Antimicrobial activity of silastic tympanostomy tubes impregnated with silver oxide. A double-blind randomized multicenter trial.

OBJECTIVE: To test the null hypothesis that impregnation of tympanostomy tubes with silver oxide did not alter the rate of postintubation otorrhea. DESIGN: Multicenter, double-blind, randomized clinical trial. OUTCOME MEASURE: Rates of postoperative otorrhea during a 1-year study in ears implanted with Silastic tubes compared with contralateral, identical tubes impregnated with silver oxide. SETTING AND PARTICIPANTS: Eight sites in the United States, 125 children aged 1.5 months to 12 years who had bilateral otitis media with effusion or bilateral recurrent acute otitis media. RESULTS: The overall incidence of postoperative otorrhea was 9.78% in the control ears and 5.08% in the ears with silver oxide-impregnated tubes (P = .01), but no effect was seen during the immediate postoperative period. Granulation tissue was seen adjacent to the tube during two visits in the ears with standard tubes (0.54%) and during two visits in the ears with experimental tubes (0.53%); cholesteatomas did not occur in either group. CONCLUSION: Silastic tubes impregnated with silver oxide seem to diminish the incidence of postoperative otorrhea in ears requiring long-term ventilation.

Otorrhea after insertion of silver oxide-impregnated silastic tympanostomy tubes.

BACKGROUND: Silver oxide-impregnated tympanostomy tubes have been shown to decrease the incidence of postoperative otorrhea, but without a significant effect in the first postoperative week. OBJECTIVE: To evaluate prospectively our results with silver oxide-impregnated tympanostomy tubes and to identify factors associated with a higher incidence of early postoperative otorrhea. DESIGN: Prospective nonrandomized study. SETTING: University referral center. PATIENTS AND OTHER PARTICIPANTS: Six hundred thirty patients with chronic otitis media with effusion or recurrent otitis media. INTERVENTIONS: Silver oxide-impregnated Silastic tympanostomy tubes were inserted in 1254 ears. Subjects with mucoid or purulent effusions or blood at the myringotomy site at surgery were treated with topical antibiotic prophylaxis (sulfacetamide sodium-prednisolone acetate or neomycin sulfate-polymyxin B sulfate-hydrocortisone) for 5 days after tympanostomy tube placement. MAIN OUTCOME MEASURES: Incidence of otorrhea after tympanostomy tube insertion at 1 week and 1, 3, 6, 9, and 12 months after surgery. RESULTS: The overall incidence of postoperative otorrhea was 1.9%. The incidence of otorrhea in the first postoperative week was 5.6%; the incidence of otorrhea after the first postoperative week was 1.2% (P<.001). Within the first postoperative week, a significantly greater incidence of otorrhea was noted in patients younger than 3 years (7.8%), in patients with mucoid effusions at surgery (8.6%), and in patients younger than 3 years with mucoid effusions at surgery (15.2%). CONCLUSIONS: Silver oxide-impregnated tympanostomy tubes are associated with a low overall incidence of postoperative otorrhea. A significantly higher incidence of otorrhea is seen during the first postoperative week, compared with the incidence after the first week. Patients with thick middle ear effusions and age younger than 3 years have a significantly greater incidence of early otorrhea after tympanostomy tube placement.

Endotracheal tube safety during electrodissection tonsillectomy.

A case report of an endotracheal tube fire occurring during electrodissection tonsillectomy is presented. The authors believe that this incident occurred because a retrograde leak of ventilating gases around an uncuffed endotracheal tube during positive-pressure ventilation produced a high oxygen concentration in the mouth, allowing indirect ignition of the tube. In vitro testing supported this hypothesis. Ignition tests on polyvinylchloride endotracheal tubes using electrocautery in various oxygen concentrations were performed. As oxygen concentration increased, the endotracheal tube could be moved further from the cautery and still allow ignition of the tube. At 52% oxygen, with the cautery set at 25-W coagulation current, the endotracheal tube could not be ignited. Recommendations to prevent a recurrence of this incident are included.

Intraoperative ketorolac and posttonsillectomy bleeding.

OBJECTIVE: To determine the occurrence of posttonsillectomy bleeding in patients who received intraoperative ketorolac tromethamine. DESIGN: Retrospective analysis. SETTING: Academic tertiary care center. PATIENTS: Three hundred eleven patients who underwent tonsillectomy in an 18-month period. MAIN OUTCOME MEASURE: Occurrence of bleeding complications in patients who received ketorolac during tonsillectomy. RESULTS: Fifty-eight of 311 patients who underwent tonsillectomy received intraoperative ketorolac with an overall postoperative bleeding rate of 17%. This high rate of bleeding complications compares with 4.4% in the remaining 253 patients who received traditional opioid analgesics. CONCLUSIONS: Until further controlled studies have been conducted, the use of ketorolac in patients undergoing tonsillectomy should be avoided because of the increased incidence of postoperative bleeding complications.

Study of humidification potential of a heat and moisture exchanger in tracheotomized dogs.

Though a heat and moisture exchanger (HME) has been used in clinical practice following a tracheotomy on a limited basis, no work has been done to document the humidification potential of an HME in this situation. Eighteen dogs underwent tracheotomy and were killed at either 1 day (nine dogs) or 10 days (nine dogs) postoperatively. Following the tracheotomy, the animals were divided into three groups according to the type of humidification received: ambient conditions, warm mist, or HME. The tracheal mucosa was studied for histologic changes in the cilia, the epithelium, submucosal reaction, and mucus production at the level of the carina. The results were significant (p = .02) for the interaction of the experimental type and method of treatment in their effect on the histologic changes noted at the carina. The study supports the use of an HME as an alternative for long-term humidification in a patient with a tracheotomy.

The use of a portable capnometer as a tracheostomy monitor in an animal model.

Home care of a tracheostomy patient in the pediatric age group is a challenging problem. Accidental decannulation is always a potential hazard in children with tracheostomies. The most effective monitoring system in these individuals is an experienced, alert observer. Unfortunately, caretakers cannot be expected to provide constant surveillance. Because of this, various types of mechanical monitoring systems have been developed for patients with tracheostomies. An animal model was employed to investigate the reliability of a portable capnometer in assessing the status of a tracheostomy tube under varying experimental conditions. The capnometer was found to be a reliable tool and it will now be evaluated in the clinical setting.

Irradiated costal cartilage graft in experimental laryngotracheal reconstruction.

Autogenous costal cartilage graft has been employed successfully to correct subglottic stenosis. In an effort to reduce the morbidity and operative time, the use of irradiated homologous costal cartilage was investigated. Irradiated homologous grafting was performed to the subglottic region of 37 young New Zealand rabbits. The rabbits were sacrificed at 2.5- and 4-month intervals, and the grafts histologically examined. Fifty percent of the grafts were epithelialized and 50% revealed at least partial resorption. The percentage of grafts which resorbed were unrelated to the length of implantation. Because of the higher rate of resorption of the irradiated cartilage over autogenous fresh cartilage, the latter is still the preferred material.

Respiratory distress associated with bilateral nasolacrimal duct cysts.

Nasolacrimal duct system cysts with intranasal extension is a rarely reported cause of respiratory distress in the newborn. Nine often previously reported patients have demonstrated a paranasal mass on examination. Most of these patients have been female and most have required surgical intervention to relieve the obstruction. We present a case of a male newborn with bilateral NLDS cysts with intranasal extension causing respiratory distress, and no evidence of paranasal mass on examination. Nasal endoscopy is essential in the work-up of all patients with nasal obstruction and respiratory distress. The MRI scan was used in the diagnostic work-up to further evaluate the condition. The NLDS cysts with nasal extension resolved spontaneously.

Nasolacrimal duct obstruction secondary to ectopic teeth.

OBJECTIVE: To describe two patients with nasolacrimal duct obstruction (NLDO) caused by ectopic eruption of teeth. The literature concerning nasal and other unusual ectopic sites of tooth eruption is reviewed. DESIGN: Two interventional case reports and literature review. PARTICIPANTS: A 3-year-old girl with epiphora and recurrent dacryocystitis of the right eye. Previous medical and surgical management was unsuccessful. A 32-year-old female with a long history of right eye discomfort and epiphora. Previous examinations and workup were negative. INTERVENTION: A computed tomographic (CT) scan of the orbits and sinuses was performed in both patients. The ectopic teeth were surgically removed. MAIN OUTCOME MEASURES: Nasolacrimal system function and response to treatment at the last follow-up were recorded. RESULTS: In the first patient, CT imaging disclosed two teeth within the right inferior meatus compressing the nasolacrimal duct. In the second patient, CT revealed a large dental structure in the maxillary sinus compressing the nasolacrimal duct. Endoscopic tooth extraction and nasolacrimal duct probing in the first patient and surgical removal of the dental structure in the second patient effected complete resolution of symptoms. Both patients were symptom free at last follow-up. CONCLUSIONS: These cases suggest that ectopic eruption of teeth should be added to the differential diagnosis of NLDO. Surgical removal of the ectopic teeth compressing the nasolacrimal duct results in resolution of the lacrimal drainage obstruction.