ABSTRACT
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.
Subject(s)
Hearing Loss, Sensorineural/drug therapy , Injections, Intralesional/adverse effects , Meniere Disease/drug therapy , Steroids/administration & dosage , Tympanic Membrane Perforation/etiology , Adult , Age Distribution , Aged , Audiometry/methods , Cohort Studies , Female , Follow-Up Studies , Hearing Loss, Sensorineural/diagnosis , Hearing Loss, Sudden/diagnosis , Hearing Loss, Sudden/drug therapy , Humans , Incidence , Male , Meniere Disease/diagnosis , Middle Aged , Predictive Value of Tests , Regression Analysis , Retrospective Studies , Risk Assessment , Sex Distribution , Time Factors , Tympanic Membrane/drug effects , Tympanic Membrane Perforation/epidemiology , Tympanic Membrane Perforation/physiopathology , Wound Healing/physiologyABSTRACT
OBJECTIVE/HYPOTHESIS: Elevation of the superficial musculoaponeurotic system (SMAS) with or without fat graft interposition during superficial parotidectomy prevents a concave facial deformity and Frey's syndrome. STUDY DESIGN: Retrospective, case-control study. METHODS: Charts for 248 patients who underwent superficial parotidectomy were reviewed for pathologic, radiographic, clinical, and operative data. Sixteen patients who underwent SMAS elevation and 34 patients who underwent SMAS elevation with fat graft interposition were included in two study groups. Nonreconstructed controls were randomly selected from a pool of patients who had unilateral, superficial parotidectomy and were matched based on pathologic specimen volume. Patients were surveyed for their postoperative symptoms. RESULTS: Patients undergoing SMAS elevation alone (n = 16) compared with controls (n = 19) had greater facial symmetry (12% vs. 32%, P = .147) and a lower incidence of symptomatic Frey's syndrome (6.3% vs. 18.6%, P = .382). Patients undergoing SMAS elevation and fat graft interposition (n = 34) compared with controls (n = 38) had less facial asymmetry (9% vs. 39%, P = .002) and a lower incidence of symptomatic Frey's syndrome (6% vs. 28%, P = .04). Complications among the study and control groups were comparable. CONCLUSIONS: Simultaneous reconstruction of a superficial parotidectomy defect using SMAS elevation with or without fat grafting may improve postoperative facial symmetry and decrease the incidence of symptomatic Frey's syndrome without increasing complications.
Subject(s)
Abdominal Fat/transplantation , Muscle, Skeletal/surgery , Parotid Neoplasms/surgery , Plastic Surgery Procedures/methods , Subcutaneous Tissue/surgery , Adult , Aged , Case-Control Studies , Esthetics , Facial Asymmetry/epidemiology , Facial Nerve/pathology , Facial Nerve/surgery , Fascia/pathology , Fasciotomy , Female , Humans , Male , Middle Aged , Muscle, Skeletal/pathology , Neoplasm Invasiveness , Parotid Neoplasms/pathology , Patient Satisfaction , Postoperative Period , Retrospective Studies , Subcutaneous Tissue/pathology , Surveys and Questionnaires , Sweating, Gustatory/epidemiologyABSTRACT
A 76-year-old female, with a history of asthma and tracheal bronchitis, presented with a non-ST elevation, myocardial infarction. Chest x-ray on admission showed a widened mediastinum, which was further evaluated with a computed tomography (CT) scan. It disclosed a giant substernal goiter compressing the trachea and the ascending aorta. Cardiac catheterization showed significant coronary disease unsuitable for percutaneous intervention; thus, the patient was scheduled for coronary artery bypass grafting. Single stage thyroidectomy immediately followed by coronary artery bypass was performed. After surgery, her upper airway symptoms were improved, and no cardiac events were noted. Collaboration between otolaryngology and thoracic surgery teams contributed to good outcomes for this patient with substernal goiter and severe cardiac disease.