Radiofrequency Ablation for Inferior Turbinate Hypertrophy: Predictive Factors for Short and Long-Term Outcomes.

OBJECTIVES: Radiofrequency Ablation (RFA) is a widely used technique for treatment of nasal obstruction due to inferior turbinate hypertrophy. This study aims to evaluate short and long-term outcome after RFA. Secondly, predictive factors for this outcome were evaluated. METHODS: A prospective clinical study was performed in 65 patients to evaluate short-term outcome and predictive factors (Study A). To evaluate long-term outcome and predictive factors we performed a second clinical study in 124 patients (Study B). Patients scored nasal symptoms on a 1 to 5 points visual analogue scale (VAS) and filled in questionnaires about their comorbidity, previous nasal surgery, and medication use. RESULTS: Study A: There was significant short-term (6-8 weeks after RFA) improvement in nasal obstruction (VAS -1.3, P < .001), trouble exercising (VAS -1.5, P < .001), trouble sleeping (VAS -0.9, P < .001), snoring (VAS -1.1, P< .001), and hyposmia (VAS -0.6, P = .004). Smoking (R2 = .065, P = .047) was a predictor for less optimized and previous use of decongestive nasal spray (R2 = .135, P = .005) for better short-term outcome. Study B: Nasal obstruction significantly decreased in the long term (1-5 years after RFA) compared to VAS before RFA (VAS -1.5, P < .001), but slightly increased compared to VAS 6 to 8 weeks after RFA (VAS +0.3, P = .036). Allergy (R2 = .066, P = .006), asthma (R2 = .068, P = .005), and previous use of corticosteroid nasal spray (R2 = .050, P = .016) were associated with a less optimized and older age (R2 = .217, P < .001) with better long-term outcome. CONCLUSION: RFA is an efficient treatment for nasal obstruction, and improves sleeping, exercising, snoring, and hyposmia. Predictors for good short-term outcome were previous use of decongestive nasal spray and no smoking. Predictors for a less optimized long-term outcome were allergy, asthma, and previous use of corticosteroid nasal spray. Older age was associated with better long-term outcome.

An evaluation of preservation of residual hearing using the suprameatal approach for cochlear implantation: can this implantation technique be used for preservation of residual hearing?

OBJECTIVES/HYPOTHESIS: The preservation of residual hearing has become a high priority in cochlear implant surgery. This study was designed to substantiate whether conservation of residual hearing can be preserved after cochlear implantation using the suprameatal approach. STUDY DESIGN: Retrospective chart review. METHODS: Retrospective chart review was performed in 109 severely to profoundly hearing impaired cochlear recipients who had some measurable hearing preoperatively. Subsequently, the pre- and postoperative pure-tone thresholds were analyzed by three different analyses to observe the degree of hearing preservation. RESULTS: Single-subject results showed a complete conservation of residual hearing (change in pure-tone average [ΔPTA] ≤ 10 dB) in 27 of 109 patients (24.7%). Partial conservation of residual hearing (ΔPTA > 10 dB) was observed in 77 patients (70.6%), but these percentages have been affected severely by ceiling effects. Furthermore, group-subject results demonstrated that the median postoperative PTA was 11.7 dB worse than the preoperative PTA. For individual frequencies, the median deteriorations were 15, 20, 10, and 5 dB at 250, 500, 1,000, and 2,000 Hz, respectively. Stratification for the absence of postoperative hearing thresholds showed a conservation of measurable postoperative hearing levels in 17.4% of all study patients. CONCLUSIONS: The results of this study demonstrate that complete preservation of residual hearing is possible in a limited number of patients using the suprameatal approach technique for cochlear implantation. For a reliable analysis of the audiometric effects of cochlear implant surgery, it is important to take into account the ceiling effects, therefore using different calculation methods to estimate the accurate deterioration of hearing thresholds.

The suprameatal approach: a safe alternative surgical technique for cochlear implantation.

OBJECTIVE: To report on surgical complications arising postoperatively in 104 patients undergoing cochlear implantation surgery using the suprameatal approach (SMA). Second, to examine the advantages and disadvantages of the SMA technique compared with the classic mastoidectomy using the posterior tympanotomy approach. STUDY DESIGN: Retrospective study assessing surgical complications in deaf adults and children undergoing cochlear implantation. SETTING: Tertiary referral center for cochlear implantation (Academic Medical Centre). PATIENTS: The mean age at the time of surgery was 39.6 years (1.0-82.3 yr), and the mean duration of deafness was 26.3 years (0.3-66.0 yr). The main cause was a congenital hearing loss (30.8%) and a progressive sensorineural hearing loss e.c.i. (25.0%), followed by meningitis (12.5%) and otosclerosis (6.7%). The mean duration of follow-up after surgery was 25.7 months (range, 3.0-59.0 mo). RESULTS: The overall major complication rate was 3.7% (4 of 107). All complications developed postoperatively. The major complications consisted of extrusion of the implant due to wound infection (n = 2), a wrong route for the electrode (n = 1), and device failure (n = 1). The minor complication rate was 23.4% (25 of 107). The mean time taken for cochlear implantation was 111.7 minutes (range, 60.0-261.1 min). CONCLUSION: This study confirms the SMA is a safe, simple, and quick technique that is feasible for cochlear implantation in most cases. Although the stretching of the electrode array when it enters the scala tympani and a low-lying dura could present a potential restriction for the SMA technique, our results do not support this hypothesis.

Comparison of two approaches to the surgical management of cochlear implantation.

OBJECTIVES/HYPOTHESIS: Our study was designed to compare two surgical approaches that are currently employed in cochlear implantation. METHODS: There were 315 patients who were divided into two groups according to the surgical technique used for implantation. The suprameatal approach (SMA) was followed for 104 patients (107 implantations) in Amsterdam, whereas the mastoidectomy with posterior tympanotomy approach (MPTA) was adhered to for 211 (214 implantations) in Maastricht. The outcome variables of interest were duration of surgery and peri- or postoperative complications. RESULTS: In the SMA group the incidence of major and minor complications was 3.7% (4/107) and 23.4% (25/107), respectively, whereas it was 6.5% (14/214) and 22.4% (48/214), respectively, in the MPTA group. A chi-square statistic of 1.096 (P = .295) and 0.021 (P = .884) for minor and major complications, respectively, indicated no statistically significant differences between the two techniques. Mean duration of surgery was significantly shorter (P < .0005) in the SMA (111.7 minutes) than in the MPTA (132.2 minutes) group. CONCLUSIONS: The suprameatal approach is clearly a good alternative to the classical surgery technique for cochlear implantation.

Cochlear implantation in patients with chronic otitis media: 7 years' experience in Maastricht.

The purpose of this paper is to propose management options for cochlear implantation in chronic otitis media (COM) based on our 7-year experience. Thirteen patients with COM who were candidates for cochlear implantation were identified. COM was divided in an inactive and an active form based on clinical and radiological findings. One major complications and one minor complication were identified in the study group. In case of an active infection or in case of a unstable cavity we advise cochlear implantation as a staged procedure. A single stage procedure is recommended in case of patients with COM presenting with a dry perforation or a stable cavity.

Breast-conserving therapy for palpable and nonpalpable breast cancer: can surgical residents do the job irrespective of experience?

BACKGROUND: The aim of this study was to evaluate the influence of operative experience in obtaining tumor-free margins in breast-conserving therapy. In the case of palpable breast cancers, lumpectomies can safely be performed by any surgical resident. For nonpalpable breast cancers, lumpectomies should be treated only by senior residents or attending surgeons, even if supervision during the operation is given by an attending surgeon for junior residents. Radicality of breast carcinoma excision, defined by the tumor-free margin of the removed specimen has been determined to be the major prognostic factor for local recurrence. The aim of this study was to evaluate the influence of operative experience in obtaining tumor-free margins in breast-conserving therapy (BCT). Can lumpectomy for breast carcinoma be performed by surgical residents safely? METHODS: All lumpectomies for breast carcinoma between 1999 and 2003 were included out of a prospective database of a single institution. Radicality of resection and patient and histopathologic tumor characteristics were analyzed for 660 lumpectomies. Operative experience of the surgeon performing the lumpectomy was staged as junior residents (JR, years 1-3 in residency), senior residents (SR; years 4-6 in residency), and attending surgeon (AS). RESULTS: A significant difference in obtaining tumor-free margins for palpable tumors was found between ASs (81%) vs. SRs assisted by another resident (92%). For nonpalpable tumors, a significant difference was found in two groups: (1) SRs assisted by another surgical resident (86%) vs. JRs assisted by another surgical resident (61%) and (2) ASs (83%) vs. JRs assisted by another resident (61%) or assisted by an AS (73%). CONCLUSION: Surgical residents can safely perform BCT in patients with palpable breast cancer. The level of experience has no statistical significance for palpable tumors in a high-volume center. Nonpalpable lesions should be treated only by SRs or ASs.