scholarly journals Outcomes of Mastoidectomy With Antibiotic Catheter Irrigation for Patients With Draining Ventilation Tubes

2021 ◽  
pp. 014556132110257
Author(s):  
Joel W. Jones ◽  
Daniel P. Ballard ◽  
Todd A. Hillman ◽  
Douglas A. Chen
Keyword(s):  
Chart Review ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Otitis Media With Effusion ◽  
Tympanostomy Tube ◽  
Indwelling Catheter ◽  
Intravenous Antibiotics ◽  
Significant Difference ◽  
Ventilation Tubes ◽  
Catheter Irrigation

Objectives: To evaluate the effectiveness of mastoidectomy with antibiotic catheter irrigation in patients with chronic tympanostomy tube otorrhea. Methods: A chart review of adult and pediatric patients with persistent tympanostomy tube otorrhea who had failed outpatient medical management and underwent mastoidectomy with placement of a temporary indwelling catheter for antibiotic instillation was performed. Patients were retrospectively followed for recurrent drainage after 2 months and outcomes were categorized as resolution (0-1 episodes of otorrhea or otitis media with effusion during follow-up), improvement (2-3 episodes), or continued episodic (>3 episodes). Results: There were 22 patients and 23 operated ears. Median age was 46 years (interquartile range, IQR = 29-65). The median duration of otorrhea from referral was 5.5 months (IQR = 2.8-12). Following surgery, 14 ears had resolution of drainage, 6 had improvement, and 3 had episodic. The observed percentage of resolved/improved ears (87%) was significant ( P = .0005, 95% CI = 67.9%-95.5%). Median follow-up time was 25 months (IQR = 12-59). Pre and postoperative pure tone averages improved (difference of medians = −3.3 dB, P = .02) with no significant difference in word recognition scores ( P = .68). Methicillin-resistant Staphylococcus aureus was the most common isolated microbe while no growth was most frequently noted on intraoperative cultures. Conclusions: Mastoidectomy with antibiotic catheter irrigation may be an effective surgical strategy, and single stage alternative to intravenous antibiotics, for select patients with persistent tube otorrhea who have failed topical and oral antibiotics.

Outcomes of Individuals with Transfemoral and Contralateral Transtibial Amputation due to Dysvascular Etiologies

2009 ◽  
Vol 33 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Sukhinder Bhangu ◽  
Michael Devlin ◽  
Tim Pauley
Keyword(s):  
Functional Outcome ◽  
Scale Score ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Walk Test ◽  
Amputation Level ◽  
Significant Difference ◽  
Transfemoral Prosthesis ◽  
Minute Walk

Objective: To evaluate the functional outcome of individuals with transfemoral and contralateral transtibial amputations secondary to peripheral vascular disease.Methods: A retrospective chart review followed by phone interview. The primary outcome measures were the discharge 2-minute walk test, Frenchay Activities Index, and the Houghton Scale.Results: There were 31 dysvascular individuals identified to have a combination of transfemoral/transtibial (TF/TT) amputation admitted to our institution for rehabilitation from February 1998 to June 2007. The mortality at follow up was 68%. There were eight surviving amputees. The average 2-minute walk test score was 31.9 m at the time of discharge from our inpatient program. Of these, the average Frenchay Activities Index was 15.3. The average Houghton Scale score for use of the transtibial prosthesis alone was 2.1. The average Houghton Scale score for use of both prostheses was 1.5. Comparisons between groups based on initial amputation level revealed a significant difference of being fitted with a transfemoral prosthesis. Those whom initially had a TT amputation were less likely to ultimately be fitted with a TF prosthesis ( X21,n=31 = 4.76, p < 0.05).Conclusion: The overall functional outcome of individuals with a combination of TF/TT amputation due to dysvascular causes is poor. These individuals have a low level of ambulation, activity, and prosthetic use.

scholarly journals Tympanostomy tube sequelae in children with otitis media with effusion: a three-year follow-up study

2005 ◽  
Vol 71 (4) ◽  
pp. 415-420 ◽  
Author(s):  
Maria Beatriz Rotta Pereira ◽  
Denise Rotta Ruttkay Pereira ◽  
Sady Selaimen da Costa
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Tympanostomy Tube ◽  
Follow Up Study

A comparison of performance of Shepard and Sheehy collar button ventilation tubes

1991 ◽  
Vol 105 (11) ◽  
pp. 896-898 ◽  
Author(s):  
Judith M. Heaton ◽  
Brian J. G. Bingham ◽  
Jonathan Osborne
Keyword(s):  
Otitis Media With Effusion ◽  
Complication Rates ◽  
Middle Ear Effusion ◽  
Recurrence Rates ◽  
Tube Extrusion ◽  
Increased Risk ◽  
Significant Difference ◽  
Ventilation Tubes ◽  
Ear Effusion

AbstractThis study was designed to confirm the longer in situ life of the Sheehy collar button compared with the Shepard tube and to assess the complication rate associated with the two tubes. Cases of bilateral otitis media with effusion had a Shepard tube inserted in one ear and a Sheehy contralaterally. The insertion position was allocated randomly. The patients were then assessed at three-monthly intervals for two years. In 71 percent of those in whom at least on tube had extruded, the Sheehy remained in situ longer. The antero-inferior tube remained longer than the postero-inferior whichever type was used. There was no significant difference between complication rates, or recurrence rates of middle ear effusion after tube extrusion, for the two types. We conclude that use of a Sheehy rather than a Shepard tube carries no increased risk of complications and the patient may require further surgery less often in total.

scholarly journals Incidence, Etiology, and Outcomes of Altered Mental Status in the Perioperative Setting of Liver Transplantation

2017 ◽  
Vol 8 (3) ◽  
pp. 124-128 ◽  
Author(s):  
Christopher Lening ◽  
Vatche G. Agopian ◽  
Ronald W. Busuttil ◽  
David S. Liebeskind
Keyword(s):  
Liver Transplantation ◽  
Mental Status ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Altered Mental Status ◽  
Sudden Onset ◽  
Transplant Patients ◽  
Significant Difference ◽  
Presentation Group

Background: We examined neurologic consultations for altered mental status in perioperative liver transplant patients to determine the overall incidence, to assess the presumed etiology and the data reviewed to determine that etiology, and to assess outcomes. Methods: Retrospective chart review conducted for all 728 adult patients receiving orthotopic liver transplantation (OLT) between January 01, 2010, to June 30, 2014, with identification of 218 receiving neurology consults between 30 days pre-OLT and 90 days post-OLT, with review of all records necessary to determine initial findings and follow-up examination. Results: Seventy-three consults for 69 patients were identified, with 27 felt to be altered since a procedure, 20 with sudden-onset altered mentation, and 26 with gradual or waxing–waning course. A single underlying etiology was identified in only 19 cases, with multiple factors involved in all others, with metabolic, toxic, infectious, and structural etiologies most often implicated. There was no statistically significant difference in outcome for those with altered mental status consults versus the total OLT population, though the sudden-onset presentation group did show significantly increased mortality rates. Conclusions: This systematic study illustrates the variety of potential causes of altered mentation within the perioperative setting of liver transplantation. Workup including neuroimaging (preferably magnetic resonance imaging), infectious cultures, and expanded metabolic laboratory tests should be undertaken.

scholarly journals Self-Retaining Harpoon Tympanostomy Tube with Applicator

2007 ◽  
Vol 22 (1-2) ◽  
pp. 27-30
Author(s):  
Konrad P. Aguila
Keyword(s):  
Case Report ◽  
Otitis Media With Effusion ◽  
Low Cost ◽  
Tertiary Hospital ◽  
Tympanostomy Tube ◽  
Tube Insertion ◽  
Middle Ear Ventilation ◽  
Metro Manila ◽  
Endoscopic Guidance

Objective: To describe a novel harpoon design for a low cost, self retaining tympanostomy tube with applicator used in a 38-year-old female for otitis media with effusion. Methods:    Study design: Instrumental Innovation/Case Report Setting:  Tertiary Hospital in Metro Manila Results:   The tympanostomy tube was inserted under endoscopic guidance within 10 seconds, remained in place for two months with relief of symptoms, and spontaneously extruded by the seventh month of follow-up. Conclusion:  The harpoon-designed tube with applicator provided ease of insertion and good anchorage in the tympanic membrane.  Maximizing the use of a stylet-needle as both perforator and applicator simplified the tympanostomy and ventilating tube insertion procedures into a single maneuver.     Key words: middle ear ventilation, tympanostomy tube insertion, grommet  insertion, instrumentation

scholarly journals Utility of telemedicine in pediatric rheumatology during the COVID-19 pandemic

2021 ◽  
Author(s):  
Ashley Perdue ◽  
Charles Mullett ◽  
Amna Umer ◽  
Paul Rosen
Keyword(s):  
Pediatric Rheumatology ◽  
Chart Review ◽  
Patient Characteristics ◽  
Rapid Expansion ◽  
Office Visits ◽  
Chi Square ◽  
Rheumatology Clinic ◽  
Significant Difference ◽  
Pediatric Rheumatology Clinic

Abstract Background: During the COVID-19 pandemic, telemedicine has provided an alternative to in-person visits for patients practicing social distancing and undergoing quarantine. During this time, there has been a rapid expansion of telemedicine and its implementation in various clinical specialties and settings. In this observational study we aim to examine the utility of telemedicine in a pediatric rheumatology clinic, for 3 months during the COVID-19 pandemic.Methods: A review of outpatient pediatric rheumatology telemedicine encounters were conducted from April-June 2020. Telemedicine visits (n=75) were compared to patients seen in practice over the prior year in office-based visits (March 2019-March 2020) (n=415). Patient characteristics, information on no-show visits, completed visits, new patient or follow-up status, and if new patients had received a visit within 2 weeks of calling to schedule an appointment were analyzed by chart review. An independent sample t-test and Chi Square statistic was used to determine statical significance between the two groups. A two-proportion z-test was used to compare visit metrics.Results: The percentage of new patients utilizing telemedicine (60%) was lower and statistically significant compared to the percentage of new patient office visits (84%) the previous year (p<0.0001). There was no change in no-show rate between groups and patient characteristics were similar.Conclusions: This study demonstrates a statistically significant decrease in new patient visits during the pandemic with telemedicine-only appointments compared to in-office visits over the previous year. This suggests a possible hesitation to seek care during this time. However, there was no significant difference among patient characteristics between telemedicine visits during the pandemic and during in-office visits in the previous year. In our experience, patient visits were able to be conducted via telemedicine with a limited physical exam using caregiver’s help during the pandemic. However, further studies will need to ascertain patient satisfaction and preference for telemedicine in the future.

Successful outpatient treatment of sinusitis exacerbations caused by community-acquired methicillin-resistant Staphylococcus aureus

2005 ◽  
Vol 132 (6) ◽  
pp. 828-833 ◽  
Author(s):  
Roland Z. Gerencer
Keyword(s):  
Outpatient Treatment ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Outpatient Basis ◽  
Oral Antibiotics ◽  
Clinical Resolution ◽  
Topical Antibiotics ◽  
Intravenous Antibiotics ◽  
The Mean ◽  
Mean Time

OBJECTIVE: To determine whether community-acquired MRSA sinusitis can be adequately treated on an outpatient basis without the need for intravenous antibiotics. STUDY DESIGN AND SETTING: Retrospective review of all cases of community-acquired MRSA sinusitis encountered by the author over a 36-month period. RESULTS: Of 29 patients who tested positive for MRSA sinusitis, 26 patients had follow-up information available and were retrospectively reviewed. The average follow-up period was 12.0 months (range: 1–36 mo). Twelve infectious episodes of MRSA were treated with oral antibiotics alone and 16 were treated with a combination of oral and topical antibiotics. The mean time to clinical resolution with these regimens was 5.7 weeks (range: 3–8 wks). Two patients experienced recurrent MRSA infections resulting in a recurrence rate of 7.7% and an overall resolution rate of 92.3%. CONCLUSIONS: Community-acquired MRSA sinusitis can be very adequately treated on an outpatient basis with culture-directed oral and topical antibiotics.

Development of tympanosclerosis in children with otitis media with effusion and ventilation tubes

1991 ◽  
Vol 105 (8) ◽  
pp. 614-617 ◽  
Author(s):  
A. R. Maw
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Ventilation Tube ◽  
Rate Of Development ◽  
Ventilation Tubes ◽  
Contralateral Ear

AbstractVentilation tube (VT) insertion is an accepted treatment for chronic otitismedia with effusion (OME) in children. One hundred and eighty five children with bilateral OME were treated by unilateral myringotomy and VT insertion with no treatment to the contralateral ear. During a 5 year follow-up 95 of the children required only one VT but the remainer required more than one but always treatment was carried out to the same ear. The rate of development of tympanosclerosis was measured and scored. After 2–3 yearsthe extent of the sclerotic changes stabilised and the rate of development reached 37–39 per cent in ears receiving only one VT, compared with 47–49 per cent in ears treated by more than one tube. The extent of the changes was no different whether or not one or more than one tube had been inserted. There was no overall evidence of resolution of sclerotic change with time.

scholarly journals Importance of early ventilation tubes insertion in chronic otitis media with effusion in children with congenital cleft palate

2018 ◽  
Vol 75 (3) ◽  
pp. 253-259
Author(s):  
Vladan Subarevic ◽  
Nenad Arsovic ◽  
Radoje Simic ◽  
Katarina Stankovic
Keyword(s):  
Cleft Palate ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Speech Development ◽  
Middle Ear Effusion ◽  
Ventilation Tubes ◽  
Congenital Cleft ◽  
Ear Effusion

Background/Aim. Otitis media with effusion (OME) is almost universal in children with cleft palate with an incidence of more than 90%, but the approach to managing this problem varies significantly among authors. The Eustachian tube dysfunction is the main factor that leads to the presence of the middle ear effusion. This is especially prominent in children with congenital cleft palate and explains the prolonged course of this process. The objective of this study was to determine the effectiveness of early ventilation tubes insertion in children with cleft palate at the time of palatoplasty by monitoring the course and duration of the disease as well as development of complications. Methods. In the prospective study with predefined regular follow-up intervals and parameters, the two groups of children were observed. The group one (E) included 45 children with congenital cleft palate who underwent the early insertion of ventilation tubes during palatoplasty, and the group two (C) had the same number of children with cleft palate who were treated conservatively on an as-needed basis. Assessment parameters were findings of otomicroscopy, tympanometry, play and pure tone audiometry. Each child was followed-up for 5 full years at total of nine follow-up examinations. Results. Result analysis showed that there were no statistically important differences between the two study groups in terms of the course and duration of the presence of the middle ear effusion, or in terms of complications and speech development. Conclusion. Based on the results obtained, we can conclude that there is no significant benefit in early ventilation tubes insertion in children with cleft palate, therefore our recommendation is watchful waiting and a conservative treatment on an as-needed basis, with the ventilation tubes insertion when a surgeon, based on his or her experience and individual findings considers it necessary.

scholarly journals Chronological Impact of Earthquakes on Blood Pressure: A Literature Review and Retrospective Study of Hypertension in Haiti Before and After the 2010 Earthquake

2021 ◽  
Vol 8 ◽  
Author(s):  
Ayman R. Fath ◽  
Amro Aglan ◽  
Jeri Platt ◽  
Jordan R. Yaron ◽  
Kyle S. Varkoly ◽  
...  
Keyword(s):  
Literature Review ◽  
Chart Review ◽  
Retrospective Studies ◽  
Retrospective Chart Review ◽  
Chronic Effects ◽  
Significant Difference ◽  
Before And After ◽  
Early Health ◽  
Significant Change

Objective: We review prior studies on the incidence of hypertension (HTN) after earthquakes and present a retrospective analysis of HTN after the 2010 earthquake in Haiti.Methods: Prior reports on HTN incidence were reviewed and a retrospective chart review for diagnosis of HTN in 4,308 patient charts was performed over a 7 year period (five clinics). A retrospective cohort study (RCS) was then performed on 11 patients with linear follow-up.Results: The Literature review revealed a significant increase in acute and subacute HTN following earthquakes. However, the chronic effects of earthquakes varied. Our chart review uncovered no significant difference in diagnosed HTN in a Fort-Liberté clinic 128 kilometers (km) distant and 4 weeks post-event. A secondary linear RCS for 11 individuals, prior to and after the earthquake, also did not detect a significant change in HTN prevalence.Conclusion: Prior studies demonstrate acute and subacute, increases in HTN after earthquakes, but late changes have varied. Retrospective studies in the Fort-Liberté clinic, 128 km distant and 4 weeks post-event, revealed no significant change in HTN, confirming prior findings that changes in HTN after earthquakes are early and local events. Further work examining HTN after earthquakes is needed to improve early health care after natural disasters.

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