Analgesia after tonsillectomy with controlled intravenous morphine - overdue or exaggerated?

Abstract Objective: To assess the value of a morphine Patient Controlled Intravenous Analgesia (PCIA) after Tonsillectomies (TE). Methods: 30 adult patients were treated with oral analgesics (protocol group) and compared to 30 patients treated with a morphine PCIA for the first 3 Postoperative Days (PODs) after TE. Average and maximum pain severities (Numeric Rating Scale - NRS: 0-10) on PODs 1-3, analgesic score, quality of life, patient satisfaction and side effects were defined as outcome measures. Results: Average pain severities of the protocol and the PCIA group were of similar magnitude (NRS) (POD1: 4.48 vs. 4.71 [p = 0.68], POD2: 4.75 vs. 4.22 [p = 0.32] and POD3: 4.44 vs. 4.25 [p = 0.71]). Maximum pain intensities on POD1 (p = 0.92), POD2 (p = 0.51) and POD3 (p = 0.36) were also comparable between both groups. Patients with a PCIA consumed significantly more opioids (p = 0.001) without significant more side-effects. Conclusion: The PCIA did not provide a superior pain control compared to oral analgesics. In view of the considerable effort and the high opioid consumption, it cannot be recommended as a standardized application for pain control after TE.

Telementoring of Open and Laparoscopic Knot Tying and Suturing Is Possible: A Randomized Controlled Study.

AIM: Several motor learning models have been used to teach highly complex procedural skills in medical education. The aim of this randomized controlled trial was to assess the efficiency of telementoring of open and laparoscopic suturing of medical students compared to conventional in-person teaching and training. METHODS: After randomization, 23 medical students were assigned to either the telementoring or the in-person training group. Both groups were taught by surgically trained residence with a student-teacher ratio of 1:1 (teacher-student). Open suturing was assessed in a model of congenital diaphragmatic hernia and laparoscopic suturing in a model of bowel anastomosis. All subjects were trained according to the spaced learning concept for 3 hours. Primary end points were time, knot quality, precision, knot strength, and overall knotting performance/competency. Furthermore, we utilized the Surgery Task Load Index to evaluate the cognitive load of both teaching techniques. Students' subjective progress regarding skill acquisitions and acceptance of telementoring was assessed using a nine-item questionnaire. RESULTS: All 23 trainees significantly improved after training in all knot attributes. More than 90% of all subjects reached proficiency in both groups. In-person training and telementoring were similarly practical, and no significant differences regarding speed, knot quality, precision, knot stability, and procedure performance/competency were found. Students perceived no difference in acquisition of factual or applicational knowledge between the two groups. General acceptance of telementoring was moderate in both groups before training, but increased during training in students actually assigned to this group, in comparison to students assigned to conventional teaching. CONCLUSION: The current study shows that telementoring of open and laparoscopic suturing is an ideal answer to the current coronavirus disease 2019 pandemic, ensuring continuous training. On-site training and telementoring are similarly effective, leading to substantial improvement in proficiency in intracorporeal suturing and knot tying. Likewise, students' subjective progress regarding skill acquisitions and cognitive load does not differ between teaching methods. Skepticism toward telementoring decreases after exposure to this learning method. Given our results, telementoring should be considered a highly effective and resource-saving educational approach even after the current pandemic.

Postoperative Pain Treatment With Continuous Local Anesthetic Wound Infusion in Patients With Head and Neck Cancer: A Nonrandomized Clinical Trial.

Importance: Up to 80% of patients with head and neck cancer undergoing ablative surgery and neck dissection develop postoperative pain with detrimental effects on quality of life that also contributes to neuropathic and chronic postoperative pain. Objective: To investigate the association of continuous local anesthetic wound infusion with pain management after head and neck surgery. Design, Setting, and Participants: This prospective, longitudinal, nonrandomized clinical study carried out in a single tertiary referral center (December 1, 2015, to July 1, 2017) included 2 groups of 30 patients. Patients were consecutively enrolled and presented for ablative head and neck surgery including selective neck dissection and studied from the preoperative through the fourth postoperative day. Interventions: The control group was treated according to a standardized escalating oral treatment protocol (ibuprofen, metamizole, opioids). The intervention group was treated with an intraoperatively applied pain catheter (InfiltraLong plus FuserPump, Pajunk, ropivacaine, 0.2%, 3 mL/h) that was removed 72 hours after operating. Main Outcomes and Measures: Average and maximum pain intensities on a numeric rating scale; quality of life using the acute version of the validated 36-Item Short Form Survey; and neuropathic pain using the validated 12-Item painDETECT questionnaire. Consumption of opioid and nonopioid analgesics and evaluation of catheter-associated complications. Results: During postoperative days 1 through 4, patients of the intervention group (mean [SD] age, 63.2 [13.3 years; 9 [30%] women) experienced lower mean (SD) (1.6 [1.4] vs 2.7 [1.8]; η2p = 0.09 [0.01-0.21]) and maximum (2.4 [2.2] vs 4.2 [2.0]; η2p = 0.11 [0.01-0.24]) pain intensities compared with the control group (mean [SD] age, 62.5 [13.6] years; 5 [17%] women). The intervention group also reported less neuropathic pain (mean [SD], 5.4 [3.4] vs 7.6 [5.1]; η2p = 0.09 [0.004 - 0.22]) and higher quality of life regarding vitality (56.2 [21.5] vs 43.8 [20.9], r = 0.29; 95% CI, 0.01-0.52) and pain (66.8 [27.3] vs 49.5 [27.7], r = 0.31; 95% CI, 0.04-0.54). Patients from the intervention group requested nonopioid analgesics considerably less often (n = 17 [57% ]vs n = 29 [97%]; ϕ = 0.47; 95% CI, 0.30-0.67) associated with a noticeably lower need to escalate pain treatment (n = 3 [10%] vs n = 9 [30%]; mean [SD] ibuprofen dose: 500 [173] mg vs 1133 [650] mg; r = 0.64; 95% CI, 0.02-0.91). No catheter-associated complications were observed. Conclusions and Relevance: Continuous anesthetic wound infusion is associated with reduced postoperative pain and decreased demand for analgesics. It therefore expands the treatment options for postoperative pain in head and neck cancer. Trial Registration: German Clinical Trials Register: DRKS00009378.

Lipid Storage and Interferon Response Determine the Phenotype of Ground Glass Hepatocytes in Mice and Humans.

BACKGROUND AND AIMS: A histopathological hallmark of chronic hepatitis B virus (HBV) infection is the presence of ground glass hepatocytes (GGHs). GGHs are liver cells that exhibit eosinophilic, granular, glassy cytoplasm in light microscopy and are characterized by accumulation of HBV surface (HBs) proteins in the endoplasmic reticulum (ER). More important, GGHs have been accepted as a precursor of HCC and may represent preneoplastic lesions of the liver. METHODS: Here we show that the reason for ground glass phenotype of hepatocytes in patients with chronic hepatitis B (CHB) and in HBs transgenic mice is a complex formation between HBs proteins and lipid droplets (LDs) within the ER. RESULTS: As fat is a main component of LDs their presence reduces the protein density of HBs aggregates. Therefore, they adsorb less amount of eosin during hematoxylin-eosin staining and appear dull in light microscopy. However, after induction of interferon response in the liver LDs were not only co-localized with HBs but also distributed throughout the cytoplasm of hepatocytes. The uniform distribution of LDs weakens the contrast between HBs aggregates and the rest of the cytoplasm and complicates the identification of GGHs. Suppression of interferon response restored the ground glass phenotype of hepatocytes. CONCLUSIONS: Complex formation between HBs and LDs represents a very important feature of CHB that could affect LDs functions in hepatocytes. The strain specific activation of the interferon response in the liver of HBs/c mice prevented the development of GGHs. Thus, manipulation of LDs could provide a new treatment strategy in the prevention of liver cancer.

Evaluation of a New Material From an Allogenic Collagen Scaffold as a Suitable Coupling Option for Round Window Vibroplasty.

INTRODUCTION: In round window vibroplasty the most efficient coupling technique for contact of the floating mass transducer (FMT) to the round window membrane (RWM) is yet to be determined. Various materials placed between the FMT and the RWM have been proposed to enable better stimulation of the cochlea. Collagenous scaffolds derived from decellularized extracellular cartilage matrices as a commercially available biomaterial are already used for other applications in ear surgery. We aimed to examine the coupling properties of collagen scaffolds compared with commonly used other materials (round window soft coupler, porcine perichondrium, and cartilage) as interponate between the FMT and the RWM in vibroplasty. METHODS: A well-established in vitro temporal bone model was used. Volume velocities were measured with collagen scaffold compared with different interponates (round window soft coupler, porcine perichondrium, and cartilage) at 800, 1000, 1250, 1600, 2000, 2500, 3150, and 4000 Hz levels. RESULTS: Statistical analysis revealed no superiority of commonly used materials compared with collagen scaffolds at all tested volume velocities (p > 0.05). DISCUSSION: We could demonstrate that collagenous scaffolds of decellularized extracellular cartilage matrices have similar vibrational properties as conventional coupling materials of the FMT to the RWM in vibroplasty. Therefore, as a commercially available new material they display a suitable coupling option for round window vibroplasty.

The diagnostic value of computed tomography in delayed complications after cochlear implantation.

BACKGROUND: Delayed complications after cochlear implant (CI) surgery can result in the need for revision surgery. Temporal bone computed tomography (tCT) is frequently used in the diagnostic work-up for these patients. AIMS/OBJECTIVES: We aimed to test for the value of tCT in delayed complications after CI surgery. MATERIAL AND METHODS: Retrospective chart review including all patients with CI who were consecutively enrolled in our academic tertiary care centre and received a tCT due to delayed complications between January 2008 and December 2017. RESULTS: A total of 85 patients with a mean age of 28 years at CI surgery were identified. Mean time between CI and tCT was 4.3 years. Reasons for performance of tCT were device malfunction (20%), cephalgia (20%), scalp hematoma/seroma (15.3%), device failure (11.8%), vertigo (10.6%), local infection (7.1%), trauma (5.9%), meningism (3.5%), tinnitus (3.5%) and facial palsy (2.4%). No abnormalities in tCT were detected in 82.4%. However, an abnormal tCT was a predictor for surgical therapy (p < .001). CONCLUSIONS AND SIGNIFICANCE: We recommend the performance of tCT in CI patients with delayed complications to identify or rule out pathology in order to choose the most ideal and relevant individual treatment.

Swine cysticercosis and associated risk factors in non-technified pig breeding in semi-arid region of Sergipe state, Brazil.

The aim of this study was to determine the frequency of Taenia solium anti-metacestode antibodies in slaughtered pigs in a semi-arid region of the "Alto Sertão" of Sergipe state, Brazil, and verify the risk factors associated with swine cysticercosis. For this, 230 samples of swine blood from two slaughterhouses were collected and analyzed by indirect ELISA. The pigs came from five non-technical properties in the semi-arid region of the Alto Sertão of Sergipe state. Searches for cysts in the skeletal muscles of the pigs were performed during slaughter. In addition, an epidemiological questionnaire was applied to the pigs' original properties to determine risk factors. Besides that, the official health services database was evaluated for confirmed cases of neurocysticercosis and taeniasis in humans in the last 5 years, living in the studied region. Seropositivity in pigs was 12.6%, with no significant difference between males and females. No cysts were found in the carcasses of the slaughtered pigs. A positive association was found for properties that discharge domestic sewage into the environment, in river or streams, increasing the risk of positivity by 5.72 times. When analyzing the database of official agencies, there were no records of cases of neurocysticercosis or taeniasis in the resident population in the last 5 years. However, there were frequent cases of idiopathic epilepsy. The results demonstrate that study area is endemic for swine cysticercosis and serves as a warning of the possibility of the occurrence of the taeniasis-cysticercosis complex.

Differences in the coinfective process of Staphylococcus aureus and Streptococcus agalactiae in bovine mammary epithelial cells infected by Mycobacterium avium subsp. paratuberculosis.

The interactions between Mycobacterium avium subsp. paratuberculosis (MAP) and the causative agents of bovine mastitis are still relatively unknown. Still, it is suspected that they may contribute to the worsening and persistence of mastitis within the mammary epithelial cells. Considering the growing economic implications of paratuberculosis and subclinical mastitis in dairy herds, this study aimed to determine the coinfection interaction between MAP and S. aureus or S. agalactiae in bovine mammary epithelial cells (MAC-T) in an ex-vivo model. For this purpose, internalisation tests of MAP + S. aureus or MAP + S. agalactiae were performed in MAC-T cells for 10, 30 and 120 min. The qPCR was performed to quantify internalised MAP at the time of exposure. Colony-forming units were counted on BHI agar medium for internalised subclinical mastitis bacteria at each time of infection. Viability tests of MAC-T cells, using the lactate dehydrogenase assay, were performed. The results showed that in the MAC-T cells previously infected by MAP and subsequently by S. aureus, there was a rapid internalisation in the first 10 min, maintaining a higher number of internalised bacteria during all exposure times. Regarding MAP + S. agalactiae, there were no changes in the internalisation patterns. The amount of MAP remained constant at all times evaluated, and there was no compromise in the viability of MAC-T cells during the tests. Thus, the results demonstrate the existence of an interaction between MAP + S. aureus, favouring internalisation and being able to contribute to the persistence of subclinical mastitis in dairy herds.

Expression Profiling of Extracellular Matrix Genes Reveals Global and Entity-Specific Characteristics in Adenoid Cystic, Mucoepidermoid and Salivary Duct Carcinomas.

The composition of the extracellular matrix (ECM) plays a pivotal role in tumour initiation, metastasis and therapy resistance. Until now, the ECM composition of salivary gland carcinomas (SGC) has not been studied. We quantitatively analysed the mRNA of 28 ECM-related genes of 34 adenoid cystic (AdCy; n = 11), mucoepidermoid (MuEp; n = 14) and salivary duct carcinomas (SaDu; n = 9). An incremental overexpression of six collagens (including COL11A1) and four glycoproteins from MuEp and SaDu suggested a common ECM alteration. Conversely, AdCy and MuEp displayed a distinct overexpression of COL27A1 and LAMB3, respectively. Nonhierarchical clustering and principal component analysis revealed a more specific pattern for AdCy with low expression of the common gene signature. In situ studies at the RNA and protein level confirmed these results and indicated that, in contrast to MuEp and SaDu, ECM production in AdCy results from tumour cells and not from cancer-associated fibroblasts (CAFs). Our findings reveal different modes of ECM production leading to common and distinct RNA signatures in SGC. Of note, an overexpression of COL27A1, as in AdCy, has not been linked to any other neoplasm so far. Here, we contribute to the dissection of the ECM composition in SGC and identified a panel of deferentially expressed genes, which could be putative targets for SGC therapy and overcoming therapeutic resistance.

Expression of podoplanin correlates with prognosis in nasopharyngeal carcinoma.

PURPOSE: Podoplanin is a membrane-bound glycoprotein that plays a role in lymphangiogenesis. Several studies suggest a role of podoplanin in head-and-neck cancer. The purpose of the current study was to evaluate the role of podoplanin as a prognostic marker in nasopharyngeal carcinoma. METHODS: In a monocentric retrospective analysis, data of 42 patients with primary diagnosis of nasopharyngeal carcinoma (diagnosed between 2004 and 2017) were examined regarding the relationship between the immunohistochemically analyzed podoplanin expression status and corresponding clinical and oncological parameters. RESULTS: The mean age was 56.6 years. The majority (61.9%) had an advanced tumor stage (T3-T4). The 5-year overall survival was 54%. 33% showed a positive expression of podoplanin. In patients with tumors with podoplanin expression, 5-year overall survival was 15%, while in patients with tumors without podoplanin expression, 5-year overall survival was 75% (p = 0.017, univariate analysis). In multivariate analysis, podoplanin expression was shown to be the only independent prognostic marker for nasopharyngeal carcinoma (p = 0.025). CONCLUSION: This retrospective study shows that podoplanin expression is a potential prognostic marker for nasopharyngeal carcinomas. In the future, clinical use could filter out more aggressive courses and allow therapy escalation in those cases.

Inhibition of Escherichia coli invasion into bovine mammary epithelial cells previously infected by Mycobacterium avium subsp. paratuberculosis.

Background: The coinfection process of Escherichia coli, an etiological agent of clinical mastitis and Mycobacterium avium subsp. paratuberculosis (MAP), a non-mastitic etiological agent in the bovine mammary gland is not fully known.Objective: Verify the ability of MAP to interfere with the invasion and translocation of E. coli in bovine mammary epithelial cell line (MAC-T).Methods: For the invasion assay, MAC-T cells were challenged with MAP K10 for 2 h and then challenged with E. coli for 10, 30 and 120 min. For the translocation assay, the trans well plates were used and the challenge sequence was repeated as previously described. The amount of E. coli in the assays was determined by counting colony forming units (CFU) in Luria-Bertani medium. Quantitative real-time PCR was used to quantify MAP in MAC-T cells. To verify the viability of the MAC-T cells, the MTT assay was performed. MAP culture supernatant was also evaluated at different percentages for E. coli growth.Results: Previous MAP infection in MAC-T cells inhibited E. coli invasion in 10, 30 and 120 min. No significant interference of MAP in the translocation of E. coli from the apical-basal direction was verified. Quantity of MAP DNA inside the MAC-T cells was statistically similar. Neither reduction in MAC-T cells viability was detected during the experiment nor MAP-released factor in the supernatant inhibited E. coli invasion.Conclusion: These findings suggest that MAP-positive cows could be more resistant to E. coli infection, but when infected, could rapidly translocate E. coli to the subepithelial region.

Preservation of Vestibular Function and Residual Hearing After Round Window Cochlear Implantation.

OBJECTIVE: To examine the possible correlation between the loss of short-term residual hearing and vestibular function after cochlear implantation (CI). STUDY DESIGN: Retrospective patient review. SETTING: Academic tertiary referral center. PATIENTS: One hundred twenty patients with normal vestibular function (VF) in the caloric testing and residual hearing (RH) at the frequencies 250, 500, and 1000 Hz on the surgery side between 2008 and 2016 were included in the study. INTERVENTION: Primary CI on the first side via round window with a conventional full-length electrode. MAIN OUTCOME MEASURES: Changes of RH and VF 7 weeks after surgery were analyzed. Preservation of RH was defined as measurable postoperative thresholds at the frequencies 250, 500, and 1000 Hz in the pure-tone audiogram. Preservation of the VF after CI was assessed both by an absolute and relative threshold in the caloric testing. RESULTS: Seven weeks after implantation, the preservation of RH was achieved in 52 (43.3 %) patients and the preservation of VF in 95 (79.2 %) patients on the operated side. There was no significant statistical correlation between these two parameters. CONCLUSION: The loss of RH was more than twice as frequent as the loss of VF. However, no statistical correlation between the failure of the two inner ear functions was found. The exact causes are still unknown, but our data could give an indication that there may be different underlying pathomechanisms.

Evaluation of Coupling Efficiency in Round Window Vibroplasty With a New Handheld Probe.

HYPOTHESIS: A handheld measuring probe was developed that analyzes the vibration characteristics of the stapes footplate after backward stimulation of the cochlea in round window vibroplasty. In temporal bone experiments, the measuring accuracy of the probe was tested. BACKGROUND: In round window vibroplasty, the effectiveness of the transmitted vibrations into the inner ear is provided with limited visual and tactile information. Currently, there is no objective measuring tool available. METHODS: In five unfixed temporal bones, a floating mass transducer was coupled to the round window membrane. During the excitation with different voltage levels (0, 5, 25, 100, 300 mV root mean square) corresponding to 0, 80, 94, 106, and 116 dB equivalent ear canal sound pressure respectively, the deflections of the footplate were recorded in parallel by laser Doppler vibrometry and the measuring probe. RESULTS: The probe allowed for differentiation of the coupling efficiency. The measured footplate vibrations from the excitation levels of 106 dB (and 116 dB) were statistically significant compared with the testing without excitation. The footplate deflections determined in parallel by laser Doppler vibrometry showed comparable results. CONCLUSION: In principal, the newly developed measuring probe allows for measuring the quality of retrograde cochlear excitation in a round window vibroplasty by detecting footplate vibrations. Further developments are directed for its application in clinical, intraoperative procedures.

Cochlear implantation after canal wall down mastoidectomy - Outcomes after partial mastoid obliteration.

OBJECTIVE: To describe and evaluate the partial mastoid obliteration of the so-called radical mastoid cavity after canal-wall down mastoidectomy (CWD) for cochlear implantation (CI) compared to overclosure of the external ear canal as two stage procedures. METHODS: Out of 1020 patients undergoing cochlear implantation between January 1st, 2003 and June 15th, 2016 at the Department of Otolaryngology, Head & Neck Surgery, University Hospital Cologne, eight patients underwent obliteration of the radical cavity prior to cochlear implantation. In four additional patients, the external ear canal was overclosed prior to cochlear implantation. RESULTS: Patients undergoing partial mastoid obliteration (five ♀, 4 left ears) and overclosure of the external ear canal (one ♀, 3 left ears) averaged 56years and 61years, respectively. The radical cavities had been present for 21.8years on average before partial obliteration and for 19.5years before overclosure. Cochlear implantation following mastoid obliteration was performed after a mean period of 5.1months and 3.8months after overclosure. After partial mastoid obliteration, complete insertion of all electrodes was achieved and the clinical courses were uneventful for all patients. Likewise, no patient revealed any complications after overclosure of the external ear canal. CONCLUSION: Partial mastoid obliteration with bone paté and cartilage after canal wall down mastoidectomy can be advocated as a feasible alternative technique that allows for a safe subsequent cochlear implantation.

Acquired stenosis of the external auditory canal - long-term results and patient satisfaction.

BACKGROUND: The surgical treatment of acquired post-inflammatory atresia of the external auditory canal (EAC) is challenging. Based on the long-term surgical experience, a modified split skin graft technique has been established at our clinic. AIMS/OBJECTIVES: The aim was to evaluate the clinical and audiological data and patient satisfaction after performing meatoplasty. MATERIAL AND METHODS: In total, 16 patients were included who underwent intraoperative enlargement of the bony EAC, resection of the fibrotic scar tissue, reconstruction with split skin grafts and splinting of the anterior tympanomeatal angle in the period of 2004-2016. Patients presented at a long-term follow-up appointment for reevaluation. RESULTS: The mean follow-up time was 52 months after surgery. The pure-tone average (52 dB vs. 31 dB) and the air-bone gap (27 dB vs. 11 dB) decreased significantly compared to the preoperative status. The grade of stenosis also showed a significant improvement during the follow-up visit. Complete re-atresia was observed only in two patients (10.5%). CONCLUSION: The applied surgical technique is a safe and successful treatment option for acquired atresia of the EAC. SIGNIFICANCE: The study provides important data for the surgical treatment of acquired atresia of the EAC and corroborates the significance of intensive aftercare.

Pharyngeal fistulas after total laryngectomy with and without tracheostoma plasty according to Herrmann.

PURPOSE: Pharyngeal fistula (PF) is one of the most common complications after total laryngectomy (TL). The tracheostoma plasty technique according to Herrmann (TPH) represents an alternative surgical technique to shape the tracheostoma. The aim of this study was to determine whether the performance of a TPH affects the incidence of PF after TL. A secondary aim was to identify potential risk factors for the development of PF with regard to TPH. METHODS: Retrospective evaluation of records of 151 consecutive patients at two tertiary care centers with regard to the occurrence and risk factors of PF after TL with and without TPH. RESULTS: 60 patients with TPH and 91 patients without TPH contributed to the results. The overall incidence of PF was 21.2% (32 out of 151). 23.3% (14 out of 60) of patients with TPH and 19.8% (18 of 91) of patients without TPH developed a PF (p = 0.91). Binary logistic regression analysis revealed significant influence of salvage surgery on the risk to develop PF (odds ratio = 2.9; 95% CI 1.16-7.23; p = 0.026). The occurrence of PF was not significantly influenced by any other investigated factors including performance of TPH. CONCLUSIONS: Performance of TPH after TL does not increase the incidence of PF. Thus, TPH can be considered as a safe alternative surgical technique for the shaping of the tracheostoma following TL.

Cochlear implantation using the underwater technique: long-term results.

INTRODUCTION: The opening of the round window and the insertion of the electrode array into the scala tympani during cochlear implant surgery can lead to a pressure shock of the delicate inner ear structures. By filling the tympanic cavity with Ringer Solution during these surgical steps (underwater technique), the hydrostatic pressure of the fluid acts as a smooth pressure stabilizer, avoiding a pressure shock of the inner ear structures. The aim of this retrospective study was to present long-term results of this new method of cochlear implantation in underwater technique. METHODS: Altogether, 47 implantations in 43 patients with residual hearing at the frequencies 250, 500 and 1000 Hz in the unaided preoperative pure tone audiometry were included. A cochlear implantation via round window with a conventional full-length electrode was performed in underwater technique. Changes of residual hearing 7 weeks and 24 months after surgery were analyzed. RESULTS: Overall postimplant hearing preservation 7 weeks after implantation was achieved in 22 ears (47%). Subsequent follow-up was performed on average 24 months after surgery (range 12 months-4.2 years) in all patients. At this late postoperative evaluation, preservation of hearing was recorded in 18 ears (38%). Neither the follow-up time nor the type of electrode had a significant impact on the postoperative hearing loss. CONCLUSION: The underwater technique is an atraumatic cochlear implantation technique with hearing preservation rates comparable to results in literature and a very small hearing preservation decline rate over time even when using full-length CI electrodes.

Surgical Treatment for Early Stage Glottic Carcinoma with Involvement of the Anterior Commissure.

Objective Assessment of the value of transoral laser microsurgery (TLM) compared with open surgery (OS) for early stage squamous cell carcinoma of the glottic larynx with special regard to involvement of the anterior commissure (AC). Study Design Case series with chart review. Setting Tertiary care otolaryngology clinic. Subjects and Methods Review of clinicopathological data of all patients with previously untreated T1a, T1b, and T2 glottic squamous cell carcinoma of the larynx who were consecutively enrolled over a 10-year period (January 1, 1992, to December 31, 2002). Results Local recurrence rate was 20.4% (10 of 49) for TLM and 10.7% (3 of 28) for OS. Comparison of the TLM and OS groups regarding local recurrence rates revealed a significant difference only for tumors invading the AC ( P = .046). Within the TLM group, tumors with involvement of the AC showed a significantly higher recurrence rate (38.1%; 8 of 21) compared with tumors without involvement of the AC (7.1%; 2 of 28; P = .008). In the OS group, involvement of the AC revealed no significant difference ( P = .45). The overall survival in both groups was comparable in both groups (TLM, 93.9%; OS, 89.3%; P = .47). Conclusion TLM and OS are equally effective surgical treatments for early stage glottic cancer without involvement of the AC, with selection of treatment based on pretreatment endoscopy. However, TLM is associated with less morbidity. In case of invasion of the AC, OS yields lower recurrence rates.

Analysis of the dura involvement in cholesteatoma surgery.

OBJECTIVE: The involvement of the dura is a rare yet potentially life-threatening complication during cholesteatoma surgery. Thus, the knowledge about treatment and consequences of this issue is of great importance to every ear surgeon. METHODS: This retrospective study analyzed the dura involvement with regard to the type of defect, reconstruction method used, and the post-operative complications of 1291 pediatric and adult cholesteatoma surgeries performed at an academic tertiary care center over a twelve-year period. RESULTS: From a total of 1291 cholesteatoma surgeries, we identified 84 patients (6.5%) with dura involvement intraoperatively, most of them adult patients. The majority of the reported cases were bony defects and exposed dura without CSF leakage (79.73%, 67 out of 84). In 14.28% of the cases (12 out of 84) a meningo(encephalo)cele or dura defect with liquorrhea were detected. In 30 surgeries (35.7%, 30 out of 84) no reconstruction of the lateral skull base was considered necessary. The most common material used for reconstruction was conchal cartilage (25.0%, 21 out of 84), followed by polydioxanone (PDS)-foil (11.9%, 10 out of 84), bone pâté (9.5%, 8 out of 84) and a combination of materials (17.9%, 15 out of 84). Revision surgery of the reconstruction was necessary in 16.7% (14 out of 84) of the cases. Long-term evaluation (mean of 19.3 months) showed no complication related to the skull base defect. CONCLUSION: During cholesteatoma surgery, bony and dura defects can be managed effectively, with good long-term reliability. No intracranial or mastoidal complications are expected.

Acoustic effects of the reconstructed lateral epitympanic wall in a temporal bone and clinical study.

OBJECTIVE: Acoustic evaluation of reconstruction of the lateral epitympanic wall with bone or cartilage in a temporal bone study, and evaluation of audiometric data of patients who underwent cholesteatoma surgery with reconstruction of the lateral epitympanic wall with horseshoe-shaped cartilage. STUDY DESIGN: Temporal bone study and retrospective chart review. METHODS: Preparation of temporal bones included reconstruction of the epitympanic wall with fixated and loose cartilage and bone. The volume velocities of the stapes footplate were measured from the inner-ear side of the footplate by laser scanning doppler vibrometry following sound stimulation in the outer ear canal. Additionally, the audiometric data of 13 consecutive patients who underwent epitympanic cholesteatoma surgery, with an intact ossicular chain and reconstruction of the scutum with a horseshoe-shaped cartilage in contact with the malleus' neck, were evaluated retrospectively. RESULTS: The experimental results showed similar volume velocities at the stapes footplate for the fixated and unfixated cartilage as well as for the unfixated bone. However, the fixated bone yielded significantly reduced volume velocities. Clinical data confirmed that the cartilaginous horseshoe- technique allowed for a stable reconstruction of the scutum with satisfying audiometric outcome. CONCLUSION: In case of cholesteatoma surgery and the need for the reconstruction of the scutum, no adverse effects on hearing outcome are to be expected by using the malleus' neck as an anchoring point for cartilaginous scutum reconstruction. LEVEL OF EVIDENCE: NA. Laryngoscope, 127:1427-1434, 2017.