Ventilation Tube Insertion Research Articles

Evaluating the accuracy and readability of ChatGPT in providing parental guidance for adenoidectomy, tonsillectomy, and ventilation tube insertion surgery

ObjectivesThis study examined the potential of ChatGPT as an accurate and readable source of information for parents seeking guidance on adenoidectomy, tonsillectomy, and ventilation tube insertion surgeries (ATVtis). MethodsChatGPT was tasked with identifying the top 15 most frequently asked questions by parents on internet search engines for each of the three specific surgical procedures. We removed repeated questions from the initial set of 45. Subsequently, we asked ChatGPT to generate answers to the remaining 33 questions. Seven highly experienced otolaryngologists individually assessed the accuracy of the responses using a four-level grading scale, from completely incorrect to comprehensive. The readability of responses was determined using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores. The questions were categorized into four groups: Diagnosis and Preparation Process, Surgical Information, Risks and Complications, and Postoperative Process. Responses were then compared based on accuracy grade, FRE, and FKGL scores. ResultsSeven evaluators each assessed 33 AI-generated responses, providing a total of 231 evaluations. Among the evaluated responses, 167 (72.3 %) were classified as ‘comprehensive.’ Sixty-two responses (26.8 %) were categorized as ‘correct but inadequate,’ and two responses (0.9 %) were assessed as ‘some correct, some incorrect.’ None of the responses were adjudged ‘completely incorrect’ by any assessors. The average FRE and FGKL scores were 57.15(±10.73) and 9.95(±1.91), respectively. Upon analyzing the responses from ChatGPT, 3 (9.1 %) were at or below the sixth-grade reading level recommended by the American Medical Association (AMA). No significant differences were found between the groups regarding readability and accuracy scores (p > 0.05). ConclusionsChatGPT can provide accurate answers to questions on various topics related to ATVtis. However, ChatGPT's answers may be too complex for some readers, as they are generally written at a high school level. This is above the sixth-grade reading level recommended for patient information by the AMA. According to our study, more than three-quarters of the AI-generated responses were at or above the 10th-grade reading level, raising concerns about the ChatGPT text's readability.

Disease-specific Quality of Life in Irish Children with Otitis Media with Effusion

Introduction: Otitis media with effusion (OME) is one of the most common diseases of childhood and causes significant morbidity for children. The benefits of ventilation tubes (VTs) are well established, but the subjective impact of surgery on Irish children’s quality of life (QoL) has not been studied. Methods: A prospective single-unit cohort study used a validated QoL survey (Otitis Media-6 [OM-6]) to determine the impact of VT placement on QoL. The OM-6 survey uses a Likert scale, with the higher the value on the Likert scale, the poorer the QoL perceived. Results: Seventy-six children with a mean (range) age of 6 (0.5–13) years were recruited for this study. The overall mean OM-6 score for the 76 children was 3.2. Twenty-six children proceeded to surgery. The mean OM-6 score in this cohort preoperatively was 4.5 and reduced to 1.35 at 3 months post-VT placement. Conclusion: This study highlights the poor QoL experienced by Irish children with OME. The OM-6 scores are considerably higher in our series than previously published international series. VT insertion leads to an improvement in QoL scores. This validated questionnaire should be a routine adjunct in the holistic management of children with OME.

Otitis in Patients With Community-Acquired Bacterial Meningitis: A Nationwide Prospective Cohort Study.

Otitis is commonly associated with community-acquired bacterial meningitis, but the role of ear surgery as treatment is debated. In this study, we investigated the impact of otitis and ear surgery on outcome of adults with community-acquired bacterial meningitis. We analyzed episodes of adults with community-acquired bacterial meningitis from a nationwide prospective cohort study in the Netherlands, between March 2006 and July 2021. A total of 2548 episodes of community-acquired bacterial meningitis were evaluated. Otitis was present in 696 episodes (27%). In these patients the primary causative pathogen was Streptococcus pneumoniae (615 of 696 [88%]), followed by Streptococcus pyogenes (5%) and Haemophilus influenzae (4%). In 519 of 632 otitis episodes (82%) an ear-nose-throat specialist was consulted, and surgery was performed in 287 of 519 (55%). The types of surgery performed were myringotomy with ventilation tube insertion in 110 of 287 episodes (38%), mastoidectomy in 103 of 287 (36%), and myringotomy alone in 74 of 287 (26%). Unfavorable outcome occurred in 210 of 696 episodes (30%) and in 65 of 696 episodes was fatal (9%). Otitis was associated with a favorable outcome in a multivariable analysis (odds ratio 0.74; 95% confidence interval [CI] .59-.92; P = .008). There was no association between outcome and ear surgery. Otitis is a common focus of infection in community-acquired bacterial meningitis in adults, with S. pneumoniae being the most common causative pathogen. Presence of otitis is associated with a favorable outcome. Ear surgery's impact on the outcome of otogenic meningitis patients remains uncertain.

Dupilumab in the Treatment of Eosinophilic Otitis Media: A Case Report

Eosinophilic otitis media (EOM) differs from classic chronic otitis media as it is a refractory disease with the accumulation of eosinophils in thick mucinous middle ear effusion and mucosa. A 66-year-old male with a history of asthma, chronic sinusitis with polyposis, nasal polyposis, and multiple sets of ventilation tubes was presented to our center for the management of hearing loss and otorrhea. He had a history of consistent otorrhea and hearing loss even with the ventilation tube insertions and medical treatment. Both systemic and intratympanic steroid was administered, but the effect was insignificant and other systemic adverse effects occurred. Finally, the otologic symptoms including hearing loss and otorrhea improved after being given a Dupilumab injection. This case report discusses Dupilumab treatment resulting in remission in a patient suffering from refractory EOM.

Changes in Otitis Media During COVID-19.

During the COVID-19 pandemic, various non-pharmaceutical interventions such as individual hygiene practices like hand washing, social distancing, and mandates for the use of masks in public spaces were implemented to reduce the spread of the disease. Otitis media (OM) is a common infectious disease. How the changed environment due to the COVID-19 pandemic has influenced the prevalence of infectious diseases like OM is not known. This study aimed to investigate how OM prevalence and trends changed during COVID-19 in Korea. OM patient data from 2017 to 2021 were extracted from the Health Insurance Review and Assessment Service database. Patients diagnosed with disease code H66 (suppurative and unspecified otitis media) were selected for analysis. Data on OM prevalence, gender, region, medical institution, and number of ventilating-tube prescriptions were analyzed. All age groups were included, and ages were categorized into 5-year ranges. The number of patients diagnosed with the OM disease code decreased continuously from 2017 to 2021 (1 598 205, 1 560 178, 1 520 948, 983 701, and 734 901). The average OM prevalence per 1000 persons decreased by 45.0% from 30.2 in 2017 to 2019 to 16.6 in 2020 to 2021. The change of OM prevalence was greater for the 0 to 5 age group than other age groups. The decrease in average prevalence per 1000 persons was greatest in the 0 to 5 age group (48.6% decrease from 358.2 in 2017-2019 to 184.1 in 2020-2021). The impact of environmental changes on ventilation-tube insertion was smaller than on OM prevalence. The average number of ventilating-tube insertions decreased by 28.1% from 27 311 in 2017 to 2019 to 19 650 in 2020 to 2021. OM prevalence decreased by 45.0%, and the number of ventilating-tube insertions decreased by 28.1% in Korea during COVID-19.

The effect of otitis media with effusion on phonological performance of preschool children

ObjectivesPhonological development is dependent on the integrity of the auditory system. Otitis media with effusion (OME) may affect speech perception in children and therefore phonological development. The aim of this study was to investigate the impact of persistent OME on the phonological performance of preschool children.MethodsSixty children with persistent OME who were candidates for myringotomy and ventilation tube insertion were included in this prospective observational study. We assessed their phonological skills before and after surgery (3 and 6 months) by phonological production tasks that included calculation of percentage of consonants correct (PCC) and process density index (PDI).ResultsWe detected preoperative poor phonological performance in 91.7% of children. We found statistically significant differences in PCC and PDI between the three time periods. Also, there was a significant improvement after 6 months compared to 3 months.ConclusionsOME has an adverse consequence on the phonological performance of preschool children, it can affect different domains such as PCC and PDI. The findings of this study revealed that myringotomy with ventilation tube insertion for children with persistent OME could aid in the development of intact phonological skills.

Safety, tolerability, and effect of a single aural dose of Dornase alfa at the time of ventilation tube surgery for otitis media: A Phase 1b double randomized control trial

BackgroundOne third of children require repeat ventilation tube insertion (VTI) for otitis media. Disease recurrence is associated with persistent middle ear bacterial biofilms. With demonstration that Dornase alfa (a DNase) disrupts middle ear effusion biofilms ex vivo, we identified potential for this as an anti-biofilm therapy to prevent repeat VTI. First, safety and tolerability needed to be measured. MethodsThis was a phase 1B double-blinded randomized control trial conducted in Western Australia. Children between 6 months and 5 years undergoing VTI for bilateral middle ear effusion were recruited between 2012 and 2014 and followed for two years. Children's ears were randomized to receive either Dornase alfa (1 mg/mL) or 0.9 % sodium chloride (placebo) at time of surgery. Children were followed up at 2 weeks post-VTI and at 3-monthly intervals for 2 years. Outcomes assessed were: 1) safety and tolerability, 2) otorrhoea frequency, 3) blocked or extruded ventilation tube (VT) frequency, 4) time to blockage or extrusion, 5) time to infection recurrence and/or need for repeat VTI. ResultsSixty children (mean age 2.3 years) were enrolled with 87 % reaching study endpoint. Treatment did not change otorrhoea frequency. Hearing improved in all children following VTI, with no indication of ototoxicity. Dornase alfa had some effect on increasing time until VT extrusion (p = 0.099); and blockage and/or extrusion (p = 0.122). Frequency of recurrence and time until recurrence were similar. Fourteen children required repeat VTI within the follow-up period. ConclusionA single application of Dornase alfa into the middle ear at time of VTI was safe, non-ototoxic, and well-tolerated. Trial registrationACTRN12623000504617.

Sensibilidade auditiva e condições de orelha média com e sem tubo de ventilação na fissura labiopalatina

ABSTRACT Purpose To characterize and compare hearing and middle ear status in patients with cleft lip and palate with or without a history of ventilation tube insertion. Methods Retrospective study that involved the analysis of 463 medical records of patients with non-syndromic repaired unilateral cleft lip and palate. Otoscopy, immittance measures, audiometry and ventilation tube history over 10 years were analyzed. Results From 440 medical records included in the study, 254 (58%) had a history of VT insertion, while 186 (42%) did not. The percentage of abnormal findings in otoscopic examination was consistently higher for ears with a history of VT and statistical analysis revealed an association between history of VT and fluid in the middle ear (p<0.001); tympanic opacification (p<0.001); tympanic retraction (p<0.001) tympanic perforation (p<0.001) and tympanosclerosis (p<0.001). The type B tympanometric curve was observed in 46.4% of ears with a history of present VT, compared to 16.3% in individuals with an absent history of VT (p<0.001) and the difference of 30.1% between groups was significant (p<0.001), indicating association between VT and type B curve. Hearing loss was more frequent in ears with a history of VT (34.2%), when compared to ears without this history (10.4%), with a statistically significant difference (p<0.001), indicating positive association between VT and hearing loss. Conclusion Worse otoscopic and auditory results were found in patients with cleft lip and palate with a history of VT.

Tactics of treatment the children with pharyngeal tonsil hypertrophy in combination with otitis media with effusion

Actual tactics of treatment for children with otitis media with effusion in combination with pharyngeal tonsil hypertrophy involve medical treatment and observation for 3 months. The next step is to resolve the issue of surgical treatment, however, there are differences in its scope: adenotomy, tympanopuncture/myringotomy, ventilation tubes introduce may be performed. The modern method of adenotomy (endoscopic power assisted adenotomy) has advantages over the classical one due to precision and better possibilities of removal of lymphoid tissue in the peritubar and perichoanal parts of the nasopharynx. The aim of our study was to increase the effectiveness of surgical treatment of children with otitis media with effusion and pharyngeal tonsil hypertrophy. Prospective results of treatment for 47 children with otitis media with effusion in combination with pharyngeal tonsil hypertrophy were studied. In 47 children with otitis media with effusion in combination with pharyngeal tonsil hypertrophy, endoscopic energy adenotomy with tympanopuncture with intratympanic administration of dexamethasone was performed. At the time of adenotomy, all children had been suffering from otitis media with effusion for 3 months or more, and medical treatment had no effect. The examination 1 month after the intervention established, the secretion in the tympanic cavity in 6.4% of children who subsequently require insertion of ventilation tube. In 80.8% of cases, normalization of intratympanic pressure was observed in one month after adenotomy with tympanopuncture. The average values of intratympanic pressure in patients in 2 and 4 weeks after the simultaneously intervention was (76.5±7.8) dPa and (51.3±8.5) dPa, respectively. Power assisted adenotomy with simultaneous tympanopuncture is an effective method of treating children with otitis media with effusion and pharyngeal tonsil hypertrophy and can be recommended for use in clinical practice. Keywords: otitis, otitis with effusion, tonsils hypertrophy, tonsil pharyngeal, adenotomy, inflammatory diseases of the upper respiratory ways.

Diagnosis of Eosinophilic Otitis Media Using Blood Eosinophil Levels

Eosinophilic otitis media (EOM) is a rare middle ear disease with unfavorable outcomes. Under the current diagnostic criteria of EOM, it is challenging to suspect EOM before tympanostomy. Therefore, this study attempted to use blood eosinophil levels for the differential diagnosis of EOM from other conditions. Three disease groups with features of recurrent otorrhea were categorized, which included the following: EOM (n = 9), granulomatosis with polyangiitis (GPA, n = 12), and primary ciliary dyskinesia (PCD, n = 6). Clinical and radiological characteristics were analyzed in the three groups. Patients who underwent ventilation tube insertion due to serous otitis media were enrolled as the control group (n = 225) to evaluate the diagnostic validity of blood eosinophilia. The EOM group showed a significantly higher blood eosinophil concentration (p < 0.001) and blood eosinophil count (p < 0.001) compared to the GPA and PCD groups. The estimated sensitivity and specificity for diagnosing EOM from OME patients who underwent ventilation tube insertion were 100% and 95.6%, respectively. In addition, EOM tended to have protympanic space soft tissue density and a relatively clear retrotympanic space in temporal bone computerized tomography. Blood eosinophil evaluation is a significant clinical indicator of EOM. Furthermore, the assessment of exclusive protympanic soft tissue density can provide an additional diagnostic clue.

The effect of ventilation tube insertion in pediatric cochlear implantation candidates with otitis media with effusion on postoperative complications

ObjectiveOtitis media with effusion (OME) is a common finding in pediatric cochlear implant(CI) candidates and may be managed by inserting ventilation tubes. This study aimed to compare postoperative complication rates in children who underwent CI without and with OME, including patients who were treated without and with ventilation tube insertion. MethodsA population-based retrospective cohort study was conducted, including all CI patients, under ten years of age, at our institution, between 2007 and 2020. The study's population was divided into three groups based on their middle ear status at CI: 1) OME previously treated with VT, 2) untreated OME, and 3) normal-aerated ears. Postoperative complications of the groups were reviewed and served as our primary outcome measure. ResultsOf the 257 implanted ears included, 53, 42, and 162 ears belonged to the VT-treated OME, untreated OME, and aerated groups, respectively. Acute mastoiditis (AM) rate was significantly higher in the OME group compared to the aerated groups (9.5 % vs. 2.5 %, p = 0.0134) and in the VT-treated compared to the untreated OME groups (15.1 % vs. 2.3 %, p = 0.0356). Similarly, the rate of developing chronic suppurative otitis media without cholesteatoma (CSOMWC) was significantly higher in the OME compared to the aerated groups (12.6 % vs. 2.5 %, p = 0.0011) and in the VT-treated compared to the untreated OME groups (18.8 % vs. 4.7 %, p = 0.0366). Other complications rated were very low and similar between the groups. No other statistical difference was found between the groups. ConclusionVT insertion in pediatric CI candidates with OME increased postoperative AM and CSOMWC. We believe that, at least in our population, VT introduction prior to CI, for OME, surgery should be avoided.

Impact of ventilation tube insertion on long-term language outcomes at 6 and 10 years of age: A prospective pregnancy cohort study.

Investigating the impact of early childhood ventilation tube insertion (VTI) on long-term language outcomes. Longitudinal cohort study. A total of 2900 pregnant women participated in the Raine Study between 1989 and 1991 in Western Australia, and 2868 children have been followed up. Based on parental reports, 314 children had a history of recurrent otitis media but did not undergo VTI (rOM group); another 94 received VTI (VTI group); while 1735 had no history of rOM (reference group) in the first 3 years of childhood. Children with data on outcomes and confounders were included in analyses of PPVT-R at ages 6 (n = 1567) and 10 years (n = 1313) and CELF-III at 10 years (n = 1410) (approximately 5% in the VTI group and 15% in the rOM group). Peabody Picture Vocabulary Test-Revised edition and Clinical Evaluation of Language Fundamentals® Preschool-3. At 6 years, mean PPVT-R scores were significantly lower in the VTI group than the reference group (β = -3.3; 95% CI [-6.5 to -0.04], p = .047). At 10 years, while the difference between the VTI and reference groups was less pronounced for PPVT-R scores, there was a small but consistent trend of lower measures, on average, across CELF-III scores (expressive: β = -3.4 [-7.1 to 0.27], p = .069; receptive: β = -4.1 [-7.9 to -0.34], p = .033; total: β = -3.9 [-7.5 to -0.21], p = .038). There was no evidence to suggest that language outcomes in the rOM group differed from the reference group. Lower scores of language outcomes in school-aged children who received VTI in early childhood may suggest a long-term risk which should be considered alongside the potential benefits of VTI.

Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm.

Fifteen studies published between 2000 and 2022 were selected, including 120 patients (62 M/58 F) with an average age of 4.96 years old (range = 4 months-16 years; SD: 4.2). The paralysis frequently has a sudden onset and is of a severe grade (medium House-Brackmann (HB) score at onset: 4.68; SD: 0.5); however, it tends to have an almost complete recovery in most patients (88.49% HB 1 at follow-up). Its first-line treatment must be based on the use of antibiotics (beta-lactam antibiotics as penicillins or cephalosporins). Corticosteroids should be used concomitantly for their anti-inflammatory and neuroprotective actions; however, there is no unanimity between authors about their application. Myringotomy, with or without ventilation tube insertion, is indicated in cases where the tympanic membrane is intact. Other kinds of surgery should be performed only in patients who have a worsening of their AOM symptoms or a worsening in HB score even with clinical treatment. The obtained data show that a conservative treatment can be sufficient for complete recovery in most patients, and it is preferred as the first-line therapy. Mastoidectomy should be performed only in patients with acute mastoiditis and without symptom improvement after a conservative approach. There are insufficient data in the current literature to provide clear selection criteria for patients who need to undergo mastoidectomy with facial nerve decompression. The choice of this treatment is based on an individual center expertise. Further studies are needed to clarify the role of corticosteroids and the role of facial nerve decompression in this clinical scenario.

Modified Intravenous Cannula Ventilation Tubes for Otic Barotrauma Prevention.

Objectives: Middle ear barotrauma is a common complication of hyperbaric oxygen therapy (HBOT). Tympanostomy tube placement prevents barotrauma by facilitating middle ear equalization. We describe variations on techniques published by Mooney et al and Zhang et al for placing modified peripheral intravenous cannula (PIVC) ventilation tubes, which can be performed at the bedside under topical anesthesia. We aim to evaluate the safety and efficacy of this technique when performed to prevent otic barotrauma in patients undergoing HBOT. Methods: We performed an analytical observational study at a tertiary metropolitan Australian hospital with a state-wide adult hyperbaric service between 2018 and 2022. Patients were identified via unit audits. Patient, HBOT, and procedural factors were analyzed against complications using Fisher's exact test with Bonferroni correction and simple logistic regression. Results: Over 4 years, 112 patients (220 ears) underwent modified PIVC ventilation tube insertion. Mean age was 58.6 years (95% CI: 55.7-61.6, SD: 15.9). Thirty-eight patients (33.9%) were female, 74 (66.1%) were male. Thirty-four ears (15.5%) had preexisting barotrauma at the time of tympanostomy tube insertion. Patients underwent a mean of 11.5 dives (95% CI: 9.0-14.0, SD: 13.4), with ventilation tubes being required for a mean of 15.0 days (95% CI: 9.0-14.0, SD: 24.0) to complete HBOT. Fourteen ventilation tubes (6.4%) developed blockage during HBOT, and 12 (5.5%) prematurely extruded. Sixteen ears (7.3%) required reinsertion of ventilation tubes. Nine ears (4.1%) suffered barotrauma despite ventilation tube insertion. Conclusions: Otic barotrauma prophylaxis is paramount for safety during HBOT. We describe a safe, effective, and convenient technique for barotrauma prevention using modified PIVCs.

Speech and Burden of Secondary Surgical Interventions Following One-Stage Repair of Unilateral Cleft Lip and Palate and Alveolar Bone Grafting Performed at Different Timings.

A comprehensive assessment of the treatment outcome in cleft lip and palate involves evaluating speech and the impact of speech-correcting surgical interventions. This retrospective case-control study compared the speech outcomes of 37 boys and 19 girls with unilateral cleft lip and palate (UCLP) who underwent one-stage cleft repair at an average age of 8.1 months and alveolar bone grafting either before or after 6 years of age, with a non-cleft control group at an average age of 10 years. Two experienced speech and language pathologists conducted perceptual speech assessments using a specialized test of 27 sentences designed for Polish-speaking cleft patients. The results revealed that 5.3% had severe hypernasality, 1.8% had severely impaired speech intelligibility, 10.7% exhibited retracted compensatory articulations, and 7.1% displayed facial grimacing. Mild hyponasality was observed in 12.3% of patients, while 16.1% exhibited voice abnormalities. Additionally, 12.5% of patients required orofacial fistula repairs, 3.6% underwent pharyngoplasties, and 28.6% received ear ventilation tube insertions. The study indicates that speech abnormalities in UCLP patients were relatively infrequent and not highly severe, suggesting that the primary UCLP repair method presented effectively reduced the need for further surgical interventions, leading to positive speech outcomes.

Acquired Cholesteatomas Behind Intact Tympanic Membranes of Adults: A Series of 13 Cases.

Background and Objective: Acquired cholesteatomas behind intact tympanic membrane (ITMC) are rarely encountered in adults in the otology clinic, and the clinical and imaging features of ITMC in adults remain unclear to date. ITMC patients are commonly overlooked because of the absence of both a typical retraction pocket and a tympanic membrane (TM) perforation. The objective of this study was to describe clinical features, pathogenesis, and surgical outcomes in a series of adult patients with acquired ITMC. Materials and Methods: The clinical records of 13 adult patients diagnosed with ITMC were retrospectively reviewed. ITMC were classified into those associated with otitis media with effusion (OME; Group A) and histories of previous perforations (Group B). Results: A total of 13 cases with unilaterally acquired ITMC were included, of which 10 (76.9%) were in Group A and 3 (23.1%) were in Group B. All Group A patients exhibited white masses behind intact TMs, in the anterosuperior quadrants of 6 and the posterior upper quadrants of 4. In Group B patients, white masses in the middle ear were lacking. The TMs were atrophic and white myringosclerotic plaques were evident. The cholesteatomas were confined to the antrum and aditus ad antrum in 2 Group B patients but extended to the epitympanum in 1. All 10 Group A patients had extensive cholesteatomas but intact (noneroded) malleoli. Conclusions: An acquired ITMC should be suspected if symptoms worsen or new symptoms develop in adults with OME or a history of perforation, although the TM is intact with or without pars flaccida retraction, computed tomography/magnetic resonance imaging should be performed. Canal wall up mastoidectomy combined with ventilation tube insertion effectively treated ITMC associated with OME.

Gathering validity evidence for a 3D-printed simulator for training of myringotomy and ventilation tube insertion.

This study aimed to gather validity evidence according to Messick's framework for a novel 3D-printed simulator for myringotomy with ventilation tube insertion for use in technical skills training of otorhinolaryngology (ORL) residents. The study included 15 junior ORL residents (trainees) and 13 experienced teaching otolaryngologists (experts). Experts and trainees first received an identically structured introduction to the procedure, simulator, and simulation setup. Five procedures performed by each participant were video-recorded and ordered randomly for blinded rating by two independent raters. The rating tools used were a global rating scale (GBRS) and a task-specific checklist. Validity evidence was collected according to Messick's framework. Differences in time consumption and performance scores were analyzed. Finally, a pass/fail standard was established using the contrasting groups' method. Trainees used significantly more time per procedure (109 s, 95% CI: 99-120) than experts (82 s, 95% CI: 71-93; p < .001). Adjusted for repetition and rater leniency, experts achieved an average GBRS score of 18.8 (95% CI: 18.3-19.2) out of 20 points, whereas trainees achieved an average of 17.1 points (95% CI: 16.6-17.5; p < .001). In contrast to the task-specific checklist, the GBRS score discriminated between repetition number and participant experience. The pass/fail standard for the GBRS was established at 18.4 points. We established educational validity evidence for a novel 3D-printed model for simulation-based training of ventilation tube insertion and established a reliable pass/fail standard. 1b.

Outcomes and Prognostic Factors of Balloon Eustachian Tuboplasty Combined With Ventilation Tubes Insertion in Children: A Retrospective Study.

Objective: To evaluate the efficacy and safety of balloon eustachian tuboplasty (BET) combined with ventilation tube (VT) insertion in pediatric population and to identify the predictive factors for symptom recurrence. Methods: We conducted a retrospective study between August 2018 and February 2022 at Shenzhen Children's Hospital. The study analyzed the data of pediatric patients who underwent BET + VT insertion, as well as the data of pediatric patients who underwent VT insertion alone. The outcomes were efficacy, safety, and predictive factors of BET combined with VT. Kaplan‒Meier curves were used to examine the failure-free survival rate. A multivariate Cox regression model was used to identify the independent predictors of BET failure. Results: We evaluated the data of 29 pediatric patients (48 ears) who underwent BET with VT insertion (BET + VT group) and the data of 29 pediatric patients (46 ears) who underwent VT insertion alone (VT group). The total effectiveness rates at the first follow-up after VT removal and at 12 months in the BET + VT group were 90.9% and 84.6%, respectively. The decrease in the air-bone gap (ABG) was more significant in the BET + VT group at 12 months (13.7 ± 10.8 vs 6.4 ± 15.3, P < .05). The subgroup analyses did not show any significant difference between the groups in high-risk. For non-high-risk patients, the decrease in the ABG was more significant in the BET + VT group (14.2 ± 10.6 vs 4.3 ± 13.1, P < .05) at 12 months. The multivariate analysis showed that a history of VT insertion was independently associated with a higher rate of recurrence in the BET + VT group (hazard ratio 3.177; 95% CI, 1.027-9.826; P < .05). Conclusions: BET + VT insertion is an effective procedure to decrease the ABG in pediatric patients with eustachian tube dysfunction (ETD) who have no risk factors for conventional therapy failure. Treatment of patients with ETDs who have coexisting risk factors remains a challenge that warrants further high-quality prospective research.

Bacteriology and trends of antimicrobial resistance of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus in otitis media: A retrospective data analysis.

Otitis media (OM) has a high prevalence worldwide and the treatment is crucial because hearing loss in children can lead to growth disorders such as language development disorders. The aim of this study is to analyse the changes in bacterial strains and the trends of antibiotic susceptibility in otitis media with effusion (OME), chronic otitis media (COM) and cholesteatomatous otitis media (Chole OM). This retrospective study involved 2926 patients diagnosed with OME, COM, or Chole OM between January 2000 and December 2020. The clinical data were collected and analysed through chart review from May 2021 to July 2021. Two tertiary medical centres. The 2926 OM patients. An otorrhea sample was collected on the first day of their hospital visit. Middle ear fluid samples for bacterial culture and antibiotics susceptibility test were collected from patients during middle ear surgery, including ventilation tube insertion. In each type of OM, the distribution of bacterial strains in the 2000s and the 2010s was compared. In addition, changes in the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PA) and trends in their antibiotic susceptibility over the last 10 years were analysed. The most frequently detected bacterial strains in OME, COM and Chole OM over the study period were coagulase-negative Staphylococcus (CNS) (29.6%), MRSA (24.1%), and PA (20.1%). Compared to the 2000s, the proportion of non-typable Haemophilus influenzae in OME and MRSA in COM increased in the 2010s (27.4%-31.6% and 1.5%-29.5%, respectively). In total three types of OM, although there was no significant trend of change in detection rates of MRSA, PA, and multidrug resistant-P. aeruginosa (MDR-PA) during the last 10 years, resistance to the Quinolone class of MRSA and PA tended to increase (P < .05). The composition of bacterial strains in each types of OM has changed over the past 20 years. Additionally, the antibiotic resistance of MRSA and PA has increased in the last decade. Therefore, when using empirical antibiotics in necessary situations, it is necessary to change to an appropriate antibiotic through a bacterial culture test and antimicrobial susceptibility test.

Impact of flail chest injury on morbidity and outcome: ten years’ experience at a tertiary care hospital in a developing country

BackgroundOne of the worst types of severe chest injuries seen by clinicians is flail chest. This study aims to measure the overall mortality rate among flail chest patients and then to correlate mortality with several demographic, pathologic, and management factors.MethodologyA retrospective observational study tracked a total of 376 flail chest patients admitted to the emergency intensive care unit (EICU) and surgical intensive care unit (SICU) at Zagazig University over 120 months. The main outcome measurement was overall mortality. The secondary outcomes were the association of age and sex, concomitant head injury, lung and cardiac contusions, the onset of mechanical ventilation (MV) and chest tubes insertion, the length of mechanical ventilation and ICU stay in days, injury severity score (ISS), associated surgeries, pneumonia, sepsis, the implication of standard fluid therapy and steroid therapy, and the systemic and regional analgesia, with the overall mortality rates.ResultsThe mortality rate was 19.9% overall. The shorter onset of MV and chest tube insertion, and the longer ICU, and hospital length of stay were noted in the mortality group compared with the survived group (P-value less than 0.05). Concomitant head injuries, associated surgeries, pneumonia, pneumothorax, sepsis, lung and myocardial contusion, standard fluid therapy, and steroid therapy were significantly correlated with mortality (P-value less than 0.05). MV had no statistically significant effect on mortality. Regional analgesia (58.8%) had a significantly higher survival rate than intravenous fentanyl infusion (41.2%). In multivariate analysis, sepsis, concomitant head injury, and high ISS were independent predictors for mortality [OR (95% CI) = 568.98 (19.49–16613.52), 6.86 (2.86–16.49), and 1.19 (1.09–1.30), respectively].ConclusionThe current report recorded mortality of 19.9% between flail chest injury patients. Sepsis, concomitant head injury, and higher ISS are the independent risk factors for mortality when associated with flail chest injury. Considering restricted fluid management strategy and regional analgesia may help better outcome for flail chest injury patients.