How effective is postoperative packing in FESS patients? A critical analysis of published interventional studies

The present study aimed to assess the clinical effectiveness of absorbable packing alone, non-absorbable packing alone, and absorbable versus non-absorbable packing in the postoperative care of FESS patients, regarding bleeding control, adhesion formation, wound healing, and overall patient comfort. Systematic literature review in Medline and other database sources until July 2013, and critical analysis of pooled data were conducted. Blinded prospective randomized control trials, prospective, and retrospective comparative studies were included in study selection. The total number of analyzed studies was 19. Placing packs in the middle meatus after endoscopic procedures does not seem to be harmful for postoperative patient care. Regarding the postoperative bleeding rate, absorbable packing is not superior to no postoperative packing (strength of recommendation A). Comparing absorbable to non-absorbable packing, the former one seems slightly more effective than the latter in the aforementioned domain (strength of recommendation C). Absorbable packing was also found more effective than non-absorbable packing as a means of reducing the postoperative adhesion rate (strength of recommendation B), and more effective in comparison with not placing any packing material at all (strength of recommendation C). Non-absorbable packing also proves more effective than no postoperative packing in preventing the appearance of such adhesions (strength of recommendation A). Absorbable packing is also more comfortable compared to non-absorbable materials (strength of recommendation A), or no postoperative packing in FESS patients (strength of recommendation B). The comparative analysis between the different packing modalities performed in the present study may help surgeons design a more individualized postoperative patient care.

Laryngeal Involvement in Connective Tissue Disorders. Is it Important for Patient Management?

Connective tissue disorders (CTDs) involve multiple organ systems and may have a significant impact on the overall health and quality of life of the affected individuals. The present paper aims to review the current knowledge on the laryngeal manifestations of CDTs, and describe the available diagnostic and treatment options. Systematic literature review in Medline and other database sources. Information from related books was also included. Prospective controlled, double-blind prospective, prospective, and transversal cohort studies, case series, case reports, systematic reviews, and consensus papers. Laryngeal involvement mostly occurs in rheumatoid arthritis (13-75% of patients). It is not uncommon in active and progressive clinical course, though can also occur in silent or inactive CDTs. The crico-arytenoid joint is the most commonly affected site. Common symptoms include throat pain, dyphonia and hoarseness. Careful clinical assessment of the larynx by flexible naso-endoscopy, video-stroboscopy, or direct laryngoscopy, and appropriate imaging are required for pertinent patient management. Stridor is a sign of a life-threatening condition, and may require prompt surgical intervention. However, mild symptomatology may mislead clinicians, and the related diagnosis may be significantly delayed. The current evidence as identified in the present study suggest that laryngeal manifestations of CDTs are often underdiagnosed, due to a range of non- specific symptoms. A multidisciplinary team approach with ENT input is necessary to improve the overall patient management.

Is cartilage better than temporalis muscle fascia in type I tympanoplasty? Implications for current surgical practice

The aim of this study was to compare the hearing results and graft integration rates in patients undergoing myringoplasty for the reconstruction of the tympanic membrane, with the use of either cartilage or temporalis muscle fascia (TMF). A systematic literature review in Medline and other database sources up to February 2012 was carried out, and the pooled data were meta-analyzed. Twelve studies were systematically analyzed. One represented level I, one level II and ten level III evidence. The total number of treated patients was 1,286. Cartilage reconstruction was used in 536, TMF in 750 cases. Two level III studies showed a significant difference between the pre- and postoperative air-bone gap closure, in favor of cartilage grafting. The mean graft integration rate was 92.4 % in the cartilage group and 84.3 % in the TMF group (p < 0.05). The rates of re-perforations were 7.6 and 15.5 %, respectively (p < 0.05). Among the other complications of type I tympanoplasty, retraction pockets, otitis media with effusion, anterior blunting, and graft lateralization were usually surgically managed, whereas most of the rest were minor and could be dealt with conservatively. The graft integration rate in myringoplasty is higher after using cartilage, in comparison with fascia reconstructions (grade C strength of recommendation), and the rate of re-perforation is significantly lower. Although cartilage is primarily used as grafting material in cases of Eustachian tube dysfunction, adhesive otitis media, and subtotal perforation in everyday surgical practice, a wider utilization for the reconstruction of the tympanic membrane in myringoplasties can be recommended.

Effect of type I tympanoplasty on the resonant frequency of the middle ear: comparison between chondrotympanoplasty and temporalis fascia grafting

AIMS

To evaluate the effect of type I chondrotympanoplasty on the resonant frequency (RF) of the middle ear and compare it to the respective outcomes of type I tympanoplasty using temporalis fascia grafting (TFG). Hearing results and respective graft integration rates were also assessed.

MATERIALS AND METHODS

A retrospective comparative study was conducted of patients who had undergone type I tympanoplasty at a tertiary university hospital. Selection criteria included tympanic membrane perforation following chronic otitis media, trauma, or grommet insertion; an intact ossicular chain; a dry ear for at least 3 months; and normal middle ear mucosa. Patients with ossicular discontinuity, ossiculoplasty, cholesteatoma, previous ear surgery, syndromes affecting the middle ear, or younger than 16 years old were excluded.

RESULTS

Sixty-nine patients met the inclusion criteria; chondrotympanoplasty was performed in 39 and TFG in 30. Three patients showed incomplete tympanic membrane closure at follow-up. The graft integration rate was 97.4% in the chondrotympanoplasty group and 93.3% in the TFG group. An air-bone gap closure within 10 dB was achieved in 73.7% of the chondrotympanoplasty patients versus 67.9% of the TFG patients. Hearing gain of 21 to 30 dB in air conduction thresholds was obtained in 65.8% of the chondrotympanoplasty patients and 60.7% of their TFG counterparts. RF was 808 ± 458 Hz in the chondrotympanoplasty group and 628 ± 256 Hz in the TFG group. The RF remained within the normal range in 73.7% of chondrotympanoplasty patients versus 42.9% of TFG patients.

CONCLUSIONS

Chondrotympanoplasty has hearing results comparable to those of TFG myringoplasty. The cartilage can be used without concerns regarding its impact on the middle ear mechanics as the sound-conducive properties of the tympanic membrane remain unchanged.

Cochlear implantation following temporal bone fracture

Patients with bilateral temporal bone fractures frequently suffer profound hearing loss. These patients may benefit from cochlear implantation. Displaced fracture lines and ossification of the cochlea might complicate insertion of the electrode array. In the present paper we present a case of a failed cochlear implantation due to ossification of the cochlea, followed by a successful one on the opposite side in a patient who sustained bilateral temporal bone fractures. Preoperative imaging may identify these factors, help guide the appropriate surgical approach and choose which side to implant. We aim to highlight the necessity of imaging and discuss the reliability of computed tomography (CT) scanning in predicting cochlear patency in cases of temporal bone fracture. Possible management options in the case of complex cochlear implantation are also described.

A pain in the neck: a rare case of isolated hyoid bone trauma

We report the first case of dislocation of the symphysis between the great cornu and the body of the hyoid bone following strangulation in survivors. The present paper presents a rare case of injury to the hyoid bone and reviews the current knowledge on hyoid bone injuries in survivors.