A Systematic Review and Meta‐Analysis: Timing of Elective Removal of Tympanostomy Tubes

xlomafota13 shared this article with you from Inoreader A Systematic Review and Meta‐Analysis: Timing of Elective Removal of Tympanostomy Tubes Via The Laryngoscope Objective(s) Tympanostomy tube (TT) placement is the most common surgical procedure in children. Less than 10% of TT do not self-extrude. This study is a systematic review (SR) on elective TT removal in the pediatric population: timing, perforation rates, and role of simultaneous repair. A PICOTS (population, intervention, comparison, outcome, timing, setting) question was formulated: In pediatric patients who have retained TT, what is the preferred time to elective removal of such tubes, and what are the outcomes in terms of perforation rates? Does an intervention at the time of TT removal improve perforation rates? Study Design Systematic review and meta-analysis. Methods We searched four major electronic databases: EMBASE, MEDLINE, CDSR, CCRCT for articles published prior to 02/19/20. EndNote® was used to gather references, review abstracts, and obtain full text articles. Inclusion criteria were studies reporting patients aged 0 to 18 years undergoing elective TT removal with follow-up greater than 3 months. Exclusion criteria included patients >18 years, duplicate patient series, or case series with fewer than five patients. Articles that were not available in English, not available in full text, and those that only addressed long-acting TT were excluded. Data were pooled and meta-analysis was conducted to examine how timing of TT removal, patching of the tympanic membrane, or any TM intervention at TT removal affected outcomes. Results A total of 1,064 references were found. We identified 63 unique studies for full text review. Of these, 17 were selected for SR. MINORS (Methodological Index for Nonrandomized Studies) scores were low-revealing high bias among the studies. Reported perforation rates after elective TT removal ranged from 0% to 57%. Four studies had data suitable for comparative meta-analysis, which showed a significant increase in perforation rates after elective removal of TT after 3 years compared to removal prior to 3 years (OR 2.89; CI 1.78–4.69). No difference in perforation rates were identified when TM intervention vs. no intervention at time of TT removal was performed (six studies: OR 1.21; CI 0.71–2.07). No difference in perforation rates was identified when the type of TM intervention was compared, including freshening of TM edges, to patching with various materials (paper, fat, gelfoam®/gelfilm®, Trichloroacetic acid) (three studies: OR 1.07; CI 0.52–2.19). Conclusion From the data reviewed in this SR and meta-analysis, elective TT removal at or prior to 3 years' retention showed decreased perforation rates. However, TM intervention at the time of TT removal was not shown to lower perforation rates. In the absence of tube complications such as granuloma formation, nonfunctional tube, or chronic tube otorrhea, it may be reasonable to wait up to 3 years to electively remove a retained TT. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Postoperative Inhaled Steroids Following Glottic Airway Surgery Reduces Granulation Tissue Formation

xlomafota13 shared this article with you from Inoreader Postoperative Inhaled Steroids Following Glottic Airway Surgery Reduces Granulation Tissue Formation Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Dec 30:34894211065805. doi: 10.1177/00034894211065805. Online ahead of print. ABSTRACT OBJECTIVES: Transoral laser surgery for glottic stenosis (transverse cordotomy and anteromedial arytenoidectomy (TCAMA)) is often complicated by granulation tissue (GT) formation. GT can cause dyspnea and may require surgical removal to alleviate airway obstruction. Inhaled corticosteroids (ICS) have been shown to reduce benign vocal fold granulomas, however its use to prevent GT formation has not been described. We aimed to analyze the effect of immediate postoperative ICS on GT formation in patients undergoing transoral laser surgery for glottic stenosis. METHODS: A retrospective analysis of patients that had transoral laser surgery for glottic stenosis from 2000 to 2019 was conducted. Surgical instances were grouped into those that received postoperative ICS and those that did not. Demographics, diagnosis, comorbidities, intraoperative adjuvant therapy, and perioperative medications were collected. Differences in GT formation and need for surgical removal were compared between groups. A multivariate exact logistic regression model was performed. RESULTS: Forty-four patients were included; 16 required 2 glottic airway surgeries (60 surgical instances). Of the 23 instances where patients received immediate postoperative ICS, 0 patients developed GT; and of the 37 instances that did not receive postoperative ICS, 15 (40.5%) developed GT (P < .0001). Eight (53.3%) of these cases returned to the OR for GT removal. ICS use was solely associated with the absence of GT formation (P = .042) in the multivariate analysis. CONCLUSIONS: Immediate postoperative use of ICS seems to be a safe and effective method to prevent granulation tissue formation and subsequent surgery in patients following transoral laser airway surgery for glottic stenosis. PMID:34965742 | DOI:10.1177/00034894211065805 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

High-Definition 3-D Exoscope for Micro-Laryngeal Surgery: A Preliminary Clinical Experience in 41 Patients

xlomafota13 shared this article with you from Inoreader High-Definition 3-D Exoscope for Micro-Laryngeal Surgery: A Preliminary Clinical Experience in 41 Patients Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Dec 30:34894211063741. doi: 10.1177/00034894211063741. Online ahead of print. ABSTRACT OBJECTIVE: The aim of this prospective clinical study is to evaluate the feasibility of the micro-laryngeal surgery (MLS) using a 3D operating exoscope (OE) in substitution to a conventional operating microscope (OM). METHODS: A total of 41 consecutive patients were included (male: 26; median age: 55.0 years; IQR: 46.0-68.0). After each procedure, the s urgeon and the scrub nurse were asked to fill out a tailored questionnaire on a 3-point Likert scale (1-not acceptable, 2-acceptable, 3-good) including 12 items. RESULTS: The majority of the procedures were therapeutic (n = 31, 75.6%), while the remaining were diagnostic (n = 10, 24.4%). All surgeries were successfully completed without the support of the OM, and no complications or unwanted delays were detected. The majority of the individual items were judged "good" either by surgeons (n = 399, 81.1%) and scrub nurses (n = 287, 87.5%). The natural posture during the procedure, and the ease of use the joystick and focusing were the best-rated items by the surgeons. CONCLUSIONS: This study demonstrates the feasibility of MLS using the OE. Further comparative clinical studies are needed to clarify its real value in substitution to a conventional operating microscope and to better define advantages and disadvantages. PMID:34965750 | DOI:10.1177/00034894211063741 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Successful Oral Levothyroxine Desensitization in a Patient with Severe Hypothyroidism Post Radioactive Iodine Therapy: A Case Report

xlomafota13 shared this article with you from Inoreader Successful Oral Levothyroxine Desensitization in a Patient with Severe Hypothyroidism Post Radioactive Iodine Therapy: A Case Report Via radioactive iodine J ASEAN Fed Endocr Soc. 2021;36(2):213-215. doi: 10.15605/jafes.036.02.10. Epub 2021 Aug 19. ABSTRACT Levothyroxine remains the standard therapy for patients with hypothyroidism worldwide. Levothyroxine allergy is rarely seen and alternative therapies are less efficacious and scarcely available. The use of liothyronine (LT3) monotherapy is less favoured due to its short half-life and unpredictable pharmacological profile. We report a 59-year-old male with a hypersensitivity reactio n to levothyroxine who was successfully desensitized with oral levothyroxine within a day using a 14-step protocol. PMID:34966208 | PMC:PMC8666481 | DOI:10.15605/jafes.036.02.10 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Associations of Hearing Loss and Dual Sensory Loss With Mortality

xlomafota13 shared this article with you from Inoreader Associations of Hearing Loss and Dual Sensory Loss With Mortality Via JAMA Otolaryngology–Head & Neck Surgery Online First This systematic review and meta-analysis assesses the epidemiol ogical associations of hearing loss and dual sensory loss with mortality among adults. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effect of Perioperative Patient Education via Animated Videos in Patients Undergoing Head and Neck Surgery

xlomafota13 shared this article with you from Inoreader Effect of Perioperative Patient Education via Animated Videos in Patients Undergoing Head and Neck Surgery Via JAMA Otolaryngology–Head & Neck Surgery Online First This randomized clinical trial examines the efficacy of an anim ated surgical guide in helping Canadian patients who are undergoing head and neck surgery feel more satisfied with their surgery and recovery process. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.