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BACKGROUND: Since its introduction by Wullstein, the binocular surgical microscope has remained the gold standard of visualization in the field of otology. However, in the last decade, new technology became available in the form of the three-dimensional (3D) exoscope. In this article, we describe our experience thus far in pediatric cochlear implantation with the 3D exoscope. METHODS: This article is about prospective descriptive study of all exoscopic cochlear implant (CI) cases in a quaternary pediatric CI center performed with the Vitom[R] 3D system. All pediatric patients (age <18) were included without exclusion criteria, and our experience and conversion to microscope rates are reported. RESULTS: Since the introduction of the exoscope to our unit, we have successfully performed 68 cases, of which 53 were bilateral cochlear implantations. The age of the patient varied between 10 months and 209 months (average: 64 months; median 46.5 months). There were a total of 121 implantations (96 primary implantations, 24 revision implantations). There were 2 conversions to the traditional microscopic technique. CONCLUSION: The exoscope provides a 3D high-definition (4K) images in CI surgery. There is limited data regarding its use, and we identified a number of advantages including efficiency, occupational health, theater utilization, surgical training, and safety. Although there are areas still for improvement, such as loss of signal-to-noise ratio at higher magnification, manual focus, and lack of electromagnetic articulation in the holding arm, we have found it to be a useful addition to the surgical armamentarium within pediatric cochlear implantation. KEYWORDS: Children with cochlear implants, cochlear implantation, ear surgery

ObjectivesLimited data suggest that swimmers might be affected by poor quality of sleep significantly. The aim was to explore the prevalence of sleep disturbances in swimmers and possible link between rhinitis and sleep disturbance.MethodsStudy 1 was an observational case–control, questionnaire-based study involving 157 elite and non-elite swimmers, 36 non-swimming athletes and 50 controls. In study 2, we measured sleep quality and duration using actigraphy in 20 elite swimmers. We also looked for presence of sleep-disordered breathing using overnight pulse oximetry monitor.ResultsIn study 1, we observed a significant difference in prevalence of excessive daytime sleepiness between groups of elite swimmers and controls. Pittsburgh Sleep Quality Index (PSQI) scores do not suggest that quality of sleep in group of swimmers is impaired. In study 2, we found that prevalence of obstructive sleep apnoea (OSA) in elite swimmers defined as oxygen desaturation index ≥5 was 30%. Analysis of actigraphy data revealed that on nights prior to training days, ‘going to’ bed time was significantly earlier and total sleep time was significantly reduced.ConclusionSwimmers and non-swimming athletes suffer significantly more with excessive daytime sleepiness than healthy controls. In elite swimmers, this is likely linked to high prevalence of OSA. PSQI scores do not suggest that quality of sleep in group of swimmers is impaired, but actigraphy shows great variations between sleep pattern preceding training and rest day. This seems to be associated with early-morning sessions which can be a disruptive element of weekly sleep patterns.

The aim was to assess whether renal investigations for grade 3 chronic kidney disease and referrals for specialist advice are being documented according to the 2006 Royal Colleges of Physicians and General Practitioners and Renal Association guidance 2 in the notes of those psychiatric in-patients currently prescribed lithium across the Trust. Of 18 in-patients prescribed lithium: (a) 3 (16.7%) patients had one-off abnormal results with other values recorded within the normal range; (b) 1 (5.6%) patient had one documented eGFR (54) that was abnormal. There was agreement that the current lithium documentation charts should be modified to include eGFR as a routine part of the lithium work up and ongoing monitoring process.

Since its introduction by Wullstein, the binocular surgical microscope has remained the gold standard of visualization in the field of otology. All pediatric patients (age <18) were included without exclusion criteria, and our experience and conversion to microscope rates are reported. Since the introduction of the exoscope to our unit, we have successfully performed 68 cases, of which 53 were bilateral cochlear implantations. In relation to cochlear implantation, a systematic review has concluded the paucity of relevant studies signifies its use as the primary modality cannot be supported.· Also, as the basal turn of the cochlea follows a more posterior angle than that of the ear canal, the trajectory of the classical posterior tympanotomy remains the most suitable pathway for access.' RESULTS At the time of publication, there are 2 surgeons routinely utilizing the exoscope for Cl surgery. Since the introduction of the exoscope to our unit, we have successfully performed 115 CI surgeries, of which 43 were primary bilateral cochlear implantations. [...]the post hoc power analysis revealed that our study is in fact underpowered to demonstrate smaller differences in operating times (Dz < 0.4) Complications and Conversion to Microscopic Technique No complications were noted during this time period.