Validated mobile applications in otolaryngology head and neck surgery for patient and physicians: A systematic literature review.

IMPORTANCE: Mobile apps in the field of ORL-HNS, are widely used by patients and physicians, but neither necessarily developed in collaboration with healthcare professionals nor subjected to regulations by the United States Food and Drug Administration guidelines, with a resultant potential of risk for its users. OBJECTIVE: To provide the ORL-HNS physician with an updated list of scientific peer review literature- validated mobile apps for safe use for both the clinician and the patients, for screening, diagnosis, therapy and follow up for various ORL-HNS pathologies. EVIDENCE REVIEW: A comprehensive systematic review of the scientific literature was conducted in "PubMed," "EMBASE," and "Web of Science" without limitation of publication date up to January 1st, 2023. The included papers validated mobile apps in the ORL-HNS discipline. Each study was evaluated using the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) tool. FINDINGS: From the thousands of unregulated ORL-HNS mobile apps available for download and use in the various app stores, only 17 apps were validated for safe use by the clinician and/or patient. Their information is listed. CONCLUSIONS AND RELEVANCE: The limited number of validated mobile apps highlights the importance to use validated apps in clinical practice, to improve evidence-based medicine and patient safety. Physician are encouraged to use and recommend their patients to use validated mobile apps only, like any other tool in clinical practice in the evidence-based era.

Questioning the value of stalk drilling after external auditory canal osteoma excision: case series, literature review, and meta-analysis.

OBJECTIVES: To question the value of drilling the site of the stalk ("insertion site" or "stalk" drilling) of a pedunculated external auditory canal osteoma (EACO) in reducing recurrence. DATA SOURCES: A retrospective medical chart review of all patients treated for EACO in one tertiary medical center, a systematic literature review using Medline via "PubMed", "Embase", and "Google scholar" search, and a meta-analysis of the proportion for recurrence of EACO with and without drilling. RESULTS: The local cohort included 19 patients and the EACO origin was the anterior EAC wall in 42% and the superior EAC wall in 26%. The most common presenting symptoms were aural fullness and impacted cerumen (53% each), followed by conductive hearing loss (42%). All patients underwent post-excision canaloplasty, and one sustained EACO recurrence. Six studies suitable for analysis were identified (63 EACOs). Hearing loss, aural fullness, otalgia, and cerumen impaction were the most common clinical presentations. The most common EACO insertion site was the anterior EAC wall (37.5%), followed by the superior EAC and posterior walls (25% each). The inferior EAC wall was least affected (12.5%). There was no significant difference in recurrence between EACOs whose stalk insertions were drilled (proportion 0.09, 95% confidence interval [CI] 0.01-0.22) to the ones whose insertion was not drilled (proportion 0.05, 95% CI 0.00-0.17). The overall recurrence proportion was 0.07 (95% confidence interval 0.02-0.15). CONCLUSION: EACO insertion site drilling does not reduce recurrence and should be avoided in the absence of a definite pedicle projecting to the EAC lumen.

Success and safety of endoscopic versus microscopic resection of temporal bone paraganglioma: a meta-analysis.

PURPOSE: Temporal bone paraganglioma (TBP) are the most common tumors of the middle ear. They pose a challenge in otologic surgery due to their extensive vascularity and intricate location within the middle ear. This meta-analysis aimed to compare the safety and efficacy of two surgical approaches, microscopic middle ear surgery (MMES) and endoscopic middle ear surgery (EMES), in the resection of TBP. METHODS: Eligible studies published after 1988 were identified through systematic searches of "PubMed", "Scopus" and "Google Scholar". Retrospective studies and randomized/non-randomized control trials reporting on surgical approaches for TBP with a minimum of five adult patients were included. RESULTS: A total of 595 records were initially identified. After removing 229 duplicates, 349 articles were excluded based upon article subject, title and abstract. Following the review of full texts, 13 articles were assessed for eligibility. The pooled analysis included a total of 529 ears, with a complication rate of 7.8% for EMES and 14.2% for MMES. Subgroup differences indicated no significant variation between the two methods (p = 0.2945). CONCLUSION: Both EMES and MMES demonstrated favorable surgical outcomes with low complication rates for TBP resection. These findings suggest that EMES is a safe and effective method for TBP resection and one that is comparable to MMES. Since the risk of bleeding is significant in these tumors, a third-hand technique, endoscopic bipolar cautery or laser-assisted hemostasis should be considered. Conversion to MMES is another option when visibility is critically affected by bleeding.

Neurovascular conflict and sudden unilateral sensorineural hearing loss: coincidence or coexistence?

OBJECTIVE: To study the association between neurovascular conflict (NVC) of the 8th cranial nerve (CN8) and unilateral sudden sensorineural hearing loss SSNHL (SSNHL). METHODS: A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Google-Scholar" was conducted. Meta-analysis of pooled data was performed for NVC prevalence of SSNHL affected ears versus controls. RESULTS: The literature search identified 941 publications, of which, 9 included in qualitative synthesis (1030 ears) and 5 in quantitative synthesis (484 ears). NVC was as prevalent as 0.8-69% for affected ears and as 19-57% for controlled ears. No association between MRI protocol and NVC prevalence was proved. An odds ratio of 1.05 (95% confidence interval = 0.79-1.39) was calculated for association of NVC in unilateral SSNHL ears versus controls. CONCLUSION: The prevalence of NVC of CN8 in unilateral SSNHL affected ears is not significantly bigger than controls. Hence, NVC of CN8 is probably NOT associated with unilateral SSNHL.

The impact of eustachian tube function on intra-tympanic steroid administration.

OBJECTIVES: This study investigated the impact of eustachian tube (ET) function (ETF) on therapeutic success on candidates for intra-tympanic administration of steroids (ITAoS), due to idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: Medical chart review in two university-affiliated medical centers was performed. Included were consecutive adult patients diagnosed with unilateral ISSNHL between 2012 and 2019 who were treated with ITAoS due to incomplete or no recovery following systemic steroidal therapy. ETF was assessed by means tympanometry, before the initiation of ITAoS. The cohort was divided into an ET dysfunction group (ETD(+)) and a functioning ET group (control: ETD(-)). The audiologic response to treatment was recorded at the last follow-up. RESULTS: A total of 64 suitable patients [median (interquartile, IQR) age 49 (38-63) years] were enrolled. The ETD(+) group included 20 patients and the remaining 44 patients served as controls. Demographic and clinical parameters were not significantly different between the two groups at presentation. Hearing thresholds were improved significantly better, at frequencies 250, 500, 1, 2, 4, and 8 kHz (p = 0.001-0.040) in the ETD(+) group. CONCLUSION: ETD(+) is associated with better efficacy of ITAoS.

Is tympanic infrared thermometry valid in non-naive tympanic membranes?

OBJECTIVE: To investigate the impact of with tympanostomy tubes (TT) on infrared tympanic membrane thermometer (ITMT) results and to provide a systematic review of ITMT results in non-naïve tympanic membranes. STUDY DESIGN: Original prospective blinded case series and systematic literature review. SETTINGS: A single tertiary university-affiliated medical center. METHODS: ITMT measurements of patients with unilateral TT and contralateral naïve control ear were randomly conducted by a single investigator blinded to the TT side before and after cerumen was removed from the external auditory canals. A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Google Scholar" on comparable published cases was performed. RESULTS: The mean paired differences (95% confidence interval [CI]) between ventilated and non-ventilated ears before and after cerumen removal were 0.08 ºC/0.14 ºF (-0.04 to 0.19 ºC/- 0.07º-0.34º) and 0.62 ºC/1.12 ºF (0.04-0.25 ºC/0.07-0.45 ºF), respectively (P < 0.001 and P = 0.01, respectively). CONCLUSION: These findings support the validity and accuracy of ITMT in the setting of ventilated ears.

CT findings in temporal bone sites in skull base osteomyelitis from malignant otitis externa.

OBJECTIVES: To identify the earliest sites and spread patterns of bony erosions on high-resolution temporal bone computerized tomographic (HRTBCT) scans and conjugate the radiological findings with clinical/laboratory data for guiding the interpretation of CT images of skull base osteomyelitis (SBOM) from malignant otitis externa (MOE). STUDY DESIGN: Retrospective and prospective medical records analysis. METHODS: The medical records of all patients who presented to a referral medical center during 2015-2022 and initially diagnosed with SBOM. Radiological assessment of each sub-site was performed by 2 qualified neuro-radiologist, who were blind to the clinical data. RESULTS: 33 patients were enrolled. All patients suffered edema and exudates of the external auditory canal (EAC). The most common osseous markers for SBOM were dehiscence or irregularity of the anterior EAC wall and temporomandibular joint (TMJ) medial wall (21/33, 64% patients, each), followed by a fistula from the TMJ to the EAC (20/33, 61% patients). Eustachian tube bony walls and condylar irregularity and/or dehiscence were as prevalent as 16/33, 48% of patients, each. EAC inferior and posterior walls of the EACs were irregular or dehiscent in patients with more advanced disease. CONCLUSIONS: The high symptomatologic overlap between SBOM and other aural pathologies might cause diagnostic (and subsequent treatment) delay and result in dire complications. EAC edema and irregularity or dehiscence of the anterior EAC wall are the most common early CT findings associated with SBOM caused by MOE.

Spontaneous recovery rate of idiopathic sudden sensorineural hearing loss: A systematic review and meta-analysis.

PURPOSE: Steroids comprise the mainstay of treatment for idiopathic sudden sensorineural hearing loss (ISSNHL). Since steroidal treatment was integrated to clinical practice guidelines, newly published no-treatment or placebo arms in clinical trials are scarce. To evaluate the effectiveness of steroidal treatment ± hyperbaric oxygen therapy, the data should be compared to spontaneous recovery. The aim of this paper is to find the most accurate spontaneous recovery rate, in the light of which, other treatment modalities should be judged. MATERIALS AND METHODS: Eligible studies published until July 2021 were identified through systematic searches of 'PubMed', 'Web of Science' and 'Google Scholar'. Retrospective studies and randomised/non-randomised control trials involving only adult participants (≥18 years) with ISSNHL, and placebo/no treatment were included. Only articles that used the American Academy of Otolaryngology-Head and Neck Surgery's diagnostic criteria for ISSNHL were included. RESULTS: 942 records initially identified, 166 duplicates and 753 articles were excluded based on article subject, title, and abstract. The full texts of 13 articles were reviewed. Seven studies were included for qualitative synthesis, five papers included in quantitative synthesis. 180 ears were included in pooled statistics. The pooled spontaneous recovery was 60.28% (95% confidence interval [CI] = 38.88%-79.94%) with a heterogeneity of 86.0% (95% CI = 69.4%-93.6%). CONCLUSIONS: Spontaneous recovery of ISSNHL should not be over-looked, as it may be close to 60%. This may have both clinical and research implications.

Bell's palsy and pregnancy: Incidence, comorbidities and complications. A meta-analysis and systematic review of the literature.

OBJECTIVES: Data on the association between Bell's palsy (BP) and pregnancy is scarce and there is an ongoing debate regarding the association of BP and pregnancy. MAIN OUTCOME MEASURES: We aimed to investigate the prevalence of BP among pregnant patients and determine the frequency of pregnant women in BP cohorts and vice versa, assess which term of the pregnancy and peripartum bears a higher risk for BP occurrence, and determine the prevalence of maternal comorbidities associated with BP during pregnancy. DESIGN: Meta analysis. SETTINGS: Screening standard articles and extracting data from Ovid MEDLINE (1960-2021), Embase (1960-2021), and Web of Science (1960-2021). All study types were included except for case reports. MEASURES: Data were pooled by means of both fixed and random-effects models. RESULTS: The search strategy identified 147 records. Twenty-five of the studies that met our inclusion criteria described 809 pregnant patients with BP in a total of 11,813 BP patients and they were included in the meta-analysis. The incidence of BP among the pregnant patients was 0.05%; The incidence of pregnant patients among all BP patients was 6.62%. Most of the BP occurrences were during the third trimester (68.82%). The pooled incidence of gestational diabetes mellitus; hypertension; pre-eclampsia/eclampsia and fetal complications among the pregnant patients with BP was 6.3%, 13.97%, 9.54%, and 6.74%, respectively. CONCLUSIONS: This meta-analysis revealed a low incidence of BP during pregnancy. A Higher proportion occurred during the third trimester. The association of BP and pregnancy warrants further exploration.

Association of inflammatory markers with hearing loss in young adults.

OBJECTIVES: To assess the correlation between inflammatory markers (IM) and hearing loss (HL) in a large cohort of apparently healthy individuals. DESIGN: A cross sectional study. SETTING: Tel-Aviv Medical Center (a tertiary referral center) Inflammatory Survey Participants Individuals who attended the Tel-Aviv Medical Center Inflammatory Survey (TAMCIS) for a routine annual health check. RESULTS: Out of 2,500 individuals included in the final study cohort, 1,170 (47.3%) had some hearing impairment. Those with a hearing loss in 1 or both ears had significantly higher levels of neutrophils, lymphocytes, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and red blood cell counts. There was a difference between low- and high- frequencies losses associated with the inflammatory status. CONCLUSIONS: IM levels were associated with the presence of a HL, supporting a link between inflammatory changes and hearing loss.

The impact of thyroidectomy on obstructive sleep apnea: a systematic review and meta-analysis.

PURPOSE: Various thyroid pathologies are speculated to contribute to obstructive sleep apnea (OSA). The underlying mechanisms of the intricate relationship between OSA and thyroid structure and function, and whether thyroidectomy can alleviate OSA symptoms remain unclear. An assessment of the impact of thyroidectomy on OSA is warranted. METHODS: A systematic review of four electronic databases (PubMed (Medline), Embase, the Cochrane library, and ClinicalTrials.gov) was performed up to February 2022. The primary outcomes were preoperative and postoperative Apnea/Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Berlin questionnaire scores, and continuous positive airway pressure (CPAP) use. A meta-analysis of continuous measures and odd ratios was conducted. Small-scale studies underwent a qualitative meta-analysis. RESULTS: Six cohort studies on 221 OSA patients who underwent thyroidectomies were included. The results showed that thyroidectomy was associated with significant reduction in postoperative AHI (Mean difference [MD], -6.39, 95% CI, -12.46 to -0.32), however, no significant association was found with CPAP withdrawal (Odd ratio [OR], 0.38, 95% CI, 0.12-1.18). Neither the Berlin questionnaire score (OR, 0.19, 95% CI, 0.03-1.17) nor the ESS improved postoperatively (MD, -1.04, 95% CI, -6.37 to 4.29). CONCLUSION: This meta-analysis provides a quantitative estimate for the effect of the thyroidectomy on OSA and suggests that thyroidectomy is associated with limited clinical improvement of polysomnographic measures. Future large-scale, well-designed prospective studies are necessary to validate these findings and to refine accordingly the preoperative assessment of both medical conditions individually and in combination.

Characterization of pain after tympanoplasty and tympanomastoidectomy and analysis of risk factors. A prospective cohort study.

PURPOSE: To characterize postoperative pain after tympanoplasty and tympanomastoidectomy and correlate between pain severity and various technical aspects of the surgery. METHODS: We carried out a prospective cohort study of patients undergoing ear surgery in a tertiary referral center between 7/2018 and 7/2019. Patients filled in a pain questionnaire and scored pain intensity on a visual analog scale preoperatively and on postoperative days (POD) 1-4, 21, and 49. The responses were correlated with clinical and operative data, including surgical technique-related details. RESULTS: Sixty-two patients participated in the study (27 males and 35 females, average age 41.1 ± 20.02 years [range 18-68]). The median preoperative VAS was 5, followed by 6 on POD1, 5 on POD3, and 1 at 3 and 9 weeks. The preoperative questionnaire score normalized to 10 was 4.5 (32/70), 5.1 on POD1, 4.7 on POD3, 0.85 at 3 weeks and 0.85 at 9 weeks. The predictive factors for increased postoperative pain were younger age, the presence of a comorbidity, revision surgery, preoperative dizziness or tinnitus and postoperative tinnitus. The predictive factors for decreased pain were smoking and the addition of a mastoidectomy. None of the factors related to the surgical technique (e.g., surgical approaches, type of reconstruction, specific surgeon) significantly affected the questionnaire responses or the pain VAS intensity scores. CONCLUSIONS: We demonstrated that younger age, the presence of a comorbidity, revision surgery, preoperative dizziness or tinnitus and postoperative tinnitus were predictors of increased pain after tympanoplasty and tympanomastoidectomy, while the inclusion of a mastoidectomy was a predictor of decreased pain.

Laryngectomy-free survival after salvage partial laryngectomy: a systematic review and meta-analysis.

PURPOSE: Radiotherapy (RT) is widely used for early glottic cancer. Patients failing this treatment are referred to surgical management of their disease. Salvage partial laryngectomy (SPL) has the advantage of preserving laryngeal function with total laryngectomy (TL) remaining as a last resort. The purpose of this study was to determine the efficacy of SPL in preventing total laryngectomy, following failed RT, for early glottic cancer. METHODS: A meta-analysis of all published English literature was performed. All publications that included patients undergoing SPL were reviewed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) reporting guidelines. The search strategy identified 154 relevant articles. A total of 15 retrospective studies that included 323 suitable patients were subsequently analyzed in this meta-analysis. The main outcome measure was the rate of laryngectomy-free survival (LFS) following SPL. The indications for salvage TL (i.e., disease recurrence and poorly functional larynxes) as well as subgroup analyses for open and trans-oral SPLs were also calculated. RESULTS: The overall rate of LFS following SPL was 81.2% (fixed effects model range: 75.7-86.8%). Salvage TL following SPL were performed in 96.8% due to disease recurrence and in 3.2% to poorly functional larynxes. A subgroup analysis showed a 90.4% LFS after open SPL and 78.6% following trans-oral SPL. CONCLUSION: A high rate of successful salvage partial laryngectomies, regardless of surgical technique, is to be anticipated in well-selected patients after RT failure.

To patch or not to patch acute isolated traumatic tympanic membrane perforations: a case series and systematic literature review.

OBJECTIVE: To date, there is no consensus about the benefits of paper patching over spontaneous healing in the management of isolated acute traumatic tympanic membrane perforations (IATTMP). In this systematic literature review and case series, we compared paper patching of IATTMP to spontaneous healing in terms of healing rate and time to heal. DATABASES REVIEWED: A systematic literature search of English-language studies published from 1/1975 to 9/2020 was conducted using PubMed via MEDLINE, and 201 studies were identified. Another 346 studies were derived from the references of those articles. Twenty-four studies remained after omitting duplications and articles that did not meet the inclusion criteria. METHODS: Demographics, medical history, physical examination, and audiometric results in the selected publications and in a new series of patients treated for IATTMP between 1/2018 and 1/2021 in a single tertiary referral center were retrieved and analyzed. RESULTS: The literature review yielded 2796 ears of which 466 underwent paper patching (intervention arm). Complete perforation healing was documented in 67-97% of control arm and 92-93% of intervention arm. Our new series included 29 ears of which six underwent paper patching. Complete healing was observed in 83% and 78% in the interventional and control arms, respectively. CONCLUSIONS: Although paper patching and watchful waiting had similar success rates in patients with IATTMP, healing after paper patching was slightly quicker among our patients. Patching is a readily applicable and technically simple office-based intervention that should be preferentially considered for IATTMP.

Real life safety of systemic steroids for sudden sensorineural hearing loss: a chart review.

OBJECTIVES: To report adverse events (AEs) associated with systemic steroid treatment in idiopathic sudden sensorineural hearing loss (ISSNHL). MATERIAL AND METHODS: A retrospective chart review of consecutive patients newly diagnosed with ISSNHL necessitating systemic steroidal treatment was conducted from 1/2017 to 2/2021. Blood pressure (BP) was monitored three times daily and morning fasting glucose was monitored once daily during treatment. An AE was defined as a fasting blood glucose level > 160 mg/dl, systolic BP > 80 mmHg, and diastolic BP > 100 mmHg. RESULTS: In total, 143 patients were enrolled [69 (48%) males and 74 (52%) females] of whom 29 (20%) had diabetes mellitus (DM) and 46 (32%) had hypertension (HTN). The cohort's median age (interquartile range) was 58 (37-69) years. Fifty-three patients (37%) did not complete the oral steroidal treatment due to any AE (glycemic or hypertensive). Background DM highly correlated with increased risk of a glycemic event (0.59 vs. 0.13 for diabetic and non-diabetic patients, respectively, P < 0.001). HTN correlated significantly with increased risk of an overall AE (0.54 vs. 0.29 for hypertensive and non-hypertensive patients, respectively, P = 0.001). Neither pre-treatment BP nor glucose level predicted the risk of an AE (P = 0.310 and 0.521, respectively). CONCLUSIONS: AEs due to systemic steroidal treatment are common among ISSNHL patients. Demographic and baseline values cannot predict the risk of AEs which can occur throughout the entire duration of treatment. Patients with DM and HTN are at the greatest risk of AEs. Tight blood glucose and BP monitoring are recommended during treatment.

Prophylactic central neck dissection has no advantage in patients with metastatic papillary thyroid cancer to the lateral neck.

BACKGROUND: Papillary thyroid cancer (PTC) usually metastasizes via lymphatic channels in a sequential fashion, first to the central compartment, followed by the lateral neck. PTC patients diagnosed with lateral neck disease (N1b) without proof for central involvement traditionally undergo prophylactic central neck dissection (pCND). However, substantial evidence on outcomes to support this approach is lacking. MATERIALS AND METHODS: We conducted a dual center retrospective study to compare the rate of central neck recurrence between N1b PTC patients undergoing pCND and those spared pCND. All patients diagnosed with N1b PTC who underwent total thyroidectomy and lateral neck dissections with or without pCND between January 1998 and December 2015 were included in this study. The rates of central neck recurrences were compared between the groups. RESULTS: The 111 patients who met the inclusion criteria were 44 females (39.6%) and 67 males (60.4%), with a mean age of 50.2 ± 17.7 years, and a mean follow-up of 10.2 ± 5.3 years. Sixty patients (54.1%) underwent a pCND and 51 patients (45.9%) did not (non-pCND). During follow-up, 18 patients (16.2%) had level VI recurrences, 13 in the pCND group and 5 in the non-pCND group. Cox-regression models with propensity scoring did not reveal any inclination or an advantage for performing pCND. CONCLUSION: The present study demonstrated no advantage in performing pCND to prevent central neck recurrence among PTC patients with lateral neck involvement only. These findings question the need for pCND in patients without clinical evidence of central neck disease.

Validation of a smartphone-based Rinne test to detect an air-bone gap.

OBJECTIVE: To validate a smartphone-based Rinne test employing the vibration application of mobile telephones. STUDY DESIGN: Prospective controlled clinical study. SETTING: Tertiary referral medical center. METHODS: Twenty consecutive patients hospitalized in the otolaryngology department of a tertiary medical center due to unilateral hearing loss (HL study group), and 30 consecutive inpatients on the same ward who had no otological history (controls) were enrolled. Each participant underwent the traditional 512 Hz tuning fork-based Rinne test, as well as a smartphone-based Rinne test by means of a single uncovered smartphone with a vibration application. The test results were compared to those of formal audiometry. RESULTS: The overall agreement between the traditional Rinne test and the smartphone-based test was 98%. The Sensitivity was 85% for both tests, specificity was 90% and 93% for smartphone and tuning fork tests, respectively. The smartphone-based Rinne test could correctly discriminate between patients with an air-bone gap ≥ 25 dB at 512 Hz from patients with a lower or no air-bone gap at 512 Hz. The smartphone-based Rinne could not evaluate two patients with a moderately severe/severe sensorineural hearing loss due to their inability to detect the vibrations. CONCLUSION: A smartphone-based Rinne test was validated for the detection of an air-bone gap ≥ 25 dB at 512 Hz in the clinical setting. The validity of patient-operated smartphone-based Rinne test awaits further study. LEVEL OF EVIDENCE: 2B.

Meta-analysis of time to extrusion of tympanostomy tubes by tympanic membrane quadrant.

OBJECTIVES: To investigate the published time to extrusion of tympanostomy tubes inserted in the various quadrants of the tympanic membrane. METHODS: Publications were selected by a search with 'PubMed', 'Embase' and 'Web of Science'. A meta-analysis of time to extrusion as a function of tympanic membrane quadrant intubation was performed. DESIGN, SETTING, PARTICIPANT-NOT RELEVANT MAIN OUTCOME MEASURED: Extrusion rate of tympanostomy tubes inserted in the various quadrants of the tympanic membrane. RESULTS: Eleven studies describing 2232 tympanostomy tubes were enrolled into the quantitative meta-analysis. The extrusion rate was evaluated at 3-month intervals up to 24 months post-intubation, and it did not differ significantly at any of the time points tested for the superior and inferior anterior quadrants. The cumulative extrusion rates were as follows: 11 and 9%, 32 and 23%, 59 and 36%, 80 and 67%, 87 and 70%, 88 and 82%, and 96 and 89% in the superior and anterior quadrants, respectively, at 3, 6, 9, 15, 18, 21 and 24 months post-intubation, respectively. CONCLUSION: Time to extrusion of tympanostomy tubes are similar for all 3 tympanic membrane quadrants. The anterior superior quadrant intubation has no superiority in terms of intubation time.

Questioning the Justification of Frontal Sinusotomy for Odontogenic Sinusitis.

PURPOSE: Odontogenic sinusitis (OS) can be caused by infectious conditions of the posterior maxillary teeth. The maxillary sinus has been most often involved because of its proximity to the posterior maxillary teeth. Often the anterior ethmoids and frontal sinuses will be involved by the infective process. The underlying odontogenic condition must be addressed before or during sinus surgery. The role of frontal sinusotomy in the treatment of these patients has been poorly described. Our objective was to present the surgical outcomes of patients with OS involving the frontal sinus who had undergone middle meatal antrostomy alone. PATIENTS AND METHODS: A prospective analysis of all patients who had undergone surgery at a single tertiary center to treat OS involving the frontal sinus from November 2015 to December 2018 was performed. Their preoperative assessment findings, surgical findings, and postoperative outcomes were analyzed. RESULTS: A total of 45 patients (23 men and 22 women), with a median age of 57 years (range, 20 to 83 years), were enrolled in the present study. All anterior sinuses (frontal, anterior ethmoids, and maxillary sinuses) were clinically and radiographically involved in all the patients. Each patient underwent endoscopic wide maxillary middle meatal antrostomy concurrent with dental intervention. The average follow-up was 7 months. No signs of active frontal disease were detected by postoperative endoscopy in any patient, and no patient required revision surgery. CONCLUSIONS: The results from the present study have shown that no justification exists for frontal sinusotomy for the treatment of OS involving the frontal sinus. Frontal sinusitis is a secondary infectious and inflammatory process that will resolve once the underlying odontogenic condition has healed and wide middle meatal antrostomy has been performed.

Iatrogenic cholesteatoma originating from a misplaced tympanomeatal flap during tympanoplasty: a series of five patients.

PURPOSE: To report our experience of a sequence of events that resulted in an iatrogenic cholesteatoma originating from the external auditory canal (EAC) years after tympanoplasty that had included a tympanomeatal flap. METHODS: Data on the presentation and pathogenesis of iatrogenic cholesteatomas arising from misplaced tympanomeatal flaps during tympanoplasty without mastoidectomy were retrieved from the patients' medical records and analyzed. RESULTS: Five patients were identified with cholesteatomas involving the EAC. They all had recurrent ear infections and varying degrees of conductive hearing loss. Each patient's past surgical history included one or more tympanoplasties in which an ipsilateral tympanomeatal flap had been raised. None had undergone a mastoidectomy. Two patients presented with small cholesteatomas that had developed over an average of 6.5 years after surgery. Three patients had large cholesteatomas that had developed over an average of 33.7 years after surgery. Clinical presentations and imaging studies suggested a misplaced tympanomeatal flap as the most likely source of cholesteatoma. CONCLUSION: Tympanomeatal flap misplacement may cause iatrogenic cholesteatoma formation originating from the EAC during tympanoplasty even without mastoidectomy. These cholesteatomas can grow substantially before becoming symptomatic as they extend to and through the mastoid. They may not affect the sound conduction system until late in the course of the disease. Meticulous replacement of tympanomeatal flaps and exercising a high index of suspicion postoperatively can reduce the incidence of this complication.