Introduction:
Vestibular schwannomas (VS) are a rare cause of asymmetrical hearing loss, and routine screening with magnetic resonance imaging (MRI) can be costly. At present, no consensus exists on what qualifies as “asymmetrical sensorineural hearing loss” (ASNHL) and when a patient should be referred for screening.
Objectives:
1) Evaluation of published audiometric protocols on the basis of sensitivity and specificity when applied to local clinical cohort of patients with ASNHL; 2) determination of clinical risks of missing VS and potential wastes in screening “radiologically normal” cases; 3) assessment of the cost of MRI screening.
Methods:
Cross-sectional study with chart review in a 2-year (2015–2016) cohort of 1059 patients who underwent MRI screening and audiometry indicating sensorineural hearing loss. Fourteen previously published audiometric protocols were assessed for their sensitivity and specificity in guiding radiological diagnosis of VS, and cost analysis was performed.
Results:
6/14 audiometric protocols had a sensitivity greater than 85%. Diagnostic specificity ranged from 22.91 to 82.76%, clinical risks from 0 to 50%, and potential wastes from 17.24 to 77.09%. Average annual cost of screening was £64,069. Application of proposed local screening protocol had a projected cost saving of 32.19%. Cost of screening patients that benefit from treatment was compared with a utility function that quantified expected benefit.
Conclusions:
Development of an easy-to-apply algorithm incorporating high-sensitivity audiometric protocols may result in significant cost saving, with minimal clinical risk of missing cases. There was disparity between screening costs and monetary “benefit” of hearing.
Patients referred from the direct referral audiology clinic had a low incidence of vestibular schwannoma detection. Their detection rate for significant incidental findings was similar to previous reports. If the current protocol had not been in place, over 300 patients would have been needlessly added to the ENT clinic list. Thus, general practitioner referral to direct referral audiology clinics provides a cost-effective way of managing asymmetrical sensorineural hearing loss in older patients. The number of such clinics could be expanded.
Introduction
Endobronchial blood clot causing airway obstruction is a rare but potentially life-threatening condition and can occur in a variety of clinical settings.
Case report
A male laryngectomy, with a background of bronchogenic carcinoma was treated conservatively for tracheitis following an episode of upper respiratory tract infection. However, he later developed airway obstruction secondary to endobronchial bleeding with endobronchial clot formation. Conventional methods of suctioning and rigid bronchoscopy with forceps failed to remove the hematoma. A Fogarty embolec tomy catheter was used to remove the hematoma, relieving the airway obstruction.
Discussion
The Fogarty embolectomy catheter has been widely used in various vascular operations for removal of arterial and venous emboli over the last years. However, its application in nonvascular cases is not widely published.
Conclusion
We report a case of tracheitis, complicated by an endobronchial clot in a laryngectomy patient, and demonstrated the use of Fogarty embolectomy catheter in such case when conventional methods fail.
How to cite this article
Wong B. The use of a Fogarty Catheter in a Case of an Endobronchial Blood Clot in a Laryn gectomy Patient. Int J Head Neck Surg 2015;6(3):118120.
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