Tympanoplasty success based on surgeon and patient-reported outcomes perspectives : a 10-year review in a tertiary center

AVAILABILITY OF DATA AND MATERIALS : The dataset used and/or analyzed during the current study are available from the author on reasonable request.BACKGROUND : The latest international trends in healthcare put more emphasis on patients’ perspectives in reporting success in surgical procedures. A holistic approach in measuring surgical outcomes, defined as global success, should include the patient’s perioperative experiences, expectations, and outcome measures. In published literature, surgeons propose several definitions of post-operative successful surgical outcomes following tympanoplasty. Most surgical outcomes and the surgeon’s definition of success exclude the patient’s perspectives. Patient-reported outcomes would allow surgeons to understand and measure the benefit of the several procedures performed from the perspective of the patients. Current definitions of successful tympanoplasty do not capture patient reported outcomes which are important to patients. A divergence is frequently found between outcomes relevant to the patient and to the surgeon. Patient-reported outcomes would complement traditionally measured clinical outcomes by the surgeon to give a true global outcome measuring success. The main aim of the current study was to propose a definition of true global success following tympanoplasty by combining the patient’s and the surgeon’s reported satisfaction rate based on the indication and the goals for the operation. RESULTS : A total of 128 procedures were performed on128 ears in 125 patients, of which 52% (n = 57) were done on the right and 48% (n = 61) on the left side. There was no significant difference between the two groups (p = 0.07). There was a female preponderance, with 62% females and 44% males (p = 0.105). The majority of patients, 63% (n = 68), were between the age of 26 and 45 years, while 19% (n = 20) fell into the 46- to 60-year age range, with no significant difference between the groups (p = 0.21). There was complete graft take in 77% (107/128) of the ears in whereas 23% (21/128) of the ears the graft had not taken at the 6-month follow-up period. The true global success satisfaction rate was 92% (chi-square test = 119; p = 0.001) compared to the 77% surgical success. CONCLUSION : In assessing success in tympanoplasty, the patient- and surgeon-reported outcomes, when considered against agreed goals and indications, correlate well statistically. In this cohort, the true global success satisfaction rate was 92% (chi-square test = 119; p = 0.001 < 0.05) compared to 77% surgical success, based on graft take only. The combination of patient- and surgeon-reported outcomes would be beneficial in reporting true global success in tympanoplasty.https://ejo.springeropen.comam2023Otorhinolaryngolog

A bedside system for clinical grading of parotid gland enlargement

There are limited data on grading of parotid gland mass, and currently no bedside clinical grading system is available. Parotid enlargement is common in patients with HIV/AIDS, and the size of the gland can change depending on the progression of disease, with or without treatment. This needs to be recorded accurately and communicated properly. A novel system for bedside clinical grading of parotid gland enlargement using a soft tape measure is proposed

A bedside system for clinical grading of parotid gland enlargement

There are limited data on grading of parotid gland mass, and currently no bedside clinical grading system is available. Parotid enlargement is common in patients with HIV/AIDS, and the size of the gland can change depending on the progression of disease, with or without treatment. This needs to be recorded accurately and communicated properly. A novel system for bedside clinical grading of parotid gland enlargement using a soft tape measure is proposed.http://www.samj.org.zaam201

Migraine induced recurrent bloody otorrhea : a spontaneous extra-cranial hemorrhagic phenomena: case series

No abstract available.http://www.elsevier.com/locate/amjotohj2023Otorhinolaryngolog

Otosclerosis and TGF-β1 gene in black South Africans

Limited literature is available on the epidemiology and genetics of otosclerosis among SA Blacks in which it is extremely rare. We undertook this study as we had documented cases of clinical oval window otosclerosis confirmed surgically among South African Blacks

The application of xylocaine 10% pump-spray to improve immediate post-adenotonsillectomy pain in children : a randomized controlled trial

INTRODUCTION : Post-adenotonsillectomy pain is often severe, requiring substantial analgesia in the first 48–72 h. This pain is not only distressing to the patient and his or her parents, but often reflects poorly on an otherwise well performed procedure. Safe, simple and effective post-adenotonsillectomy pain control is still clinically elusive, even though a multitude of surgical and analgesic interventions have been proposed. OBJECTIVES : To investigate the analgesic properties of immediate post-operative application of xylocaine 10% pump spray to the tonsillar fossae in children having undergone adenotonsillectomy and how this impacts on anesthetic emergence and pain control in the first 24-h. METHODS : In this double-blinded, randomized, placebo-controlled trial, 80 children were stratified into two groups: Group I (3-8 years-old) and Group II (9–14 years-old). Within these groups, participants were randomized to receive either xylocaine 10% pump spray or normal saline 0.9% post-operatively. A standardized anesthetic/analgesic regime was used intra-operatively. The same surgeon performed all surgeries using bi-polar diathermy. Outcome variables included state of anesthetic emergence; pain scores at specific intervals; need for rescue analgesia; post-operative nausea and vomiting; time to first oral intake and comfort associated with initial oral intake. RESULTS : Xylocaine 10% pump spray consistently provided superior pain control at all time intervals compared to normal saline 0.9% (p = 0.011). This was most pronounced in children 3–8 years old (Group I). Xylocaine 10% pump spray and normal saline 0.9% provided similar pain relief in children 9–14 years old (Group (II) (p = 0.640). Children receiving xylocaine had a decreased incidence of emergence delirium and consistently required less rescue analgesia (p = 0.005). Children who received xylocaine did not eat sooner post-operatively, but they experienced less pain when ingesting liquids (p = 0.003) and solids (p = 0.000). Children who received xylocaine did not experience increased post-operative complications (p = 1.000) or nausea and vomiting (p = 0.153). CONCLUSION : Xylocaine 10% spray may serve as a valuable adjunct to effective pain control post-adenotonsillectomy, especially if long acting opioids are contraindicated, as with patients with obstructive sleep apnea. The benefit of xylocaine appears to be negligible when a long acting opioid is administered. The benefits of xylocaine were most noteworthy in children aged 3–8 years old. This is the largest trial (n = 80) to date to assess the efficacy of xylocaine spray in isolation post-adenotonsillectomy. Xylocaine also offers improved comfort with oral intake and decreases emergence delirium and need for rescue analgesia without any increase in post-operative complications. Local anesthesia may decrease costs and help to solve the conundrum of a painless adenotonsillectomy especially in resource-limited settings.https://www.elsevier.com/locate/ijporlhj2023Otorhinolaryngolog

Otolaryngological and head and neck manifestations in HIV-infected patients seen at Steve Biko Academic Hospital in Pretoria, South Africa

BACKGROUND. Sub-Saharan Africa has the highest incidence of HIV infection. According to recent census statistics, 5.6 million people in South Africa (SA) are HIV-positive, the highest number of infected individuals worldwide. Over 80% of HIV-infected individuals will present with ear, nose and throat (ENT) manifestations. Previous studies show that oral diseases seem to be the most common ENT-related manifestation, reported in about 40 - 50% of HIV-infected patients. In SA, there is lack of local information regarding the otolaryngological and head and neck manifestations in HIV-infected individuals. OBJECTIVE. To ascertain our local trends of ENT and head and neck manifestations in HIV-infected patients seen at our specialised ENT-HIV Clinic, Steve Biko Academic Hospital, Pretoria, Gauteng Province, SA. METHODS. A 1-year prospective study involving 153 HIV-infected patients was conducted in the clinic from January to December 2011. Patient history was taken and examinations were performed based on the World Health Organization (WHO) HIV/AIDS classification system. Data analysis was performed using Epi Info 7 software. RESULTS. The most common manifestations were adenoid hypertrophy/hyperplasia followed by cervical lymphadenopathy, chronic suppurative otitis media, otitis media with effusion and sensory-neural hearing loss. CONCLUSION. Patients typically presented with early manifestations during symptomatic WHO stages I and II in contrast to results reported in similar developing world studies from Iran, Nigeria and India. A possible explanation may lie in the SA government HIV Counselling and Testing campaign and the antiretroviral rollout programme, the effectiveness of which is becoming evident.http://www.samj.org.zaam201

Profound childhood hearing loss in a South Africa cohort : risk profile, diagnosis and age of intervention

OBJECTIVE : To describe profound childhood hearing loss in a South African population of pediatric cochlear implant recipients in terms of risk profile, and age of diagnosis and intervention. METHODS : A retrospective review of patient files for 264 pediatric cochlear implant recipients from five cochlear implant programs was conducted. Data was captured from 264 eligible subjects, of which all were implanted between 1996 and 2013 and PCEHL was confirmed under the age of 5 years old. Data collected included demographical information, risk factors from case histories, diagnostic test procedures conducted, diagnosis (type, onset and degree of hearing loss) and documented ages of caregiver suspicion, initial diagnosis and intervention. RESULTS : Risk factors for permanent childhood hearing loss were present in 51.1% of cases, with the most prevalent risks being NICU admittance (28.1%), family history of childhood hearing loss (19.6%) and prematurity (15.1%). An associated syndrome was diagnosed in 10% of children and 23.5% presented with at least one additional developmental condition. Hearing loss for most (77.6%) children was confirmed as congenital/early onset, while 20.3% presented with postnatal onset of hearing loss. ANSD was diagnosed in 5% of children, with admittance to NICU (80%) and hyperbilirubinemia (50%) being the most prevalent risk factors for these cases. Hearing loss was typically diagnosed late (15.3 months), resulting in delayed initial hearing aid fitting (18.8 months), enrollment in early intervention services (19.5 months) and eventual cochlear implantation (43.6 months). CONCLUSION : Most prevalent risk factors in profound childhood hearing loss were admittance to NICU, family history and prematurity. Diagnosis and intervention was typically delayed predisposing this population to poorer outcomes.http://www.elsevier.com/locate/ijporlhb201

Blood otorrhea : blood stained sweaty ear discharges : Hematohidrosis; four case series (2001-2013)

Hematohidrosis/hematidrosis/hemidrosis is a rare clinical condition in which human being sweats blood under condition of extreme physical or emotional stress [1. Jerajai HR, Bhagyashri Jaju, Phiske MM, and Nitin Lade. Hematohidrosis-a rare clinical phenomenon. Indian J Dermatol. 2009 Jul-Sep; 54(3): 290-292; 2. Martinez NL, Mas IB, Paz AFM, Boronat JL. Recurrent bleeding in an 18-year old girl. Arch Dermatol.2012; 148(8):960-961.] The capillary blood vessels that feed the sweat glands rupture, causing them to exude blood as sweat, under stressful conditions, occurring in religious (Jesus Christ prayer experience in Gethsemane) and non-religious (soldier sweat blood before battle) [2. Martinez NL, Mas IB, Paz AFM, Boronat JL. Recurrent bleeding in an 18-year old girl. Arch Dermatol.2012; 148(8):960-961.]. It is a condition where there is a spontaneous painless bleeding through unbroken skin in any part of the body. It is self-limiting in nature with a good prognosis [3. Patel RM, Mahajan S. Hematohidrosis: A rare clinical entity. Indian Dermatol Online J.2010 Jul; 1(1):30-2.]. The diagnosis of hematohidrosis is made on the presence of bloody discharge without any obvious cause through intact skin, witnessed and confirmed by health professional/doctor/nurse and the presence of blood components on biochemistry studies of the discharge. Hematohidrosis is a well-recognised diagnosis according to International Classification of Diseases (ICD-9-CM: 705-89) (ICD9 Data.com; 2013). This study reports the clinical finding, radiology, audiology and histology of four cases of a rare isolated otological hematohidrosis. Our cases are of particular interest because to our knowledge these are the first documented cases of psychogenic hematohidrosis isolated otological (ear) presentation. A comprehensive literature review was performed on reports documenting hematohidrosis/hematidrosis cases. The clinical presentation, diagnosis, treatment, pathophysiology and epidemiology of hematohidrosis. The purpose is to report and raise awareness of hematohidrosis among ENT patients.http://www.elsevier.com/locate/amjotohb201

Grommets and swimmers ear

Acute otitis media (AOM) is one of the most common childhood illnesses. While many children experience sporadic AOM episode, an important group suffer from recurrent AOM (rAOM), defined as three or more episodes in six months or four or more in one year. In this subset of children AOM poses a true burden through frequent episodes of ear pain, irritation, restlessness, pyrexia, general illness, sleepless nights and time lost from nursery or school. This group of children will suffer from poor language and school progress and will require temporary transient relief with ventilation tubes (grommets) or tympanotomy tubes can be offered for rAOM. Myringotomy with tympanostomy tubes is the most common otological surgery.http://www.safpj.co.za/index.php/safpjam2018Otorhinolaryngolog