Introduction: Little is understood about caregivers’ lived experiences when first caring for patients on the nasogastric tube at home in an Asian setting. To enhance understanding, our study aimed to chart these caregivers’ psycho-emotional evolutions felt during such caregiving experiences in Singapore. Method: Utilizing purposive sampling, a descriptive phenomenological study was performed, with semi-structured interviews of 10 caregivers of persons on nasogastric tube feeding conducted. Thematic analysis was utilized. Results: Our findings chart four psycho-emotional transitions of a caregiver’s journey in nasogastric tube feeding and the cultural dynamics involved—(a) Disruption of Caregivers’ Normality: Attempting to Grasp Reality, (b) Encountering Road-Blocks: Despondency Arises and Frustrations Abound, (c) Adjusting to the New Normal: Reclaiming Confidence and Positivity, (d) Thriving and Integrating into the New Normal, and (e) Cultural Dynamics At Play. Discussion: Our findings illuminate the understanding of caregivers’ varying needs, guiding delivery of culturally-congruent caregiver support targeted at each psycho-emotional evolution.
Dysphagia is a common condition amongst older adults that hinders the safe consumption of food and drink. If unaddressed, this could increase the risk of malnutrition, dehydration and choking (Igarashi et al., 2020). This is an urgent problem in rapidly ageing societies such as Singapore, with more older adults at risk of dysphagia (Ang et al., 2019;Lim et al., 2018).Enteral nutrition feeding typically serves as a long-term solution for older adults with dysphagia (Blumenstein et al., 2014;Crary & Groher, 2006). Patients and caregivers prefer the nasogastric tube (NGT) feeding route across Asia, due to their concerns on the surgical installation of percutaneous feeding tubes (Lin et al., 2011;Shah et al., 2012;Yeh et al., 2010). However, this comes with greater risk for poor techniques leading to complications such as aspiration pneumonia and tube blockage, often requiring emergency treatment and hospitalization (Chang et al., 2019). Furthermore, a systematic review of caregivers' experiences providing enteral feeding at home found that many lack appropriate information and support, with many having to find their own way to cope (Mou et al., 2021). Hence,
A 36-year-old male who had history of hearing loss since childhood presented with a chronically discharging right ear.HRCT temporal bones revealed non-dependent opacification in the epi-and meso-tympanum with medially displaced head of malleus, erosion of incus and the tegmen tympani suspicious for an attic cholesteatoma. In addition, there was a serpiginous structure seen extending across the posterior aspect of the mastoid temporal bone which was thought to represent a trans-mastoid emissary vein. MRI subsequently performed showed both the lesions (in the middle ear cavity and the serpiginous structure in the mastoid) were hyperintense on Propeller DW (b value 1000 sec/mm 2 ) sequence suggesting 2 cholesteatomas. The serpiginous structure in the mastoid did not show post contrast enhancement thus excluding a vascular lesion. A canal wall down mastoidectomy was done which confirmed both the findings. CommentThe imaging appearance of cholesteatomas has been extensively discussed in the literature. On HRCT, cholesteatoma generally presents as locally aggressive soft tissue mass causing ossicular and bony erosions. It is classically known to be hyperintense on Propeller Diffusion weighted (type of Non-EPI sequence) sequence and do not show post contrast enhancement.Imaging of the soft tissue in the middle ear cavity in our case was classical for an acquired cholesteatoma on CT and MRI.The serpiginous structure in mastoid bone had welldefined scalloped margins on HRCT prompting it to represent a vascular channel. MRI subsequently performed and mainly the Propeller DW sequence had classical features for cholesteatoma thus changing the surgical plan. Given the lack of local aggressiveness and its posterior location, it may have represented a congenital cholesteatoma.A serpiginous cholesteatoma is an extremely rare form of presentation. We suggest that in cases of atypical findings on HRCT, radiologists must avail MR imaging if possible, as it can alter treatment options, as in this case.
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