Development of otology specific outcome measure: Ear Outcome Survey-16 (EOS-16)

PurposeAn important outcome measure of patient care is the impact on the patient’s health-related quality of life (HRQoL). Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms, hearing problems, psychosocial impact, and the need for care. The optimal length of the recall period has not been studied. For these reasons, a new survey is needed that would cover most chronic ear diseases.MethodsA preliminary 24-item survey (EOS-24) was created. Untreated adult patients (included n = 186) with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument. The recruiting otologists evaluated the severity of the disease and the disability caused by it. A control group was recruited. Based on the patients’ responses in different diagnosis groups, the items were reduced according to pre-defined criteria. The resulting survey was validated using a thorough statistical analysis.ResultsThe relevance and necessity of the original 24 items were thoroughly investigated, leading to the exclusion of 8 items and the modification of 1. The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups, thus constituting the final instrument, EOS-16. The most suitable recall period was three months.ConclusionsEOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population. The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.     

Evolution and safety of day-case major ear surgery

AimsTo study the evolution of middle-ear surgery in 2019 in relation to the French Health Authority target of 66% day-surgery by 2020.Material and methodsA single-center retrospective observational study included all patients undergoing otologic surgery between January 2014 and December 2018 in a university hospital center. 1064 of the 1368 patients were scheduled for outpatient surgery: 309 for otosclerosis, 355 for tympanoplasty with or without ossiculoplasty, 376 for cholesteatoma and 24 for other procedures. Two groups were constituted: day-surgery and conventional, according to hospital stay. Surgery time, follow-up duration, number of crossovers to conventional admission, number of emergency postoperative consultations, number of readmissions and data from the phone-call systematically made the day after surgery were analyzed. The main objective was to evaluate the safety of outpatient surgery for major middle-ear interventions compared to a control group managed under conventional admission during the same period.Results27 patients (2.5%) required crossover, mainly due to disabling vertigo (57.7%). 53 patients (4.9%) consulted before the scheduled 8th day consultation, because of severe pain (23.5%) or dizziness (34.0%). Only 10 patients required emergency readmission.ConclusionProvided that the inclusion criteria are met, all major middle-ear surgery procedures can be performed as day-surgery under satisfactory safety conditions.     

抓住亮点,以点带面—耳内科建设体会

耳内科学是耳鼻咽喉科学领域中,通过非手术方法治疗眩晕、耳鸣、耳聋等的一门新兴亚科。近年来在国内外学者不懈努力下,耳内科学发展迅猛。笔者主要通过所在科室开展耳内科工作的经历,阐述如何在综合医院将耳内科做强做大或者做出特色。笔者认为,根据医院原有条件选择一个项目作为＂亮点＂,并努力使这个＂亮点＂光彩夺目,扩大科室的社会影响力,得到医院的足够重视,进而带动耳内科学领域其他疾病诊疗水平的全面提升。笔者相信,耳内科学必定迎来辉煌的明天。     

Lista de verificación para la evaluación de imágenes de resonancia magnética en patología otológica

Otolaryngology specialists must be familiar with radiological studies that allow the diagnosis of different otological pathologies. Magnetic resonance imaging is a complement to computed tomography, which allows a better evaluation of soft tissues and contributes to the differential diagnosis of space-occupying lesions located in the temporal bone and lateral skull base. It is also the technique of choice for the evaluation of the inner ear and the anatomical structures located in the cerebellopontine angle. In this article we present a checklist for magnetic resonance imaging of the ear with different sections that will allow a systematic review of all structures of interest in otological practice, as well as the preferred sequences for each situation.     

Endoscopic ear surgery: A case series and first United Kingdom experience

AIM: To present the United Kingdom's first case series of 70 otological cases of endoscopic and non-endoscopic ear surgeries.METHODS: Prospective case series incorporating a range of endoscopic procedures performed using a 4 mm, 18 cm rigid endoscope, performed by a single surgeon at a single centre. Primary outcome measures included mean average pre and post-operative air-bone gap hearing thresholds and duration of surgery.RESULTS: Thirty-eight patients underwent endoscopic assisted ear surgery and 32 underwent non-endoscopic assisted ear surgery. In both surgical groups, there was a significant difference between pre and post-operative mean air-bone gaps(P = 0.02). Mean operating time was comparable between both groups. Eight patients developed post-operative complications.CONCLUSION: Endoscopic ear surgery can be performed safely in a range of otological procedures. This has the potential to become a well-established surgical option for middle ear surgery in the near future. Advantages and limitations are discussed.     

French Society of ENT (SFORL) guidelines. Indications for cochlear implantation in adults

The authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding indications for cochlear implantation in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members’ experience, then read over by an independent reading group to edit the final version. Guidelines were graded A, B, C or “expert opinion” according to decreasing level of evidence. There is no upper age limit to cochlear implantation in the absence of proven dementia and if autonomy is at least partial. Bilateral implantation may be proposed if unilateral implantation fails to provide sufficiently good spatial localization, speech perception in noise and quality of life, and should be preceded by binaural hearing assessment. Rehabilitation by acoustic and electrical stimulation may be proposed when low-frequency hearing persists. Quality of life should be assessed before and after implantation.     

The billy goat and the goatee of the ear

The term tragus is used to describe the small, flat, triangular cartilaginous prominence situated anteriorly to the entrance of the external auditory canal. The purpose of this historical note is to study the etymology of the term tragus, meaning billy goat, and to analyse the process that led to its current anatomical definition and the various interpretations of this term in the medical literature.