A new adhesive bone conduction hearing system as a treatment option for transient hearing loss after middle ear surgery.

OBJECTIVE: The objective of this prospective, single-subject, repeated measures study was to evaluate the audiological benefit and patient satisfaction with an adhesive, pressure-free bone conduction hearing system (ADHEAR; MED-EL, Innsbruck, Austria) in patients who underwent middle ear surgery with transient hearing loss due to auditory canal tamponade. METHODS: Eleven adult subjects suffering from transient conductive hearing loss were enrolled in the study and followed up to 3 weeks after middle ear surgery. Bone and air conduction thresholds were measured pre and postoperatively to evaluate eligibility for enrollment. Postoperative unaided and aided sound-field thresholds, as well as speech tests in quiet and noise were compared to confirm hearing improvement with the hearing system. To determine patient satisfaction, the SSQ12 and a system-specific quality of life questionnaire was administered to all subjects. RESULTS: Speech perception for monosyllables in quiet improved by 46%, with statistical significance for the ADHEAR system compared to the unaided condition after one week. The functional hearing gain improved by 19 dB. Speech perception in noise with the device was - 6.7 dB SNR on average, with a statistically significant improvement of 2.7 dB SNR. The results of the questionnaire showed a high level of patient satisfaction and subjective hearing improvement. No serious skin reactions or other severe complications occurred. CONCLUSION: As long as the auditory canal is blocked due to tamponade, patients benefit from hearing rehabilitation. This adhesive hearing system is a safe and effective device to treat transient conductive hearing loss and may considerably improve treatment for patients even with short-term hearing loss.

Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial.

STUDY OBJECTIVE: The primary objective of this study is to compare the effectiveness of 3 treatment protocols to stop anterior epistaxis: classic compression, nasal packing, and local application of tranexamic acid. It also aims to determine the frequency of rebleeding after each of these protocols. METHODS: This single-center, prospective, randomized controlled study was conducted with patients who had spontaneous anterior epistaxis. The study compared the effect of 3 treatment options, tranexamic acid with compression but without nasal packing, nasal packing (Merocel), and simple nasal external compression, on the primary outcome of stopping anterior epistaxis bleeding within 15 minutes. RESULTS: Among the 135 patients enrolled, the median age was 60 years (interquartile range 25% to 75%: 48 to 72 years) and 70 patients (51.9%) were women. The success rate in the compression with tranexamic acid group was 91.1% (41 of 45 patients); in the nasal packing group, 93.3% (42 of 45 patients); and in the compression with saline solution group, 71.1% (32 of 45 patients). There was an overall statistically significant difference among the 3 treatment groups but no significant difference in pairwise comparison between the compression with tranexamic acid and nasal packing groups. In regard to no rebleeding within 24 hours, the study found rates of 86.7% in the tranexamic acid group, 74% in the nasal packing group, and 60% in the compression with saline solution group. CONCLUSION: Applying external compression after administering tranexamic acid through the nostrils by atomizer stops bleeding as effectively as anterior nasal packing using Merocel. In addition, the tranexamic acid approach is superior to Merocel in terms of decreasing rebleeding rates.

Effects of polymer-based, silver nanoparticle-coated silicone splints on the nasal mucosa of rats.

Infection is a serious complication after nasal packing that otolaryngologists seek to avoid. The aim of this study is to investigate the use of silver (Ag) nanoparticle, which serves as antimicrobial agents, with nasal tampons. The study design is an experimental animal model and the setting is tertiary referral center. Twenty-four rats were randomized into the following four groups: (1) control group (n = 6); (2) silicone nasal splint (SNS) group (n  =  6); (3) polypropylene-grafted polyethylene glycol (PP-g-PEG) amphiphilic graft copolymer-coated SNS group (n  =  6); and (4) Ag nanoparticle-embedded PP-g-PEG (Ag-PP-g-PEG) amphiphilic graft copolymer-coated SNS group (n  =  6). These tampons were applied to rats for 48 h, after which they were removed in a sterile manner, and the rats were sacrificed. The nasal septa of the rats were excised, and assessments of tissue changes in the nasal mucosa were compared among the groups. The removed tampons were microbiologically examined, and quantitative analyses were made. When the groups were compared microbiologically, there were no significant differences in bacterial colonization rates of coagulase-negative Staphylococcus spp. among the three groups (p = 0.519), but there was a statistically significant difference among bacterial colonization rates of Heamophilus parainfluenzae and Corynebacterium spp. (p = 0.018, p = 0.004). We found that H. parainfluenzae grew less robustly in the Ag-PP-g-PEG than the PP-g-PEG group (p = 0.017). However, we found no significant difference between the Ag-PP-g-PEG and SNS groups, or between the SNS and PP-g-PEG groups. The growth of Corynebacterium spp. did not differ significantly between the Ag-PP-g-PEG and SNS groups (p = 1.000). When Group 4 was compared with Group 2, the former showed less inflammation. Compared with other tampons, Ag-PP-g-PEG amphiphilic graft copolymer-coated silicone nasal tampons caused less microbiological colonization and inflammation. Therefore, the use of these tampons may prevent secondary infections and reduce the risk of developing complications by minimizing tissue damage.

The Effects of Nasal Packing and Transseptal Suturing After Septoplasty on Olfactory Function, Patient Comfort, and Mucociliary Clearance.

BACKGROUND: This study compared the effects of nasal packing and transseptal suturing after septoplasty by evaluating olfactory function, pain, and mucociliary clearance. METHODS: The study enrolled 39 patients diagnosed with isolated septal deviation. The patients were randomly assigned to 2 groups. In Group A (n = 21), transseptal sutures were placed for septal stabilization after the septoplasty. In Group B (n = 18), both nasal passages were packed with Merocel tampons after the septoplasty. It was made Sniffin Sticks test, sacchranirine test, and pain and discomfort scales preoperatively, 1 week postoperatively and 3 months postoperatively on all patients. RESULTS: There was no postoperative bleeding, submucoperichondrial haematoma, or abscess formation in either group. The postoperative discomfort and pain scores were increased in Group B (the packing group) in our study, the mucociliary clearance improved after septoplasty in both groups, and there was no significant difference in mucociliary clearance between the 2 groups. The odor threshold, odor identification, and odor discrimination were significantly increased 3 months postoperatively, but not 1 week postoperatively. CONCLUSIONS: Nasal packing causes more discomfort and pain than transseptal suturing, while there was no significant difference in olfactory functions or the mucociliary clearance after septoplasty between nasal packing and transseptal suturing.

The effect of the duration of merocel in a glove finger on postoperative morbidity.

We examined the effects of the duration of keeping a Merocel nasal packing in the nose and the application technique (packing applied either directly or inside a glove finger) on postoperative morbidity and complications. The study included 129 patients (67 males and 62 females; age range 18 to 56 years) undergoing nasal septoplasty without turbinate intervention. The patients were randomly assigned into 4 groups. In group 1 and group 2, Merocel was directly applied in the nasal cavity for 24 hours and 48 hours, respectively; in group 3 and group 4, Merocel was kept in the nasal cavity in a powder-free glove finger for 24 hours and for 48 hours, respectively. Pain and discomfort scores were evaluated by a visual analog scale. The time taken between removal of the tampon and when the patients began to breathe comfortably was called the nasal obstruction time. The differences in mean discomfort score between the groups were not statistically significant (P > 0.05), while the mean pain scores were statistically higher in groups 1 and 2 than in groups 3 and 4 (P < 0.05). The nasal obstruction time was statistically shorter in groups 2 and 4 than in groups 1 and 3 (P < 0.05). Therefore, keeping Merocel inside a glove finger in place for 48 hours notably reduces the pain occurring during the removal of the nasal tampon. It also reduces nasal obstruction time and prevents synechia, leakage, bleeding, and septal hematoma, without compromising patient comfort.

Histopathological changes of nasal mucosa after nasal packing with Merocel.

OBJECTIVE: To determine histopathological changes in nasal mucosa associated with duration of nasal packing with Merocel tampons. METHODS: This study included 24 healthy rabbits, 6 rabbits per group. In group A, no tampon was applied. In group B, Merocel nasal tampons were applied and removed after 24 hours. In group C, the tampons were removed after 48 hours. In group D, the tampons were removed after 5 days. Specimens were obtained from the septum of each rabbit, including cartilage. Histopathological examination was performed. RESULTS: Significant differences were observed in terms of inflammatory infiltration and loss of cilia between groups A and B. Significant differences were also observed in terms of inflammatory infiltration, haematoma, cilia loss, epithelium dysplasia and cartilage degeneration between groups B and C. There were significant differences in terms of cilia loss, epithelium dysplasia and subepithelial fibrosis between groups C and D. Cartilage degeneration was mild in one animal in group B and in two animals in group C, and was moderate in four animals in group C. CONCLUSION: It is recommended that Merocel nasal tampons are removed within 48 hours to preserve nasal mucosal function. Keeping the pack longer may cause cartilage degeneration and other complications.

[Nasal packing after FESS--time is over?]. / Nasentamponade nach FESS--ein Auslaufmodell?

National and international tendencies to avoid nasal packing after FESS are closed related to the surgical surgery (atraumatic endoscopic surgery, avoidance of resection of turbinates, meticulose coagulation). At the end of each operation a benefit-risk-analysis should be performed, whether nasal packing is indicated and which one. In endonasal surgery only those conventional nasal packing materials should be used - if necessary - which have a smooth surface and minimize mucosal damage, potential worsening of wound healing and negative impact on patient comfort. So called hemostatic/resorbable materials are a first step to these direction. But they are critical, because these materials cause increased synechiae and sometimes foreign body reactions because of incorporation into the mucosa. Occlusion of the nose via simple taping of the nasal entrance is a simple and very effective method to create a moist environment to optimize endonasal wound healing or management of a dry nose.

Pharyngeal pack placement in minor oral surgery: A prospective, randomized, controlled study.

We conducted a prospective, randomized, controlled study to investigate the influence of pharyngeal pack placement on postoperative nausea, vomiting, and throat pain after minor oral surgery. Our study group was made up of 80 patients-45 men and 35 women, aged 19 to 52 years (mean: 27.3)-who underwent a minor oral surgical procedure under general anesthesia. Patients were randomly assigned to one of three groups: 20 patients who received a pharyngeal pack under videolaryngoscopic guidance (video guidance group), 20 who had a pack placed blindly (blind insertion group), and 40 patients who received no pack at all (control group). Postoperative nausea occurred in only 4 patients (20%) in the blind insertion group (p < 0.007). No patient experienced postoperative vomiting. Postoperative throat pain occurred in all 20 video guidance patients (100%), in 17 of the blind insertion patients (85%), and in 20 of the controls (50%). The difference between the controls and each of the two pack groups was statistically significant (p < 0.006); the difference between the two pack groups was not significant.

Toxic shock syndrome associated with use of a nasal tampon.

Toxic shock syndrome has been noted to occur with nasal surgery, both with and without packing. A new synthetic sponge, described as a nasal tampon, has become available for use as packing after surgery. Herein is reported the first case of toxic shock syndrome associated with the use of this nasal tampon.

Long-term stability of Teflon orbital implants.

Teflon orbital floor implants have become controversial owing to reports of implant-related complications. To determine the actual incidence of Teflon implant-related complications and factors associated with complications, we conducted a long-term follow-up study of 77 selected patients. We obtained data on 35 implants in 31 patients with a mean follow-up period of 16 years, representing an experience of 528 patient-implant years. The short-term complication rate (within 1 month of surgery) was 3.9 percent. The long-term complication rate was 2.8 percent. Concomitant antral packing and implantation of Teflon sheet were associated with a markedly higher risk of implant pocket infection. There was no case of implant migration with proper fixation. Facial growth was normal in three children in the series. We conclude that Teflon sheet is well-tolerated in the orbit in the long term. The low complication rate can be further reduced with proper fixation of the implant and avoidance of antral packing at the time of implantation.

Post-vitrectomy observation of Coat's disease associated with exudative retinal detachment, successfully treated with long-term silicone oil tamponade.

BACKGROUND: Treating Coat's disease with exudative retinal detachment remains a challenge, since vitreous surgery is frequently accompanied by serious complications such as secondary glaucoma. CASE: A 25-year-old woman with Coat's disease of the right eye had cystic exudative retinal detachment along the naso-inferior vessels at the peripheral retina, due to 5-o'clock telangiectasia. Right visual acuity was finger counting. This patient underwent vitrectomy simultaneously with cataract surgery, completed with silicone oil replacement, with thorough drainage of subretinal exudates through the artificial break. Although the complication of secondary glaucoma developed as a result of using silicone oil, approximately three years after the operation, this condition was ameliorated by removing the silicone oil. Thus, blindness was prevented in this patient. CONCLUSION: Long-term tamponade with silicone oil facilitates performing vitreous surgery in this patient suffering from Coat's disease associated from exudative retinal detachment.

Swallowing of tonsillar pack in recovery following general anaesthesia.

A patient swallowed a tonsillar pack in the recovery room after a procedure under general anaesthesia. This is a first reported case to our knowledge. We describe the incident to try to avoid it happening again.

Cerebrospinal fluid rhinorrhoea as a complication of endoscopic endonasal reduction of blowout fractures.

BACKGROUND: Unless the orbital contents are supported, the insertion of nasal packing material during endoscopic endonasal surgery may cause serious intracranial complications such as cerebrospinal fluid leakage. METHODS: Case report and literature review. RESULTS: We report a patient with iatrogenic cerebrospinal fluid rhinorrhoea caused by intracranial entry of a Silastic sheet inserted into the nasal cavity. This skull defect and the surrounding skull base were successfully reconstructed in a multilayer fashion via an endoscopic endonasal approach. CONCLUSION: This case highlights the need for caution when inserting nasal packing material. During endoscopic endonasal reduction of blowout fractures, great care must be taken to support the orbital contents, in order to avoid serious intracranial complications such as cerebrospinal fluid leakage.

Effects of NasoPore packing in the middle ear cavity of the guinea pig.

OBJECTIVE: To evaluate the effects of NasoPore after packing of the middle ear in guinea pigs. STUDY DESIGN: A randomized, prospective, controlled animal study. SETTING: University laboratory. SUBJECTS AND METHODS: Forty-one guinea pigs were divided into 3 groups. In group 1(n=12), the middle ears of animals were unilaterally implanted with NasoPore, leaving the contralateral middle ears packed with absorbable gelatin sponge soaked in a solution containing kanamycin and furosemide as an ototoxicity-positive control; group 2 (n = 17) underwent the same experimental protocol as group 1, except the gelatin sponge was unsoaked; in group 3 (n = 12), NasoPore was inserted unilaterally and no packing material was placed into the contralateral ear. Auditory brainstem responses (ABRs) were performed preoperatively and 3 months after the procedure. The surface preparation and scanning electron microscopy (SEM) were assessed 3 months postoperatively, whereas pathology of middle ear was analyzed in 5 samples of group 2. RESULTS: ABR thresholds of the contralateral ear significantly increased in group 1 and were slightly shifted in group 2 compared with the NasoPore-packed and nonpacked ears 3 months postoperatively. The NasoPore-packed middle ears were found to have less fibrosis and inflammation and less thickened bone and tympanic membranes than Gelfoam-packed ears. Surface preparations and SEM showed no ototoxicity in the inner ear of NasoPore-packed ears. CONCLUSION: NasoPore appears to be effective for use in otosurgery. It caused less fibrosis in the middle ear than conventional packing agents and no ototoxicity to the inner ear.

Intravitreous silicone balloon: an experimental study.

A specially designed silicone balloon, expanded in vivo with normal saline, was tested for possible use as a retinal tamponade in desperate cases of rhegmatogenous retinal detachment. In six pigmented rabbits there were extensive postoperative complications, but in eight owl monkeys results were noticeably better. When the seam of the balloon was in contact with the retina there were adverse effects; seamless areas of the balloon did not appear to disturb the retina. Histopathologic studies indicated that excessive expansion of the balloon can cause significant damage, but that carefully controlled expansion can probably minimize complications. The presence of the balloon appears to alter electroretinographic response, but without necessarily causing histopathologic changes. Balloons of this type have been used in treatment of a small number of otherwise inoperable cases of retinal detachment with promising results.

[Review: pathophysiology and methodology of nasal packing]. / Ubersicht: Art und Wirkung geläufiger Nasentamponaden.

Nasal packing is a frequent procedure to control spontaneous nasal bleeding or postoperative oozing following different types of nasal surgery. It strives for internal stabilization of the nasal framework and for optimizing wound healing by prevention of stenosis or synechia. A lot of different materials is used and there is no accepted standard concerning the type and application. A review on pathophysiology of the packed nose is given together with a survey on customary packing materials focussing on the specific merits, demerits and side-effects including economical aspects.

Toxic shock syndrome: the effect of solid phase materials on the physiology of Staphylococcus aureus.

Rayon and chemically modified cotton were compared for their effects in vitro on the physiology of a strain of Staphylococcus aureus isolated from a patient with toxic shock syndrome. Two types of experiment were carried out. The materials were used to pretreat the medium before culturing in the absence of the materials. Chemically modified cotton was either added or removed from three hour cultures and incubation continued. The rayon treated medium had little effect on growth or exoenzyme/toxin production by S. aureus. The chemically modified cotton greatly reduced growth of S. aureus and decreased exoenzyme/toxin production when added to three hour cultures. However, pretreated medium and cultures grown for three hours with the material present followed by incubation in its absence increased the exoenzyme/toxin production by S. aureus. The in vitro data suggests large effects of chemically modified cotton on the physiology of S. aureus by in some way, at present unknown, altering the growth medium.

Do ventilated packs reduce post-operative eustachian tube dysfunction?

Nasal packing is associated with post-operative Eustachian tube dysfunction in patients undergoing nasal surgical procedures. The effect of cannulated nasal packs which may improve nasopharyngeal ventilation was investigated in a prospective randomized controlled trial. Adult elective patients without tympanometric evidence of pre-operative Eustachian tube dysfunction were recruited. All subjects underwent single or combined intranasal surgical procedures and were randomized to receive either bilateral cannulated or non-cannulated Merocel nasal packs. Middle ear pressures (MEP) were recorded pre-operatively and post-operatively before nasal pack removal. Left and right ear results were amalgamated for analysis and 40 adults, 20 in each group were analysed. There was no difference in pre-operative MEP, -15 dPa (median value) in both groups. Post-operatively the MEP changed in both groups P < 0.0001. There was no significant inter group difference in the post-operative median MEP, -85 dPa in the cannulated and -70 dPa in the control groups, (95% c.i. for the difference in the medians -25-55 dPa). Nasal surgery with post-operative packing leads to an objective reduction in MEP which is not altered by venting the packs.