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Dhariwal A, Manjaly JG, Patel B, Morris-Jones S, David K, Khetarpal P, Beale T, Mehta N, Logan S. Management and Clinical Outcomes of 37 Patients with Necrotizing Otitis Externa: Retrospective Review of a Standardized 6-Week Treatment Pathway. J Int Adv Otol 2023; 19:223-227. [PMID: 37272640 DOI: 10.5152/iao.2023.22637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Necrotizing otitis externa is an invasive infection, affecting older patients, with significant associated morbidity. Despite this, there are no randomized controlled trials that address management, and therefore, treatment approaches may vary considerably. We describe the management and outcomes of 37 patients managed using a multidisciplinary treatment pathway for necrotizing otitis externa over a 5-year period. The pathway is based on a standardized antibiotic regime of 3 weeks of intravenous ceftazidime plus oral ciprofloxacin, followed by a further 3 weeks of ciprofloxacin. METHODS This is a retrospective review of all patients diagnosed with necrotizing otitis externa since the introduction of our pathway in 2016. We include data on patient demographics, comorbidities, microbiology, length of stay, and length of antimicrobial treatment. Outcome data, including mortality, relapse and treatment failure, and adverse effects of treatment, are presented. RESULTS The median age of our patients was 82 years. About 54% of patients had diabetes mellitus or another cause of immunocompromise. Pseudomonas aeruginosa was isolated in 68%. The median duration of inpatient stay was 9 days, and median treatment duration was 6 weeks. Of 37 patients, 32 were cured (86%), and of the remaining 5 patients, there were 2 mortalities unrelated to necrotizing otitis externa and 3 patients with recurrent infections due to anatomical abnormalities. CONCLUSION We note favorable treatment outcomes when using a standardized multidisciplinary pathway and a 6-week course of antibiotic therapy.
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Affiliation(s)
| | - Joseph G Manjaly
- NIHR UCLH BRC Deafness and Hearing Problems Theme, Ear Institute, University College London, London, UK
| | - Bhavesh Patel
- Department of Otology, Royal National ENT and Eastman Dental Hospitals, London, UK
| | - Stephen Morris-Jones
- Department of Clinical Microbiology, University College London Hospital, London, UK
| | - Kate David
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Priya Khetarpal
- Department of Children's Emergency , University Hospital Lewisham, London, UK
| | - Tim Beale
- Department of Radiology, University College London Hospital, London, UK
| | - Nishchay Mehta
- Department of Otology, Royal National ENT and Eastman Dental Hospitals, London, UK
| | - Sarah Logan
- Hospital of Tropical Diseases, Infection Division, University College London Hospital, London, UK
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Kanona H, Jawad S, Hare J, Mehta N, Manjaly JG, Lavy J, Khalil S, Shaida A, Saeed S. Do Filling Defects of the Vestibule Represent a Neuroradiological Marker for Congenital Cytomegalovirus? A Retrospective Case Series. Audiol Neurootol 2023; 28:6-11. [PMID: 36273454 DOI: 10.1159/000526119] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/04/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The aim of this study was to investigate whether radiological marker(s) of the inner ear can be detected in congenital cytomegalovirus (cCMV) patients with severe-profound sensorineural hearing loss. METHODS A retrospective imaging review of confirmed cCMV paediatric patients that had undergone consecutive cochlear implantation was performed at a tertiary hospital. Available pre- and postoperative imaging was examined, and abnormalities of the labyrinth were catalogued by a consultant neuroradiologist in the study group and control group. RESULTS Twenty-eight paediatric patients with cCMV having undergone cochlear implantation were identified between the ages of 1-15 years (mean 4.7 years) at the time of implantation. Increased density of the vestibule on computed tomography (CT) or filling defects of the vestibule on magnetic resonance imaging (MRI) were identified in 11 and 4 patients, respectively, of the 24 in the case series. No filling defects were identified in any of the 48 CT and MRI control group. CONCLUSION This study demonstrates a potential novel radiological finding of the inner ear of patients with cCMV. With more research, greater onus placed on MRI and CT for inner ear assessment may facilitate early detection and treatment for patients at risk of significant hearing loss. Further prospective studies in this area will help to validate radiological markers in order to establish a comprehensive inner ear classification system for neuroradiological features in cCMV.
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Affiliation(s)
- Hala Kanona
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospitals, University College London Hospitals, London, UK
| | - Susan Jawad
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospitals, University College London Hospitals, London, UK
| | - Julie Hare
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospitals, University College London Hospitals, London, UK
| | - Nishchay Mehta
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospitals, University College London Hospitals, London, UK.,University College London Ear Institute, London, UK.,University College London Hospitals Biomedical Research Centre, National Institute for Health Research, London, UK
| | - Joseph G Manjaly
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospitals, University College London Hospitals, London, UK.,University College London Hospitals Biomedical Research Centre, National Institute for Health Research, London, UK
| | - Jeremy Lavy
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospitals, University College London Hospitals, London, UK
| | - Sherif Khalil
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospitals, University College London Hospitals, London, UK
| | - Azhar Shaida
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospitals, University College London Hospitals, London, UK
| | - Shakeel Saeed
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospitals, University College London Hospitals, London, UK.,University College London Ear Institute, London, UK
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Kanona H, Forde C, Van Rooyen AM, Keating P, Bradley J, Pendolino AL, Mehta N, Manjaly JG, Khalil S, Lavy J, Saeed SR, Shaida A. Cochlear implant outcomes in patients with Meniere's disease: a large case series. Cochlear Implants Int 2022; 23:339-346. [PMID: 36050279 DOI: 10.1080/14670100.2022.2112998] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To perform a matched cohort study to assess whether patients with Meniere's Disease (MD) require more intensive auditory rehabilitation following cochlear implantation (CI) and identify factors that may affect outcomes in patients with MD. METHODS A retrospective case review was performed. MD and control patients were matched for age, biological sex, implant manufacturer and electrode design. Outcomes measured were speech scores, number of visits to audiology department following switch-on, and post-operative active MD. RESULTS Forty consecutive implanted MD patients were identified between May 1993 and May 2019. Patients with active MD following CI required significantly more visits to the audiology department compared to controls (P < 0.01) and patients who had inactive MD post-operatively (P < 0.01). However, in MD patients, active MD was less likely following CI (P = 0.03). In patients who continued to experience active MD post-operatively, further medical and surgical ablative intervention was required to control ongoing Meniere's attacks. CONCLUSION We present the largest case series of performance outcomes in CI patients with MD. Although speech outcomes in MD patients are comparable to controls, patients with active MD pre-operatively are more likely to experience variation in CI performance requiring a prolonged period of auditory rehabilitation compared to inactive preoperative MD.
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Affiliation(s)
- Hala Kanona
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | - Cillian Forde
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | - Anne M Van Rooyen
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | | | - Jane Bradley
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | - Alfonso Luca Pendolino
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | - Nishchay Mehta
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
- University College London Ear Institute, London, UK
| | - Joseph G Manjaly
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
- University College London Ear Institute, London, UK
- NIHR UCLH BRC Deafness and Hearing Problems Theme, Ear Institute, University College London, London, UK
| | - Sherif Khalil
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | - Jeremy Lavy
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
| | - Shakeel R Saeed
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
- University College London Ear Institute, London, UK
| | - Azhar Shaida
- The Royal National Ear Nose and Throat Hospital and Eastman Dental Hospital, University College Hospitals, London, UK
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Forde CT, Dimitrov L, Doal S, Patel J, Clare D, Burslem M, Mehta N, Manjaly JG. Delivery of remote otology care: a UK pilot feasibility study. BMJ Open Qual 2022; 11:bmjoq-2021-001444. [PMID: 35135752 PMCID: PMC8830265 DOI: 10.1136/bmjoq-2021-001444] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction The COVID-19 pandemic has catalysed the need to implement the National Health Service Long-Term Plan to deliver more care in the community and to reduce face-to-face hospital appointments by up to 33%. This study aimed to assess the feasibility of a remote otology service from triage through to delivery. Methods New adult otology referrals at a tertiary ear, nose and throat (ENT) hospital aged between 18 and 70 with hearing loss or tinnitus were included. Patients attended an audiology-led community clinic where they underwent a focused history, audiometric testing, and a smartphone-based application and otoscope (Tympa System) was used to capture still and video images of their eardrums. The information was reviewed by ENT clinicians using a remote review platform with a subset of patients subsequently undergoing an in-person review to measure concordance between the two assessments. Results 58 patients participated. 75% of patients had their pathways shortened by one hospital visit with 65% avoiding any hospital attendances. 24% required an additional face-to-face appointment due to incomplete views of the tympanic membrane or need for additional examinations. Electronic validation by a blinded consultant otologist demonstrated a diagnosis concordance of 95%, and concordance between remote-review and in-person consultations in the 12 patients who agreed to attend for an in-person review was 83.3%. 98% of patients were satisfied with the pathway. Conclusion This pilot service is feasible, safe and non-inferior to the traditional outpatient model in the included patient group. There is potential for the development of a community audiology-led service or use for general practioner advice and guidance.
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Affiliation(s)
- Cillian T Forde
- ENT Department, Royal National Throat Nose and Ear Hospital, London, UK
| | - Lilia Dimitrov
- ENT Department, Royal National Throat Nose and Ear Hospital, London, UK
- evidENT Ucl Ear Institute, University College London, London, UK
- National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Suneal Doal
- Department of Audiology, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Jay Patel
- Department of Audiology, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Dawn Clare
- Department of Audiology, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Michael Burslem
- ENT Department, Royal National Throat Nose and Ear Hospital, London, UK
| | - Nishchay Mehta
- ENT Department, Royal National Throat Nose and Ear Hospital, London, UK
- evidENT Ucl Ear Institute, University College London, London, UK
- National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Joseph G Manjaly
- ENT Department, Royal National Throat Nose and Ear Hospital, London, UK
- evidENT Ucl Ear Institute, University College London, London, UK
- National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
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Lindenroth L, Merlin J, Bano S, G. Manjaly J, Mehta N, Stoyanov D. Intrinsic force sensing for motion estimation in a parallel, fluidic soft robot for endoluminal interventions. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3193627] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lukas Lindenroth
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley St., Fitzrovia, UK
| | - Jeref Merlin
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley St., Fitzrovia, UK
| | - Sophia Bano
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley St., Fitzrovia, UK
| | - Joseph G. Manjaly
- University College London Hospitals Biomedical Research Centre, National Institute for Health Research, UK
| | - Nishchay Mehta
- University College London Hospitals Biomedical Research Centre, National Institute for Health Research, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley St., Fitzrovia, UK
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Hammond-Kenny A, Borsetto D, Manjaly JG, Panova T, Vijendren A, Bance M, Tysome JR, Axon PR, Donnelly NP. Cochlear Implantation in Elderly Patients: Survival Duration, Hearing Outcomes, Complication Rates, and Cost Utility. Audiol Neurootol 2021; 27:156-165. [PMID: 34419952 DOI: 10.1159/000517315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/23/2020] [Accepted: 05/19/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The prevalence of hearing loss and its consequences is increasing as the elderly population grows. As the guidelines for cochlear implantation (CI) expand, the number of elderly CI recipients is also increasing. We report complication rates, survival duration, and audiological outcomes for CI recipients aged 80 years and over and discuss the cost utility of CI in this age group. METHODS A retrospective cohort study was undertaken of all CI recipients (126 cases), aged 80 years and over at the time of their surgery, implanted at our institution (Cambridge University Hospitals) during a period from January 1, 2001, to March 31, 2019. Data on survival at 1, 3, and 5 years post-implantation, post-operative complications and functional hearing outcomes including audiometric and speech discrimination outcomes (Bamford-Kowal-Bench sentence test) have been reported. RESULTS The mean age at implantation was 84 years. The mean audiometric score improved from 108 dB HL to 28 dB HL post-implantation. The mean Bamford-Kowal-Bench score improved from 14% to 66% and 73% at 2 and 12 months post-implantation, respectively. The complication rate was 15.3%. The survival probability at 1 year post-implantation was 0.95 for females and 0.93 for males, at 3 years was 0.89 for females and 0.81 for males, and at 5 years was 0.74 for females and 0.54 for males. CONCLUSION CI is safe and well-tolerated in this age group and elderly patients gain similar audiometric and functional benefit as found for younger age groups.
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Affiliation(s)
- Amy Hammond-Kenny
- Department of Otolaryngology and Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniele Borsetto
- Department of Otolaryngology and Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Joseph G Manjaly
- Department of Otolaryngology and Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Tsvetemira Panova
- Department of Otolaryngology and Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ananth Vijendren
- Department of Otolaryngology and Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Manohar Bance
- Department of Otolaryngology and Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - James R Tysome
- Department of Otolaryngology and Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Patrick R Axon
- Department of Otolaryngology and Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Neil P Donnelly
- Department of Otolaryngology and Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Smith ME, Hardman JC, Mehta N, Jones GH, Mandavia R, Anderson C, Khan M, Abdelaziz A, Al-Dulaimy B, Amin N, Anmolsingh R, Anwar B, Bance M, Belfield K, Bhutta M, Buchanan R, Chandrasekharan D, Chu M, Chundu S, Conroy K, Crundwell G, Daniel M, Daniels J, De S, Dobbs S, Doshi J, Farr M, Ferdous T, Fragkouli E, Freeman S, Ghosh S, Gosnell E, Hannan SA, Heward E, Javed F, John D, Nicholls H, Kasbekar AV, Khan H, Khan H, Khwaja S, Kotecha B, Krishnan M, Kumar N, Lamb T, Lancer H, Manjaly JG, Martinez Del Pero M, McClenaghan F, Milinis K, Mistry N, Mohammed H, Morris E, Morris-Jones S, Padee J, Pal S, Patel S, Pericleous A, Qayyum A, Rouhani M, Saeed H, Santhiyapillai M, Seymour K, Sharma S, Siau R, Singh A, Stapleton E, Stephenson K, Stynes G, Subramanian B, Summerfield N, Swords C, Trinidade A, Tse A, Twumasi E, Ubhi H, Unadkat S, Vijendren A, Wasson J, Watson G, Williams G, Wilson J, Yao A, Youssef A, Lloyd SKW, Tysome JR. Acute otitis externa: Consensus definition, diagnostic criteria and core outcome set development. PLoS One 2021; 16:e0251395. [PMID: 33989313 PMCID: PMC8121300 DOI: 10.1371/journal.pone.0251395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. STUDY DESIGN COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. SETTING Stakeholders from the United Kingdom. SUBJECTS AND METHODS Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. RESULTS Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was 'diffuse inflammation of the ear canal skin of less than 6 weeks duration'. CONCLUSION The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life.
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Affiliation(s)
| | - John C Hardman
- The Royal Marsden Hospital London, London, United Kingdom
| | - Nishchay Mehta
- Royal National ENT Hospital London, London, United Kingdom
| | - Gareth H Jones
- Aintree University Hospitals Liverpool, Liverpool, United Kingdom
| | - Rishi Mandavia
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Maha Khan
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Nikul Amin
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Bilal Anwar
- Salford Royal Hospital, Salford, United Kingdom
| | - Manohar Bance
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Katherine Belfield
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Mahmood Bhutta
- Brighton Sussex University Hospitals, Brighton, United Kingdom
| | | | | | - Michael Chu
- Health Education North West, Manchester, United Kingdom
| | | | - Katherine Conroy
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Gemma Crundwell
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Mat Daniel
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Jessica Daniels
- Tameside and Glossop NHS Integrated Care Trust, Ashton-under-Lyne, United Kingdom
| | - Sujata De
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Sian Dobbs
- Health Education North West, Manchester, United Kingdom
| | - Jayesh Doshi
- Heartlands Hospital Birmingham, Birmingham, United Kingdom
| | - Matthew Farr
- University of Sheffield, Sheffield, United Kingdom
| | - Tanjinah Ferdous
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Eleni Fragkouli
- Oxford University Hospitals Foundation Trust, Oxford, United Kingdom
| | | | - Samit Ghosh
- Pennine Acute Trust, Manchester, United Kingdom
| | - Emma Gosnell
- Royal Bolton Hospital, Farnworth, United Kingdom
| | - S Alam Hannan
- Royal National ENT Hospital London, London, United Kingdom
| | - Elliot Heward
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Faisal Javed
- Heartlands Hospital Birmingham, Birmingham, United Kingdom
| | - Deepa John
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Anand V Kasbekar
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Haroon Khan
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Hammad Khan
- Royal Preston Hospital, Fulwood, United Kingdom
| | - Sadie Khwaja
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Bhik Kotecha
- Nuffield Health Brentwood Hospital, Brentwood, United Kingdom
| | | | - Nirmal Kumar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | - Tamara Lamb
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Hannah Lancer
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | | | | | | | - Kristijonas Milinis
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Nina Mistry
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - Hassan Mohammed
- Newcastle Upon Tyne University Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, United Kingdom
| | - Stephen Morris-Jones
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jessica Padee
- University of Manchester, Manchester, United Kingdom
| | - Surojit Pal
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Sanjay Patel
- Aintree University Hospitals Liverpool, Liverpool, United Kingdom
| | | | - Asad Qayyum
- North West Anglia NHS Foundation Trust, Peterborough, United Kingdom
| | - Maral Rouhani
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Haroon Saeed
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Kay Seymour
- Barts Health NHS Trust, London, United Kingdom
| | - Sunil Sharma
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Richard Siau
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Arvind Singh
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Emma Stapleton
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Gill Stynes
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | - Neil Summerfield
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Aaron Trinidade
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, United Kingdom
| | - Antonia Tse
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Emmanuel Twumasi
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Harmony Ubhi
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Samit Unadkat
- Royal National ENT Hospital London, London, United Kingdom
| | | | - Joe Wasson
- East Kent Hospitals NHS Foundation Trust, Canterbury, United Kingdom
| | - Glen Watson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Janet Wilson
- Newcastle Upon Tyne University Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | | | - Ahmed Youssef
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Simon K W Lloyd
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Lindenroth L, Bano S, Stilli A, Manjaly JG, Stoyanov D. A Fluidic Soft Robot for Needle Guidance and Motion Compensation in Intratympanic Steroid Injections. IEEE Robot Autom Lett 2021. [DOI: 10.1109/lra.2021.3051568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Sudden onset sensorineural hearing loss (SSNHL) is frequently seen by otolaryngologists. The exact pathophysiology of the disease is still unknown, with the most likely causative factor being following a viral infection. Immediate steroids are the best treatment to improve prognosis. Despite a plethora of papers in the literature describing SSNHL, there are only a few reported cases of hearing loss following COVID-19, none of which have been reported in the UK. This paper presents the first UK case of SSNHL following COVID-19. Physical examination and imaging excluded any other cause of hearing loss. A literature review showed that four other cases have been previously described. Hearing loss can be a significant cause of morbidity and can easily be missed in the intensive care setting. Being aware and screening for SSNHL following COVID-19 enables an early course of steroids, which offers the best chance of recovering hearing.
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Affiliation(s)
- Foteini Stefania Koumpa
- University College London, London, UK
- Royal National Throat Nose and Ear Hospital, London, UK
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10
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Abstract
This study aims to determine the benefit of stapes surgery for otosclerosis in 121 patients with a mixed hearing loss and a preoperative bone conduction (BC) threshold >30 dB. Average postoperative air conduction (AC) improved from 61.5 dB to 34.3 dB. Average air-bone gap closed from 27.1 dB to 6.1 dB. Bone conduction improved from 34.3 dB to 28.2 dB, with 38% of patients achieving a postoperative AC of <30 dB. Glasgow Benefit Inventory scores showed significantly increased quality of life postoperatively in the 88 patients who responded to follow-up, with an average score of 56. There was a mean reduction in daily hearing aid use postsurgery of 5.48 hours, with 56% of patients who responded to follow-up questionnaire no longer needing to use one. When assessing suitability for stapes surgery, surgeons should consider that preoperative BC thresholds may be a poor indicator of the true cochlear reserve and therefore the potential for improvement in AC thresholds and quality of life.
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Affiliation(s)
- Jacob J Rapier
- 158988Royal National Throat, Nose and Ear Hospital, London, United Kingdom.,4919UCL Medical School, London, United Kingdom
| | | | - Joseph G Manjaly
- 158988Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Robert Nash
- 158988Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Jeremy A Lavy
- 158988Royal National Throat, Nose and Ear Hospital, London, United Kingdom
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11
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Vijendren A, Borsetto D, Barker EJ, Manjaly JG, Tysome JR, Axon PR, Donnelly NP, Bance ML. A systematic review on prevention and management of wound infections from cochlear implantation. Clin Otolaryngol 2019; 44:1059-1070. [PMID: 31561283 DOI: 10.1111/coa.13444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/25/2019] [Revised: 08/01/2019] [Accepted: 09/23/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE OF REVIEW Surgical site infections are a recognised complication of cochlear implant (CI) surgery with significant morbidity. Our aim was to search for the optimum prevention and management strategy to deal with this issue. TYPE OF REVIEW Systematic review. SEARCH STRATEGY A systematic literature search was undertaken from the databases of Embase, CINAHL, MEDLINE® , Web of Science, Scopus and Cochrane Library according to the predefined inclusion and exclusion criteria. EVALUATION METHOD All relevant titles, abstracts and full-text articles were reviewed by two authors who resolved any differences by discussion and consultation with senior authors. RESULTS Fourteen articles were included in our review. The overall quality of evidence was low with the vast majority of the studies being retrospective case series and expert opinions. No randomised controlled trials were noted. We found consistent reports that intraoperative prophylactic antibiotics should be given to all patients undergoing CI and that the vast majority of CI wound infections had grown Staphylococcal spp. or Pseudomonas spp. CONCLUSION Our review has not identified any reliable or reproducible strategies to prevent and deal with wound infections after CI. We strongly encourage further research within this field and would suggest that a consensus of opinions from a multidisciplinary panel of experts may be a pragmatic way forward as an effective guide.
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Affiliation(s)
- Ananth Vijendren
- Department of ENT, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - Daniele Borsetto
- Department of ENT, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - Eleanor J Barker
- University of Cambridge Medical Library, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Joseph G Manjaly
- Department of ENT, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - James R Tysome
- Department of ENT, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - Patrick R Axon
- Department of ENT, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - Neil P Donnelly
- Department of ENT, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - Manohar L Bance
- Department of ENT, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
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12
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Abstract
The objective of this study is to evaluate stapes surgery in patients with otosclerosis and "profound" hearing loss. This means they meet hearing threshold criteria for cochlear implantation (CI). We performed a retrospective study and patient questionnaire. The results from 33 patients (35 ears) were recorded (mean age: 63.6, range: 40-85). The primary outcome measure was hearing thresholds recorded before and after surgery at 0.5, 1, 2, 3, and 4 kHz. Hearing thresholds at 2 and 4 kHz were also analyzed. Glasgow Benefit Inventory (GBI) was used in 21 patients to assess life quality changes. Hearing thresholds improved in 80% of ears (mean improvement, 26.3 dB), were unchanged in 11.4%, and worsened in 8.6%. Mean GBI score was +20.7. Hearing aid use decreased in 23.8% and ceased in 28.6%. One patient subsequently underwent CI. For patients with profound otosclerosis, stapes surgery provides a quantitative improvement in hearing thresholds and improvement in quality of life, with reduced reliance on hearing aids. This avoids CI, auditory rehabilitation, and a change in quality and tonality of sound.
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Affiliation(s)
| | - Joseph G Manjaly
- 1 Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Robert Nash
- 1 Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Abir Mukherjee
- 1 Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Jeremy A Lavy
- 1 Royal National Throat, Nose and Ear Hospital, London, United Kingdom
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13
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Heyes R, Ramdoo K, Manjaly JG, Charn TC, Tatla T. Prophylactic use of fibrin sealant (ARTISS™) for facilitating safe transition to drain-free thyroid surgery: A single-centre case series review of 109 procedures. Clin Otolaryngol 2017; 42:1081-1085. [PMID: 28235239 DOI: 10.1111/coa.12854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2017] [Indexed: 11/27/2022]
Affiliation(s)
- R Heyes
- Department of Otolaryngology - Head and Neck Surgery, Northwick Park Hospital, London, UK
| | - K Ramdoo
- Department of Otolaryngology - Head and Neck Surgery, Northwick Park Hospital, London, UK
| | - J G Manjaly
- Department of Otolaryngology - Head and Neck Surgery, Northwick Park Hospital, London, UK
| | - T C Charn
- Department of Otolaryngology - Head and Neck Surgery, Northwick Park Hospital, London, UK
| | - T Tatla
- Department of Otolaryngology - Head and Neck Surgery, Northwick Park Hospital, London, UK
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14
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Abstract
Suspected paediatric aerodigestive tract foreign body (FB) ingestion or aspiration is a commonly encountered emergency. Management may require a general anaesthetic for retrieval with bronchoscopy, laryngoscopy and oesophagoscopy, each dependent on the history and investigations of the case in question. We describe the case of a foreign body, which was missed in the nasopharynx for more than 3 years and also discuss how pressures on National Health Service (NHS) referral and follow-up patterns may have altered the time course of the eventual discovery.
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Affiliation(s)
- Krishan Ramdoo
- Ear Institute, University College London, London, UK Department of Ear, Nose and Throat Surgery, Northwick Park Hospital, London, UK
| | - Joseph G Manjaly
- Department of Ear, Nose and Throat Surgery, Northwick Park Hospital, London, UK
| | - Taran Tatla
- Department of Ear, Nose and Throat Surgery, Northwick Park Hospital, London, UK
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15
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Jones HAS, Manjaly JG, Sandison A, Almeyda JS, Sandhu GS. Acute airway obstruction secondary to vocal fold heterotopic ossification. Head Neck Pathol 2014; 9:96-9. [PMID: 24682868 PMCID: PMC4382488 DOI: 10.1007/s12105-014-0539-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 03/23/2014] [Indexed: 11/30/2022]
Abstract
A 29-year old man of Eritrean origin presented with acute stridor and respiratory distress on a background 1 year history of progressive breathing difficulty and worsening inspiratory stridor. Fibreoptic laryngoscopy revealed an indeterminate swelling of the left vocal fold leaving no clear airway visible. The patient refused surgical tracheostomy. Microlaryngoscopy revealed a hard, calcified mass arising from the left cord preventing intubation. Histological analysis after excision revealed features consistent with heterotopic ossification. At 4 months repeat microlaryngoscopy was performed revealing normal appearance of the larynx and subglottis. Heterotopic ossification in the larynx is a very rare condition that presents a diagnostic and therapeutic challenge. In the first documented case in the larynx, we describe how the disease caused life threatening airway obstruction, but was managed in a way that led to preservation of laryngeal function and complete resolution of the condition.
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Affiliation(s)
- Huw A. S. Jones
- />National Centre for Airway Reconstruction, Department of Otolaryngology, Charing Cross Hospital, London, UK , />Department of ENT, Northwick Park Hospital, Watford Rd, Harrow, Middlesex, HA1 3UJ UK
| | - Joseph G. Manjaly
- />Department of Otolaryngology, West Middlesex University Hospital, London, UK
| | - Ann Sandison
- />National Centre for Airway Reconstruction, Department of Otolaryngology, Charing Cross Hospital, London, UK
| | - John S. Almeyda
- />Department of Otolaryngology, West Middlesex University Hospital, London, UK
| | - Gurpreet S. Sandhu
- />National Centre for Airway Reconstruction, Department of Otolaryngology, Charing Cross Hospital, London, UK
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16
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Smith HK, Manjaly JG, Yousri T, Upadhyay N, Taylor H, Nicol SG, Livingstone JA. Informed consent in trauma: does written information improve patient recall of risks? A prospective randomised study. Injury 2012; 43:1534-8. [PMID: 21782171 DOI: 10.1016/j.injury.2011.06.419] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [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] [Received: 02/24/2011] [Revised: 05/29/2011] [Accepted: 06/27/2011] [Indexed: 02/02/2023]
Abstract
Informed consent is vital to good surgical practice. Pain, sedative medication and psychological distress resulting from trauma are likely to adversely affect a patient's ability to understand and retain information thus impairing the quality of the consent process. This study aims to assess whether provision of written information improves trauma patient's recall of the risks associated with their surgery. 121 consecutive trauma patients were randomised to receive structured verbal information or structured verbal information with the addition of supplementary written information at the time of obtaining consent for their surgery. Patients were followed up post-operatively (mean 3.2 days) with a questionnaire to assess recall of risks discussed during the consent interview and satisfaction with the consent process. Recall of risks discussed in the consent interview was found to be significantly improved in the group receiving written and verbal information compared to verbal information alone (mean questionnaire score 41% vs. 64%), p=0.0014 using the Mann-Whitney U test. Patient satisfaction with the consent process was improved in the group receiving written and verbal information and 90% of patients in both groups expressed a preference for both written and verbal information compared to verbal information alone. Patients awaiting surgery following trauma can pose a challenge to adequately inform about benefits conferred, the likely post operative course and potential risks. Written information is a simple and cost-effective means to improve the consent process and was popular with patients.
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Affiliation(s)
- Hannah K Smith
- Department of Trauma & Orthopaedics Bristol Royal Infirmary Upper Maudlin Street Bristol BS2 8HW United Kingdom.
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17
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Manjaly JG, Reece-Smith AM, Sivaloganathan SS, Thuraisamy C, Smallwood KL, Jonas E, Longman RJ. Improving dosing of gentamicin in the obese patient: a 3-cycle drug chart and case note audit. JRSM Short Rep 2012; 3:25. [PMID: 22715426 PMCID: PMC3375840 DOI: 10.1258/shorts.2012.011131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives To assess the use of an electronic dose calculator to improve accuracy in the use of a complex Gentamicin prescription policy and assess turnaround time of blood sampling to dose delivery in an NHS hospital. Design Retrospective review of drug chart, case notes and hospital antibiotic database. Setting University Hospitals Bristol, UK Participants Patients receiving once daily intravenous gentamicin using the trust protocol, during the same time window for 3 consecutive years. Main outcome measures i) Accuracy of dose and frequency prescription of Gentamicin. ii) Time frame for measurement of serum Gentamicin levels. Results Following the introduction of the online calculator, prescribing errors in obese patients dropped from 43% to 20%, a similar level as in non-obese patients. Errors in frequency calculations dropped from 12.8% to 4%. On average, drug doses could be administered within 2.5 hours of a blood sample being taken. Conclusions Online tools can be used to improve prescribing for the complex dosing policies that will increasingly been required to tailor prescribing in obese patients. Serum gentamicin levels can be measured within a 2.5 hour time frame in the environment of an NHS hospital.
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19
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Affiliation(s)
- Joseph G Manjaly
- Department of ENT, Salisbury District Hospital , Salisbury SP2 8BJ , UK
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20
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Manjaly JG, Smith HK. Re: Appraisal of litigation against English Health Trusts in the treatment of adults with ENT pathology. Clin Otolaryngol 2011; 36:393; author reply 394. [PMID: 21848555 DOI: 10.1111/j.1749-4486.2011.02339.x] [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: 11/26/2022]
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21
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Manjaly JG, Corlett JC, Dale O, Vaughan-Shaw PG, Frost R. Long-Term Repeated Cricopharyngeal Dilatation for OPMD. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811416318a128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Oculopharyngeal muscular dystrophy (OPMD) is a rare, autosomal dominant, progressive degenerative muscle disorder featuring dysphagia with limited therapeutic options. Cricopharyngeal myotomy improves symptoms, yet dysphagia frequently recurs, failing to prevent aspiration and enteral feeding. The objective is to evaluate safety and efficacy of repeated endoscopic dilatation for OPMD over a 15-year period. Method: All patients at our unit with genetically confirmed OPMD were included. Cricopharyngeal dilatation was performed with a wire-guided 18 mm Savary-Gilliard bougie. Repeat dilatation was offered when symptoms recurred. Symptom severity prior to initial dilatation and at follow-up was evaluated using the Sydney Swallow Questionnaire (SSQ). Results: Nine patients (7 female, 2 male) were included. Median total treatment period was 13 years (range, 3-15 years), median number of dilatations per patient was 7.2 (1-16), and median interval between treatments was 15 months (range, 4.5-45 months). All patients recorded sustained symptom improvement. Mean SSQ score was 1108 out of 1700 (SD ± 272.9) prior to first dilatation and 298 out of 1700 (SD ± 189.1) at last follow-up, representing a 73% decrease (95% CI 52-94) in degree of dysphagia symptoms (Paired t test, P = .0001). All mean scores for individual questions also showed significant improvement ( P < .05). No adverse events were reported with all patients maintaining oral feeding at last follow-up. Conclusion: Repeated cricopharyngeal dilatation is a safe, effective, well-tolerated, and long-lasting treatment for dysphagia in OPMD.
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22
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Manjaly JG, Vaughan-Shaw PG, Dale OT, Tyler S, Corlett JCR, Frost RA. Cricopharyngeal dilatation for the long-term treatment of dysphagia in oculopharyngeal muscular dystrophy. Dysphagia 2011; 27:216-20. [PMID: 21805106 DOI: 10.1007/s00455-011-9356-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 07/06/2011] [Indexed: 10/17/2022]
Abstract
Oculopharyngeal muscular dystrophy (OPMD) is a rare autosomal dominant, progressive degenerative muscle disorder featuring dysphagia with limited therapeutic options. The aim of this study was to evaluate the safety and efficacy of repeated endoscopic dilatation for OPMD over a 15-year period. All patients seen at our Regional Swallowing Clinic with OPMD confirmed by genetic analysis were included. Cricopharyngeal dilatation was performed as an outpatient procedure using a wire-guided 18-mm (54 Fr) Savary-Gilliard bougie with the patient under sedation. Patients were offered repeat endoscopic dilatation when symptoms recurred. Symptom severity prior to initial dilatation and at follow-up was evaluated using the Sydney Swallow Questionnaire (SSQ). Nine patients (7 female, 2 male) were included for analysis. Median total treatment period was 13 years (range = 3-15), median number of dilatations per patient was 7.2 (range = 1-16), and median interval between treatments was 15 months (range = 4.5-45). All patients recorded sustained symptom improvement. Mean SSQ score (out of 1,700) was 1,108.11 (SD ± 272.85) prior to first dilatation and 297.78 (SD ± 189.14) at last follow-up, representing a 73% decrease (95% CI = 52-94) in degree of dysphagia symptoms (paired t-test, P = 0.0001). All mean scores for individual questions also showed significant improvement (P < 0.05). No adverse events were reported with all patients maintaining oral feeding at last follow-up. Repeated cricopharyngeal dilatation is a safe, effective, well-tolerated, and long-lasting treatment for dysphagia in OPMD.
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Affiliation(s)
- Joseph G Manjaly
- Departments of ENT and Radiology, Salisbury NHS Foundation Trust, Salisbury, UK.
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23
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Vaughan-Shaw PG, Pavlou P, Manjaly JG, Ward P. Thromboprophylaxis in trauma: a review of methods, evidence and guidelines. Acta Orthop Belg 2011; 77:1-8. [PMID: 21473437] [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: 05/30/2023]
Abstract
Venous thromboembolism is a common cause of morbidity and mortality in trauma patients. Mechanical and pharmacological methods of thromboprophylaxis are available and guidelines relating to thromboprophylaxis in trauma include those published by the American College of Chest Physicians, the UK-based National Institute of Clinical Excellence, the Scottish Intercollegiate Guidelines Network and US-based Eastern Association for the Surgery of Trauma. All four guidelines have in common a recommendation for the use of low-molecular-weight heparin except where contraindicated. However, there is little consensus between guidelines relating to which mechanical methods should be used. Given the risk of thromboembolism in trauma patients and increasing interest in this condition clinicians should be aware of local and national guidelines relating to venous thromboembolism prevention in trauma patients. This paper reviews methods of thromboprophylaxis and compares guidelines relating to their use in trauma patients.
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24
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Bates DO, MacMillan PP, Manjaly JG, Qiu Y, Hudson SJ, Bevan HS, Hunter AJ, Soothill PW, Read M, Donaldson LF, Harper SJ. The endogenous anti-angiogenic family of splice variants of VEGF, VEGFxxxb, are down-regulated in pre-eclamptic placentae at term. Clin Sci (Lond) 2006; 110:575-85. [PMID: 16451124 DOI: 10.1042/cs20050292] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PET (pre-eclamptic toxaemia) has recently been linked with alterations in production of a VEGFR1 [VEGF (vascular endothelial growth factor) receptor 1] splice variant that acts as a circulating inhibitor. We have recently described a family of naturally occurring splice variants of VEGF, termed VEGFxxxb, that also appear to act as inhibitors of conventional VEGFxxx-mediated angiogenesis. To determine whether alteration in splicing of VEGF-VEGFR family members extended beyond VEGFR1, we investigated the effect of pre-eclampsia on placental VEGFxxxb mRNA and protein expression. VEGFxxx and VEGFxxxb mRNA and protein were both found in normal human term placentae. VEGFxxx protein formed the majority of the total VEGF protein (980+/-195 pg/mg), whereas VEGFxxxb (11.5 pg/mg) was found to form a small part of the total VEGF protein expression (1.5+/-0.24%). Evidence for VEGF165b, VEGF121b and VEGF145b expression was found. In pre-eclamptic placentae, there was a significant down-regulation of VEGFxxxb isoforms, but a small up-regulation of VEGFxxx isoforms. In normal placenta VEGFxxxb and VEGFxxx concentrations were positively correlated (r=0.69, P<0.02), whereas in pre-eclamptic placentae, there was a significant negative correlation between VEGFxxxb and VEGFxxx protein expression (r=-0.8, P<0.02), indicating that there was a significant uncoupling of the splicing regulation of the VEGF isoforms. Combined with previous studies showing increased soluble VEGFR1 isoforms in human pre-eclampsia, these data suggest that there may be a common mechanism in pre-eclampsia that involves dysregulation of mRNA splicing of members of the VEGF-VEGFR axis.
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Affiliation(s)
- David O Bates
- Microvascular Research Laboratories, Department of Physiology, Preclinical Veterinary School, University of Bristol, Bristol BS2 8EJ, UK.
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