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Hammond WT, Gray MW. Broken silicone earplugs: removal success using a small camera in a deployed environment. BMJ Mil Health 2024; 170:267-268. [PMID: 36427862 DOI: 10.1136/military-2022-002251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/29/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - M W Gray
- Emergency Medicine, US Army Medical Department, Fort Sam Houston, San Antonio, Texas, USA
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Ibekwe TS, Rogers C, Nnodu O, Ramma L. Protocol for a comparative cross-sectional study on characterisation of auditory impairment in sickle cell disease and sickle cell trait and its impact on health-related quality of life in Nigeria. BMJ Open 2024; 14:e077200. [PMID: 38286692 PMCID: PMC10826583 DOI: 10.1136/bmjopen-2023-077200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/06/2023] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) and sickle cell traits (SCT) are genetically inherited red blood cell disorders common among people of African descent. Nigeria has a high prevalence of SCD, with a prevalence of 2.28%-3% and SCT, 25%-30%. Poorly managed SCD and SCT can lead to sensorineural hearing loss and health-related quality of life (HRQoL) issues. This research aims to assess these possible complications of SCD and SCT in Nigeria. METHODS AND ANALYSIS The study will use a comparative cross-sectional design at study power 80% to investigate the association between SCD/SCT, hearing impairment and HRQoL. Participants will be divided into two groups: a cohort and a control group. Hearing levels will be assessed through audiometric assessments and categorised by type and severity of hearing impairments using WHO classifications. HRQoL will also be assessed using WHO Disability Assessment Schedule 2.0. Statistical analyses will be performed using the SAS V.9.4, with parametric or non-parametric analysis depending on the distribution. Relationship between key variables will be determined via correlational tests, χ2, Fisher's exact test and multivariable logistic regression analyses. ETHICS AND DISSEMINATION The proposal has been fully reviewed and registered by the University of Cape Town's Faculty of Health Sciences Human Research Ethics Committee (HREC REF 228/2022) and the University of Abuja Teaching Hospital Human Research Ethics Committee (HREC/PR/2020/08/007). Information dissemination will be through conferences, peer-review publication and personal communications. The Strengthening the Reporting of Observational Studies in Epidemiology statement will be followed in writing the manuscript.
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Affiliation(s)
- Titus S Ibekwe
- Department of Otorhinolaryngology, University of Abuja, Abuja, Nigeria
- Division of Communication Sciences and Disorders, Department of Health and Rehabilitation Sciences, University of Cape Town Faculty of Health Sciences, Observatory, South Africa
| | - Christine Rogers
- Division of Communication Sciences and Disorders, Department of Health and Rehabilitation Sciences, University of Cape Town Faculty of Health Sciences, Observatory, South Africa
| | - Obiageli Nnodu
- Centre of Excellence for Sickle Cell Disease Research & Training (CESRTA), University of Abuja, Abuja, Nigeria
| | - Lebogang Ramma
- Division of Communication Sciences and Disorders, Department of Health and Rehabilitation Sciences, University of Cape Town Faculty of Health Sciences, Observatory, South Africa
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Schwarze K, Mathmann P, Schäfer K, Brannath W, Höhne PH, Altin S, Prein L, Naghipour A, Zielonkowski SM, Wasmuth S, Kanaan O, Am Zehnhoff-Dinnesen A, Schwalen AS, Schotenröhr A, Scharpenberg M, Schlierenkamp S, Stuhrmann N, Lang-Roth R, Demir M, Diekmann S, Neumann A, Gietmann C, Neumann K. Effectiveness and costs of a low-threshold hearing screening programme ( HörGeist) for individuals with intellectual disabilities: protocol for a screening study. BMJ Open 2023; 13:e070259. [PMID: 37202136 DOI: 10.1136/bmjopen-2022-070259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Individuals with intellectual disabilities (ID) often suffer from hearing loss, in most cases undiagnosed or inappropriately treated. The implementation of a programme of systematic hearing screening, diagnostics, therapy initiation or allocation and long-term monitoring within the living environments of individuals with ID (nurseries, schools, workshops, homes), therefore, seems beneficial. METHODS AND ANALYSIS The study aims to assess the effectiveness and costs of a low-threshold screening programme for individuals with ID. Within this programme 1050 individuals with ID of all ages will undergo hearing screening and an immediate reference diagnosis in their living environment (outreach cohort). The recruitment of participants in the outreach group will take place within 158 institutions, for example, schools, kindergartens and places of living or work. If an individual fails the screening assessment, subsequent full audiometric diagnostics will follow and, if hearing loss is confirmed, initiation of therapy or referral to and monitoring of such therapy. A control cohort of 141 participants will receive an invitation from their health insurance provider via their family for the same procedure but within a clinic (clinical cohort). A second screening measurement will be performed with both cohorts 1 year later and the previous therapy outcome will be checked. It is hypothesised that this programme leads to a relevant reduction in the number of untreated or inadequately treated cases of hearing loss and strengthens the communication skills of the newly or better-treated individuals. Secondary outcomes include the age-dependent prevalence of hearing loss in individuals with ID, the costs associated with this programme, cost of illness before-and-after enrolment and modelling of the programme's cost-effectiveness compared with regular care. ETHICS AND DISSEMINATION The study has been approved by the Institutional Ethics Review Board of the Medical Association of Westphalia-Lippe and the University of Münster (No. 2020-843 f-S). Participants or guardians will provide written informed consent. Findings will be disseminated through presentations, peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER DRKS00024804.
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Affiliation(s)
- Katharina Schwarze
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Philipp Mathmann
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Karolin Schäfer
- Department of Special Education and Rehabilitation, Education and Aural Rehabilitation of People who are Deaf or Hard of Hearing, University of Cologne, Cologne, Germany
| | - Werner Brannath
- Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | | | | | - Lukas Prein
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Awa Naghipour
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | | | - Susanne Wasmuth
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Oliver Kanaan
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | | | - Anna Sophia Schwalen
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Anna Schotenröhr
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Martin Scharpenberg
- Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Sarah Schlierenkamp
- Essener Forschungsinstitut für Medizinmanagement - EsFoMed GmbH, Essen, Germany
| | - Nicole Stuhrmann
- Practice for Otolaryngology, Phoniatrics & Paediatric Audiology, Duesseldorf-Meerbusch, Germany
- Phoniatrics and Paediatric Audiology, Head and Neck Surgery, Helios HSK, Wiesbaden, Germany
| | - Ruth Lang-Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Muhittin Demir
- Department of Otorhinolaryngology, Division of Phoniatrics and Paediatric Audiology, University Medicine Essen, Essen, Germany
| | - Sandra Diekmann
- Essener Forschungsinstitut für Medizinmanagement - EsFoMed GmbH, Essen, Germany
| | - Anja Neumann
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Corinna Gietmann
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Katrin Neumann
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
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Jakobsen Y, Christensen Andersen LA, Schmidt JH. Study protocol for a randomised controlled trial evaluating the benefits from bimodal solution with cochlear implant and hearing aid versus bilateral hearing aids in patients with asymmetric speech identification scores. BMJ Open 2022; 12:e070296. [PMID: 36581413 PMCID: PMC9806092 DOI: 10.1136/bmjopen-2022-070296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Cochlear implant (CI) and hearing aid (HA) in a bimodal solution (CI+HA) is compared with bilateral HAs (HA+HA) to test if the bimodal solution results in better speech intelligibility and self-reported quality of life. METHODS AND ANALYSIS This randomised controlled trial is conducted in Odense University Hospital, Denmark. Sixty adult bilateral HA users referred for CI surgery are enrolled if eligible and undergo: audiometry, speech perception in noise (HINT: Hearing in Noise Test), Speech Identification Scores and video head impulse test. All participants will receive new replacement HAs. After 1 month they will be randomly assigned (1:1) to the intervention group (CI+HA) or to the delayed intervention control group (HA+HA). The intervention group (CI+HA) will receive a CI on the ear with a poorer speech recognition score and continue using the HA on the other ear. The control group (HA+HA) will receive a CI after a total of 4 months of bilateral HA use.The primary outcome measures are speech intelligibility measured objectively with HINT (sentences in noise) and DANTALE I (words) and subjectively with the Speech, Spatial and Qualities of Hearing scale questionnaire. Secondary outcomes are patient reported Health-Related Quality of Life scores assessed with the Nijmegen Cochlear Implant Questionnaire, the Tinnitus Handicap Inventory and Dizziness Handicap Inventory. Third outcome is listening effort assessed with pupil dilation during HINT.In conclusion, the purpose is to improve the clinical decision-making for CI candidacy and optimise bimodal solutions. ETHICS AND DISSEMINATION This study protocol was approved by the Ethics Committee Southern Denmark project ID S-20200074G. All participants are required to sign an informed consent form.This study will be published on completion in peer-reviewed publications and scientific conferences. TRIAL REGISTRATION NUMBER NCT04919928.
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Affiliation(s)
- Yeliz Jakobsen
- Department of Oto-Rhino-Laryngology, Odense University Hospital, Odense C, Denmark
- Department of Audiology, Odense University Hospital, Odense C, Denmark
| | | | - Jesper Hvass Schmidt
- Department of Oto-Rhino-Laryngology, Odense University Hospital, Odense C, Denmark
- Department of Audiology, Odense University Hospital, Odense C, Denmark
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Yan L, Zheng H, Zhang H, Dai L, Zhang Q. Is mesenchymal stem cell effective for allergic rhinitis? A protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e062435. [PMID: 36270760 PMCID: PMC9594526 DOI: 10.1136/bmjopen-2022-062435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Allergic rhinitis (AR) is a kind of widespread but unrecognised inflammatory disorder of nasal mucosa, characterised by itching, sneezing, runny nose and nasal congestion. The efficacy of mesenchymal stem cells (MSCs) in the treatment of AR remains controversial. This protocol describes a systematic review and meta-analysis approach to assess the efficacy and safety of MSCs in the treatment of AR. METHODS AND ANALYSIS Eight databases (PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP and Wanfang) will be searched from the database inception to 1 December 2023. All randomised controlled trials related to MSCs for AR will be included. The primary outcomes will be therapeutic effect, serum IgE index and Visual Analogue Scale score for nasal symptoms. Risk of bias will be assessed using the Cochrane Collaboration's tool for assessing risk of bias. Article selection, data extraction and risk of bias assessment will be performed in duplicate by two independent reviewers. ETHICS AND DISSEMINATION Ethics approval is not required because individual patient data are not included. This protocol was registered in the international Prospective Register of Systematic Reviews on 22 January 2022. The systematic review and meta-analysis will be submitted for publication in a peer-reviewed journal. The findings will also be disseminated through conference presentations. PROSPERO REGISTRATION NUMBER CRD42022303146.
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Affiliation(s)
- Le Yan
- School of Medical and Life Sciences, Chengdu College of Traditional Chinese Medicine, Chengdu, China
| | - Hanxue Zheng
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese, Chengdu, Sichuan, China
| | - Huiping Zhang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lintong Dai
- Panzhihua City Hospital of Integrated Traditional Chinese and Western Medicine, Panzhihua, Sichuan, China
| | - Qinxiu Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Wu E, Ni J, Zhu Z, Xu H, Ci J, Tao L, Xie T. Association of sleep duration and noise exposure with hearing loss among Chinese and American adults: two cross-sectional studies. BMJ Open 2022; 12:e062535. [PMID: 36127089 PMCID: PMC9490609 DOI: 10.1136/bmjopen-2022-062535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine the associations of sleep duration (SPD) and noise exposure with hearing loss (HL) among Chinese and American adults. DESIGN Two cross-sectional studies. SETTING The National Health and Nutrition Examination Survey (2011-2012), and Zhejiang Chinese participants between 1 January 2018 and 1 November 2021. PARTICIPANTS 3322 adults from the USA and 4452 adults from Zhejiang, China. MAIN OUTCOME MEASURES HL was defined as a pure-tone average >20 dB in the better ear at low frequency (500, 1000 and 2000 Hz), speech frequency (500, 1000, 2000 and 4000 Hz) or high frequency (3000, 4000, 6000 and 8000 Hz). Binary logistic regression analysis quantified the associations between SPD, noise exposure (at work or off-work) and HL. RESULTS SPD ≥8 hours/night had an OR of 0.71 (95% CI 0.59 to 0.84) for high-frequency HL vs. an SPD of 6-8 hours/night among the Chinese participants but had an OR of 1.28 (95% CI 1.03 to 1.58) among American participants. Noise exposure (both at work and off-work) was associated with poorer low-frequency (OR 1.58, 1.43; p<0.05), speech-frequency (OR 1.63, 1.29; p<0.05) and high-frequency (OR 1.37, 1.23; p<0.05) hearing among the Chinese participants; and it was associated with worse high-frequency hearing (OR 1.43, 1.66; p<0.05) among the American participants. The negative relationship between SPD ≥8 hours/night and HL was mainly observed in the Chinese participants with noise exposure (OR <1, p<0.05), and SPD ≥8 hours/night associated with poorer HF hearing was only identified in the American participants without noise exposure (OR >1, p<0.05). CONCLUSIONS Noise exposure was associated with poorer hearing. SPD ≥8 hours/night was negatively associated with HL in the Chinese participants especially when exposed to noise. SPD ≥8 hours/night was related to poorer high-frequency hearing in the American participants when they had no noise exposure.
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Affiliation(s)
- E Wu
- School of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang, China
- Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines; Engineering Laboratory of Development and Application of Traditional Chinese Medicines; Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Juntao Ni
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhaohui Zhu
- School of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Hongquan Xu
- School of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang, China
- Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines; Engineering Laboratory of Development and Application of Traditional Chinese Medicines; Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jun Ci
- Department of Otorhinolaryngology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lin Tao
- School of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang, China
- Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines; Engineering Laboratory of Development and Application of Traditional Chinese Medicines; Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Tian Xie
- School of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang, China
- Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines; Engineering Laboratory of Development and Application of Traditional Chinese Medicines; Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Gür E, Binkhamis G, Kluk K. Effects of multiple sclerosis on the audio-vestibular system: a systematic review. BMJ Open 2022; 12:e060540. [PMID: 35977771 PMCID: PMC9389089 DOI: 10.1136/bmjopen-2021-060540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Systematically investigate the effects of multiple sclerosis (MS) on the audio-vestibular system. METHODS Systematic review of literature investigating audio-vestibular conditions in persons with MS (PwMS) aged ≥18 years. PubMed, Scopus, NICE and Web of Science were searched. Randomised controlled trials, and cohort, case-control, observational and retrospective studies in English, published from 2000 to 21 November 2021, evaluated PwMS with at least one outcome (pure tone audiometry, auditory brainstem response, otoacoustic emissions, cortical auditory evoked potentials, functional MRI assessing auditory function, vestibular evoked myogenic potentials, videonystagmography, electronystagmography, posturography, rotary chair, gaps in noise, word discrimination scores, duration pattern sequence test), were included. Study selection and assessments of bias were independently conducted by two reviewers using the Risk of Bias Assessment Tool for Non-randomized Studies, Newcastle-Ottawa Scale (NOS) and the NOS adapted for cross-sectional studies. RESULTS 35 studies were included. Auditory function was evaluated in 714 PwMS and 501 controls, vestibular function was evaluated in 682 PwMS and 446 controls. Peripheral auditory function results were contradictory between studies; some found abnormalities in PwMS, and others found no differences. Tests of brainstem and central auditory functions were more consistently found to be abnormal in PwMS. Most vestibular tests were reported as abnormal in PwMS, abnormalities were either peripheral or central or both. However, quantitative analyses could not be performed due to discrepancies between studies in results reporting, test stimulus and recording parameters. CONCLUSIONS Although abnormal results on auditory and vestibular tests were noted in PwMS, specific effects of MS on the audio-vestibular system could not be determined due to the heterogeneity between studies that restricted the ability to conduct any quantitative analyses. Further research with consistent reporting, consistent stimulus and consistent recording parameters is needed in order to quantify the effects of MS on the auditory and vestibular systems. PROSPERO REGISTRATION NUMBER CRD42020180094.
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Affiliation(s)
- Evrim Gür
- Manchester Centre for Audiology and Deafness (ManCAD), School of Health Sciences, Ellen Wilkinson Building, The University of Manchester, Manchester, UK
| | - Ghada Binkhamis
- Manchester Centre for Audiology and Deafness (ManCAD), School of Health Sciences, Ellen Wilkinson Building, The University of Manchester, Manchester, UK
- Communication and Swallowing Disorders, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Karolina Kluk
- Manchester Centre for Audiology and Deafness (ManCAD), School of Health Sciences, Ellen Wilkinson Building, The University of Manchester, Manchester, UK
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Assouly K, Smit AL, Stegeman I. Effect of electrical stimulation with a cochlear implant on tinnitus impact: protocol of an individual patient data meta-analysis. BMJ Open 2022; 12:e063432. [PMID: 35715189 PMCID: PMC9208004 DOI: 10.1136/bmjopen-2022-063432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/31/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Tinnitus is the perception of sound without an external stimulus, often experienced as a ringing, buzzing sound. While several studies have shown a reduction in tinnitus distress following cochlear implantation, others showed an increase or no change after implantation. At this stage, clinicians have little certainty when counselling their patients prior to implantation regarding tinnitus post-implantation. To help clinicians to counsel cochlear implant (CI) candidates on the risk of developing or improving tinnitus after implantation, we aim to assess the effect of electrical stimulation with a CI on tinnitus impact for individual adult patients with tinnitus. We will also apply prediction models to individual patient data (IPD) of clinical trials to find predictive factors of the effect of electrical stimulation on tinnitus impact. METHOD AND ANALYSIS The IPD meta-analysis is a follow-up project of the systematic review on cochlear implantation in patients with tinnitus as a primary complaint. First, the systematic searches will be updated to date. Methodological quality of eligible studies will be assessed using the Risk of Bias In Non-randomised Studies of Intervention tool (ROBINS-I). Based on a data-sharing agreement, authors of the eligible studies will be invited to share their deidentified and complete IPD. The primary outcome is the effect of electrical stimulation with a CI on tinnitus impact 1 month or more post-implantation. IPD meta-analysis will be used to assess the primary outcome, while differentiating the tinnitus impact questionnaires. Second, linear regression analyses will be used to model the effect of electrical stimulation on tinnitus impact based on relevant predictors. ETHICS AND DISSEMINATION The Medical Research Involving Human Subject Act does not apply, and ethical approval is not required. The study results will be made accessible to the public in a peer-review open access journal. PROSPERO REGISTRATION NUMBER CRD42022319367, review ongoing.
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Affiliation(s)
- Kelly Assouly
- Department of Otorhinolaryngology and Head & Neck Surgery, UMC Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands
- Cochlear Technology Centre Belgium, Mechelen, Belgium
| | - Adriana L Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, UMC Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head & Neck Surgery, UMC Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands
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Nobre ML, Sarmento ACA, Nobre MG, Bedaque HDP, Medeiros KS, Cobucci RN, Gonçalves AK. Image guidance for endoscopic sinus surgery in patients with chronic rhinosinusitis: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e053436. [PMID: 35459663 PMCID: PMC9036459 DOI: 10.1136/bmjopen-2021-053436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Endoscopic sinus surgery (ESS) is a current procedure for treating patients with chronic rhinosinusitis (CRS). Image-guided surgery (IGS) for ESS may help reduce complications and improve precision. However, it is uncertain in which cases IGS is beneficial. This work aims to compare ESS with and without IGS in patients with CRS. METHODS AND ANALYSIS PubMed, Embase, Scopus, Web of Science, Scielo, Cochrane Central Register of Controlled Trials, CINAHL, LILACS and Clinicaltrials.gov will be searched for reported clinical trials comparing the quality of life and perioperative outcomes of ESS with and without navigation. The search is planned for 20 April 2022. Three independent authors will select eligible articles and extract their data. The risk of bias will be assessed using the Cochrane Handbook for Systematic Reviews of Interventions. The Grading of Recommendation Assessment, Development and Evaluation method will evaluate the strength of the evidence. Data synthesis will be performed using the Review Manager software V.5.4.1. To assess heterogeneity, I2 statistics will be computed. Additionally, meta-analysis will be performed if the included studies are sufficiently homogenous. ETHICS AND DISSEMINATION This study reviews published data, and thus it is not necessary to obtain ethical approval. The findings of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020214791.
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Affiliation(s)
- Maria Luisa Nobre
- Health Sciences Postgraduate Program, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Surgery, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | | | - Kleyton Santos Medeiros
- Health Sciences Postgraduate Program, Federal University of Rio Grande do Norte, Natal, Brazil
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
| | | | - Ana Katherine Gonçalves
- Health Sciences Postgraduate Program, Federal University of Rio Grande do Norte, Natal, Brazil
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Taylor S, Cairns A, Glass BD. Feasibility, accessibility and acceptability a pharmacist-led ear health intervention at rural community pharmacies (LISTEN UP): a mixed-methods study in Queensland, Australia. BMJ Open 2022; 12:e057011. [PMID: 35365533 PMCID: PMC8977761 DOI: 10.1136/bmjopen-2021-057011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Ear disease in rural and remote communities is occurring at high rates, with limited access to health services and health providers contributing to the problem. Community pharmacists are well-placed to provide expanded services to improve ear health in rural communities. We aimed to evaluate the feasibility, accessibility and acceptability of a pharmacist-led intervention for ear disease in consumers presenting to community pharmacy. DESIGN Prospective preintervention and postintervention mixed-methods study. An ethnographic lens of rural culture was applied to the descriptive qualitative component of the study. SETTING Two rural community pharmacies in Queensland, Australia. PARTICIPANTS People aged 6 months or older, who present with an ear complaint to a participating community pharmacy. INTERVENTION LISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Programme) is a community pharmacy-based intervention to improve the management of ear health. Trained pharmacists conducted ear examinations using otoscopy and tympanometry on consumers following a LISTEN UP protocol. They made recommendations including no treatment, pharmacy only products or general practitioner (GP) referral. Consumers were contacted 7 days later for follow-up. RESULTS 55 rural consumers participated in the study. The most commonly reported complaints were 'blocked ear' and 'ear pain'. Pharmacists recommended over-the-counter products to two-thirds of the participants and referred one quarter to a GP. 90% (50/55) of the consumers were highly satisfied with the service and would recommend the service. All consumers described the service positively with particular reference to convenience, improved confidence and appreciation of the knowledge gained about their ear complaint. Pharmacists were motivated to upskill and manage workflow to incorporate the service and expected both consumers and GPs to be more accepting of future expanded services as a result of LISTEN UP. However, without funding to provide the service, during the study other remunerated pharmacy tasks took priority over providing LISTEN UP. CONCLUSION Rural community pharmacists can provide an acceptable and accessible ear health service; however, it is not feasible without a clear funding structure to provide resources including additional pharmacists, equipment and training. TRIAL REGISTRATION NUMBER ACTRN12620001297910.
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Affiliation(s)
- Selina Taylor
- Centre for Rural and Remote Health Mount Isa, James Cook University, Mount Isa, Queensland, Australia
| | - Alice Cairns
- Centre for Rural and Remote Health Mount Isa, James Cook University, Mount Isa, Queensland, Australia
| | - Beverley Dawn Glass
- Pharmacy, James Cook University Division of Tropical Health and Medicine, Townsville, Queensland, Australia
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Tan HQM, Pendolino AL, Andrews PJ, Choi D. Prevalence of olfactory dysfunction and quality of life in hospitalised patients 1 year after SARS-CoV-2 infection: a cohort study. BMJ Open 2022; 12:e054598. [PMID: 35078845 PMCID: PMC8795927 DOI: 10.1136/bmjopen-2021-054598] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/01/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To determine the long-term prevalence of olfactory and/or gustatory dysfunction (OD±GD), associated risk factors and impact on quality of life (QoL) in previously hospitalised patients with COVID-19 1 year after infection. DESIGN A single-centre cohort study. SETTING Patients admitted at a large central London hospital with COVID-19 infection between 10 February 2020 and 22 May 2020. PARTICIPANTS 150 adult subjects with previously confirmed SARS-CoV-2 infection were recruited between 10 December 2020 and 29 January 2021. Participants were predominantly male (102/150, 68.0%); mean age 58.0±15.9 years and 41.2% (56/136) were of black, Asian and minority ethnic backgrounds. MAIN OUTCOME MEASURES EQ-5D-5L values and Sino-Nasal Outcome Test-22 (SNOT-22) scores. RESULTS Long-term prevalence of OD±GD was 12.8% (19/149) at median time of 264.5 days following SARS-CoV-2 infection onset. Patients with OD±GD had a significantly higher median total SNOT-22 score (46.1; Q1-Q3: 23.0-60.0; 95% CI 23.0 to 60.0) compared with those without (16.0; Q1-Q3: 5.0-30.5; 95% CI 12.0 to 18.0) (p=0.0002), reflecting poorer QoL, particularly psychological well-being (p=0.0004), which was not alleviated with time (p=0.4977). Median EQ-5D-5L value was not significantly different between patients with OD±GD (0.70; Q1-Q3: 0.38-0.83; 95% CI 0.38 to 0.83) and those without (0.83; Q1-Q3: 0.61-0.94; 95% CI 0.75 to 0.89) (p=0.0627). Age, sex, ethnicity, smoking status, highest C reactive protein value, intubation and ventilation, and oxygen supplementation were not found to influence OD±GD (p>0.05). CONCLUSIONS 12.8% of previously hospitalised patients with COVID-19 in London still report persistent problems with smell or taste up to a year after infection, impacting their QoL. Increased holistic support including psychological therapy and olfactory rehabilitation for affected patients may help to reduce long-term morbidity.
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Affiliation(s)
- Hui Qi Mandy Tan
- UCL Medical School, University College London, London, UK
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Alfonso Luca Pendolino
- Department of Ear, Nose and Throat, Royal National ENT & Eastman Dental Hospitals, London, UK
- UCL Ear Institute, University College London, London, UK
| | - Peter J Andrews
- Department of Ear, Nose and Throat, Royal National ENT & Eastman Dental Hospitals, London, UK
- UCL Ear Institute, University College London, London, UK
| | - David Choi
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
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Payten CL, Nguyen DD, Novakovic D, O'Neill J, Chacon AM, Weir KA, Madill CJ. Telehealth voice assessment by speech language pathologists during a global pandemic using principles of a primary contact model: an observational cohort study protocol. BMJ Open 2022; 12:e052518. [PMID: 35039289 PMCID: PMC8764716 DOI: 10.1136/bmjopen-2021-052518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION SARS-CoV-2, a highly contagious severe acute respiratory syndrome, has spread to most countries in the world and resulted in a change to practice patterns for the assessment and diagnosis of people with voice disorders. Many services are transitioning to telehealth models to maintain physical distancing measures and conserve personal protective equipment used by healthcare workers during laryngoscopy examinations. The speech-language pathology primary contact (SLPPC) assessment for patients referred to ear, nose and throat (ENT) services in Australia has been shown to reduce waiting times for assessment while streamlining access to ENT assessment and allied health practitioner treatment pathways. METHODS AND ANALYSIS A prospective observational cohort study will see patients in a newly developed telehealth model which uses the principles from a usual care SLPPC assessment protocol. Participants will be offered an initial telehealth assessment (speech-language pathology primary contact telehealth (SLPPC-T)) prior to being prioritised for a face-to-face laryngoscopy assessment to complete the diagnostic process. The telehealth assessment will collect sociodemographic information, personal and family medical history, key symptoms, onset and variability of symptoms, red-flag signs or symptoms for laryngeal malignancy, and clinical voice assessment data for auditory-perceptual and acoustic analysis. The study outcomes include (1) association of signs, symptoms and specific voice measures collected during SLPPC-T with voice disorder classification provided after laryngoscopy; (2) degree of concordance between voice disorder classification after SLPPC-T and after laryngoscopy; (3) health service and patient-related costs and health outcomes of the SLPPC-T; (4) patient and stakeholder views and beliefs about the SLPPC-T process. ETHICS AND DISSEMINATION Ethical approval has been granted prior to commencement of the study enrolment by the Gold Coast Hospital and Health Service Human Research Ethics Committee (reference number HREC/2020/QGC/62832). Results will be shared through the publication of articles in peer-reviewed medical journals and presentation at national and international scientific meetings. TRIAL REGISTRATION NUMBER ACTRN12621000427875.
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Affiliation(s)
- Christopher L Payten
- Department of Speech Pathology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Duy Duong Nguyen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Novakovic
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John O'Neill
- Department of Ear, Nose and Throat, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Antonia M Chacon
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kelly A Weir
- School of Allied Health Sciences, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
- Department of Research and Education, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Catherine J Madill
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Wu Q, Yuan L, Qiu H, Wang X, Huang X, Zheng R, Yang Q. Efficacy and safety of omalizumab in chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2021; 11:e047344. [PMID: 34479933 PMCID: PMC8420736 DOI: 10.1136/bmjopen-2020-047344] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the efficacy and safety of omalizumab for chronic rhinosinusitis with nasal polyps (CRSwNP) and to identify evidence gaps that will guide future research on omalizumab for CRSwNP. DESIGN Systematic review and meta-analysis. DATA SOURCES A comprehensive search was performed in PubMed, Embase, Web of Science and the Cochrane Library on 13 October 2020. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) comparing omalizumab with placebo, given for at least 16 weeks in adult patients with CRSwNP. DATA EXTRACTION AND SYNTHESIS Two independent authors screened search results, extracted data and assessed studies using the Cochrane risk of bias tool. Data were pooled using the inverse-variance method and expressed as mean differences (MDs) with 95% CIs. Heterogeneity was assessed by the χ2 test and the I2 statistic. RESULTS A total of four RCTs involving 303 participants were identified. When comparing omalizumab to placebo, there was a significant difference in Nasal Polyps Score (MD=-1.20; 95% CI -1.48 to -0.92), Nasal Congestion Score (MD=-0.67; 95% CI -0.86 to -0.48), Sino-Nasal Outcome Test-22 (MD=-15.62; 95% CI -19.79 to -11.45), Total Nasal Symptom Score (MD=-1.84; 95% CI -2.43 to -1.25) and reduced need for surgery (risk ratio (RR)=5.61; 95% CI 1.99 to 15.81). Furthermore, there was no difference in the risk of serious adverse events ((RR=1.40; 95% CI 0.29 to 6.80), adverse events (RR=0.83; 95% CI 0.60 to 1.15) and rescue systemic corticosteroid (RR=0.52; 95% CI 0.17 to 1.61). CONCLUSIONS This was the first meta-analysis that identified omalizumab significantly improved endoscopic, clinical and patient-reported outcomes in adults with moderate to severe CRSwNP and it was safe and well tolerated. PROSPERO REGISTRATION NUMBER CRD42020207639.
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Affiliation(s)
- Qingwu Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Lianxiong Yuan
- Department of Science and Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Huijun Qiu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xinyue Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xuekun Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Rui Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Qintai Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
- Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
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Abstract
OBJECTIVES The current study examined predictors of outcomes of internet-based cognitive-behavioural therapy (ICBT) for individuals with tinnitus. DESIGN Secondary analysis of intervention studies. SETTING Internet-based guided tinnitus intervention provided in the UK. PARTICIPANTS 228 individuals who underwent ICBT. INTERVENTIONS ICBT. PRIMARY AND SECONDARY OUTCOME MEASURES The key predictor variables included demographic, tinnitus, hearing-related and treatment-related variables as well as clinical factors (eg, anxiety, depression, insomnia), which can have an impact on the treatment outcome. A 13-point reduction in Tinnitus Functional Index (TFI) scores has been defined as a successful outcome. RESULTS Of the 228 subjects who were included in the study, 65% had a successful ICBT outcome. As per the univariate analysis, participants with a master's degree or above had the highest odds of having a larger reduction in tinnitus severity (OR 3.47; 95% CI 1.32 to 12.51), compared with the participants who had education only up to high school or less. Additionally, the baseline tinnitus severity was found to be a significant variable (OR 2.65; 95% CI 1.50 to 4.67) contributing to a successful outcome with the intervention. Both linear and logistic regression models have identified education level and baseline tinnitus severity to be significant predictor variables contributing to a reduction in tinnitus severity post-ICBT. As per the linear regression model, participants who had received disability allowance had shown a 25.3-point lower TFI reduction compared with those who did not experience a decrease in their workload due to tinnitus after adjusting for baseline tinnitus severity and their education level. CONCLUSIONS Predictors of intervention outcome can be used as a means of triaging patients to the most suited form of treatment to achieve optimal outcomes and to make healthcare savings. Future studies should consider including a heterogeneous group of participants as well as other predictor variables not included in the current study.ClinicalTrial.gov Registration: NCT02370810 (completed); NCT02665975 (completed).
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Affiliation(s)
- Hansapani Rodrigo
- School of Mathematical and Statistical Sciences, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Eldré W Beukes
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas, USA
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Chelmsford, UK
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institute, Stockholm, Sweden
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas, USA
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
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Inciarte A, Cardozo C, Chumbita M, Alcubilla P, Torres B, González Cordón A, Rico V, Aguero D, García-Pouton N, Hernández-Meneses M, Albiach L, Meira F, De la Mora L, Linares L, Puerta-Alcalde P, Macaya I, Mensa J, Laguno M, Ambrosioni J, Ramos A, Morata L, Bodro M, Moreno-García E, Moreno A, Sola M, Rojas J, Leal L, Torres M, Garcia-Vidal C, Martínez JA, Alobid I, Soriano A, Garcia F. Gustatory and olfactory dysfunctions in hospitalised patients with COVID-19 pneumonia: a prospective study. BMJ Open 2021; 11:e040775. [PMID: 34404693 PMCID: PMC8375450 DOI: 10.1136/bmjopen-2020-040775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 04/28/2021] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Identifying undetected clinical signs is imperative in the prevention of SARS-CoV-2. OBJECTIVE To establish the prevalence of clinical gustatory and olfactory dysfunctions in patients with COVID-19 pneumonia. Clinical outcomes and recovery rates associated with gustatory and olfactory dysfunctions were also assessed. DESIGN A prospective study was performed in 80 patients admitted to Hospital Clínic of Barcelona (Spain) for COVID-19 pneumonia. Patients were re-evaluated in the ward daily until discharge. Gustatory and olfactory dysfunction symptoms were retrospectively collected from emergency room (ER) charts after first assessments. Follow-up was performed in telemedicine consultation. SETTING The single-centre study was performed in a hospitalisation ward at a university hospital. PARTICIPANTS Consecutive patients meeting hospitalisation criteria for COVID-19 pneumonia were eligible. Study exclusion criteria were patients who could not speak, had previous gustatory and olfactory dysfunctions or whose PCR tests for SARS-CoV-19 were negative. INTERVENTIONS Systematic assessment of gustatory and olfactory symptoms with standardised questions. OUTCOMES Prevalence of gustatory and olfactory dysfunctions in patients with COVID-19 pneumonia. RESULTS Of the 80 study subjects, 62.5% were male and the median age was 57 years. Half of the cohort (n=40) presented with comorbidities. The prevalence of chemosensitive disorder was 73.8% (n=59) (95% CI: 63.8 to 83.8), although self-reported symptoms were recorded in only 26.3% (n=21) of patients in the ER. Gustatory and olfactory dysfunctions were observed in 58.8% (n=47) and 55% (n=44) of cases, respectively. They were also the first symptoms in 25% (n=20) of patients. Anosmia was associated with ageusia, OR: 7, 95% CI: 2.3 to 21.8, p=0.001). No differences in clinical outcomes were observed when patients with and without gustatory and olfactory dysfunctions were compared. Recovery rates were 20% (n=10) and 85% (n=42) at days 7 and 45, respectively. CONCLUSION The prevalence of gustatory and olfactory dysfunctions in COVID-19 pneumonia was much higher than in self-report. Presence of gustatory and olfactory dysfunctions was not a predictor of clinical outcomes.
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Affiliation(s)
- Alexy Inciarte
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Celia Cardozo
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Mariana Chumbita
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Pau Alcubilla
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Berta Torres
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Ana González Cordón
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Veronica Rico
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Daiana Aguero
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Laia Albiach
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Fernanda Meira
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Lorena De la Mora
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Laura Linares
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | | | - Irene Macaya
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Montse Laguno
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Angela Ramos
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Laura Morata
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | | | - Antonio Moreno
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Montse Sola
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Jhon Rojas
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Lorna Leal
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
| | - Manuel Torres
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Jose Antonio Martínez
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Isam Alobid
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
| | - Felipe Garcia
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciencies, University of Barcelona, Barcelona, Spain
- AIDS and HIV infection, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
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Schenck AA, Kruyt JM, van Benthem PP, Cannegieter SC, van den Hout WB, Böhringer S, Hammer S, Hombergen SPM, Blom HM. Effectiveness of endolymphatic duct blockage versus endolymphatic sac decompression in patients with intractable Ménière's disease: study protocol for a double-blinded, randomised controlled trial. BMJ Open 2021; 11:e054514. [PMID: 34376454 PMCID: PMC8356157 DOI: 10.1136/bmjopen-2021-054514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Outcomes of surgery for Ménière's disease (MD) remain discordant. Recently, a new surgical procedure in which the endolymphatic duct is clipped was proposed. To date, only one prospective trial assessing this technique was published, yielding promising results. This protocol describes a prospective, double-blinded, randomised controlled trial that will be carried out to assess the effectiveness of this surgical intervention. METHODS Eighty-four patients with intractable MD will be recruited from 13 hospitals in the Netherlands. Intraoperatively, randomisation will determine whether endolymphatic duct blockage (EDB) or endolymphatic sac decompression (ESD) will be performed. Randomisation will be 1:1 stratified for gender and duration of MD (recent-onset versus mature MD). All participants receive vestibular rehabilitation after surgery. Patients are followed up during 1 year after surgery. Follow-up visits will take place at 1 week, 3 months, 6 months and 12 months after surgery. The main study endpoint is proportion of patients who are free of vertigo spells at 12 months postoperatively. Secondary parameters include cumulative number of vertigo bouts, co-intervention, tinnitus, hearing, quality of life, cost effectiveness and a budget impact analysis. Total duration of the study is 4 years. ANALYSIS The primary analysis will follow the intention-to-treat principle. For the primary outcome, a χ2 test will be performed. Secondary outcomes will be analysed using a linear mixed model (EDB versus decompression group) at the different time measurement point. ETHICS AND DISSEMINATION This study was reviewed and approved by a board of specialists before funding was obtained, as well as by the Medical Research Ethics Committee Leiden-The Hague-Delft and the boards of all participating centres. Results of this study will be published in international peer-reviewed scientific journals and will be presented on (inter)national scientific conferences and meetings. TRIAL REGISTRATION NUMBERS NL9095 and ISRCTN12074571; Pre-Results.
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Affiliation(s)
- Annejet A Schenck
- Department of Otorhinolaryngology, Haga Hospital, The Hague, The Netherlands
| | - Josephina M Kruyt
- Department of Otorhinolaryngology, Medical Centre Haaglanden, The Hague, The Netherlands
| | - Peter Paul van Benthem
- Department of Otorhinolaryngology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Suzanne C Cannegieter
- Department of Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wilbert B van den Hout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Stefan Böhringer
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Henk M Blom
- Department of Otorhinolaryngology, Haga Hospital, The Hague, The Netherlands
- Department of Otorhinolaryngology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium
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Almufarrij I, Dillon H, Munro KJ. Is the outcome of fitting hearing aids to adults affected by whether an audiogram-based prescription formula is individually applied? A systematic review protocol. BMJ Open 2021; 11:e045899. [PMID: 34341039 PMCID: PMC8330563 DOI: 10.1136/bmjopen-2020-045899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Hearing aids are typically programmed using the individual's audiometric thresholds. Developments in technology have resulted in a new category of direct-to-consumer devices, which are not programmed using the individual's audiometric thresholds. This review aims to identify whether programming hearing aids using the individual's audiogram-based prescription results in better outcomes for adults with hearing loss. METHODS AND ANALYSIS The methods of this review are reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. On 23 August 2020, eight different databases were systematically searched without any restrictions: EMBASE, MEDLINE, PubMed, PsycINFO, Web of Science, Cochrane Library, Emcare and Academic Search Premier. To ensure that this review includes the most recent evidence, the searches will be repeated at the final write-up stage. The population of interest of this review will be adults with any degree or type of hearing loss. The studies should compare hearing aids programmed using an audiogram-based prescription (and verified in the real ear) with those not programmed on the basis of the individual's audiogram. The primary outcome of interest is consumers' listening preferences. Hearing-specific health-related quality of life, self-reported listening ability, speech intelligibility of words and sentences in quiet and noisy situations, sound quality ratings and adverse events are the secondary outcomes of interest. Both randomised and non-randomised controlled trials will be included. The quality of each individual study and the overall evidence will be assessed using Downs and Black's checklist and the Grading of Recommendations, Assessment, Development and Evaluations tool, respectively. ETHICS AND DISSEMINATION We will only retrieve and analyse data from published studies, so no ethical approval is required. The review findings will be published in a peer-reviewed journal and presented at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42020197232.
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Affiliation(s)
- Ibrahim Almufarrij
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, UK
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Harvey Dillon
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, UK
- Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
| | - Kevin J Munro
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, UK
- Manchester University Hospitals NHS Foundation, Trust Manchester Academic Health Science Centre, Manchester, UK
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Xu M, Zang J, Luo S, Wang J, Li X. Long-term survival outcomes and adverse effects of nasopharyngeal carcinoma patients treated with IMRT in a non-endemic region: a population-based retrospective study. BMJ Open 2021; 11:e045417. [PMID: 34341036 PMCID: PMC8330594 DOI: 10.1136/bmjopen-2020-045417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the long-term survival outcomes and adverse effects of intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) and to summarise the experiences of IMRT in NPC in the past few decades in non-endemic northwest China. DESIGN A population-based retrospective study. SETTING An experience of using IMRT in non-endemic region of China. PARTICIPANTS The study included 792 newly diagnosed and non-metastatic NPC patients who received IMRT from January 2006 to September 2018 in Xijing Hospital. OUTCOME MEASURES The survival outcomes, adverse effects and failure patterns were evaluated by univariate, multivariate and subgroup analyses. RESULTS With a median follow-up time of 46.2 months, the 5-year local recurrence-free survival, regional recurrence-free survival, distant metastasis-free survival, disease-free survival (DFS) and overall survival (OS) rates were 90.8%, 97.0%, 82.8%, 69.6% and 78.0%, respectively. Multivariate analysis showed that age, N stage, clinical stage, pathological type and primary tumour volume of more than 23 cm3 were the independent prognosis factors for DFS (all p<0.05); age, N stage, pathological type, cervical lymph node necrosis, and anaemia were significantly associated with OS (all p<0.05). The most common acute toxicities of IMRT were dermatitis, mucositis and dysphagia. Xerostomia and hearing impairment were the top two late toxicities. The main failure patterns were distant metastasis and local and/or regional relapses. CONCLUSIONS Similar survival, toxicities and failure patterns have been observed in patients treated with IMRT in a non-endemic area of China when compared with that in endemic areas. Induction chemotherapy combined with concurrent chemoradiotherapy may benefit locally advanced NPC in non-endemic areas of China.
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Affiliation(s)
- Man Xu
- Department of Gengral Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Radiation Oncology, Xi'an Gaoxin Hospital, Xi'an, Shaanxi, China
| | - Jian Zang
- Department of Radiation Oncology, Air Force Medical University Xijing Hospital, Xian, Shaanxi, China
| | - Shanquan Luo
- Department of Radiation Oncology, Air Force Medical University Xijing Hospital, Xian, Shaanxi, China
| | - Jianhua Wang
- Department of Radiation Oncology, Air Force Medical University Xijing Hospital, Xian, Shaanxi, China
| | - Xuqi Li
- Department of Gengral Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Matos-Semedo F, Cruz C, Inácio F, Gama JMR, Nwaru BI, Taborda-Barata L. House dust mite (HDM) and storage mite (SM) molecular sensitisation profiles and association with clinical outcomes in allergic asthma and rhinitis: protocol for a systematic review. BMJ Open 2021; 11:e046519. [PMID: 34312197 PMCID: PMC8314702 DOI: 10.1136/bmjopen-2020-046519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Identification and characterisation of single allergens at molecular level is important. Component-resolved diagnosis offers the possibility of higher diagnostic precision, thereby allowing better patient management. House dust mites (HDM) have a worldwide distribution. Studies from different countries have shown that IgE-mediated allergy to storage mites (SM) is important in rural and urban populations. With the availability of HDM and SM molecular allergen components, studies have investigated whether different molecular sensitisation profiles are associated with clinical disease outcomes. However, no previous systematic review has synthesised the underlying evidence. METHODS AND ANALYSIS We will search Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), MEDLINE, EMBASE, CINAHL, AMED, ISI Web of Science (Science and Social Science Index) from inception to March 2020. Unpublished and ongoing work, as well as research in progress will be searched in www.ClinicalTrials.gov; www.controlledtrials.com and wwwanzctrorgau. We will contact an international panel of experts in this field. No language restrictions will apply; translations will be undertaken where necessary. The Critical Appraisal Skills Programme quality assessment tool will be used to appraise the methodological quality of included studies. A descriptive summary with data tables will be constructed, and if adequate, meta-analysis using random effects will be performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be followed for reporting. ETHICS AND DISSEMINATION Since this systematic review will be only based on published and retrievable literature, no ethics approval is required. We will publish the systematic review in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER reviewregistry959.
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Affiliation(s)
- Filipa Matos-Semedo
- Department of Immunoallergy, Hospital da Luz, Lisbon, Portugal
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Cíntia Cruz
- Department of Immunoallergy, Hospital da Luz, Lisbon, Portugal
| | - Filipe Inácio
- Department of Immunoallergology, Hospital de São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Jorge M R Gama
- Mathematics, Centre of Mathematics and Applications, University of Beira Interior, Covilhã, Portugal
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Luís Taborda-Barata
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
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20
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Abstract
OBJECTIVES We performed a cross-sectional analysis of data from the nationwide Korea National Health and Nutrition Examination Survey to evaluate the association between obesity and chronic rhinosinusitis with nasal polyps (CRSwNP) or without nasal polyp (CRSsNP). DESIGN Retrospective cross-sectional analysis of health survey data. SETTING Voluntary survey of representative South Korean populations. PARTICIPANTS In total, 32 384 individuals aged 19 years or older with available data on CRS and obesity were included. PRIMARY AND SECONDARY OUTCOME MEASURES Diagnosis of CRSwNP or CRSsNP was performed by trained otolaryngologists through sinus endoscopy and surveys of medical history. General and central obesity was diagnosed using body mass index (BMI) and waist circumference (WC), respectively. METHODS A multivariate logistic regression analysis was used to clarify the association between CRSwNP or CRSsNP and obesity according to BMI and WC. Non-obese individuals were recruited as controls. RESULTS The prevalence of CRSwNP was higher in the general (OR, 1.438; 95% CI, 1.170 to 1.768; p<0.001) and central (OR, 1.251; 95% CI, 1.031 to 1.520; p=0.033) obesity groups than in the control group. Prevalence of CRSsNP was not correlated with obesity. In a logistic regression analysis, olfactory dysfunction (OR, 1.329; 95% CI, 1.137 to 1.553; p<0.001) and purulent discharge (OR, 1.383; 95% CI, 1.193 to 1.603; p<0.001) showed a higher incidence in the central obesity group than in the control group. CONCLUSIONS We demonstrated an association between CRSwNP and general and central obesity. Further investigations on the mechanism underlying this correlation are necessary for an improved understanding of the pathogenesis of CRSwNP.
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Affiliation(s)
- Jae-Sung Nam
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Ho Roh
- Department of Medical Statistics, Yonsei University College of Medicine, Seoul, Korea
| | - Wasan Almazouq Fahad
- Department of Otorhinolaryngology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hae-Eun Noh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Gyun Ha
- Department of Otorhinolaryngology, Yonsei University Yongin Severance Hospital, Yongin, Korea
| | - Joo-Heon Yoon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
- Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
- Korea Mouse Sensory Phenotyping Center, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Hoon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
- Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
- Korea Mouse Sensory Phenotyping Center, Yonsei University College of Medicine, Seoul, Korea
- Taste Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
- Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
- Korea Mouse Sensory Phenotyping Center, Yonsei University College of Medicine, Seoul, Korea
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Assouly K, Smit AL, Stegeman I, Rhebergen KS, van Dijk B, Stokroos R. Cochlear implantation for tinnitus in adults with bilateral hearing loss: protocol of a randomised controlled trial. BMJ Open 2021; 11:e043288. [PMID: 34006544 PMCID: PMC8130732 DOI: 10.1136/bmjopen-2020-043288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Tinnitus is the perception of sound without an external stimulus, often experienced as a ringing or buzzing sound. Subjective tinnitus is assumed to origin from changes in neural activity caused by reduced or lack of auditory input, for instance due to hearing loss. Since auditory deprivation is thought to be one of the causes of tinnitus, increasing the auditory input by cochlear implantation might be a possible treatment. In studies assessing cochlear implantation for patients with hearing loss, tinnitus relief was seen as a secondary outcome. Therefore, we will assess the effect of cochlear implantation in patients with primarily tinnitus complaints. METHOD AND ANALYSIS In this randomised controlled trial starting in January 2021 at the ENT department of the UMC Utrecht (the Netherlands), patients with a primary complaint of tinnitus will be included. Fifty patients (Tinnitus Functional Index (TFI) >32, Beck's Depression Index <19, pure tone average at 0.5, 1, 2 and 4 kHz: bilateral threshold between 50 and ≤75 dB) will be randomised towards cochlear implantation or no intervention. Primary outcome of the study is tinnitus burden as measured by the TFI. Outcomes of interest are tinnitus severity, hearing performances (tinnitus pitch and loudness, speech perception), quality of life, depression and patient-related changes. Outcomes will be evaluated prior to implantation and at 3 and 6 months after the surgery. The control group will receive questionnaires at 3 and 6 months after randomisation. We expect a significant difference between the cochlear implant recipients and the control group for tinnitus burden. ETHICS AND DISSEMINATION This research protocol was approved by the Institutional Review Board of the University Medical Center (UMC) Utrecht (NL70319.041.19, V5.0, January 2021). The trial results will be made accessible to the public in a peer-review journal. TRIAL REGISTRATION NUMBER Trial registration number NL8693; Pre-results.
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Affiliation(s)
- Kelly Assouly
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Cochlear Technology Centre, Mechelen, Belgium
| | - Adriana L Smit
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Koenraad S Rhebergen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Robert Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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22
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Coulter M, Mickelson RC, Dye JL, Myers EE, Ambrosio AA. Laryngotracheal and pharyngoesophageal traumatic injuries from US military operations in Iraq and Afghanistan, 2003-2017. BMJ Mil Health 2021; 169:231-235. [PMID: 33911010 DOI: 10.1136/bmjmilitary-2020-001769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Laryngotracheal and pharyngo-oesophageal trauma present military providers with especially difficult, life-threatening challenges. Although effective treatment strategies are crucial, there is no clear consensus. This study of combat injuries from Iraq and Afghanistan describes initial treatment outcomes. METHODS US service members who sustained 'laryngotracheal' and 'pharyngoesophageal' injuries while deployed in military operations from 2003 to 2017 were identified from the Expeditionary Medical Encounter Database. Those with inhalation or ingestion injuries and an Injury Severity Score (ISS) <16 were excluded. Data on demographics, survival, mechanism and type of injury and diagnostic and therapeutic intervention were recorded. RESULTS A total of 111 service members met inclusion criteria. Nearly one-third (32.4%) were killed in action (KIA) or died of wounds (DoW). Fatality was not significantly associated with age, theatre of operation, type of injury or mechanism of injury, but was associated with a higher ISS and those in the Marines. Although survival rates were not significantly different, the frequency of these injuries decreased after the introduction of cervical collar protection in 2007. Of those who DoW or survived, 41.1% required a surgical airway. Tracheobronchoscopy was performed in 25.6%, oesophagoscopy in 20.0% and oesophagram in 6.7%. Of the 85 with penetrating neck injuries, 43 (50.6%) underwent neck exploration, in which 31 (72.1%) required intervention. CONCLUSIONS Severe laryngotracheal and pharyngo-oesophageal injuries have a high fatality rate and demand prompt treatment from skilled providers. Further work will elucidate preventive measures and clear management algorithms to optimise outcomes.
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Affiliation(s)
- Michael Coulter
- Otolaryngology-Head & Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - R C Mickelson
- Otolaryngology-Head and Neck Surgery, US Naval Hospital Yokosuka, Yokosuka, Yokohama, Japan
| | - J L Dye
- Axiom Resource Management, San Diego, California, USA
| | - E E Myers
- Naval Health Research Center, San Diego, California, USA
| | - A A Ambrosio
- Otolaryngology-Head & Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
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Watson J, Coleman E, Jackson C, Bell K, Maynard C, Hickson L, Forster A, Fairhurst C, Hewitt C, Gardner R, Iley K, Gailey L, Thyer NJ. Randomised controlled feasibility trial of an active communication education programme plus hearing aid provision versus hearing aid provision alone (ACE To HEAR). BMJ Open 2021; 11:e043364. [PMID: 33827834 PMCID: PMC8031014 DOI: 10.1136/bmjopen-2020-043364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To establish the acceptability and feasibility of delivering the Active Communication Education (ACE) programme to increase quality of life through improving communication and hearing aid use in the UK National Health Service. DESIGN Randomised controlled, open feasibility trial with embedded economic and process evaluations. SETTING Audiology departments in two hospitals in two UK cities. PARTICIPANTS Twelve hearing aid users aged 18 years or over who reported moderate or less than moderate benefit from their new hearing aid. INTERVENTIONS Consenting participants (along with a significant other) were to be randomised by a remote, centralised randomisation service in groups to ACE plus treatment-as-usual (intervention group) or treatment-as-usual only (control group). PRIMARY OUTCOME MEASURES The primary outcomes were related to feasibility: recruitment, retention, treatment adherence and acceptability to participants and fidelity of treatment delivery. SECONDARY OUTCOME MEASURES International Outcomes Inventory for Hearing Aids, Self-Assessment of Communication, EQ-5D-5L and Short-Form 36. Blinding of the participants and facilitator was not possible. RESULTS Twelve hearing aid users and six significant others consented to take part. Eight hearing aid users were randomised: four to the intervention group; and four to treatment-as-usual only. Four significant others participated alongside the randomised participants. Recruitment to the study was very low and centres only screened 466 hearing aid users over the 15-month recruitment period, compared with the approximately 3500 anticipated. Only one ACE group and one control group were formed. ACE could be delivered and appeared acceptable to participants. We were unable to robustly assess attrition and attendance rates due to the low sample size. CONCLUSIONS While ACE appeared acceptable to hearing aid users and feasible to deliver, it was not feasible to identify and recruit participants struggling with their hearing aids at the 3-month posthearing aid fitting point. TRIAL REGISTRATION NUMBER ISRCTN28090877.
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Affiliation(s)
- Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Kerry Bell
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Christina Maynard
- Leeds Institute of Cardiovascular & Metabolic Medicine, Univerity of Leeds, Leeds, UK
| | - Louise Hickson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Rob Gardner
- Audiology Department, Bradford Royal Infirmary, Bradford, UK
| | - Kate Iley
- Audiology Department, York Teaching Hospital NHS Foundation Trust, York, UK
| | | | - Nicholas J Thyer
- Leeds Institute of Cardiovascular & Metabolic Medicine, Univerity of Leeds, Leeds, UK
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Affiliation(s)
- Jeyasakthy Saniasiaya
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Prepageran Narayanan
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Abstract
INTRODUCTION Dizziness is one of the most common symptoms seen in chronic vestibular syndrome, which has been linked to an increased risk of falls, substantial disability and negative psychological consequences. Recent evidence demonstrated that vestibular rehabilitation therapy (VRT) is effective for treating chronic vestibular symptoms. However, the delivery of VRT remains challenging because of lack of facility, insufficient qualified physiotherapist resources, as well as being in the actual situation of the pandemic. WeChat, the most widely used mobile app in China, offers a more viable way of delivering VRT than traditional office-based approaches do. This study aimed to evaluate the effectiveness of the WeChat-VRT programme for patients with chronic vestibular syndrome. METHODS AND ANALYSIS This is a parallel-group, assessor-blinded randomised controlled trial. Fifty patients who experienced chronic vestibular symptoms longer than 3 months will be randomised into either the WeChat-VRT group or the usual care (UC) group. Participants in the WeChat-VRT group will receive 8-week VRT mainly through the WeChat app. Participants in the UC group will receive once-weekly VRT in the clinic for 8 weeks and remaining time home-based exercise. Outcome assessments will take place at baseline and at the 8th, 12th and 24th weeks after randomisation. The primary outcome will be the change from baseline to the eighth week on the patients' functional improvements quantified by the Functional Gait Assessment (FGA). The secondary outcomes will include dynamic balance function, emotional well-being, and vestibular activity and participation level. Intention-to-treat analysis will be performed using generalised estimation equation modelling. ETHICS AND DISSEMINATION The trial has been reviewed and approved by the Institutional Review Board of Eye and Ear Nose Throat Hospital of Fudan University (reference number 2017047/1). The study findings will be disseminated via peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER ChiCTR2000029457; Pre-results.
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Affiliation(s)
- Peixia Wu
- Nursing Department, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Yafang Wan
- Nursing Department, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Yu Zhuang
- Fudan University School of Nursing, Shanghai, China
| | - Chennan Wang
- Fudan University School of Nursing, Shanghai, China
| | - Shuxin Xi
- Medical Department, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Hui Zhu
- Shanghai Chaorun Network Technology Ltd, Shanghai, China
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Cai Y, Yu JG, Chen Y, Liu C, Xiao L, M Grais E, Zhao F, Lan L, Zeng S, Zeng J, Wu M, Su Y, Li Y, Zheng Y. Investigating the use of a two-stage attention-aware convolutional neural network for the automated diagnosis of otitis media from tympanic membrane images: a prediction model development and validation study. BMJ Open 2021; 11:e041139. [PMID: 33478963 PMCID: PMC7825258 DOI: 10.1136/bmjopen-2020-041139] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study investigated the usefulness and performance of a two-stage attention-aware convolutional neural network (CNN) for the automated diagnosis of otitis media from tympanic membrane (TM) images. DESIGN A classification model development and validation study in ears with otitis media based on otoscopic TM images. Two commonly used CNNs were trained and evaluated on the dataset. On the basis of a Class Activation Map (CAM), a two-stage classification pipeline was developed to improve accuracy and reliability, and simulate an expert reading the TM images. SETTING AND PARTICIPANTS This is a retrospective study using otoendoscopic images obtained from the Department of Otorhinolaryngology in China. A dataset was generated with 6066 otoscopic images from 2022 participants comprising four kinds of TM images, that is, normal eardrum, otitis media with effusion (OME) and two stages of chronic suppurative otitis media (CSOM). RESULTS The proposed method achieved an overall accuracy of 93.4% using ResNet50 as the backbone network in a threefold cross-validation. The F1 Score of classification for normal images was 94.3%, and 96.8% for OME. There was a small difference between the active and inactive status of CSOM, achieving 91.7% and 82.4% F1 scores, respectively. The results demonstrate a classification performance equivalent to the diagnosis level of an associate professor in otolaryngology. CONCLUSIONS CNNs provide a useful and effective tool for the automated classification of TM images. In addition, having a weakly supervised method such as CAM can help the network focus on discriminative parts of the image and improve performance with a relatively small database. This two-stage method is beneficial to improve the accuracy of diagnosis of otitis media for junior otolaryngologists and physicians in other disciplines.
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Affiliation(s)
- Yuexin Cai
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Jin-Gang Yu
- Department of Automation Science and Engineering, South China University of Technology School, Guangzhou, Guangdong, China
| | - Yuebo Chen
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Chu Liu
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Lichao Xiao
- Department of Automation Science and Engineering, South China University of Technology School, Guangzhou, Guangdong, China
| | - Emad M Grais
- Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Fei Zhao
- Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Liping Lan
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Shengxin Zeng
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Junbo Zeng
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Minjian Wu
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yuejia Su
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yuanqing Li
- Department of Automation Science and Engineering, South China University of Technology School, Guangzhou, Guangdong, China
| | - Yiqing Zheng
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
- Institute of Hearing and Speech-Language Science, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
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Abstract
OBJECTIVE To assess incidence and changes in tinnitus and bothersome tinnitus as well as associated risk factors in a large sample of UK adults. DESIGN Prospective cohort study. SETTING UK. PARTICIPANTS For cross-sectional analysis, a group of 168 348 participants aged between 40 and 69 years with hearing and tinnitus data from the UK Biobank resource. Longitudinal analysis included a subset of 4746 people who attended a 4-year retest assessment. MAIN OUTCOME MEASURES Presence and bothersomeness of tinnitus. RESULTS 17.7% and 5.8% of participants reported tinnitus or bothersome tinnitus, respectively. The 4-year incidence of tinnitus was 8.7%. Multivariate logistic regression models suggested that age, hearing difficulties, work noise exposure, ototoxic medication and neuroticism were all positively associated with both tinnitus and bothersome tinnitus. Reduced odds of tinnitus, but not bothersome tinnitus, was seen in alcohol drinkers versus non-drinkers. Male gender was associated with increased odds of tinnitus, while female gender was associated with increased odds of bothersome tinnitus. At follow-up, of those originally reporting tinnitus, 18.3% reported no tinnitus. Of those still reporting tinnitus, 9% reported improvement and 9% reported tinnitus becoming more bothersome, with the rest unchanged. Male gender and alcohol consumption were associated with tinnitus being reported less bothersome, and hearing difficulties were associated with the odds of tinnitus being reported as more bothersome. CONCLUSIONS This study is one of the few to provide data on the natural history of tinnitus in a non-clinical population, suggesting that resolution is relatively uncommon, with improvement and worsening of symptoms equally likely. There was limited evidence for any modifiable lifestyle factors being associated with changes in tinnitus symptoms. In view of the largely persistent nature of tinnitus, public health strategies should focus on: (1) primary prevention and (2) managing symptoms in people that have tinnitus and monitoring changes in bothersomeness.
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Affiliation(s)
- Piers Dawes
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, UK
- The Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
| | - John Newall
- The Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
| | | | - David M Baguley
- Department of Hearing Sciences, Division of Clinical Neurosciences, School of Medicine, Universityof Nottingham, Nottingham, UK
- Nottingham Audiology Services, Nottingham University NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
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Swaminathan R, Mukundadura BP, Prasad S. Impact of enhanced personal protective equipment on the physical and mental well-being of healthcare workers during COVID-19. Postgrad Med J 2020; 98:231-233. [PMID: 33273107 DOI: 10.1136/postgradmedj-2020-139150] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The COVID-19 pandemic has necessitated the use of enhanced personal protective equipment (PPE) in healthcare workers in patient-facing roles. We describe the impact on the physical and mental well-being of healthcare professionals who use enhanced PPE consistently. METHODS We conducted a single-centre, cross-sectional study among healthcare professionals who use enhanced PPE. A web-based questionnaire was disseminated to evaluate the effects on individuals' physical and mental well-being. Physical and mental impact was assessed through a visual analogue scale. RESULTS Prospective analysis of the views of 72 respondents is reported. 63.9% were women and 36.1% were men. Physical impact included exhaustion, headache, skin changes, breathlessness and a negative impact on vision. Communication difficulties, somnolence, negative impact on overall performance and difficulties in using surgical instrumentation were reported. CONCLUSION Our study demonstrates the undeniable negative impact on the front-line healthcare workers using enhanced PPE and lays the ground for larger multicentric assessments given for it to potentially be the norm for the foreseeable future.
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Affiliation(s)
| | | | - Shashi Prasad
- Ear, Nose and Throat, University Hospital Coventry, Coventry, UK
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Kilty S, Thavorn K, Janjua A, Lee J, MacDonald K, Meen E, Micomonaco D, Rotenberg B, Sowerby LJ, Tewfik M, Adams S, Frenette H, Lasso A, Fergusson DA. Endoscopic polypectomy performed in clinic for chronic rhinosinusitis with nasal polyps: study protocol for the EPIC multicentre randomised controlled trial. BMJ Open 2020; 10:e042413. [PMID: 33268434 PMCID: PMC7713191 DOI: 10.1136/bmjopen-2020-042413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) is common, with a Canadian prevalence of 5%, and associated with significant morbidity. Understandably, CRS impairs workplace productivity but that productivity substantially increases following surgical treatment. CRS with nasal polyps (CRSwNP), the most common type of CRS, is usually treated with a combination of medications and endoscopic sinus surgery (ESS). Historically, surgical treatment has only been performed in the operating room at a cost of about $C3500. However, recent studies have shown that a de-escalated procedure, endoscopic polypectomy performed in clinic (EPIC), can provide an improvement in patient symptoms to levels equal to those for ESS. Moreover, EPIC has additional proposed advantages including shorter recovery time, significantly lower cost to the healthcare system and shorter wait time for the patient. There is currently insufficient evidence to draw conclusions about the superiority of polypectomy or ESS for the management of CRSwNP. METHODS AND ANALYSIS We designed a multicentre, open-label, randomised controlled trial to evaluate whether EPIC was non-inferior to the current clinical standard, ESS for the treatment of CRSwNP. The primary outcome is the Sinonasal Outcome Test-22 score measured at baseline and at 3 months after surgery. Other outcomes include peak nasal inspiratory flow, quality of life measured by the EuroQoL 5 Dimensions 5 Levels questionnaire and work impairment using the Work Productivity and Activity Impairment Questionnaire.We aim to recruit 140 patients from sites across Canada. Participants will be randomly assigned to EPIC or ESS and followed up for 3 months in clinic after the procedure. Additionally, participants will enter a 5-year long-term follow-up period. ETHICS AND DISSEMINATION This study was approved by the Ottawa Health Sciences Network Research Ethics Board for all sites in Ontario, Canada (study number CTO0801). Sites located outside of Ontario obtained approval from their local/institutional research ethics board. TRIAL REGISTRATION NUMBER NCT02975310.
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Affiliation(s)
- Shaun Kilty
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Otolaryngology- Head & Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Arif Janjua
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - John Lee
- Department of Otolaryngology-Head and Neck Surgery, Saint Michael's Hospital, Toronto, Ontario, Canada
| | - Kristian MacDonald
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eric Meen
- Department of Otolaryngology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Damian Micomonaco
- Department of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Brian Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Marc Tewfik
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Susan Adams
- Patient Representative, Ottawa, Ontario, Canada
| | | | - Andrea Lasso
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Tsai YT, Tsai MS, Hsu CM, Fang KH, Huang EI, Liu CY, Lin MH, Yang YH, Lee YC, Chang GH. End-stage renal disease as a risk factor for epiglottitis: a population-based cohort study in Taiwan. BMJ Open 2020; 10:e038683. [PMID: 33148739 PMCID: PMC7640511 DOI: 10.1136/bmjopen-2020-038683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Patients with uremia are prone to infection; however, end-stage renal disease (ESRD) as a risk factor for acute epiglottitis warrants study. We investigated the risk of severe epiglottitis requiring hospitalisation in patients with ESRD. SETTING We conducted a retrospective matched cohort study by using the claims data of Taiwan's National Health Insurance Research Database. PARTICIPANTS We identified an ESRD cohort with 87 908 patients newly diagnosed in 2000-2013 and underwent dialysis. The non-ESRD cohort comprised patients who had not received a diagnosis of ESRD, and they were matches to the ESRD cohort (1:1) by sex, age, residence urbanisation level, monthly income, and diabetes and hypertension status. PRIMARY AND SECONDARY OUTCOME MEASURES The cumulative incidence of epiglottitis at the end of 2013 was analysed with Kaplan-Meier methods and log-rank tests. The HR of epiglottitis was calculated using the Cox proportional hazards model after adjustment for confounding factors. RESULTS The overall epiglottitis incidence rate was 94% greater in the ESRD cohort than in the non-ESRD cohort (10.3 vs 5.3 cases per 100 000 person-years, p=0.002), with an adjusted HR of 1.89 (95% CI: 1.23 to 2.91, p=0.004). In the log-rank analysis, compared with the non-ESRD group, the epiglottitis cumulative incidence was significantly higher in the ESRD group (p=0.003). Epiglottitis did not exhibit an association with higher rates of airway interventions, intensive care unit admissions or longer hospitalisation in patients with ESRD than in controls. CONCLUSIONS This nationwide matched cohort study indicated that ESRD patients should be monitored for the risk of severe epiglottitis requiring hospitalisation.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan
| | - Ku-Hao Fang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ethan I Huang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan
| | - Yi-Chan Lee
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Geng-He Chang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan
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Mandavia R, Hannink G, Ahmed MN, Premakumar Y, Chu TSM, Blackshaw H, Ferdous T, Mehta N, Manjaly J, Khan M, Schilder AG. Prognostic factors for outcomes of idiopathic sudden sensorineural hearing loss: protocol for the SeaSHeL national prospective cohort study. BMJ Open 2020; 10:e038552. [PMID: 32988948 PMCID: PMC7523222 DOI: 10.1136/bmjopen-2020-038552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The mainstay of treatment for idiopathic sudden sensorineural hearing loss (SSNHL) includes oral steroids, intratympanic steroid injections or a combination of both. The National Institute for Health and Care Excellence, in their recent hearing loss guidelines, highlighted the paucity of evidence assessing the comparative effectiveness of these treatments; and the National Institute for Health Research (NIHR) Health Technology Assessment Programme has since released a commissioned call for a trial to identify the most effective route of administration of steroids as a first-line treatment for idiopathic SSNHL. For such trials to be run effectively, reliable information is needed on patients with SSNHL: where they present, numbers, demographics, treatment pathways, as well as outcomes. This study will collect these data in a nationwide cohort study of patients presenting with SSNHL across 97 National Health Service (NHS) trusts. The study will be delivered through ear, nose and throat (ENT) trainee networks, the NIHR Clinical Research Network (CRN) Audiology Champions and the NIHR CRN. Importantly, this study will also provide a dataset to develop a prognostic model to predict recovery for patients with idiopathic SSNHL. The study objectives are to: (1) map the patient pathway and identify the characteristics of adult patients presenting to NHS ENT and hearing services with SSNHL, (2) develop a prognostic model to predict recovery for patients with idiopathic SSNHL and (3) establish the impact of idiopathic SSNHL on patients' quality of life (QoL). METHODS AND ANALYSIS Study design: national multicentre prospective cohort study across 97 NHS trusts. INCLUSION CRITERIA adult patients presenting to NHS ENT and hearing services with SSNHL. OUTCOMES change in auditory function; change in QoL score. ANALYSIS multivariable prognostic model, using prespecified candidate predictors. Mean change in QoL scores will be calculated from initial presentation to follow-up. ETHICS AND DISSEMINATION Health Research Authority and NHS Research Ethics Committee approved the study. Publication will be on behalf of study sites and collaborators. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04108598).
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Affiliation(s)
- Rishi Mandavia
- University College London Hospitals Biomedical Research Centre, National Institute for Health Research, London, UK
- evidENT, University College London Ear Institute, London, UK
- SFO UK Students and Foundation Doctors in Otolaryngology, London, UK
| | - Gerjon Hannink
- Department of Operating Rooms, Radboudumc, Nijmegen, The Netherlands
| | - Muhammad Nayeem Ahmed
- evidENT, University College London Ear Institute, London, UK
- University of Leeds School of Medicine, Leeds, UK
| | | | - Timothy Shun Man Chu
- SFO UK Students and Foundation Doctors in Otolaryngology, London, UK
- Newcastle University School of Clinical Medical Sciences, Newcastle upon Tyne, UK
| | - Helen Blackshaw
- University College London Hospitals Biomedical Research Centre, National Institute for Health Research, London, UK
- evidENT, University College London Ear Institute, London, UK
| | - Tanjinah Ferdous
- University College London Hospitals Biomedical Research Centre, National Institute for Health Research, London, UK
- evidENT, University College London Ear Institute, London, UK
| | - Nishchay Mehta
- University College London Hospitals Biomedical Research Centre, National Institute for Health Research, London, UK
- evidENT, University College London Ear Institute, London, UK
| | - Joseph Manjaly
- University College London Hospitals Biomedical Research Centre, National Institute for Health Research, London, UK
- evidENT, University College London Ear Institute, London, UK
| | - Maha Khan
- Health Education North West, Manchester, UK
| | - Anne Gm Schilder
- University College London Hospitals Biomedical Research Centre, National Institute for Health Research, London, UK
- evidENT, University College London Ear Institute, London, UK
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Danneels M, Van Hecke R, Leyssens L, Degeest S, Cambier D, van de Berg R, Van Rompaey V, Maes L. 2BALANCE: a cognitive-motor dual-task protocol for individuals with vestibular dysfunction. BMJ Open 2020; 10:e037138. [PMID: 32665391 PMCID: PMC7365489 DOI: 10.1136/bmjopen-2020-037138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/11/2020] [Accepted: 06/09/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Aside from primary vestibular symptoms such as vertigo and dizziness, persons with vestibular dysfunction frequently express cognitive and motor problems. These symptoms have mainly been assessed in single-task setting, which might not represent activities of daily living accurately. Therefore, a dual-task protocol, consisting of the simultaneous performance of cognitive and motor tasks, was developed. This protocol assesses cognitive and motor performance in general, as well as cognitive-motor interference in specific. METHODS AND ANALYSIS The motor component of the 2BALANCE protocol consists of a static and dynamic postural task. These motor tasks are combined with different cognitive tasks assessing visuospatial cognition, processing speed, working memory and response inhibition. First, test-retest reliability will be assessed with an interval of 2 weeks in a group of young adults. Second, the 2BALANCE protocol will be validated in persons with bilateral vestibulopathy. Finally, the protocol will be implemented in persons with unilateral vestibular loss. DISCUSSION AND CONCLUSIONS The 2BALANCE project aims to elucidate the impact of vestibular dysfunction on cognitive and motor performance in dual-task setting. This protocol represents everyday situations better than single-task protocols, as dual-tasks such as reading street signs while walking are often encountered during daily activities. Ultimately, this project could enable individualised and holistic clinical care in these patients, taking into account single as well as dual-task performance. ETHICS AND DISSEMINATION The current study was approved by the ethics committee of Ghent University Hospital on 5 July 2019 with registration number B670201940465. All research findings will be disseminated in peer-reviewed journals and presented at vestibular as well as multidisciplinary international conferences and meetings. TRIALS REGISTRATION NUMBER NCT04126798, pre-results phase.
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Affiliation(s)
- Maya Danneels
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Ruth Van Hecke
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Laura Leyssens
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Sofie Degeest
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Dirk Cambier
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
- Faculty of Physics, Tomsk State University, Tomsk, Russian Federation
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, Universiteit Antwerpen, Antwerpen, Belgium
- Department of Otorhinolaryngology and Head & Neck Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
- Department of Otorhinolaryngology, University Hospital Ghent, Gent, Belgium
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Chong W, Tuang GJ. Lost and found: missing denture in an amnesic elderly man. Postgrad Med J 2019; 96:359. [PMID: 31753963 DOI: 10.1136/postgradmedj-2019-137226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 10/22/2019] [Accepted: 11/10/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Winton Chong
- Department of Otorhinoloryngology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Geng Ju Tuang
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Selayang, Batu Caves, Malaysia
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Bikbov MM, Fayzrakhmanov RR, Kazakbaeva GM, Zainullin RM, Salavatova VF, Gilmanshin TR, Arslangareeva II, Nikitin NA, Panda-Jonas S, Mukhamadieva SR, Yakupova DF, Khikmatullin RI, Aminev SK, Nuriev IF, Zaynetdinov AF, Uzianbaeva YV, Jonas JB. Self-reported hearing loss in Russians: the population-based Ural Eye and Medical Study. BMJ Open 2019; 9:e024644. [PMID: 30898811 PMCID: PMC6475155 DOI: 10.1136/bmjopen-2018-024644] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE With data on frequency of hearing loss in Russia and Eastern Europe generally lacking, we assessed the prevalence of hearing loss in a Russian population. SETTING The population-based Ural Eye and Medical Study was conducted in the rural and urban regions of Bashkortostan, Russia. PARTICIPANTS With an inclusion criterion of age 40+ years, the study included 5899 (80.5%) out of 7328 eligible individuals (mean age: 59.0±10.7 years; range: 40-94 years). PRIMARY AND SECONDARY OUTCOME MEASURES Hearing loss was examined in 5397 (91.5%) study participants, assessed using a standardised interview with questions from the 'Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S)'. RESULTS The prevalence of self-reported hearing loss (26.1%, 95% CI 24.2 to 27.2) increased from 10.9% (95% CI 8.0 to 13.7) in participants aged 40-45 years old to 59.0% (95% CI 51.6 to 66.4) in those aged 80+ years old. It was higher for men than for women in the 60-80 years age group (38.93%, 95% CI 35.8 to 42.1, vs 32.8%, 95% CI 30.2 to 35.3; p=0.003). On multivariable analysis, higher prevalence of hearing loss was associated with older age (p<0.001; OR [per year of age]: 1.06 [1.06 to 1.07]), male gender (p<0.001; OR: 1.26 [1.09 to 1.47]), higher depression score (p<0.001; OR: 1.06 [1.04 to 1.08]), higher prevalence of headache (p=0.001; OR: 1.27 [1.10 to 1.47]), history of cardiovascular diseases including stroke (p=0.001; OR: 1.32 [1.13 to 1.55]), and osteoarthritis (p<0.001; OR: 1.40 [1.18 to 1.67]), physically vigorous activity during work (p<0.001; OR: 1.40 [1.21 to 1.62]), alcohol consumption (p<0.001; OR: 1.51 [1.28 to 1.78]), and dry eye feeling (p<0.001; OR: 1.67 [1.30 to 2.16]). It was marginally correlated with a higher anxiety score (p=0.07; OR: 1.03 [0.998 to 1.06]). It was independent of diabetes (p=0.52), arterial hypertension (p=0.20), level of education (p=0.11), region of habitation (p=0.70), blood concentration of high-density lipoproteins (p=0.17) and low-density lipoproteins (p=0.52), current smoking (p=0.95) and smoking pack-years (p=0.37), and best corrected visual acuity (p=0.93). CONCLUSIONS As in other countries the prevalence of hearing loss is high in this elderly population in Russia. It is primarily or secondarily associated with older age, depression, male gender, cardiovascular disease and alcohol consumption.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Vas V, Akeroyd MA, Hall DA. A Data-Driven Synthesis of Research Evidence for Domains of Hearing Loss, as Reported by Adults With Hearing Loss and Their Communication Partners. Trends Hear 2019; 21:2331216517734088. [PMID: 28982021 PMCID: PMC5638151 DOI: 10.1177/2331216517734088] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A number of assessment tools exist to evaluate the impact of hearing loss, with little
consensus among researchers as to either preference or psychometric adequacy. The item
content of hearing loss assessment tools should seek to capture the impact of hearing loss
on everyday life, but to date no one has synthesized the range of hearing loss complaints
from the perspectives of the person with hearing loss and their communication partner. The
current review aims to synthesize the evidence on person with hearing loss- and
communication partner-reported complaints of hearing loss. Searches were conducted in Cos
Conference Papers Index, the Cumulative Index to Nursing and Allied Health Literature,
Excerpta Medica Database, PubMed, Web of Science, and Google Scholar to identify
publications from May 1982 to August 2015. A manual search of four relevant journals
updated the search to May 2017. Of the 9,516 titles identified, 78 records (comprising
20,306 participants) met inclusion criteria and were taken through to data collection.
Data were analyzed using meta-ethnography to form domains representing the person with
hearing loss- and communication partner-reported complaints of hearing loss as reported in
research. Domains and subdomains mutual to both perspectives are related to “Auditory”
(listening, communicating, and speaking), “Social” (relationships, isolation, social life,
occupational, and interventions), and “Self” (effort and fatigue, emotions, identity, and
stigma). Our framework contributes fundamental new knowledge and a unique resource that
enables researchers and clinicians to consider the broader impacts of hearing loss. Our
findings can also be used to guide questions during diagnostic assessment and to evaluate
existing measures of hearing loss.
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Affiliation(s)
- Venessa Vas
- 1 National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK.,2 Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, 170718 University of Nottingham , UK
| | - Michael A Akeroyd
- 3 Medical Research Council Institute of Hearing Research, School of Medicine, The 170718 University of Nottingham , University Park, Nottingham, UK
| | - Deborah A Hall
- 1 National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK.,2 Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, 170718 University of Nottingham , UK
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Spernovasilis N, Stylianou K, Milioni A, Panagiotakis S. Microscopic polyangiitis after streptococcal pharyngitis in a young woman. Postgrad Med J 2018; 94:728. [PMID: 30282781 DOI: 10.1136/postgradmedj-2018-135674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 09/09/2018] [Accepted: 09/15/2018] [Indexed: 11/04/2022]
Affiliation(s)
| | - Kostas Stylianou
- Department of Nephrology, University Hospital of Heraklion, Heraklion, Greece
| | - Athanasia Milioni
- Department of Otorhinolaryngology, University Hospital of Heraklion, Heraklion, Greece
| | - Simeon Panagiotakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
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Abstract
OBJECTIVE It is believed that Meniere's disease (MD) is associated with vascular disorders, but few studies have reported the relationship between retinal vascular disorders and MD. We evaluated and compared the retinal vascular calibres in patients with MD with healthy subjects matched for age, sex and vascular risk factors using retinal photographs to explore the association between MD and retinal vascular calibre. STUDY DESIGN A prospective study. SETTING Tertiary referral centre. PARTICIPANTS Sixty patients with MD and 62 healthy subjects matched for age, sex and vascular risk factors were enrolled in this study. Twenty-four patients with MD had migraines, and 36 patients with MD did not have migraines. MAIN OUTCOME MEASURE Retinal vascular calibres were calculated and compared not only between patients with MD and healthy subjects but also between subgroups of patients with MD. RESULTS Compared with healthy subjects, patients with MD had a slightly larger retinal artery calibre (126.30±10.45vs 119.61±15.86, p=0.006) and a higher retinal artery/vein ratio (0.79±0.09vs 0.75±0.10, p=0.005). Among patients with MD, those with migraines had a larger retinal artery calibre (130.73±11.55vs 123.35±8.61, p=0.006) than those without migraines. Moreover, the presence of migraines and the high frequency of vertigo attacks appeared to increase the retinal artery calibre. CONCLUSIONS Our study suggests that a relationship exists between retinal vascular calibre and MD. Although the pathophysiological relationship between migraine and MD remains unclear, the presence of migraine attacks may aggravate endolymphatic hydrops (EH) and accelerate the outflow of EH in patients with MD. More extensive studies are required to explore the association between retinal vascular calibre and MD.
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Affiliation(s)
- Yixu Wang
- Department of Otolaryngology, Head and Neck Surgery, People’s Hospital, Peking University, Beijing, China
| | - Tongxiang Diao
- Department of Otolaryngology, Head and Neck Surgery, People’s Hospital, Peking University, Beijing, China
| | - Lin Han
- Department of Otolaryngology, Head and Neck Surgery, People’s Hospital, Peking University, Beijing, China
| | - Ye Tao
- Department of Ophthalmology, People’s Hospital, Peking University, Beijing, China
| | - Lisheng Yu
- Department of Otolaryngology, Head and Neck Surgery, People’s Hospital, Peking University, Beijing, China
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Mandavia R, Knight A, Carter AW, Toal C, Mossialos E, Littlejohns P, Schilder AG. What are the requirements for developing a successful national registry of auditory implants? A qualitative study. BMJ Open 2018; 8:e021720. [PMID: 30209155 PMCID: PMC6144326 DOI: 10.1136/bmjopen-2018-021720] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Hearing loss is an area of unmet need, and industry is targeting this field with a growing range of surgically implanted hearing devices. Currently, there is no comprehensive UK registry capturing data on these devices; in its absence, it is difficult to monitor clinical and cost-effectiveness and develop national policy. Recognising that developing such a registry faces considerable challenges, it is important to gather opinions from stakeholders and patients. This paper builds on our systematic review on surgical registry development and aims to identify the specific requirements for developing a successful national registry of auditory implants. DESIGN Qualitative study. PARTICIPANTS Data were collected in two ways: (1) semistructured interviews with UK professional stakeholders; and (2) focus groups with patients with hearing loss. The interview and focus group schedules were informed by our systematic review on registry development. Data were analysed using directed content analysis. Judges mapped the themes obtained against a conceptual framework developed from our systematic review on registry development. The conceptual framework consisted of five categories for successful registry development: (1) planning, (2) registry governance, (3) registry dataset, (4) anticipating challenges, (5) implementing solutions. RESULTS Twenty-seven themes emerged from 40 semistructured interviews with professional stakeholders and 18 themes emerged from three patient focus groups. The most important factor for registry success was high rates of data completion. Benefits of developing a successful registry of auditory implants include: strengthening the evidence base and regulation of auditory implants, driving quality and safety improvements, increased transparency, facilitating patient decision-making and informing policy and guidelines development. CONCLUSIONS This study identifies the requirements for developing a successful national registry of auditory implants, benefiting from the involvement of numerous professional stakeholder groups and patients with hearing loss. Our approach may be used internationally to inform successful registry development.
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Affiliation(s)
- Rishi Mandavia
- evidENT, UCL Ear Institute, Royal National Throat, Nose and Ear Hospital, London, UK
| | - Alec Knight
- Health Service and Population Research Department, King's College London, London, UK
| | | | - Connor Toal
- School of Medicine, University College London, London, UK
| | - Elias Mossialos
- Centre for Health Policy, Imperial College London, London, UK
| | - Peter Littlejohns
- Health Service and Population Research Department, King's College London, London, UK
| | - Anne Gm Schilder
- evidENT, UCL Ear Institute, Royal National Throat, Nose and Ear Hospital, London, UK
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Blackshaw H, Carding P, Jepson M, Mat Baki M, Ambler G, Schilder A, Morris S, Degun A, Yu R, Husbands S, Knowles H, Walton C, Karagama Y, Heathcote K, Birchall M. Does laryngeal reinnervation or type I thyroplasty give better voice results for patients with unilateral vocal fold paralysis (VOCALIST): study protocol for a feasibility randomised controlled trial. BMJ Open 2017; 7:e016871. [PMID: 28965097 PMCID: PMC5640104 DOI: 10.1136/bmjopen-2017-016871] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION A functioning voice is essential for normal human communication. A good voice requires two moving vocal folds; if one fold is paralysed (unilateral vocal fold paralysis (UVFP)) people suffer from a breathy, weak voice that tires easily and is unable to function normally. UVFP can also result in choking and breathlessness. Current treatment for adults with UVFP is speech therapy to stimulate recovery of vocal fold (VF) motion or function and/or injection of the paralysed VF with a material to move it into a more favourable position for the functioning VF to close against. When these therapies are unsuccessful, or only provide temporary relief, surgery is offered. Two available surgical techniques are: (1) surgical medialisation; placing an implant near the paralysed VF to move it to the middle (thyroplasty) and/or repositioning the cartilage (arytenoid adduction) or (2) restoring the nerve supply to the VF (laryngeal reinnervation). Currently there is limited evidence to determine which surgery should be offered to adults with UVFP. METHODS AND ANALYSIS A feasibility study to test the practicality of running a multicentre, randomised clinical trial of surgery for UVFP, including: (1) a qualitative study to understand the recruitment process and how it operates in clinical centres and (2) a small randomised trial of 30 participants recruited at 3 UK sites comparing non-selective laryngeal reinnervation to type I thyroplasty. Participants will be followed up for 12 months. The primary outcome focuses on recruitment and retention, with secondary outcomes covering voice, swallowing and quality of life. ETHICS AND DISSEMINATION Ethical approval was received from National Research Ethics Service-Committee Bromley (reference 11/LO/0583). In addition to dissemination of results through presentation and publication of peer-reviewed articles, results will be shared with key clinician and patient groups required to develop the future large-scale randomised controlled trial. TRIAL REGISTRATION NUMBER ISRCTN90201732; 16 December 2015.
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Affiliation(s)
| | - Paul Carding
- School of Allied Health, Australian National Catholic University, North Sydney, New South Wales, Australia
| | - Marcus Jepson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Marina Mat Baki
- Faculty of Medicine, National University of Malaysia, Malaysia
| | - Gareth Ambler
- Statistical Science, University College London, London, UK
| | - Anne Schilder
- Ear Institute, University College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Aneeka Degun
- Ear Institute, University College London, London, UK
| | - Rosamund Yu
- UCL Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Samantha Husbands
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Helen Knowles
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chloe Walton
- School of Allied Health, Australian National Catholic University, North Sydney, New South Wales, Australia
| | - Yakubu Karagama
- Department of Otolaryngology-Head & Neck Surgery, Manchester Royal Infirmary, Manchester, UK
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