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European archives of oto-rhino-laryngology [journal]
- Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2013 May 18.
One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in "high risk" patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care.
- Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2013 May 17.
Neuromonitoring in thyroid surgery has been employed to make nerve identification easier and decrease the rates of laryngeal nerve injuries. Several individual randomized controlled trials (RCTs) have been published, which did not identify statistical differences in the rates of recurrent laryngeal nerve (RLN) or external branch of the superior laryngeal nerve (EBSLN) injuries. The objective of this report is to perform meta-analysis of the combined results of individual studies to measure the frequency of RLN and EBSLN injuries in patients who underwent thyroidectomy with routine neuromonitoring in comparison with common practice of search and identification. RCTs comparing routine neuromonitoring versus no use in patients who underwent elective partial or total thyroidectomy were evaluated. Outcomes measured were temporary and definitive palsy of the RLN and EBSLN. A systematic review and meta-analysis was done using random effects model. GRADE was used to classify quality of evidence. Six studies with 1,602 patients and 3,064 nerves at risk were identified. Methodological quality assessment showed high risk of bias in most items. Funnel plot did not reveal publication bias. The risk difference for temporary RLN palsy, definitive RLN palsy, temporary EBSLN palsy, and definitive EBSLN palsy were -2 % (95 % confidence interval -5.1 to 1); 0 % (-1 to 1); -9 % (-15 to -2) and -1 % (-4 to 2), respectively. Quality was rated low or very low in most outcomes due to methodological flaws. Meta-analysis did not demonstrate a statistically significant decrease in the risk of temporary or definitive RLN injury and definitive EBSLN injury with the use of neuromonitoring. The neuromonitoring group had a statistically significant decrease in the risk of temporary EBSLN injury.
- Surgery and proton pump inhibitors for treatment of vocal process granulomas. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2013 May 16.
The aim of this study was to analyze the outcomes of vocal process granulomas treated with surgery and proton pump inhibitors and to specify related factors of recurrence. The medical records of patients with diagnosis of vocal process granuloma between 2000 and 2012 were reviewed. All patients were treated with surgery and proton pump inhibitors for at least 1 month. Forty-one patients were reviewed; mean follow-up time was 45 months. There was no recurrence among the patients who had a recent history of intubation. The recurrence rates of contact granuloma was 38.7 %, and significantly related to the frequency of surgery (P = 0.042), but was not significantly associated with the history of acid reflux (P = 0.676) and vocal abuse (P = 0.447), lesion size (P = 0.203) or surgical techniques (P = 0.331). Surgery combined with proton pump inhibitors was partially effective for the vocal process granulomas, especially with intubated patients. However, repeat surgery for recurrent contact granuloma should be preceded with caution due to high recurrence rates.
- Using bilaterally fascioperichondrial flaps with a distal and a proximal base combined with conventional otoplasty. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2013 May 14.
Prominent ears are the most common aesthetic abnormality of the external ear. Mustardè sutures and conchal setback are usually used for otoplasty, additional various cartilage-manipulation methods are also presented. One adjunctive technique that is often used involves the elevation of a fascial flap beneath which is sutured for additional cover, potentially reducing the risk of complications and recurrence. In the literature, this flap is traditionally raised with a proximal or distal base but it can be raised both distally and proximally with a number of advantages as we demonstrate. This article presents a technique to raise the fascioperichondrial flap with both a proximal and a distal base as an addition to conventional otoplasty. One hundred consecutive patients, followed up for at least 12 months, have been reviewed. One hundred ninety otoplasties were performed in 100 patients (10 unilateral), 65 women and 35 men. The mean age was 20.6 years, and the mean follow-up time was 16.3 months, respectively. No patient has developed skin necrosis or suture extrusion. In two patients (One bilateral and one unilateral for a total of three ears) a further procedure has been required to improve symmetry (1.5 %). Using the retro auricular fascioperichondrial flap combined with other techniques offers good results and can be used as a standard procedure in the surgical treatment of prominent ears.
- Does rheumatoid arthritis have an effect on audiovestibular tests? [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2013 May 12.
The study aimed to determine the characteristics of hearing loss, vestibular responses and the incidence of vestibular disturbances in RA patients. This prospective study was performed at the Otolaryngology Department of Bozok University School of Medicine between May and November 2012. Eighty-one RA patients (69 women and 12 men) with a mean age of 40.8 ± 13.4 years (23-67 years) and 81 healthy controls (67 women and 14 men) with a mean age of 41.3 ± 13.8 years (24-66 years). Each subject was tested with low and high-frequency audiometry by a single experienced investigator under standard audiometric testing conditions. For each set of tests, mean values of air and bone conduction at each frequency and tympanometric values were calculated for the study groups. Videonystagmography (VNG) including smooth pursuit, saccade, positional, and caloric tests were also performed. The mean air conduction threshold values at high frequencies (4,000, 6,000, and 8,000 Hz) in RA group were lower than control groups. The difference between mean air conduction threshold values of the control groups against RA group at high frequencies were statistically significant (p < 0.05). There was no statistically significance between the two groups in tympanometric values (p < 0.05). VNG testing revealed central abnormalities in twenty patients (24.69 %), peripheral abnormalities in five patients (6.17 %), and mixed abnormalities in six patients (7.4 %). There was no association between VNG abnormalities in patients with RA and age, sex, duration of disease, accompanying vertigo complaint, the laboratory findings and hearing levels (p < 0.05). Our findings suggest an association of RA and audiovestibular system dysfunction regardless clinical and demographic situation of patients. We assume the hearing and vestibular disturbances in RA are more prevalent than previously recognized. Also hearing losses in high frequencies in RA patients may be considered as an indicator of cochlear involvement in this disease.
- Drug-induced sleep endoscopy: a two drug comparison and simultaneous polysomnography. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2013 May 12.
The purpose of the present study was to compare pharyngeal and polysomnographical findings during drug-induced sleep endoscopy (DISE) performed with either propofol or midazolam as a single sedative agent. It is prospective, non-randomized, double-blinded case series study. Sixteen patients with sleep disordered breathing were sedated first with propofol and after full wake up with midazolam. Simultaneous polysomnography (PSG) was performed. We compared the zones of obstruction and vibration found with both drugs using the VOTE classification. Simultaneous PSG findings are also compared. There were 15 men and one woman; the mean age was 42.7 years old, mean body mass index 26.9 kg/m(2). Average DISE duration was 20 min with Propofol and 14.3 min with Midazolam. The induced sleep stage obtained was N2 with both drugs. Outpatient physical exam did not correlate with drug-induced sleep findings. There was a good correlation between DISE results with both drugs in all the areas of collapse except the velum (p < 0.005). Using a continuous perfusion, there is a good agreement in the findings observed in DISE performed with propofol and midazolam and PSG.
- Patient specific or routine preoperative workup in septoplasty: which one is cost-effective? [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2013 May 12.
This study aimed at determining the limits of preoperative investigation and calculate estimated cost analysis in septoplasty with and without turbinate surgery. A retrospective chart review. The study was conducted at secondary referral center. A retrospective chart review of patients who have undergone septoplasty over a 1-year period was performed. The need for routine (battery testing) versus patient specific preoperative workup of 380 septoplasty patients was evaluated. Mean age of the patients was 31.5 ± 4.6. The patients were classified into three groups according to preoperative routine laboratory testing results: (1) normal group (2) abnormal group and (3) abnormal out of action limit group. Medical records were revaluated by an anesthesiologist and ear nose throat doctor according to preoperative American Society of Anesthesiologists guidelines to calculate estimated possible costs in case of patient specific preoperative workup. Three hundred seventy-seven patients were within ASA 1 group and three patients were within ASA 2. According to preoperative battery testing results, 5.8 % of the patients (n = 22) were in group 1, 93.4 % (n = 355) were in group 2, 0.8 % (n = 3) were in group 3. Surgery was postponed due to concomitant pathologies for about 44 days (10-180 days) in four patients (1.1 %). Preoperative routine laboratory testing costs were calculated as $41.08 ± 6.69 (40.25-128.78) per patient. When medical records were reevaluated retrospectively, estimated cost per patient would be $8.91 ± 10.40 (7.18-79.91) if patient specific preoperative workup were done. Individual preoperative testing would save $12,226.78 annually and total cost would decrease from $15,612.41 to $3,385.62. (p = 0.001). Patient-specific preoperative workup is more cost effective than routine battery testing in septoplasty with and without turbinate surgery.
- Preemptive peritonsillar infiltration with lidocaine for relief of bipolar adult post-tonsillectomy pain: a randomized, double-blinded clinical study. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2013 May 11.
There are discordant results in the studies of the peritonsillar infiltration in adults undergoing the tonsillectomy. The study is to compare the effect of the preemptive peritonsillar infiltration with lidocaine in bipolar tonsillectomy in adult. 172 adult patients were randomly located into five groups before tonsillectomy: group 0: without the peritonsillar infiltration, group 1: for 3 ml normal saline with 1:200,000 epinephrine per tonsil, group 2: for 3 ml 1 %lidocaine with 1:200,000 epinephrine per tonsil, group 3: for 8 ml normal saline with 1:200,000 epinephrine per tonsil, group 4: for 8 ml lidocaine with 1:200,000 epinephrine per tonsil. The post-operative pain in the following 7 days was assessed by visual analog scale. Operation time and post-operative bleeding were also recorded. No significant differences were found between operative times, post-tonsillectomy hemorrhage between the five groups. The differences between pain scores of the group 0, group 1 and group 2 were not statistically significant (P > 0.05). The differences between pain scores of group 3, group 4 against group 0, group 1, group 2 were statistically significant (P < 0.05). We found the volume of peritonsillar infiltration might contribute to the relief of pain of the bipolar post-tonsillectomy.
- ENT-HNS education: what undergraduate students want? [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2013 May 11.