elsewhere for augmentation rhinoplasty with alloplastic materials end eventually revised for complications occurred. Type of alloplastic materials used, complications developed, and results obtained were revised by medical charts, photo documentation, and histopathologic data examined. Literature data were considered in order to define alloplastic materials possibilities in this kind of nasal reconstruction