Background: Prospective study investigating the incidence of concurrent Eustachian Tube dysfunction (ETD) in patients with CRS refractory to medical therapy, and the effect of Endoscopic Sinus Surgery (ESS) on ETD in this patient group.Methods: Prospective study of 57 CRS patients. Outcome measures were SNOT-22 and ETDQ-7 questionnaires, tympanometry and Valsalva manoeuvre recorded pre-operatively and at 3 and 9 months post ESS.Results: There was a moderate positive correlation between pre-operative ETDQ-7 and SNOT 22 scores (r=0.5715, p<0.0001). 68% of patients recorded positive ETDQ-7 scores pre-operatively, mean=20.6 (SD±10.34). Mean ETDQ-7 scores were significantly lower at 3 months; mean=11.4 (SD±5.65) (P<0.0001) and 9 months mean=11.4 (SD±6.15) (P<0.0001) following ESS. Type A tympanograms increased form 76.6% pre-operatively, to 94.5% at 3 months and 96% at 9 months. Reported positive Valsalva increased from 38% pre-operatively to 96% at 3 and 9 months. Mean ETDQ-7 scores were higher in the CRSwNP group; 24.34 (SD±9.2) compared to the CRSsNP group; 18.11 (SD±10.3), (p=0.6101). 16 patients in the cohort had existing diagnoses of asthma, of which 4 had documented aspirin sensitivity. The mean pre-operative SNOT-22 score in this overall subgroup was 64.81 (SD=±20.13) compared with 49.07 (SD=±21.37) in non-asthmatic patients (p=0.0168).
Conclusions:We found a high incidence of concurrent ETD symptoms in patients with severe CRS, which improve following ESS.Further research is required to better understand the association between CRS and ETD in order to provide effective treatments.
Video assessment of myringotomy and ventilation tube insertion may represent a valid, feasible tool for use in summative and formative assessments of trainee ENT surgeons. Remote scoring of assessment procedures minimises bias and enables blinding of raters. ENT is well positioned to benefit from video assessment due to the high number of surgical procedures within the specialty that are performed utilising digital technology.
Where possible PH should be drained in an operating theatre. Multicentre randomized controlled trials are required to further investigate the impact of drainage technique and post-drainage management on outcome.
An 89-year-old man presented to the outpatient clinic with a 2-month history of persistent unilateral left-sided otalgia, otorrhoea and reduced hearing despite oral and topical antibiotics. Treatment was protracted, requiring a 4-month hospital admission for intravenous antifungal medication as well as 3 further months of oral antifungal treatment. We describe the clinical presentation, complications and treatment of this potentially fatal condition in the context of an unusual, and easily missed, causative organism.
Obesity has been suggested as a risk factor for chronic kidney disease. However, it has also been suggested that the association between obesity and impaired glomerular filtration rate (GFR) arises from the invalid use of body surface area (BSA) for scaling. This study assesses the effect of obesity on GFR by comparing the age-dependent decline in obese (body mass index (BMI) 430 kg/m 2 ; n ¼ 149) and non-obese patients (n ¼ 589), aged 430 years, referred for measurement of GFR (Cr-51-EDTA and three blood samples). GFR was scaled to a BSA of 1.73 m 2 (GFR/BSA) and extracellular fluid volume of 13 l (GFR/ECV), both corrected for the one-compartment assumption. When non-obese patients were categorized into 10-year age brackets (from 31 to 470), GFR/BSA and GFR/ECV declined from 92 ml per min per 1.73 m 2 and 95 ml per min per 13 l, respectively, at 31-40 years to 58 and 59 at 470. The declines in obese patients were similar with corresponding values of 88 ml per min per 1.73 m 2 and 97 ml per min per 13 l at 31-40 and 57 and 59 at 470 years. Linear regression analysis of non-categorized data from age 40 years showed rates of decline slightly slower in the obese (0.82 vs 0.95 ml per min per 1.73 m 2 per year and 0.87 vs 1.02 ml per min per 13 l per year). No effect of obesity on renal function was shown. Scaling to BSA did not distort the results.
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