Interventions for Adult Eustachian Tube Dysfunction: a Systematic Review
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Perforated Eardrum
Vinod K. Anand, MD, FACS Nose and Sinus Clinic Perforated Eardrum A perforated eardrum is a hole or rupture m the eardrum, a thin membrane which separated the ear canal and the middle ear. The medical term for eardrum is tympanic membrane. The middle ear is connected to the nose by the eustachian tube. A perforated eardrum is often accompanied by decreased hearing and occasional discharge. Paih is usually not persistent. Causes of Eardrum Perforation The causes of perforated eardrum are usually from trauma or infection. A perforated eardrum can occur: if the ear is struck squarely with an open hand with a skull fracture after a sudden explosion if an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal. as a result of hot slag (from welding) or acid entering the ear canal Middle ear infections may cause pain, hearing loss and spontaneous rupture (tear) of the eardrum resulting in a perforation. In this circumstance, there may be infected or bloody drainage from the ear. In medical terms, this is called otitis media with perforation. On rare occasions a small hole may remain in the eardrum after a previously placed P.E. tube (pressure equalizing) either falls out or is removed by the physician. Most eardrum perforations heal spontaneously within weeks after rupture, although some may take up to several months. During the healing process the ear must be protected from water and trauma. Those eardrum perforations which do not heal on their own may require surgery. Effects on Hearing from Perforated Eardrum Usually, the larger the perforation, the greater the loss of hearing. -
Upregulation of Peroxisome Proliferator-Activated Receptor-Α And
Upregulation of peroxisome proliferator-activated receptor-α and the lipid metabolism pathway promotes carcinogenesis of ampullary cancer Chih-Yang Wang, Ying-Jui Chao, Yi-Ling Chen, Tzu-Wen Wang, Nam Nhut Phan, Hui-Ping Hsu, Yan-Shen Shan, Ming-Derg Lai 1 Supplementary Table 1. Demographics and clinical outcomes of five patients with ampullary cancer Time of Tumor Time to Age Differentia survival/ Sex Staging size Morphology Recurrence recurrence Condition (years) tion expired (cm) (months) (months) T2N0, 51 F 211 Polypoid Unknown No -- Survived 193 stage Ib T2N0, 2.41.5 58 F Mixed Good Yes 14 Expired 17 stage Ib 0.6 T3N0, 4.53.5 68 M Polypoid Good No -- Survived 162 stage IIA 1.2 T3N0, 66 M 110.8 Ulcerative Good Yes 64 Expired 227 stage IIA T3N0, 60 M 21.81 Mixed Moderate Yes 5.6 Expired 16.7 stage IIA 2 Supplementary Table 2. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of an ampullary cancer microarray using the Database for Annotation, Visualization and Integrated Discovery (DAVID). This table contains only pathways with p values that ranged 0.0001~0.05. KEGG Pathway p value Genes Pentose and 1.50E-04 UGT1A6, CRYL1, UGT1A8, AKR1B1, UGT2B11, UGT2A3, glucuronate UGT2B10, UGT2B7, XYLB interconversions Drug metabolism 1.63E-04 CYP3A4, XDH, UGT1A6, CYP3A5, CES2, CYP3A7, UGT1A8, NAT2, UGT2B11, DPYD, UGT2A3, UGT2B10, UGT2B7 Maturity-onset 2.43E-04 HNF1A, HNF4A, SLC2A2, PKLR, NEUROD1, HNF4G, diabetes of the PDX1, NR5A2, NKX2-2 young Starch and sucrose 6.03E-04 GBA3, UGT1A6, G6PC, UGT1A8, ENPP3, MGAM, SI, metabolism -
Otitis Media: Causes and Treatment
Otitis media: causes and treatment This leaflet is for patients with otitis media (infection of the middle ear). If you do not understand anything or have any other concerns, please speak to a member of staff. What is otitis media? It is inflammation and infection of the middle ear. This is the eardrum and the small space behind the eardrum. What causes otitis media? Inflammation and blockage of the Eustachian tube following chest infection, colds, flu and throat infection which can cause a build-up of mucus in the middle ear. What are the symptoms? • Earache. • Dulled hearing may develop for a few days. • Fever (high temperature). • Sometimes the eardrum perforates (bursts). This lets out infected mucus, and the ear becomes runny for a few days. As the pain is due to a tense eardrum, if the eardrum bursts, the pain often settles. A perforated eardrum usually heals quickly after the infection clears. It is important that during the next 6 weeks that the ear canal is kept dry during the healing process. Once the infection (and perforation) have cleared, your hearing should return to normal. What is the treatment for otitis media? Most bouts of ear infection will clear on their own within three days. The immune system can usually clear bacteria or viruses causing ear infections. • Painkillers such as Paracetamol or Ibuprofen will ease the pain and will also lower a raised temperature. It is important that you take painkillers as prescribed until the pain eases. • Antibiotics are prescribed if the infection is severe, or is getting worse after 2-3 days. -
(CD-P-PH/PHO) Report Classification/Justifica
COMMITTEE OF EXPERTS ON THE CLASSIFICATION OF MEDICINES AS REGARDS THEIR SUPPLY (CD-P-PH/PHO) Report classification/justification of medicines belonging to the ATC group R01 (Nasal preparations) Table of Contents Page INTRODUCTION 5 DISCLAIMER 7 GLOSSARY OF TERMS USED IN THIS DOCUMENT 8 ACTIVE SUBSTANCES Cyclopentamine (ATC: R01AA02) 10 Ephedrine (ATC: R01AA03) 11 Phenylephrine (ATC: R01AA04) 14 Oxymetazoline (ATC: R01AA05) 16 Tetryzoline (ATC: R01AA06) 19 Xylometazoline (ATC: R01AA07) 20 Naphazoline (ATC: R01AA08) 23 Tramazoline (ATC: R01AA09) 26 Metizoline (ATC: R01AA10) 29 Tuaminoheptane (ATC: R01AA11) 30 Fenoxazoline (ATC: R01AA12) 31 Tymazoline (ATC: R01AA13) 32 Epinephrine (ATC: R01AA14) 33 Indanazoline (ATC: R01AA15) 34 Phenylephrine (ATC: R01AB01) 35 Naphazoline (ATC: R01AB02) 37 Tetryzoline (ATC: R01AB03) 39 Ephedrine (ATC: R01AB05) 40 Xylometazoline (ATC: R01AB06) 41 Oxymetazoline (ATC: R01AB07) 45 Tuaminoheptane (ATC: R01AB08) 46 Cromoglicic Acid (ATC: R01AC01) 49 2 Levocabastine (ATC: R01AC02) 51 Azelastine (ATC: R01AC03) 53 Antazoline (ATC: R01AC04) 56 Spaglumic Acid (ATC: R01AC05) 57 Thonzylamine (ATC: R01AC06) 58 Nedocromil (ATC: R01AC07) 59 Olopatadine (ATC: R01AC08) 60 Cromoglicic Acid, Combinations (ATC: R01AC51) 61 Beclometasone (ATC: R01AD01) 62 Prednisolone (ATC: R01AD02) 66 Dexamethasone (ATC: R01AD03) 67 Flunisolide (ATC: R01AD04) 68 Budesonide (ATC: R01AD05) 69 Betamethasone (ATC: R01AD06) 72 Tixocortol (ATC: R01AD07) 73 Fluticasone (ATC: R01AD08) 74 Mometasone (ATC: R01AD09) 78 Triamcinolone (ATC: R01AD11) 82 -
Conceptual Model for Using Imidazoline Derivative Solutions in Pulpal Management
Journal of Clinical Medicine Review Conceptual Model for Using Imidazoline Derivative Solutions in Pulpal Management Robert S. Jones Division of Pediatric Dentistry, Department of Developmental & Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA; [email protected] Abstract: Alpha-adrenergic agonists, such as the Imidazoline derivatives (ImDs) of oxymetazoline and xylometazoline, are highly effective hemostatic agents. ImDs have not been widely used in dentistry but their use in medicine, specifically in ophthalmology and otolaryngology, warrants consideration for pulpal hemostasis. This review presents dental healthcare professionals with an overview of ImDs in medicine. ImD solutions have the potential to be more effective and biocompatible than existing topical hemostatic compounds in pulpal management. Through a comprehensive analysis of the pharmacology of ImDs and the microphysiology of hemostasis regulation in oral tissues, a conceptual model of pulpal management by ImD solutions is presented. Keywords: hemostasis; alpha-adrenergic agonists; imidazoline; oxymetazoline; nasal; dental pulp; mucosa; apexogenesis; pulpotomy; direct pulp cap; dentistry 1. Overview Citation: Jones, R.S. Conceptual The purpose of this review is to formulate a conceptual model on the potential man- Model for Using Imidazoline agement of pulpal tissue by imidazoline derivatives (ImDs) based on a review of the Derivative Solutions in Pulpal literature that examines the hemostatic properties and mechanistic actions of these com- Management. J. Clin. Med. 2021, 10, 1212. https://doi.org/10.3390/ pounds in other human tissues. Commercial ImDs are formulated in solution with an- jcm10061212 timicrobial preservatives in order to act as ‘parenteral topical agents’ and used to manage ophthalmic inflammation, nasal congestion, and to control bleeding during otolaryngology Academic Editor: Rosalia surgery [1,2]. -
Congenital Malformations of the External and Middle Ear: High-Resolution CT Findings of Surgical Import
71 Congenital Malformations of the External and Middle Ear: High-Resolution CT Findings of Surgical Import Joel D. Swartz1 The external auditory canal, middle ear, and bulk of the ossicular chain develop from Eric N. Faerber1 the first branchial groove, first and second branchial arches, and first pharyngeal pouch. Embryologic development of these structures is complex and only rarely are two anomalies identical. Development of the inner ear structures occurs independently of external ear structures, and concomitant involvement is unusual. This study includes 11 cases of unilateral external auditory canal atresia and two cases of bilateral atresia. Eight cases (four bilateral) of isolated congenital ossicular anomalies are also included. Emphasis is placed on findings of surgical import. All patients were studied with computed tomography only, because it was believed that the bony and soft-tissue detail achieved is superior to that with conventional multidirectional tomography. High-resolution computed tomography (CT) has emerged as the method of choice for evaluation of the temporal bone. The purpose of this study was to provide a detailed analysis of congenital aural malformations to emphasize findings deemed critical by surgeons. Materials and Methods A General Electric 8800 CT/T scanner was used in all cases. Overlapping CT sections of 1.5 mm thickness were obtained in axial and coronal projections [1]. Infants and very young children required heavy sedation or general anesthesia. If an endotracheal tube was used, a coronal view in the supine position was necessary to facilitate patient monitoring. Excellent images were obtained in all patients, usually within 40 min . All images were targeted using high-bone-detail algorithms. -
FEEVA / FVE Position for Improving Availability of Medicines Bringing Added Clinical Benefit for Treatment in Horses
Brussels, 9 March 2017 FVE/017/doc/029 FEEVA / FVE position for improving availability of medicines bringing added clinical benefit for treatment in horses Request to include tenoic acid, phenylbutazone for systemic use and tetracaine, tetryzoline, synephrine, rifamycine, polymyxine B for ophthalmic use on the list of substances bringing added clinical benefit for treatment in horses. The therapeutic arsenal of medicines for horses (food-producing species in the European Union) is limited. Considering this, the EU has provided specific regulations for the horse industry to derogate from the principle that food animals can only be treated with active substances for which a Maximum Limit of Residues (MLR) has been established. Therefore, Regulation (EC) No 1950/2006 of 13 December 2006 in accordance with Directive 2001/82 / EC of the European Parliament and the Council on the Community code relating to veterinary medicinal, establishes a list of essential substances and substances bringing added clinical benefit for the treatment of horses. The ‘essential and clinical benefit list’ in Regulation 1950/2006 allows the treatment of horses whose meat or products are intended for human consumption with listed substances. Substances included in this list are considered as essential for the treatment of equine diseases and/or present additional clinical benefit, even if they don't have a defined MRL. In these cases, a waiting period of six months must be respected before sending treated animals for human consumption. According to the legislation substances bringing added clinical benefit may be used, for the specific disease conditions, based on improved efficacy or safety or a major contribution to treatment compared to other products authorized for Equidae. -
Discovery of Novel Imidazolines and Imidazoles As Selective TAAR1
Discovery of Novel Imidazolines and Imidazoles as Selective TAAR1 Partial Agonists for the Treatment of Psychiatric Disorders Giuseppe Cecere, pRED, Discovery Chemistry F. Hoffmann-La Roche AG, Basel, Switzerland Biological Rationale Trace amines are known for four decades Trace Amines - phenylethylamine p- tyramine p- octopamine tryptamine (PEA) Biogenic Amines dopamine norepinephrine serotonin ( DA) (NE) (5-HT) • Structurally related to classical biogenic amine neurotransmitters (DA, NE, 5-HT) • Co-localised & released with biogenic amines in same cells and vesicles • Low concentrations in CNS, rapidly catabolized by monoamine oxidase (MAO) • Dysregulation linked to psychiatric disorders such as schizophrenia & 2 depression Trace Amines Metabolism 3 Biological Rationale Trace Amine-Associated Receptors (TAARs) p-Tyramine extracellular TAAR1 Discrete family of GPCR’s Subtypes TAAR1-TAAR9 known intracellular Gs Structural similarity with the rhodopsin and adrenergic receptor superfamily adenylate Activation of the TAAR1 cyclase receptor leads to cAMP elevation of intracellular cAMP levels • First discovered in 2001 (Borowsky & Bunzow); characterised and classified at Roche in 2004 • Trace amines are endogenous ligands of TAAR1 • TAAR1 is expressed throughout the limbic and monoaminergic system in the brain Borowsky, B. et al., PNAS 2001, 98, 8966; Bunzow, J. R. et al., Mol. Pharmacol. 2001, 60, 1181. Lindemann L, Hoener MC, Trends Pharmacol Sci 2005, 26, 274. 4 Biological Rationale Electrical activity of dopaminergic neurons + p-tyramine -
Test Summary Sheet For
Test Summary Sheet for: 8054B Postmortem, Expanded with NPS, Blood (Forensic) The following test codes are contained in this document: 1. 8054B Postmortem, Expanded with NPS, Blood (Forensic) 2. 50000B Acetaminophen Confirmation, Blood (Forensic) 3. 52250B Alcohols and Acetone Confirmation, Blood (Forensic) 4. 52143B Alfentanil and Sufentanil Confirmation, Blood (Forensic) 5. 52168B Amitriptyline and Metabolite Confirmation, Blood (Forensic) 6. 52239B Amoxapine Confirmation, Blood (Forensic) 7. 52485B Amphetamines Confirmation, Blood (Forensic) 8. 52416B Aripiprazole Confirmation, Blood (Forensic) 9. 52007B Atomoxetine Confirmation, Blood (Forensic) 10. 50011B Barbiturates Confirmation, Blood (Forensic) 11. 52365B Bath Salts Confirmation, Blood (Forensic) 12. 52367B Bath Salts Confirmation, Blood (Forensic) 13. 50012B Benzodiazepines Confirmation, Blood (Forensic) 14. 52443B Benztropine Confirmation, Blood (Forensic) 15. 52245B Brompheniramine Confirmation, Blood (Forensic) 16. 52011B Bupivacaine Confirmation, Blood (Forensic) 17. 52012B Bupropion and Metabolite Confirmation, Blood (Forensic) 18. 52444B Buspirone Confirmation, Blood (Forensic) 19. 52198B Cannabinoids Confirmation, Blood (Forensic) 20. 52015B Carbamazepine and Metabolite Confirmation, Blood (Forensic) 21. 52017B Carisoprodol and Metabolite Confirmation, Blood (Forensic) 22. 52440B Chlorpheniramine Confirmation, Blood (Forensic) 23. 52272B Chlorpromazine Confirmation, Blood (Forensic) 24. 52482B Citalopram Confirmation, Blood (Forensic) 25. 52274B Clomipramine and Metabolite -
Determinants of Conductive Hearing Loss in Tympanic Membrane Perforation
Clinical and Experimental Otorhinolaryngology Vol. 8, No. 2: 92-96, June 2015 http://dx.doi.org/10.3342/ceo.2015.8.2.92 pISSN 1976-8710 eISSN 2005-0720 Original Article Determinants of Conductive Hearing Loss in Tympanic Membrane Perforation Hanaro Park·Seung No Hong·Hyo Sang Kim·Jae Joon Han·Juyong Chung·Myung-Whan Seo·Seung-Ha Oh Sun-O Chang·Jun Ho Lee Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea Objectives. Tympanic membrane perforations are common, but there have been few studies of the factors determining the extent of the resulting conductive hearing loss. The aims of this study were to determine whether the size of tympan- ic membrane perforation, pneumatization of middle ear & mastoid cavity, and location of perforation were correlated with air-bone gap (ABG) of patients. Methods. Forty-two patients who underwent tympanoplasty type I or myringoplasty were included and preoperative audi- ometry were analyzed. Digital image processing was applied in computed tomography for the estimation of middle ear & mastoid pneumatization volume and tympanic membrane photograph for the evaluation of perforation size and location. Results. Preoperative mean ABG increased with perforation size (P=0.018), and correlated inversely with the middle ear & mastoid volume (P=0.005). However, perforations in anterior versus posterior locations showed no significant dif- ferences in mean ABG (P=0.924). Conclusion. The degree of conductive hearing loss resulting from a tympanic membrane perforation would be expected with the size of perforation and pneumatization of middle ear and mastoid. Keywords. Tympanic Membrane Perforation; Tympanoplasty INTRODUCTION ear, and corresponding models have been suggested [1-3]. -
ANATOMY of EAR Basic Ear Anatomy
ANATOMY OF EAR Basic Ear Anatomy • Expected outcomes • To understand the hearing mechanism • To be able to identify the structures of the ear Development of Ear 1. Pinna develops from 1st & 2nd Branchial arch (Hillocks of His). Starts at 6 Weeks & is complete by 20 weeks. 2. E.A.M. develops from dorsal end of 1st branchial arch starting at 6-8 weeks and is complete by 28 weeks. 3. Middle Ear development —Malleus & Incus develop between 6-8 weeks from 1st & 2nd branchial arch. Branchial arches & Development of Ear Dev. contd---- • T.M at 28 weeks from all 3 germinal layers . • Foot plate of stapes develops from otic capsule b/w 6- 8 weeks. • Inner ear develops from otic capsule starting at 5 weeks & is complete by 25 weeks. • Development of external/middle/inner ear is independent of each other. Development of ear External Ear • It consists of - Pinna and External auditory meatus. Pinna • It is made up of fibro elastic cartilage covered by skin and connected to the surrounding parts by ligaments and muscles. • Various landmarks on the pinna are helix, antihelix, lobule, tragus, concha, scaphoid fossa and triangular fossa • Pinna has two surfaces i.e. medial or cranial surface and a lateral surface . • Cymba concha lies between crus helix and crus antihelix. It is an important landmark for mastoid antrum. Anatomy of external ear • Landmarks of pinna Anatomy of external ear • Bat-Ear is the most common congenital anomaly of pinna in which antihelix has not developed and excessive conchal cartilage is present. • Corrections of Pinna defects are done at 6 years of age. -
Onward Referral of Adults with Hearing Difficulty Directly Referred to Audiology Services
Guidance for Audiologists: Onward Referral of Adults with Hearing Difficulty Directly Referred to Audiology Services Produced by: Service Quality Committee of the British Academy of Audiology Key Authors: Hanna Jeffery Suzanne Jennings Laura Turton Date of publication: November 2016 (minor amendment July 2017) Review date: November 2021 BAA – Service Quality Committee Acknowledgements The Service Quality Committee would like to thank all those who provided their opinions on the draft of this document sent out for consultation, including BAA members, The British Society of Audiology, The British Association of Audiological Physicians, ENT UK and The Royal College of General Practitioners. This document is a British Academy of Audiology document and has not been endorsed by any other organisation. Introduction This document is intended to guide Audiologists in service planning and in making referrals for a medical or other professional opinion. Along with “Guidelines for Primary Care: Direct Referral of Adults with Hearing Difficulty to Audiology Services (2016)1”, this document replaces the earlier guidelines (BAA 20092, TTSA 19893,4) and has been approved by the Board of the British Academy of Audiology. This document comprises a set of criteria which define the circumstances in which an Audiologist in the UK should refer an adult with hearing difficulties for a medical or other professional opinion. If any of these are found, then the patient should be referred to an Ear, Nose and Throat (ENT) department, to their GP or to an Audiologist with an extended scope of practice. The criteria have been written for all adults (age 18+), but local specifications regarding age range for direct referral should be adhered to.