Techniques
Richard P. Usatine, Daniel L. Stulberg, Graham B. Colver in Cutaneous Cryosurgery, 2014
The easiest way to constrain the spray is to use small aperture tips, bent spray extensions, and an intermittent spray when needed. It is often helpful to localize the spray’s area of skin contact especially when working close to sensitive areas such as the eyes. Spray shields, cones, and simple improvised barriers can prevent overspray or concentrate the spray to a focused area. There are commercially available neoprene cones and a clear plastic disc with four different diameter openings that can be used to constrain the liquid nitrogen spray (see Figures 3.17–3.19, Chapter 3). Otoscope tips can also be used. For cryosurgery near the eye or other sensitive structures, overspray can be prevented by using a tongue depressor, gauze, or a tongue depressor wrapped with gauze (Figure 5.17).
Teleaudiology
Stavros Hatzopoulos, Andrea Ciorba, Mark Krumm in Advances in Audiology and Hearing Science, 2020
Starting in 2000, Henryk Skarzynski and his team developed and implemented a modern telemedicine program in Poland. At that time, Skarzynski and his associates conducted one of the first teleconsultation programs in which video-otoscopy images of the ear were transmitted via Internet connections to other medical centers for teleducational purposes. One of the first smartphone applications was also developed by this center for telemedicine use in hearing healthcare. Specifically, in 2004, the first video-otoscope image of the ear was sent directly on mobile phone for viewing by the phone user. This pioneering solution provided indicated that portable mobile devices, such as smartphones, could be used effectively for telemedicine services.
Ear, nose and throat
Gina Johnson, Ian Hill-Smith, Chirag Bakhai in The Minor Illness Manual, 2018
This is a form of infected eczema that causes itchy discomfort rather than pain. It may follow inappropriate probing of the ear with a hairgrip or cotton bud or the presence of a foreign body. Insertion of the otoscope is often uncomfortable. The canal looks irregular, red or moist, perhaps with discharge. It can be recurrent, often with secondary fungal infection occurring after initial antibiotic treatment. The most common pathogens are Pseudomonas (20%–60%) and Staphylococcus (10%–70%), which may co-exist. The treatment for otitis externa may vary depending on the presence of perforation of the tympanic membrane or grommets (see Box 5.4).
Tinnitus following COVID-19 vaccination: report of three cases
Published in International Journal of Audiology, 2022
Daniela Parrino, Andrea Frosolini, Chiara Gallo, Romolo Daniele De Siati, Giacomo Spinato, Cosimo de Filippis
A 37-year-old woman was referred to our department complaining of sudden onset of right tinnitus 7 hours after her first dose of COVID-19 vaccine. She reported short-term dizziness, but she did not notice hearing loss. Local pain at injection site was reported as another vaccine side effect. Her previous medical history was relevant for glaucoma and undifferentiated connective tissue disease. She denied any previous audio-vestibular disorder except for an episode of transient tinnitus related to unremembered side acute otitis media 20 years previously. She was not taking any home medications and had no known allergies. She did not report any previous COVID-19 diagnosis. Otoscopy examination was normal bilaterally. Spontaneous nystagmus was absent as well as other focal neurological symptoms. PTa revealed bilateral normal hearing with slight asymmetry on the right ear. The Psychoacoustic Measures of Tinnitus resulted in a 20 dB pure tone at 10000 Hz. The THI score was 90/100. A 10-day course of oral corticosteroid therapy with tapering regimen was started. PTa performed after treatment showed no significant changes. The Psychoacoustic Measures of Tinnitus and THI score slightly improved (78/100), but the patient still complained of tinnitus and an accompanying bilateral ear fullness sensation. A second line therapy was started. A magnetic resonance imaging (MRI) of the internal auditory meatus or cerebellopontine angle ruled out any possible abnormality.
Surgical, speech, and hearing outcomes at five years of age in internationally adopted children and Swedish-born children with cleft lip and/or palate
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Johnna Sahlsten Schölin, Åsa Jonasson, Jessica Axelsson, Christina Havstam, Christina Persson, Radi Jönsson, Hans Mark
The otological and audiological investigations were performed at the 5-year visit, i.e. on the same day as the speech and surgery assessment for all children. A control group of 20 children from the general pediatric population without CL/P and without any known disability was assessed in the same manner at age 5 years (±2 weeks). The children were examined by microscopic otoscopy to assess the status of the external ear, ear canal, tympanic membrane, and middle ear. Pneumatic otoscopy was performed when deemed appropriate in the clinical setting. Age and developmentally appropriate psychoacoustic testing and acoustic impedance testing (tympanometry) were performed on the same day. ISO 389, ISO 8253–1, and ISO 8253–2 standards were used. The type of hearing impairment was defined according to hearing levels with a screening level of 20 dB, tympanometry findings, and clinical investigation findings. Hearing loss was defined according to clinical definitions: pure-tone average (0.5–4 kHz) >20 dB hearing level. The number of children and ears with in situ tympanostomy tubes was reported.
Telemedicine beyond the pandemic: challenges in the pediatric immunology clinic
Published in Expert Review of Clinical Immunology, 2023
Aarti Pandya, Sonya Parashar, Morgan Waller, Jay Portnoy
A variety of implementations of telemedicine currently are in widespread use. The most common is synchronous video telepresence which consists of encounters between a provider and patient, often referred to as virtual visits [18]. Prior to COVID 19, most of these encounters were restricted to facilitated visits in which a patient travels to a nearby clinic termed ‘the originating site.’ From there, they could speak with a provider at a different location termed ‘the distant site.’ This interaction relied on the clinic’s technology and the assistance of a tele-facilitator (usually a trained nurse or respiratory therapist). During facilitated visits, digital equipment could be used to transmit relevant aspects of a physical exam to the provider [19]. Common uses of this technology include a digital otoscope to examine the tympanic membrane, a high-resolution camera for oral and skin examination, a digital stethoscope to auscultate heart and breath sounds and there is even a digital fundoscope which permits examination of a patient’s retina. The assumption underlying facilitated visits is that a facilitator is required at the patient’s location to operate the technology and that a physical exam is necessary for a valid medical encounter to take place.
Related Knowledge Centers
- Auricle
- Ear Canal
- Eardrum
- Medical Device
- Ear
- Earwax
- Magnifying Glass
- Speculum
- Pneumatic Otoscopy
- Ophthalmoscopy