Balloon Dilation Eustachian Tuboplasty Combined with Tympanotomy Tube Insertion for Treatment of Refractory Otitis Media with Effusion: A Randomized, Prospective, Controlled Trial Comparing Local Anesthesia Combined Sedation Versus General Anesthesia.

BACKGROUND Balloon dilation eustachian tuboplasty (BET) is used to treat eustachian dysfunction but its therapeutic effect and cost-effectiveness when combined with tympanotomy tube insertion (TBI) on refractory otitis media with effusion under local anesthesia with sedation compared to traditional general anesthesia are not well understood. MATERIAL AND METHODS Forty patients with refractory secretory otitis media who received BET+TBI were enrolled in this study and randomized into the local anesthesia with sedation group (n=20) and general anesthesia group (n=20). Tympanometry (TMM), 7-item eustachian tube dysfunction questionnaire (ETDQ-7) results, intraoperative anesthesia accidents, and operation costs were compared between the groups. RESULTS Patients in the local anesthesia with sedation group exhibited intraoperative awareness and pain. Differences in TMM, ETDQ-7 results, and postoperative VAS scores between the groups were comparable (P>0.05). Notably, operative time and treatment costs in the local anesthesia group were lower compared with general anesthesia group. CONCLUSIONS The treatment effects and safety of local anesthesia and general anesthesia under BET combined with TBI for treatment of refractory otitis media with effusion are comparable. However, further studies should aim at reducing pain and discomfort.

Training Room Procedures and Use of Therapeutic Modalities in Athletes.

Athletic trainers, physical therapists, and team physicians have differing roles when providing care, yet often need to collaborate. Athletic trainers and physical therapists use a variety of therapeutic modalities and manual therapy techniques in conjunction with rehabilitation exercises to improve outcomes. Clinicians must be knowledgeable of the scientific rationale for each modality to choose the most effective treatment for the specific condition and stage of recovery. The team physician should be familiar with the use of common procedures in an athletic training room. Here, we review the most current evidence and the basic methods encountered in athletic training room settings.

Assessing ototoxicity and patients' satisfaction of topical local anaesthesia in myringotomy and ventilation tube insertion.

OBJECTIVES: Animal studies have suggested that exposure of the middle ear to topical local anaesthesia may be ototoxic. This study aimed to report sensorineural hearing outcomes and patients' satisfaction in those who underwent myringotomy and ventilation tube insertion using topical local anaesthesia. METHODS: Twenty-nine patients (32 ears) were operated on. Pre- and post-operative audiology findings were compared. A Likert-type questionnaire on treatment satisfaction was completed at the end of the procedure. RESULTS: Median patient age was 55 years (range, 27-88 years). Pre- and post-operative bone conduction pure tone averages were 26.76 dB and 25.26 dB respectively (mean reduction of -1.22 dB, 95 per cent confidence interval of -5.91 to 8.13 dB; p = 0.7538). One ear (3 per cent) had a reduction in pure tone average of 10 dB. CONCLUSION: The results suggest that sensorineural hearing loss is not a complication of ear exposure to topical local anaesthesia during myringotomy and ventilation tube insertion. The procedure was well perceived.

In-Office Balloon Dilation of the Eustachian Tube under Local Anesthesia.

Balloon dilation of the Eustachian tube (BDET) is an effective treatment of Eustachian tube dysfunction. This procedure can be performed under local anesthesia in the office. This article outlines the evolution of BDET under local anesthesia, describes the techniques of in-office BDET and provides an algorithm to identify suitable patients for this procedure.

Assesment of the treatment of earlobe keloids with triamcinolone injections, surgical resection, and local pressure.

OBJECTIVE: To evaluate the combined treatment of ear lobe keloids. METHODS: We studied 46 consecutive patients with 81 ear lobe keloids. Patients underwent local infiltration of triamcinolone acetonide (TCN) at concentrations of 40 mg/ml (Group 1), 20 mg/ml (Group 2) and 10mg/ml (Group 3). The volume of TCN infiltrate varied according to the size of the lesion. Treatment consisted of three monthly injections before surgery, excision of keloid in the fourth month and perioperative infiltration, followed by two more leaks TCN within two months. Patients used earrings pressure on the scar after operation for four months. The pressure exerted by earrings in the ear lobe was measured electronically. Post-treatment follow-up of patients was 24 months. RESULTS: TCN at concentrations of 20mg/ml and 40 mg/ml were effective for the treatment of keloids, no difference between the groups (p = 0.58). However, patients in which TCN was infiltrated the 10mg/ml had poor involution of keloid and the study of this group was stopped. CONCLUSION: the combination of infiltration TCN month to 20 mg/mL (1.2mg to 2.0mg per mm3 TCN injury), surgical excision and pressure application device is effective for treatment of keloid ear lobe.

Multidisciplinary approach to lethal bleeding from an arteriovenous malformation in the external auditory canal.

Arteriovenous malformations (AVMs) are composed of abnormally connecting feeding arteries as well as draining veins and lack a regulatory system. Frequent recurrences and unpredictable behavior are their main problems. Potential mortality and morbidity associated with therapeutic procedures must be considered with these patients. Improper treatment often aggravates the condition, potentially rendering therapy more complex. A multidisciplinary approach, including an endovascular approach, surgical excision, and flap reconstruction, is considered to completely eradicate an AVM. This study introduces a complicated case of AVM with massive bleeding through the external auditory canal that was treated with a multidisciplinary approach.

[Bilateral Eustachian tube dilation in infants: an alternative treatment for persistent middle ear functional dysfunction]. / Beidseitige Tubendilatation beim Kleinkind: Eine Therapiealternative bei persistierender Mittelohrfunktionsstörung.

Balloon dilation has become established as a novel method for managing chronic ventilatory dysfunction of the Eustachian tube. This treatment has so far not been used in children. This article presents the first case of a pediatric patient who required antibiotics for recurrent middle ear infections and was successfully treated with Eustachian tube dilation. After a single dilation the patient was almost free of symptoms. Further studies are required in order to establish this treatment in the management of children with recurrent ventilatory dysfunction of the Eustachian tube which does not respond to conventional therapy and to define existing and potential new indications for this treatment approach.

Clinical use of vestibular evoked myogenic potentials in the evaluation of patients with air-bone gaps.

OBJECTIVE: To determine the value of vestibular evoked myogenic potential (VEMP) test in clinical evaluation of air-bone gaps. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: A total of 120 patients underwent VEMP testing during clinical investigation of significant air-bone gaps in their audiograms. INTERVENTION(S): Otologic examination and surgeries, high-resolution computerized tomography (CT), air and bone audiometry, tympanometry, acoustic reflex, and VEMP test. MAIN OUTCOME MEASURE(S): Imaging studies demonstrating structural anomalies in the temporal bone. Audiologic outcomes of air-bone gaps and VEMP thresholds. Surgical findings confirming imaging results. RESULTS: Middle ear pathologies, such as otosclerosis and chronic otitis media, were identified in 50 patients, and all of them had absent VEMP responses elicited by air-conduction stimuli. Moreover, 13 of them had successful middle ear surgeries with closures of the air-bone gaps. Abnormally low VEMP thresholds were found in 71 of 73 ears with inner ear anomalies, such as semicircular canal dehiscence and enlarged vestibular aqueduct. Seven patients with superior semicircular canal dehiscence underwent plugging procedure via middle fossa approach, and VEMP thresholds became normalized after the surgery in 3 of them. VEMP test failed to provide accurate diagnosis in only 3 cases. CONCLUSION: Air-bone gaps may be a result of various otologic pathologies, and the VEMP test is useful during clinical evaluation, better than tympanometry and acoustic reflexes. To avoid unnecessary middle ear surgery for air-bone gaps with unknown or unsure cause, VEMP test should be used in the differential diagnosis before an expensive imaging study.

Complementary and alternative medicine use among patients undergoing otolaryngologic surgery.

OBJECTIVE: The use of complementary and alternative medicine (CAM) may influence surgical care by inducing coagulopathies and interacting with other medication. We investigated the prevalence and pattern of CAM use in patients admitted to our department for elective otolaryngologic surgery. DESIGN: Cross-sectional survey. SETTING: Tertiary care referral centre in northeast Scotland. METHOD AND PATIENTS: All adult patients admitted for elective surgery, over a 14-week period from October 2005 to January 2006, were requested to complete an anonymous questionnaire. Data were analyzed with descriptive statistics using SPSS version 12 (SPSS Inc, Chicago, IL). MAIN OUTCOME MEASURES: To establish the prevalence of CAM use in patients admitted for surgery in our unit. Secondary measures included the type of CAM used, indications for use, perceived benefit, and communication with the family physician. RESULTS: Sixty-three percent (177 of 285) of the patient group had used CAM-36% in the preceding year. Popular remedies were cod liver oil, garlic, aloe vera, cranberry, echinacea, primrose oil, herbal vitamin supplement, and St. John's wort. Nonherbal therapies included massage, acupuncture, chiropractic, aromatherapy, reflexology, yoga, homeopathy, and osteopathy. Nine percent used CAM for their admission illness. Only 8% (15 of 177) found CAM ineffective. Only 76 of 177 (43%) had discussed their CAM use with their family doctor. CONCLUSION: Despite concerns over its safety, efficacy, and cost-effectiveness, the use of CAM is common among patients undergoing otolaryngologic and head and neck surgery. This has implications for all health care workers involved in their care, in particular the anesthetist and the surgeon. A detailed history of CAM use by patients should be taken and documented during the preoperative clerking.

Auricular hematoma and cauliflower deformation of the ear: from art to medicine.

Auricular hematoma and cauliflower deformation of the ear are unique in several respects. Knowledge about it began, in antiquity, through artists, particularly Greek and Roman, and then Japanese in the 18th century with their representation of cauliflower deformation of the ear on sculptures and paintings of pugilists and wrestlers. It is only in the 19th century that physicians began to make substantive progress in understanding this abnormality. It was first thought to be associated with mental disease, but by the beginning of the 20th century, its etiology was recognized as being caused by trauma and was then named auricular hematoma. The second step in the understanding of this affliction was the observation that auricular hematoma progresses toward cauliflower deformation of the ear, which was named cauliflower ear. Recognition of this evolution led to the development of therapies. During the second half of the 20th century, different treatments were developed. They included various hematoma drainage techniques with special bandages to prevent hematoma recurrence and ensuing progression to cauliflower ear. In summary, cauliflower deformation of the ear is an old artistic affliction that has only recently received medical attention.

The preauricular sinus: factors contributing to recurrence after surgery.

PURPOSE: The objective of this study was to summarize clinical presentation, treatment, and recurrence of preauricular sinuses. MATERIALS AND METHODS: This retrospective, institutional review board-approved study reviewed the medical records of patients who underwent preauricular fistulectomy between January 1995 and June 2005 at university-based hospitals in South Korea. Only patients who underwent classic preauricular fistulectomy (not incision and drainage) and could be followed up for at least 3 months were included in the study. RESULTS: A total of 191 patients (206 ears) were enrolled. The right and left ears were involved in 79 and 97 patients, respectively. The most common location of the preauricular pit was the anterior margin of the ascending limb of the helix (93.2%). The most common indication for surgery was the recurrent exacerbation of acute infection (58.3%). The recurrence rate after surgery was 4.9%. Surgery under local anesthesia contributed to recurrence after the procedure (P = .009) and the cases that featured local infiltrative anesthesia had a higher rate of recurrence than the cases that had general anesthesia with an odds ratio of 6.875. CONCLUSIONS: Although this study showed that surgery under local anesthesia contributed to recurrence, it did not mean that it was only the anesthesia technique that influenced the recurrence. Surgeons should bear in mind that complete removal of the epithelial lining provides a lower recurrence rate, especially under local anesthesia. The main limitation of this study was that recurrent cases were too few to allow a statistical analysis.

Local anesthesia for middle ear surgery.

The adequacy of anesthesia and comfort during surgery was assessed for 100 consecutive patients undergoing middle ear surgery using local anesthesia, both by the patients themselves and by the surgeon. The possibility of inducing an iatrogenic facial weakness was also evaluated. Both the surgeon and the majority of patients were pleased with the quality of anesthesia and little adverse effects occurred as a consequence of local anesthesia itself.

[Hyperbaric oxygen therapy application in otorhinolaryngology and head and neck surgery: state of the art and review of literature]. / Applicazioni dell'ossigenoterapia iperbarica in otorinolaringoiatria e in chirurgia cervico-facciale: stato dell'arte e revisione della letteratura.

Hyperbaric Oxygen Therapy (HOT) encompasses an extensive research area in which new indications, some of which are now well-codified, have emerged both in the fields of medical and surgical pathology. Its utilization in carefully targeted clinical situations, in which its true efficacy can be demonstrated, is first of all connected with medicolegal responsibility, in suspected iatrogenic accidents; its application must furthermore be subordinated to a favourable cost/benefit ratio for the health service employing it. In otorhinolaryngology and head and neck surgery, HOT is a strategic therapeutic weapon in several applications. Its most widely recognized indications are radiation lesions, chronic osteomyelitis of the mandible, head and neck infections, malignant external otitis, sudden hypoacusia, chronic tinnitus, encephalitis, treatment of the gasseous embolus, skin grafts, vascularized flaps, cervicoencephalic traumas. HOT indications as a radiosensitizing and/or chemiosensitizing factor are still being studied. Both a review of the literature and our experience appear, beyond any doubt, to confirm that HOT promotes faster recovery and reduces hospital stays, thus qualifying as a new therapeutic aid that complements the usual well-established methods.

Atypical indications for OtoScan laser-assisted myringotomy.

OBJECTIVE: To describe the role of OtoScan laser-assisted myringotomy (OtoLAM) for indications other than chronic otitis media or recurrent acute otitis media. STUDY DESIGN: Cross-sectional review. METHODS: Twenty-seven office-based OtoLAM procedures were performed in 21 patients for "atypical" reasons. The indications included middle ear dysfunction with necessary air travel (n = 10) or hyperbaric oxygen treatment (n = 6), mastoiditis with postauricular cellulitis (n = 2), canal exostosis prohibiting tympanostomy (n = 1), acute otitis media accompanied by seizures (n = 1), and chronic middle ear effusion in a patient with hemophilia (n = 1). RESULTS: In each of the 20 cases available for follow-up, middle ear disease resolved with closure of the laser-assisted myringotomy. At a later date, two patients (10%) underwent another OtoLAM in the opposite ear and four patients (20%) required repeat OtoLAM in the same or both ears. Three patients (15%) ultimately underwent myringotomy tube placement because of recurrent middle ear dysfunction. CONCLUSIONS: Although this report contains preliminary data, the data suggest that OtoLAM may provide an additional option in the care of certain patients who have previously been treated with myringotomy tubes.

Effect of artificial airway on ear complications from hyperbaric oxygen.

Hyperbaric oxygen treatment is associated with an increased risk of barotrauma to the tympanic membrane and middle ear. An artificial airway may compromise normal eustachian tube function and equilibration of middle ear pressures. This retrospective study was designed to evaluate the risk of middle ear complications in 267 patients receiving hyperbaric oxygen (HBO) therapy and to compare those with and without artificial airways. Charts of all patients were reviewed for middle ear and tympanic membrane complications and myringotomy tube placement. Eighteen of the 267 patients had artificial airways. Seventeen (94%) of these 18 patients developed middle ear or tympanic membrane complications, and 11 (61%) required tympanostomy tubes for pain, hemotympanum, or serous otitis. In contrast, 114 (45.8%) of the 249 patients without airways developed ear complications, and 53 (21.3%) required tympanostomy tubes. These results suggest that patients with an artificial airway who are receiving HBO therapy are at greater risk for developing tympanic membrane and middle ear complications than nonintubated patients. Similarly, patients with artificial airways receiving HBO frequently require placement of tympanostomy tubes.

Ligmaject system for local anaesthesia in otology.

The Ligmaject syringe for local anaesthetic injection incorporates a pistol-grip handle and a ratchet system designed to inject a very tiny aliquot of anaesthetic per 'click'. This instrument was used to provide local anaesthesia for 22 otological procedures on consenting adults. The performance of the Ligmaject syringe compared favourably with that of the conventional dental syringe in terms of patient acceptability and user convenience.

[The sympatho-adrenergic stress reaction in ear surgery using various anesthesia technics]. / Die sympathoadrenerge Stressreaktion bei Ohroperationen unter verschiedenen Anästhesietechniken.

The aim of the present study was to investigate the effects of various anaesthetic procedures on the endocrine stress responses during ear microsurgical operations. Simple mastoidectomies, radical mastoidectomies and tympano plastics were carried out in 49 patients under the following randomised anaesthetic procedures: Group 1 halothane anaesthesia and retroauricular infiltration anaesthesia with lidocaine and ornipressin (n = 14), Group 2 fentanyl anaesthesia and retroauricular anaesthesia with lidocaine and ornipressin (n = 10), Group 3 fentanyl anaesthesia and retroauricular infiltration anaesthesia with lidocaine and epinephrine (n = 14), and Group 4 retroauricular infiltration anaesthesia with prilocaine and epinephrine (n = 14). The plasma levels of epinephrine, norepinephrine, glucose, lactate and free glycerol were measured in addition to mean arterial pressure (MAP) and heart rate (HR) immediately before anaesthesia, 10 minutes after skin incision, 10 minutes after having started bone drilling, at the end of the operation and 3 hours after operation. All data were subjected to covariance analysis including the age factor. Plasma catecholamine concentrations remained within the normal range during the investigation in patients subjected to general anaesthesia (Groups 1-3). Plasma catecholamines (epinephrine and norepinephrine) increased significantly in Group 4 (retroauricular infiltration anaesthesia). There were no group variabilities with regard to MAP and HR. The plasma levels of epinephrine and norepinephrine demonstrate a direct response to stress followed by a secondary change in glucose, lactate and free glycerol. The beneficial effect of general anaesthesia is documented by normal plasma levels of epinephrine and norepinephrine throughout the operation.(ABSTRACT TRUNCATED AT 250 WORDS)