Postoperative pain after transcanal endoscopic ear surgery: A systematic literature review.

OBJECTIVE: Transcanal endoscopic ear surgery is hypothesized to result in less postoperative pain when compared to nonendoscopic techniques due to its minimally invasive nature. In this systematic literature review, we aim to summarize and evaluate the evidence surrounding postoperative pain control and analgesic utilization after transcanal endoscopic ear surgery. DATABASES REVIEWED: PubMed, EMBASE, and Cochrane. METHODS: A systematic literature search was performed using standardized methodology. Computerized and manual searches were performed to identify studies that evaluated postoperative pain outcomes following endoscopic ear surgery. Only studies that met predetermined criteria were selected and evaluated for quality and bias. Extracted data included demographics, pain scores, analgesic administered as well as the diagnosis and type of surgery undertaken. Exclusion criteria included letters/commentaries and reviews, lack of pain outcome data and studies not concerning endoscopic ear surgery. RESULTS: The systematic literature review included 24 studies. Seven were RCTs, 10 were prospective and 7 were retrospective observational studies. A total of 1859 patients were evaluated for surgical approach and postoperative pain levels and analgesic use. Due to the lack of sufficient reporting of the data, a meta-analysis was not applicable. In the qualitative synthesis for the primary outcome, weighted pooled analysis showed that there was a slight reduction in postoperative pain after transcanal endoscopic ear surgery. Based on the Cochrane risk of bias tool, the quality for the finding is low. CONCLUSION: There is a small reduction in postoperative pain after transcanal endoscopic ear surgery when compared to nonendoscopic approaches, however, the clinical significance of this reduction is unclear. The evidence was from studies of only low to moderate quality.

Epithelioid angiomatous nodule of the nasal cavity: Report of 2 cases.

Epithelioid angiomatous nodule (EAN) is a novel clinicopathological entity characterized by a benign proliferation of endothelial cells with prominent epithelioid features. It can arise from any region of the body although it is increasingly being recognized in the head and neck. This paper presents two cases of EAN arising in the nasal cavity where the clinical presentations were recurrent unilateral epistaxis. In both cases, the lesions were excised endoscopically. Histopathologic analysis showed well-circumscribed proliferation of solid sheets of epithelioid endothelial cells and vascular channels in a background of mild chronic inflammatory infiltrate. Cytologic atypia was absent with rare mitotic figures seen. Immunohistochemical studies with CD31 and CD34 were strongly positive, thus confirming a vascular origin. Postoperative recovery was uneventful and no recurrence was seen in the follow-up period. EAN can be differentiated from other lesions demonstrating epithelioid vascular proliferation by means of clinical and histopathological characteristics. The present series seeks to inform that EAN should be regarded as a possible, albeit rare, cause of recurrent unilateral epistaxis. We advocate for endoscopic excision of EAN of the nasal cavity for diagnostic and therapeutic purposes.