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1.
Sci Rep ; 11(1): 17875, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34504194

RESUMO

Ear molding therapy is a nonsurgical technique to correct certain congenital auricular deformities. While the advantages of nonsurgical treatments over otoplasty are well-described, few studies have assessed aesthetic outcomes. In this study, we compared assessments of outcomes of ear molding therapy for 283 ears by experienced healthcare providers and a previously developed deep learning CNN model. 2D photographs of ears were obtained as a standard of care in our onsite photography studio. Physician assistants (PAs) rated the photographs using a 5-point Likert scale ranging from 1(poor) to 5(excellent) and the CNN assessment was categorical, classifying each photo as either "normal" or "deformed". On average, the PAs classified 75.6% of photographs as good to excellent outcomes (scores 4 and 5). Similarly, the CNN classified 75.3% of the photographs as normal. The inter-rater agreement between the PAs ranged between 72 and 81%, while there was a 69.6% agreement between the machine model and the inter-rater majority agreement between at least two PAs (i.e., when at least two PAs gave a simultaneous score < 4 or ≥ 4). This study shows that noninvasive ear molding therapy has excellent outcomes in general. In addition, it indicates that with further training and validation, machine learning techniques, like CNN, have the capability to accurately mimic provider assessment while removing the subjectivity of human evaluation making it a robust tool for ear deformity identification and outcome evaluation.


Assuntos
Otopatias/cirurgia , Orelha Externa/anormalidades , Pessoal de Saúde , Redes Neurais de Computação , Otopatias/congênito , Estética , Auxiliares de Audição , Humanos , Avaliação de Resultados em Cuidados de Saúde , Fotografação , Procedimentos Cirúrgicos Reconstrutivos/métodos
2.
J Laryngol Otol ; 135(9): 759-764, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34348811

RESUMO

OBJECTIVE: This study aimed to examine the medical literature regarding the natural history and management of keratosis obturans. METHOD: PubMed was queried via the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, and the methodological quality of each study was assessed using the Methodological Index for Non-Randomized Studies criteria. RESULTS: Fifty-one studies were abstracted, and dual investigator screening resulted in five retrospective studies for final analysis. All studies included patients afflicted with either unilateral (n = 75) or bilateral keratosis obturans (n = 8). The definition of keratosis obturans was present in three studies: a desquamated keratin plug within the external auditory canal. Mean and median Methodological Index for Non-Randomized Studies scores were 9.5 and 9.5, respectively. All patients underwent keratosis obturans exenteration with microscopy. Two studies reported an outcome instrument to evaluate endpoints: marked stillette and audiometry. No complications were observed with follow-up periods from 3 weeks to 3.5 years. CONCLUSION: This comprehensive review highlights a lack of published evidence relating to keratosis obturans. However, it appears keratosis obturans treatment is safe and efficacious with identifiable clinical practice patterns.


Assuntos
Otopatias/cirurgia , Ceratose/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Meato Acústico Externo/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
3.
Otol Neurotol ; 42(9): e1273-e1278, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34420020

RESUMO

OBJECTIVE: Despite the efforts to treat patients with patulous Eustachian tube (PET), intractable symptoms of PET may require surgical intervention. In this study, we introduce our surgical technique of "transtympanic tripod-shaped angiocatheter" (TTA) insertion and evaluate the safety and efficacy of the procedure in patients with intractable PET. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Thirty-two cases (26 patients) diagnosed with intractable PET between the years 2011 and 2019 were included in this study. INTERVENTION: All cases were surgically treated with TTA insertion. MAIN OUTCOME MEASURES: The clinical characteristics, surgical results, complication rates, and the level of satisfaction by questionnaires were analyzed for evaluation. RESULTS: The mean age of enrolled patients was 40.9 ±â€Š19.5 years, with slight male gender predominance (59.4% vs. 40.6%). Both ears were operated in six patients, simultaneously in three. All patients successfully received the insertion of TTA, with no immediate complication. Eleven cases were re-inserted after the first insertion due to the recurrence of symptoms or spontaneous extrusion of TTA. No major complications were observed during the follow-up period of 1 to 115 months (mean 37.7 mo). The average Visual Analogue Scale score of PET symptoms was significantly decreased (p < 0.05), along with 92% of patients with relief from autophony symptoms. CONCLUSIONS: TTA insertion is a relatively simple procedure that can be performed in a short period under local anesthesia. Surgical intervention of TTA insertion for patients with intractable PET symptoms seems promising with a high success rate.


Assuntos
Otopatias , Tuba Auditiva , Otite Média , Adulto , Otopatias/cirurgia , Tuba Auditiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
5.
Otol Neurotol ; 42(5): 774-782, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33687172

RESUMO

OBJECTIVE: Auricular pseudocyst (AP: intracartilaginous cyst, endochondral AP, cystic chondromalacia, and benign idiopathic cystic chondromalacia) is a benign condition of unknown etiology. This report systematically reviews the published demographics, treatment protocols, and outcomes of AP between the various medical disciplines, and compares the findings to a theretofore-unreported 12-patient cohort. Primary outcome measure was AP complete resolution without recurrence. DATA SOURCE: A systematic literature search of "MEDLINE" via "PubMed" and "Google Scholar" was performed in June, 2020. The 12 new patients were enrolled between January 2016 and December 2020. STUDY SELECTION: Seventy-four papers met the study inclusion criteria and provided data on sex distribution, surgical approach and outcome, performance of approaches according to medical specialty, and recurrence rates of the reported AP populations. DATA EXTRACTION: The appropriateness and study design quality were independently assessed by two reviewers. DATA SYNTHESIS: The primary outcome was therapeutic success. A comparative analysis was also performed on the same extracted information that was retrieved from the medical files of the 12 new patients (10 men, 2 women, average age 24 yrs, range, 17-38). CONCLUSIONS: AP is not uncommon. In line with the published literature, incision and curettage with excision of the anterior pseudocystic wall (deroofing) resulted in a recurrence rate of less than 17% with good cosmetic outcome among all 12 patients. Aspiration alone was associated with increased recurrence rates. Deroofing emerged as the preferred modality, with good cosmetic outcome and reduced recurrence rate. It was usually performed by otolaryngologists, while dermatologists used more conservative approach more frequently. Incision and drainage combined with compression reduces risk of recurrence.


Assuntos
Cistos , Otopatias , Adulto , Cistos/cirurgia , Drenagem , Otopatias/cirurgia , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Resultado do Tratamento , Adulto Jovem
6.
Am J Otolaryngol ; 42(4): 103002, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33780899

RESUMO

OBJECTIVE: Erosion of the long process of the incus is the most common ossicular chain pathology occurring in the course of chronic middle ear disease. The aim of this study was to evaluate our experience in the reconstruction of short-length defects of the long process of the incus using hydroxyapatite bone cement over a period of 15 years. METHODS: The medical records of all patients treated with hydroxyapatite bone cement for an isolated short-length erosion of the long process of the incus or the lenticular process at an academic tertiary referral center between 2005 and 2019 were studied retrospectively. RESULTS: 48 patients made up our study sample (19 men, 29 women). The mean age at the time of surgery was 38.1 years. The mean preoperative air-bone gap (ABG) was 21.36 dB. The mean postoperative ABG was 15.89 dB within 8 weeks of surgery and 11.81 dB at least 6 months after surgery. The postoperative ABG had significantly improved compared to preoperative ABG values at both the short- and middle-term follow-up (p < 0.001 for both). An ABG ≤ 20 dB was achieved in 68% in the short term and 83% in the middle term. The mean ABG in the long term (< 12 months) was 11.1 dB. CONCLUSION: Restoration of the anatomic and functional continuity of the ossicular chain using hydroxyapatite cement in defects of the long process of the incus seems to warrant a satisfactory audiologic outcome in the majority of cases.


Assuntos
Cimentos Ósseos , Otopatias/cirurgia , Orelha Média/cirurgia , Hidroxiapatitas , Bigorna/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Idoso , Criança , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
Am J Otolaryngol ; 42(4): 102976, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33610922

RESUMO

Branchial cleft anomalies (BCA) are among the most common congenital anomalies found in the pediatric head and neck. The embryology of these congenital anomalies is well understood, which allows clinicians to anticipate their diagnosis when a pediatric patient presents with a head or neck mass. The predictable anatomy of the various types of BCA allows for improved surgical planning to prevent recurrence and ensure complete resection. This report details an unusual location of a first BCA located in the ear lobule of a 10-month old male. There has been no documented first BCA at the ear lobule in the literature.


Assuntos
Região Branquial/anormalidades , Anormalidades Craniofaciais/cirurgia , Cistos/cirurgia , Otopatias/cirurgia , Orelha/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Doenças Faríngeas/cirurgia , Região Branquial/fisiologia , Região Branquial/cirurgia , Anormalidades Craniofaciais/complicações , Cistos/etiologia , Cistos/patologia , Otopatias/patologia , Otopatias/terapia , Hematoma/terapia , Humanos , Lactente , Masculino , Paracentese , Doenças Faríngeas/complicações , Complicações Pós-Operatórias/terapia , Irrigação Terapêutica , Resultado do Tratamento
8.
J Plast Reconstr Aesthet Surg ; 74(9): 2341-2348, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33637465

RESUMO

BACKGROUND: There is currently a lack of patient-reported outcome measures for ear reconstruction. We developed the EAR-Q to measure ear appearance and post-operative adverse effects from the patient perspective. METHODS: Field-test data were collected from children and young adults in eight countries between 13 May 2016 and 12 December 2019. Rasch measurement theory (RMT) analysis was used to refine the scales and to examine their psychometric properties. RESULTS: Participants had microtia (n = 607), prominent ears (n = 145) or another ear condition (n = 111), and provided 960 assessments for the Appearance scale (e.g., size, shape, photos), and 137 assessments for the Adverse Effects scale (e.g., itchy, painful, numb). RMT analysis led to the reduction of each scale to 10-items. Data fit the Rasch model for the Appearance (X2(80) = 90.9, p = 0.19) and Adverse Effects (X2(20) = 24.5, p = 0.22) scales. All items in each scale had ordered thresholds and good item fit. There was no evidence of differential item function for the Appearance scale by age, gender, language, or type of ear condition. Reliability was high for the Appearance scale, with person separation index (PSI) and Cronbach alpha values with and without extremes ≥0.92. Reliability for the Adverse Effects scale was adequate (i.e., PSI and Cronbach alpha values ≥0.71). Higher scores (liked appearance more) correlated with higher scores (better) on Psychological, Social and School scales. INTERPRETATION: The EAR-Q can be used in those 8-29 years of age to understand the patient perspective in clinical practice and research, and in addition, can be used to benchmark outcomes for ear reconstruction internationally.


Assuntos
Otopatias/psicologia , Otopatias/cirurgia , Medidas de Resultados Relatados pelo Paciente , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Adulto , Criança , Estética , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes
9.
Vet Surg ; 50(3): 677-686, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33491783

RESUMO

OBJECTIVES: To describe the use of near infrared fluorescence (NIRF) imaging with indocyanine green (ICG) for vascular visualization in two caudal auricular axial pattern flaps (APF). ANIMALS: Two client-owned cats with upper eyelid masses. STUDY DESIGN: Clinical case report. METHODS: Wide surgical excision with enucleation was performed by using a caudal auricular APF for closure. Flap margins and perforating artery location were approximated with anatomical landmarks. The caudal auricular artery origin was then visualized percutaneously by using an exoscope with NIRF camera and light source after a single 2.5-mg dose of IV ICG. Margins were adjusted as required. The flaps were routinely elevated with continued intraoperative visualization of the artery and rotated to complete closure. RESULTS: After IV ICG administration, fluorescence was initially visualized after 15 to 18 seconds and remained visible for up to 26 minutes. The achieved visualization led to flap margin adjustments in cat 1. Both cats recovered with minimal flap congestion, excellent hair regrowth, and no long-term complications (>186 days). Cat 1 experienced 100% flap survival. Cat 2 experienced 10% partial thickness flap necrosis, but revision was not required, and the flap was healed at recheck 85 days postoperatively. CONCLUSION: The use of ICG for APF vessel visualization prior to and during flap elevation resulted in transcutaneous visualization of the perforating vessel and improved awareness of vessel location intraoperatively. These two cats experienced excellent flap survival without major complications. This report highlights the potential benefits of ICG NIRF in APF for animals undergoing reconstructive surgery.


Assuntos
Doenças do Gato/diagnóstico por imagem , Corantes/administração & dosagem , Otopatias/veterinária , Orelha/diagnóstico por imagem , Verde de Indocianina/administração & dosagem , Imagem Óptica/veterinária , Retalhos Cirúrgicos/veterinária , Animais , Doenças do Gato/cirurgia , Gatos , Orelha/cirurgia , Otopatias/diagnóstico por imagem , Otopatias/cirurgia , Raios Infravermelhos , Masculino
10.
Anticancer Res ; 41(2): 919-925, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517298

RESUMO

BACKGROUND/AIM: We investigated the dosimetric characteristics of electron radiotherapy for auricular keloid using real-time variable-shape tungsten rubber (STR). PATIENTS AND METHODS: For the first evaluation, STR was shaped into a rectangular irradiation field (3.0×5.0 cm2). In the next step, the STR was reshaped to fit the target (3.5×6.5 cm2) for the second evaluation. Percentage depth doses (PDDs) and lateral dose profiles were obtained with 6-MeV electron beams and compared with those of low-melting-point lead (LML). RESULTS: Compared to the LML on electron applicator, PDD differences were within 0.4 mm, while the penumbras as width of 20-80% dose levels were smaller (maximum reductions: 75.8% and 82.9% at first and second evaluations, respectively). The treatment process of shaping the STR, decision on output, and irradiation was completed within 45 min. CONCLUSION: Electron radiotherapy using STR for keloid can be performed with excellent dose distribution in a short time. First clinical experience found the STR is suitable for use in individualized and immediate electron radiotherapy.


Assuntos
Otopatias/radioterapia , Queloide/radioterapia , Proteção Radiológica/instrumentação , Adulto , Otopatias/cirurgia , Feminino , Humanos , Queloide/cirurgia , Cuidados Pós-Operatórios , Dosagem Radioterapêutica , Borracha , Fatores de Tempo , Tungstênio
11.
Am J Otolaryngol ; 42(2): 102863, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33401156

RESUMO

OBJECTIVE: Pseudocyst of the auricle is a benign cystic lesions of the ear. A variety of methods have been proposed priorly with different treatment effects. Although aggressive treatments may have good results, we aimed to introduce a less invasive method that also yield optimal cosmetic outcome. PATIENTS AND METHODS: From August 2019 to April 2020, a total of 32 patients with pseudocyst of the auricle were treated with a novel negative pressure drainage method. RESULTS: The treatment has performed successfully in all patients. Only 2 patients experienced negative pressure drainage device detachment, and recovered smoothly after reinstallment. Patients were followed up for an average period of 3 months. The appearance of the auricle was recovered excellent in all patients. There were no postoperative complications or episodes of recurrence during the follow-up period. CONCLUSION: Considering the excellent cosmetic outcome and free of recurrence, we would recommend our negative pressure drainage method as a first-line treatment for all patients with auricular pseudocyst.


Assuntos
Cistos/cirurgia , Drenagem/métodos , Pavilhão Auricular/cirurgia , Otopatias/cirurgia , Adulto , Drenagem/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Fatores de Tempo , Resultado do Tratamento
12.
Am J Otolaryngol ; 42(2): 102875, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33418180

RESUMO

PURPOSE: Middle ear disease is increasingly being managed via transcanal endoscopic ear surgery (TEES). A limitation of TEES is that it restricts the surgeon to single-handed dissection. One solution to this would be an endoscope holder to facilitate two-handed dissection. Current endoscope holders are stationary, and can cause potential damage from endoscope contact with the ossicles or ear canal if unintended head motion occurs from inadequate anesthetic. A dynamic device that could detect and react to patient motion would mitigate these concerns, but currently there is little formal characterization of the frequency, velocity and acceleration of unintended patient head motion during otologic procedures performed under general anesthesia. The present study aims to characterize intraoperative patient head motion kinematics during cases utilizing TEES. MATERIALS AND METHODS: This is a prospective study of adults undergoing otologic procedures performed with general anesthesia and without paralysis. Head motion was characterized using a nine-axis inertial measurement unit (IMU), (LPMS-B2, Life Performance Research) mounted to each patient's forehead for the procedure duration. RESULTS: Data was collected across 10 cases; 50% of patients were female and mean age was 50 ± 14 years. There was observed patient head motion in 40% of cases with maximum linear acceleration of 0.75 m/s2 and angular velocity of 12.50 degrees/s. CONCLUSIONS: Patient movement during otologic procedures was commonly observed, demonstrating the need for a dynamic holder to allow two-handed TEES. Results from this study are the first objective characterization of patient head motion kinematics during otologic procedures performed under general anesthesia.


Assuntos
Otopatias/cirurgia , Orelha Média/cirurgia , Endoscopia/métodos , Cabeça/fisiologia , Movimento/fisiologia , Procedimentos Cirúrgicos Otológicos/métodos , Adulto , Anestesia Geral , Meato Acústico Externo , Ossículos da Orelha , Endoscopia/efeitos adversos , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Estudos Prospectivos
13.
Laryngoscope ; 131(7): 1657-1662, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33150972

RESUMO

OBJECTIVES/HYPOTHESIS: The objective of this study is to demonstrate that balloon eustachian tuboplasty (BET) is safe and had limited complications in the pediatric patient population. STUDY DESIGN: Retrospective chart review. METHODS: This study analyzed the medical records of 43 consecutive encounters of patients under the age of 18 years old who underwent attempted BET. Charts of patients' postoperative appointments and appointments 30 days following the procedure were reviewed. Any complications that were reported by the surgeons' operative report or documented postoperatively were stratified by the Classification of Surgical Complications as outlined by the American College of Surgeons. Additional data points that were analyzed included concomitant surgical procedures, estimated blood loss, and demographic information. RESULTS: A cohort of 43 pediatric patient encounters were investigated. There was a total of two complications from BET (4.7%) and one aborted case. The complications included epistaxis controlled with oxymetazoline and pressure, and vertigo that was later attributed to vestibular migraines. One case was aborted due to inadequate exposure. The average age of patients evaluated was 12.4 ± 3.2 years old with a range of 6.6 to 17.7 years old. CONCLUSIONS: In this retrospective cohort, BET was demonstrated to be a relatively safe intervention with an overall complication rate of 4.7% in patients as young as 6.6 years old with recurrent or chronic eustachian tube dysfunction and/or related issues. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1657-1662, 2021.


Assuntos
Otopatias/cirurgia , Tuba Auditiva/cirurgia , Complicações Pós-Operatórias/epidemiologia , Timpanoplastia/efeitos adversos , Adolescente , Criança , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Timpanoplastia/instrumentação , Timpanoplastia/métodos
14.
Acta Otolaryngol ; 141(1): 23-28, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33185137

RESUMO

BACKGROUND: Current surgical microscopes suffer from inherent constraints in achievable viewing angles and require manual interaction to control settings. Overcoming these limitations may provide benefits for otologic surgical procedures. OBJECTIVES: We present a first feasibility and usability assessment of a novel commercial surgical microscope featuring a virtual-reality interface and hands-free control of a robot-mounted 3D-camera. MATERIALS AND METHODS: Ex vivo feasibility tests were conducted in a human cadaveric head sample based on common otologic procedures. Usability metrics were obtained from feedback forms. In a first clinical case, the device was used to perform a tympanoplasty in a 68-year-old patient with a subtotal tympanic membrane perforation. RESULTS: Overall practicability of using the device for otologic procedures could be confirmed in the ex vivo tests. Beneficial aspects of the novel system which were subjectively encountered in the ex vivo tests and the first clinical case included hands-free control, visualization quality, and teaching potential. CONCLUSIONS AND SIGNIFICANCE: The novel virtual reality 3D-microscope bears potential to provide benefits for various otologic procedures, which will be evaluated more quantitatively in clinical follow-up studies.


Assuntos
Imageamento Tridimensional/métodos , Microscopia/instrumentação , Microcirurgia/métodos , Procedimentos Cirúrgicos Otológicos/métodos , Cirurgia Assistida por Computador/métodos , Interface Usuário-Computador , Realidade Virtual , Idoso , Cadáver , Otopatias/diagnóstico , Otopatias/cirurgia , Desenho de Equipamento , Estudos de Viabilidade , Humanos , Masculino , Microcirurgia/instrumentação
15.
Otolaryngol Head Neck Surg ; 164(3): 652-656, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32894994

RESUMO

OBJECTIVE: To demonstrate the feasibility of a novel procedure whereby a suture is placed transorally in the tensor veli palatini muscle to tighten it, thereby dilating the cartilaginous portion of the eustachian tube (ET). STUDY DESIGN: The study design was a prospective cadaveric experiment to examine the feasibility of a novel treatment for ET dysfunction. SETTING: Academic medical center in a research-oriented operating room with intraoperative computed tomography (CT) capabilities. METHODS: Seven fresh-frozen cadaver heads were obtained, each of which was thawed for 36 hours prior to use. The preprocedural volumes of the cartilaginous ET were measured by filling the ET with an iodine-containing radiocontrast agent via the nasopharynx and then obtaining CT images. Submucosal flaps in the soft palate were raised, and sutures were placed in the tensor veli palatini bilaterally to increase tension. After completion of the procedure, contrast placement and CT imaging were repeated. Three-dimensional models of the ETs were created, and the volumes were measured and compared. RESULTS: Of the 14 ETs evaluated, 13 showed an increase in postprocedure volume. On average, postprocedure volumes showed a 57% increase from preprocedure volumes (mean relative change, 57.1%; P = .013). CONCLUSION: Placement of a tension-holding suture in the tensor veli palatini muscle can reliably dilate the cartilaginous portion of the ET. Such a procedure may be useful in the treatment of ET dysfunction.


Assuntos
Otopatias/cirurgia , Tuba Auditiva , Músculos Palatinos/cirurgia , Técnicas de Sutura , Adulto , Cadáver , Estudos de Viabilidade , Humanos
16.
Eur Arch Otorhinolaryngol ; 278(7): 2219-2224, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32797273

RESUMO

OBJECTIVE: To determine the effectiveness of a soft-tissue bulking agent comparing novel approaches of Eustachian tube (ET) augmentation procedures: transpalatinatal Eustachian tube augmentation in local and general anesthesia versus an augmentation with velotraction under general anesthesia. The clinical endpoint was the resolution of symptoms related to unilateral patulous Eustachian tube dysfunction (PETD) requiring no additional revision augmentations. STUDY DESIGN: Combined retrospective clinical chart review. SETTING: Tertiary referral center. METHODS: Patients suffering from PETD underwent one of the following procedures: Group (A) transpalatinatal soft-tissue bulking agent with infiltration/augmentation under local anesthesia in a sitting position, group (B) transpalatinatal soft-tissue bulking agent infiltration/augmentation under general anesthesia in the flat position or group (C) infiltration/transoral augmentation of the ET with velotraction under general anesthesia in a flat position. The requirement to repeat the procedure due to recurrence of any PETD-related symptoms was recorded and retrospectively analyzed. RESULTS: A total of 50 procedures were executed in 50 patients with unilateral PETD. The necessity to perform a second procedure has analyzed a mean of 6 months postoperatively (range: 6-17 months). Compared to the transpalatinatal augmentation in local anesthesia (group A) (100% success rate), the 6-month failure rate was significantly higher for transpalatinatal augmentation under general anesthesia (group B) (80% success rate) and velotraction augmentation under general anesthesia (group C) (67% success rate). Patient cohort with transpalatinatal augmentation under general anesthesia required 20% and augmentation with velotraction under general anesthesia in 33% revision augmentation procedures reviewed at 6 months follow-up (mean follow-up 11.2 months). CONCLUSIONS: Although all different approaches resulted in a reduction of PETD related symptoms, the transpalatinatal ET augmentation in local anesthesia achieved a statistically significant superior clinical improvement. A complete resolution of PETD related symptoms was obtained and required additional procedures. This improvement may be related to the intraoperative "feedback" by the patients in local anesthesia in the sitting position eliminating the necessity for repeated procedures.


Assuntos
Otopatias , Tuba Auditiva , Otite Média , Procedimentos Cirúrgicos Otológicos , Otopatias/diagnóstico , Otopatias/cirurgia , Tuba Auditiva/cirurgia , Humanos , Estudos Retrospectivos
18.
Otolaryngol Head Neck Surg ; 164(1): 67-73, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32660367

RESUMO

OBJECTIVE: To investigate small-particle aerosolization from mastoidectomy relevant to potential viral transmission and to test source-control mitigation strategies. STUDY DESIGN: Cadaveric simulation. SETTING: Surgical simulation laboratory. METHODS: An optical particle size spectrometer was used to quantify 1- to 10-µm aerosols 30 cm from mastoid cortex drilling. Two barrier drapes were evaluated: OtoTent1, a drape sheet affixed to the microscope; OtoTent2, a custom-structured drape that enclosed the surgical field with specialized ports. RESULTS: Mastoid drilling without a barrier drape, with or without an aerosol-scavenging second suction, generated large amounts of 1- to 10-µm particulate. Drilling under OtoTent1 generated a high density of particles when compared with baseline environmental levels (P < .001, U = 107). By contrast, when drilling was conducted under OtoTent2, mean particle density remained at baseline. Adding a second suction inside OtoTent1 or OtoTent2 kept particle density at baseline levels. Significant aerosols were released upon removal of OtoTent1 or OtoTent2 despite a 60-second pause before drape removal after drilling (P < .001, U = 0, n = 10, 12; P < .001, U = 2, n = 12, 12, respectively). However, particle density did not increase above baseline when a second suction and a pause before removal were both employed. CONCLUSIONS: Mastoidectomy without a barrier, even when a second suction was added, generated substantial 1- to 10-µm aerosols. During drilling, large amounts of aerosols above baseline levels were detected with OtoTent1 but not OtoTent2. For both drapes, a second suction was an effective mitigation strategy during drilling. Last, the combination of a second suction and a pause before removal prevented aerosol escape during the removal of either drape.


Assuntos
Aerossóis/efeitos adversos , COVID-19/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Otopatias/cirurgia , Mastoidectomia/métodos , Procedimentos Cirúrgicos Otológicos/normas , Equipamento de Proteção Individual , Cadáver , Comorbidade , Otopatias/epidemiologia , Humanos , Processo Mastoide/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , SARS-CoV-2
19.
Otol Neurotol ; 42(4): 566-572, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33351568

RESUMO

OBJECTIVE: Determine the safety and efficacy of balloon dilation of the Eustachian tube (ET) in pediatric patients. STUDY DESIGN: Retrospective matched cohort study. SETTING: Tertiary medical center. PATIENTS: Pediatric patients (<18 yr) with persistent (>1.5 yr) chronic Eustachian tube dysfunction (ETD) with previous tympanostomy tube (TT) insertion versus matched controls. INTERVENTIONS: Balloon dilation of the cartilaginous ET (BDET) was performed using concomitant myringotomy with/without tube placement and adjunctive procedures if indicated versus controls (TT). MAIN OUTCOME MEASURES: Otitis media with effusion (OME)/retraction with need for additional tube, tympanogram, audiogram, otomicroscopy, ET mucosal inflammation/opening score, and Valsalva maneuver. RESULTS: Forty six ETs (26 patients), ages 7 to 17 years (mean 12.5) underwent BDET. Mean follow-up was 2.3 years (standard deviation [SD], 1.1; range, 6 mo-5 yr). Significant improvements were observed for all measures. Tympanic membranes were healthy in 9% preoperatively, 38% at 6 months, 55% at 12 months, and 93% at 36 months postoperatively. Tympanograms improved to type A in 50% at 6 months, 59% at 12 months, and 85% at 36 months. Mean scores of mucosal inflammation declined from 3.2 (±0.6) preoperatively to 2.5 (±0.7) at 6 months and 1.7 (±0.6) at 36 months postoperatively. BDET had lower risk of failure versus TT insertion (adjusted hazard ratio [HR] 0.26; 95% confidence interval [CI]: 0.10, 0.70; p = 0.007). Probability of being failure free at 2 years was 87% (95% CI: 70, 94%) after BDET and 56% (95% CI: 40, 70%) after TT insertions. CONCLUSIONS: BDET is a safe and possibly effective procedure in selected pediatric patients with chronic ETD.


Assuntos
Otopatias , Tuba Auditiva , Adolescente , Criança , Estudos de Coortes , Dilatação , Otopatias/cirurgia , Tuba Auditiva/cirurgia , Humanos , Estudos Retrospectivos
20.
Acta otorrinolaringol. cir. cabeza cuello ; 49(1): 43-51, 2021. ilus, tab, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1151895

RESUMO

Introducción: la dilatación endoscópica con balón ha mostrado ser una herramienta terapéutica y efectiva para el tratamiento de la disfunción de la trompa de Eustaquio. Al momento se desconocen los resultados en la población colombiana. Objetivos: determinar la mejoría clínica de la dilatación de la trompa de Eustaquio en pacientes adultos con disfunción tubárica crónica, en un centro de IV nivel de atención en Bogotá. Diseño: estudio observacional retrospectivo con componente analítico. Métodos: se revisaron los registros clínicos de pacientes intervenidos con la dilatación endoscópica de la trompa de Eustaquio; se describen los cambios objetivos y subjetivos en el posoperatorio. Resultados: se obtuvieron 22 pacientes entre los 18 y 66 años con seguimiento de 6 a 22 meses. Al 84,5 % se les realizó la intervención bilateral y al 15,8 % la unilateral, para un total de 38 oídos intervenidos. El 60 % lograron la normalización del timpanograma. Hubo una mejoría de las presiones del oído medio de -102,5 a -3,5 daPa (p = 0,005). Se alcanzó una mejoría estadísticamente significativa en 6/7 síntomas según la escala de severidad y reducción del gap aéreo-óseo en 7 dB y 4 dB del promedio de tonos puros por vía aérea (PTA) (p = 0,249; p = 0,711). Además, se generó un impacto positivo promedio de +32 en la escala de calidad de vida según el Glasgow Benefit Inventory (GBI). Conclusión: la dilatación de trompa de Eustaquio resulta ser una terapéutica segura y eficaz en población adulta, con mejoras estadísticamente significativas en la severidad de los síntomas y en las presiones del oído medio, lo cual genera un impacto positivo en la escala de calidad de vida según el GBI.


Introduction: Endoscopic balloon dilation has been shown to be a therapeutic and effective tool for the treatment of eustachian tube dysfunction. Now, the results in the Colombian population are unknown. Aim: Describe the clinical improvement of eustachian tube dilation in adult patients with chronic tubal dysfunction, in a 4th level complexity hospital in Bogotá. Design: Retrospective observational study with analytical component. Methods: The clinical records of patients undergoing endoscopic dilatation of the Eustachian tube were reviewed. Objective and subjective changes in the postoperative period are described. Results: 22 patients were obtained between 18 and 66 years and follow-up from 6 to 22 months. 84.5 % underwent bilateral intervention and 15.8 % unilaterally for a total of 38 operated ears. 60 % achieved tympanogram normalization. There was improvement of middle ear pressures from -102.5 to -3.5 daPa (p = 0.005). Statistically significant improvement in 6/7 symptoms according to the severity scale and reduction of air-bone Gap in 7 dB and 4 dB of airway PTA (p = 0.249; p = 0.711). Generating an average positive impact of +32 on the quality-of-life scale according to the Glasgow Benefit Inventory (GBI). Conclusions: Eustachian tube dilation proves to be a safe and effective therapy in an adult population with statistically significant improvements in the severity of symptoms, and in middle ear pressures. Generating a positive impact on the scale of quality of life according to the GBI.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Otopatias/cirurgia , Tuba Auditiva/cirurgia , Qualidade de Vida , Doença Crônica , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento , Dilatação , Otopatias/diagnóstico
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