Mobile tablet audiometry in fluctuating autoimmune ear disease

Abstract Background Autoimmune inner ear disease (AIED) is a rare condition characterized by bilateral fluctuating sensorineural hearing loss (SNHL). The labile nature of this hearing loss makes it difficult to accurately quantify with conventional methods, and therefore it is challenging to rehabilitate. Methods Over a 9-month period one pediatric patient with severe AIED was monitored and conducted home audiograms using a previously validated testing system (Shoebox Audiometry). During this period he also underwent several clinical audiograms. The correlation between clinical and home audiograms was analyzed with a Pearson coefficient, and the range and frequency of fluctuations was recorded. Results Sixty-four automated home audiograms and nine clinical audiograms were conducted. When tested at home using a calibrated system the pure tone average (PTA) fluctuated between 12 dB and 72 dB indicating large variability in hearing. Fluctuations were frequent: on 28 occasions the PTA varied by at least 5 dB when retested within 4 days. The mean PTA was 50 dB and 95% of the thresholds were within 36 dB of the mean. Clinical audiograms obtained on the same day or within 1 day of home testing were highly concordant (with a Pearson coefficient of 0.93). Conclusion AIED can result in significant fluctuations in hearing over short periods of time. Home testing enables a more granular look at variations over time and correlates well with clinical testing, and thus facilitates rapid action and informed rehabilitation

Does medical school research productivity predict a resident’s research productivity during residency?

Abstract Background Research productivity is an important component of the CanMEDS Scholar role and is an accreditation requirement of Canadian Otolaryngology training programs. Our objective was to determine if an association exists between publication rates before and during Otolaryngology residency. Methods We obtained the names for all certified Canadian Otolaryngologists who graduated between 1998 and 2013 inclusive, and conducted a Medline search for all of their publications. Otolaryngologists were subgrouped based on year of residency graduation and the number of articles published pre-residency and during residency (0 or ≥1). Chi-squared analyses were used to evaluate whether publications pre-residency and year of graduation were associated with publications during residency. Results We obtained data for 312 Canadian Otolaryngologists. Of those 312 graduates, 46 (14.7%) had no identifiable publications on PubMed and were excluded from the final data analysis. Otolaryngology residents had a mean 0.65 (95% CI 0.50-0.80) publications before residency and 3.35 (95% CI 2.90-3.80) publications during residency. Between 1998 and 2013, mean publication rates before and during residency both increased significantly (R 2 = 0.594 and R 2 = 0.759, respectively), whereas publication rates after residency graduation has stagnated (R 2 = 0.023). The odds of publishing during residency was 5.85 times higher (95% CI 2.69-12.71) if a resident published prior to residency (p < 0.0001). The Spearman correlation coefficient between publications before and during residency is 0.472 (p < 0.0001). Conclusion Residents who publish at least one paper before residency are nearly six times as likely to publish during residency than those who did not publish before residency. These findings may help guide Otolaryngology program selection committees in ranking the best CaRMS candidates

Additional file 1: of Mobile tablet audiometry in fluctuating autoimmune ear disease

Complete audiometric dataset. (XLSX 31 kb

A case report of severe nasal ischemia from cold agglutinin disease and a novel treatment protocol including HBOT

Abstract Cold agglutinin disease (CAD) is a rare condition leading to blood agglutination and autoimmune hemolytic anemia. Cutaneous ischemia resulting from CAD in the head and neck is uncommon. Treatment regimens and outcomes vary widely in the literature and no clear protocol exists. This manuscript describes a patient with CAD who developed severe ischemia of the nose that resolved completely without sequellae following a medical regimen of aspirin, low molecular weight heparin, nitroglycerin ointment and hyperbaric oxygen therapy (HBOT). To our knowledge, this is the first reported case where nitroglycerin ointment or HBOT was successfully employed in the treatment of this complication

When symptoms don’t fit: a case series of conversion disorder in the pediatric otolaryngology practice

Abstract Background Conversion disorder refers to functional bodily impairments that can be precipitated by high stress situations including trauma and surgery. Symptoms of conversion disorder may mimic or complicate otolaryngology diseases in the pediatric population. Case presentation In this report, the authors describe 3 cases of conversion disorder that presented to a pediatric otolaryngology-head and neck surgery practice. This report highlights a unique population of patients who have not previously been investigated. The clinical presentation and management of these cases are discussed in detail. Non-organic otolaryngology symptoms of conversion disorder in the pediatric population are reviewed. In addition, we discuss the challenges faced by clinicians in appropriately identifying and treating these patients and present an approach to management of their care. Conclusion In this report, the authors highlight the importance of considering psychogenic illnesses in patients with atypical clinical presentations of otolaryngology disorders

The Radial Forearm Free Flap for Scalp and Forehead Reconstruction: A 20 Year Experience

Keypoints The ideal free flap for scalp reconstruction has adequate thickness, surface area and vascular pedicle length. The simplest possible method of reconstruction should be considered in all patients while achieving adequate resection and a good functional outcome. The radial forearm free flap provides excellent texture, color, pedicle length and reliability. It provides for outstanding coverage of the forehead, temple, vertex and occiput reconstruction. In our experience, it is as hardy as the latissimus dorsi flap in withstanding postoperative adjuvant radiation, and confers multiple advantages over the latissimus dorsi free flap including faster healing times and shorter hospital stays

Comparison of Radial Forearm Free Flap and Gastric Pull‐up in Pharyngo‐esophageal Reconstruction

Despite multiple reconstructive approaches proposed over the past several decades, there remains no consensus on the optimal method of reconstructing pharyngo‐esophageal defects. In this paper, we compare our experience with tubed radial forearm free flap (RFF) and gastric pull‐up (GP). Patients who underwent GP had lower rates of stricture formation, regardless of preoperative radiation status. Patients who underwent preoperative radiation had higher rates of stricture and fistula formation. Non‐radiated patients also had higher rates of return to oral diet. Gastric pull‐up offers lower rates of stricture and fistula formation, as well as high rates of return to oral diet. Patients who underwent preoperative radiation suffered higher rates of stricture and fistula regardless of reconstructive method