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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Surgery to remove the obstructing ear canal bone is usually performed under general anesthesia in an operating room and aided by the use of a binocular microscope. Most ear surgeons use a drill to remove the bone and may approach the area directly via the ear canal or by making an incision behind the ear and dissecting the ear forward. In using a drilling technique it is important to keep the thin inner ear canal skin away from the drill to preserve the skin and allow optimal skin coverage at the conclusion of the surgery.
Some doctors now prefer to use 1 millimeter chisels to remove the obstructing bone and enter directly through the ear canal. This technique enhances skin preservation. This technique may, in some cases, be performed under sedation with local anesthesia.
During recuperation from surgery it is extremely important not to expose the ear canal to water to minimize the chance of infection or complications.
Depending on the condition of the ear canal and the surgical technique used, the ear canal may require several weeks to several months to heal.
Unprotected exposure of ear canals to cold water and wind after treatment can lead to regrowth of bone and the need for repeated operations on the same ear.
Courses of treatment typically include the following:
- Draining the pus once awhile as it can build up a strong odor
- Antibiotics when infection occurs.
- Surgical excision is indicated with recurrent fistular infections, preferably after significant healing of the infection. In case of a persistent infection, infection drainage is performed during the excision operation. The operation is generally performed by an appropriately trained specialist surgeon e.g. an otolaryngologist or a specialist General Surgeon.
- The fistula can be excised as a cosmetic operation even though no infection appeared. The procedure is considered an elective operation in the absence of any associated complications.
The widespread use of wetsuits has allowed people to surf in much colder waters, which has increased the incidence and severity of surfer's ear for people who do not properly protect their ears.
- Avoid activity during extremely cold or windy conditions.
- Keep the ear canal as warm and dry as possible.
- Ear plugs
- Wetsuit hood
- Swim cap
- Diving helmet
Because an acute hematoma can lead to cauliflower ear, prompt evacuation of the blood is needed to prevent permanent deformity. The outer ear is prone to infections, so antibiotics are usually prescribed. Pressure is applied by bandaging, helping the skin and the cartilage to reconnect. Without medical intervention the ear can suffer serious damage. Disruption of the ear canal is possible. The outer ear may wrinkle, and can become slightly pale due to reduced blood flow; hence the common term "cauliflower ear". Cosmetic procedures are available that can possibly improve the appearance of the ear.
Conservative treatment for bunions include changes in footwear, the use of orthotics (accommodative padding and shielding), rest, ice, and pain medications such as acetaminophen or nonsteroidal anti-inflammatory drugs. These treatments address symptoms but do not correct the actual deformity. If the discomfort persists and is severe or when aesthetic correction of the deformity is desired, surgical correction by an orthopedic surgeon or a podiatric surgeon may be necessary.
Patients are advised to treat with bed rest and avoiding activities that increase intracranial pressure (i.e. weightlifting, valsalva, scuba diving, flying in airplanes) with the hopes of the membrane healing on their own. Appropriate Physical therapy / vestibular rehabilitation techniques can be helpful in managing symptoms of movement sensitivity.
Orthotics are splints or regulators while conservative measures include various footwear like gelled toe spacers, bunion/toe separators, bunion regulators, bunion splints, and bunion cushions. There are a variety of available orthotics (or orthoses) including over-the-counter or off-the-shelf commercial products and as necessary, custom-molded orthotics that are generally prescribed medical devices.
Hearing aids are a common treatment for hearing loss disorders. A more specific treatment is surgical, involving excision of the sclerotic areas and then further repair of the ossicular chain. There are several techniques, sometimes involving two surgeries; success rates are, however, variable. Damage to the inner ear as a result of surgical procedures is a possible and serious concern, as it can result in forms of sensorineural deafness.
There is some low quality evidence suggesting that mometasone may lead to symptomatic improvement in children with adenoid hypertrophy.
Surgical removal of the adenoids is a procedure called adenoidectomy. Carried out through the mouth under a general anaesthetic, adenoidectomy involves the adenoids being curetted, cauterised, lasered, or otherwise ablated. Adenoidectomy is most often performed because of nasal obstruction, but is also performed to reduce middle ear infections and fluid (otitis media). The procedure is often carried out at the same time as a tonsillectomy, since the adenoids can be clearly seen and assessed by the surgeon at that time.
These are intended to improve Eustachian tube function. Adenoidectomy can improve middle ear function and nasal steroid sprays can reduce adenoid size but it is not known whether these treatments alter tympanic membrane retraction.
Enlargement of the Eustachian tube opening in the nose with laser or balloon dilatation is being evaluated as a potential treatment for tympanic membrane retraction.
The treatment will vary with the different grades, but the most common is a surgical repair. The surgical option is cosmetic reconstruction of the external ear's normal shape and repair of the ear canal. In less severe cases the reconstruction will be sufficient to restore hearing. In grades of anotia/microtia that affect the middle ear the surgery with the use of a Bone Anchored Hearing Aid (BAHA) will likely restore the hearing. The BAHA may be surgically implanted onto the skull which would allow for some hearing repair by conduction through the skull bone. "This allows sound vibrations to travel through bones in the head to the inner ear."
BAHA: An implantable hearing device. It is the only hearing aid device that works via direct bone conduction.
There are many different treatments for ingrown hairs:
- They can be removed with tweezers (though this can be painful) or dislodged with a rotable medical device for ingrown hairs.
- Some people who chronically get ingrown hairs use laser treatment or electrolysis to completely prevent hair growth.
- There are different products that prevent or cure ingrown hairs. Some are alcohol-based, while others are alcohol-free. For some, alcohol can cause skin irritation and thus alcohol-free products may be preferred.
- Prophylactic treatments include twice daily topical application of diluted glycolic acid.
- Applying salicylic acid solution is also a common remedy for ingrown hairs caused by waxing or shaving.
- Use an exfoliating glove in the shower and exfoliate the area every day.
Other treatments include putting a warm washcloth over the ingrown hair, shaving in a different direction, exfoliating with facial scrubs, brushes, sponges, towels, salves, or creams containing acids, and ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs).
The most common treatment is the acne medication isotretinoin. It may be combined with prednisone. Dapsone, which is normally used to treat leprosy, is a riskier medication but is sometimes prescribed in cases where the normal therapy is ineffectual. Antibiotics such as tetracycline or erythromycin may also be prescribed. An alternative option is to treat with carbon dioxide laser therapy, followed by topical tretinoin therapy.
Surgery may be necessary to remove large nodules. Alternatively, nodules can be injected with corticosteroids such as triamcinolone.
This can be done by annual evaluations by multidiciplinary team involving otolaryngologist, clinical geneticist, a pediatrician, the expertise of an educator of the deaf, a neurologist is appropriate.
Earlier workers suggested the use of calcium fluoride; now sodium fluoride is the preferred compound. Fluoride ions inhibit the rapid progression of disease. In the otosclerotic ear, there occurs formation of hydroxylapatite crystals which lead to stapes (or other) fixation. The administration of fluoride replaces the hydroxyl radical with fluoride leading to the formation of fluorapatite crystals. Hence, the progression of disease is considerably slowed down and active disease process is arrested.
This treatment cannot reverse conductive hearing loss, but may slow the progression of both the conductive and sensorineural components of the disease process. Otofluor, containing sodium fluoride, is one treatment. Recently, some success has been claimed with a second such treatment, bisphosphonate medications that inhibit bone destruction. However, these early reports are based on non-randomized case studies that do not meet standards of clinical trials. There are numerous side-effects to both pharmaceutical treatments, including occasional stomach upset, allergic itching, and increased joint pains which can lead to arthritis. In the worst case, bisphosphonates may lead to osteonecrosis of the auditory canal itself. Finally, neither approach has been proven to be beneficial after the commonly preferred method of surgery has been undertaken.
The treatment of branchio-oto-renal syndrome is done per each affected area (or organ). For example, a person with hearing problems should have appropriate supports and prompt attention for any inflammation of the ear.
A specialist should observe any kidney problems. Surgical repair may be needed depending on the degree of a defect or problem, whether a transplant or dialysis is needed.
Conservative management of minor cases involves icing, a firm compression bandage, and avoidance of the aggravating activity. This can also be augmented with oral or topical anti-inflammatory medications such as NSAIDs. Elbow padding can also be used for symptomatic relief. Treatment for more severe cases may include the excess bursa fluid with a syringe (draining of the bursa), or injecting into the bursa a hydrocortisone type medication which is aimed at relieving the inflammation and preventing further accumulation of fluid.
In case of infection, the bursitis should be treated with an antibiotic.
If the fluid continues to return after multiple drainings or the bursa is constantly causing pain to the patient, surgery to remove the bursa is an option. The minor operation removes the bursa from the elbow and is left to regrow but at a normal size over a period of ten to fourteen days. It is usually done under general anesthetic and has minimal risks. The surgery does not disturb any muscle, ligament, or joint structures. To recover from surgical removal, a splint will be applied to the arm to protect the skin. Exercises will be prescribed to improve range of motion.
Cholesteatoma is a persistent disease. Once the diagnosis of cholesteatoma is made in a patient who can tolerate a general anesthetic, the standard treatment is to surgically remove the growth.
The challenge of cholesteatoma surgery is to permanently remove the cholesteatoma whilst retaining or reconstructing the normal functions of the structures housed within the temporal bone.
The general objective of cholesteatoma surgery has two parts. It is both directed against the underlying pathology and directed towards maintaining the normal functions of the temporal bone. These aims are conflicting and this makes cholesteatoma surgery extremely challenging.
Sometimes, the situation results in a clash of surgical aims. The need to fully remove a progressive disease like cholesteatoma is the surgeon's first priority. Preservation of hearing is secondary to this primary aim. If the disease can be removed easily so that there is no increased risk of residual disease, then the ossicles may be preserved. If the disease is difficult to remove, so that there is an increased risk of residual disease, then removal of involved ossicles in order to fully clear cholesteatoma has generally been regarded as necessary and reasonable.
In other words, the aims of cholesteatoma treatment form a hierarchy. The paramount objective is the complete removal of cholesteatoma. The remaining objectives, such as hearing preservation, are subordinate to the need for complete removal of cholesteatoma. This hierarchy of aims has led to the development of a wide range of strategies for the treatment of cholesteatoma.
Once diagnosed, the gap in the temporal bone can be repaired by surgical resurfacing of the affected bone or plugging of the superior semicircular canal. These techniques are performed by accessing the site of the dehiscence either via a middle fossa craniotomy or via a canal drilled through the transmastoid bone behind the affected ear. Bone cement has been the material most often used, in spite of its tendency to slippage and resorption, and a consequent high failure rate; recently, soft tissue grafts have been substituted.
Headgear called a "scrum cap" in rugby, or simply "headgear" or earguard in wrestling and other martial arts, that protects the ears is worn to help prevent this condition. For some athletes, however, a cauliflower ear is considered a badge of courage or experience.
There are various methods to treat otosclerosis. However the method of choice is a procedure known as Stapedectomy.
Early attempts at hearing restoration via the simple freeing the stapes from its sclerotic attachments to the oval window were met with temporary improvement in hearing, but the conductive hearing loss would almost always recur. A stapedectomy consists of removing a portion of the sclerotic stapes footplate and replacing it with an implant that is secured to the incus. This procedure restores continuity of ossicular movement and allows transmission of sound waves from the eardrum to the inner ear.
A modern variant of this surgery called a stapedotomy, is performed by drilling a small hole in the stapes footplate with a micro-drill or a laser, and the insertion of a piston-like prothesis. The success rate of either surgery depends greatly on the skill and the familiarity with the procedure of the surgeon. However, comparisons have shown stapedotomy to yield results at least as good as stapedectomy, with fewer complications, and thus stapedotomy is preferred under normal circumstances.
Cysts can be removed by excision.
In case of fronto-ethmoidal epidermoid cysts, surgical resection appears to be the mainstay of treatment; however, the extent of resection is dictated by adherence of the tumor capsule to the surrounding vital structures.
Hydrogen peroxide gel (HO) was previously recommended for cyst treatment, particularly those on body piercings. However the gel cannot adequately permeate the cyst and was not found to be effective. Hydrogen peroxide is no longer recommended for wound care by doctors as it can damage the healing tissues.
On body piercings, self treatment with a hot saline soak to help drain the cyst and the use of an antibacterial or medicated talcum powder (Use of talc is no longer recommended due to recently discovered associations with multiple cancers.) to help dry out the bump and reduce bacterial proliferation is generally recommended until medical advice can be obtained. Piercings, however, are more likely to be victims of hypertrophic scarring than a cyst. Cheek piercings seem to be the piercing most prone to cysts due to the possible interruption of saliva ducts.
The age when outer ear surgery can be attempted depends upon the technique chosen. The earliest is 7 for Rib Cartilage Grafts. However, some surgeons recommend waiting until a later age, such as 8–10 when the ear is closer to adult size. External ear prostheses have been made for children as young as 5.
For auricular reconstruction, there are several different options:
1. "Rib Cartilage Graft Reconstruction:" This surgery may be performed by specialists in the technique. It involves sculpting the patient's own rib cartilage into the form of an ear. Because the cartilage is the patient's own living tissue, the reconstructed ear continues to grow as the child does. In order to be sure that the rib cage is large enough to provide the necessary donor tissue, some surgeons wait until the patient is 8 years of age; however, some surgeons with more experience with this technique may begin the surgery on a child aged six. The major advantage of this surgery is that the patient's own tissue is used for the reconstruction. This surgery varies from two to four stages depending on the surgeon's preferred method. A novel one stage ear reconstruction technique is performed by a few select surgeons. One team is able to reconstruct the entire external ear and ear canal in one operation.
2. "Reconstruct the ear using a polyethylene plastic implant (also called Medpor):" This is a 1–2 stage surgery that can start at age 3 and can be done as an outpatient without hospitalization. Using the porous framework, which allows the patient's tissue to grow into the material and the patient's own tissue flap, a new ear is constructed in a single surgery. A small second surgery is performed in 3–6 months if needed for minor adjustments. This surgery should only be performed by experts in the techniques involved. The use of porous polyethylene implants for ear reconstruction was initiated in the 1980s by Alexander Berghaus.
3. "Ear Prosthesis:" An auricular (ear) prosthesis is custom made by an anaplastologist to mirror the other ear. Prosthetic ears can appear very realistic. They require a few minutes of daily care. They are typically made of silicone, which is colored to match the surrounding skin and can be attached using either adhesive or with titanium screws inserted into the skull to which the prosthetic is attached with a magnetic or bar/clip type system. These screws are the same as the BAHA (bone anchored hearing aid) screws and can be placed simultaneously. The biggest advantage over any surgery is having a prosthetic ear that allows the affected ear to appear as normal as possible to the natural ear. The biggest disadvantage is the daily care involved and knowing that the prosthesis is not real.