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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

Efficacy of using NRT thresholds in cochlear implants fitting,in prelingual pediatric patients

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Journal of Otology 2019年第4期14卷 128-135页

作者： Ahmed Allam Ahmed Eldegwi department of otolaryngology Mansoura University

Objective:To evaluate the efficacy of using neural response telemetry(NRT)thresholds in predicting behavioural thresholds during programming of cochlear implant in prelingual ***:Prospective study of 28 cochlear implants implanted with Nucleus 24 cochlear *** recorded NRT-thresholds on electrode numbers 1,6,11,16 and 22 of the electrode array in each patient,the neural response thresholds were correlated with the behavioural map after six months of programming the ***:The mean neural response telemetry level was significantly higher than the mean threshold level(T-level)but lower than the comfortable level(C-level)in all the electrodes *** levels could statistically significantly predict T behavioural levels and comfortable behavioural levels,p<*** was a strong positive correlation between comfortable thresholds and neural response telemetry level measurements and behavioural threshold level and neural response telemetry threshold ***:There is a useful role for neural response telemetry values in predicting the behavioural threshold and comfortable values in prelingual *** the NRT values with behavioural observations can improve the programming of cochlear implants.

关键词： NRT ECAP Behavioural levels Cochlear implant Programming

Surgical resection of a large hypopharyngeal hemangioma in an adult using neodymium-doped yttrium aluminum garnet laser: A case report

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World Journal of Clinical Cases 2020年第5期8卷 932-938页

作者： Mang Jin Cheng-Yu Wang Yun-Xiang Da Wei Zhu Hui Jiang department of otolaryngology Jinshan Hospital Fudan University

BACKGROUND Generally,hemangiomas do not require surgical intervention;however,cases of large hemangiomas,potentially involving the throat and trachea,necessitate surgical ***,we present a case of hypopharyngeal hemangioma in an adult that was successfully treated with neodymium-doped yttrium aluminum garnet(Nd-YAG)*** SUMMARY Laryngoscopic examination of a 61-year-old man demonstrated the presence of a large,submucosal vascular lesion that extended into the epiglottis,left arytenoid cartilage,lateral to the aryepiglottic fold,and pyriform *** lesion was resected and photocoagulated with limited hemorrhage using Nd:YAG *** hypopharyngeal hemangioma was completely *** patient showed no recurrence of hypopharyngeal hemangioma during the 1.5-year follow-up *** Laser therapy is one of the effective tools for treating hemangiomas with rapid,uncontrolled growth or in functional areas,with few side effects and *** present case of a male patient with a large hypopharyngeal hemangioma,treated with YAG laser,demonstrates the efficacy of laser photocoagulation in treating cases of hemangiomas,without the risk of bleeding or airway *** favorable postoperative outcomes demonstrated by our patient with Nd:YAG laser therapy indicate its consideration in the therapy of similar cases.

关键词： Yttrium aluminum garnet laser Large Adult Surgical resection Hypopharyngeal Hemangioma Case report

Effect of Hypertension on Hearing Function,LDH and ChE of the Cochlea in Older Rats

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2003年第3期23卷 306-309页

作者：李穗龚树生杨燕珍余青松 department of otolaryngology

The relationship between the hypertension and the aging process of hearing organ was investigated Twenty Wistar 3-month old rats and 20 Wistar 12-month old rats, 20 spontaneously hypertensive rat stroke-prone (SHRSP) 3-month old rats and 20 SHRSP 12-month old rats free of middle ear infections as observed under otomicroscopy, with normal tympanic membrane and auricle reflex, were selected to be divided into two experimental groups and two control groups respectively The tail artery blood pressure was measured non-invasively The threshold of auditory brainstem response (ABR) was measured by Spirit TM evoked potential meter The LDH and ChE staining in the inner ear was performed and the optical density was analyzed by the HPIAS analysis system The results showed that there was no difference in the ABR thresholds, the activities of LDH and ChE between Wistar 3-month old group and SHRSP 3-month old group ( P >0 05) The mean value of ABR threshold and the activities of LDH and ChE in the Wistar 12-month old group at relevant sections were significantly greater than those in the two 3-month old groups ( P< 0 05), whereas the mean value of ABR threshold and the activities of LDH and ChE in the SHRSP 12-month old group at relevant sections were significantly higher than those in the 3-month old control group ( P< 0 01) It was concluded that presbycusis existed in the Wistar 12-month old group rats The glycogenosis and the abnormal secretion of neural transmitter were discerned after hypertension All the above factors may worsen the aging of the hearing system

关键词： spontaneously hypertensive rat stroke-prone hypertension presbycusis cochlea electric physiology enzyme histochemistry

Combined inhibitors of angiogenesis and histone deacetylase:Efficacy in rat hepatoma

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World Journal of Gastroenterology 2011年第31期17卷 3623-3629页

作者： Marion Ganslmayer Annette Zimmermann Steffen Zopf Christoph Herold Medical department 1 University hospital Erlangen-Nuernberg department of otolaryngology University of Marburg

AIM:To evaluate the antitumoral effect of combined inhibitors of angiogenesis and histone deacetylases in an experimental rat hepatoma ***:MH7777A hepatoma cells were injected into the liver of male Buffalo *** 7 d treatment with the vascular endothelial growth factor receptor antagonist PTK787/ZK222584(PTK/ZK),the histone deacetylase inhibitor MS-275,tamoxifen(TAM) and/or retinoic acid was initiated(n ≥ 8 animals/group).Natural tumor development was shown in untreated control groups(control 1 with n = 12,control 2 with n = 8).The control groups were initiated at different time points to demonstrate the stability of the hepatoma *** documentation of possible side effects,we documented any change in body weight,loss of fur and *** 21 d treatment,the rats were *** target parameters were tumor size and metastasis ***,immunohistochemistry for the proliferating cell nuclear antigen(PCNA) and TdT-mediated dUTP-biotin nick end labeling(TUNEL) assay were ***:The control groups developed large tumor nodules with extrahepatic tumor burden in the lung and abdominal organs(control 1:6.18 cm3 ± 4.14 cm3 and control 2:8.0 cm3 ± 4.44 cm3 28 d after tumor cell injection).The tumor volume did not differ significantly in the control groups(P = 0.13).As single agents MS-275 and PTK/ZK reduced tumor volume by 58.6% ± 2.6% and 48.7% ± 3.2% vs control group 1,which was significant only for MS-275(P = 0.025).The combination of MS-275 and PTK/ZK induced a nearly complete and highly significant tumor shrinkage by 90.3% ± 1%(P = 0.005).Addition of TAM showed no further efficacy,while quadruple therapy with retinoic acid increased antitumoral efficacy(tumor reduction by 93 ± 1%) and side *** positive cells were not significantly reduced by the single agents,while dual therapy(MS-275 and PTK/ZK) and quadruple therapy reduced the PCNA-positive cell fraction significantly by 9.1 and 20.6% vs control 1(P < 0.05).Th

关键词： PTK787 ZK222584 MS-275 Hepatocellular carcinoma Histone deacetylase inhibitor

Auditory nerve preservation and regeneration in man:relevance for cochlear implantation

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Neural Regeneration Research 2015年第5期10卷 710-712页

作者： Helge Rask-Andersen Wei Liu department of Surgical Sciences Head and Neck SurgerySection of OtolaryngologyUppsala University Hospital departments of otolaryngology Uppsala University Hospital

Human hearing relies on 15,000 hair cells （HCs） or mecha- noreceptors sited in a 34 mm long helical shaped epithelial ridge. There may be several explanations for their vulner- ability in man and regrettably, they do not regenerate. Ap- proximately 35,000 bipolar neurons have their soma situated in the modiolus of the cochlea. Human afferents consist of two separate systems; one is represented by the large type I cells innervating the inner HCs （IHCs, n = 3,400） and the other one by the small type Ⅱcells innervating the outer HCs （OHCs, n = 12,000）. Type I spiral ganglion neurons （SGNs） constitute 96% of the afferent nerve population. Unlike in other mammals, their somas together with the pre- and post-somatic segments are unmyelinated. Type II nerve cell soma and fibers are unmyelinated.

关键词： cell Auditory nerve preservation and regeneration in man

Effect of face masks on speech understanding: A clinical perspective during speech audiometry

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Journal of Otology 2022年第3期17卷 140-145页

作者： Rawish Kumar Sanjay Kumar Munjal Anuradha Sharma Md Noorain Alam Naresh K.Panda department of otolaryngology PGIMERChandigarhIndia

The objective was to measure the effect of various face masks on speech recognition threshold and the word recognition score in the presence of varying background noise levels.20 normal-hearing adult subjects(a total of 40 ears)*** tone audiometry followed by speech recognition threshold and word recognition score at the most comfortable level in varying signal-to-noise ratios(SNR0,SNR10,and SNR15)using surgical,pleated cloth,and N95 *** surgical,cloth,and N95 masks,speech recognition thresholds increased by 1.8 dB,4.4 dB,and 5.05 dB,*** recognition scores decreased by 32%without a mask,43.7%in a surgical mask,46.3%in a cloth mask,and 46.7%in N95 mask conditions,between SNR15 and *** speech recognition threshold was negatively affected with cloth and N95 *** masks do not affect the word recognition scores at lower background noise ***,as the signal-to-noise ratio decreased,even the surgical,cloth,and N95 masks significantly impacted the word recognition score even in normal-hearing individuals.

关键词： Face masks Speech recognition threshold Word recognition score Signal-to-noise ratio Communication

Clinical applications of free medial tibial flap with posterior tibial artery for head and neck reconstruction after tumor resection

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Chinese Journal of Cancer Research 2017年第3期29卷 231-236页

作者： Qi Zhong Jugao Fang Zhigang Huang Xiaohong Chen Lizhen Hou Yang Zhang Pingdong Li Hongzhi Ma Hongbo Xu department of otolaryngology Head and Neck Surgery Beijing Tongren Hospital Capital Medical University Beijing Institute of otolaryngology Key Laboratory of otolaryngology Head and Neck Surgery (Capital Medical University) Ministry of Education

Tumor resection causes damage in the head and neck which creates problems in swallowing, chewing, articulation, and vision, all of which seriously affect patients' quality of life. In this work, we evaluated the application of a free medial tibial flap in reconstruction of head and neck defects after tumor resection. We discussed the anatomy, surgical technique, and the advantages and disadvantages of the flap. We found several benefits for the flap, such as, it is especially effective for the defects that require thin-layer epithelium to cover or the separated soft tissue defect; a two-team approach can be used because the donor site is far away from the head and neck; and the flap is easy to integrate because of the subcutaneous fat layer of the free medial tibial flap is thin and the flap is soft. Thus, the medial tibial flap could replace the forearm flap for certain applications.

关键词： Head and neck free flap posterior tibial artery reconstruction

Olfactory ensheathing cells promote nerve regeneration and functional recovery after facial nerve defects

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Neural Regeneration Research 2019年第1期14卷 124-131页

作者： Jian Gu He Xu Ya-Ping Xu Huan-Hai Liu Jun-Tian Lang Xiao-Ping Chen Wei-Hua Xu Yue Deng Jing-Ping Fan department of otolaryngology Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine department of otolaryngology Head and Neck Surgery Changzheng Hospital Second Military Medical University department of otolaryngology Head and Neck Surgery Gongli Hospital Second Military Medical University

Olfactory ensheathing cells from the olfactory bulb and olfactory mucosa have been tbund to increase axonal sprouting and pathfinding and promote the recovery of vibrissae motor performance in facial nerve transection injured rats. However, it is not yet clear whether olfactory ensheathing cells promote the reparation of facial nerve defects in rats. In this study, a collagen sponge and silicone tube neural conduit was implanted into the 6-mm defect of the buccal branch of the facial nerve in adult rats. Olfactory ensheathing cells isolated from the olfactory bulb of newborn Sprague-Dawley rats were injected into the neural conduits connecting the ends of tile broken nerves, the morphology and function of the regenerated nerves were compared between the rats implanted with olfactory ensheathing cells with the rats injected with saline. Facial paralysis was assessed. Nerve electrography was used to measure facial nerve-induced action potentials. Visual inspection, anatomical microscopy and hematoxylin-eosin staining were used to assess the histomorphology around the trans planted neural conduit and the morphology of the regenerated nerve. Using fluorogold retrograde tracing, toluidine blue staining and lead uranyl acetate staining, we also measured the number of neurons in the anterior exterior lateral f：acial nerve motor nucleus, the number of myelinated nerve fibers, and nerve fiber diameter and myelin sheath thickness, respectively. After surgery, olfactory ensheathing cells de- creased facial paralysis and the latency of the facial nerve-induced action potentials. There were no differences in the general morphology of the regenerating nerves between the rats implanted with olfactory ensheathing cells and the rats injected with saline. Between-group results showed that olfactory ensheathing cell treatment increased the number of regenerated neurons, improved nerve fiber morphology, and increased the number of myelinated nerve fibers, nerve fiber diameter, and myel

关键词： nerve regeneration facial nerve defects olfactory ensheathing cells nerve fibers myelination neurons nerve muscle action potentials facial nerve motor nucleus neural regeneration