Factors Impacting the Use or Rejection of Hearing Aids-A Systematic Review and Meta-Analysis.

PURPOSE: To examine the prevalence of adherence to hearing aids and determine their rejection causes. METHODS: This study was conducted according to the Preferred Reporting terms for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed an electronic search using PubMed, BVS, and Embase. RESULTS: 21 studies that met the inclusion criteria were selected. They analyzed a total of 12,696 individuals. We observed that the most common causes for positive adherence to hearing aid use included having a higher degree of hearing loss, patients being aware of their condition, and requiring the device in their daily life. The most common causes for rejection were the lack of perceived benefits or discomfort with the use of the device. The results from the meta-analysis show a prevalence of patients who used their hearing aid of 0.623 (95% CI 0.531, 0.714). Both groups are highly heterogeneous (I2 = 99.31% in each group, p < 0.05). CONCLUSIONS: A significant proportion of patients (38%) do not use their hearing aid devices. Homogeneous multicenter studies using the same methodology are needed to analyze the causes of rejection of hearing aids.

Implant loss and crestal bone loss in early loading versus delayed and immediate loading in edentulous mandibles. A systematic review and meta-analysis.

BACKGROUND: Information about the risk of early loss and crestal bone loss of dental implants which have been loaded early is scant if compared with data available for those conventionally or immediately loaded. A meta-analysis of early loss and crestal bone loss in immediate or delayed loaded full mandibular denture retaining dental implants has been recently published. It is interesting to evaluate also the risks of early versus immediate and delayed loading in complete mandibular restorations. The purpose of this systematic review and meta-analysis was to study early (EL) versus immediate (IL) and delayed loading (DL) protocols in edentulous mandibles to determine whether differences exist in implant success and crestal bone loss. MATERIAL AND METHODS: The literature review was conducted in PubMed, Web of Science, and the Cochrane Library. Seven randomized clinical trials were included. RESULTS: The result of a meta-analysis of implant loss before 1 year in EL versus IL was 0.34 (95% CI: 0.08, 1.52), favoring the EL control group, while the outcome for crestal bone loss at the three-year observation was -0.10 (95% CI: -0.28, 0.09), with a tendency toward reduced bone loss for EL. In the EL versus DL group, the result of the meta-analysis of implant loss before one year was inconclusive, while in the comparison regarding crestal bone loss in the first year of observation, the result was -0.03 (95% CI: -0.08,-0.02) with a tendency to less bone loss in EL. CONCLUSIONS: The risk of early implant loss in the IL group was higher than in the EL group. The results in terms of early implant loss in EL versus DL are inconclusive. Besides, crestal bone loss is greater in immediately and delayed loaded implants, at 1 and 3 years of observation, compared to those loaded early. Key words:Dental implants, early dental implant loading, dental prostheses, implant- supported, alveolar bone loss, meta-analysis.

Implant loss and crestal bone loss in immediate versus delayed load in edentulous mandibles: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: The current trend is to shorten the loading times of dental implants. However, information about the risk of early loss of implants that have been loaded immediately is scant if compared with data available for those conventionally loaded. PURPOSE: The purpose of this systematic review and meta-analysis was to study immediate (IL) and delayed loading (DL) protocols in edentulous mandibles to determine whether differences exist in implant success and crestal bone loss and to evaluate these possible differences in relation to the type of prosthesis and the splinting of the implants. MATERIAL AND METHODS: The literature review was conducted in PubMed, Scopus, and the Cochrane Library. Nine randomized clinical trials were included. RESULTS: The result of a meta-analysis of implant loss before 1 year was 2.63 (95% CI: 1.22, 5.68), favoring the DL control group, while the outcome for crestal bone loss at the observation year was 0.42 (95% CI: -0.35, 1.20), with a tendency toward reduced bone loss for DL. CONCLUSIONS: The risk of early loss in the IL group was higher than that in the DL group. For removable prostheses and nonsplinted implants, DL was preferred. The quality of scientific evidence significantly favors DL.

Laryngeal paralysis detected in preoperative laryngoscopy in malignant and benign thyroid disease. Systematic review and meta-analysis. / Parálisis laríngea detectada en la laringoscopia preoperatoria en enfermedad de tiroides maligna y benigna. Revisión sistemática y metaanálisis.

There is controversy regarding the performance of preoperative laryngoscopy (LP) in thyroid surgery, with different recommendations being made, based on observational studies, in various publications. The aim of the study was to know the prevalence of laryngeal paralysis found in the LPs of patients who underwent thyroidectomy in benign and malignant pathology. A systematic review was carried out with 29 articles included for the qualitative study and a meta-analysis of 13 articles in which the data could be obtained to evaluate the same effect (in all patients in which an LP was carried out, those with preoperative laryngeal paralysis were included, and assigned to malignant or benign postoperative histology groups). The pooled prevalence of preoperative paralysis in benign pathology was 1.1% (95% CI 0.7 to 1.7%, 71% I2) and in 6.3% malignant pathology (95% CI 3.8 to 9.4%; I2 85%). The prevalence was significantly higher among patients with malignant pathology with an estimated effect RR 5.66, 95% CI, 2.48, 12.88. The studies analyzed present biases that will need to be corrected in future research, eliminating blinding biases in the selection and allocation of patients or in the laryngoscopy technique used. The LP in thyroid surgery evaluates possible disorders of laryngeal motility. The prevalence of laryngeal paralysis in thyroid pathology found in LPs in patients with a postoperative diagnosis of malignant pathology was higher than in the benign pathology group. This information is necessary for interpreting the intraoperative neuromonitoring signal and for making informed decisions.

Recommendations on the use of neuromonitoring in thyroid and parathyroid surgery. / Recomendaciones sobre el uso de la neuromonitorización en cirugía de tiroides y paratiroides.

INTRODUCTION: Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary. OBJECTIVE: To develop a support document for guidance on the use of IONM in TPTS. METHOD: Work group consensus through systematic review and the Delphi method. RESULTS: Seven sections were identified on which points of consensus were identified: indications, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications. CONCLUSIONS: IONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral thyroidectomy or previous contralateral paralysis. The accuracy of IONM depends on variables such as accomplished technique, technology and training in the correct execution of the technique and interpretation of the signal. This document is a starting point for future agreements on TPTS in each of the sections of consensus.

Bilateral recurrent laryngeal nerve injury in total thyroidectomy with or without intraoperative neuromonitoring. Systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVE: The risk of producing bilateral laryngeal paralysis (BLP) in total thyroidectomy (TT) is low, but it is a concern for the surgeon and a serious safety incident that may compromise the airway, require reintubation or tracheostomy and cause serious sequelae or death. Neuromonitoring (NM), as an early diagnostic tool for the existence of injury to the recurrent laryngeal nerve (RLN), has not been shown to have reduced the risk, even though published series show lower incidences. Our objective was to estimate the risk of bilateral RLN paralysis with and without NM TT by systematic review and meta-analysis. METHOD: We performed a systematic review of clinical trials, cohort studies and case series with total thyroidectomy without NM published in the period 2000-2014. A database search was performed using PubMed, Scopus (EMBASE) and the Cochrane Library. Heterogeneity between studies was explored and weighted risks grouped according to random effects models were estimated. RESULTS: We selected 40 articles and estimates of risk were identified in 54 case series (without NM, 25; with NM, 29) with 30,922 patients. The prevalence of BLP in the series with NM was lower compared to that without NM (2.43‰, [1.55 to 3.5‰] versus 5.18‰ [2.53 to 8.7‰]). This difference is equivalent to an absolute risk reduction of 2.75‰ with a number needed to treat of 364.13. The NM group was more homogeneous (I2=7.52%) than those without NM (I2=79.32%). The observed differences in the subgroup analysis were very imprecise because the number of observed paralysis was very low. CONCLUSIONS: The risk of bilateral paralysis is lower in studies with neuromonitoring.

Development of a checklist in risk management in thyroidectomy.

INTRODUCTION: Communication failures may result in inadequate treatment and patient harm, and are among the most common causes of sentinel events. Checklists are part of cycles to improve quality of the care process, promote communication between professionals involved in the different stages, help detect failures and risks, and increase patient safety. The lack of checklists at each stage was identified as a factor contributing to communication failures. OBJECTIVE: To design checklists at different stages of the thyroidectomy care process to improve the communication between the professionals involved. METHOD: Multidisciplinary working team consisting of specialists in otolaryngology, anesthesiology, and endocrinology. The process of thyroidectomy was divided into three stages (preoperative -A-, operative -B- and postoperative -C-). Potential safety incidents and failures at each stage and their contributing factors (causes) were identified by literature review and brainstorming. Checklists for each checkpoint were designed by consensus of the working group. RESULTS: The items correspond to factors contributing to the occurrence of incidents in the perioperative stage of thyroidectomy related to patients, technological equipment, environment, management, and organization. Lists of items should be checked by the appropriate specialist in each stage. CONCLUSIONS: Checklists in thyroid surgery are tools that allow for testing at different checkpoints data related to factors contributing to the occurrence of failures at each stage of the care process.

Usefulness of neuromonitoring in thyroid surgery.

INTRODUCTION: Identifying the recurrent laryngeal nerve is the gold standard for reducing injury in thyroidectomy. OBJECTIVE: To evaluate the usefulness of neuromonitoring in identifying the recurrent laryngeal nerve. METHODS: This was a study of 259 recurrent laryngeal nerves at risk during thyroidectomy performed with neuromonitoring (group A: 129 nerves) and without neuromonitoring (control group B: 130 nerves). RESULTS: The percentage of visually unidentified nerves was 18% in group A and 20% in group B, with no statistical difference. From the moment of non-identification, identification with neuromonitoring was achieved in group A in 100% of cases. The difference was statistically significant. The positive and negative predictive value of neuromonitoring was 100%. CONCLUSIONS: Neuromonitoring helps to identify the recurrent laryngeal nerve and increases the security of the surgeon in the technique. It is advisable to perform neuromonitoring routinely in thyroid surgery.

[Hemostatic systems in thyroid surgery and complications]. / Sistemas de hemostasia en cirugía tiroidea y complicaciones.

INTRODUCTION: There have been significant technological advances for hemostasis in thyroid surgery, which allow more precise and safer vascular sealing than the traditional bond associated with mono- or bipolar electrocoagulation. OBJECTIVE: To compare the complications in total thyroidectomy using traditional techniques (ligation and electrocoagulation, including LigaSure) compared to the exclusive use of the Ultracision Harmonic scalpel, performing dissection, cutting and hemostasis simultaneously. METHODS: Retrospective descriptive non-randomized comparative study with 887 patients who underwent total thyroidectomy by the same surgeon. They were distributed into Group A (traditional techniques in 468 patients, January 1997 to September 2006) and Group B (Harmonic Ultracision in 419 patients, October 2006 to May 2010). RESULTS: There was a statistically-significant lower incidence of complications in Group B (0.95% versus 4.06% in group A): bleeding (0.24% versus 1.92% in group A), tracheostomy (0% versus 1.28%) and intensive care unit stay (0% versus 4.06%). Improvement of surgical activity parameters was also significant for Group B: shorter operation time (60 minutes versus 180 minutes), fewer hospital stays (4.62 versus 8.5 stays) and increase in operations per month (9.63 versus 4 interventions). Persistent sequelae (recurrent paralysis [0.48%] and hypoparathyroidism [0.47%]) decreased in the second group but the difference was not statistically significant compared to Group A. The cost per patient was lower in Group B CONCLUSIONS: The Ultracision Harmonic scalpel system is the technique of choice for thyroid surgery.