Rate of tympanic membrane perforation after intratympanic steroid injection.

PURPOSE: To determine the rate of persistent tympanic membrane perforation after intratympanic steroid injection. To determine which comorbid conditions and risk factors are associated with prolonged time to perforation closure following intratympanic steroid injection. MATERIALS AND METHODS: Clinical data were gathered for patients who had undergone intratympanic steroid injection to treat sudden sensorineural hearing loss or Ménière's disease. Primary outcomes analysis included rate of persistent tympanic membrane perforation, defined as perforation at least 90days following last injection, and time to perforation healing. Age, sex, number of injections, smoking status, diabetes mellitus, previous head and neck irradiation, and concurrent oral steroids, were analyzed as potential predictors of persistent perforation. RESULTS: One hundred ninety two patients were included in this study. Three patients (1.6%) had persistent tympanic membrane perforations. All three patients received multiple injections. One patient underwent tympanoplasty for repair of persistent perforation. The median time to perforation healing was 18days. There was no statistically significant variable associated with time to perforation healing. However, patients with prior history of head and neck radiation averaged 36.5days for perforation healing compared to 17.5days with no prior history of radiation and this approached statistical significance (p=0.078). CONCLUSIONS: The rate of persistent tympanic membrane perforation following intratympanic steroid injection is low. Patients with a history of radiation to the head and neck may be at increased risk for prolonged time for closure of perforation.

Single Layer Biomaterial Repair of Frontal Sinus Encephalocele in a Pediatric Patient.

INTRODUCTION: Reconstruction of skull base defects are determined by size, location, and complexity of the defect. METHODS: Case report. CASE DISCUSSION: An 11-year old girl presented with a right frontoethmoidal encephalocele after an episode of meningitis. An endoscopic approach was performed with a Draf III to provide exposure. The skull base defect extended superolateral over the orbit, which limited the choice of reconstructive options. The defect was successfully repaired with a single layer onlay graft of bovine collagen matrix. CONCLUSIONS: Single layer repairs using commercial biomaterials should be considered where multilayer closure or vascularized flaps may not be possible. Laryngoscope, 131:E1750-E1752, 2021.

Rhinitis and Sinusitis in the Geriatric Population.

Rhinitis and sinusitis are common medical conditions that affect the geriatric population and have a significant impact on their quality of life. Because few studies examine differences in the clinical management between the geriatric and general adult population, therapies should be based on current guidelines. Special considerations should be made when treating these patients in regards to multiple comorbidities and the potential for drug interactions from polypharmacy. Further research on the pathogenesis of sinusitis in the geriatric population may provide specific differences in the clinical management in this population.

Anatomy and Physiology of Nasal Obstruction.

Nasal obstruction is a common presenting symptom to clinicians and affects up to one-third of the population. There are several factors that cause nasal obstruction, including anatomic, physiologic, and pathophysiologic factors. The anatomy and physiology of nasal obstruction is complicated and is influenced by patency of nasal passages, mucociliary function, airflow receptors, autonomic function, and degree of mucosal inflammation. Common anatomic causes include internal nasal valve stenosis/collapse, septal deviation, and turbinate hypertrophy. Common physiologic causes include sinonasal inflammatory disorders and iatrogenic causes.

Radiological changes in anterior cervical discectomy and fusion with cage and plate construct: the significance of the anterior spur formation sign.

STUDY DESIGN: Retrospective review. OBJECTIVE: To analyze the changes of fusion process and radiological parameters during the postoperative period after anterior cervical discectomy and fusion with cage and plate construct (ACDF-CPC). SUMMARY OF BACKGROUND DATA: Because of its well-reported efficacy, plate augmentation has been performed to avoid the various complications associated with the cage-alone procedure. The radiological changes at the fusion site after ACDF-CPC have yet to be fully explored. METHODS: Seventy-eight patients (122 fusion sites) who underwent ACDF-CPC were observed at 6 weeks and at 3, 6, 12, and 24 months postoperatively. Fusion status was classified into 3 categories: Type I (pseudoarthrosis), Type II (borderline), and Type III (fusion). Changes at the fusion site were described through radiological parameters at each follow-up time point. In addition, the ability of the radiological parameters to predict fusion rates was analyzed. RESULTS: The fusion process after ACDF-CPC progresses slower when compared with the standard procedure utilizing autograft. Fusion between bone graft chips begins at 6 weeks post surgery. At 3 months, initial bone bridging between graft and host bones begins to form. Anterior spur formation occurs at 3 to 6 months, and "kissing" lesions form at 6 to 12 months. Bony incorporation is achieved at 1 to 2 years. Persistent or newly developed Type I at the 1-year follow-up exhibited significantly higher pseudoarthrosis rates in comparison with rates determined at the 3- and 6-month time points. Among 29 subsidence cases, 9 of the 16 (56.3%) cases that exhibited anterior spur formation eventually achieved fusion, whereas 2 of the 13 (15.4%) cases that did not exhibit anterior spur formation eventually achieved fusion. In cases that demonstrated anterior spur formation, the fusion rate was significantly higher than in cases without it (P = 0.016). CONCLUSION: The fusion process after ACDF-CPC progresses slower than the standard procedure utilizing autograft. Cage subsidence of greater than 2 mm, a radiolucent defect, or a halo sign are poor prognostic signs indicating a high probability for pseudoarthrosis when detected radiographically after 1 year postoperatively. The anterior spur formation sign and "kissing" lesion, on the contrary, represent signs for eventual successful fusion.

Variability in the management of idiopathic sudden sensorineural hearing loss.

OBJECTIVES: To evaluate current trends in the management of idiopathic sudden sensorineural hearing loss (ISSNHL), determine if variance in diagnostic and treatment protocols exists, and compare diagnostic and treatment strategies of ISSNHL between nonotologists/neurotologists (NONs) and otologists/neurotologists (ONs). STUDY DESIGN: Cross-sectional survey of practicing otolaryngologists. SETTING: Otolaryngology practices within the United States. SUBJECTS AND METHODS: In January 2010, a survey was mailed to 500 NONs and 500 ONs. Data were collected and analyzed using χ(2), standard deviations, and variance. RESULTS: A variety and distribution of responses were seen in the definition of ISSNHL, including dB loss necessary for diagnosis, number of consecutive frequencies involved, and maximum duration of hearing loss. Differences in diagnostic tools were also seen, with 50.4% of respondents (NON 34.2%, ON 66.7%; P = .0001) always using magnetic resonance imaging in their workup. Of the total respondents, 26.7% (NON 35.0%, ON 18.3%; P < .0001) preferred oral steroids alone; 22.1% (NON 11.7%, ON 32.5%; P < .0001) preferred a combination of oral and intratympanic steroids. Of the respondents, 68.6% (NON 57.5%, ON 80.0%; P = .0003) would continue with additional treatment after partial response; 20.8% (NON 33.3%, ON 8.3%; P < .005) would retreat with oral steroids alone and 46.6% (NON 35.8%, ON 57.3%; P < .05) with intratympanic injections. Overall, 69.2% (NON 45.8%, ON 92.5%; P = .0001) were very comfortable managing ISSNHL. CONCLUSION: Significant differences exist in the diagnosis and treatment of ISSNHL. Such lack of uniformity highlights the need for strong evidence-based research-ultimately leading to formalized practice guidelines and educational outreach.