Fibrin Glue-Coated Collagen Complex Patch: A Novel Material for Surgical Repair of Spontaneous Temporal Bone Cerebrospinal Fluid Leak and Encephalocele.

OBJECTIVE: To compare outcomes of surgical repair of temporal bone encephalocele and cerebrospinal fluid (CSF) leak using fibrin glue-coated collagen (FGCC) complex patch versus other materials for repair of dura. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary care hospital. PATIENTS: Fifty-two adult patients undergoing transmastoid (TM), middle fossa (MF) or combined approach repair of spontaneous MF CSF leak between 2016 and 2020. INTERVENTIONS: Exposure of bony defect via TM approach, MF craniotomy, or combined TM/MF, and repair of the associated dura defect with FGCC complex patch, or other materials (acellular collagen matrix, bovine collagen, autologous fascia, fibrin tissue sealant). MAIN OUTCOME MEASURES: Successful repair without recurrent CSF leak or encephalocele throughout follow-up. Cost of materials used in duraplasty. RESULTS: Sixty-four percent of patients were female. Mean (standard deviation) age at repair was 61.4 (12.1) years. Mean (standard deviation) body mass index was 35.0 (8.3) kg/m 2 . Forty-nine (94%) patients had successful repair without known recurrence of CSF leak or encephalocele over a median follow-up interval of 11.7 months. Average duraplasty material cost was significantly lower with FGCC in comparison with other nonautologous materials (FGCC+: $1259.94, FGCC-: $1652.58; p = 0.004). No significant differences in recurrence risk (FGCC+: 6.9%, FGCC-: 6.9%; p > 0.999) or operative time (FGCC+: 153.7 min, FGCC-: 155.4 min; p = 0.88) were detected based on material used for duraplasty. CONCLUSIONS: All materials studied demonstrate effective and sustained means of repair for MF CSF leak and encephalocele, including in the presence of multiple defects. Use of FGCC for duraplasty produces noninferior surgical results to other nonautologous materials in repair of spontaneous CSF leaks of the temporal bone and may be more cost-effective.

Association of Perioperative Complications with Vitamin D Levels in Major Head and Neck Surgery.

OBJECTIVES/HYPOTHESIS: To investigate the association of vitamin D level and perioperative complications in patients undergoing major head and neck surgery. STUDY DESIGN: Retrospective Cohort Study. METHODS: A retrospective chart review was performed for all patients undergoing reconstructive head and neck surgery between December 2017 and December 2019. Data regarding patient demographics, serum 25-hydroxyvitamin D (calcidiol) level, hospital course, prior radiation, and fistula formation were collected. Patients were categorized by serum calcidiol level as deficient (<20 ng/mL) or sufficient (≧20 ng/mL) and outcomes were compared between groups. RESULTS: Fifty-seven patients were included in the analysis. Average age at time of surgery was 62.6 ± 10.6 years. Patients with vitamin D levels <20 ng/mL were considered deficient and ≧20 ng/mL were considered sufficient. Individuals in the deficient group (n = 29) had a mean serum calcidiol level of 13.95 ± 3.95 ng/mL, whereas those in the sufficient group (n = 28) had a mean calcidiol level of 28.53 ± 5.73 ng/mL. The rate of fistula was 41.4% in the deficient group, whereas patients in the sufficient group had a rate of fistula of 14.3% (P = .038). On multivariate analysis, higher serum calcidiol level above 20 ng/mL was associated with a lower likelihood of developing fistulae with an odds ratio 0.830 (95% confidence interval: 0.718-0.960, P = .012). CONCLUSION: Vitamin D deficiency may play a role in development of fistula after major head and neck surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:578-583, 2022.

Nasal Foreign Body, an Unanticipated Complication of COVID-19 Care: A Case Report.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has changed the way we practice medicine. Standards of care are evolving in an effort to diagnose, manage, and treat the cause of this global pandemic, as well as to protect the health care workforce. These practices can have unexpected and potentially dangerous consequences, particularly for patient populations with confounding factors that put them at increased risk for complications and poor outcomes. CASE REPORT: A 52-year-old previously healthy woman presented with 4 days of nasal pain and discharge after using a home collection kit in an attempt to obtain a nasopharyngeal viral sample for COVID-19 testing. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With treatments, policies, and procedures that are rapidly evolving and often deviating from established, evidence-based, usual care in response to the COVID-19 pandemic, emergency physicians must be cognizant of and monitor for poor outcomes and potential downstream complications, especially in underserved patient populations.

Bone conduction implants.

PURPOSE OF REVIEW: To discuss the different types of bone conduction implants available today and describe the types of hearing loss that could benefit from bone conduction implants. RECENT FINDINGS: Bone conduction implants have been used successfully for over two decades. However, there have been barriers to their use because of skin complications and limited high-frequency hearing gains. Recently developed technologies, such as active bone conduction implants may overcome some of these limitations, potentially opening the door for improved aided benefit and increased patient satisfaction from bone conduction amplification. SUMMARY: A variety of bone conduction implants currently exist, with suitable amplification options available for many different types and severities of hearing loss and patient preferences.