Otology – Otoscopy
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UPDATE VOLUME 20 • ISSUE 3 the Newsletter of the Council for Accreditation in Occupational Hearing Conservation
Fall 2008 UPDATE VOLUME 20 • ISSUE 3 The Newsletter of the Council for Accreditation in Occupational Hearing Conservation Hearing noise-induced hearing loss and further degradation of communication. If too much hearing protection is provided, Conservation the combined effects of the hearing loss and the attenuation provided by the hearing protector may result in critical sounds for the Hearing- and communication signals becoming inaudible. I’m often asked what type of hearing protector is best for Impaired Worker workers with hearing impairment. Considering that there is no ‘best’ HPD for all workers in any hearing category, it Introduction by Ted Madison should come as no surprise that no single type of device will The prevalence of hearing loss among persons enrolled meet the needs of all those with hearing loss. What seems in occupational hearing conservation programs (HCPs) is to be consistent, however, is that each case is unique, and difficult to determine. Recently, Tak and Calvert (2008) that extra time and effort is required to help these workers estimated that 11.4% of the overall US workforce reports find the right combination of protection, having hearing difficulty of varying communication and auditory awareness. degrees and that approximately ¼ of Consultation with an audiologist or other the hearing difficulty reported can hearing health care professional is also be attributed to employment. These an important step in most cases. estimates are based on analysis of data One valuable resource is the OSHA from the US National Health Interview Safety & Health Information Bulletin Survey (NHIS) that were collected (SHIB) titled “Hearing Conservation from 1997 to 2003. -
Instruction Sheet: Otitis Externa
University of North Carolina Wilmington Abrons Student Health Center INSTRUCTION SHEET: OTITIS EXTERNA The Student Health Provider has diagnosed otitis externa, also known as external ear infection, or swimmer's ear. Otitis externa is a bacterial/fungal infection in the ear canal (the ear canal goes from the outside opening of the ear to the eardrum). Water in the ear, from swimming or bathing, makes the ear canal prone to infection. Hot and humid weather also predisposes to infection. Symptoms of otitis externa include: ear pain, fullness or itching in the ear, ear drainage, and temporary loss of hearing. These symptoms are similar to those caused by otitis media (middle ear infection). To differentiate between external ear infection and middle ear infection, the provider looks in the ear with an instrument called an otoscope. It is important to distinguish between the two infections, as they are treated differently: External otitis is treated with drops in the ear canal, while middle ear infection is sometimes treated with an antibiotic by mouth. MEASURES YOU SHOULD TAKE TO HELP TREAT EXTERNAL EAR INFECTION: 1. Use the ear drops regularly, as directed on the prescription. 2. The key to treatment is getting the drops down into the canal and keeping the medicine there. To accomplish this: Lie on your side, with the unaffected ear down. Put three to four drops in the infected ear canal, then gently pull the outer ear back and forth several times, working the medicine deeper into the ear canal. Remain still, good-ear-side-down for about 15 minutes. -
The Ear, Nose, and Throat Exam Jeffrey Texiera, MD and Joshua Jabaut, MD CPT, MC, USA LT, MC, USN
The Ear, Nose, and Throat Exam Jeffrey Texiera, MD and Joshua Jabaut, MD CPT, MC, USA LT, MC, USN Midatlantic Regional Occupational and Environmental Medicine Conference Sept. 23, 2017 Disclosures ●We have no funding or financial interest in any product featured in this presentation. The items included are for demonstration purposes only. ●We have no conflicts of interest to disclose. Overview ● Overview of clinically oriented anatomy - presented in the format of the exam ● The approach ● The examination ● Variants of normal anatomy ● ENT emergencies ● Summary/highlights ● Questions Anatomy ● The head and neck exam consists of some of the most comprehensive and complicated anatomy in the human body. ● The ear, nose, and throat comprise a portion of that exam and a focused clinical encounter for an acute ENT complaint may require only this portion of the exam. Ears www.Medscape.com www.taqplayer.info Ear – Vestibular organ www.humanantomylibrary.com Nose/Sinus Anatomy Inferior Middle Turbinate Turbinate Septum Dorsum Sidewalls Ala Floor Tip www.ENT4Students.blogspot.com Columella Vestibule www.beautyepic.com Oral cavity and oropharynx (throat) www.apsubiology.org Neck www.rdhmag.com The Ear, Nose, and Throat exam Perform in a standardized systematic way that works for you Do it the same way every time, this mitigates risk of missing a portion of the exam Practice the exam to increase comfort with performance and familiarize self with variants of normal Describe what you are doing to the patient, describe what you see in your documentation Use your PPE as appropriate A question to keep in mind… ●T/F: The otoscope is the optimal tool for examining the tympanic membrane. -
Usefulness of the Harmonic Scalpel in Thyroid Surgery
ORIGINAL ISSN: 2005-162X J Korean Thyroid Assoc 2012 November 5(2): 138-142 ARTICLE http://dx.doi.org/10.11106/jkta.2012.5.2.138 Usefulness of the Harmonic Scalpel in Thyroid Surgery Hwan Choe, Kwang-Yoon Jung, Soon-Young Kwon, Jeong-Soo Woo, Min Woo Park and Seung-Kuk Baek Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea Background and Objectives: The harmonic scalpel using the ultrasonic energy is able to grasp and divide tissue while sealing small vessels in narrow operating fields. The aim of the present study was to evaluate the usefulness of the harmonic scalpel in thyroid surgery. Materials and Methods: This study was performed for 247 patients who underwent thyroidectomy. According to the use of harmonic Scalpel, the patients could be divided into two groups: the conventional technique (CT) group of knot tying and the harmonic scalpel (HS) group. Results: For hemithyroidectomy, operation time and hospital stay were shorter in the HS group compared with the CT group (p＜0.05). For total thyroidectomy with central neck dissection (CND), operation time, total drainage volume, drain removal date, and hospital stay were significantly reduced in the HS group (p＜0.05). Among the patients who underwent total thyroidectomy with CND with the HS, one patient (2.9%) showed transient recurrent laryngeal nerve palsy. Transient hypoparathyroidism showed significantly lower incidence in the HS group (p＜0.05). Conclusion: HS might be cost-effective by reducing operation time and hospital stay -
Consultation Diagnoses and Procedures Billed Among Recent Graduates Practicing General Otolaryngology – Head & Neck Surger
Eskander et al. Journal of Otolaryngology - Head and Neck Surgery (2018) 47:47 https://doi.org/10.1186/s40463-018-0293-8 ORIGINALRESEARCHARTICLE Open Access Consultation diagnoses and procedures billed among recent graduates practicing general otolaryngology – head & neck surgery in Ontario, Canada Antoine Eskander1,2,3* , Paolo Campisi4, Ian J. Witterick5 and David D. Pothier6 Abstract Background: An analysis of the scope of practice of recent Otolaryngology – Head and Neck Surgery (OHNS) graduates working as general otolaryngologists has not been previously performed. As Canadian OHNS residency programs implement competency-based training strategies, this data may be used to align residency curricula with the clinical and surgical practice of recent graduates. Methods: Ontario billing data were used to identify the most common diagnostic and procedure codes used by general otolaryngologists issued a billing number between 2006 and 2012. The codes were categorized by OHNS subspecialty. Practitioners with a narrow range of procedure codes or a high rate of complex procedure codes, were deemed subspecialists and therefore excluded. Results: There were 108 recent graduates in a general practice identified. The most common diagnostic codes assigned to consultation billings were categorized as ‘otology’ (42%), ‘general otolaryngology’ (35%), ‘rhinology’ (17%) and ‘head and neck’ (4%). The most common procedure codes were categorized as ‘general otolaryngology’ (45%), ‘otology’ (23%), ‘head and neck’ (13%) and ‘rhinology’ (9%). The top 5 procedures were nasolaryngoscopy, ear microdebridement, myringotomy with insertion of ventilation tube, tonsillectomy, and turbinate reduction. Although otology encompassed a large proportion of procedures billed, tympanoplasty and mastoidectomy were surprisingly uncommon. Conclusion: This is the first study to analyze the nature of the clinical and surgical cases managed by recent OHNS graduates. -
Cleaning, Disinfection and Sterilization Guide
CLEANING, DISINFECTION AND STERILIZATION GUIDE Revision 5.2 Copyright 2016, Brainlab AG Germany. All rights reserved. TABLE OF CONTENTS TABLE OF CONTENTS GENERAL INFORMATION...................................................................................................7 Contact Data and Legal Information......................................................................................................7 Contact Data................................................................................................................................................7 Legal Information .........................................................................................................................................8 Symbols .......................................................................................................................................................9 Symbols Used in This Guide ........................................................................................................................9 Hardware Symbols.....................................................................................................................................10 Hardware....................................................................................................................................................13 Using the Hardware ...................................................................................................................................13 Documentation .........................................................................................................................................14 -
Balancing Everything out Fifteen Years of Research Into Dizziness, Balance and the Pathology of Ménière’S Disease
Making It Better Balancing Everything Out Fifteen years of research into dizziness, balance and the pathology of Ménière’s disease The Ménière’s Society The Page 1 www.menieres.org.ukMénière’s Society Making It Better Index of References and Sources Further details of the reference sources and research projects discussed in this paper can be found at the following locations: V Osei -Lah, B Ceranic and L M Luxon (2008). Kirby, S.E. and Yardley, L. (2009) Clinical value of tone burst vestibular evoked The contribution of symptoms of post-traumatic myogenic potentials at threshold in acute stress disorder (PTSD), health anxiety and and stable Ménière’s disease. The Journal intolerance of uncertainty to distress in Ménière’s of Laryngology & Otology, 122, pp 452 457 disease. Journal of Nervous and Mental Disease, doi:10.1017/S0022215107009152 197,(5), 324-329 www.journals.cambridge.org/action/ www.eprints.soton.ac.uk/54655 displayAbstract?fromPage=online&aid=1850772 Yardley L., Dibb B. and Osborne G. (2003) A W Morrison, M E S Bailey and G A J Morrison Factors associated with quality of life in Meniere’s (2009). Familial Ménière’s disease: clinical and disease. Clinical Otolaryngology, 28, (5), 436-441. genetic aspects. The Journal of Laryngology (doi:10.1046/j.1365-2273.2003.00740.x). & Otology, 123, pp 29-37. doi:10.1017/S0022215108002788. Yardley L, Kirby S. Evaluation of booklet-based www.journals.cambridge.org/action/ self-management of symptoms in Ménière’s displayAbstract?fromPage=online&aid=3107936 disease: a randomized controlled trial. Psychosom Med 2006;68:762–9 Clinical and cost effectiveness Sandhu, J. -
Eardrum Regeneration: Membrane Repair
OUTLINE Watch an animation at: Infographic: go.nature.com/2smjfq8 Pages S6–S7 EARDRUM REGENERATION: MEMBRANE REPAIR Can tissue engineering provide a cheap and convenient alternative to surgery for eardrum repair? DIANA GRADINARU he eardrum, or tympanic membrane, forms the interface between the outside world and the delicate bony structures Tof the middle ear — the ossicles — that conduct sound vibrations to the inner ear. At just a fraction of a millimetre thick and held under tension, the membrane is perfectly adapted to transmit even the faintest of vibrations. But the qualities that make the eardrum such a good conductor of sound come at a price: fra- gility. Burst eardrums are a major cause of conductive hearing loss — when sounds can’t pass from the outer to the inner ear. Most burst eardrums are caused by infections or trauma. The vast majority heal on their own in about ten days, but for a small proportion of people the perforation fails to heal natu- rally. These chronic ruptures cause conductive hearing loss and group (S. Kanemaru et al. Otol. Neurotol. 32, 1218–1223; 2011). increase the risk of middle ear infections, which can have serious In a commentary in the same journal, Robert Jackler, a head complications. and neck surgeon at Stanford University, California, wrote that, Surgical intervention is the only option for people with ear- should the results be replicated, the procedure represents “poten- drums that won’t heal. Tympanoplasty involves collecting graft tially the greatest advance in otology since the invention of the material from the patient to use as a patch over the perforation. -
Older Adult Hearing Loss and Screening Key Points • Eighty Percent of Older American Adults Have Untreated Hearing Loss. •
Older Adult Hearing Loss and Screening Key Points Eighty percent of older American adults have untreated hearing loss. Hearing loss is associated with decreased quality of life, depression, communication disorders, social withdrawal and cognitive impairment. Overview Definition Presbycusis is another term for age-related sensorineural hearing loss (ARHL). o Damage to the cochlea, Cranial Nerve VIII, or Internal Auditory canal o Bilateral, symmetric, high-frequency sensorineural hearing loss Noise-induced hearing loss (NIHL) o Direct mechanical injury to sensory hair cells in the cochlea o Continuous noise exposure Aging and hearing loss Cell reduction in auditory cortex Acoustic nerve (CN VIII) fiber degeneration Inner ear sensory cell loss and membrane calcification Risk Factors Advancing Age (ARHI) Exposure to loud noises or ototoxic agents (i.e. loud machinery) (NIHL) Other External ear or middle ear conductive hearing loss risk factors include: o Cerumen impaction o Middle ear fluid o Perforated tympanic membrane Assessment Recommendations for hearing assessments: Screening all older adults over the age of 65 years. Screening should be conducted in a primary care setting. Obtain history of chronic medical conditions (diabetes mellitus, CAD), ear infections, ear trauma, occupation Medication review assessing for use of diuretics (loop), aspirin, antineoplastic (cisplatin, 5- fluorouracil), antimalarial (chloroquine, quinine), and antibiotic (aminoglycosides, erythromycin, tetracycline, vancomycin) Assessment Instruments available include: o Hearing Handicap Inventory for the Elderly Screening (HHIE-S) https://www.audiology.org/sites/default/files/PracticeManagement/Medicare_HHI.pdf . 10 question questionnaire . Score greater than 10 points should be referred to an audiologist o Audio Scope (Welch Allyn, Inc.) . Otoscope examination . Test hearing o Whispered Voice Test, finger rub or a watch tick test o Ask the question - “Do you have a hearing problem now?” If any of the above four are positive – referral to an Audiologist is indicated. -
Is One Ear Good Enough? Unilateral Hearing Loss and Preschoolers’ Comprehension of the English Plural
JSLHR Research Note Is One Ear Good Enough? Unilateral Hearing Loss and Preschoolers’ Comprehension of the English Plural Benjamin Davies,a,b,c Nan Xu Rattanasone,a,b,c Aleisha Davis,b,d and Katherine Demutha,b,c Purpose: The plural is one of the first grammatical morphemes whether an auditorily presented novel word was singular acquired by English-speaking children with normal hearing (e.g., tep, koss)orplural(e.g.,teps, kosses)bytouchingthe (NH). Yet, those with hearing loss show delays in both plural appropriate novel picture. comprehension and production. However, little is known Results: Like their NH peers, children with UHL demonstrated about the effects of unilateral hearing loss (UHL) on children’s comprehension of novel singulars. However, they were acquisition of the plural, where children’s ability to perceive significantly less accurate at identifying novel plurals, fricatives (e.g., the /s/ in cats) can be compromised. This withperformanceatchance.However,thereweresigns study therefore tested whether children with UHL were able that their ability to identify novel plurals may improve with to identify the grammatical number of newly heard words, age. both singular and plural. Conclusion: While comparable to their NH peers at identifying Method: Eleven 3- to 5-year-olds with UHL participated in novel singulars, these results suggest that young children a novel word two-alternative forced choice task presented with UHL do not yet have a robust representation of plural on an iPad. Their results were compared to those of 129 NH morphology, particularly on words they have not encountered 3- to 5-year-olds. During the task, children had to choose before. -
Laryngology and Otology
The Journal of Laryngology and Otology (Founded in 1887 by MORELL MACKENZIE and NORRIS WOLFENDEN) March 1972 Can present day audiology really help in diagnosis ? — An otologist's question By R. R. A. COLES* (Southampton) THE question asked in the title of this lecture is apt, and one which I have been asked on many occasions. Therefore, I am glad of this opportunity to answer it both formally and at some length. The key words in the title are 'diagnosis' and 'otologist', and they were intended to convey two points. Firstly, that the scope of this presentation is restricted to the diagnostic role of audiology and to its practice in hospital or associated clinics in support of the otologist, as distinct from paedo-audiology which is concerned more with local health and educational authorities. I will, however, touch on some of the electrophysiological techniques of measure- ment used in support of conventional paedo-audiological assessment, as these have uses in the hospital type of audiology as well and the facilities for them may often be sited in Department of Health and Social Security (D.H.S.S.) establishments. The second point derived from the key words is to stress that it is the otologist and not the audiologist who has responsibility for making the diagnosis, except perhaps in those occasional instances where the audiologist is medically qualified. On the other hand, any specialist investigation infers not only the performance of tests but also the freedom to select those tests most appropriate to the particular patient, their appropriateness often only becoming apparent as the examination itself proceeds. -
The Basic Surgery Kit
GLOBAL EXCLUSIVE > SURGERY > PEER REVIEWED The Basic Surgery Kit Jan Janovec, MVDr, MRCVS VRCC Veterinary Referrals Laurent Findji, DMV, MS, MRCVS, DECVS Fitzpatrick Referrals Considering the virtually limitless range of surgical instruments, it can be difficult to assemble a cost-effective basic surgery kit. Some instruments may misleadingly appear multipurpose, but their misuse may damage them, leading to unnecessary replacement costs or, worse, intraoperative accidents putting the patient’s safety at risk. Many instru- ments are available in different qualities and materials (eg, tungsten carbide instruments— more expensive but much more resistant to wear and corrosion than stainless steel) and Minimal Basic Surgery Kit varied sizes to match the purpose of their use as well as the size of the surgeon’s hand. n 1 instrument case Cutting Instruments n 1 scalpel handle Scalpel n 1 pair Mayo scissors The scalpel is an indispensible item in a surgical kit designed to make sharp incisions. Scalpel incision is the least traumatic way of dissection, but provides no hemostasis. n 1 pair Metzenbaum scissors Scalpel handles come in various sizes, each accommodating a range of disposable n 1 pair suture scissors blades (Figure 1). Entirely disposable scalpels are also available. n 1 pair Mayo-Hegar needle holder Scissors n 1 pair Brown-Adson tissue forceps Scissors are used for cutting, albeit with some crushing effect, and for blunt dissection. n 1 pair DeBakey tissue forceps Fine scissors, such as Metzenbaum scissors (Figure 2), should be reserved for cutting n 4 pairs mosquito hemostatic forceps and dissecting delicate tissues. Sturdier scissors, such as Mayo or suture scissors, are designed for use on denser tissues (eg, fascia) or inanimate objects (eg, sutures, drapes).