Anatomic and audiometric outcomes of porcine intestinal submucosa for tympanic membrane repair

Objective

Surgical repair of tympanic membrane perforations has been traditionally performed with autologous soft-tissue grafts with high success rates. Newer allografts such as porcine small intestine submucosa (pSIS) have been employed as alternatives to minimize donor morbidity and surgical time, and in cases where autologous tissue may not be available. The comparative anatomic and audiometric success rates of these tissues is still unclear.

Study design

Retrospective case-control series of anatomic and audiometric outcomes of autologous soft tissue versus pSIS graft for primary, isolated transmeatal tympanic membrane repair.

Methods

Analysis of patients undergoing primary transmeatal tympanic membrane repair with autologous soft tissue or pSIS. Patients with otorrhea, cholesteatoma or retraction pockets, those who had cartilage grafts or ossicular reconstruction, and revision procedures were excluded. Pre- and post-surgery air-bone gaps (ABG) and pure tone averages (PTA) were compared. Graft success was defined as closure of the perforation at 2-month follow-up visit.

Results

The success rate for both the autologous soft tissue and the pSIS arm is 93.8%. There was no statistical significance (p < .05) between the post-op ABG, change in ABG, post-op PTA, change in PTA, or graft success rate between the two groups with either lumped cohort or matched-pairs analysis.

Conclusions

pSIS grafts are effective for repair of tympanic membrane perforations with hearing outcomes and graft success rates comparable to autologous soft tissue.

Lay summary

Repair of tympanic membrane perforations is traditionally done using a soft-tissue graft harvested from the patient at the time of surgery. pSIS is a newer graft material that is equally effective in terms of anatomical and audiometric outcomes.

Level of evidence

Level 3b.

Hearing Aid Patient Education Materials: Is There Room for Improvement?

Purpose: The purpose of this study was to analyze and compare the readability of patient education materials (PEMs) from leading manufacturers of behind-the-ear style hearing aids and popular hearing aid information Web sites to determine if they meet guidelines recommended by public health agencies.

Research Design: Analysis of hearing aid PEMs.

Methods: Printed user guides from six of the leading manufacturers of BTE hearing aids and 15 of the most popular hearing aid–information Web sites were accessed online and analyzed for readability using the Gunning-Fog Index, New Fog Count, Raygor Estimate Graph, Simple Measure of Gobbledygook, and Flesch Reading Ease score.

Results: Overall average grade–level readability for all six printed manufacturer user manuals was calculated to be written at a 10th grade reading level. Overall average grade-level readabilities for all 15 popular online hearing aid–information Web sites representing professional organizations, suppliers, and health information services were calculated to be written at 10th, 10th, and 11th grade reading levels, respectively. Average Flesch Reading Ease scores for all printed guides and online patient information Web sites were calculated to fall within the fairly difficult category for readability.

Conclusions: PEMs provided by top hearing aid manufactures and popular hearing aid Web sites are written well above the reading level recommended by the National Institutes of Health. Consideration should be given toward simplifying these materials in order to enhance user experience and increase compliance among behind-the-ear hearing aid users.

Tracheostomy in the Extremely Premature Neonate: A Multi-Institutional Study

OBJECTIVE

(1) To describe characteristics associated with tracheostomy placement and (2) to describe associated in-hospital morbidity in extremely premature infants.

STUDY DESIGN

Pooled retrospective analysis of charts.

SETTING

Academic children's hospitals.

SUBJECTS AND METHODS

The patient records of premature infants (23-28 weeks gestational age) who underwent tracheostomy between January 1, 2012, and December 31, 2017, were reviewed from 4 academic children's hospitals. Demographics, procedural morbidity, feeding, respiratory, and neurodevelopmental outcomes at the time of transfer from the neonatal intensive care unit (NICU) were obtained. The contribution of baseline characteristics to mortality, neurodevelopmental, and feeding outcomes was also assessed.

RESULTS

The charts of 119 infants were included. The mean gestational age was 25.5 (95% confidence interval, 25.2-25.7) weeks. The mean birth weight was 712 (671-752) g. Approximately 50% was African American. The principal comorbidity was chronic lung disease (92.4%). Overall, 60.5% of the infants had at least 1 complication. At the time of transfer, most remained mechanically ventilated (94%) and dependent on a feeding tube (90%). Necrotizing enterocolitis increased the risk of feeding impairment (P = .002) and death (P = .03).

CONCLUSIONS

Tracheostomy in the extremely premature neonate is primarily performed for chronic lung disease. Complications occur frequently, with skin breakdown being the most common. Placement of a tracheostomy does not seem to mitigate the systemic morbidity associated with extreme prematurity.

Traumatic Tympanic Membrane Perforations Diagnosed in Emergency Departments

Importance

Tympanic membrane perforations (TMPs) are frequent events leading to evaluation in the primary care and otolaryngology offices or the emergency department (ED). Despite specific warning labels on packaging of cotton-tipped applicators regarding the risk of injury to the ear canal with personal use, these products are commonly used to remove ear cerumen.

Objective

To analyze the mechanism of injury for traumatic TMPs among patients presenting to the ED.

Design, Setting, and Participants

Cross-sectional analysis of cases from 100 emergency departments in the United States. The National Electronic Injury Surveillance System was searched on April 3, 2015, for ear-related injuries with analysis information regarding patient age, patient sex, time and date of injury, specific injury diagnoses, and specific injury mechanisms that occurred across 5 years, from January 1, 2010, through December 31, 2014.

Main Outcomes and Measures

Diagnoses of traumatic TMP documented in the ED visit record as well as patient demographics, diagnoses, and other aspects of the injury, including mechanism of injury.

Results

There were 949 case entries in the database for traumatic TMP, which extrapolates to 4852 ED visits nationally. Of 949 patients evaluated, 568 (59.8%) were men and 381 (40.2%) were women resulting in a male to female ratio of 1.49:1. Most injuries occurred in patients 18 years or younger (602 of 949 [63.4%]) with children younger than 6 years most at risk (331 of 949 [34.9%]). Ear canal instrumentation including foreign bodies was noted in 581 of 949 cases (61.2%), with cotton-tipped applicators noted in 261 (44.9%) of these cases. While foreign body instrumentation represented the leading cause of traumatic TMP in patients aged 0 to 5 years (284 of 331 cases [85.8%]), 6 to 12 years (108 of 158 [68.4%]), 19 to 36 years (85 of 223 [38.1%]), 37 to 54 years (48 of 91 [52.7%]), and 55 years or older (22 of 33 [66.7%]), water trauma was the leading cause of TMP in patients aged 13 to 18 years (43 of 113 cases [38.1%]).

Conclusions and Relevance

Traumatic TMP represents a common reason for evaluation in the ED. Despite common warnings regarding risk of injury to the tympanic membrane with use of a cotton-tipped applicator, it is still a major cause of traumatic TMPs. Other injury mechanisms also play an important role in the teenage and young adult populations.

The Role of Surgery in Management of Samter's Triad: A Systematic Review

OBJECTIVE

Aspirin-exacerbated respiratory disease (AERD) represents a severe form of chronic rhinosinusitis (CRS) characterized by nasal polyposis, bronchial asthma, and aspirin intolerance. This syndrome, known as Samter's triad, is more difficult to manage than routine CRS and poses a challenge to the treating clinician. We performed a systematic review of the literature to determine the role of endoscopic sinus surgery in patients with AERD who are on adjuvant medical therapies.

DATA SOURCES

PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Cochrane Technology Assessments, Cochrane Economic Evaluations, Cochrane Groups, and Clinicaltrials.gov.

REVIEW METHODS

A systematic review of the literature was performed using the 2009 PRISMA guidelines. Studies with both preoperative and postoperative data for patients with AERD who underwent sinus surgery were considered appropriate for inclusion. Publications were written in English, included patients aged 18 years or older, and had a minimum follow-up of 3 months.

RESULTS

Eighteen studies met criteria for inclusion in our review. The primary outcome was change in symptom profile as measured by sinonasal and asthma symptom scores. Most studies demonstrated improvement in sinus- and asthma-related symptoms and quality-of-life measures after endoscopic sinus surgery.

CONCLUSION

This review, which did not exclude the use of concomitant medical therapy, suggests that surgery is beneficial in AERD management. Evidence demonstrates improvement in sinonasal and asthma symptom severity and frequency, radiographic and endoscopy scores, and quality of life after surgery.

"Beaned": A 5-Year Analysis of Baseball-Related Injuries of the Face

OBJECTIVES

Baseball remains one of the most popular and safest games played by children and adults in America and worldwide. Rules and equipment changes have continued to make the game safer. For youth leagues, pitching restrictions, safety balls, helmets, and face mask equipment continue to make the game safer. With increased utilization of safety equipment, the objective was to analyze recent trends in baseball-related facial injuries.

STUDY DESIGN

Cross-sectional analysis of a national database.

METHODS

The National Electronic Injury Surveillance System was searched for baseball-related facial injuries with analysis of incidence, age, and sex and specific injury diagnoses, mechanisms, and facial locations.

RESULTS

From 2009 to 2013, there were 5270 cases entries, or 187,533 estimated emergency department (ED) visits, due to baseball-related facial injuries. During this time, there was a significant decline in the incidence of ED visits (P = .014). Inclusion criteria were met by 3208 visits. The majority of injuries occurred in patients ≤18 years old (81.5%). The most common injury was laceration (33.2%), followed by contusion (29.7%) and fracture (26.9%), while the most common injury site on the face was the nose (24.9%). The injuries were most commonly due to impact from a baseball (70%) or a bat (12.5%).

CONCLUSION

The overall incidence of ED visits due to baseball-related facial injuries has decreased over the past 5 years, concurrent with increased societal use of protective equipment. Nonetheless, these injuries remain a common source for ED visits, and a continued effort to utilize safety measures should be made, particularly in youth leagues.