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Millions of people across the world suffer from disabling hearing loss. Appropriate interventions lead to improved speech and language skills, educational advancement, and improved social integration. A major limitation to improving care is identifying those with disabling hearing loss in low-resource countries.
This review article summarises information on currently available hearing screening platforms and technology available from published reports and the authors’ personal experiences of hearing loss identification in low-resource areas of the world. The paper reviews the scope and capabilities of portable hearing screening platforms, including the pros and cons of each technology and how they have been utilised in low-resource environments.
Portable hearing screening tools are readily available to assess hearing loss in low-resource areas. Each technology has advantages and limitations that should be considered when identifying the optimal methods to assess needs in each country.
Malignant otitis externa is a potentially fatal infection of the skull base. With an ageing population and increasing prevalence of diabetes, the incidence of malignant otitis externa in the British population is rising. To date, there remain no accepted diagnostic criteria, few prognostic indicators and no consensus treatment pathways.
A prospective case series was conducted at a tertiary referral teaching hospital.
A cohort of susceptible individuals predominates (elderly, male, with immunosuppression and diabetes), with 25 per cent reporting a preceding incident. Otorrhoea, otalgia and canal granulation were the commonest presenting features, alongside positive pseudomonas cultures. No clear markers for predicating disease severity were isolated; however, a high initial haemoglobin A1c level demonstrated a significant moderately positive correlation with length of treatment.
A treatment pathway designed to provide a standardised approach to investigation and treatment is proposed, which aims to increase earlier diagnosis, streamline care and facilitate the development of best practice.
There is growing concern over a future shortfall in provision of UK otolaryngology consultants. There is a declining rate of applications to otolaryngology specialty training in the UK.
This study aimed to systematically review the literature to establish what factors influence medical students’ and junior doctors’ decision to pursue a career in otolaryngology.
Medline, Embase and PubMed databases were searched in January 2019. Additional manual reference checks of identified literature were performed.
Eleven articles were included in the review. Common factors that positively influenced the decision to pursue a career in otolaryngology were exposure to the specialty, positive role models and a good work-life balance. Lack of exposure was a consistent deterrent from pursuing a career in otolaryngology.
This review reiterates the need for greater exposure to otolaryngology in the undergraduate curriculum. In addition, mentorship for students with an interest in otolaryngology should be a priority.
Ménière's disease often presents with aural fullness, for reasons that are currently not well understood. Transtympanic ventilation tube insertion has been historically used for the management of this symptom, though the nature and mechanism of effectiveness is unclear.
To give an overview of the data available on the effects of ventilation tube insertion on aural fullness in Ménière's disease.
The databases PubMed, Embase, Medline, Scopus, Web of Science, Central and Google Scholar were searched to identify relevant records. Records were subsequently analysed and data extracted.
Only two studies directly measured the effect of ventilation tube insertion on aural fullness, while three others measured it as a placebo to assess another treatment. Considerable heterogeneity was found amongst the studies, including conflicting conclusions.
There is a paucity of evidence investigating the effect of grommet insertion on aural fullness in Ménière's disease. This work directs future research into this topic.
Endoscopic septoplasty is an alternative approach for a deviated nasal septum. Since its introduction, numerous techniques have been developed, each with its own advantages and limitations. A literature review is presented, along with our experience with endoscopic spur resection.
The Medline and Google Scholar databases were searched for relevant literature, and the records of all patients undergoing endoscopic spur resection at the University Hospitals Leuven between 2001 and 2015 were reviewed.
Results and conclusion
Endoscopic septoplasty offers improved visualisation and the option of limited flap dissection, which are particularly helpful when dealing with isolated spurs, posterior deviations and revision septoplasty. It enhances teaching and improves surgical transition to endoscopic sinus surgery. Reported success and complication rates are comparable to those seen in traditional approaches. Endoscopic spur resection, as conducted at the University Hospitals Leuven, was shown to be a quick, safe and efficient technique when dealing with isolated septal spurs, especially when combined with endoscopic sinus surgery.
To review the literature regarding screening for vestibular schwannoma in the context of demographic changes leading to increasing numbers of elderly patients presenting with asymmetric auditory symptoms.
A systematic review of the literature was performed, with narrative synthesis and statistical analysis of data where appropriate.
Vestibular schwannomas diagnosed in patients aged over 70 years exhibit slower growth patterns and tend to be of smaller size compared to those tumours in younger age groups. This fact, combined with reduced life expectancy, renders the probability of these tumours in the elderly requiring active treatment with surgery or stereotactic radiotherapy to be extremely low. Vestibular schwannomas in the elderly are much more likely to be managed by serial monitoring with magnetic resonance imaging. The weighted yield of magnetic resonance imaging in the diagnosis of vestibular schwannoma in all age groups is 1.18 per cent, with almost 85 scans required to diagnose 1 tumour.
An evidence-based approach to the investigation of asymmetric hearing loss and tinnitus in the elderly patient can be used to formulate guidelines for the rational use of magnetic resonance imaging in this population.
ENT disease prevalence, risk factors and treatment vary between developed and developing countries. Health provision, particularly disease prevention strategies and surgery, in developing countries is poor, manifesting as a high frequency of common and preventable diseases. Healthcare systems in developing countries are unsustainable, and the technological advances that provide ENT surgery with novel diagnostic and treatment opportunities are inaccessible.
A multifaceted approach is essential to improve the care of patients with ENT diseases in developing countries. Public health efforts must focus on educating the local community, reducing high-risk behaviours and decreasing the frequency of preventable diseases. Governments must be pressured to prioritise the funding of long-term, sustainable efforts with effective disease prevention strategies. Providing local healthcare professionals with high-quality ENT training so that self-sustaining and low-cost care can be delivered, mainly in a primary care setting, is key.
To evaluate mastoid pneumatisation and facial canal dimensions.
In this retrospective study, 169 multidetector computed tomography scans of temporal bone were reviewed. Facial canal dimensions were evaluated at the labyrinthine, tympanic and mastoid segments using axial and coronal multidetector computed tomography scans of temporal bone. Mastoid pneumatisation and facial canal dehiscence were evaluated. Facial canal dehiscence was measured if it was found to be present.
This study showed that facial canal dimensions decreased in pneumatised mastoids. Facial canal dimensions in females were smaller than in males. Facial canal dehiscence was detected in 5.9 per cent and 6.5 per cent of the patients on the right and left sides, respectively. No correlations were found between facial canal dehiscence and mastoid pneumatisation. The length of dehiscence was 1.92 ± 0.44 mm (range, 0.86–2.51 mm) on the left side. In older subjects, left facial canal dehiscence was detected more, and the length of the dehiscence increased.
This study concluded that during surgery, facial canal dehiscence should be kept in mind in order to avoid complications.