Charmaine Woods - Academia.edu (original) (raw)

Papers by Charmaine Woods

Research paper thumbnail of Bedside voice assessments cannot be used as a screening test for laryngeal injury following prolonged intubation in an intensive care population

Australian journal of otolaryngology, Apr 1, 2022

Research paper thumbnail of An Observational Pragmatic Quality of Life Study on Paediatric Tonsillectomy and Waiting for Surgery

Introduction Paediatric tonsillectomy performed for sleep disordered breathing or recurrent tonsi... more Introduction Paediatric tonsillectomy performed for sleep disordered breathing or recurrent tonsillitis and the effects on a child’s quality of life symptoms while waiting for surgery in an Australian public health system have not previously been investigated. This study investigated parental perceptions of the effects of tonsillectomy on their child’s quality of life while awaiting tonsillectomy and following surgery. Design, Setting and Participants An observational study was undertaken at a tertiary Australian hospital. Parents of paediatric patients (2 to 16 years of age) listed for tonsillectomy completed a validated quality of life questionnaire (T—14 Paediatric Throat Disorders Outcome Test) at the initial consultation, on day of surgery, 6 weeks post-operatively and 6 months post-operatively. T-14 scores were compared using the Related-Samples Wilcoxon Signed Rank Test. Results Parents of 167 children participated in this study. There was a median wait time of 174 days (IQR ...

Research paper thumbnail of Additional file 1 of Ear microbiota and middle ear disease: a longitudinal pilot study of Aboriginal children in a remote south Australian setting

Research paper thumbnail of Delays in Time to Head and Neck Cancer Treatment: A South Australian Perspective

Medicina, 2022

Background and Objectives: In head and neck cancer, delays in time to treatment are associated wi... more Background and Objectives: In head and neck cancer, delays in time to treatment are associated with poorer clinical outcomes. Within Australia, it is recommended that primary treatment is initiated within 56 days of initial referral. The aim of this study was to assess whether head and neck cancer treatment was delivered within these timeframe guidelines at our institution and identify factors associated with treatment delays. Methods: This retrospective cohort study assessed patients newly diagnosed with head and neck cancer over a 24 months period (2018 to 2019) at Flinders Medical Centre, Australia. Time to treatment intervals were calculated for comparison to local timeframe guidelines. Results: A total of 72 patients met the inclusion criteria. The median time from specialist referral to treatment initiation was 45.5 days (IQR 29–61), with 72% meeting the 56 days guideline. On univariate logistic regression, patients undergoing primary radiotherapy treatment were less likely to...

Research paper thumbnail of 51 Spinal, Not Vagal Mechanosensitive Afferents Innervate the Rat Pancreas

Gastroenterology, 2008

rats with single sc injection of ERα agonist propylpyrazole-triol (PPT; 1, 10, and 100 µg/ kg), E... more rats with single sc injection of ERα agonist propylpyrazole-triol (PPT; 1, 10, and 100 µg/ kg), ERβ agonist diarylpropionitrile (DPN; 1, 10 or 100 µg/kg), GPR30 receptor agonist, G1 (0.1, 1, 10, and 50 µg/kg), or vehicle (10% DMSO) 30 min prior to the 5HTP administration and CRD stimulation. Estrogen receptor antagonist ICI 182,780 (1, 3, and 10 mg/kg, sc) or vehicle were given with estrogen in OVX rats and followed by 5-HTP administration and CRD stimulation. (4) Confocal microscopy examined the collateralization of GPR30 and 5HT3 receptors in dorsal root ganglion (DRG) at L6 and S1 spinal level. Histological examination was done in distal colon for signs of inflammation. Results (1) The 5HTPtreated rats had significantly higher viscero-motor reflex than controls (enhanced VH), while OVX eliminated the hypersensitivity. A single injection of E or E+P, but not P alone, rapidly restored 5HTP-induced VH in 30 minutes. (2) G1 (1 to 50 µg/kg), but not PPT or DPN, can rapidly restore the 5HTP-induced VH in OVX rats. The 5HTP-induced VH can still be observed in OVX rats with the co-administration of ICI 182,780 and E. (3) Collateralization of GPR30 and 5HT3 receptors was seen in DRG neurons. No significant inflammation was noted in the colonic mucosa. Conclusions (1) Estrogen rapidly modulates 5-HTP-induced VH through the new GPR30 receptor, but not the classical ERα or β. (2) DRG may be involved in this rapid physiological response. (3) The future GPR30 receptor antagonist may be a potential pain modulator for female IBS patients.

Research paper thumbnail of Distribution of nitric oxide synthase and vasoactive intestinal polypeptide immunoreactivity in the sphincter of Oddi and duodenum of the possum

Cell and Tissue Research, 2001

The nitrergic innervation of the sphincter of Oddi (SO) and duodenum in the Australian brush-tail... more The nitrergic innervation of the sphincter of Oddi (SO) and duodenum in the Australian brush-tailed possum and the possible association of this innervation with the neuropeptide vasoactive intestinal polypeptide (VIP) were investigated by using immunohistochemical localisation of nitric oxide synthase (NOS) and VIP, together with the general neuronal marker, protein gene product 9.5 (PGP9.5). Whole-mount preparations of the duodenum and attached SO without the mucosa, submucosa and circular muscle (n=12) were double-and triplelabelled. The density of myenteric nerve cell bodies of the SO in the more distal region (duodenal end) was significantly higher than that in the more proximal region. In the SO, approximately 50% of all cells were NOS-immunoreactive (IR), with 27% of the NOS-IR cells being VIP-IR. Within the duodenal myenteric plexus, NOS immunoreactivity was present in about 25% of all neurons, with 27% of these NOS-IR neurons also being VIP-IR, a similar proportion to that in the SO. Varicose nerve fibres with NOS and VIP immunoreactivity were present within the myenteric and submucous plexuses of the SO and duodenum, and in the circular and longitudinal muscle layers. The NOS-positive cells within both the SO and duodenum were unipolar, displaying a typical Dogiel type I morphology. The myenteric plexuses of the SO and duodenum were in direct continuity, with many interconnecting nerve trunks, some of which showed NOS and VIP immunoreactivity. Thus, the possum possesses an extensive NOS innervation of the SO and duodenum, with a significantly higher proportion of NOS-IR neurons within the SO, a subset of which contains VIP.

Research paper thumbnail of Ear microbiota and middle ear disease: a longitudinal pilot study of Aboriginal children in a remote south Australian setting

BMC Microbiology, 2022

Background Otitis media (OM) is a major disease burden in Australian Aboriginal children, contrib... more Background Otitis media (OM) is a major disease burden in Australian Aboriginal children, contributing to serious long-term health outcomes. We report a pilot analysis of OM in children attending an outreach ear and hearing clinic in a remote south Australian community over a two-year period. Our study focuses on longitudinal relationships between ear canal microbiota characteristics with nasopharyngeal microbiota, and clinical and treatment variables. Results Middle ear health status were assessed in 19 children (aged 3 months to 8 years) presenting in remote western South Australia and medical interventions were recorded. Over the two-year study period, chronic suppurative OM was diagnosed at least once in 7 children (37%), acute OM with perforation in 4 children (21%), OM with effusion in 11 children (58%), while only 1 child had no ear disease. Microbiota analysis of 19 children (51 sets of left and right ear canal swabs and nasopharyngeal swabs) revealed a core group of bacteri...

Research paper thumbnail of Risk of Airway Fire with the use of KTP Laser and High Flow Humidified Oxygen Delivery in a Laryngeal Surgery Model

Background Airway surgery presents a unique environment for operating room fire to occur. This st... more Background Airway surgery presents a unique environment for operating room fire to occur. This study aims to explore the factors of combustion when using KTP laser with high flow oxygen in an ex-vivo model. MethodsThe variables tested were varying tissue type, tissue condition, oxygen concentration, laser setting, and smoke evacuation in a stainless-steel model. Outcome measures were time of lasing to the first spark and/or flame. A multivariate Cox proportional hazard model was used to determine the risk of spark and flame across the different risk factors. ResultsFor every 10% increase in oxygen concentration above 60% the risk of flame increased by a factor of 2.3. Continuous laser setting at 2.6W increased the risk by a factor of 72.8. The risk of lasing adipose tissue is 7.3 times higher than that of muscle. Charred tissue increases the risk of flame by a factor of 92.8. Flame occurred without a preceding spark 93.6% of the time. Conclusions Using KTP laser in the pulsed mode w...

Research paper thumbnail of Health Related Quality of Life T-14 Outcomes for Pediatric Bizact Tonsillectomy

Medicina

Objectives: The objective of this study was to assess the T-14 outcomes of the BizactTM device fo... more Objectives: The objective of this study was to assess the T-14 outcomes of the BizactTM device for tonsillectomy in a pediatric population. Methods: A case series chart review was undertaken at a public tertiary teaching hospital and private otolaryngology practice, with data collected from pediatric patients who underwent a BizactTM tonsillectomy between July 2016 and October 2019 for any indication, whose parents consented to completing the T-14 questionnaire providing a parental perspective of the child’s quality of life. Primary outcomes were T-14 scores recorded preoperatively and 6 weeks post-operatively. Secondary outcome measures were postoperative complications, including hemorrhage and readmission. Results: 146 patients were identified. There was a significant improvement in T-14 scores from a median of 24 (Interquartile range (IQR) 18–33) prior to surgery to 2 (IQR 0–4) at 6 weeks postoperatively (p < 0.001). The post-tonsillectomy hemorrhage rate was 6.1% (9/146 parti...

Research paper thumbnail of Development of a non-invasive exhaled breath test for the diagnosis of head and neck cancer

British Journal of Cancer

Background Improving the ability to identify early-stage head and neck squamous cell carcinoma (H... more Background Improving the ability to identify early-stage head and neck squamous cell carcinoma (HNSCC) can improve treatment outcomes and patient morbidity. We sought to determine the diagnostic accuracy of breath analysis as a non-invasive test for detecting HNSCC. Methods Standardised breath samples were collected from 181 patients suspected of HNSCC prior to any treatment. A selected ion flow-tube mass spectrometer was used to analyse breath for volatile organic compounds. Diagnosis was confirmed by histopathology. A binomial logistic regression model was used to differentiate breath profiles between cancer and control (benign disease) patients based on mass spectrometry derived variables. Results In all, 66% of participants had early-stage primary tumours (T1 and T2) and 58% had regional node metastasis. The optimised logistic regression model using three variables had a sensitivity and specificity of 80% and 86%, respectively, with an AUC for ROC curve of 0.821 (95%CI 0.625–1.0...

Research paper thumbnail of A review of breath analysis techniques in head and neck cancer

Research paper thumbnail of Effect of Multilevel Upper Airway Surgery vs Medical Management on the Apnea-Hypopnea Index and Patient-Reported Daytime Sleepiness Among Patients With Moderate or Severe Obstructive Sleep Apnea

Research paper thumbnail of Breath methane to hydrogen ratio as a surrogate marker of intestinal dysbiosis in head and neck cancer

Scientific Reports

Exhaled breath compounds can non-invasively detect head and neck squamous cell carcinoma (HNSCC).... more Exhaled breath compounds can non-invasively detect head and neck squamous cell carcinoma (HNSCC). Here we investigated exhaled compounds related to intestinal bacterial carbohydrate fermentation. Fasting breath samples were collected into 3 litre FlexFoil PLUS bags from patients awaiting a biopsy procedure for suspected HNSCC. Samples were analysed using a Syft selected ion flow-tube mass spectrometer and a Quintron BreathTracker. Two tailed non-parametric significance testing was conducted with corrections for multiple imputations. 74 patients were diagnosed (histological) with HNSCC and 61 patients were benign (controls). The methane to hydrogen ratio was significantly different between cancer and non-cancer controls (p = 0.0440). This ratio increased with tumour stage with a significant difference between T1 and T4 tumours (p = 0.0259). Hydrogen levels were significantly higher in controls who were smokers (p = 0.0129), with no smoking dependent methane changes. There were no dif...

Research paper thumbnail of Is there a role for up-to-date imaging in patients awaiting sinus surgery?

Australian Journal of Otolaryngology

Background: Endoscopic sinus surgery (ESS) is indicated in chronic rhinosinusitis (CRS) if medica... more Background: Endoscopic sinus surgery (ESS) is indicated in chronic rhinosinusitis (CRS) if medical therapy fails. There is a long waiting time for patients to be seen in the outpatient clinic at Australian public hospitals. A repeat computed tomography (CT) sinus scan may be performed when the patient is seen in clinic before deciding on the extent of ESS if the previous CT scan was over a year ago. This study aims to determine if there is a difference in radiology scores between the two scans and whether the repeat CT changes the extent of the planned sinus surgery. Methods: This is a retrospective multicentre Australian study. Patients who underwent two CT scans at least 12 months apart prior to ESS were included in the study. Two rhinologists reviewed the anonymized CT scans independently using the Lund-Mackay score (LMS) and decided the likely extent of surgery based on each CT scan. Wilcoxon signed-rank test was used to determine statistical significance. Results: Fifty-six patients met the inclusion criteria. The median [interquartile range (IQR)] time difference between the two scans was 2.1 (1.5-3.7) years. There were no significant differences in LMS between the first and second CT scans (P=0.43) or the extent of planned ESS (P=0.95). Conclusions: There is no significant evidence of LMS worsening while patients are on the waiting list to be seen in the ENT outpatient clinic. Many factors play a role in the extent of ESS, however, a repeat CT scan does not significantly affect the extent of ESS.

Research paper thumbnail of The use of transnasal humidified rapid insufflation ventilatory exchange in laryngeal and pharyngeal surgery: Flinders case series

Australian Journal of Otolaryngology

Background: Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is a new anaes... more Background: Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is a new anaesthetic technique that allows for prolonged apnoeic oxygenation without intubation. THRIVE is often conducted in patients with a normal body mass index (BMI) and mild systemic disease. However, it is unclear if patients with an increased BMI or significant co-morbidities are able to safely undergo laryngeal and pharyngeal surgery with THRIVE. Methods: A 14-month retrospective case note review was conducted in patients who underwent THRIVE for ear, nose, and throat (ENT) upper airway surgery. Factors were analysed to identify relationships with the requirement for rescue ventilation: age, BMI, American Society of Anaesthesiologists (ASA) physical status, smoking status, medical history and procedure type. An analysis was performed using non-parametric tests and odds ratios. Results: THRIVE was used with the following upper airway procedures (n=56): microlaryngoscopy with injection laryngoplasty (n=7), microlaryngoscopy with biopsy (n=14), microlaryngoscopy with potassium titanyl phosphate (KTP) laser use (n=11), panendoscopy with biopsy (n=10), oesophageal dilatation (n=3), subglottic stenosis dilatation (n=10), and stapling of a pharyngeal pouch (n=1). Rescue bag and mask ventilation or intubation were required in 21% of cases (n=12). A weight of more than 80 kg or BMI more than 30 were 5.2 and 5.7 times respectively more likely to require rescue ventilation (Fisher Exact Test P=0.023 and P=0.021). Conclusions: THRIVE can be safely used for a variety of laryngeal and pharyngeal procedures. However, there is a higher likelihood of rescue ventilation if the patient is over 80 kg or has a BMI over 30. Prospective investigation with a larger dataset of patients is required to validate these results.

Research paper thumbnail of Circulating microRNAs in head and neck cancer: a scoping review of methods

Clinical & Experimental Metastasis

Research paper thumbnail of THE SALIVARY TRIPEPTIDE ANALOGUE feG MAY AMELIORATE CAERULEIN-INDUCED ACUTE PANCREATITIS VIA DOWNREGULATION OF ICAM-1 EXPRESSION

Research paper thumbnail of Does gene expression in laryngeal sub-sites differ between patients with laryngopharyngeal reflux and controls?

Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery, Jan 16, 2017

to identify laryngeal mRNA gene changes in patients with laryngopharyngeal reflux (LPR). Laryngea... more to identify laryngeal mRNA gene changes in patients with laryngopharyngeal reflux (LPR). Laryngeal biopsies from non-smoking LPR patients (n=10; Reflux Symptom Index (RSI) >12 and a Reflux Finding Score (RFS) >6) and controls (n=9; RSI <12 and RFS <6) were collected from 4 sub-sites (true vocal cord, false vocal cord, medial arytenoid, posterior commissure) of the larynx. qRT-PCR analyses were conducted on 20 reflux and inflammation related genes, including interleukin 6 and 8, cytokeratin 8 and 14, mucin genes MUC 1, 2, 3B, 4, 5B, 6 & 7, and carbonic anhydrase III. Statistical analysis (Mann Whitney U test) compared gene expression levels between LPR and control groups at each sub-site. Site-specific differences in squamous metaplasia and gene expression were noted in LPR patients, with the majority present in the medial arytenoid region. Significant differences were noted in genes related to mucosal defense and inflammation, including CRNN, CD1d, TGFβ-1, MUC2, MUC5B, C...

Research paper thumbnail of Activation of Rat Pancreas Mechanosensitive Spinal Afferents in a Novel in Vitro Preparation

Research paper thumbnail of Long term quality of life outcomes following treatment for adult obstructive sleep apnoea: Comparison of upper airway surgery, continuous positive airway pressure and mandibular advancement splints

Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery, Jan 29, 2016

Long term quality of life (QOL) outcomes, complications and clinical effectiveness in patients un... more Long term quality of life (QOL) outcomes, complications and clinical effectiveness in patients undergoing treatment with upper airway surgery (UAS), continuous positive airway pressure (CPAP) and mandibular advancement splints (MAS) for adult obstructive sleep apnoea (OSA). Retrospective cohort study. Multi-disciplinary OSA clinic in University teaching hospital. Consecutive, simultaneously treated patients with OSA undergoing UAS (n= 83), CPAP (n=83), MAS (n=79). Glasgow Benefit Inventory (GBI), Snoring Severity Scale (SSS), Epworth Sleepiness Score (ESS) and side effects in all three groups were recorded at a mean of 34.5 months following start of treatment and compared via ANOVA analysis with Bonferroni adjustment for pair-wise comparisons. UAS demonstrated a statistically significant QOL benefit over MAS. All three groups showed a significant improvement in SSS with CPAP significantly better than MAS, but equivalent to UAS. Uncomplicated UAS provided a greater QOL outcome than c...

Research paper thumbnail of Bedside voice assessments cannot be used as a screening test for laryngeal injury following prolonged intubation in an intensive care population

Australian journal of otolaryngology, Apr 1, 2022

Research paper thumbnail of An Observational Pragmatic Quality of Life Study on Paediatric Tonsillectomy and Waiting for Surgery

Introduction Paediatric tonsillectomy performed for sleep disordered breathing or recurrent tonsi... more Introduction Paediatric tonsillectomy performed for sleep disordered breathing or recurrent tonsillitis and the effects on a child’s quality of life symptoms while waiting for surgery in an Australian public health system have not previously been investigated. This study investigated parental perceptions of the effects of tonsillectomy on their child’s quality of life while awaiting tonsillectomy and following surgery. Design, Setting and Participants An observational study was undertaken at a tertiary Australian hospital. Parents of paediatric patients (2 to 16 years of age) listed for tonsillectomy completed a validated quality of life questionnaire (T—14 Paediatric Throat Disorders Outcome Test) at the initial consultation, on day of surgery, 6 weeks post-operatively and 6 months post-operatively. T-14 scores were compared using the Related-Samples Wilcoxon Signed Rank Test. Results Parents of 167 children participated in this study. There was a median wait time of 174 days (IQR ...

Research paper thumbnail of Additional file 1 of Ear microbiota and middle ear disease: a longitudinal pilot study of Aboriginal children in a remote south Australian setting

Research paper thumbnail of Delays in Time to Head and Neck Cancer Treatment: A South Australian Perspective

Medicina, 2022

Background and Objectives: In head and neck cancer, delays in time to treatment are associated wi... more Background and Objectives: In head and neck cancer, delays in time to treatment are associated with poorer clinical outcomes. Within Australia, it is recommended that primary treatment is initiated within 56 days of initial referral. The aim of this study was to assess whether head and neck cancer treatment was delivered within these timeframe guidelines at our institution and identify factors associated with treatment delays. Methods: This retrospective cohort study assessed patients newly diagnosed with head and neck cancer over a 24 months period (2018 to 2019) at Flinders Medical Centre, Australia. Time to treatment intervals were calculated for comparison to local timeframe guidelines. Results: A total of 72 patients met the inclusion criteria. The median time from specialist referral to treatment initiation was 45.5 days (IQR 29–61), with 72% meeting the 56 days guideline. On univariate logistic regression, patients undergoing primary radiotherapy treatment were less likely to...

Research paper thumbnail of 51 Spinal, Not Vagal Mechanosensitive Afferents Innervate the Rat Pancreas

Gastroenterology, 2008

rats with single sc injection of ERα agonist propylpyrazole-triol (PPT; 1, 10, and 100 µg/ kg), E... more rats with single sc injection of ERα agonist propylpyrazole-triol (PPT; 1, 10, and 100 µg/ kg), ERβ agonist diarylpropionitrile (DPN; 1, 10 or 100 µg/kg), GPR30 receptor agonist, G1 (0.1, 1, 10, and 50 µg/kg), or vehicle (10% DMSO) 30 min prior to the 5HTP administration and CRD stimulation. Estrogen receptor antagonist ICI 182,780 (1, 3, and 10 mg/kg, sc) or vehicle were given with estrogen in OVX rats and followed by 5-HTP administration and CRD stimulation. (4) Confocal microscopy examined the collateralization of GPR30 and 5HT3 receptors in dorsal root ganglion (DRG) at L6 and S1 spinal level. Histological examination was done in distal colon for signs of inflammation. Results (1) The 5HTPtreated rats had significantly higher viscero-motor reflex than controls (enhanced VH), while OVX eliminated the hypersensitivity. A single injection of E or E+P, but not P alone, rapidly restored 5HTP-induced VH in 30 minutes. (2) G1 (1 to 50 µg/kg), but not PPT or DPN, can rapidly restore the 5HTP-induced VH in OVX rats. The 5HTP-induced VH can still be observed in OVX rats with the co-administration of ICI 182,780 and E. (3) Collateralization of GPR30 and 5HT3 receptors was seen in DRG neurons. No significant inflammation was noted in the colonic mucosa. Conclusions (1) Estrogen rapidly modulates 5-HTP-induced VH through the new GPR30 receptor, but not the classical ERα or β. (2) DRG may be involved in this rapid physiological response. (3) The future GPR30 receptor antagonist may be a potential pain modulator for female IBS patients.

Research paper thumbnail of Distribution of nitric oxide synthase and vasoactive intestinal polypeptide immunoreactivity in the sphincter of Oddi and duodenum of the possum

Cell and Tissue Research, 2001

The nitrergic innervation of the sphincter of Oddi (SO) and duodenum in the Australian brush-tail... more The nitrergic innervation of the sphincter of Oddi (SO) and duodenum in the Australian brush-tailed possum and the possible association of this innervation with the neuropeptide vasoactive intestinal polypeptide (VIP) were investigated by using immunohistochemical localisation of nitric oxide synthase (NOS) and VIP, together with the general neuronal marker, protein gene product 9.5 (PGP9.5). Whole-mount preparations of the duodenum and attached SO without the mucosa, submucosa and circular muscle (n=12) were double-and triplelabelled. The density of myenteric nerve cell bodies of the SO in the more distal region (duodenal end) was significantly higher than that in the more proximal region. In the SO, approximately 50% of all cells were NOS-immunoreactive (IR), with 27% of the NOS-IR cells being VIP-IR. Within the duodenal myenteric plexus, NOS immunoreactivity was present in about 25% of all neurons, with 27% of these NOS-IR neurons also being VIP-IR, a similar proportion to that in the SO. Varicose nerve fibres with NOS and VIP immunoreactivity were present within the myenteric and submucous plexuses of the SO and duodenum, and in the circular and longitudinal muscle layers. The NOS-positive cells within both the SO and duodenum were unipolar, displaying a typical Dogiel type I morphology. The myenteric plexuses of the SO and duodenum were in direct continuity, with many interconnecting nerve trunks, some of which showed NOS and VIP immunoreactivity. Thus, the possum possesses an extensive NOS innervation of the SO and duodenum, with a significantly higher proportion of NOS-IR neurons within the SO, a subset of which contains VIP.

Research paper thumbnail of Ear microbiota and middle ear disease: a longitudinal pilot study of Aboriginal children in a remote south Australian setting

BMC Microbiology, 2022

Background Otitis media (OM) is a major disease burden in Australian Aboriginal children, contrib... more Background Otitis media (OM) is a major disease burden in Australian Aboriginal children, contributing to serious long-term health outcomes. We report a pilot analysis of OM in children attending an outreach ear and hearing clinic in a remote south Australian community over a two-year period. Our study focuses on longitudinal relationships between ear canal microbiota characteristics with nasopharyngeal microbiota, and clinical and treatment variables. Results Middle ear health status were assessed in 19 children (aged 3 months to 8 years) presenting in remote western South Australia and medical interventions were recorded. Over the two-year study period, chronic suppurative OM was diagnosed at least once in 7 children (37%), acute OM with perforation in 4 children (21%), OM with effusion in 11 children (58%), while only 1 child had no ear disease. Microbiota analysis of 19 children (51 sets of left and right ear canal swabs and nasopharyngeal swabs) revealed a core group of bacteri...

Research paper thumbnail of Risk of Airway Fire with the use of KTP Laser and High Flow Humidified Oxygen Delivery in a Laryngeal Surgery Model

Background Airway surgery presents a unique environment for operating room fire to occur. This st... more Background Airway surgery presents a unique environment for operating room fire to occur. This study aims to explore the factors of combustion when using KTP laser with high flow oxygen in an ex-vivo model. MethodsThe variables tested were varying tissue type, tissue condition, oxygen concentration, laser setting, and smoke evacuation in a stainless-steel model. Outcome measures were time of lasing to the first spark and/or flame. A multivariate Cox proportional hazard model was used to determine the risk of spark and flame across the different risk factors. ResultsFor every 10% increase in oxygen concentration above 60% the risk of flame increased by a factor of 2.3. Continuous laser setting at 2.6W increased the risk by a factor of 72.8. The risk of lasing adipose tissue is 7.3 times higher than that of muscle. Charred tissue increases the risk of flame by a factor of 92.8. Flame occurred without a preceding spark 93.6% of the time. Conclusions Using KTP laser in the pulsed mode w...

Research paper thumbnail of Health Related Quality of Life T-14 Outcomes for Pediatric Bizact Tonsillectomy

Medicina

Objectives: The objective of this study was to assess the T-14 outcomes of the BizactTM device fo... more Objectives: The objective of this study was to assess the T-14 outcomes of the BizactTM device for tonsillectomy in a pediatric population. Methods: A case series chart review was undertaken at a public tertiary teaching hospital and private otolaryngology practice, with data collected from pediatric patients who underwent a BizactTM tonsillectomy between July 2016 and October 2019 for any indication, whose parents consented to completing the T-14 questionnaire providing a parental perspective of the child’s quality of life. Primary outcomes were T-14 scores recorded preoperatively and 6 weeks post-operatively. Secondary outcome measures were postoperative complications, including hemorrhage and readmission. Results: 146 patients were identified. There was a significant improvement in T-14 scores from a median of 24 (Interquartile range (IQR) 18–33) prior to surgery to 2 (IQR 0–4) at 6 weeks postoperatively (p < 0.001). The post-tonsillectomy hemorrhage rate was 6.1% (9/146 parti...

Research paper thumbnail of Development of a non-invasive exhaled breath test for the diagnosis of head and neck cancer

British Journal of Cancer

Background Improving the ability to identify early-stage head and neck squamous cell carcinoma (H... more Background Improving the ability to identify early-stage head and neck squamous cell carcinoma (HNSCC) can improve treatment outcomes and patient morbidity. We sought to determine the diagnostic accuracy of breath analysis as a non-invasive test for detecting HNSCC. Methods Standardised breath samples were collected from 181 patients suspected of HNSCC prior to any treatment. A selected ion flow-tube mass spectrometer was used to analyse breath for volatile organic compounds. Diagnosis was confirmed by histopathology. A binomial logistic regression model was used to differentiate breath profiles between cancer and control (benign disease) patients based on mass spectrometry derived variables. Results In all, 66% of participants had early-stage primary tumours (T1 and T2) and 58% had regional node metastasis. The optimised logistic regression model using three variables had a sensitivity and specificity of 80% and 86%, respectively, with an AUC for ROC curve of 0.821 (95%CI 0.625–1.0...

Research paper thumbnail of A review of breath analysis techniques in head and neck cancer

Research paper thumbnail of Effect of Multilevel Upper Airway Surgery vs Medical Management on the Apnea-Hypopnea Index and Patient-Reported Daytime Sleepiness Among Patients With Moderate or Severe Obstructive Sleep Apnea

Research paper thumbnail of Breath methane to hydrogen ratio as a surrogate marker of intestinal dysbiosis in head and neck cancer

Scientific Reports

Exhaled breath compounds can non-invasively detect head and neck squamous cell carcinoma (HNSCC).... more Exhaled breath compounds can non-invasively detect head and neck squamous cell carcinoma (HNSCC). Here we investigated exhaled compounds related to intestinal bacterial carbohydrate fermentation. Fasting breath samples were collected into 3 litre FlexFoil PLUS bags from patients awaiting a biopsy procedure for suspected HNSCC. Samples were analysed using a Syft selected ion flow-tube mass spectrometer and a Quintron BreathTracker. Two tailed non-parametric significance testing was conducted with corrections for multiple imputations. 74 patients were diagnosed (histological) with HNSCC and 61 patients were benign (controls). The methane to hydrogen ratio was significantly different between cancer and non-cancer controls (p = 0.0440). This ratio increased with tumour stage with a significant difference between T1 and T4 tumours (p = 0.0259). Hydrogen levels were significantly higher in controls who were smokers (p = 0.0129), with no smoking dependent methane changes. There were no dif...

Research paper thumbnail of Is there a role for up-to-date imaging in patients awaiting sinus surgery?

Australian Journal of Otolaryngology

Background: Endoscopic sinus surgery (ESS) is indicated in chronic rhinosinusitis (CRS) if medica... more Background: Endoscopic sinus surgery (ESS) is indicated in chronic rhinosinusitis (CRS) if medical therapy fails. There is a long waiting time for patients to be seen in the outpatient clinic at Australian public hospitals. A repeat computed tomography (CT) sinus scan may be performed when the patient is seen in clinic before deciding on the extent of ESS if the previous CT scan was over a year ago. This study aims to determine if there is a difference in radiology scores between the two scans and whether the repeat CT changes the extent of the planned sinus surgery. Methods: This is a retrospective multicentre Australian study. Patients who underwent two CT scans at least 12 months apart prior to ESS were included in the study. Two rhinologists reviewed the anonymized CT scans independently using the Lund-Mackay score (LMS) and decided the likely extent of surgery based on each CT scan. Wilcoxon signed-rank test was used to determine statistical significance. Results: Fifty-six patients met the inclusion criteria. The median [interquartile range (IQR)] time difference between the two scans was 2.1 (1.5-3.7) years. There were no significant differences in LMS between the first and second CT scans (P=0.43) or the extent of planned ESS (P=0.95). Conclusions: There is no significant evidence of LMS worsening while patients are on the waiting list to be seen in the ENT outpatient clinic. Many factors play a role in the extent of ESS, however, a repeat CT scan does not significantly affect the extent of ESS.

Research paper thumbnail of The use of transnasal humidified rapid insufflation ventilatory exchange in laryngeal and pharyngeal surgery: Flinders case series

Australian Journal of Otolaryngology

Background: Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is a new anaes... more Background: Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is a new anaesthetic technique that allows for prolonged apnoeic oxygenation without intubation. THRIVE is often conducted in patients with a normal body mass index (BMI) and mild systemic disease. However, it is unclear if patients with an increased BMI or significant co-morbidities are able to safely undergo laryngeal and pharyngeal surgery with THRIVE. Methods: A 14-month retrospective case note review was conducted in patients who underwent THRIVE for ear, nose, and throat (ENT) upper airway surgery. Factors were analysed to identify relationships with the requirement for rescue ventilation: age, BMI, American Society of Anaesthesiologists (ASA) physical status, smoking status, medical history and procedure type. An analysis was performed using non-parametric tests and odds ratios. Results: THRIVE was used with the following upper airway procedures (n=56): microlaryngoscopy with injection laryngoplasty (n=7), microlaryngoscopy with biopsy (n=14), microlaryngoscopy with potassium titanyl phosphate (KTP) laser use (n=11), panendoscopy with biopsy (n=10), oesophageal dilatation (n=3), subglottic stenosis dilatation (n=10), and stapling of a pharyngeal pouch (n=1). Rescue bag and mask ventilation or intubation were required in 21% of cases (n=12). A weight of more than 80 kg or BMI more than 30 were 5.2 and 5.7 times respectively more likely to require rescue ventilation (Fisher Exact Test P=0.023 and P=0.021). Conclusions: THRIVE can be safely used for a variety of laryngeal and pharyngeal procedures. However, there is a higher likelihood of rescue ventilation if the patient is over 80 kg or has a BMI over 30. Prospective investigation with a larger dataset of patients is required to validate these results.

Research paper thumbnail of Circulating microRNAs in head and neck cancer: a scoping review of methods

Clinical & Experimental Metastasis

Research paper thumbnail of THE SALIVARY TRIPEPTIDE ANALOGUE feG MAY AMELIORATE CAERULEIN-INDUCED ACUTE PANCREATITIS VIA DOWNREGULATION OF ICAM-1 EXPRESSION

Research paper thumbnail of Does gene expression in laryngeal sub-sites differ between patients with laryngopharyngeal reflux and controls?

Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery, Jan 16, 2017

to identify laryngeal mRNA gene changes in patients with laryngopharyngeal reflux (LPR). Laryngea... more to identify laryngeal mRNA gene changes in patients with laryngopharyngeal reflux (LPR). Laryngeal biopsies from non-smoking LPR patients (n=10; Reflux Symptom Index (RSI) >12 and a Reflux Finding Score (RFS) >6) and controls (n=9; RSI <12 and RFS <6) were collected from 4 sub-sites (true vocal cord, false vocal cord, medial arytenoid, posterior commissure) of the larynx. qRT-PCR analyses were conducted on 20 reflux and inflammation related genes, including interleukin 6 and 8, cytokeratin 8 and 14, mucin genes MUC 1, 2, 3B, 4, 5B, 6 & 7, and carbonic anhydrase III. Statistical analysis (Mann Whitney U test) compared gene expression levels between LPR and control groups at each sub-site. Site-specific differences in squamous metaplasia and gene expression were noted in LPR patients, with the majority present in the medial arytenoid region. Significant differences were noted in genes related to mucosal defense and inflammation, including CRNN, CD1d, TGFβ-1, MUC2, MUC5B, C...

Research paper thumbnail of Activation of Rat Pancreas Mechanosensitive Spinal Afferents in a Novel in Vitro Preparation

Research paper thumbnail of Long term quality of life outcomes following treatment for adult obstructive sleep apnoea: Comparison of upper airway surgery, continuous positive airway pressure and mandibular advancement splints

Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery, Jan 29, 2016

Long term quality of life (QOL) outcomes, complications and clinical effectiveness in patients un... more Long term quality of life (QOL) outcomes, complications and clinical effectiveness in patients undergoing treatment with upper airway surgery (UAS), continuous positive airway pressure (CPAP) and mandibular advancement splints (MAS) for adult obstructive sleep apnoea (OSA). Retrospective cohort study. Multi-disciplinary OSA clinic in University teaching hospital. Consecutive, simultaneously treated patients with OSA undergoing UAS (n= 83), CPAP (n=83), MAS (n=79). Glasgow Benefit Inventory (GBI), Snoring Severity Scale (SSS), Epworth Sleepiness Score (ESS) and side effects in all three groups were recorded at a mean of 34.5 months following start of treatment and compared via ANOVA analysis with Bonferroni adjustment for pair-wise comparisons. UAS demonstrated a statistically significant QOL benefit over MAS. All three groups showed a significant improvement in SSS with CPAP significantly better than MAS, but equivalent to UAS. Uncomplicated UAS provided a greater QOL outcome than c...