Survival outcomes in acute invasive fungal sinusitis: A systematic review and quantitative synthesis of published evidence.

Laryngoscope. 2013 Jan 8. doi: 10.1002/lary.23912. [Epub ahead of print]
Survival outcomes in acute invasive fungal sinusitis: A systematic review and quantitative synthesis of published evidence.
Turner JH, Soudry E, Nayak JV, Hwang PH.
Source
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A. justinhturner@gmail.com.
Abstract
OBJECTIVES/HYPOTHESIS:
Acute invasive fungal sinusitis (AIFS) is an aggressive and often fatal infection. Despite improvements in medical and surgical therapy, survival remains limited and the factors that contribute to patient outcomes remain poorly understood. The current study systematically reviews and quantitatively synthesizes the published literature to characterize prognostic factors associated with survival.
STUDY DESIGN:
Systematic review.
METHODS:
Fifty-two studies comprising a total of 807 patients met inclusion criteria and were used for analysis of treatment, presentation, and outcomes. Univariate and multivariate logistic regression was used to identify prognostic factors.
RESULTS:
All studies were classified as level 4 evidence, as per definitions provided by the Oxford Center for Evidence-Based Medicine. The most common presenting symptoms of patients with AIFS were facial swelling (64.5%), fever (62.9%), and nasal congestion (52.2%). Most patients were treated with a combination of intravenous antifungal medication and surgery. The overall survival rate was 49.7%. On univariate analysis, poor prognosis was associated with renal/liver failure, altered mental status, and intracranial extension. Patients who were diabetic, had surgery, or received liposomal amphotericin B had an improved chance of survival. On multivariate analysis, advanced age and intracranial involvement were identified as independent negative prognostic factors. Positive prognostic factors again included diabetes and surgical resection.
CONCLUSIONS:
The overall mortality of patients with AIFS remains high, with only half of the patients surviving. Diabetic patients appear to have a better overall survival than patients with other comorbidities. Patients who have intracranial involvement, or who do not receive surgery as part of their therapy, have a poor prognosis. Laryngoscope, 2012.
Copyright © 2013 The American Laryngological, Rhinological, and Otological Society, Inc.
PMID: 23300010 [PubMed - as supplied by publisher]

Complications in endonasal sinus surgery: a 5-year retrospective study of 2,596 patients. Siedek V, Pilzweger E, Betz C, Berghaus A, Leunig A.

Eur Arch Otorhinolaryngol. 2012 Mar 31. [Epub ahead of print]
Complications in endonasal sinus surgery: a 5-year retrospective study of 2,596 patients.
Siedek V, Pilzweger E, Betz C, Berghaus A, Leunig A.
Source
Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany, vanessa.siedek@med.uni-muenchen.de.
Abstract
Recent developments should have aided to reduce postoperative complications of endoscopic sinonasal surgery: Computerised tomography (CT) and magnetic resonance imaging (MRI) allow a more precise preoperative view of the anatomic situation and possible variations. The Lund-MacKay-Index provides a tool to assess the extent of the disease, and by introducing microscopic-endonasal and computer-assisted sinunasal surgery (CAS) as well as providing the corresponding training technical progress has been made. We analysed the data of 2,596 patients with acute or chronic rhinosinusitis who underwent surgery between 2000 and 2005 using the procedure of Stammberger. We saw 3.1 % minor complications (minor bleedings, perforation of the lamina papyracea), 0.9 % major complications (severe bleedings, cerebrospinal fluid (CSF) leaks, lesion of the ductus lacrimalis), and one (0.04 %) serious complication (meningitis). When we compared these figures with those of reports from the late 90s by correlating opacification, type of operation, the surgeon's experience and employing CAS with the outcome we did not find a distinct improvement in the rate of postoperative complications. Serious complications and those resulting in permanent harm such as carotid artery injury, cerebral deficit or death have, however, become very rare. A grading into I (minor), II (major) and III (serious) complications is proposed, to point out this critical grade-III proportion, which should not exceed 0.1 %.

Hematopoietic stem cell transplantation and rhinosinusitis: The utility of screening sinus computed tomography.

Laryngoscope. 2012 Sep 10. doi: 10.1002/lary.23564. [Epub ahead of print]
Hematopoietic stem cell transplantation and rhinosinusitis: The utility of screening sinus computed tomography.
Fulmer S, Kim SW, Mace JC, Leach ME, Tarima S, Xiang Q, Soler ZM, Bredeson C, Loehrl TA, Poetker DM.
Source
Division of Rhinology and Sinus Surgery, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS:
To compare prehematopoietic stem cell transplantation (SCT) sinus computed tomography (CT) scans to post-SCT sinus CT scans and to evaluate the relationship between pre-SCT sinus CT scans and the incidence of otolaryngology consultation after SCT.
STUDY DESIGN:
Retrospective chart review.
METHODS:
Charts of 228 adult SCT patients from January 2003 to June 2009 with pre-SCT sinus CT scans were reviewed. Data gathered included diagnosis, type of SCT, otolaryngology referral requests, and rhinosinusitis management. Pre- and post-SCT sinus CT scans were scored using the staging system introduced by Lund and Mackay.
RESULTS:
Two hundred thirty-nine SCTs were performed on the 228 patients included in this study. No disease was identified on 25.1% of pre-SCT CT scans, mild sinus inflammation was identified on 60.7% of scans, 11.3% had moderate inflammation, and 2.9% had severe inflammation. Pre-SCT scans were found to be predictive of post-SCT CT scans. A significant proportion of patients demonstrated worsening of their Lund-Mackay score post-SCT. Pre-SCT CT scores had no predictive ability for otolaryngology consultations.
CONCLUSIONS:
Pre-SCT CT scan scores are associated with post-SCT scan scores; disease severity on CT may worsen following SCT and may be useful for stratifying patients into surgical versus non-surgical candidates. Further study is needed to outline the benefit of sinus surgery in these patients. Laryngoscope, 2012.
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
PMID: 22965703 [PubMed - as supplied by publisher]

Relationship between rhinitis and nocturnal cough in school children.

Pediatr Allergy Immunol. 2012 May 3. doi: 10.1111/j.1399-3038.2012.01309.x. [Epub ahead of print] Relationship between rhinitis and nocturnal cough in school children. Higuchi O, Adachi Y, Itazawa T, Ito Y, Yoshida K, Ohya Y, Odajima H, Akasawa A, Miyawaki T. Source Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan Division of Allergy, Tokyo Metropolitan Children's Hospital, Tokyo, Japan Division of Allergy, National Center for Child Health and Development, Tokyo, Japan Department of Pediatrics, Fukuoka National Hospital, Fukuoka, Japan. Abstract To cite this article: Higuchi O, Adachi Y, Itazawa T, Ito Y, Yoshida K, Ohya Y, Odajima H, Akasawa A, Miyawaki T. Relationship between rhinitis and nocturnal cough in school children. Pediatr Allergy Immunol 2012. ABSTRACT: Background:  There is a complex relationship between rhinitis, asthma, and nocturnal cough. Methods:  To evaluate whether rhinitis is an important risk factor for nocturnal cough and whether this effect is independent of asthma, we analyzed data collected using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire in a population-based nationwide survey. A child who had experienced a dry cough at night in the past 12 months in the absence of a cold was defined as having nocturnal cough. Results:  After excluding 11,475 records with incomplete data, data from 136,506 children were analyzed. Nocturnal cough was significantly more prevalent in children with current rhinitis compared with children without rhinitis. The association between rhinitis and nocturnal cough was significant in children who had current asthma (adjusted OR [95% CI]: 2.26 [2.00-2.56] in children aged 6-7 yr, 1.90 [1.58-2.30] in those aged 13-14 yr, and 1.86 [1.60-2.19] in those aged 16-17 yr), and this association was even higher among children who had no asthma (adjusted OR [95% CI]: 3.65 [3.36-3.97] in children aged 6-7 yr, 3.05 [2.79-3.32] in those aged 13-14 yr, and 2.69 [2.51-2.88] in those aged 16-17 yr). Conclusions:  There was a close association between rhinitis and nocturnal cough in young children through adolescents, and this effect was independent of asthma. Upper airways should be examined in children with nocturnal cough.

Montelukast in the treatment of allergic rhinitis: an evidence-based review.

Abstract Cysteinyl-leukotrienes (CysLTs) are endogenous mediators of inflammation and play an important role in allergic airway disease by stimulating bronchoconstriction, mucus production, mucosal oedema and inflammation, airway infiltration by eosinophils, and dendritic cell maturation that prepares for future allergic response. Montelukast inhibits these actions by blocking type 1 CysLT receptors found on immunocytes, smooth muscle and endothelium in the respiratory mucosa. Initially developed as a treatment for asthma, montelukast has more recently found use in the treatment of allergic rhinitis (AR). We conducted a systematic review of studies that have evaluated montelukast in the treatment of seasonal AR (SAR) and perennial AR (PAR), with and without concomitant asthma. Primary consideration was given to large, randomised, placebo-controlled, double-blind clinical trials in which AR endpoints were assessed and the use of concurrent treatments for AR was excluded. Eight such studies were found in the literature. The primary endpoint in these was daytime nasal symptom severity represented by a composite score derived from individual self-ratings of nasal congestion, rhinorrhoea, nasal pruritus and sneezing. Secondary endpoints have included these individual nasal symptom scores, additional scores for eye, ear and throat symptoms, the impact of rhinitis on quality of sleep, global evaluations of outcome by patients and physicians, and measures of the severity of concomitant asthma. A general outcome was that patients treated with montelukast had significantly greater improvements in their symptoms of SAR and PAR than did patients who were given a placebo. As monotherapy, montelukast exhibited efficacy similar to that of loratadine, but less than that of the intranasally administered corticosteroid fluticasone propionate. The use of montelukast in combination with antihistamines such as loratadine or cetirizine has generally resulted in greater efficacy than when these agents were used alone, and in some studies has produced results comparable with intranasally applied corticosteroids. In patients with AR comorbid with asthma, montelukast treatment has resulted in significant improvements in both, compared with placebo. Montelukast is well tolerated and has a favourable safety profile; adverse events have occurred at similar frequencies in patients taking either montelukast or placebo. Montelukast provides an effective and well tolerated oral treatment for allergic airway inflammation in patients with SAR or PAR without asthma, and in patients in whom AR is comorbid with asthma.

Prednisolone in Bell's palsy related to treatment start and age.

Prednisolone in Bell's palsy related to treatment start and age.
Axelsson S, Berg T, Jonsson L, Engström M, Kanerva M, Pitkäranta A, Stjernquist-Desatnik A.
Source
Department of Otorhinolaryngology-Head and Neck Surgery, Lund University Hospital, Lund, Sweden. sara.axelsson@skane.se
Abstract
OBJECTIVE:
To evaluate if treatment start and age are related to the outcome in Bell's palsy patients treated with prednisolone.
STUDY DESIGN:
Prospective, randomized, double-blind, placebo-controlled, multicenter trial.
SETTING:
Sixteen otorhinolaryngologic centers in Sweden and 1 in Finland.
PATIENTS:
Data were collected from the Scandinavian Bell's palsy study. A total of 829 patients were treated within 72 hours of onset of palsy. Follow-up was 12 months.
INTERVENTION:
Patients were randomly assigned to treatment with placebo plus placebo (n = 206), prednisolone plus placebo (n = 210), valacyclovir plus placebo (n = 207), or prednisolone plus valacyclovir (n = 206).
MAIN OUTCOME MEASURES:
Facial function was assessed with the Sunnybrook grading system, and complete recovery was defined as Sunnybrook = 100. Time from onset of palsy to treatment start was registered.
RESULTS:
Patients treated with prednisolone within 24 hours and 25 to 48 hours had significantly higher complete recovery rates, 66% (103/156) and 76% (128/168), than patients given no prednisolone, 51% (77/152) and 58% (102/177) (p = 0.008 and p = 0.0003, respectively). For patients treated within 49 to 72 hours of palsy onset, there were no significant differences. Patients aged 40 years or older had significantly higher complete recovery rates if treated with prednisolone, whereas patients aged younger than 40 years did not differ with respect to prednisolone treatment. However, synkinesis was significantly less in patients younger than 40 years given prednisolone (p = 0.002).
CONCLUSION:
Treatment with prednisolone within 48 hours of onset of palsy resulted in significantly higher complete recovery rates and less synkinesis compared with no prednisolone

Incidence of laryngospasm and bronchospasm in pediatric adenotonsillectomy.

Laryngoscope. 2012 Feb;122(2):425-8. doi: 10.1002/lary.22423. Epub 2012 Jan 17.
Incidence of laryngospasm and bronchospasm in pediatric adenotonsillectomy.
Orestes MI, Lander L, Verghese S, Shah RK.
Source
National Capitol Consortium Otolaryngology Residency Training Program, Walter Reed Army Medical Center, Washington, D.C.
Abstract
OBJECTIVES/HYPOTHESIS:
To evaluate and describe airway complications in pediatric adenotonsillectomy.
STUDY DESIGN:
Retrospective case-control study.
METHODS:
A chart review of patients that underwent adenotonsillectomy between 2006 and 2010 was performed. Perioperative complications, patient characteristics, and surgeon and anesthesia technique were recorded.
RESULTS:
A total of 682 charts were reviewed. Eleven cases (1.6%) of laryngospasm were identified: one was preoperative, seven occurred in the operating room postextubation, and three occurred in the recovery area. Four patients were given succinylcholine, one was reintubated, and the other cases were managed conservatively. Mean age of patients with laryngospasm was 5.87 years (standard deviation [SD], 4.01; 1.9-15.8 years). There were 12 cases (1.8%) of bronchospasm; all were treated with nebulized albuterol. Mean age of patients with bronchospasm was 5.81 years (SD, 4.17; 1.8-14.1 years). Overall, 22 patients required antiemetics (3.3%), 19 required albuterol (2.9%), and five required racemic epinephrine (0.8%). Compared to the children without airway complications, there was no difference in age, weight, American Society of Anesthesiologists status, length of surgery, need for admission, and anesthesia technique in those that had laryngospasm. Patients with bronchospasm, compared to the patients without complications, had faster surgeries (P < .05), were more likely to have underlying asthma (P < .05), and were more likely to be admitted (P < .05). There were no unexpected admissions or other morbidities.
CONCLUSIONS:
The rates of laryngospasm (1.6%) and bronchospasm (1.8%) are significantly lower than reported in the literature, reflecting refinements in modern anesthesia/surgical technique. Knowledge of at-risk patients can facilitate planning to potentially reduce the incidence of perioperative airway complications during adenotonsillectomy.
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

The use of ice-lollies for pain relief post paediatric tonsillectomy. A single-blinded, randomised, controlled trial.

Clin Otolaryngol. 2011 Nov 10. doi: 10.1111/j.1749-4486.2011.02410.x. [Epub ahead of print]
The use of ice-lollies for pain relief post paediatric tonsillectomy. A single-blinded, randomised, controlled trial.
Sylvester DC, Rafferty A, Bew S, Knight LC.
Source
Department of Otolaryngology, York District Hospital, Wiggington Road, York, YO31 8HE, UK Department of Otolaryngology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
Abstract
Objectives:  To assess whether the use of ice-lollies after tonsillectomy with or without adenoidectomy in children aged 2-12 reduces pain in the immediate post-operative period. Design: A prospective, randomised, single-blinded study design consisting of two groups with an intention to treat analysis. Setting:  Tertiary referral centre. Participants:  Children aged 2-12 undergoing tonsillectomy with or without adenoidectomy. Main outcome Measures:  Pain assessment by nursing staff in the form of the validated modified Children's Hospital of Eastern Ontario Pain Scale at 15, 30 and 60 minutes and 4 hours. Results:  Ninety-two patients were recruited into the study with 46 allocated to receive an ice-lolly and 41 not to receive an ice-lolly after exclusion of those with incomplete data. The 2 groups were comparable for number, age, sex and diagnosis. The pain score at every time interval was lower in the group that had received the ice-lolly compared with the group that had not. This was statistically significant at 30 (p= 0.008) and 60 minutes (p= 0.049) . Conclusion:  Our data suggests that ice-lollies are a cheap, effective and safe method of reducing post-operative pain up to one hour following paediatric tonsillectomy.

Eur Arch Otorhinolaryngol. 2011 Sep 17. [Epub ahead of print]

Does the open rhinoplasty incision decrease nasal projection?

Coskun BU, Sozen E, Seneldir S, Ozkaya I, Yildirim O, Korkut AY, Dadas B.

Source

II Ear Nose Throat Head and Neck Surgery, Sisli Etfal Training and Education Hospital, Adnan Saygun Caddesi Kelaynak Sokak, Kibele Sitesi 10. Blok Daire:1, Ulus, Istanbul, 34340, Turkey, bernauslu@gmail.com.

Abstract

To evaluate the effects of open rhinoplasty incisions on tip projection using digitized photographs. Thirty-one patients, who underwent open technique rhinoplasty were prospectively included in the study. The lateral aspect photographs were taken before the operations. Following midcolumellar incision septal elevation was done until septal cartilage was shown. After replacing the skin totally back and suturing midcolumellar incision, the intraoperative photographs were taken. The projection indexes were measured by Goode method from the photographs and the measurements were compared. A statistically significant decline of the nasal projection was established after open technique approach. Open rhinoplasty approach led to the decrease of the nasal tip projection. This result was thought to be the effect of ligamentous disruption.

PMID:

21927892

[PubMed - as supplied by publisher]

Eur Arch Otorhinolaryngol. 2011 Nov;268(11):1611-6. Epub 2011 Jul 8.

Cricothyroid approximation for voice and swallowing rehabilitation of high vagal paralysis secondary to skull base neoplasms.

Thakar A, Sikka K, Verma R, Preetam C.

Source

Department of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.

Abstract

This study documents the speech and swallowing outcomes of isolated ipsilateral cricothyroid approximation (aka tensioning thyroplasty; Type IV thyroplasty) for the treatment of high vagal paralysis (combined superior laryngeal nerve and recurrent laryngeal nerve paralysis). This is a pilot study of five cases with high vagal paralysis consequent to skull base neoplasms. Unilateral cricothyroid tensioning sutures were used. In all cases, vocal fold tensioning and vertical realignment of lax vocal folds were achieved. A partial, but acceptable medialization of vocal cord position was achieved. In all cases, aspiration was minimized and normal swallow function was restored by 6 weeks. The voice outcome was excellent in four cases and acceptable in one. Cricothyroid approximation restores vocal fold tension; in addition, it restores vertical vocal fold position and partially restores horizontal vocal fold position. Good voice and swallowing outcomes have been achieved. The procedure is quick, safe, and convenient when combined with a skull-base excision procedure. Further evaluation is merited.

PMID:

21739100

[PubMed - in process]

Effect of myringoplasty on inner ear function

Effect of myringoplasty on inner ear function
Reviewed by: Ahmed A Saada
May/Jun 2011 (Vol 20 No 2)

This is an interesting prospective study that describes bone threshold changes after myringoplasty, thus reflecting the effect of such a procedure on inner ear function. Eligible subjects included 134 patients who underwent primary underlay type I tympanoplasty (myringoplasty). Bone conduction thresholds were determined before surgery and 6-12 months postoperatively. Details of the surgical procedure and audiological testing are described; and several variables were considered such as possible ossicular chain trauma, cochlear dysfunction, perforation size, presence of tympanic granulation tissue, myringosclerosis or tympanosclerosis, ossicular chain fixation and external canal drilling. A transcanal approach was used in 59% of cases, whereas a postauricular approach was used in the remaining 41%. There were no significant differences in preoperative threshold by all variables except ossicular chain fixation, granulation tissue and tympanosclerosis. Postoperatively, the only significant differences were noted by perforation size, ossicular chain fixation, surgical approach and external canal drilling. Details of such differences in bone conduction threshold for each frequency tested are displayed in tables. Mechanisms of cochlear damage in cases of otitis media are discussed, including the role of endogenous and exogenous substances. However, other factors that may play a role in bone conduction hearing impairment are thoroughly analysed. In conclusion, the authors observed statistically significant evidence that mechanical factors are associated with poorer bone conduction thresholds. Moreover, they stated that anatomically successful myringoplasty can slightly improve bone conduction with minimal risk of impairment.
Reference
Inner ear function following underlay myringoplasty.
Redaelli de Zinis LO, Cottelli M, Koka M.
AUDIOLOGY & NEUROTOLOGY
2010;15:149-5
http://www.entandaudiologynews.com/reviews/

Beware of the tonsillar remnant

Beware of the tonsillar remnant
Reviewed by: James Kennedy
Jul/Aug 2011 (Vol 20 No 3)

Squamous cell carcinoma (SCC) of the tonsil is the most common malignant tumour of the oropharynx. However, squamous cell carcinoma of the tonsillar remnant (SCCTR) in a previously tonsillectomised patient is rare, with only one previously documented case report in the literature. This well presented study is a retrospective review of patients presenting with SCCTR at the head and neck unit at Guy’s, Kings and St Thomas’ NHS Trusts from 2000 to 2007. In the seven-year period, 251 patients presented with SCC, and ten (4%) had a tonsillectomy performed in childhood. In this study, five patients (50%) had no obvious site of primary tumour when initially seen in clinic. In patients with no primary indentified the authors stress the importance of a systematic approach and advocate following the BAO-HNS guidelines for the management of head and neck cancer. The therapeutic strategy for SCCTR will depend on the stage of the disease at diagnosis. In this series all patients deemed curable were given combined treatment with surgery and radiotherapy. The two year disease free survival was found to be 89% and for five year 83%. The study highlights the importance of a high index of suspicion in patients who have previously undergone tonsillectomies and who present with, potentially, occult primary SCC in the head and neck region. A tonsil biopsy should be performed when investigating an unknown primary, despite childhood tonsillectomy and a normal appearance of the tonsillar remnant. The series concludes by suggesting that SCCTR can be considered as a clinical sub-group within SCC of the tonsil. The management strategy of these patients however should be the same as for patients with primary SCC and they appear to have similar oncologic outcomes.
Reference
Squamous cell carcinoma of the tonsillar remnant – clinical presentation and oncological outcome.
Skilbeck CJ, Jeannon J, O'Connell M, Morgan PR, Simo R.
HEAD & NECK ONCOLOGY
2011;3:4

http://www.entandaudiologynews.com/reviews/

Get a Hearing Aid, Save Your Brain?

A new study in the Journal of Neuroscience reports that when people lose hearing as they age, the gray matter in the auditory part of the brain actually shrinks. This in turn reduces total brain volume. They found this out by examining the brain activity of older people with hearing loss and also measuring the amount of gray matter in the auditory cortex of the brain. Therefore, the study's authors recommend hearing aids to preserve the brain as well as help an aging person to hear better. Although this study was focused on older people, the authors concluded that the results could also have major implications for younger people who lose hearing through excessive noise exposure.
READ MORE

Grafts in myringoplasty: utilizing a silk fibroin scaffold as a novel device.

Expert Rev Med Devices. 2009 Nov;6(6):653-64.
Grafts in myringoplasty: utilizing a silk fibroin scaffold as a novel device.
Levin B, Rajkhowa R, Redmond SL, Atlas MD.
Source
Ear Science Institute Australia, Ear Sciences Centre, School of Surgery, The University of Western Australia, Sir Charles Gairdner Hospital, Perth, WA, Australia. blevin@med.usyd.edu.au
Abstract
Chronic perforations of the eardrum or tympanic membrane represent a significant source of morbidity worldwide. Myringoplasty is the operative repair of a perforated tympanic membrane and is a procedure commonly performed by otolaryngologists. Its purpose is to close the tympanic membrane, improve hearing and limit patient susceptibility to middle ear infections. The success rates of the different surgical techniques used to perform a myringoplasty, and the optimal graft materials to achieve complete closure and restore hearing, vary significantly in the literature. A number of autologous tissues, homografts and synthetic materials are described as graft options. With the advent and development of tissue engineering in the last decade, a number of biomaterials have been studied and attempts have been made to mimic biological functions with these materials. Fibroin, a core structural protein in silk from silkworms, has been widely studied with biomedical applications in mind. Several cell types, including keratinocytes, have grown on silk biomaterials, and scaffolds manufactured from silk have successfully been used in wound healing and for tissue engineering purposes. This review focuses on the current available grafts for myringoplasty and their limitations, and examines the biomechanical properties of silk, assessing the potential benefits of a silk fibroin scaffold as a novel device for use as a graft in myringoplasty surgery.

Silicon gel sheeting for preventing and treating hypertrophic and keloid scars.

Cochrane Database Syst Rev. 2006 Jan 25;(1):CD003826.
Silicon gel sheeting for preventing and treating hypertrophic and keloid scars.
O'Brien L, Pandit A.
Source

Alfred Hospital, Occupational Therapy, PO Box 315, Prahran, Victoria, Australia, 3181. l.obrien@alfred.org.au
Abstract
BACKGROUND:

Keloid and hypertrophic scars are common and are caused by a proliferation of dermal tissue following skin injury. They cause functional and psychological problems for patients, and their management can be difficult. The use of silicon gel sheeting to prevent and treat hypertrophic scarring is still relatively new, and started in 1981 with treatment of burn scars.
OBJECTIVES:

To determine the effectiveness of silicon gel sheeting for: (1) prevention of hypertrophic or keloid scarring in people with newly healed wounds (e.g. post surgery); (2) treatment of established scarring in people with existing keloid or hypertrophic scars.
SEARCH STRATEGY:

Trials were identified from searches of the Cochrane Wounds Group Specialised Register (searched September 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005); MEDLINE (1989 to June 2002); EMBASE (1988 to May 2002); CINAHL (1982 to May 2002) and reference lists of articles and relevant reviews. The major supplier of silicon gel sheeting (Smith and Nephew) was approached for details of unpublished, ongoing and recently published trials.
SELECTION CRITERIA:

Any randomised or quasi-randomised controlled trials, or controlled clinical trials comparing silicon gel sheeting for prevention or treatment of hypertrophic or keloid scars against no treatment, placebo, or any other treatment type except surgery.
DATA COLLECTION AND ANALYSIS:

All relevant trials were assessed for methodological quality. Data were extracted independently by both reviewers using a standardized form, and the results cross-checked. All trials, meeting the selection criteria were assessed for methodological quality.
MAIN RESULTS:

Thirteen trials, involving 559 people, ranging in age from 2 to 81 years, were included in the review. The trials compared adhesive silicon gel sheeting with control; non-silicon gel sheeting; silicon gel plates with added Vitamin E; laser therapy; triamcinolone acetonide injection, and non-adhesive silicon gel sheeting. In the prevention studies, when compared with a no treatment option; whilst silicon gel sheeting reduced the incidence of hypertrophic scarring in people prone to scarring, (RR 0.46, 95% CI 0.21 to 0.98) these studies were highly susceptible to bias. Silicon gel sheeting produced a statistically significant improvement in scar elasticity, (RR 8.60, 95% CI 2.55 to 29.02), but again these studies were highly susceptible to bias.
AUTHORS' CONCLUSIONS:

Trials evaluating silicon gel sheeting as a treatment for hypertrophic and keloid scarring are of poor quality and highly susceptible to bias. There is weak evidence of a benefit of silicon gel sheeting as a prevention for abnormal scarring in high risk individuals but the poor quality of research means a great deal of uncertainty prevails.

Esophageal stethoscope. Another possible cause of vocal cord paralysis.

Esophageal stethoscope. Another possible cause of vocal cord paralysis.
Friedman M, Toriumi DM.
Source

Department of Otolaryngology-Head and Neck Surgery, University of Illinois College of Medicine, Chicago.
Abstract

Hoarseness after endotracheal intubation can result from compression of the anterior branch of the recurrent laryngeal nerve as it passes behind the thyroid cartilage to innervate the lateral cricoarytenoid muscle. This usually occurs when the cuff of the endotracheal tube lies in the larynx instead of the trachea. When a nasogastric tube is positioned in the midline, resultant postcricoid inflammation can result in vocal cord immobility. This may result from neuropraxia of the posterior branch of the recurrent laryngeal nerve that innervates the posterior cricoarytenoid and interarytenoid muscles, or inflammatory spasm of the interarytenoid muscles themselves. We present a case of vocal cord paralysis after general anesthesia that may have been caused by an esophageal stethoscope. The mechanism for vocal cord immobility could be similar to that of a midline nasogastric tube with resultant postcricoid inflammation. We describe measures that can be taken to prevent vocal cord paralysis after intubation of the larynx or esophagus.

Determinants of spontaneous healing in traumatic perforations of the tympanic membrane

Clin Otolaryngol. 2008 Oct;33(5):420-6.
Determinants of spontaneous healing in traumatic perforations of the tympanic membrane.
Orji FT, Agu CC.
Source

Department of Otolaryngology, Federal Medical Center Umuahia, Abia State, Nigeria. tochiorji@yahoo.com
Abstract
OBJECTIVES:

To analyse the various factors influencing spontaneous healing of traumatic tympanic membrane perforation in West Africa.
STUDY DESIGN:

Prospective clinical study. Setting: Tertiary referral centre.
PARTICIPANTS:

Consecutive patients with traumatic tympanic membrane perforations without history of previous middle ear disease.
MAIN OUTCOME MEASURES:

Healing outcome at 4, 8, 12 weeks; effects of perforation size, location, and mode of injury, active intervention and ear discharge on healing outcome.
RESULTS:

Fifty-three patients, 32 (60%) men and 21 (40%) women, aged 2-86 years, with traumatic tympanic membrane perforation who met our inclusion criteria were analysed. Ninety-four percent of the perforations healed spontaneously. Spontaneous healing was significantly correlated with age (P < 0.05). It was significantly delayed by large perforations estimated at 50% or more of entire tympanic membrane, ear discharge, wrong intervention on acute perforation by ear syringing, and by penetrating injuries sustained through the ear canal (P < 0.05, P < 0.01, P < 0.01 and P < 0.01 respectively). Perforations in the anterior versus posterior quadrants showed no significant difference in the healing rate (P > 0.05). Non-healing of the traumatic perforation was significantly associated with the large perforations, ear discharge and wrong intervention by ear syringing in chi-square test (P = 0.01, P = 0.02 and P < 0.001 respectively), but only with penetrating injuries sustained through the ear canal and the ear syringing intervention in logistic regression test (P = 0.02 and P = 0.04 respectively).
CONCLUSION:

The rate of spontaneous healing of traumatic tympanic membrane perforation varied inversely with age of patient and size of perforation. It was delayed by middle-ear infection, as well as in ears that sustain direct injuries and in ears that had wrong interventions. However, it was not dependent on whether the perforation was in the anterior or posterior location. Logistic regression analysis revealed that penetrating injuries sustained through the ear canal and the ear syringing intervention were the only risk factors important in predicting the non-healing of traumatic tympanic membrane perforation.

Water as a fast acting wax softening agent before ear syringing.

Water as a fast acting wax softening agent before ear syringing.
Pavlidis C, Pickering JA.
Source
Dimboola Medical Centre, Victoria. drpavlidis@bigpond.com
Abstract
BACKGROUND:
Dispute exists over the best treatment for softening occlusive earwax. Some require the patient to go away for days before returning for syringing. Some syringe immediately with no preparation.

METHODS:
An open, nonblinded, randomised controlled trial was conducted in one rural general practice. Effects of instillation of water into the ear canal for 15 minutes before syringing were compared to effects of syringing immediately.

RESULTS:
Thirty-nine ears (of 26 patients) were randomised. Ear wax was removed entirely by syringing in all ears. Prior instillation of water required a mean 7.5 (+/- 7.3) attempts at syringing versus a mean 25.4 (+/- 39.4) attempts for ears that were syringed immediately (p=0.043).

DISCUSSION:
Prior installation of water before syringing seems to be an effective and simple method of reducing the number of attempts required to clear the ear of occlusive wax.

Bone-anchored devices in single-sided deafness.

Adv Otorhinolaryngol. 2011;71:92-102. Epub 2011 Mar 8.
Bone-anchored devices in single-sided deafness.
Stewart CM, Clark JH, Niparko JK.
Source
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Abstract
Single sided deafness (SSD) implies sensorineural hearing loss in one ear with normal contralateral hearing function. Traditionally, SSD patients have been overlooked due to a belief that the preserved functioning of the contralateral ear compensates for the nonhearing side. SSD patients however experience multiple audiological difficulties, particularly when the sound source is situated on the non-hearing side or in the presence of competing sounds. Through reviewing current literature, we describe the role of bone-anchored devices (Baha) in the management of SSD patients. Recent publications for Baha in SSD have demonstrated consistent objective and subjective improvement in audiologic metrics when compared to unaided conditions. There is also evidence of benefit provided by Baha by the Abbreviated Profile of Hearing Aid Benefit, in global measures of ease of communication, reverberation, and background noise, but not typically in aversiveness to sounds. Interestingly, despite some patients gaining minimal objective or subjective benefits, the majority of these patients still report improved quality of life and would recommend the procedure. Despite increasing evidence for the role of Baha in the management of SSD in the literature, much of these data are based on older technology. Further reports should specify the processor type used and the etiology of the hearing loss to ensure accuracy of future data.

Wrong-site sinus surgery in otolaryngology

Approximately 10 percent of survey respondents know of a case of wrong-site sinus surgery occurring; the majority of respondents are concerned about a wrong-sinus or wrong-sided surgery occurring in their practice. Otolaryngologists should be vigilant regarding the potential for inverted computed tomography images; there should be national efforts to address this latent systems defect. Surgeons should be trained in understanding the role of and engaging in disclosure and in other techniques that are of greatest support to the patient. Consideration of sinus-specific checklists should be led by the societies representing sinus surgeons.

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• Use site markers
• EUM must before starting Ear Surgery.
• Read CT again & correctly at table.
• Faith in others may cause error.
• Avoid multi tasking.
• Analyse near misses
• Use a ckeck List