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Pinczel AJ, Woods CM, Catcheside PG, Woodman RJ, Carney AS, Chai-Coetzer CL, Chia M, Cistulli PA, Hodge JC, Jones A, Lam ME, Lewis R, McArdle N, Ooi EH, Rea SC, Rees G, Singh B, Stow N, Yeo A, Antic N, McEvoy RD, Weaver EM, MacKay SG. Sleep apnea multi-level surgery trial: long-term observational outcomes. Sleep 2024; 47:zsad218. [PMID: 37607039 DOI: 10.1093/sleep/zsad218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/02/2023] [Indexed: 08/24/2023] Open
Abstract
STUDY OBJECTIVES The sleep apnea multi-level surgery (SAMS) randomized clinical trial showed surgery improved outcomes at 6 months compared to ongoing medical management in patients with moderate or severe obstructive sleep apnea (OSA) who failed continuous positive airway pressure therapy. This study reports the long-term outcomes of the multi-level surgery as a case series. METHODS Surgical participants were reassessed >2 years postoperatively with the same outcomes reported in the main SAMS trial. Primary outcomes were apnea-hypopnea index (AHI) and Epworth sleepiness scale (ESS), with secondary outcomes including other polysomnography measures, symptoms, quality of life, and adverse events. Long-term effectiveness (baseline to long-term follow-up [LTFU]) and interval changes (6 month to LTFU) were assessed using mixed effects regression models. Control participants were also reassessed for rate of subsequent surgery and outcomes. RESULTS 36/48 (75%) of surgical participants were reevaluated (mean (standard deviation)) 3.5 (1.0) years following surgery, with 29 undergoing polysomnography. AHI was 41/h (23) at preoperative baseline and 21/h (18) at follow-up, representing persistent improvement of -24/h (95% CI -32, -17; p < 0.001). ESS was 12.3 (3.5) at baseline and 5.5 (3.9) at follow-up, representing persistent improvement of -6.8 (95% CI -8.3, -5.4; p < 0.001). Secondary outcomes were improved long term, and adverse events were minor. Interval change analysis suggests stability of outcomes. 36/43 (84%) of the control participants were reevaluated, with 25 (69%) reporting subsequent surgery, with symptom and quality of life improvements. CONCLUSION Multi-level upper airway surgery improves OSA burden with long-term maintenance of treatment effect in adults with moderate or severe OSA in whom conventional therapy failed. CLINICAL TRIAL Multi-level airway surgery in patients with moderate-severe obstructive sleep apnea (OSA) who have failed medical management to assess change in OSA events and daytime sleepiness; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366019&isReview=true; ACTRN12614000338662.
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Affiliation(s)
- Alison J Pinczel
- Adelaide Institute for Sleep Health, FHMRI Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Charmaine M Woods
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Peter G Catcheside
- Adelaide Institute for Sleep Health, FHMRI Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Richard J Woodman
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Andrew Simon Carney
- Adelaide Institute for Sleep Health, FHMRI Sleep Health, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Southern ENT and Adelaide Sinus Centre, Flinders Private Hospital, Adelaide, SA, Australia
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, FHMRI Sleep Health, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Michael Chia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Peter A Cistulli
- Charles Perkins Centre, Faculty for Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - John-Charles Hodge
- Ear Nose and Throat Department, Royal Adelaide Hospital, Adelaide, SA, Australia
- ICON Cancer Centre, Adelaide, SA, Australia
- Department of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Andrew Jones
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
- Illawarra Sleep Medicine Centre, Wollongong, NSW, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Matthew E Lam
- Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia
| | - Richard Lewis
- Head and Neck Surgery, Hollywood Medical Centre, Perth, WA, Australia
- Department of Otolaryngology, Royal Perth Hospital, Perth, WA, Australia
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Perth, WA, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Eng H Ooi
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Adelaide, SA, Australia
- Adelaide ENT Surgery, Flinders Private Hospital, Adelaide, SA, Australia
| | - Siobhan Clare Rea
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Perth, WA, Australia
| | - Guy Rees
- ENT Surgeons, Memorial Hospital, North Adelaide, SA, Australia
- Department of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Perth, WA, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Faculty of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Nicholas Stow
- Sydney Centre for Ear, Nose and Throat, Sydney, NSW, Australia
- Sleep Clinic, The Woolcock Clinic, Glebe, NSW, Australia
| | - Aeneas Yeo
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Nick Antic
- Adelaide Institute for Sleep Health, FHMRI Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Ronald Doug McEvoy
- Adelaide Institute for Sleep Health, FHMRI Sleep Health, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Edward M Weaver
- Department of Otolaryngology/Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Surgery Service, Seattle Veterans Affairs Medical Center, Seattle, WA, USA
| | - Stuart G MacKay
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia
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Connell J, Harrison E, Bassiouni A, Sahota R, Laden S, Carney AS, Foreman A, Krishnan S, O'Brien S, Hodge J. FiveQ: A new easy-to-use validated clinical instrument for tinnitus severity. Clin Otolaryngol 2022; 47:672-679. [PMID: 35996981 PMCID: PMC9826215 DOI: 10.1111/coa.13973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/22/2022] [Accepted: 07/03/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Tinnitus is a complex and debilitating phenomenon with potentially significant implications on quality of life. New presentations can be resource and time intensive for clinicians. Validated comprehensive tinnitus questionnaires may lack practical utility in the high-volume clinical setting. Concise, targeted questionnaires may offer an efficient alternative. This study aimed to assess the validity of the FiveQ, a novel five question construct designed to measure tinnitus severity. Convergent validity was assessed through correlating FiveQ against two comprehensive validated questionnaires, the Tinnitus Handicap Questionnaire (THQ) and Tinnitus Handicap Inventory (THI). DESIGN Cross-sectional study with prospective recruitment. The 117 voluntarily recruited participants completed the FiveQ, THI and THQ questionnaires. Results were comparatively analysed. SETTING Recruitment was via electronic and print media, audiology clinics and public and private otolaryngology outpatient clinics. Surveys were completed electronically. PARTICIPANTS Members of the public aged over 18 with subjective tinnitus were invited to participate. MAIN OUTCOME MEASURED Analyses for establishing the content validity, construct validity, internal consistency, explorary factor analysis, and responsiveness of FiveQ was performed. RESULTS FiveQ demonstrated a high positive correlation with both the THI (r = 0.773, p < .001) and THQ (r = 0.808, p < .001). Internal consistency for FiveQ reached an acceptable threshold (Cronbach's alpha 0.86). Exploratory factor analysis demonstrated that one latent factor underlies the five items of the FiveQ. FiveQ demonstrated better responsiveness than both the THI and THQ after a 6 week interval repeat measurement. CONCLUSION FiveQ demonstrated high-positive correlations with existing validated tinnitus questionnaires as well as acceptable internal consistency and factor analysis. The concise construct of FiveQ allows clinicians to efficiently estimate tinnitus severity, target treatment towards dominant symptoms and establish a reliable estimation of treatment response following interventions.
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Affiliation(s)
- James Connell
- Department of Otolaryngology Head and Neck SurgeryRoyal Adelaide HospitalSouth AustraliaAustralia,Faculty of Health and Medical ScienceUniversity of AdelaideSouth AustraliaAustralia
| | - Ella Harrison
- College of Medicine and Public HealthFlinders UniversitySouth AustraliaAustralia
| | - Ahmed Bassiouni
- Department of Otolaryngology Head and Neck SurgeryRoyal Adelaide HospitalSouth AustraliaAustralia,Faculty of Health and Medical ScienceUniversity of AdelaideSouth AustraliaAustralia
| | - Raguwinder Sahota
- Department of Otolaryngology Head and Neck SurgeryRoyal Adelaide HospitalSouth AustraliaAustralia
| | - Stephanie Laden
- Faculty of Health and Medical ScienceUniversity of AdelaideSouth AustraliaAustralia
| | - Andrew Simon Carney
- College of Medicine and Public HealthFlinders UniversitySouth AustraliaAustralia
| | - Andrew Foreman
- Department of Otolaryngology Head and Neck SurgeryRoyal Adelaide HospitalSouth AustraliaAustralia,Faculty of Health and Medical ScienceUniversity of AdelaideSouth AustraliaAustralia
| | - Suren Krishnan
- Department of Otolaryngology Head and Neck SurgeryRoyal Adelaide HospitalSouth AustraliaAustralia
| | - Sinead O'Brien
- Faculty of Health and Medical ScienceUniversity of AdelaideSouth AustraliaAustralia
| | - John‐Charles Hodge
- Department of Otolaryngology Head and Neck SurgeryRoyal Adelaide HospitalSouth AustraliaAustralia
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3
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Morris J, Lee Z, Sanchez L, Carney AS. Hearing loss increases with size but not site of tympanic membrane perforation in Aboriginal Australian children in remote locations. Laryngoscope Investig Otolaryngol 2022; 7:2050-2056. [PMID: 36544968 PMCID: PMC9764780 DOI: 10.1002/lio2.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/08/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the effect of size, site, and activity of tympanic membrane (TM) perforation on hearing loss (HL) in Aboriginal and Torres Strait Islander (ATSI) children. Design Observational study. Methodology Children aged 5-18 years who identified as ATSI at seven Anangu community schools within the Anangu Pitjantjatjara Yankunytjatjara Lands and Maralinga Lands of South Australia underwent 4-frequency pure-tone audiometry (0.5, 1, 2, and 4 kHz) and video-otoscopy (VO). VO data was reviewed by surgeons for a middle ear diagnosis and VO files with TM perforations were then classified by perforation site (AS, AI, PS, PI, A, P, I) and size (<25%, 25%-50%, 50%-75%, or 75%-100%). Results Five hundred seventy-five VO files with matching audiological data were obtained. Active perforations (35 dBHL; 28-44 IQR) demonstrated greater HL than inactive perforations (31 dBHL; 29-39 IQR) p = .0029. For inactive perforations there was a significant difference between <25% and all larger perforations (p < .0001) whereas for active perforations the significance changed to between <25% (p < .0001) and 25%-50% (p < .05) when compared to larger perforations. When perforation site was compared within all size/activity groups, no statistically different findings were identified. In all analyses, findings did not change when individual frequencies were compared to 4-frequency pure-tone average dBHL. Conclusion In ATSI children from remote communities, HL is greater in ears with larger perforations and active middle ear disease but there was no relationship between perforation site and HL.Level of evidence: Level 4.
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Affiliation(s)
- Jack Morris
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Zoe Lee
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Linnett Sanchez
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Andrew Simon Carney
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
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Mayne GC, Woods CM, Dharmawardana N, Wang T, Krishnan S, Hodge JC, Foreman A, Boase S, Carney AS, Sigston EAW, Watson DI, Ooi EH, Hussey DJ. Correction: Cross validated serum small extracellular vesicle microRNAs for the detection of oropharyngeal squamous cell carcinoma. J Transl Med 2022; 20:282. [PMID: 35733203 PMCID: PMC9215024 DOI: 10.1186/s12967-022-03434-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- G C Mayne
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, SA, 5042, Australia
| | - C M Woods
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, SA, 5042, Australia
| | - N Dharmawardana
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, SA, 5042, Australia
| | - T Wang
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - S Krishnan
- Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, 5000, Australia
| | - J C Hodge
- Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, 5000, Australia
| | - A Foreman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, 5000, Australia
| | - S Boase
- Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, 5000, Australia.,Flinders University, Adelaide, SA, 5042, Australia
| | - A S Carney
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - E A W Sigston
- Department of Otorhinolaryngology Head & Neck, Monash Health and Department of Surgery, Monash University, Clayton, VIC, 3168, Australia
| | - D I Watson
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, SA, 5042, Australia
| | - E H Ooi
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, SA, 5042, Australia
| | - D J Hussey
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, SA, 5042, Australia.
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5
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Hellings PW, Scadding G, Bachert C, Bjermer L, Canonica GW, Cardell LO, Carney AS, Constantinidis J, Deneyer L, Diamant Z, Durham S, Gevaert P, Harvey R, Hopkins C, Kjeldsen A, Klimek L, Lund VJ, Price D, Rimmer J, Ryan D, Roberts G, Sahlstrand-Johnson P, Salmi S, Samji M, Scadding G, Smith P, Steinsvik A, Wagenmann M, Seys S, Wahn U, Fokkens WJ. EUFOREA treatment algorithm for allergic rhinitis. Rhinology 2021; 58:626-628. [PMID: 32991658 DOI: 10.4193/rhin20.246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- P W Hellings
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology Research Group, Leuven, Belgium; University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium; University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium; Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, The Netherlands
| | - G Scadding
- RNENT Hospital, Huntley Street, London, UK
| | - C Bachert
- Upper Airways Research Laboratory, Dept of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Division of ENT diseases, CLINTEC, Karolinska Institute, University of Stockholm, Sweden;Sun Yat-sen University, International Airway Research Center, First Affiliated Hospital, Guangzhou, China
| | - L Bjermer
- Dept of Respiratory Medicine and Allergology, Skane Uni- versity Hospital, Lund, Sweden
| | - G W Canonica
- Personalized Medicine Asthma and Allergy Clinic, Humanitas University and Research Hospital, Milan, Italy, and SANI-Severe Asthma Network Italy
| | - L O Cardell
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - A S Carney
- Ear, Nose, and Throat (ENT) Department, Flinders Univer- sity, Bedford Park, South Australia, Australia
| | - J Constantinidis
- 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - L Deneyer
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - Z Diamant
- Dept of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden; Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; Dept Clin Pharm and Pharmacol, Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands
| | - S Durham
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - P Gevaert
- Upper Airways Research Laboratory, Dept of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - R Harvey
- Rhinology and Skull Base, Applied medical research center, University of New South Wales, Sydney, Australia; Faculty of medicine and heath sciences, Macquarie University, Sydney, Australia
| | - C Hopkins
- Ear, Nose and Throat Department, Guys and St. Thomas Hospital, London, United Kingdom
| | - A Kjeldsen
- Department of Otorhinolaryngology Head and Neck surgery, Odense University Hospital, Denmark; University of Southern Denmark, Odense, Denmark
| | - L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany; Mainz University Allergy Center, Mainz, Germany
| | - V J Lund
- Royal National Throat, Nose and Ear Hospital, UCLH, London, UK
| | - D Price
- Optimum Patient Care, Cambridge, UK; Observational and Pragmatic Research Institute, Singapore
| | - J Rimmer
- Monash Health, Monash University, Melbourne, Australia
| | - D Ryan
- Usher institute, University of Edinburgh, Edinburgh, UK
| | - G Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, United Kingdom;NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; University of Southampton, Southampton, United Kingdom
| | - P Sahlstrand-Johnson
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Skane University Hospital, Malmoo, Sweden
| | - S Salmi
- Helsinki University Hospital, Helsinki, Finland
| | - M Samji
- Imperial College London, London, UK
| | - G Scadding
- Royal Brompton and Ha- refield NHS Trust, London, UK
| | - P Smith
- Clinical Medicine, Griffith University, Southport, QLD, Australia
| | - A Steinsvik
- Department of Otorhinolaryngo- logy, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - M Wagenmann
- Department of Otorhinolaryngology, Universitatsklinikum Dusseldorf, Dusseldorf, Germany
| | - S Seys
- 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - U Wahn
- Klinik fur Padiatrie m.S. Pneumologie und Immunologie, Charite, Berlin, Germany
| | - W J Fokkens
- Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, The Netherlands
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Hellings PW, Scadding G, Bachert C, Bjermer L, Canonica GW, Cardell LO, Carney AS, Constantinidis J, Deneyer L, Diamant Z, Durham S, Gevaert P, Harvey R, Hopkins C, Kjeldsen A, Klimek L, Lund VJ, Price D, Rimmer J, Ryan D, Roberts G, Sahlstrand-Johnson P, Salmi S, Samji M, Scadding G, Smith P, Steinsvik A, Wagenmann M, Seys S, Wahn U, Fokkens WJ. EUFOREA treatment algorithm for allergic rhinitis. Rhinology 2020; 58:618-622. [PMID: 32991658 DOI: 10.4193/rhin20.376] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- P W Hellings
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology Research Group, Leuven, Belgium; University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium; University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium; Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, The Netherlands
| | - G Scadding
- RNENT Hospital, Huntley Street, London, UK
| | - C Bachert
- Upper Airways Research Laboratory, Dept of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Division of ENT diseases, CLINTEC, Karolinska Institute, University of Stockholm, Sweden;Sun Yat-sen University, International Airway Research Center, First Affiliated Hospital, Guangzhou, China
| | - L Bjermer
- Dept of Respiratory Medicine and Allergology, Skane Uni- versity Hospital, Lund, Sweden
| | - G W Canonica
- Personalized Medicine Asthma and Allergy Clinic, Humanitas University and Research Hospital, Milan, Italy, and SANI-Severe Asthma Network Italy
| | - L O Cardell
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - A S Carney
- Ear, Nose, and Throat (ENT) Department, Flinders Univer- sity, Bedford Park, South Australia, Australia
| | - J Constantinidis
- 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - L Deneyer
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - Z Diamant
- Dept of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden; Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; Dept Clin Pharm and Pharmacol, Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands
| | - S Durham
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - P Gevaert
- Upper Airways Research Laboratory, Dept of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - R Harvey
- Rhinology and Skull Base, Applied medical research center, University of New South Wales, Sydney, Australia; Faculty of medicine and heath sciences, Macquarie University, Sydney, Australia
| | - C Hopkins
- Ear, Nose and Throat Department, Guys and St. Thomas Hospital, London, United Kingdom
| | - A Kjeldsen
- Department of Otorhinolaryngology Head and Neck surgery, Odense University Hospital, Denmark; University of Southern Denmark, Odense, Denmark
| | - L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany; Mainz University Allergy Center, Mainz, Germany
| | - V J Lund
- Royal National Throat, Nose and Ear Hospital, UCLH, London, UK
| | - D Price
- Optimum Patient Care, Cambridge, UK; Observational and Pragmatic Research Institute, Singapore
| | - J Rimmer
- Monash Health, Monash University, Melbourne, Australia
| | - D Ryan
- Usher institute, University of Edinburgh, Edinburgh, UK
| | - G Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, United Kingdom;NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; University of Southampton, Southampton, United Kingdom
| | - P Sahlstrand-Johnson
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Skane University Hospital, Malmoo, Sweden
| | - S Salmi
- Helsinki University Hospital, Helsinki, Finland
| | - M Samji
- Imperial College London, London, UK
| | - G Scadding
- Royal Brompton and Ha- refield NHS Trust, London, UK
| | - P Smith
- Clinical Medicine, Griffith University, Southport, QLD, Australia
| | - A Steinsvik
- Department of Otorhinolaryngo- logy, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - M Wagenmann
- Department of Otorhinolaryngology, Universitatsklinikum Dusseldorf, Dusseldorf, Germany
| | - S Seys
- 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - U Wahn
- Klinik fur Padiatrie m.S. Pneumologie und Immunologie, Charite, Berlin, Germany
| | - W J Fokkens
- Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, The Netherlands
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Attard S, Carney AS. Paediatric patient bleeding and pain outcomes following subtotal (tonsillotomy) and total tonsillectomy: a 10-year consecutive, single surgeon series. ANZ J Surg 2020; 90:2532-2536. [PMID: 32964591 DOI: 10.1111/ans.16306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/10/2020] [Accepted: 08/26/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Subtotal tonsil surgery (tonsillotomy) remains a controversial procedure. We aimed to document bleeding rates and return to normal activity for total versus subtotal tonsil surgery in the paediatric population. METHODS A 10-year cohort of 608 children from a single-surgeon series was analysed. Bleeding events were classified using the Flinders modification of the Stammberger criteria. Return to normal activity was defined as normal diet and return to childcare/school. RESULTS A total of 8.3% of tonsil procedures and a subtotal of 1.8% of procedures had some kind of bleeding episode (P < 0.01; odds ratio 3.2; 95% confidence interval (CI) 1.3-7.6). When blood-stained sputum (type A bleed) was excluded, this dropped to 2.5% versus 0.3%, respectively (P < 0.05; odds ratio 8.5; 95% CI 1.2-96.0). Return to normal activities occurred at a mean of 11.1 (95% CI 9.7-12.5) versus 4.6 (95% CI 4.0-5.3) days, respectively (P < 0.0001). CONCLUSION In this 10-year single surgeon series, subtotal tonsillectomy or 'tonsillotomy' was associated with a significant reduction in both prevalence and severity of bleeding, in addition to a more rapid return to normal activities when compared to total tonsillectomy.
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Affiliation(s)
- Sara Attard
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Simon Carney
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Mayne GC, Woods CM, Dharmawardana N, Wang T, Krishnan S, Hodge JC, Foreman A, Boase S, Carney AS, Sigston EAW, Watson DI, Ooi EH, Hussey DJ. Cross validated serum small extracellular vesicle microRNAs for the detection of oropharyngeal squamous cell carcinoma. J Transl Med 2020; 18:280. [PMID: 32650803 PMCID: PMC7350687 DOI: 10.1186/s12967-020-02446-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Oropharyngeal squamous cell carcinoma (OPSCC) is often diagnosed at an advanced stage because the disease often causes minimal symptoms other than metastasis to neck lymph nodes. Better tools are required to assist with the early detection of OPSCC. MicroRNAs (miRNAs, miRs) are potential biomarkers for early head and neck squamous cell cancer diagnosis, prognosis, recurrence, and presence of metastatic disease. However, there is no widespread agreement on a panel of miRNAs with clinically meaningful utility for head and neck squamous cell cancers. This could be due to variations in the collection, storage, pre-processing, and isolation of RNA, but several reports have indicated that the selection and reproducibility of biomarkers has been widely affected by the methods used for data analysis. The primary analysis issues appear to be model overfitting and the incorrect application of statistical techniques. The purpose of this study was to develop a robust statistical approach to identify a miRNA signature that can distinguish controls and patients with inflammatory disease from patients with human papilloma virus positive (HPV +) OPSCC. METHODS Small extracellular vesicles were harvested from the serum of 20 control patients, 20 patients with gastroesophageal reflux disease (GORD), and 40 patients with locally advanced HPV + OPSCC. MicroRNAs were purified, and expression profiled on OpenArray™. A novel cross validation method, using lasso regression, was developed to stabilise selection of miRNAs for inclusion in a prediction model. The method, named StaVarSel (for Stable Variable Selection), was used to derive a diagnostic biomarker signature. RESULTS A standard cross validation approach was unable to produce a biomarker signature with good cross validated predictive capacity. In contrast, StaVarSel produced a regression model containing 11 miRNA ratios with potential clinical utility. Sample permutations indicated that the estimated cross validated prediction accuracy of the 11-miR-ratio model was not due to chance alone. CONCLUSIONS We developed a novel method, StaVarSel, that was able to identify a panel of miRNAs, present in small extracellular vesicles derived from blood serum, that robustly cross validated as a biomarker for the detection of HPV + OPSCC. This approach could be used to derive diagnostic biomarkers of other head and neck cancers.
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Affiliation(s)
- G C Mayne
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - C M Woods
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - N Dharmawardana
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - T Wang
- Flinders Health and Medical Research Institute, Flinders University , Bedford Park, South Australia, 5042, Australia
| | - S Krishnan
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - J C Hodge
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - A Foreman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - S Boase
- Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, 5000, Australia
- Flinders University, South Australia, South Australia, 5042, Australia
| | - A S Carney
- Flinders Health and Medical Research Institute, Flinders University , Bedford Park, South Australia, 5042, Australia
| | - E A W Sigston
- Department of Otorhinolaryngology Head & Neck, Monash Health and Department of Surgery, Monash University, Clayton, Victoria, 3168, Australia
| | - D I Watson
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - E H Ooi
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - D J Hussey
- Flinders Health and Medical Research Institute, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia.
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9
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Sanchez L, Carney AS, Esterman A, Sparrow K, Turner D. Does access to saltwater swimming pools reduce ear pathology and hearing loss in school children of remote arid zone aboriginal communities? A prospective 3-year cohort study. Clin Otolaryngol 2019; 44:736-742. [PMID: 31095860 DOI: 10.1111/coa.13364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/04/2019] [Accepted: 05/12/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess whether access to saltwater chlorinated swimming pools in remote Aboriginal communities is beneficial in reducing levels of middle ear disease and hearing loss in school children. DESIGN A prospective 3-year cohort study of children in 10 remote Aboriginal communities in South Australia with (n = 4) or without (n = 6) swimming pools. SETTING Outback Australia. PARTICIPANTS Eight hundred and thirteen school-age children residing in remote South Australia. MAIN OUTCOME MEASURES Prevalence of open and closed middle ear disease and prevalence of hearing loss. RESULTS About 2107 ear assessments were conducted during the study period. 70.7% of children in communities with pools failed a screening test of hearing compared with 68.6% of children in non-pool communities (P = 0.637). 32.3% of children had chronic otitis media (COM). There was no difference between pool and non-pool communities in the frequency of either inactive (19.4% pool vs 22.6% non-pool; P = 0.232) or active (19.8% pool vs 17.8% non-pool; P = 0.383) COM. In children with bilateral intact tympanic membranes, 21.2% had unilateral and 20.6 had bilateral type B tympanograms. There was no difference between pool and non-pool communities in the frequency of type B tympanometry (P = 0.465). CONCLUSIONS Hearing loss associated with both open and closed middle ear disease remains highly prevalent in children living in remote Aboriginal communities in South Australia. Access to swimming pools in this population does not appear to significantly reduce these high levels of middle ear disease or associated hearing loss.
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Affiliation(s)
- Linnett Sanchez
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Simon Carney
- Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Adrian Esterman
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Karen Sparrow
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - David Turner
- College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia
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10
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Smith P, Price D, Harvey R, Carney AS, Kritikos V, Bosnic-Anticevich SZ, Christian L, Skinner D, Carter V, Durieux AMS. Medication-related costs of rhinitis in Australia: a NostraData cross-sectional study of pharmacy purchases. J Asthma Allergy 2017; 10:153-161. [PMID: 28533689 PMCID: PMC5431691 DOI: 10.2147/jaa.s128431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose There is a relative paucity of research regarding medication expenditure associated with multiple-therapy use for rhinitis in Australia. To describe 1) the nature and extent of multiple-therapy use for rhinitis in Australia using data on therapies purchased with prescription or over-the-counter (OTC) and 2) additional costs incurred by multiple-therapy use compared with intranasal corticosteroid (INCS) therapy alone. Patients and methods A retrospective observational study was carried out using a database containing anonymous pharmacy transaction data available from 20% of pharmacies in Australia that links doctor prescriptions and OTC purchase information. Pharmacy purchases of at least one prescription or OTC rhinitis treatment, with or without additional asthma/chronic obstructive pulmonary disease (COPD) therapy, by patients during 2013 and 2014 were assessed. Results In total, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over 24 months. The majority of rhinitis therapy transactions were single-therapy purchases without additional asthma/COPD therapy. Of the single therapies purchased, 73% were oral antihistamines (OAHs) and 15% were INCS therapy. Dual-therapy purchases of INCSs and OAHs accounted for 40% of multiple-therapy purchases. Patients frequently purchased OAHs, nonsteroidal nasal sprays, and eye drops for allergic conjunctivitis alongside INCSs, resulting in higher financial costs (up to AU$21 per treatment episode) compared with INCS monotherapy. Conclusion This study highlighted the significant burden posed on community pharmacy to address the needs of people with rhinitis symptoms, and the failure to translate the evidence that INCSs are the most effective monotherapy for moderate to severe and/or persistent rhinitis into clinical practice in light of the lack of evidence supporting combination of INCS and OAH therapy. Health care professional engagement, especially at the pharmacy level, will be extremely important if we wish to ensure that the purchase of rhinitis treatment is in accordance with guidelines and that their use is optimal.
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Affiliation(s)
- Pete Smith
- Clinical Medicine, Griffith University, Southport, QLD, Australia
| | - David Price
- Observational and Pragmatic Research Institute, Singapore.,Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Richard Harvey
- Applied Medical Research Center, University of New South Wales, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Andrew Simon Carney
- Department of Otolaryngology - Head and Neck Surgery, Flinders University, Adelaide, SA, Australia
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Sinthia Z Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,Central Sydney Area Health Service, Sydney, NSW, Australia
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11
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Dharmawardana N, Ruthenbeck G, Woods C, Elmiyeh B, Diment L, Ooi EH, Reynolds K, Carney AS. Validation of virtual-reality-based simulations for endoscopic sinus surgery. Clin Otolaryngol 2016; 40:569-79. [PMID: 25809675 DOI: 10.1111/coa.12414] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Virtual reality (VR) simulators provide an alternative to real patients for practicing surgical skills but require validation to ensure accuracy. Here, we validate the use of a virtual reality sinus surgery simulator with haptic feedback for training in Otorhinolaryngology - Head & Neck Surgery (OHNS). METHODS Participants were recruited from final-year medical students, interns, resident medical officers (RMOs), OHNS registrars and consultants. All participants completed an online questionnaire after performing four separate simulation tasks. These were then used to assess face, content and construct validity. anova with post hoc correlation was used for statistical analysis. RESULTS The following groups were compared: (i) medical students/interns, (ii) RMOs, (iii) registrars and (iv) consultants. Face validity results had a statistically significant (P < 0.05) difference between the consultant group and others, while there was no significant difference between medical student/intern and RMOs. Variability within groups was not significant. Content validity results based on consultant scoring and comments indicated that the simulations need further development in several areas to be effective for registrar-level teaching. However, students, interns and RMOs indicated that the simulations provide a useful tool for learning OHNS-related anatomy and as an introduction to ENT-specific procedures. CONCLUSIONS The VR simulations have been validated for teaching sinus anatomy and nasendoscopy to medical students, interns and RMOs. However, they require further development before they can be regarded as a valid tool for more advanced surgical training.
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Affiliation(s)
| | - G Ruthenbeck
- Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - C Woods
- Flinders Medical Centre, Adelaide, Australia.,Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - B Elmiyeh
- Flinders Medical Centre, Adelaide, Australia
| | - L Diment
- Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - E H Ooi
- Flinders Medical Centre, Adelaide, Australia.,Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - K Reynolds
- Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - A S Carney
- Flinders Medical Centre, Adelaide, Australia.,Medical Device Research Institute, Flinders University, Adelaide, Australia
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12
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Woods CM, Gunawardena I, Chia M, Vowles NJ, Ullah S, Robinson S, Carney AS. Long-term quality-of-life outcomes following treatment for adult obstructive sleep apnoea: comparison of upper airway surgery, continuous positive airway pressure and mandibular advancement splints. Clin Otolaryngol 2016; 41:762-770. [PMID: 26929262 DOI: 10.1111/coa.12641] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Long-term quality-of-life (QOL) outcomes, complications and clinical effectiveness in patients undergoing treatment with upper airway surgery (UAS), continuous positive airway pressure (CPAP) and mandibular advancement splints (MAS) for adult obstructive sleep apnoea (OSA). DESIGN Retrospective cohort study. SETTING Multidisciplinary OSA clinic in University teaching hospital. PARTICIPANTS Consecutive, simultaneously treated patients with OSA undergoing UAS (n = 83), CPAP (n = 83) and MAS (n = 79). MAIN OUTCOME MEASURES Glasgow Benefit Inventory (GBI), Snoring Severity Scale (SSS), Epworth Sleepiness Score (ESS) and side-effects in all three groups were recorded at a mean of 34.5 months following start of treatment and compared via anova with Bonferroni's adjustment for pairwise comparisons. RESULTS Upper airway surgery demonstrated a statistically significant QOL benefit over MAS. All three groups showed a significant improvement in SSS with CPAP significantly better than MAS, but equivalent to UAS. Uncomplicated UAS provided a greater QOL outcome than compliant MAS, non-compliant CPAP (P < 0.05) and comparable to compliant CPAP. Patients undergoing UAS with recorded complications still reported equivalent QOL outcomes to compliant CPAP and MAS, suggesting these surgical complications are relatively minor compared to the QOL benefit of OSA treatment. CONCLUSION Upper airway surgery showed a significant improvement in QOL outcomes compared to non-compliant CPAP or MAS and equivalent benefit to compliant CPAP. This study strongly supports the role for contemporary UAS in OSA when CPAP is not or no longer an option.
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Affiliation(s)
- C M Woods
- Flinders ENT, Flinders Medical Centre, Adelaide, SA, Australia.,Department of Surgery, Flinders University, Adelaide, SA, Australia
| | - I Gunawardena
- Flinders ENT, Flinders Medical Centre, Adelaide, SA, Australia
| | - M Chia
- Memorial Hospital, Adelaide, SA, Australia
| | - N J Vowles
- Jetty Road Dental Clinic, Adelaide, SA, Australia
| | - S Ullah
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - S Robinson
- Flinders ENT, Flinders Medical Centre, Adelaide, SA, Australia.,Department of Surgery, Flinders University, Adelaide, SA, Australia.,Memorial Hospital, Adelaide, SA, Australia
| | - A S Carney
- Flinders ENT, Flinders Medical Centre, Adelaide, SA, Australia.,Department of Surgery, Flinders University, Adelaide, SA, Australia
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13
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Woods CM, Lee VS, Hussey DJ, Irandoust S, Ooi EH, Tan LW, Carney AS. Lysozyme expression is increased in the sinus mucosa of patients with chronic rhinosinusitis. Rhinology 2012; 50:147-56. [PMID: 22616075 DOI: 10.4193/rhino11.229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The presence of fungi and bacteria in the paranasal sinuses may contribute to ongoing inflammation. Lysozyme is an innate immune peptide with bactericidal and fungicidal activity. The expression of lysozyme in chronic rhinosinusitis (CRS) is poorly understood and deficiencies in lysozyme expression may contribute to the ongoing inflammation in CRS patients. OBJECTIVE Determine lysozyme expression in sinus mucosa of normal and CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps. METHODOLOGY Sinus mucosa specimens (n = 82) were processed for standard histology, immunohistochemical localisation of lysozyme, immunofluorescent localisation of fungi, and qPCR analysis of lysozyme expression. RESULTS CRS specimens displayed high-levels of lysozyme immunoreactivity in many of the abundant serous cells. Moderate levels were detected in some epithelial cells and inflammatory cells. Low levels were detected in some subepithelial glands of control specimens. No difference in immunoreactivity was detected between CRSwNP and CRSsNP specimens. Fungal elements were not visualised in any sinus specimen. qPCR analysis demonstrated variable lysozyme expression between individuals. CONCLUSIONS Lysozyme protein expression is increased in patients with CRS, suggesting a defect in lysozyme expression is not responsible for the microbial colonisation often associated with CRS. The functional activity of lysozyme in CRS patients needs to be further investigated.
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Affiliation(s)
- C M Woods
- Flinders ENT Department of Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia
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14
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Abstract
The principles of management of the laryngeal cancer have evolved over the recent past with emphasis on organ preservation. These developments have paralleled technological advancements as well as refinement in the surgical technique. The surgeons are able to maintain physiological functions of larynx namely speech, respiration and swallowing without compromising the loco-regional control of cancer in comparison to the more radical treatment modalities. A large number of organ preservation surgeries are available to the surgeon; however, careful assessment of the stage of the cancer and selection of the patient is paramount to a successful outcome. A comprehensive review of various organ preservation techniques in vogue for the management of laryngeal cancer is presented.
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Affiliation(s)
- Sharad Chawla
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, South Australia, Australia
| | - Andrew Simon Carney
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, South Australia, Australia
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15
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Carney AS, Ward V, Malluci CL, O'donoghue GM, Robertson I, Baldwin DL, Maw AR, Coakham HB. Meningiomas involving the internal auditory canal: a diagnostic and surgical challenge. Skull Base Surg 2006; 9:87-94. [PMID: 17171123 PMCID: PMC1656800 DOI: 10.1055/s-2008-1058154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Meningiomas are the second most common lesion encountered within the cerebello-pontine angle (CPA) and rarely project into or originate from the internal auditory meatus (IAM). It is important to distinguish between meningiomas and acoustic neuromas preoperatively as the choice of surgical approach may differ depending on the tumour type. Fortunately, most lesions can be accurately diagnosed with gadolinium-enhanced magnetic resonunce imaging (MRI). We report six cases of meningioma involving the IAM, often leading to an incorrect preoperative MRI diagnosis. We highlight the challenges these tumors present to radiologists and surgeons.
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16
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Powe DG, Huskisson RS, Carney AS, Jenkins D, McEuen AR, Walls AF, Jones NS. Mucosal T-cell phenotypes in persistent atopic and nonatopic rhinitis show an association with mast cells. Allergy 2004; 59:204-12. [PMID: 14763935 DOI: 10.1046/j.1398-9995.2003.00315.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Allergic rhinitis is characterized by selective expansion of T cell subsets with a CD4+ phenotype. Recently, we identified a subpopulation of nonallergic rhinitis subjects with increased epithelial mast cell and eosinophil populations, suggestive of local mucosal allergy. Previously, T cell subsets have not been characterized in this subselection of nonallergic subjects and furthermore, their relationship to mast cell and basophil effector cells remain unidentified. OBJECTIVE To determine if a subpopulation of nonallergic subjects with idiopathic rhinitis (IR) have localized allergy confined to their nasal mucosa by comparing the T cell subsets and major histocompatibility complex (MHC) II expressing cells to persistent allergic rhinitis (PAR). Furthermore, the relationship between T cell subsets and mast cells/basophils was investigated. METHODS None of the symptomatic patients in this study were clinically allergen-challenged. Nasal turbinate mucosa was removed from patients with PAR, IR and normal controls. Morphometry was performed on immunostained sections for T cell subset populations including CD3+, CD4+, CD8+, CD25+, CD45RA+, CD45RO+, human leucocyte antigen (HLA)-DRalpha (MHC class II), mast cell tryptase and for basophils. RESULTS Subjects with persistent allergic rhinitis differed to normal controls in showing significantly increased numbers of total (CD3+), activated (CD25+) and allergen-naïve (CD45RA+) T lymphocytes in their nasal mucosa (P < 0.025). The naïve CD45RA+ memory T cells correlated to mucosal mast cells in PAR (P = 0.03). IR patients differ to allergic subjects in showing significantly reduced numbers of epithelial HLA-DRalpha+ cells (P = 0.007), but increased numbers of CD8+ lymphocytes (P = 0.02). The CD8+ T cells correlated with mucosal mast cell numbers (P = 0.02). In both rhinitis groups, basophils were present in very low numbers obviating the need for statistical analysis. CONCLUSION PAR is characterized by increased numbers of CD3+, CD25+ and CD45RA+ T lymphocytes compared with normal mucosa. Allergic and nonallergic rhinitis groups can be separated by significant differences in the number of epithelial antigen presenting cells (APCs) (HLA-DRalpha+) and sub-epithelial activated (CD25+) T cells. Moreover, IR patients do not significantly differ to their allergic counterparts with respect to total (CD3+) and naïve (CD45RA+) T cell numbers, or numbers of epithelial activated (CD25+) lymphocytes. IR subjects show significantly increased numbers of CD8+ lymphocytes compared with control mucosa and although our findings suggest that the initiating inflammatory events may differ, both rhinitis groups show a similarity in pathology involving mucosal mast cells with an association to infiltrating T cells.
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Affiliation(s)
- D G Powe
- School of Medical Molecular Science, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH, UK
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17
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Powe DG, Jagger C, Kleinjan A, Carney AS, Jenkins D, Jones NS. 'Entopy': localized mucosal allergic disease in the absence of systemic responses for atopy. Clin Exp Allergy 2003; 33:1374-9. [PMID: 14519143 DOI: 10.1046/j.1365-2222.2003.01737.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Th2 immune response in the nasal mucosa of subjects with allergic rhinitis is mediated by allergen-specific IgE. Moreover, these subjects show positive responses for markers of systemic atopy, including allergen-specific skin sensitivity and raised serum IgE titres. In contrast, idiopathic rhinitis (IR) subjects with similar histological nasal mucosal features differ in being defined as non-allergic because they have negative atopic responses. OBJECTIVE We hypothesized that it is possible to have an allergic Th2 disease pathway localized in the nasal mucosa of 'non-allergic' rhinitis subjects despite an absence of atopic responses. METHODS The presence of house dust mite and grass pollen-specific IgE antibodies was investigated in non-atopic (n=10) and atopic (n=11) subjects with persistent rhinitis and compared to normal (n=12) control subjects. Biotin-labelled allergen was used to localize specific allergen-binding antibodies in situ in sections of nasal mucosa. RESULTS Grass pollen allergen binding was detected in the nasal mucosa of 3/10 non-atopic IR subjects but, in contrast, dust mite-specific antibodies were not detected. Specific antibodies were present in a total of 8/11 mucosal samples from the allergic group, but none was detected in normal control tissues. CONCLUSION These findings support the concept of localized nasal allergy in 'non-atopic' rhinitis subjects. We propose the term 'entopy' to define this phenomenon and believe that this concept has a wider implication for localized allergic responses in other mucosal sites.
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Affiliation(s)
- D G Powe
- Department of Clinical Laboratory Sciences, Erasmus University, Dr Molewaterplein 50, Rotterdam, The Netherlands.
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Carney AS, Powe DG, Huskisson RS, Jones NS. Atypical nasal challenges in patients with idiopathic rhinitis: more evidence for the existence of allergy in the absence of atopy? Clin Exp Allergy 2002; 32:1436-40. [PMID: 12372122 DOI: 10.1046/j.1365-2745.2002.01465.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The pathophysiology of idiopathic rhinitis is unknown although evidence is accumulating to suggest that many patients may have a localized form of allergic rhinitis in the absence of other atopic symptoms and markers. This study compares detailed nasal challenge results obtained from patients with idiopathic rhinitis to those of atopic and normal controls. METHODS Patients with idiopathic rhinitis (n = 23), perennial allergic rhinitis (n = 8) and normal controls (n = 8) underwent a normal saline challenge to exclude hyper-reactivity and then bilateral nasal allergen challenges. Nasal patency was assessed by anterior active rhinomanometry. RESULTS All of the patients with atopic rhinitis demonstrated positive bilateral allergen challenges. All normal control subjects had bilateral negative challenges. Two patients in the idiopathic group tested positively to saline and were excluded from further study with 62% of the remainder testing positive to allergens. Of the idiopathic patients testing positive, 85% were sensitive to house dust mite. CONCLUSION A significant proportion of patients with idiopathic rhinitis have positive nasal challenges, the vast majority to house dust mite allergen. These findings add to the weight of evidence that suggests 'localized allergy' may exist in the absence of systemic atopic markers.
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Affiliation(s)
- A S Carney
- Department of Otolaryngology - Head and Neck Surgery, Flinder's Medical Centre, Bedford Park, Adelaide, SA, Australia.
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Carney AS, Hooi D, Powe DG, Huskisson RS, Jones NS. Autoanti-IgE antibodies in patients with allergic and idiopathic rhinitis. Clin Otolaryngol Allied Sci 2001; 26:298-301. [PMID: 11559341 DOI: 10.1046/j.1365-2273.2001.00474.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The pathophysiology of idiopathic rhinitis is unknown although evidence is accumulating to suggest that, in a proportion of patients, it may be a more localized form of allergic rhinitis in the absence of other atopic symptoms and markers. Anti-IgE is thought to be a systemic marker of atopy. This study compared serum IgG autoanti-IgE levels in patients with idiopathic rhinitis, perennial allergic rhinitis and normal controls. Serum samples were obtained from 19 patients with idiopathic rhinitis, 17 patients with perennial allergic rhinitis and 10 normal non-rhinitic controls. The presence or absence of IgG1 and IgG4 anti-IgE antibodies was detected using enzyme-linked immunosorbent assays. Eighty-eight percent of the patients with perennial allergic rhinitis had raised levels of autoanti-IgE antibodies in their serum. None of the controls or patients with idiopathic rhinitis showed raised levels (P < 0.001). Although patients with idiopathic rhinitis may exhibit clinical and pathological features of allergy, they do not show raised levels of anti-IgE in their serum.
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Affiliation(s)
- A S Carney
- Department of Otolaryngology - Head and Neck Surgery, Queen's Medical Centre, Nottingham, UK.
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Fahy CP, Carney AS, Nikolopoulos TP, Ludman CN, Gibbin KP. Cochlear implantation in children with large vestibular aqueduct syndrome and a review of the syndrome. Int J Pediatr Otorhinolaryngol 2001; 59:207-15. [PMID: 11397503 DOI: 10.1016/s0165-5876(01)00487-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Children with Large Vestibular Aqueduct Syndrome (LVAS) frequently develop speech and language skills prior to deterioration of their hearing. Operations designed to halt the progression of hearing loss have largely failed so the question of Cochlear Implantation in these children has arisen. It had been suggested that there would be technical difficulties in implanting these patients and, therefore, there had been an initial reluctance to proceed to implantation. The aim of the present paper is to assess surgical and functional outcomes in implanted children with LVAS and review the related literature. MATERIAL AND METHODS From the 170 children assessed by MRI in the Nottingham Paediatric Cochlear Implant Programme, seven (4%) were identified as having LVAS. Four of these children were implanted and had at least 12 months follow up. Two of the children are on the waiting list for implantation and one child was not implanted because of absence of the cochlear nerve. Operative findings, complications and outcome measures were recorded. The auditory skills of the children were assessed before implantation and 1 year following implantation. A literature search was done to identify other series with experience in implanting children with LVAS. RESULTS Full insertion of the electrode array was achieved in all our cases. After cochleostomy two patients experienced a mild CSF leak that was easily controlled by the muscle graft. On the first day post-operation two patients were nauseous and one had an episode of vomiting, however, all were discharged within 24 h of surgery. Initial outcome measures at 12 months post-implantation were encouraging showing significant progress in children's auditory skills. CONCLUSIONS The results of the present study and the review of the literature suggest that LVAS is not a contraindication to implantation as initial concerns about severe perilymph leaks and surgical complications have proved to be unfounded. The post-operative progress of these children in listening skills also suggest that these children are suitable for cochlear implantation
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Affiliation(s)
- C P Fahy
- Department of Otorhinolaryngology, Head and Neck Surgery, Queen's Medical Centre, NG7-2UH, Nottingham, UK.
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22
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Abstract
BACKGROUND The pathophysiology of idiopathic rhinitis is unknown but the disease is classified as being non-allergic on the basis of negative serum IgE radioallergosorbent assay (RAST) and skin prick tests. In contrast, allergic rhinitis has a Th2 type inflammatory pathology mediated by IgE and mast cells. OBJECTIVE To test the null hypothesis that there would be no difference in the cellular infiltrate for key Th2-associated inflammatory cells between allergic and idiopathic rhinitis. METHODS We applied strict selection criteria in the recruitment of allergic and idiopathic rhinitis cases. In contrast to previous studies which used cytology or small biopsies, we studied all layers of the mucosa by using whole, full-thickness nasal turbinate specimens with an average length of 2.5 cm. Immunohistochemistry and in situ hybridization techniques were used to compare the distribution and cell populations of mast cells, IgE positive (IgE+) cells, eosinophils and plasma cells in perennial allergic (n = 11) and idiopathic (n = 17) rhinitis, and control nasal mucosal tissue (n = 9). RESULTS Mast cells and IgE+ cells were significantly increased within the epithelium of allergic and idiopathic mucosa compared to normal mucosa (P < 0.05). More IgE+ cells were present in the allergic group compared to the idiopathic group with the majority of IgE+ cells being mast cells. Both rhinitic groups showed increased eosinophilia localized to the superficial submucosa compared to normal mucosa (P < 0.05). More plasma cells were present in the allergic rhinitic tissue. CONCLUSION Idiopathic and allergic rhinitic mucosa show similarities in their inflammatory infiltrate suggesting that both groups share a highly localized Th2, IgE-mediated cellular immunopathology.
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Affiliation(s)
- D G Powe
- Division of Pathology, Department of Clinical Laboratory Sciences, University Hospital Queen's Medical Centre, Nottingham, UK.
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23
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Pau H, Carney AS, Murty GE. Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome): otorhinolaryngological manifestations. Clin Otolaryngol Allied Sci 2001; 26:93-8. [PMID: 11309047 DOI: 10.1046/j.1365-2273.2001.00442.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant disorder affecting blood vessels of the skin, mucous membrane and viscera. The otorhinolaryngologist is the commonest clinician involved in management as epistaxis occurs in 93% of the patients. As marked advances have recently been made regarding the pathogenesis and management of the condition, the otorhinolaryngological perspective is reviewed.
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MESH Headings
- Administration, Intranasal
- Administration, Topical
- Chromosome Aberrations/genetics
- Chromosome Disorders
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 9/genetics
- Embolization, Therapeutic
- Estrogens/administration & dosage
- Estrogens/therapeutic use
- Female
- Gene Expression
- Humans
- Laser Therapy
- Male
- Molecular Biology/methods
- Nasal Mucosa/pathology
- Otorhinolaryngologic Surgical Procedures/methods
- Progesterone/administration & dosage
- Progesterone/therapeutic use
- Telangiectasia, Hereditary Hemorrhagic/genetics
- Telangiectasia, Hereditary Hemorrhagic/pathology
- Telangiectasia, Hereditary Hemorrhagic/therapy
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Affiliation(s)
- H Pau
- Department of Otorhinolarynogology, Leicester Royal Infirmary, Leicester, UK.
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24
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Abstract
The nasal cycle is a well-recognised physiological phenomenon where each side of the nose alternates through phases of congestion and decongestion. Although many physiological properties of the nose alternate with the nasal cycle whether this has any effect on the nasal mucociliary clearance is less clear. As the nose is a potential site for the administration of pharmaceuticals, it is essential that any factors that could affect clearance (and hence absorption) are identified. This study set out to investigate if mucociliary clearance rates differed between the clear and obstructed airway at a morning peak of the nasal cycle in five healthy volunteers with normal nasal anatomy using a dual-radioisotope labelling procedure that allows both sides of the nose to be assessed simultaneously. The clearance of the radiopharmaceutical formulations from the nasal cavity was monitored using gamma scintigraphy and decay-adjusted 50%-clearance times were calculated for each nostril. The ratios of clearance times from the patent nostril when compared to the obstructed nostril were statistically significant (two-tailed t-test; P = 0.039), the mean ratio being 2.5 : 1 (SEM +/- 0.5). It can be concluded that the nasal cycle has a marked effect on the mucociliary clearance patterns of the nose. This may have both theoretical and practical implications for the nasal delivery of drugs.
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Affiliation(s)
- R J Soane
- Department of Pharmaceutical Sciences, University of Nottingham, UK
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25
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Pau H, Carney AS, Walker R, Murty GE. Is oestrogen therapy justified in the treatment of hereditary haemorrhagic telangiectasia: a biochemical evaluation. Clin Otolaryngol Allied Sci 2000; 25:570-6. [PMID: 11123171 DOI: 10.1046/j.1365-2273.2000.00422-3.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
INTRODUCTION: Systemic and topical oestrogen can provoke squamous metaplasia of epithelium. In Hereditary Haemorrhagic Telangiectasia (HTT) the underlying telangiectasia may be protected from trauma and epistaxis reduced. Oestrogens have been advocated but their efficacy is unclear.1 Recent advances have now identified two oestrogen and one progesterone receptors. The aim of this study is to analyse the sex receptor status of HHT nasal mucosa to determine if oestrogen therapy is biochemically justified. METHOD: Five HHT patients (three men, two women) and eight controls (four men, four women) underwent nasal mucosa biopsy. Samples were fixed in formalin and paraffin embedded. Alpha oestrogen (ERalpha ), beta oestrogen (Erbeta) and progesterone receptors (PgR) receptors wre identified using mouse monoclonal antibodies by the Streptavidin-biotin peroxidase method. RESULTS: Erbeta was detected in two HHT patients (one man, one woman) and two control patients. ERalpha and PgR was absent in HHT patients. CONCLUSION: This pilot study demonstrated that a subgroup of HHT patients is Erbeta positive. Oestrogen theraphy therefore has a potential therapeutic role on a biochemical basis in these patients. Erbeta status should be determined before considering oestrogen therapy.
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Affiliation(s)
- H Pau
- ENT Department, Leicester Royal Infirmary and The Breast Cancer Research Unit, Glenfield General Hospital, Leicester, UK)
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26
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Pau H, Carney AS, Walker R, Murty GE. Is oestrogen therapy justified in the treatment of hereditary haemorrhagic telangiectasia: a biochemical evaluation. Clin Otolaryngol Allied Sci 2000; 25:547-50. [PMID: 11122297 DOI: 10.1046/j.1365-2273.2000.00415.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Systemic and topical oestrogen can provoke squamous metaplasia of epithelium. In Hereditary Haemorrhagic Telangiectasia (HHT) the underlying telangiectasia may be protected from trauma and epistaxis reduced. Oestrogens have been advocated but their efficacy is unclear. Recent advances have now identified two oestrogen and one progesterone receptors. The aim of this study is to analyse the sex receptor status of HHT nasal mucosa to determine if oestrogen therapy is biochemically justified. Five HHT patients (three men, two women) and eight controls (four men, four women) underwent nasal mucosa biopsy. Samples were fixed in formalin and paraffin embedded. Alpha oestrogen (ERalpha) and beta oestrogen (ERss) and progesterone (PgR) receptors were identified using mouse monoclonal antibodies by the Streptavidin-biotin peroxidase method. ERss was detected in two HHT subjects (1 M: 1F) and two control subjects. ERalpha and PgR was absent in HHT subjects. This pilot study demonstrated that a subgroup of HHT patients were ERss positive. Oestrogen therapy therefore has a potential therapeutic role on a biochemical basis in these patients. ERss status should be determined before considering oestrogen therapy.
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Affiliation(s)
- H Pau
- Department of Otorhinolaryngology, Leicester Royal Infirmary and The Breast Cancer Research Unit, Glenfield General Hospital, Leicester, UK.
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27
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Carney AS, Bateman ND, Jones NS. Reliable and reproducible anterior active rhinomanometry for the assessment of unilateral nasal resistance. Clin Otolaryngol Allied Sci 2000; 25:499-503. [PMID: 11122288 DOI: 10.1046/j.1365-2273.2000.00384.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Unilateral nasal resistance is now thought to be more important than total resistance in promoting obstructive symptoms. We assessed the reproducibility of anterior active rhinomanometry in measuring unilateral nasal resistance. Ten baseline readings of unilateral nasal resistance were made over a 30-min period in seven healthy subjects (14 nostrils) using anterior active rhinomanometry performed according to the International Committee for the Standardization of Rhinomanometry (ICSR) guidelines. Baseline readings revealed that measurements using anterior active rhinomanometry had an unacceptably high coefficient of variation (19%-60%). With a more time-consuming revised protocol involving multiple recordings and the identification and exclusion of erroneous data, coefficients of variation of 7%-15% were obtained. We conclude that single anterior active rhinomanometry readings are potentially prone to large errors and each researcher using such equipment must satisfy his/herself that their methodology has an acceptable coefficient of variation in their hands. The ICSR guidelines are not always sufficient to allow reproducible measurement and specially designed protocols may be necessary to produce reliable results.
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Affiliation(s)
- A S Carney
- Department of Otolaryngology/Head and Neck Surgery, Queen's Medical Centre, Nottingham, UK.
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28
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Powe DG, Hiskisson RS, Carney AS, Jenkins D, Jones NS. Idiopathic and allergic rhinitis show a similar inflammatory response. Clin Otolaryngol Allied Sci 2000; 25:570-6. [PMID: 11123170 DOI: 10.1046/j.1365-2273.2000.00422-2.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
HYPOTHESIS: Idiopathic and allergic rhinitics have similar mucosal mast cell and IgE+ cell distribution. INTRODUCTION: The pathophysiology of idiopathic rhinitis (IR) is unknown but patients differ from those with allergic rhinitis (AR) in that they do not express IgE. Our study is novel because we investigated: (1) three study groups chosen prospectively using strict selection criteria over a 4-year period; and (2) mast cell and IgE+ cell counts were on full-thickness, full-length inferior turbinate mucosa. METHODS: Patient groups: allergic (n = 17); idiopathic: (n = 16); and normal controls (n = 9). Immunohistochemistry: mast cell and IgE+ cell detection using anti-mast cell tryptase and anti-IgE antibodies with an avidin-biotin (peroxidase) complex on paraffin processed tissue. Morphometry: sections were divided into three strata comprising an epithelial layer and two submucosal layers. Statistics: Mann-Whitney non-parametric analysis. alpha = 0.05, beta = 0.2. RESULTS: The power of the study was 89%. Mast cells (P = 0.03) and IgE+ cells (P < 0.05) were significantly increased in the epithelium of idiopahtic and allergic rhinitis mucosa compared to the normal control. More IgE+ cells were counted in the AR and IR groups compared to the controls in all three strata. CONCLUSION: Mast cells and IgE+ cells are involved in the pahtophysiology of IR. We propose that IR may be a variant form of AR involving a localized IgE-mediated inflammatory response.
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Affiliation(s)
- DG Powe
- Department of Clinical Laboratory Sciences and Department of Otorhinolaryngology, Queen's Medical Centre, Nottingham, UK)
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29
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Carney AS, Gibbin KP. Perceptions of ENT training. Ann R Coll Surg Engl 2000; 82:62-5. [PMID: 10827776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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30
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Mallucci CL, Ward V, Carney AS, O'Donoghue GM, Robertson I. Clinical features and outcomes in patients with non-acoustic cerebellopontine angle tumours. J Neurol Neurosurg Psychiatry 1999; 66:768-71. [PMID: 10329752 PMCID: PMC1736400 DOI: 10.1136/jnnp.66.6.768] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Non-acoustic tumours of the cerebellopontine angle differ from vestibular schwannomas in their prevalence, clinical features, operative management, and surgical outcome. These features were studied in patients presenting to the regional neuro-otological unit. METHODS A retrospective analysis of clinical notes identified 42 patients with non-acoustic tumours of the cerebellopontine angle. Data were extracted regarding presenting clinical features, histopathological data after surgical resection, surgical morbidity and mortality, and clinical outcome (mean 32 months follow up). RESULTS The study group comprised 25 meningiomas (60%), 12 epidermoid cysts/cholesteatomata (28%), and five other tumours. In patients with meningiomas, symptoms differed considerably from patients presenting with vestibular schwannomas. Cerebellar signs were present in 52% and hearing loss in only 68%. Twenty per cent of patients had hydrocephalus at the time of diagnosis. After surgical resection, normal facial nerve function was preserved in 75% of cases. In the epidermoid group, fifth, seventh, and eighth nerve deficits were present in 42%, 33%, and 66% respectively. There were no new postoperative facial palsies. There were two recurrences (17%) requiring reoperation. Overall, there were two perioperative deaths from pneumonia and meningitis. CONCLUSIONS Patients with non-acoustic lesions of the cerebellopontine angle often present with different symptoms and signs from those found in patients with schwannomas. Hearing loss is less prevalent and cerebellar signs and facial paresis are more common as presenting features. Hydrocephalus is often present in patients presenting with cerebellopontine angle meningiomas. Non-acoustic tumours can usually be resected with facial nerve preservation.
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Affiliation(s)
- C L Mallucci
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK
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31
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Bateman ND, Carney AS, Gibbin KP. An audit of the quality of operation notes in an otolaryngology unit. J R Coll Surg Edinb 1999; 44:94-5. [PMID: 10230203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Hand-written operation notes are often produced as evidence in medico-legal cases. Incomplete and illegible notes, along with the use of confusing abbreviations, are a common source of weakness in a surgeon's defence. An audit of 100 sets of operation notes was carried out in a single otolaryngology department. Notes were scrutinised for the accuracy of data, ward, department and name of surgeon, as well as for the inclusion of unacceptable abbreviations. Using an aide-memoire attached to the front of the operation sheet, the audit was repeated with identical criteria. The aide-memoire improved the standard of operation note with respect to all measured criteria. Clear identification of operating surgeon improved from 74% to 93%, and the avoidance of unacceptable abbreviations rose from 53% to 84%. We conclude that a simple aide-memoire attached to operation note sheets can significantly improve the quality of note-keeping and potentially avoid medico-legal problems.
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Affiliation(s)
- N D Bateman
- Department of Otolaryngology-Head & Neck Surgery, Queen's Medical Centre, Nottingham, UK
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32
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33
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Abstract
From 1200 households selected at random, 2114 questionnaires were returned from individuals over 14 years old. They reported that in the previous year the prevalence of 'symptoms of nasal obstruction every day for more than 14 consecutive days' was 16.9%; 19.8% had had a 'runny nose'; 7.1% reported sneezing bouts; and 19.6% had hay fever during the same period. Also, 13.7% had had rhinosinusitis in the previous year using the criterion of 'two out of three symptoms of congestion, rhinorrhoea and sneezing for more than 1 h per day for a period in excess of 2 weeks'. The prevalence of perennial symptoms in individuals who did not have hay fever was 8.6%. Over the previous 2 years 18.2% of all respondents had visited their General Practitioner and 0.2% had visited a hospital as a result of their hay fever. Individuals who responded as having hay fever were significantly more likely to have worked in an environment with a lot of dust in the last 2 years than asymptomatic respondents (chi 2, P = 0.002), although fume exposure was not found to be a significant risk factor (P = 0.0681). Individuals with perennial symptoms were no more likely to have been working in a dusty or smoky environment. In those with either seasonal or perennial symptoms there was no significant effect of either social class or manual/non-manual occupation.
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Affiliation(s)
- N S Jones
- Department of Otorhinolaryngology, University Hospital, Nottingham, UK
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34
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Abstract
A review of the literature indicates that there is an increase in the prevalence of self-reported symptoms suggestive of seasonal allergic rhinitis over the last 70 years. The reason for this remains unclear. Epidemiological studies which relate to the effect of pollution suggest that while pollution can exacerbate respiratory tract symptoms, there is no consistent evidence that high levels result in an increase in the prevalence of allergic rhinitis. The increased prevalence of house-dust mite, an alteration in immunity--possibly related to the number of childhood respiratory tract infections, and increased disease awareness, are all factors which may influence the reported prevalence of allergic rhinitis. At present the inconsistencies which exist in the literature mean that it is possible to 'pick' publications which support one view and ignore the rest, so that a variety of views may be held, each with apparently well referenced endorsement. The criteria defined by Bradford Hill (1965) to establish causation and not mere association between any of these factors and allergic rhinitis have, as yet, not been met (see Table V).
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Affiliation(s)
- N S Jones
- Department of Otorhinolaryngology, University Hospital, Nottingham
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35
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36
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Bakri SJ, Carney AS, Downes RN, Jones NS. Endonasal laser-assisted dacryocystorhinostomy. Hosp Med 1998; 59:210-5. [PMID: 9722348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Endonasal laser-assisted dacryocystorhinostomy allows relief of epiphora caused by nasolacrimal duct obstruction. It can be performed as a day-case procedure and has many advantages over conventional approaches. This article reviews conventional, endoscopic and laser-assisted dacryocystorhinostomy and describes the technical steps of an endonasal procedure.
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Affiliation(s)
- S J Bakri
- Department of Ophthalmology, Queen's Medical Centre, Nottingham
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37
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Abstract
We studied 41 patients who had previously undergone percutaneous dilational tracheostomy at least 6 months following tracheal decannulation. The patients were examined using laryngotracheoscopy and spirometry to assess the long-term anatomical and functional consequences of percutaneous dilational tracheostomy. Apart from one patient who had requested a scar revision, no patient was symptomatic. A significant (> 10%) tracheal stenosis was identified in four asymptomatic patients, two of whom also had spirometric evidence of this obstruction. These results suggest that the long-term outcome after percutaneous tracheostomy is at least as good as that following conventional surgical tracheostomy. Refinements of the percutaneous technique, such as endoscopic guidance, may further improve the results.
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Affiliation(s)
- R C Law
- Intensive Care Unit, Frenchay Hospital, Bristol, UK
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38
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Abstract
The anatomical location and relationships of the submandibular gland are well-known to most otolaryngologists and gross variations from the norm are rare. We report a case of an atypical submandibular gland located 2 cm below the mandible which presented as a painful neck swelling with non-diagnostic fine needle aspiration cytology. Using Doppler ultrasound the mass was noted to be closely located to the facial artery and vein and following the administration of oral lemon juice, the peak systolic velocity of a small artery within the mass rose from 8.5 cm/s to 16.4 cm/s, confirming the tissue's salivary nature. We review the literature on using Doppler ultrasound in this area of the neck and discuss realistic practical applications of the technique.
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Affiliation(s)
- A S Carney
- Department of Otolaryngology, Derbyshire Royal Infirmary, Derby, UK
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39
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Cozens NJ, Sharp JF, Carney AS. Assessment of pre-operative investigations of thyroglossal cysts. J R Coll Surg Edinb 1996; 41:423-4. [PMID: 8997042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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40
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Carney AS, Jones NS. Patient selection for uvulopalatopharyngoplasty. Chest 1996; 110:864. [PMID: 8797449 DOI: 10.1378/chest.110.3.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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41
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Affiliation(s)
- A S Carney
- Department of Otolaryngology, Queen's Medical Centre, Nottingham, UK
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42
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Abstract
The ISG viewing wand is an intra-operative guidance system with a proprioceptive robotic-like jointed arm. It provides surgeons with almost instantaneously reconstructed computer-generated CT or MRI images in two or three dimensions and can correlate any point within the operative field to its corresponding locus on the reformatted scan images. In addition to having been used in over 400 neurosurgical patients in Bristol, 14 patients with skull-base, cerebello-pontine angle or temporal bone lesions have also undergone wand-guided resections. The wand has proved to be particularly useful in pre-operative planning, allowing minimally-invasive incisions, providing per-operative navigation, identifying the relationship and proximity of important anatomical structures and in assessing the extent of lesion resection. We illustrate the advantages of intra-operative image-guidance by discussing four cases. The potential applications of this form of imaging technology to other otolaryngological procedures are discussed.
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Affiliation(s)
- A S Carney
- Department of Otolaryngology, Southmead Hospital, Bristol
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43
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Carney AS. Junior doctors' hours. Don't blame the Junior Doctors Committee. BMJ 1996; 312:187. [PMID: 8563570 PMCID: PMC2349814 DOI: 10.1136/bmj.312.7024.187a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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44
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Affiliation(s)
- A S Carney
- Department of Otolaryngology, Southmead Hospital, Westbury on Trym, Bristol
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45
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Affiliation(s)
- D Birchall
- Department of Medicine, Frenchay Hospital, Bristol, UK
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46
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Carney AS, Robinson PJ. Assessment and management of snoring: a surgical perspective. Br J Hosp Med (Lond) 1995; 53:515-21. [PMID: 7640812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This article reviews the assessment and treatment options for both 'simple snorers' and those with obstructive sleep apnoea. Accurate assessment of all snorers is essential for optimal outcome and new surgical techniques now provide good symptom relief while maintaining normal palatal anatomy. The need for involvement of both respiratory physicians and otolaryngologists in the patient's care is emphasised.
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Affiliation(s)
- A S Carney
- Department of Otolaryngology, Derbyshire Royal Infirmary
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47
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Abstract
Pain following tonsillectomy is an important problem. It is caused by the surgical trauma of excision and haemostasis. Numerous surgical and pharmacological solutions have been tried, with disappointing results. Fibrin sealant is a widely used atraumatic haemostatic agent. This study aims to determine whether tonsillectomy with fibrin sealant haemostasis results in less post-operative pain than that with the conventional technique of diathermy. Fifty consecutive adult patients undergoing tonsillectomy were prospectively studied. They were randomized to receive either fibrin sealant or diathermy haemostasis. Other pain variables were controlled. Pain was measured by a visual linear analogue scale and inter-incisor distance on both the day of operation and the first post-operative day. The patients and pain measurer were blind to the randomization. The results showed that tonsillectomy with fibrin sealant haemostasis was significantly (P < 0.05) less painful than that with diathermy on both days studied and by both methods of pain measurement.
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Affiliation(s)
- S J Moralee
- Department of Otolaryngology, Royal Infirmary, Edinburgh, UK
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48
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49
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Trotter CM, Carney AS, Wilson JA. Mast cell distribution and morphology in human nasal turbinates following decalcification. Rhinology 1989; 27:81-9. [PMID: 2675276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Whole inferior nasal turbinates were used to evaluate six different fixatives followed by decalcification. H and E staining was used to assess general fixation and toluidine blue and thionin to stain mast cells metachromatically. We show that neutral buffered formalin or paraformaldehyde give the best overall fixation. Very long times (six days) are needed in TB to show maximum mast cell numbers; these numbers are never as high, nor the cells as densely stained as those in undecalcified controls. The difference in number between the two supports the hypothesis that there is more than one subset of mast cells in nasal mucosa. The more superficial mast cells have a smaller size and may be dendritic, with relatively few granules which stain faintly. Those in deeper situations are often larger, ovoid, very granular and intensely stained.
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Affiliation(s)
- C M Trotter
- Dept. of Anatomy, University of Edinburgh, United Kingdom
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Dryer RF, Buckwalter JA, Carney AS, Weinstein SL. Lyme arthritis in the Midwest: a diagnostic challenge. J Iowa Med Soc 1981; 71:249-50, 252. [PMID: 7264402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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