A pilot randomized controlled trial comparing bismuth iodine paraffin paste external ear pack and no ear pack after middle ear surgery

A Post-marketing Surveillance, Single-Centric Study to Evaluate the Safety and Tolerability of VELNEZ as a Space-Occupying Dressing Pack After Ear Surgery

PURPOSE

The purpose of this study was to evaluate the safety and tolerability of VELNEZ (Datt Mediproducts Pvt. Ltd., New Delhi, India) as a space-occupying dressing for controlling hemorrhage after ear surgery.

METHOD

A total of 21 patients were included in an open-label, interventional, single-arm post-marketing surveillance study to investigate the safety and efficacy of the VELNEZ ear pack. The patients were questioned for collecting data related to the subject's safety and comfort, adverse events, site assessment, and otoscopic examination from discharge day to last follow-up (eight follow-up visits) at regular intervals. The standardized questionnaires for VELNEZ tolerability (pain/pressure effect, infection, and general satisfaction) were used after ear surgery.

RESULTS

 The average hemorrhage control time was 1.08 ± 0.16 minutes. None of the subjects reported moderate pain at any of the study visits following surgery. This biodegradable ear pack had an average disintegration time of 25.4 days in the ear cavity. No postoperative adverse events or serious adverse events were observed.

CONCLUSION

VELNEZ is safe and effective as a space-occupying dressing pack after ear surgery and is well-tolerated by patients.

Review of endoscopic myringoplasty success: comparisons of intra-operative graft material and post-operative packing in terms of graft failure rate

Background

Myringoplasty success rate is estimated to be between 60 and 90 per cent. Factors predicting success include the choice of graft and use of auditory canal packing. This study aimed to determine the intra-operative factors associated with endoscopic myringoplasty success.

Methods

A retrospective review of all endoscopic myringoplasty cases between January 2017 and January 2020 was undertaken. Data were collected on: patient demographics, tympanic membrane perforation size, intra-operative details, audiology and post-operative outcomes.

Results

There was no significant difference in graft success rates between cases using bismuth iodoform paraffin paste and Spongostan packing (86.7 per cent vs 84.9 per cent, respectively). Conchal cartilage graft had a higher success rate (100.0 per cent) compared with Biodesign grafting biomaterial (66.7 per cent), but was not superior to tragal cartilage (84.6 per cent) or temporalis fat or fascia (80.0 per cent).

Conclusion

Spongostan packing is equivalent to bismuth iodoform paraffin paste in terms of endoscopic myringoplasty success rate. Although conchal cartilage graft had higher success rates, it was not statistically significantly different from tragal cartilage.

Effect of Physician Consultation on Satisfaction With Hearing Aid Use: A Randomized Clinical Trial

Importance

Hearing loss is one of the most common chronic disabilities in older adults, yet reported rates of users' satisfaction with hearing aids are low. Some believe that physicians can provide patients who are pursuing a hearing aid fitting an impartial opinion that will improve hearing aid satisfaction.

Objective

To determine whether a physician consultation increased or decreased patients' satisfaction with hearing aids compared with patients undergoing hearing aid fitting with a dispensing audiologist alone.

Design, Setting, and Participants

This multicenter, parallel-group, standard regimen-controlled, randomized clinical trial was conducted in offices of audiologists, family physicians, and a hospital-based neurotologist in Vancouver, British Columbia, Canada, and recruited participants from July 2016 to December 2020 with a 3-month postintervention follow-up. The final data analysis was conducted on March 25, 2022. Adult first-time hearing aid users with averaged sensorineural hearing losses of more than 25 dB were prospectively allocated by random number generation to control and intervention groups. Participants were excluded from analysis if they did not attend follow-up or complete the study questionnaire.

Interventions

Control participants were followed up solely by their dispensing audiologist. The intervention group attended a single structured visit with a physician in addition to their audiologist's determined follow-up.

Main Outcomes and Measures

Primary outcome: hearing aid satisfaction 3 months postfitting as measured by the Satisfaction with Amplification in Daily Life (SADL) questionnaire. Secondary outcome: number of returned hearing aids. Prerecruitment null hypothesis: no intergroup difference in postfitting hearing aid satisfaction. Intergroup difference in mean SADL questionnaire scores analyzed by effect size and the Student t test and proportion of returned hearing aids by the Fischer exact test.

Results

A total of 133 participants (mean [SD] age, 70.9 [8.5] years; 64 women [48.1%]) were recruited. Of these, 51 randomized to the control group (mean [SD] age, 71.7 [8.3] years; 28 women [54.9%]) and 42 to the physician intervention (mean [SD] age, 69.9 [7.6] years; 17 women [40.5%]) had results that were analyzed. There was no clinically meaningful intergroup difference in participants' SADL scores (control: mean [SD] score, 5.33 [0.72]; physician consultation: mean [SD] score, 5.35 [0.61]), the mean difference of 0.02 (95% CI, -0.25 to 0.29), or returned hearing aids (control, 1; physician consultation, 0).

Conclusions and Relevance

The results of this randomized clinical trial suggest that a physician consultation that is focused on hearing change does not alter a patient's satisfaction with hearing aids 3 months postfitting.

Trial Registration

ClinicalTrials.gov Identifier: NCT02842905.