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The Annals of Otology, Rhinology, and... Feb 2021Recent technological advances have led to the capability of performing high resolution imaging of the tympanic membrane. Smartphone technologies and applications have...
OBJECTIVES
Recent technological advances have led to the capability of performing high resolution imaging of the tympanic membrane. Smartphone technologies and applications have provided the opportunity to capture digital images and easily share them. The smartphone otoscope device was developed as a simple system that can convert a smartphone into a digital otoscope. This device has the prospective ability to improve physician-patient communication and assist with the diagnosis and management of ear disease. Our objective was to evaluate the feasibility and physician/parental satisfaction using the Cellscope® smartphone attachment for at home tympanostomy tube monitoring.
METHODS
Children between 6 months and 15 years of age at an urban tertiary children's hospital that were scheduled for bilateral tympanostomy tube insertion or underwent bilateral tympanostomy tube surgery were prospectively enrolled in the study. Comparisons were made between parental home-recorded videos and findings during in-office otoscopy. Two independent otolaryngologists reviewed the videos and concordance between inter-rater agreements was calculated. Acceptability and use questionnaires were administered to physicians and parents.
RESULTS
There was good intra-rater agreement between traditional otoscopy and video-otoscopy for tube extruding, tube blocked and tube extruded with at least 80% agreement ( < .05) and excellent inter-rater agreement between physicians for nearly all tube variables ( < .0001) There was a high degree of satisfaction with this mode of surveillance. Parents and physicians agreed that the CellScope® smartphone was easy to use, helpful with the occurrence of acute events, and appeared to improve quality of care.
CONCLUSIONS
The CellScope® smartphone is feasible for use in tympanostomy tube surveillance. Use of the device may allow otolaryngologists to easily follow a child's tympanostomy tube remotely over time and offer greater parental satisfaction.
Topics: Adolescent; Child; Child, Preschool; Feasibility Studies; Female; Humans; Infant; Male; Middle Ear Ventilation; Mobile Applications; Otoscopes; Parents; Patient Satisfaction; Pilot Projects; Prospective Studies; Smartphone; Telemedicine; Video Recording
PubMed: 32627572
DOI: 10.1177/0003489420938820 -
Clinical Case Reports Jan 2024Oto-tricho is associated with the symptoms of gag reflex and non-neuropathic tinnitus, which can be treated by removing the hair and its follicle.
KEY CLINICAL MESSAGE
Oto-tricho is associated with the symptoms of gag reflex and non-neuropathic tinnitus, which can be treated by removing the hair and its follicle.
ABSTRACT
Oto-tricho refers to a disorder of hair growth in the tympanic membrane (TM). In its early stages, it can manifest as symptoms such as tinnitus, chronic pain, cough, and nausea. If left untreated, it can potentially lead to tympanosclerosis, TM micro-perforation, and hearing loss. In this report, we present a case study of a 33-year-old male with hair and follicle growth observed on the left TM. Over the course of the past year, the patient experienced various symptoms including tinnitus, dry cough, and chronic pain. An examination with an otoscope revealed the presence of oto-tricho-tussia/tinnitus. To address the issue, the hair and hair follicles were surgically removed using direct visual guidance. Subsequent follow-up was conducted over a period of 5 months, during which no pain or infection was observed at the site of the TM. The patient's previous symptoms were successfully resolved. Furthermore, further observation of the TM revealed no evidence of hair follicles or hair regrowth.
PubMed: 38173892
DOI: 10.1002/ccr3.8412 -
BMJ Open Quality Feb 2022The COVID-19 pandemic has catalysed the need to implement the National Health Service Long-Term Plan to deliver more care in the community and to reduce face-to-face...
INTRODUCTION
The COVID-19 pandemic has catalysed the need to implement the National Health Service Long-Term Plan to deliver more care in the community and to reduce face-to-face hospital appointments by up to 33%. This study aimed to assess the feasibility of a remote otology service from triage through to delivery.
METHODS
New adult otology referrals at a tertiary ear, nose and throat (ENT) hospital aged between 18 and 70 with hearing loss or tinnitus were included. Patients attended an audiology-led community clinic where they underwent a focused history, audiometric testing, and a smartphone-based application and otoscope (Tympa System) was used to capture still and video images of their eardrums. The information was reviewed by ENT clinicians using a remote review platform with a subset of patients subsequently undergoing an in-person review to measure concordance between the two assessments.
RESULTS
58 patients participated. 75% of patients had their pathways shortened by one hospital visit with 65% avoiding any hospital attendances. 24% required an additional face-to-face appointment due to incomplete views of the tympanic membrane or need for additional examinations. Electronic validation by a blinded consultant otologist demonstrated a diagnosis concordance of 95%, and concordance between remote-review and in-person consultations in the 12 patients who agreed to attend for an in-person review was 83.3%. 98% of patients were satisfied with the pathway.
CONCLUSION
This pilot service is feasible, safe and non-inferior to the traditional outpatient model in the included patient group. There is potential for the development of a community audiology-led service or use for general practioner advice and guidance.
Topics: Adolescent; Adult; Aged; COVID-19; Feasibility Studies; Humans; Middle Aged; Otolaryngology; Pandemics; SARS-CoV-2; State Medicine; United Kingdom; Young Adult
PubMed: 35135752
DOI: 10.1136/bmjoq-2021-001444 -
American Family Physician Apr 2000Acute otitis media is overdiagnosed. Symptoms are neither sensitive nor specific for the diagnosis of otitis media; fever and ear pain are present in only one half of... (Review)
Review
Acute otitis media is overdiagnosed. Symptoms are neither sensitive nor specific for the diagnosis of otitis media; fever and ear pain are present in only one half of patients. Undue reliance on one feature--redness of the tympanic membrane--and failure to assess tympanic membrane mobility with pneumatic otoscopy contribute to inaccurate diagnoses. Adequate visualization of the tympanic membrane is often impaired by low light output from old otoscope bulbs and blockage of the ear canal by cerumen. Distinguishing acute otitis media from otitis media with effusion is clinically important because antibiotics are seldom indicated for the latter condition. A key differentiating feature is the position of the tympanic membrane: it is usually bulging in acute otitis media and in a neutral position or a retracted position in otitis media with effusion. Tympanometry and acoustic reflectometry can be useful adjunctive tools to confirm the presence of fluid in the middle ear. Selective use of tympanocentesis in cases of refractory or recurrent middle ear disease can help guide appropriate therapy and avoid unnecessary medical or surgical interventions.
Topics: Acute Disease; Diagnosis, Differential; Humans; Otitis Media; Otitis Media with Effusion; Predictive Value of Tests; Tympanic Membrane
PubMed: 10779248
DOI: No ID Found -
American Journal of Otolaryngology 2022Hearing loss is one of the self-reported symptoms of Long COVID patients, however data from objective and subjective audiological tests demonstrating diminished hearing...
INTRODUCTION
Hearing loss is one of the self-reported symptoms of Long COVID patients, however data from objective and subjective audiological tests demonstrating diminished hearing in Long COVID patients has not been published.
MATERIALS AND METHODS
Respondents of a large Long COVID online survey were invited to the ENT-department for an otologic exam. The participants were split into three groups based on their history of SARS-CoV-2 infection and persistence of symptoms. Respondents with a history of a SARS-CoV-2 infection were allocated to the Long COVID group, if they reported persistent symptoms and to the Ex COVID group, if they had regained their previous level of health. Participants without a history of SARS-CoV-2 infection made up the No COVID control group. In total, 295 ears were examined with otoscopy, tympanograms, pure tone audiometry and otoacoustic emissions. Ears with known preexisting hearing loss or status post ear surgery, as well as those with abnormal otoscopic findings, non-type A tympanograms or negative Rinne test were excluded.
RESULTS
Compared to the No COVID and Ex COVID groups, we did not find a clinically significant difference in either hearing thresholds or frequency specific TEOAEs. However, at 500 Hz the data from the left ear, but not the right ear showed a significantly better threshold in the Ex COVID group, compared to Long COVID and No COVID groups. Any of the other tested frequencies between 500 Hz and 8 kHz were not significantly different between the different groups. There was a significantly lower frequency-specific signal-to-noise-ratio of the TEOAEs in the Long COVID compared to the No COVID group at 2.8 kHz. At all other frequencies, there were no significant differences between the three groups in the TEOAE signal-to-noise-ratio.
CONCLUSION
This study detected no evidence of persistent cochlear damage months after SARS-CoV-2 infection in a large cohort of Long COVID patients, as well as those fully recovered.
Topics: Adult; Audiometry, Pure-Tone; Auditory Threshold; COVID-19; Hearing Loss, Sensorineural; Humans; Otoacoustic Emissions, Spontaneous; SARS-CoV-2; Post-Acute COVID-19 Syndrome
PubMed: 35988361
DOI: 10.1016/j.amjoto.2022.103579 -
Indian Journal of Otolaryngology and... Dec 2022Langerhans cell histiocytosis (LCH) is a proliferation of dendritic mononuclear cells with infiltration into organs locally or diffusely. Most cases occur in children....
Langerhans cell histiocytosis (LCH) is a proliferation of dendritic mononuclear cells with infiltration into organs locally or diffusely. Most cases occur in children. LCH can also present as chronic otitis media and otitis externa due to involvement of the mastoid and petrous portions of the temporal bone with partial obstruction of the auditory canal. A 4 year old male child presented with complaints of bilateral ear discharge for 4 months and inability to walk and giddiness for 2 days. On otoscopic examination, in right ear, polypoidal tissue was present in the external auditory canal which bled on touch. CECT head and MRI brain was done which showed large altered intensities in the region of bilateral external and middle ears involving the temporal bone. It also showed a well defined ovoid expansile lesion involving the skull vault in left high parietal region. Biopsy was taken from the polypoidal tissue in the right EAC which on HPE showed features suspicious for LCH. On IHC, the tissue was found out to be immunoreactive for CD 68, CD 1a and S-100 with score of 4+ for all three of the IHC markers. Patient was later put on chemotherapy and steroids which resulted in disease remission.
PubMed: 36742476
DOI: 10.1007/s12070-021-02431-0 -
BMJ Open Sport & Exercise Medicine 2020To assess awareness of external auditory exostosis (EAE) among Australian surfers.
OBJECTIVES
To assess awareness of external auditory exostosis (EAE) among Australian surfers.
METHODS
This is a cross-sectional observational study, assessing professional and recreational Australian surfers. Currently, active surfers over 18 years of age, surfing year-round, were eligible to participate. After initial screening, individuals were asked to complete a questionnaire. All included volunteers underwent bilateral otoscopic examination, to assess the presence and severity of EAE.
RESULTS
A total of 113 surfers were included in the study and were divided into two groups, based on surfing status: 93 recreational surfers and 20 professional surfers. Recreational surfers were significantly older (p<0.005), more experienced (greater years surfing; p<0.005), with lower prevalence of otological symptoms (p<0.05). The most common symptoms were water trapping, impacted wax and hearing loss. Prevalence of EAE was high for both groups (95% in the professional surfers and 82.8% in the recreational surfers); however, recreational surfers had mild grade EAE (grade 1) as the most common presentation, as opposed to professionals who had severe grade EAE (grade 3) as the most common presentation (p<0.05 between groups). Awareness of the term 'surfer's ear' was high for both groups, as was knowledge of prevention options. However, fewer considered the condition to be preventable, and an even lower number reported regular use of prevention methods.
CONCLUSION
Australian surfers had a high level of awareness of EAE; however, few reported using prevention methods, despite having a high prevalence of the condition. Health practitioners should screen susceptible individuals in order to recommend appropriate preventive measures.
PubMed: 32153980
DOI: 10.1136/bmjsem-2019-000641 -
Journal of Osteopathic Medicine Mar 2022External auditory canal exostoses (EACE) are bony formations that develop insidiously in the auditory meatus from chronic exposure to cold water and, in severe cases,...
CONTEXT
External auditory canal exostoses (EACE) are bony formations that develop insidiously in the auditory meatus from chronic exposure to cold water and, in severe cases, require surgery. This condition has been understudied in the whitewater kayakers and not yet studied in the riverboarding population. Precautions such as earplugs are thought to prevent the formation of EACE because they mechanically block cold water from contacting the sensitive skin in the external auditory canal; however, earplugs are not commonly utilized by athletes. Inquiring about hobbies and the use of protective equipment can be done during osteopathic physicians' preventive care visits.
OBJECTIVES
This article aims to determine the prevalence of EACE in Colorado whitewater athletes and their attitudes about wearing ear protection before and after an educational intervention directed at increasing awareness and prevention of EACE.
METHODS
In July 2020, participants of this cross-sectional study completed a 10-min survey that collected demographics, whitewater experience, and perceptions of EACE, followed by an educational intervention. Participant ears were photographed utilizing a digital otoscope to assess EACE, and severity ratings were categorized into one of four occlusion levels: none (0%), mild (<25%), moderate (25-75%), or severe (>75%). Spearman correlation coefficients and Wilcoxon signed-rank tests were utilized to assess changes in attitudes before and after the educational intervention.
RESULTS
Eighty-one participants (mean [SD] age = 36.3 [12.6] years, 25.9% female) completed the study: 74 kayakers and seven riverboarders. After the intervention, 60.5% (49/81) (p<0.001) reported greater understanding of EACE and 75.0% (60/80) were more likely to wear ear protection (p<0.001). Most (58.0%, 47/81) never wore ear protection. Of the 61 (75.0%) participants with at least one ear severity rating, most (55.7%, 34/61) had moderate EACE, 29.5% (18/61) had no to mild EACE, and 14.8% (9/61) had severe EACE (p<0.001). Impaired hearing was the biggest barrier to utilizing ear protection (51.6%, 33/64).
CONCLUSIONS
Our results suggested that the educational intervention improved understanding of EACE and may increase utilization of ear protection in this population. Such prevention efforts may lead to better health of whitewater paddlers by reducing the incidence of EACE. Encouraging osteopathic physicians to inquire about hobbies and protective equipment during primary care preventive visits is essential to help keep athletes in the river doing what they love for longer, contributing to a healthier and happier whole person.
Topics: Adult; Colorado; Cross-Sectional Studies; Ear Canal; Exostoses; Female; Humans; Male; Water
PubMed: 35355493
DOI: 10.1515/jom-2021-0252 -
Journal of Neurological Surgery. Part... Jun 2022Diagnostic criteria for otogenic skull base osteomyelitis (SBO) have been conflicting among researchers. We aimed to propose clinically useful diagnostic criteria...
Diagnostic criteria for otogenic skull base osteomyelitis (SBO) have been conflicting among researchers. We aimed to propose clinically useful diagnostic criteria and a staging system for otogenic SBO that is associated with infection control and mortality. The present study is designed as a retrospective one. This study was conducted at the University Hospital. Thirteen patients with otogenic SBO who met the novel rigorous diagnostic criteria consisted of symptomatic and radiological signs on high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI). Simple refractory external otitis was not included. A staging system according to disease extent revealed by HRCT and MRI is proposed: lesions limited to the temporal bone (stage 1), extending to less than half (stage 2), exceeding the midline (stage 3), and extending to the whole of the clivus (stage 4). All patients received long-term antibiotic therapy. Patients were divided into infection-uncontrolled or -controlled groups based on symptoms, otoscopic findings, and C-reactive protein level at the last follow-up. The mean follow-up period was 27.7 months. Possible prognostic factors, such as immunocompromised status and symptoms, including cranial nerve palsy, pretreatment laboratory data, and treatments, were compared between the infection-uncontrolled and -controlled groups. Disease stages were correlated with infection control and mortality. The infection-uncontrolled rate and mortality rate were 38.5 and 23.1%, respectively. There were no significant differences in possible prognostic factors between the infection-uncontrolled and -controlled groups. HRCT-based stages significantly correlated with infection control and mortality. We proposed here the clinically useful diagnostic criteria and staging systems that can predict infection control and prognosis of otogenic SBO.
PubMed: 35832975
DOI: 10.1055/s-0041-1732308 -
Journal of Otology Apr 2021Otoscopy examination can be challenging. Traditional teaching uses still image illustrations. Newer attempts use video samples to simulate the otoscopy exam which is a...
BACKGROUND
Otoscopy examination can be challenging. Traditional teaching uses still image illustrations. Newer attempts use video samples to simulate the otoscopy exam which is a dynamic process.Aims/Objective: To assess whether recorded otoscopy videos from a smartphone adaptable otoscope can be used to develop a video-based otoscopy quiz which may be used for instructing and familiarizing participants to normal anatomy and pathologic ear conditions. To use this quiz to assess current pediatric residents' competency of common otoscopy diagnosis.
METHOD AND MATERIALS
This study was conducted in 2018. Video samples of ear pathology were collected at the Albany Medical Center using a smartphone adaptable otoscope- Cellscope. The videos were used to create a video otoscopy quiz (VOQ) without clinical vignettes. 45 pediatric residents from 3 academic institutions were evaluated with the quiz.
RESULTS
The weighted mean for the VOQ was 66.90% (95%CI 58.89%-68.42%). The breakdown by questions are: myringosclerosis 72.88%, retraction pocket 80.65%, cholesteatoma 42.22%, hemotympanum 75.04%, tympanic membrane perforation 79.62%, cerumen impaction 95.46%, otitis externa 52.54%, otitis media with effusion 63.30%, acute otitis media 75.55%, normal ear 36.39%.
CONCLUSION
We found that videos of otoscopy exams can be obtained with a smartphone adaptable otoscope and validated to develop a video-based quiz, which may be used to supplement otoscopic instruction. Following our testing process, we found pediatric residents are relatively well equipped to identify ear pathology on VOQ.
PubMed: 33777119
DOI: 10.1016/j.joto.2020.08.001