#otolaryngology case reports

[literaturepublisher]

Insights and Innovations: The Importance of Case Reports in Otolaryngology

Case reports are an important part of medical research and education, providing valuable insights into the diagnosis, treatment, and management of a wide range of medical conditions. In the field of otolaryngology, case reports play a crucial role in advancing our understanding of the many conditions that affect the ear, nose, and throat.

What are case reports in otolaryngology?

A case report is a detailed description of a particular patient’s medical condition and treatment. In otolaryngology, case reports typically focus on conditions that affect the ear, nose, and throat, such as hearing loss, sinusitis, laryngeal cancer, and more.

Case reports provide valuable insights into the diagnostic process, treatment decisions, and patient outcomes, allowing other medical professionals to learn from real-world examples and apply that knowledge to their own practice.

Why are case reports important in otolaryngology?

There are several reasons why case reports are important in otolaryngology. First, they provide a unique opportunity to learn from real-world examples. By studying case reports, medical professionals can gain a better understanding of the many conditions that affect the ear, nose, and throat, including rare and unusual cases that may not be well-documented in the medical literature.

Second, case reports can help guide clinical decision-making. By analyzing the diagnostic process, treatment decisions, and patient outcomes in a particular case, medical professionals can learn what works and what doesn’t, and make more informed decisions in their own practice.

Finally, case reports can help advance our understanding of the underlying biology and mechanisms of disease in otolaryngology. By studying individual cases in detail, researchers can identify new avenues for investigation and develop new treatments and therapies.

What can we learn from case reports in otolaryngology?

There are many things that we can learn from case reports in otolaryngology. For example, case reports can help us:

Understand the diagnostic process for a particular condition

Learn about new or innovative treatments and therapies

Identify risk factors and potential complications associated with a particular condition or treatment

Gain insights into patient outcomes and quality of life

Identify areas for further research and investigation

Case reports also play an important role in medical education, providing valuable learning opportunities for medical students, residents, and practicing physicians. By studying case reports, medical professionals can gain a better understanding of the many conditions that affect the ear, nose, and throat, and develop the skills and knowledge they need to provide the best possible care for their patients.

Conclusion

Case reports are an important part of medical research and education, providing valuable insights into the diagnosis, treatment, and management of a wide range of medical conditions. In otolaryngology, case reports play a crucial role in advancing our understanding of the many conditions that affect the ear, nose, and throat, and helping medical professionals develop the skills and knowledge they need to provide the best possible care for their patients.

If you looking for Case Reports in Otolaryngology contact or visit us!

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[jcsmicasereports]

In Hindsight, A Deafening Diagnosis by Ecler Jaqua in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Dizziness is a common presentation to the outpatient, primary care physician. Its persistence, associated with hearing changes, should prompt further evaluation for more rare diagnoses such as an acoustic neuroma. Although not malignant, timely management of an acoustic neuroma is essential to prevent chronic facial paresthesia, pain, or taste disturbance, and more rarely death.

CASE PRESENTATION

This is a sample text. You can click on it to edit it inline or open the element options to access additional options for this element.

A 34-year-old female presents to the primary care physician with a 2-week history of fatigue, generalized headache, intermittent right-sided tinnitus, and dizziness that started abruptly after a dental procedure. Tinnitus is high-pitched and most often noted in the morning. The dizziness occurs mainly when changing from a supine to seated position. She has no pertinent medical history, engages in regular cardiovascular exercise but is plagued with an addiction to coffee, approximately 3 cups a day. She denies taking any medications or over-the-counter supplements.

Physical exam, including vital signs and orthostatic blood pressure measurement, is unremarkable. Differential diagnoses included benign positional vertigo and caffeine-induced headache. Plan was to obtain an audiogram, keep a headache diary, decrease caffeine consumption, and improve hydration on days of exercise.

While awaiting the audiogram, the patient presented again to her primary care physician for worsening fatigue and self-diagnosed anxiety, in addition to her stable dizziness, tinnitus, and headache. Physical exam was, once again, unremarkable. Differential diagnoses were expanded to include anemia, thyroid disorder, and vestibular migraine. Plan was to trial sumatriptan and begin laboratory evaluation for her fatigue and hair loss. Labs were unremarkable for anemia, electrolyte or vitamin imbalance, and thyroid disorder.

Almost one year later, the patient returns with persistent symptoms of fatigue, anxiety, tinnitus, dizziness, and intermittent headaches. She reports that her symptoms were overwhelming and affected all aspects of her life, not relieved with the sumatriptan. Physical exam, once again, was unremarkable. Differential diagnoses were again expanded to include Meniere’s disease, intracranial mass, and somatization disorder. Plan was to obtain the previously ordered audiogram, non-urgent magnetic resonance imaging (MRI) of her brain, and consultations with Psychology for coping techniques and Otolaryngology for her tinnitus and dizziness.

THE DIAGNOSIS

The audiogram was notable for asymmetric hearing loss (Fig 1) and subsequent imaging with MRI Brain confirmed the diagnoses of a 5mm intracanalicular tumor, suggestive of acoustic neuroma (Fig 2). The patient was offered proton therapy but elected for definitive, surgical intervention with Neurosurgery. She underwent translabyrinthine resection of the intracanalicular acoustic neuroma. Her postoperative course was complicated by facial weakness but resolved after one year. Follow-up imaging confirmed complete tumor resection and she continues to do well two years after surgery, without recurrence of the acoustic neuroma.

THE DISCUSSION

Headaches, dizziness, and tinnitus are challenging concerns because the differential diagnoses are quite broad. In this case, since the patient presents often, the symptoms were more likely to be acute and the more common diagnoses of benign paroxysmal positional vertigo, vestibular migraine, and caffeine-induced headache were considered. As the symptoms became more persistent, the clinician correctly broadened the differential diagnoses list and requested the appropriate imaging and specialty follow-up.

This patient’s diagnosis, a right-sided acoustic neuroma, was delayed by poor follow-up and procrastination in obtaining the audiogram.  Fortunately, the acoustic neuroma is a slow-growing, benign tumor that develops from schwannoma cells along the branches of cranial nerve VIII, the vestibulocochlear nerve.1 Acoustic neuroma is also known as vestibular neuroma or schwannoma, most commonly affecting individuals between 65 and 74 years old with a prevalence of 1 in 100,000.2,3,4 The most common risk factor is having a history of neurofibromatosis type 2 or exposure to high-dose radiation.5 Increased prevalence, over the last several years, has been attributed to advanced imaging technology.3 Although it is a slow-growing tumor, its growth can compresses the facial and trigeminal nerves causing facial paresthesia, pain, and taste disturbance.6 Rarely, the tumor can compress the brainstem and cause death.6,7 It can be monitored for growth or treated with radiation and/or surgery.

THE TAKEAWAY

Unfortunately, the etiology of patients’ concerns cannot always be determined. But, it should be the responsibility of the primary care physician to evaluate potentially life-threatening conditions for persistent symptoms. This case demonstrates balancing the common with the uncommon differential diagnoses and illustrates the patient’s role in adherence to the treatment plan. Although headaches, dizziness, and tinnitus are non-specific symptoms, the persistence of them should warrant further investigation with more advanced imaging and specialty consultation.

[wellnessweb]

Understanding the Microcatheters Market Size: Demand and Supply Dynamics

The Microcatheters Market Size was valued at USD 1.98 billion in 2022, and is expected to reach USD 2.71 billion by 2030 and grow at a CAGR of 4% over the forecast period 2023-2030.The microcatheters market is witnessing robust growth, driven by advancements in minimally invasive procedures and an increasing prevalence of cardiovascular diseases. These sophisticated, small-diameter catheters are essential in navigating the complex vascular pathways for diagnostic and therapeutic purposes, including neurovascular, coronary, and peripheral interventions. Technological innovations, such as improved flexibility, enhanced visibility under imaging, and specialized designs for targeted delivery of treatments, are propelling market expansion. Additionally, rising healthcare expenditure, an aging population, and heightened awareness of less invasive surgical options further fuel the demand for microcatheters across the globe.

Get Sample Copy Of This Report @ https://www.snsinsider.com/sample-request/2616

Market Scope & Overview

The analysis examines the market's main motivating and inhibiting factors, as well as recent trends and upcoming developments. In-depth analysis of the Microcatheters Market 's size, revenue, production, consumption, gross margin, pricing, and market-influencing aspects is provided in this research report. The market research report includes a comprehensive market analysis for the anticipated time frame.

The industry experts looked into a number of other sectors where manufacturers might do well in the future. The micro- and macroeconomic variables that can affect market demand are thoroughly examined in the Microcatheters Market  research report. The level of competition in the target market is rising as a result of competition in this industry between large and small businesses of all sizes.

Market Segmentation Analysis

By Product Type

Delivery Microcatheters

Aspiration Microcatheters

Diagnostic Microcatheters

Steerable Microcatheters

By Product Design

Single-Lumen Microcatheters

Dual-Lumen Microcatheters

By Application

Cardiovascular

Neurovascular

Peripheral Vascular

Oncological

Urological

Otolaryngological

By End User

Hospitals, Surgical Centers, and Specialty Clinics

Ambulatory Surgical Centers

COVID-19 Pandemic Impact Analysis

The recent research examines the growth potential of the Microcatheters Market  as well as the consequences of the ongoing COVID-19 situation. The report also includes a thorough case study analysis of significant industrial players' actions throughout the pandemic.

Regional Outlook

For stakeholders looking for new regional markets, geographic Microcatheters Market  research is an excellent resource. It helps readers understand the traits and development patterns of diverse geographic marketplaces.

Competitive Analysis

The research report goes in-depth on the filmographies, growth objectives, and business strategies of the major market players. Its statistical study of the world's Microcatheters Market  includes information on CAGR, market share, revenue, volume, and other crucial metrics. The broad worldwide market intelligence research is part of the target market investigation.

Key Reasons to Purchase to Microcatheters Market  Report

In order to significantly increase their market share and their global footprint, the top rivals, according to the study, engaged in mergers and acquisitions, collaborations, joint ventures, partnerships, product launches, and agreements.

The target market report comprises a company profile, financial information, a SWOT analysis, and a full examination of competitors in the market.

Conclusion

The competitive landscape and business models of the sector's top rivals may be better understood by industry participants with the use of Microcatheters Market  research. It will be useful if this report can help market participants get a competitive edge and make wise business decisions.

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[galynakhrushch]

In 1849, American surgeon Simon Hullihen performed the first orthognathic surgery. He reported a case involving the surgical correction of a prognathic mandibular open bite deformity caused by severe scar contractures from neck and chest burns. Hullihen conducted a staged reconstruction, including a V-shaped wedge ostectomy and the setback of the anterior mandible through an intraoral approach.

[prayagspeech]

Can you provide references or patient testimonials that highlight successful outcomes related to ENT treatments?

I don't have direct access to specific patient testimonials or references as my training data only includes information up until January 2022, and I don't have browsing capabilities to access real-time or specific medical databases. However, I can guide you on where you might find such information:

Medical Journals and Publications: Journals like the American Journal of Otolaryngology, ENT Journal, and others often publish studies and case reports detailing successful outcomes of ENT treatments. These often include patient testimonials or summaries of patient experiences.

Hospital and Clinic Websites: Many healthcare institutions publish patient stories or testimonials on their websites, which can provide insights into successful ENT treatments from best ENT doctor in Prayagraj.

Health Forums and Support Groups: Websites like patient.info, HealthUnlocked, or specific ENT-related forums sometimes feature patient testimonials or discussions on treatment outcomes.

Social Media and Review Sites: While not always scientifically validated, platforms like Facebook groups, Reddit, or health-related review sites might have anecdotal stories from patients sharing their experiences with ENT treatments.

Consulting with an ENT Specialist: If you're looking for specific success stories related to a particular treatment or condition, consulting with an ENT specialist directly can often provide firsthand accounts or direct you to resources.

When exploring patient testimonials or success stories, it's important to consider the source, ensure privacy and consent, and verify the credibility of the information provided, especially when making healthcare decisions.

[xtruss]

Why Do Some People Sneeze So Loudly? Whatever You Do, Don't Try To Hold In Your Ah-Choo.

— By RJ Mackenzie | June 29, 2024

Sneezing is a Vital Human Function, No Matter the Volume. Image: Popular Science Composite, DepositPhotos and DepositPhotos

When I sneeze, everyone knows about it. The resulting shockwave wobbles windows, awakens sleeping animals, and sets nearby humans on edge. My partner, who sneezes like a vole hiccuping, insists I do this on purpose. I maintain that the urge to sneeze at this decibel level is irresistible. Why do some people sneeze so loudly?

What Happens When We Sneeze?

Let’s establish one thing first: Sneezing is important for the body. “The nose is an air filter for the lungs,” says Mas Takashima, the chair of the Department of Otolaryngology, Head and Neck Surgery at Houston Methodist Academic Institute. Inside our nose is a tight mesh of epithelial cells (a multipurpose cell found all over the body), tiny hairs, and thick mucus. These elements, says Takashima, “trap particulates so that the lungs can be protected.” When those particulates build up, they need to be flushed out.

There are also populations of immune cells in our nose, which wake up when they detect high levels of sneeze-inducing compounds. “Some of the chemicals that are made as a consequence of that immune response cause changes in the lining of our nose,” says Sheena Cruickshank, a professor in the University of Manchester’s Division of Immunology. Those changes will be familiar to anyone who has endured a pollen-laden summer or phlegmy winter. The body makes more mucus, swelling starts in the nose, and signals are sent to the brain via the trigeminal nerve, which provides sensation to the face. This signal is processed by an area at the base of our brain called the medulla oblongata, resulting in reflexive muscle contractions. This all leads to a sneeze. But while the causes of sneezing vary, there’s no reason a virus should produce a louder sneeze than grass pollen, says Cruickshank.

What Makes Some Sneezes Louder?

Instead, the key to sneezing volume lies in the structure of our respiratory system. The first step of the sneeze reflex, says Takashima, involves deep inhalation. “

You need that air to be able to expel everything out,” he adds. While air is sucked into our lungs, our vocal cords close tightly. Once enough pressure has built up in our lungs, all the air is expelled. “It is that gush of air that’s pushing through the vocal cords that creates the sound of the sneeze,” says Takashima. The shape and “floppiness” of our vocal cords and other soft tissue at the back of the throat influence whether or not we have a quiet or booming sneeze. Lung volume also determines how much air enters and leaves our chest during a sneeze, meaning no single physical measurement will predict sneeze volume. “Some people with big lung volumes have very petite sneezes,” says Takashima.

Can I blame my resonant throat the next time I rip space-time with a sneeze? Unfortunately, Takashima says it isn’t that simple. “There’s societal norms or cultural factors that can influence the sound of a sneeze,” he says.

How To Sneeze Quietly

Takashima points out that in Japan, where there is a heavy cultural emphasis on not inconveniencing others, people manage to suppress their sneezes. The key here, he says, is to minimize the amount of resonant energy flowing through your oral cavity–in simple terms, closing your mouth. This, he says, will reduce the volume of your sneeze.

Is the solution to this deafening problem really that simple? A look at the medical literature suggests that sneeze suppression may be a surprisingly bad idea. A case study from a hospital in the Belgian city of Liège is a cautionary tale. During the peak of the COVID-19 pandemic–when loud sneezing did not go down well in public–a 38-year-old man reported pain and swelling in his face after holding back a sneeze. A scan revealed he had fractured his sinus. Takashima backs this up. “By suppressing a sneeze, you can cause some medical issues such as nose bleeds,” he says. “You can force air up the Eustachian tube, possibly causing issues with your eardrum.”

But the next time you find a dust mote tickling your throat in a library, or while a pet sleeps comfortably nearby, there is an alternative to a loud sneeze. “There are times where you don’t want to make a scene or you want to try to keep it as quiet as possible,” says Takashima. “Keeping your mouth closed as you sneeze can definitely do that.”

[chocolatedetectivehottub]

Laryngologia,

Laryngologia,

The Journal of Laryngology & Otology (JLO) is a prestigious, peer-reviewed medical journal that has been at the forefront of otolaryngology research since its inception in 1887. Initially known as The Journal of Laryngology and Rhinology, it has undergone several name changes, reflecting its expanding focus and scope over the years.

Scope and Content JLO publishes a wide range of content relevant to the fields of otology, rhinology, and laryngology. The journal features original scientific articles, clinical records, review articles, historical perspectives, case reports, and short reports. It also includes sections on radiology, pathology, oncology, abstracts, book reviews, letters to the editor, general notes, and operative surgery techniques​ (The Journal of Laryngology & Otology)​​ (Cambridge)​.

Global Reach and Contribution While the journal has its roots in the UK, it has a global outlook, accepting contributions from around the world. This international perspective ensures that the content is relevant to ENT specialists and trainees globally. JLO has become a definitive reference source in its field, known for its comprehensive and fully illustrated articles​ (Cambridge)​​ (ScimagoJR)​.

Editorial and Submission Process The journal's editorial board consists of renowned experts in the field, ensuring high-quality peer review and editorial standards. Authors wishing to submit their work can find detailed instructions on the JLO website and the Cambridge University Press site. The submission process is facilitated through an online platform, making it convenient for researchers worldwide to contribute​ (Cambridge)​​ (The Journal of Laryngology & Otology)​.

[literaturepublisher23]

Journal of Clinical and Medical Images

Journal of Clinical and Medical Images illustrations is a peer-reviewed, high impact factor medical journal established Internationally which provides a platform to publish Clinical Images, Clinical Case Reports, Medical Case Reports, Case Series (series of 2 to 6 cases) and Clinical Videos pertaining to medical conditions.

Manuscript Submission

Authors are requested to submit their manuscript by using Online Manuscript Submission Portal:

(or) also invited to submit through the Journal E-mail Id: editor.cicrj@literaturepublishers.org

Journal of Clinical Imaging Science Literature Publishers working for the growth of the researchers, scholars and students by publishing their valuable research work and case studies.

Scope of Clinical & Medical Images Journal International journal of medical case reports, hematology images, images in hematology, journals that accept case reports, case reports in hepatology, archives of clinical and medical case reports, journal of clinical case reports impact factor, clinical case reports journal impact factor, journal of otolaryngology head and neck surgery, journals accepting clinical images, journal of dental case reports, gastroenterology journal case report, ophthalmology case report journals, case reports in nephrology and dialysis, gi case report journals, clinical imaging journal impact factor, orthopedic surgery case reports, international journal of clinical case reports, journal of medical diagnostic methods, international journal of dental case reports, eye case reports, clinical case reports international impact factor, scholars journal of medical case reports, journal of invasive cardiology case report, dental case reports journal, journal of medical imaging and case reports impact factor, journal of oral health case reports, journal of clinical images and case reports impact factor, international journal of medical and dental case reports, journal of clinical images and case reports, journal of surgical technique and case report, journal of clinical and medical images impact factor, journal of case reports and medical images, journal of case reports and images in surgery, ophthalmology case studies, clinical journal of gastroenterology and hepatology, Journal of cardiology and cardiovascular medicine, clinical images journal, clinical and medical case reports, International medical case reports journal, case report journal impact factor, clinical images, journal of cardiology cases, clinical case reports journal, surgery case reports, case reports in endocrinology, case reports in orthopedics, journal of clinical case reports, journal of cardiology case reports, journal of laryngology and otology, scholars journal of medical case reports impact factor, case reports ophthalmology, case reports in dentistry, journal of medical cases, cardiology case reports journal, case reports in orthopedic research, journal of clinical imaging science impact factor, gastroenterology case reports, international journal of clinical cardiology impact factor, ophthalmology case reports, impact factor journals of medical case reports, neuro ophthalmology case reports, case reports in hematology, international journal of medical case reports impact factor, clinical case report impact factor, case reports in otolaryngology, clinical case reports journals, endocrinology case reports.

[literaturepublisher10]

Journal of Clinical and Medical Case Reports

Journal of Clinical and Medical Case Reports publishes clinical case reports, medical case series, medical case studies, medical case reports and clinical images for publication that fall under the scope of all clinical and medical studies. Journal of Clinical and Medical Case Reports mainly focuses on symptoms, signs, diagnosis, treatment, and follow-up of patient disease in different areas of the journal in diagnostic case report and treatment.

Journal Homepage: https://www.literaturepublishers.org/

Journal of Clinical and Medical Case Reports is a peer-reviewed open access high impact factor indexed Journal that publishes highly cited research work conducted as case reports in the medical field on various types of diseases, covering their respective clinical journal case reports, medical journal case report, clinical reports, medical case reports, clinical images, clinical case reports, journal of medical case reports and diagnosis issues.

Scope and Keywords: Journal of Clinical and Medical Case Reports, Open Journal of Clinical and Medical Case Reports, Journal of Medical Case Reports, Clinical and Medical Case Reports, Journal of Clinical Images and Medical Case Reports, Journal of Clinical Studies & Medical Case Reports, Journal of Clinical and Medical Case Studies, International Journal of Clinical and Medical Cases, Journal of Clinical Medicine, Clinical Case Reports, International Medical Case Reports Journal, Archives of Clinical and Medical Case Reports, Case Reports - A journal for medical case reports, International Journal of Clinical Case Reports and Reviews, Japanese Journal of Clinical and Medical Case Reports etc.

Journal of Clinical and Medical Case Reports Journal publishes only high quality articles from all over the world. Journal of Clinical and Medical Case Reports follows double blinded peer review process. All Editors are active and Editorial Board Members belonging to reputed institutions from abroad. They are senior faculty members, doctors, scientist and research fellows etc. Journal regularly releasing issues with good number of articles in the form of clinical images and case reports.  

Scope of Clinical and Medical Case Reports Journal Authors can also find this journal in their scope on the basis these keywords: medical case reports journals, journal of medical case reports, clinical image, cardiology case reports, case reports cardiology, case reports in cardiology, case reports pediatrics, pediatrics case reports, ent journal, case reports hematology, hematology case reports, journal of otolaryngology head and neck surgery, orthopaedics & traumatology, case reports gastroenterology, case reports in gastroenterology, gastroenterology case report, clinical case report journal, International journal of surgery case reports, case images, dermatology case reports, case report in ophthalmology, case report ophthalmology, case reports in surgery, clinical image journal, journal of surgical case reports, ophthalmology case report, journal of clinical imaging science, literature publishers, cardiology case report journals, journal of traumatology, case reports in nephrology, case reports nephrology, nephrology case reports, clinical images in medicine, journal of pediatric surgery case reports, medical image analysis journals, journal of medical case reports impact factor, otolaryngology case reports, clinical case reports impact factor, case reports otolaryngology, surgical case reports, journal of orthopedic case reports, case reports in neurological medicine, best case report journals, journal of otology and laryngology and, clinical imaging impact factor etc.

Medical Case Report Journal scope also includes medical advancements with an aim towards special techniques that are implementing in all aspects of the human anatomy journal. The body image journal is running with a strong desire to provide knowledge on recent scientific research and advances in the field of Clinical and Medical Studies. The aim of the clinical imaging journal is to collect an article in the Journal of Clinical and Medical Case Reports across all clinical imaging science, medical imaging science and clinical fields, thereby integrating international medical case reports and clinical knowledge.

We feel honored to associate with and invite scientists and researchers to submit their original research/ medical case report journal/ body imaging journal/ clinical imaging journal/ clinical imaging science in International journal of clinical and medical images and case reports work for publication in literature publishers: journal of clinical and medical case studies and reports. This journal considers articles in the form of a research article, review article, short communication, opinion, Image, Case reports and commentary.

Journal of Clinical and Medical Case Reports covers all the areas of Medical Science Journal that includes: case reports in oncology, oncology case reports journal, case reports in cardiology, journal of cardiology case reports, international journal of surgery case reports, case reports in surgery, journal of surgery case reports, general surgery case report, surgical case reports journal, surgery case reports journal, journal of dermatological case reports, case reports in dermatology, case reports in endocrinology, case reports endocrinology, case reports in gastroenterology, gastroenterology case report journals, case reports in hematology, case reports in nephrology, orthopedic surgery case reports, journal of orthopedic case reports, case reports in pediatrics, journal of pediatric surgery case reports, case reports in microbiology, clinical microbiology case reports, case reports in genetics, case reports in toxicity, case reports in neuroscience, case reports in ophthalmology, case reports in andrology and gynecology, case reports in dentistry, case reports in odontology, case reports in otolaryngology, case reports in ENT, case report in head and neck surgery etc.

Journal of Clinical and Medical Case Reports encourages authors and scientists all over the world to submit their work related to various diseases, clinical trials, radiology, surgery, basic research, epidemiology, and palliative care. At a time when the research on drug delivery is taking place at a tremendous phase.

Manuscript Submission

Authors are requested to submit their manuscript by using Online Manuscript Submission Portal:

(or) also invited to submit through the Journal E-mail Id: editor.cicrj@literaturepublishers.org

[mightyflamethrower]

Horrifying video reveals molting spider rustling in woman's ear

The spider in the woman's ear was making continuous, weird clicking and rustling noises that were so bad, she couldn't sleep.

Scared of spiders? You might want to look away now.

In a bizarre medical case, a woman in Taiwan got a nasty shock when doctors discovered a spider about 0.1 inch (0.25 centimeters) long crawling in her left ear canal. At first glance, it looks like there are two spiders scuttling around in there, but the second arachnid is actually just the spider's molted hard outer shell, or exoskeleton. 

The 64-year-old woman had visited an ear, nose and throat clinic at the Tainan Municipal Hospital in Taiwan after spending four days hearing weird sounds in her left ear. 

The day her symptoms started, she was woken up to a strange feeling that a creature was moving inside her ear. She then began to hear incessant beating, clicking and rustling sounds that were so bad, she struggled to sleep. 

At the hospital, doctors discovered that a small spider with bulging, brown eyes was moving within the ear's external auditory canal, the passageway that links the outside of the ear to the eardrum. They also saw that the spider had molted its ghostly white exoskeleton — something that spiders normally do when they grow so that it can be replaced with a new one. 

"She didn't feel pain because the spider was very small. It's just about 2 to 3 millimeters [0.07 to 0.12 inch]," Dr. Tengchin Wang, co-author of the report and director of the otolaryngology department at Tainan Municipal Hospital, told NBC News. 

The case report, published Oct. 21 in The New England Journal of Medicine, didn't note the species of spider or how the critter might have gotten into the woman's ear. Although these instances are rare, there have been documented cases of spiders crawling into people's ears, and it happens with insects, too: Live insects account for about 14% to 18% of cases of the foreign objects that doctors find in the external auditory canal. This is likely because the area is warm and dark, so it provides a welcoming space for these critters. 

Dr. David Kasle, an otolaryngologist at ENT Sinus and Allergy of South Florida who was not involved in the woman's case, told NBC News that the average ear, nose and throat specialist will see "tens, if not more, of bugs or some sort of arthropod" in ear canals throughout their career. However, he said this particular case was "unusual and disturbing." 

Wang had seen insects — such as ants, moths and cockroaches — in people's ears before, but he'd never come across a spider that had shed its exoskeleton inside a person's ear canal, NBC News reported. 

Wang and his team successfully removed the spider and its exoskeleton from the woman's ear by sucking it out with a thin tube, called a cannula, placed through an otoscope, a tool doctors use to look into the ear. The woman's symptoms vanished after the arachnid was removed. For bigger spiders or insects, a local anesthetic should be used to kill the critter before it's removed to "prevent excessive movements and subsequent damage to the structures of the ear," the case report authors wrote. 

However, liquids should never be used if the eardrum has been pierced and has holes in it, the authors cautioned; this wasn't the case for women in Taiwan. Wang told NBC News that, to be on the safe side, anyone who experiences any of these symptoms should see a doctor even if they think the bug or spider has exited their ear, just in case an antenna or exoskeleton got left behind.  

This article is for informational purposes only and is not meant to offer medical advice.

[world-store]

Spider: Spider in woman's ears: Unusual case for leaves doctors astonished

NEW DELHI: A 64-year-old woman in Taiwan recently found herself in an unusual and unsettling situation when she began hearing strange clicking and rustling sounds coming from within her ear. According to a report in UPI, her discomfort her seek medical attention, and her peculiar case was documented in a report authored by Dr. Tengchin Wang, the director of the otolaryngology department at Tainan…

[lupine-publishers-sjo]

Negative Pathology Report Following Salivary Gland Surgery for Suspected Primary Tumor– What Went Wrong?

Abstract

Objective: For patients undergoing an oncologic surgery, postoperative pathological diagnosis negative for a tumor is a confusing outcome. Additionally, it may carry clinical and medicolegal consequences. The study defines the causes of such discrepancies in order to prevent such instances in the future.

Methods: A retrospective cohort study of patients who had undergone resection of a major salivary gland for a suspected or diagnosed primary tumor but had no tumor on surgical pathology.

Results: Eight patients (2.5%) had negative pathology. Causes for negative pathology were A) Surgical pathology error (n=3) B) Surgical management error (n=1) C) Surgery for definite diagnosis (n=2) D) Unexplained (n=2).

Conclusions: Negative pathology in salivary gland surgery is not rare. Negative pathology should raise the suspicions of both the surgeon and the pathologist. An immediate multidisciplinary review of all data will find the cause in most cases Keywords: Negative pathology; no tumor on pathology; salivary gland tumor; parotid gland tumor

Read More About This Article Click on Below Link: https://lupinepublishers.com/otolaryngology-journal/fulltext/negative-pathology-report-following-salivary-gland-surgery-for-suspected-primary-tumor.ID.000262.php Read More about Lupine Publishers Google Scholar Articles: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=dMOUw-wAAAAJ&https://scholar.google.com/citations?view_op=view_citation&hl=en&user=dMOUw-wAAAAJ&cstart=100&pagesize=100&citation_for_view=dMOUw-wAAAAJ:vD2iS2Kej30C

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Case Reports in Clinical Medicine Journal and Images

Case Reports in Clinical Medicine Journal and Images accepting Clinical Medicine articles, journal of Clinical Medicine case reports, journal publishing Clinical Medicine case reports, images in Clinical Medicine journal, image journal in Clinical Medicine, journal of Clinical Medicine images etc. Case Reports in Clinical Medicine Journal and Images is an International, open access journal which considers case reports in all areas of clinical medicine which advance general medical knowledge. Of particular but not exclusive interest are case reports in the areas of arthritis and musculoskeletal disorders, cardiology, circulatory, respiratory and pulmonary medicine, dermatology, ear, nose and throat and otolaryngology, endocrinology, ethics, health services and epidemiology, gastroenterology, geriatrics, obstetrics and gynaecology, reproduction, women’s health, oncology, pathology, psychiatry, neurology, psychology, and trauma and intensive medicine.

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Case Reports in Clinical Medicine Journal and Images: Visual images are a rich source of the information we use in clinical medicine, yet we expend little effort to enhance our perception and recognition of these images. A new feature introduced in this issue of the Journal, Case Reports in Clinical Medicine Journal and Images, will present a broad representation of useful and clinically important visual images. We believe that exposure to these photographs will help sharpen the reader's ability to identify common forms. As doctors we encounter an enormous variety of images from day to day, including skin lesions, funduscopic views, blood smears, bone marrow smears, urine sediments, microbiologic specimens, joint etc.

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Case Reports in Dentistry - Salford Publishers

Dentistry is the diagnosis, treatment, and prevention of disorders of the teeth, gums, mouth and jaw. Often considered essential for overall oral health, dentistry can affect the health of your entire body.

The Journal of Clinical Images and Case Reports in Dentistry Journal Friend Check, Open Access Journal Case Journal which distributes case reports and case management, case report documents in dental journals over the entire field of dentistry, including dental or case reports odontology, Case Reports in Dentistry, journals, dental Pathology, reported only as oral and maxillofacial medical procedures. 

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Lupine Publishers | The Optimal Pain Management Methods Post Thoracic Surgery: A Literature Review

Abstract

Post-operative pain control is one of the key factors that can aid in fast and safe recovery after any surgical interventions. Thoracic surgery can cause significant postoperative pain which can lead to delayed recovery, delayed hospital discharge and possibly increased risk of chest complications in the form of atelectasis and even lower respiratory infections. Therefore, appropriate pain management following thoracic surgery is mandatory to prevent development of such morbidities including chronic pain.

Keywords: Thoracic Surgery, Analgesia, VATS, Robotics, Thoracotomy

Introduction

Thoracic surgical procedures can result in severe pain which can present as a challenge to be appropriately managed postoperatively. In particular, thoracotomies are well known for their severity of pain due to the incision, manipulation of muscles and ligaments, retraction of the ribs with compression, stretching of the intercostal nerves, possible rib fractures, pleural irritation, and postoperative tube thoracotomy [1]. Recognition of this has contributed to the development of minimally invasive techniques such as video assisted thoracoscopic surgeries (VATS) and lately robotic surgery [1]. These techniques not only aim to produce better aesthetic results, but also reduce post-operative pain and enhance recovery without compromising the quality of treatment offered. Poor pain management can lead to several and serious complications such as lung atelectasis, hypostatic pneumonia due to avoidance of deep breathing in these patients as a result of pain and superimposed infection [1]. Pain management as a result, does not only lead to greater patient satisfaction, but it also reduces morbidity and mortality in patients undergoing thoracic surgery [2]. Historically, post-operative pain management for thoracic surgery involved the use of narcotics alongside parenteral or oral anti-inflammatory agents [2]. Post chest tube removal patients typically are transitioned to oral analgesia. Multiple additional pain control adjuncts were also implemented with differing levels of success [1]. Over time, intra-operative techniques have been developed which aims to target pain reduction postoperatively [2]. As our understanding of both pain management and the factors that play a role in the development of pain has increased, we have been able to target these and improve postoperative pulmonary morbidity and pain scores [1,2]. We aim to review different means of pain control in this paper in order to assess their effectiveness in achieving optimum results.

Thoracotomy

The mechanism of pain in thoracotomy involves the innervation of the intercostal, sympathetic, vagus and phrenic nerves [3]. Additionally, shoulder pain may result from stretching of the joints during the operation.

After a thoracotomy, pain can persist for two months or more, and in certain incidences it recurs after a period of cessation. The incidence of chronic pain post thoracotomy is reported to be 22-67% in the population [4]. Good surgical technique and effective acute post-operative pain treatment are evident means of preventing post-thoracotomy pain and consequent pulmonary complications [4]. Due to the multifactorial character of the pain, a multimodal approach to target pain is advised. Typically, both regional and systemic anaesthesia are administered. A combination of opioids such as fentanyl or morphine are typically used [5]. A variety of techniques for the administration of local anaesthetics are available at present, and the effectiveness of each is assessed in this paper.

a) Thoracic Epidural Analgesia (TEA)

TEA was the most widely used method of means of analgesia. It was the gold standard means of pain relief [6,7]. It is typically inserted prior to general anaesthesia, at the level of T5-T6, midway along the dermatomal distribution of the thoracotomy incision. A study by Tiippana et al. [8] measured the visual analogue scale (VAS) in order to assess the presence of pain during rest and at the time at which they coughed in 114 patients of whom 89 had TEA and 22 who had other methods of pain control. TEA was effective in alleviating pain at rest and during coughing. In TEA patients, the incidence of chronic pain of at least moderate severity was 11% and 12% at 3 and 6 months, respectively. The study found that at one week after discharge, 92% of all patients needed daily pain medication. The study advised for extended postoperative analgesia for up to the week post-discharge to be administered in order to manage this. The study however concluded overall, that TEA was effective in controlling evoked post-operative pain. However, the study did encounter problems of technical form in 24% of the epidural catheters. The incidence of chronic pain, however, was lower compared with previous studies where TEA was not used. Several other studies support that TEA is superior to less invasive methods. According to Shelley B. et al. [9] TEA was preferred by 62% of the respondents over paravertebral block (PVB) with 30% and other analgesic techniques with 8%. Limitations of this technique included hypotension and urinary retention. Certain patients with active infection and on anticoagulation are excluded from epidural placement.

b) Paravertebral Block (PVB)

PVB is considered an effective method for pain management and its use has been increased in the recent years. This technique involves injecting local anaesthetic into the paravertebral space and it is able to block unilateral multi-segmental spinal and sympathetic nerves. Previous studies have shown that it is effective in achieving analgesia and is associated with a lower incidence of side effects such as nausea, vomiting, hypotension and urinary retention [10,11]. As the lungs are collapsed, it is associated with a lower risk of pneumothorax.

In a study by Davies R.G. et al. [10] there was no significant difference in pain scores, morphine consumption and supplementary use of analgesia between TEA and PVB. The rate of failed technique was lower in PVB (OR =0.28, p=0.007). Respiratory function was improved at both 24 and 48 hours with PVB but only significantly improved at 24 hours.

c) Intercostal Nerve Block (ICNB)

ICNBs are generally administered as single injections at least two dermatomes above and below the thoracotomy incision [12]. It is performed percutaneously or under direct vision, using single injections or through placement of an intercostal catheter. It can also be formed using cryotherapy. It is associated with reduced post-operative pain scores; however, it is less effective than TEA in controlling chronic pain [12]. This was illustrated by a study by Sanjay et al. [12] which found that patients that underwent ICNB had higher pain scores 4 hours post-operatively, than those who received epidural anaesthesia using 0.25% bupivacaine (p<0.05). The study concluded that in the early post-operative period there was significant impact in pain relief for both techniques, but thereafter, epidural anaesthesia was proven to significantly reduce post thoracotomy pain over ICNB. Due to the multifactorial nature of post-thoracotomy pain, various approaches are required in order to target pain. ICNBs are useful in the blockade of intercostal nerves, whilst PVB and TEA appear to block the intercostal and sympathetic nerves. Due to the inability of regional anaesthesia to block the vagus and phrenic nerves which are implicated in the pathophysiology of pain, NSAIDs and opioids are required as adjuncts. TEA is proven to be the most effective means of treating pain alongside PVB; however, it is associated with more side effects than PVB. At present, there are a limited number of studies directly comparing pain control and post-operative outcomes between PVB and TEA. There is no conclusive evidence that either method is superior to the other regarding pain control.

Video-Assisted Thoracoscopic Surgery (VATS)

Existing evidence supports the noninferiority of thoracic PVB when compared to TEA for postoperative analgesia [13]. PVB is versatile and may be applied both unilaterally or bilaterally. It can be used to avoid contralateral sympathectomy, consequently minimising hypotension. This is an apparent advantage it has over thoracic epidural. Furthermore, it offers a more favourable side effect profile when compared to epidural anaesthesia. At present, the factors taken into consideration when selecting a regional technique include tolerance of side effects associated with TEA, consensus on best practice/technique, and operator experience [13]. A randomised controlled trial by Kosiński et al. [14] compared the analgesic efficacy of continuous thoracic epidural block and percutaneous continuous PVB in 51 patients undergoing VATS lobectomy. The primary outcome measures were postoperative static (at rest) and dynamic (coughing) visual analogue pain scores (VAS), patient-controlled morphine use and side-effect profile. The study found that pain control (VAS) was superior in the PVB group at 24 hours, both at rest (1.7 vs3.3, p=0.01) and on coughing (5.8 vs 6.6, p=0.023), and control of pain at rest was also superior in the PVB group at 36 hours (3.0 vs 3.7 (p=0.025) and at 48 hours (1.2 vs 2.0, p=0.026). There were no significant differences in the postoperative morphine requirements. In regard to side-effect profile, the study showed that the incidence of postoperative urinary retention (defined as no spontaneous micturition for 8 hours or ultrasound-assessed volume of the urinary bladder >500ml) was greater in the epidural group (64.0% vs 34.6%, p=0.0036), as was the incidence of hypotension (32.0% vs 7.7%, p=0.0031). There was no significant difference in the incidence of atelectasis (4.0% vs 7.7%, p=0.0542). However, the incidence of pneumonia was significantly more frequent in the PVB group (3.8% vs 0%, p=0/0331). Kosiński et al. concluded that PVB is as effective as thoracic epidural block in regard to pain management as it offers a superior safety profile with minimal postoperative complications. A further randomised controlled trial by Okajima et al. [15] compared the requirements for postoperative supplemental analgesia in 90 patients who received wither a PVB or thoracic epidural infusion for VATS lobectomy, segmentectomy or wedge resection. The main outcome measures were pain scores at rest (verbal rating scale 0= none and 10=maximum pain), blood pressure, side effects and overall satisfaction scores relating to pain control (1=dissatisfied and 5=satisfied). The study found a similar frequency of supplemental analgesia (50mg diclofenac sodium suppository or 15mg pentazocine intramuscularly) for moderate pain in both groups, with 56% of those in the PVB group requiring ≥2 doses, compared to 48% in the epidural group (p=0.26). Hypotension, defined as a systolic blood pressure <90mmHg, occurred more frequently in the epidural group (21.2% vs 2.8%, p=0.02). There was no difference in the incidence of pruritus (3.0% vs 0%, p=0.29) and post-operative nausea and vomiting (30.3% vs 25.0%, p=0.62) between both groups. The study found no statistical difference between patient-reported satisfaction in pain control between epidural and PVB using the verbal rating scale (5.0 vs 4.5, p=0.36). The study concluded that PVB offered additional to equivalent analgesia to epidural, a lower incidence of haemodynamic instability postoperatively. A further study by Khoshbin et al. [16] performed an analysis on 81 patients undergoing VATS for pleural aspiration +/- pleurodesis, lung biopsies or bullectomy. The main outcome was postoperative pain levels, documented every 6 hours and scored against the Visual analogue Scale (0= no pain, 10= worst possible pain). In both PVB and epidural groups, bupivacaine 0.125% was the local anaesthetic of choice, with clonidine added to the epidural infusion at 300μg in 500ml. The study showed that there was no significant difference in mean pain scores between PVB or EP (2.1 vs 2.9, p=0.899), therefore concluding that PVB is as effective as epidural in controlling pain post-VATS.

Robotic Lung Surgery

Minimally invasive techniques are considered advantageous over open surgical approaches due to their shorter recovery times, reduced perceived levels of pain post-operatively and shorter postoperative length of stay in hospital [17-19]. Robotic surgery has become a popular method in recent years. Debate remains regarding whether robotic surgery is superior to VATS in regard with pain reduction. A case control study by Louie et al. [19] compared 45 robotic assisted lobectomies (RAL) to 34 VATS lobectomies. The study showed that both groups had a similar mean ICU stay (0.9 vs 0.6 days) and a mean total length of stay (4.0 vs 4.5 days). The study showed that patients that underwent robotic lobectomies had a shorter duration of analgesic use post-operatively (p=0.039) and a shorter time resuming to normal everyday activities (p=0.001). A limitation in this study was an inaccurate record of the amount of pain relief used by the patients, ultimately working as a confounding factor when interpreting the results. In a separate study by Jang et al. [18] 40 patients undergoing RAL were compared retrospectively to 80 VATS patients (40 initial patients and 40 most recent patients), all with resectable non-small cell lung cancer. The study showed that the post-operative median length of stay was significantly shorter in RAL patients compared to the initial VATS patients. The rate of post-operative complications was significantly lower in the RAL group (10%) compared to the initial VATS group (32.5%) and similar to the recent VATS group (17.5%). Post-operative recovery was easier for patients in both the RAL and VATS group due to earlier mobilisation, allowing them to return to their everyday activities quicker. In a retrospective review by Kwon et al. [17] 74 patients undergoing robotic surgery, 227 patients undergoing VATS and 201 patients undergoing anatomical pulmonary resection were assessed and compared with regard to acute (visual pain score) and chronic pain (Pain DETECT questionnaire). The study showed that there was no significant difference in acute or chronic pain between patients undergoing robotic assisted surgery and VATS. Despite no significant difference in pain scores, 69.2% of patients who underwent robotic-assisted surgery felt the approach affected their pain versus 44.2% of the patients who underwent VATS (p=0.0330). These results all support the superiority of robotic surgery over VATS and open approaches with regard to pain, length of hospital stay and recovery times. Both robotic surgery and VATS have their benefits i.e. two-versus three-dimensional view, instrument manoeuvrability, and reduced post-operative pain.

Conclusion

Since post-thoracotomy pain is multifactorial, a multimodal approach is required. In particular, ICNB blocks the intercostal nerves, and PVB and TEA appear to block the intercostal and sympathetic nerves. NSAIDs and opioids are required as valgus and phrenic nerve cannot be blocked by regional anaesthesia. TEA is evident to be the most effective in treating pain alongside with PVB. It is however associated with more side effects than PVB.

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