scholarly journals Can party balloons replace autoinflation balloons to treat glue ear: technical comparison

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2020.0178
Author(s):  
Katherine Marshall ◽  
Rafael Perera ◽  
Paul Glasziou ◽  
Susannah Fleming
Keyword(s):  
Clinical Effect ◽  
Otitis Media With Effusion ◽  
Pilot Trial ◽  
Valsalva Manoeuvre ◽  
Maximum Pressure ◽  
Inflation Pressure ◽  
Efficient Treatment ◽  
Glue Ear ◽  
Cost Efficient ◽  
Potential Use

BackgroundAutoinflation balloons are used to treat patients with otitis media with effusion to help avoid surgery.AimTo compare the ability of party balloons and Otovent® balloons to produce sufficient pressure for a Valsalva manoeuvre.Design & settingWe used pressure testing to determine the number of times each balloon could produce pressures sufficient for a Valsalva manoeuvre. Subsequently, we compared Otovent® balloons with spherical party balloons in a pilot clinical trial of 12 healthy adults.MethodEach balloon was inflated 20 times and the maximum pressure was recorded. Three balloons of each type were tested to 50 inflations to assess pressures over persistent use.ResultsOtovent® balloons mean inflation pressure was 93 mmHg (95% CI 89–97 mmHg) on first inflation, dropping to 83 mmHg (95% CI 80–86 mmHg) after 20 inflations. Two types of spherical party balloon required mean inflation pressures of 84 mmHg (95% CI 77–90 mmHg) and 108 mmHg (95% CI 97–119 mmHg) on first inflation, dropping to 74 mmHg (95% CI 68–81 mmHg) and 83 mmHg (95% CI 77–88 mmHg) after 20 inflations. In the pilot trial, there was no difference between the ability of Otovent® and spherical balloons (χ2=0.24, P=0.89) to produce the sensation of a Valsalva manoeuvre.ConclusionOtovent® balloons can be used more than the 20 times quoted by the manufacturer. The two spherical balloons produced similar pressures to Otovent® balloons, indicating potentially the same clinical effect. The pilot study suggests a potential use of spherical party balloons instead of Otovent® balloons as a cost-efficient treatment.

Tympanic membrane atelectasis in childhood otitis media with effusion

1995 ◽  
Vol 109 (6) ◽  
pp. 495-498 ◽  
Author(s):  
H. L. Tay ◽  
R. P. Mills
Keyword(s):  
Multivariate Analysis ◽  
Tympanic Membrane ◽  
Otitis Media With Effusion ◽  
Pars Tensa ◽  
Hearing Thresholds ◽  
Inferior Segment ◽  
Glue Ear ◽  
The Difference ◽  
A Prospective Study ◽  
Relevant Factors

AbstractA prospective study on the dynamics of tympanic membrane atelectasis during the treatment for glue ear was performed in a sample of 115 ears of 83 children aged between one and 11 years. The progression in the degree of pars tensa atelectasis was analysed in relation to six potentially relevant factors. Multivariate analysis showed that the factor with the most predictive value on the progression of the pars tensa retraction was the grade of atelectasis at initial detection (p<0.0001). The use of grommets did not have any significant influence on the outcome grade of atelectasis. There was an association between previous grommet insertion and localized retractions in the inferior segment of the pars tensa (P<0.0001). However, localized retractions in the postero-superior quadrant were not associated with previous grommet insertion (P<0.02). Although the hearing thresholds of atelectatic ears were significantly worse than normal ears especially at 4 kHz (p<0.006), the difference was less than 5 dB.

scholarly journals A Narrative Review: The Use of the Topical NSAID Ibuprofen for the Treatment of Knee Osteoarthritis. Supporting Clinician Decision-Making in the First-Line Treatment of Osteoarthritis

2020 ◽  
Vol 9 ◽  
pp. 117957272091494
Author(s):  
Catrin Hawthorn
Keyword(s):  
Knee Osteoarthritis ◽  
Narrative Review ◽  
Osteoarthritis Of The Knee ◽  
Topical Nsaid ◽  
First Line ◽  
Efficient Treatment ◽  
Clinical Level ◽  
Cost Efficient ◽  
Topical Nsaids ◽  
License Holder

A Narrative Review: The use of the topical nonsteroidal anti-inflammatory drugs (NSAID) ibuprofen for the treatment of knee osteoarthritis. Supporting clinician decision-making in the first-line treatment of osteoarthritis. Objective: To open discussion at a clinical level on the guidelines for the pharmacological management of osteoarthritis of the knee, this narrative review looks into the use of topical NSAID being a clinically effective, safe, and cost-efficient treatment compared to an oral alternative. Background: With the over prescription of NSAIDs in the age of above 65 years, there has been a call for increased restrictions of the sale of oral preparations of NSAIDs. It is our view that there is still a lack of awareness in the benefit of topical NSAIDs to the patient (no evidence of adverse reactions recorded by the Joint Formulary Committee [JFC] to date) as well as provider (topical application is cheaper as a National Health Service [NHS] prescription). Methods: Key online resources included PubMed, Athens, Cochrane Library, Google Scholar, MEDLINE, and relevant clinical and commissioning guidelines with the final date of data collection in March 2017. We also contacted the manufacturer and license holder directly for further clarification. Randomized, double-blind control studies, commissioned reports, International Guidelines, MEHA Guidelines, and license holder data were included. Where possible studies included had to have fair randomization and adhere to key treatment pathways as highlighted by National Institute for Health and Clinical Excellence (NICE) and other guidelines. Discussion: Current guidelines advise that patients who seek initial treatment of osteoarthritis of the knee should consider a combination of treatment modalities, including pharmacological therapies, particularly the use of NSAIDs. At a clinical level, a reoccurring issue identified with this advice is the inappropriate use of oral NSAIDs, and the concern that the risks associated with ease of access (“over the counter”), and overuse, may result in systemic adverse events in this cohort of patients. Multiple studies have examined the negative effect of oral NSAIDs and the associated risks of use. We were unable to source studies that showed any adverse systemic events from the use of topical NSAIDs; however, there are good quality trials comparing oral to topical NSAIDs, showing similar levels of efficacy at 6 and 12 weeks. Conclusion: Topical NSAIDs provide good levels of pain relief in subjects with mild to moderate knee osteoarthritis. There is also evidence for the use of the topical application being a clinically effective, safe, and cost-efficient treatment.

scholarly journals P14.126 radiation-induced optic neuropathy

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii98-iii99
Author(s):  
A Thomas ◽  
C Birzu ◽  
L Feuvret ◽  
G Noël ◽  
K Hoang-Xuan ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Clinical Effect ◽  
Checkpoint Inhibitors ◽  
Early Stage ◽  
High Dose ◽  
Efficient Treatment ◽  
Radiation Induced ◽  
Starting Date

Abstract BACKGROUND Optic neuropathy is an inflammation of the optic nerve leading to a rapidly progressive visual loss. Most frequent etiologies are multiple sclerosis, vasculitides, and infections. In the context of tumorous pathology, optic neuropathy can occur due to meningeal infiltration, tumoral compression, or antitumor therapeutics (radiation therapy, some targeted cancer therapies, and checkpoint inhibitors). In the current study, we examine radiation-induced optic neuropathy (RION), which is the most frequent among optic neuropathies caused by antitumor therapeutics. MATERIAL AND METHODS We present the cases of 3 patients who experienced RION. For each patient, we collected data on age, type of tumor, date and modalities of radiation-therapy, starting date of visual loss, ophthalmologic description, MRI images, treatment, and clinical and radiological evolution. RESULTS The three patients were aged 57 to 68 years old at the time of NORI. They had irradiation between 2013 and 2018. Two patients had proton therapy and one had whole brain irradiation. The visual loss occurred between seven and twelve months after the end of radiation therapy. In all patients the symptoms were bilateral and the loss of vision was rapidly worsened until culminating in almost total blindness. The MRI abnormalities were consistent with retrobulbar optic neuritis. The visual loss remained severe despite the treatment administered. High dose steroids had no clinical effect. Bevacizumab enabled a discrete subjective visual improvement in one patient, but a worsening of visual loss in another. Hyperbaric oxygen therapy had no clinical effect but was undertaken three months after the starting date of visual loss which is probably too late for efficiency. Interestingly one patient was treated with an anti-IL6 antibody (tocilizumab). It was administered in order to avoid fibrosis formation, which is the ultimate condition of the inflammatory process. The rationale is that radiation-induced opening of the bood-brain-barrier and destruction of endothelial and glial cells lead to reparation process through microglia activation. In-vitro studies showed an increased secretion of IL-6 (and other pro-inflammatory cytokines) by the activated microglia. Our patient could not experience benefit from tocilizumab, but the treatment was administered four months after the starting date of visual loss and fibrosis was probably already formed. CONCLUSION These cases are consistent with existing literature. The risk is mostly due to the total dose and dose per fraction of the irradiation and the prognosis is very poor with no efficient treatment at the present time. Anti-IL6 antibody could be an interesting treatment if administered at an early stage, but a future prospective clinical trial would be needed to clinically validate this hypothesis.

Otitis media with effusion ("glue ear")

BMJ ◽  
2011 ◽  
Vol 343 (jul04 2) ◽  
pp. d3770-d3770 ◽  
Author(s):  
A. Farboud ◽  
R. Skinner ◽  
R. Pratap
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Glue Ear
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