Hemorrhage Rates in Pediatric Patients Receiving Postoperative Steroids After Tonsillectomy.

Importance. Developing a safe postoperative pain regimen after tonsillectomy is important. While postoperative steroids may provide an analgesic benefit, it is not known whether steroids increase the bleeding risk after tonsillectomy. Objective. To determine whether postoperative steroids increase the risk of hemorrhage after tonsillectomy in children. Design. Retrospective cohort study. Setting. Tertiary referral academic medical center. Participants. An age- and indication-matched cohort was randomly selected from tonsillectomy patients ≤12 years old from 2012 to 2017. Intervention. Prednisolone, 0.5 mg/kg (maximum dose 20 mg/day) qAM × 3 days postoperatively. Main Outcome. Postoperative hemorrhage requiring operative intervention. Results. A total of 1358 patients were included in this study, 679 of which received postoperative steroids. The steroid group had a similar of operative intervention for post-tonsillectomy hemorrhage of 1.8% versus 2.2% in the nonsteroid group (P = .560). Conclusion and Relevance. Post-tonsillectomy steroid use is not associated with an increase in operative intervention for postoperative hemorrhage.

Incision and drainage followed by mattress suture repair of auricular hematoma.

OBJECTIVE: Auricular hematoma is a condition requiring early and effective management to prevent pathogenesis of the unsightly cauliflower ear. The objective of this study is to review cases of auricular hematoma and present incision and drainage followed by through-and-through whip-type absorbable mattress sutures without bolsters as an effective treatment. STUDY DESIGN: Retrospective chart review of auricular hematoma cases. METHODS: A 5-year retrospective evaluation of auricular hematomas presenting to an otolaryngology group was performed. Patients' charts were reviewed and data regarding the treatment and follow-up of auricular hematomas were assembled and analyzed. RESULTS: Twenty-two patients were found to present with auricular hematoma. One patient was lost to follow-up. Twenty-eight treatments were performed on 23 ears. Seven hematomas were treated with needle aspiration, two were treated with incision and drainage with iodoform wick placement, and 19 were treated with incision and drainage followed by absorbable mattress sutures. There were five hematoma reaccumulations requiring an additional procedure after treatment by an otolaryngologist. Three followed needle drainage; one followed incision and drainage with wick placement, and one followed incision and drainage with absorbable mattress sutures. CONCLUSION: Incision and drainage followed by through-and-through absorbable mattress sutures appears to be a superior method of treatment with rare reaccumulation of hematoma. This method of treatment was shown to be simple and well tolerated, and it had few complications.

Thyroidectomy-related malpractice claims.

OBJECTIVE: Little information is available regarding the frequency of thyroidectomy-related malpractice claims. Previous studies have not assessed claims that were settled or dropped before trial, providing only a limited view of the medical-legal environment. We sought to determine the frequency of thyroid surgery-related malpractice claims, their causes, and outcomes. STUDY DESIGN: Database assessment. SETTING: Academic medical center. SUBJECTS AND METHODS: The database of the Physician Insurers Association of America was reviewed. These data are estimated to represent 25% of medical malpractice claims in the United States. Claims from 1985 to 2008 with thyroid-related procedure codes were evaluated for claimant information, insured's specialty, loss description, causation, and claim outcomes. RESULTS: During the 24-year period reviewed, 380 claims related to thyroid surgery were reported. 128 claims (33.7% of total claims) resulted in an indemnity payment either due to settlement or a finding against the defendant. The average indemnity payment was $185,366 (range, $363 to $2,000,000). Among cases in which a specific outcome was reported, 55 were related to laryngeal nerve injury or voice disturbance. No substantial change occurred in the incidence of claims across the study period. During this time, approximately 2,585,000 thyroidectomies were performed. Extrapolating from the Physician Insurers Association of America data, this represents an estimated 5.9 claims per 10,000 cases. CONCLUSION: Malpractice claims related to thyroid surgery are surprisingly infrequent. While the rates of thyroid surgery have risen steadily, there has not been a corresponding increase in the rate of related malpractice claims.

Cochlear implantation using thin-film array electrodes.

OBJECTIVE: Current limitations in language perception may stem from an inability to provide high-resolution sound input. Thin-film array technology allows for a greater density of stimulating sites within the limited diameter of the scala tympani. This study examines the use of a flexible carrier to achieve adequate depth of insertion. STUDY DESIGN: A prospective human cadaveric temporal bone insertion analysis. SETTING: Academic otolaryngology department and school of electrical and computer engineering collaboration. METHODS: A prototype thin-film array electrode coupled with an insertion test device (ITD) was manufactured and inserted into 10 human cadaveric temporal bones. As controls, 2 additional temporal bones were implanted with the ITD only and 2 were unimplanted. Radiologic and histologic data were collected. RESULTS: Ten thin-film array electrodes were successfully implanted into 10 individual temporal bones via round window (5) and cochleostomy (5) approaches. Seventeen millimeters of insertion was noted for each device, with an average angular insertion depth of 292° by radiographic measurements and 392° by histologic sectioning. Electrode distance to the modiolus averaged 0.88 mm by computed tomography and 0.67 mm by histologic measurements. Average percentage trauma was 26% for the ITD-backed arrays compared with 15% and 29% for ITD only and unimplanted temporal bones, respectively. CONCLUSION: Thin-film array electrodes coupled with an ITD were successfully inserted into the human cochlea with limited trauma. With continued development and testing of this electrode design, the thin-film array may improve the language perception achieved through cochlear implantation.