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Improving efficiency and saving money in an otolaryngology urgent referral clinic

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World Journal of Clinical Cases 2015年第6期3卷 495-498页

作者： Nader Ibrahim Jagdeep Virk Jason George Behrad Elmiyeh Arvind Singh department of otolaryngology Queen’s Hospital department of otolaryngology Northwick Park Hospital

A closed loop audit of the ear nose and throat(ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed,referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The reaudit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P < 0.05. We reported a total financial saving of ￡32490 in a period of 3 mo(￡590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are nonlabour intensive can have a significant impact on service provision and cost.

关键词： Otorhinolaryngologic diseases Quality of health care Clinical audit Practice guideline Total quality management Ambulatory care facilities

Distribution of Prestin on Outer Hair Cell Basolateral Surface

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Journal of Otology 2008年第2期3卷 92-97页

作者： YU Ning1,2, ZHAI Suo-qiang1, YANG Shi-ming1, HAN Dong-yi1, ZHAO Hong-bo2, 1 department of otolaryngology & Institute of otolaryngology, CPLA General Hospital, BJ, 100853 2 department of Surgery-otolaryngology, University of Kentucky Medical Center, Lexington, KY 40536-0293 department of otolaryngology & Institute of otolaryngology CPLA General Hospital BJ 100853 department of Surgery–otolaryngology University of Kentucky Medical Center Lexington KY 40536–0293

Prestin has been identified as a motor protein responsible for outer hair cell (OHC) electromotility and is expressed on the OHC surface. Previous studies revealed that OHC electromotility and its associated nonlinear capacitance were mainly located at the OHC lateral wall and absent at the apical cuticular plate and the basal nucleus region. Immunofluorescent staining for prestin also failed to demonstrate prestin expression at the OHC basal ends in whole-mount preparation of the organ of Corti. However, there lacks a definitive demonstration of the pattern of prestin distribution. The OHC lateral wall has a trilaminate organization and is composed of the plasma membrane, cortical lattice, and subsurface cisternae. In this study, the location of prestin proteins in dissociated OHCs was examined using immunofluorescent staining and confocal microscopy. We found that prestin was uniformly expressed on the basolateral surface, including the basal pole. No staining was seen on the cuticular plate and stereocilia. When co-stained with a membrane marker di-8-ANEPPS, prestin-labeling was found to be in the outer layer of the OHC lateral wall. After separating the plasma membrane from the underlying subsurface cisternae using a hypotonic extracellular solution, prestin-labeling was found to be in the plasma membrane, not the subsurface cisternae. The data show that prestin is expressed in the plasma membrane on the entire OHC basolateral surface.

关键词： plasma mebrane outer hair cell electromotility cochlea active mechanics di-8-ANEPPS

Advantages of a miniature pig model in research on human hereditary hearing loss

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Journal of Otology 2015年第3期10卷 105-107页

作者： Weiwei Guo Shi-ming Yang department of otolaryngology Head & Neck SurgeryInstitute of Otolaryngology of PLAChinese PLA General Hospital

In medical laboratory animals, the pig is the closest species to human in evolution, except for primates. As an animal model, the pig is highly concerned by many scientists, including comparative biology, developmental biology, medical genetics. Rodents as animal model for human hearing defects has are poor producibility and reliability, due to differences in anatomical structure, evolutionary rate and metabolic rate, but these happens to be the advantages of the pig model. In this paper, we will summarize the application of miniature pig in the study of human hereditary deafness.

关键词： Mini pig Animal model Hereditary deafness

Optical recordings reveal the differential distribution of glutamatergic transmission in the cochlear and vestibular nuclei in the newborn mouse brainstem

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Journal of Otology 2009年第2期4卷 106-114页

作者： Doi Tadashi Kaneko Toshihiko Matsumoto Ayumi Asako Mikiya Yamashita Toshio department of otolaryngology Kansai Medical University

Objective Using optical imaging in brainstem slices, we studied evoked responses in the mouse cochlear (CN) and vestibular (VN) nuclei. Methods The use of optical imaging allowed us to visualize the spatiotemporal patterns of excitatory propagation in the CN and VN. Optical recordings can differentiate excitatory propagation in the ventral CN(VCN) from that in the dorsal CN(DCN). Furthermore, we assessed the relative distribution of NMDA and non-NMDA receptors in these regions using the glutamate antagonists APV (NMDA receptor antagonist) and CNQX (non-NMDA receptor antagonist) in mouse brainstem slices during postnatal days 1 to 3. Results The average sensitivity to APV was 99.1% in the VCN, 76.0% in the DCN and 64.9% in the VN. The average sensitivity to CNQX was 0.9% in the VCN, 24.0% in the DCN and 35.1% in the VN. These results indicate that the effect of APV dominated in the VCN, while both APV and CNQX were effective antagonists in the DCN and VN. In the VN, the distribution of APV-and CNQX-sensitive cells was almost completely uniform. However, in the DCN the distribution of APV-and CNQX-sensitive cells was highly complex. The area that was more sensitive to CNQX was located in the superficial layer of the DCN while the area with a higher sensitivity to APV was located progressively in the deep layer. Conclusion This optical recording data suggests that there is a differential distribution of NMDA and non-NMDA receptor mediated neurotransmission in the VCN, DCN and VN.

关键词： voltage-sensitive dye NMDA non-NMDA photo diode array

EXPERIENCE WITH OVERLAY TYMPANOPLASTY IN 83 CHINESE PATIENTS

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Journal of Otology 2014年第1期9卷 43-47页

作者： PENG Bengang MIAO Xutao WANG Xin ZHU Sixiang SUN Yiqing department of otolaryngology Jishuitan Hospital

Background In many European and American hospitals, represented by the House Ear Clinic (HEC), the overlay tympanoplasty is used with rare exception, with simultaneous canal wall up or down mastoidectomy being taken if needed. In China, underlay tympanoplasty is used across the country, but the overlay tech-nique is used rarely. The aim of the current study was to report the authors’experience with overlay tympa-noplasty in 83 Chinese patients and study its value. Methods Eight-three patients (86 ears) underwent over-lay tympanoplasty in accordance to the standard of the HEC. The patients were followed up and conditions of the external auditory canal, tympanic membrane and hearing were reviewed and analyzed. Results All patients gained stage I incision healing. The size of external auditory canal and tympanic membrane mor-phology were satisfactory. Hearing either remained unchanged or improved. There were no hearing deterio-ration or serious complications. Conclusions Overlay tympanoplasty carries positive value in treating chron-ic otitis media and cholesteatoma with the merits of procedure standardization, adequate operative exposure, thorough disease elimination and extensive adaptation.

关键词： Tympanoplasty Overlay technique External auditory canal Surgery

COMBINATIONAL ADMINISTRATION OF AMINOGLYCOSIDES AND LOOP DIURETICS AS AN EFFICIENT STRATEGY TO ESTABLISH DEAFNESS MODELS IN RATS

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Journal of Otology 2014年第2期9卷 91-96页

作者： CONG Tao LIU Riyuan YUAN Shuolong XU Liangwei YANG Shiming department of otolaryngology Head and Neck surgery Institute of OtolaryngologyChinese PLA General Hospital

It is known that aminoglycoside antibiotics can damage the vestibular and auditory sensory epithelia, and the loop diuretics can enhance the ototoxic effect of aminoglycosides. Previous studies on the synergistic effect of these two types of drugs have used mice, guinea pigs and cats, but not rats. The aim of this study was to determine this synergistic effects in rat cochleae. Rats received intravenous injections of different doses of furosemide and/or intramuscular injections of kanamycin sulfate. Au- ditory brainstem response （ABR）, scanning electron microscopy （SEM） and immunocytochemistry were used to determine the effects of drug administration. In the group receiving combined administration of furosemide and kanamycin, the ABR thresh- old showed significant elevation 3 days after drug administration, greater than single drug administration. The hair cells showed various degrees of injury from the apical turn to the basal turn of the cochlea and from the outer hair cells to the inner hair cells. Neuron fibers of the hair cells showed significant loss 7 days after the drug administration, but the number of spiral ganglia did not decrease and supporting cells showed no signs of injury. Our study suggest that combined administration of fu- rosemide and kanamycin has an synergistic ototoxic effect, and can result in hair cell loss and hearing loss in rats.

关键词： Kanamycin Furosemide Deafness model Hair cell injury, rat

Resection of recurrent third branchial cleft fistulas assisted by flexible pharyngotomy

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World Journal of Clinical Cases 2019年第23期7卷 3957-3963页

作者： Xiao-Qiong Ding Xin Zhu Ling Li Xu Feng Zhi-Chun Huang department of otolaryngology Head and Neck Surgery Zhongda Hospital Southeast University

BACKGROUND Treatment of fistulas arising from the third branchial cleft includes endoscopic cauterization or open cervical *** approaches are associated with recurrence rates of 14%-18%,and possibly greater rates when the fistula has been treated operatively *** of fistulas arising from the third branchial cleft is associated with an inordinate recurrence *** may be multifactorial and related to incomplete resection of all of the anatomical elements of the *** To present a new approach that involves complete resection of the recurrent fistula by a combined therapeutic *** Here,12 adult patients diagnosed with recurrent third branchial cleft fistulas underwent a combined therapy assisted by flexible fiber-optic pharyngoscopy to identify and resect the entry site of the fistula into the pyriform *** fistulous opening into the pyriform sinus was identified by flexible fiber-optic *** application of intubation with a guidewire by pharyngoscopy,in addition to the removal of the partial excision of the thyroid cartilage,allowed complete resection of the opening and all parts of the fistula *** All of the internal openings of the fistulas in the pharynx were found and easily identified by flexible fiber-optic *** of the 12 patients underwent complete resection of the recurrent fistula by the combined therapeutic *** were no postoperative complications such as parapharyngeal abscess or wound infection,injury or dysfunction of the recurrent laryngeal or superior laryngeal *** pharyngeal edema had degraded,and the pharyngeal wound healed postoperatively within 1 *** endoscopy and voice analysis were performed on the 14th d *** cord movements did not *** characters of voice for jitter,shimmer,and normalized noise energy were all within normal *** addition,no recurrences were observed during the 13-60 mo follow-up

关键词： Branchial cleft fistula Resection Fiber-optic pharyngoscopy Pyriform sinus fistula Guidewire

Endoscopic stapedotomy: Merits and demerits

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Journal of Otology 2018年第3期13卷 97-100页

作者： Waleed Moneir Ahmed Musaad Abd El-fattah Eslam Mahmoud Mohamed Elshaer department of otolaryngology Faculty of Medicine Mansoura University

This work is conducted in Mansoura University Hospitals,Egypt,to show the advantages and disadvantages of endoscopic stapedotomy in comparison to microscopic *** work described has not been published previously nor under consideration for publication *** authors declare that there is no conflict of *** study is a part of a master degree thesis submitted by Eslam Mahmoud as partial fulfillment for a master *** review board approval,Faculty of Medicine-Mansoura University,was obtained for the study(IRB:MS/15.09.49).

关键词： Mansoura University Hospitals Medicine-Mansoura University

Primary sino-orbital peripheral T-cell lymphoma presenting as unilateral periorbital swelling: a case report

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International Journal of Ophthalmology(English edition) 2018年第11期11卷 1881-1883页

作者： Ahmad Al Omari Firas Al Zoubi Mohammad M Alsalem Khalil M Al-Salem Hasan Mohidat department of otolaryngology Jordan University of Science and Technology department of otolaryngology Yarmouk University department of Ophthalmology Mutah University department of Ophthalmology Jordan University of Science and Technology

Dear Editor,My name is Ahmad Al Omari and I am currently working as an otorhinolaryngology assistant professor at Jordan University of Science and Technology. I am writing this letter to present a case of a primary si... 详细信息

关键词： Figure a case report Primary sino-orbital peripheral T-cell lymphoma presenting as unilateral periorbital swelling