A systematic review on prevention and management of wound infections from cochlear implantation.

OBJECTIVE OF REVIEW: Surgical site infections are a recognised complication of cochlear implant (CI) surgery with significant morbidity. Our aim was to search for the optimum prevention and management strategy to deal with this issue. TYPE OF REVIEW: Systematic review. SEARCH STRATEGY: A systematic literature search was undertaken from the databases of Embase, CINAHL, MEDLINE® , Web of Science, Scopus and Cochrane Library according to the predefined inclusion and exclusion criteria. EVALUATION METHOD: All relevant titles, abstracts and full-text articles were reviewed by two authors who resolved any differences by discussion and consultation with senior authors. RESULTS: Fourteen articles were included in our review. The overall quality of evidence was low with the vast majority of the studies being retrospective case series and expert opinions. No randomised controlled trials were noted. We found consistent reports that intraoperative prophylactic antibiotics should be given to all patients undergoing CI and that the vast majority of CI wound infections had grown Staphylococcal spp. or Pseudomonas spp. CONCLUSION: Our review has not identified any reliable or reproducible strategies to prevent and deal with wound infections after CI. We strongly encourage further research within this field and would suggest that a consensus of opinions from a multidisciplinary panel of experts may be a pragmatic way forward as an effective guide

Acute otitis externa: Consensus definition, diagnostic criteria and core outcome set development.

OBJECTIVE: Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. STUDY DESIGN: COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. SETTING: Stakeholders from the United Kingdom. SUBJECTS AND METHODS: Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. RESULTS: Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was 'diffuse inflammation of the ear canal skin of less than 6 weeks duration'. CONCLUSION: The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life

Outcome and follow-up of patients requiring emergency oesophagoscopy for food bolus obstruction over a 5-year period

Introduction: OFBO is a common occurrence in the emergency setting. Endoscopic removal via rigid or flexible oesophagoscopy is only performed following failure to pass the obstruction after a period of observation and medical management. Despite recommendations from the ESGE, there is currently a lack of high-quality evidence to support the diagnostic work-up of these patients. Purpose: The purpose of this single centre study was to assess the outcome and follow-up of this population over a 5-year period. We retrospectively collected data regarding all patients undergoing emergency oesophagoscopy between 2012–2017 and recorded their outcomes and subsequent follow-up. R esults: We found that only 33% of patients had diagnostic investigations performed post-operatively and oesophageal pathology was detected in 44% of those investigated. Eosinophilic oesophagitis was the most common diagnosis and OGD was more likely to detect pathology compared to other modalities. C onclusion: Our study suggests that our findings could have been higher had all our patients underwent further investigation. Therefore, we would recommend a diagnostic work-up in all patients following a discussion of the risks associated with an endoscopic examination. We thoroughly support further large-scale collaborative research which can shed better light of evidence on the topic

Wyniki i 5-letnia obserwacja w grupie pacjentów wymagających pilnej ezofagoskopii z powodu niedrożności wywołanej kęsem pokarmowym

Wprowadzenie: OFBO to częste zjawisko w stanach nagłych. Endoskopowe usuwanie kęsa pokarmowego za pomocą sztywnego lub giętkiego ezofagoskopu wykonywane jest dopiero w razie braku poprawy po okresie obserwacji i leczenia zachowawczego. Pomimo sugestii ESGE, obecnie nie istnieją wysokiej jakości zalecenia, które określałyby zakres niezbędnego do przeprowadzenia w tej grupie chorych procesu diagnostycznego. C el: Celem tego jednoośrodkowego badania klinicznego była ocena wyników zabiegu i dalszej 5-letniej obserwacji osób zgłaszających się do oddziału laryngologicznego z powodu niedrożności górnego odcinka przełyku. Retrospektywnie zebrano dane dotyczące wszystkich pacjentów poddanych pilnej ezofagoskopii w latach 2012–2017 oraz odnotowano ich wyniki i dalsze obserwacje. Wyniki: Stwierdzono, że tylko 33% osób wykonało badania diagnostyczne w okresie pooperacyjnym, a patologię w obrębie przełyku wykryto u 44% badanych. Najczęstsze rozpoznanie stanowiło eozynofilowe zapalenie przełyku, a OGD wykrywało patologię częściej niż inne techniki diagnostyczne. Wnioski: Niniejsze badanie sugeruje, że wyniki mogłyby być wyższe, gdyby wszyscy analizowani pacjenci zostali poddani dalszym badaniom. W związku z powyższym autorzy niniejszej pracy zalecaliby przeprowadzenie procesu diagnostycznego u wszystkich osób, po uprzednim omówieniu ryzyka związanego z badaniem endoskopowym. Całkowicie wspieramy dalsze, zakrojone na szeroką skalę międzyośrodkowe badania, które mogą rzucić lepsze światło na dowody w tej kwestii

Aetiology and management options for secondary referred otalgia: a systematic review and meta-analyses

Objectives of review: To review the literature for the evidence base for the aetiology and management of referred otalgia, looking particularly at non-malignant, neuralgic, structural and functional issues. Type of review: Systematic review. Search strategy: A systematic literature search was undertaken from the databases of EMBASE, CINAHL, MEDLINE®, BNI, and Cochrane Library according to predefined inclusion and exclusion criteria. Evaluation method: All relevant titles, abstracts and full text articles were reviewed by three authors who resolved any differences by discussion and consultation with senior author. Results: 44 articles were included in our review. The overall quality of evidence was low, with the vast majority of the studies being case-series with three cohort and four randomised-controlled trials included. The prime causes and management strategies were focussed on temporomandibular joint dysfunction (TMJD), Eagle syndrome and neuralgia. Our meta-analyses found no difference on the management strategies for the interventions found. Conclusions: Referred otalgia is common and treatment should be aimed at the underlying pathology. Potential aetiologies are vast given the extensive sensory innervation of the ear. An understanding of this and a structured approach to patient assessment is important for optimal patient management