Traumatic tympanic membrane perforations Harvie, Myriam; Roy, Catherine F; Gurberg, Joshua
Canadian Medical Association journal (CMAJ),
01/2024, Volume:
196, Issue:
3
Journal Article
Peer reviewed
Open access
Harvie et al present five things to know about traumatic tympanic membrane perforations (TMPs). TMPs typically present as sudden otalgia, hearing loss and bloody otorrhea in the context of a ...causative mechanism. Ear canal instrumentation accounts for approximately 60% of ear-related injuries (most commonly from cotton-tipped applicators).Diving or water sports are also well-recognized causes. Additionally, absence of tympanic membrane mobility on pneumatic otoscopy or conductive hearing loss on tuning fork examination (tuning fork pressed on forehead heard more loudly in the affected ear) can help establish the diagnosis.
This study investigates the physical properties upon immersion of two gelatin sponges commonly used in otologic surgery.
Absorbable gelatin sponges are often used in middle ear surgery to achieve ...hemostasis and, perhaps more importantly, to provide a "scaffolding" to support ossicular chain and/or tympanic membrane reconstructions. Their rate of dissolution may therefore affect the success of tympanic membrane closure.
An in vitro study was conducted to quantify the material changes of two absorbable gelatin sponges, a standard-density sponge and one with fewer collagen cross-linkages (low-density sponge). Volume loss (%) in 0.9% saline, 0.3% ciprofloxacin, and/or 0.1% dexamethasone as single-agent otic drops in a combination formulation was measured at 15-minute intervals for the first hour and at days 1, 3, and 5 postimmersion. Secondary end points included compressibility, porosity under microscopy, and infrared spectroscopy analysis.
The low-density sponge immersed in any of the three otic solutions showed a statistically significant greater volume loss at all time points when compared with the standard-density sponge (27.2% ± 5.4% vs. 15.4% ± 6.0% at 15 minutes and 44.8% ± 5.1% vs. 34.6% ± 2.9% at 5 days, p < 0.001). Interestingly, both sponges immersed in normal saline had lost almost half of their original volume after 15 minutes when compared with samples immersed in an otic solution (48.3% ± 4.6% vs. 21.3% ± 8.3%, respectively, p < 0.001).
The standard-density sponge immersed in an otic solution of ciprofloxacin, dexamethasone, or a combination formulation best maintained its structural integrity. Ancillary in vivo studies are required to assess the hemostatic properties, surgical outcomes, and middle ear synechiae of the above study conditions.
Foundational evidence.
Tumor‐to‐tumor metastasis is a seldom reported phenomenon whereby a neoplasm seeds within another histologically distinct tumor, with only 84 cases documented in the literature. We hereby describe ...the case of a 95‐year‐old woman who died of widespread metastases identified as a primary hepatic angiosarcoma on autopsy, and the interesting finding of a seeding foci within a dural meningioma. Although meningiomas are the most common intracranial neoplasms to harbor such a phenomenon, this is to our knowledge the first case where an angiosarcoma was identified as the donor tumor.
Patient education and engagement is a pivotal component of surgical recovery. Ensuring proper patient education involves a thorough understanding of one's diagnosis and recovery plan, while reducing ...language and learning barriers to help patients make informed decisions and improve their hospital experience.
To assess whether using an animated surgical guide will help patients who are undergoing head and neck surgery feel more satisfied with their surgery and recovery process.
A randomized clinical trial was conducted between January and August 2020 at a single tertiary care academic center in Montreal, Canada. A consecutive sample of individuals who were undergoing any of the following surgical procedures was recruited: head and neck cancer resection with or without reconstruction, parotidectomy, thyroidectomy, parathyroidectomy, laryngectomy, or transoral robotic resection. The treating team was masked to group allocation, while study participants in the nonintervention group were unaware of the multimedia platform to avoid introducing bias in their survey responses.
Patients were randomly allocated to either the treatment arm, in which they obtained access to a multimedia patient education platform, or the control arm, in which they received traditional patient education methods via clinical visits.
Primary analysis compared patient satisfaction scores on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire INFO 25, a validated questionnaire on the perceived quality of information received by patients with cancer (possible scores ranging from 20 to 80).
A total of 100 patients (50 in each arm; 63 women 63%; 6 African American 6%, 12 Hispanic/Latino 12%, 11 Middle Eastern 11%, and 78 White 78% individuals) completed the preintervention and postintervention questionnaires. In those who received access to the patient education platform, there was an 11.3-point (Cohen d = 1.02; control group score, 61.1 of 80; treatment group score, 72.4 of 80) difference of greater postoperative satisfaction scores at 1 month. While both groups felt that they received an adequate amount of information concerning their disease process, patients in the treatment arm had significantly better satisfaction with information concerning their medical tests, treatments, and other services.
This randomized clinical trial of patients undergoing head and neck cancer treatment demonstrates that multimedia patient education platforms may enhance current traditional methods, providing complementary information on patients' treatment plans and recovery process, mental health, family life, and supplementary services. Further research is currently underway to confirm whether this platform will lead to decreased hospital stay, shorter complication rates, and long-term effects.
ClinicalTrials.gov Identifier: NCT04048538.
Obesity has traditionally been described as a relative contraindication to percutaneous dilatational tracheostomy (PDT). Increased familiarity with the technique and use of bronchoscopy or real-time ...ultrasonography to enhance visualization have led many practitioners to expand the indication for PDT to patients historically deemed to have high risk of perioperative complications.
To assess the reported complication rate of PDT in critically ill adults with obesity and compare it with that of open surgical tracheostomies (OSTs) in this patient population and with that of PDT in their counterparts without obesity.
In this systematic review and meta-analysis, Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to March 1, 2022. Key terms related to percutaneous tracheostomy and obesity were included.
Original investigations of critically ill adult patients (age ≥18 years) with obesity who underwent PDT that reported at least 1 complication of interest were included. Case reports or series with fewer than 5 patients were excluded, as were studies in a language other than English or French.
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) were used, with independent extraction by multiple observers. Frequencies were reported for all dichotomous variables. Relative risks for complications were calculated using both fixed-effects and random-effects models in the meta-analysis.
Main outcomes included mortality directly associated with the procedure, conversion to OST, and complications associated with the procedure (subclassified into life-threatening or non-life-threatening adverse events).
Eighteen studies were included in the systematic review, comprising 1355 patients with obesity who underwent PDT. The PDT-related complication rate was 16.6% among patients with obesity overall (791 patients, 17 studies), most of which were non-life-threatening. Only 0.6% of cases (8 of 1314 patients, 17 studies) were aborted or converted to an OST. A meta-analysis of 12 studies (N = 4212; 1078 with obesity and 3134 without obesity) showed that patients with obesity had a higher rate of complications associated with PDT compared with their counterparts without obesity (risk ratio, 1.78; 95% CI, 1.38-2.28). A single study compared PDT with OST directly for critically ill adults with obesity; thus, the intended meta-analysis could not be performed in this subgroup.
The findings suggest that the rate of complications of PDT is low in critically ill individuals with obesity, although the risk of complications may be higher than in individuals without obesity.
Surgical Treatment of Early Glottic Cancer Silver, Jennifer A; Turkdogan, Sena; Roy, Catherine F ...
Otolaryngologic clinics of North America
56, Issue:
2
Journal Article
Peer reviewed
The incidence of all head and neck malignancies is rising worldwide, with carcinoma of the larynx constituting approximately 1% of all cancers. Early glottic cancer responds quite favorably to ...surgical intervention due to its early presentation, coupled with the low rate of regional and distant metastases. This article focuses on various approaches to the surgical treatment of early glottic cancer. Details include the clinical and radiological evaluation of laryngeal cancer, the goals of treatment, current surgical options for early disease, approach to surgical resection margins and management of nodal disease, and complications associated with each treatment modality.
To evaluate and compare perioperative outcomes of percutaneous bone-anchored hearing implant (BAHI) surgery in syndromic and nonsyndromic pediatric patients.
Retrospective cohort study.
McGill ...University Health Centre in Montreal, Quebec, Canada.
Forty-one pediatric patients (22 syndromic, 19 nonsyndromic) who underwent percutaneous BAHI surgery between March 2008 and April 2021.
Percutaneous BAHI surgery.
Patient demographics (age at surgery, gender, implant laterality), operative information (American Society of Anesthesia ASA score, anesthesia type, surgical technique, implant/abutment characteristics), and postoperative outcomes (implant stability, soft tissue integrity, surgical revisions, implant failure).
The most frequent syndromes among implanted patients were Treacher Collins (27.3%), Goldenhar (13.6%), Trisomy 21 (13.6%), and Nager (9.1%). Syndromic patients were more frequently given higher ASA scores: 2 ( p = 0.003) and 3 ( p = 0.014). All cases of implant extrusion were in syndromic patients: two posttraumatic and two failures to osseointegrate. Nine (40.9%) syndromic patients experienced a Holgers Grade 4 skin reaction at one of their postoperative follow-up visits as compared to 0% of nonsyndromic patients ( p < 0.001). Implant stability was similar between cohorts at all postoperative time-points, except for significantly greater nonsyndromic implant stability quotient scores at 16 weeks ( p = 0.027) and 31+ weeks ( p = 0.016).
Percutaneous BAHI surgery is a successful rehabilitation option in syndromic patients. However, it presents a relatively higher incidence of implant extrusion and severe postoperative skin reactions as compared to nonsyndromic patients. In light of these findings, syndromic patients may be great candidates for novel transcutaneous bone conduction implants.
