A systematic review on skin complications of bone-anchored hearing aids in relation to surgical techniques.

A systematic review to study the skin complications associated with the bone-anchored hearing aid in relation to surgical techniques. The following databases have been searched: MEDLINE, EMBASE, the Cochrane Library , Google scholar and the PubMed. The literature search date was from January 1977 until November 2013. Randomised controlled trials and retrospective studies were included. Initial search identified 420 publications. Thirty articles met the inclusion criteria of this review. The most common surgical techniques identified were full-thickness skin graft, Dermatome and linear incision techniques. The result shows that dermatome technique is associated with higher rate of skin complications when compared to linear incision and skin graft techniques. Based on the available literature, the use of a linear incision technique appears to be associated with lower skin complications; however, there is limited data available supporting this. Higher quality studies would allow a more reliable comparison between the surgical techniques.

Is cartilage tympanoplasty more effective than fascia tympanoplasty? A systematic review.

OBJECTIVE: A systematic review to compare the effectiveness of the use of cartilage (with or without perichondrium) with temporalis fascia used in tympanoplasty. DATA SOURCE: The following databases were searched for relevant studies: MEDLINE, Embase, CINAHL, the Cochrane Library including the Cochrane Central Register of Controlled Trials, Google scholar, and the PubMed. There was no restriction as to the design or date of publication. STUDY SELECTIONS: We selected randomized controlled trials (RCTs) and retrospective studies comparing cartilage and temporalis fascia tympanoplasty in relation to 2 outcomes: morphological and functional success. Initial search identified 2,091 publications. All titles and abstracts were reviewed by 2 of the authors, and 103 relevant articles were studied. However, only 14 studies met the inclusion criteria for this review. These included 3 RCTs, 10 retrospective studies, and 1 literature review. RESULTS: Three level 1 (RCTs) and 11 level 3 and 4 evidence-based studies were included (n = 1,475 patients). One RCT and 3 retrospective studies showed a statistically significant better morphological success, that is, intact ear drum with cartilage graft with or without perichondrium. There was, however, no statistically significant difference between cartilage and temporalis fascia tympanoplasty regarding function, namely, hearing outcome. The need for revision rates was approximately 10% with cartilage and 19% with fascia tympanoplasty. CONCLUSION: Tympanoplasty using cartilage with or without perichondrium has better morphological outcome than tympanoplasty using temporalis fascia. However, there was no statistically significant difference in hearing outcomes between the 2 grafts.

Do high-speed drills generate high-frequency noise in mastoid surgery?

BACKGROUND: The introduction of increasingly high speed drills for mastoid surgery has heightened the concern that cochlea damage may occur in both the operated and nonoperated ear. It has been observed clinically that this damage could be associated with frequencies above 8,000 Hz and that, to observe these changes, high-frequency audiometry should be performed. Previous studies have investigated noise transmission to the cochlea at frequencies below 4,000 Hz only. There having been, until recently, limitations to the equipment available to measure higher frequencies. OBJECTIVE: To define the characteristics of noise transmitted to the cochlea during drilling of temporal bone, specifically in the higher frequency ranges up to 20,000 Hz. METHODS: Cleaned temporal bones were fitted with 3 mutually perpendicular accelerometers, capable of measuring frequencies in the range 500 to 20,000 Hz. The system was calibrated using a Kamplex Audio Traveller AA220 pure tone audiometer, and accelerometer outputs were recorded on a personal computer at a sampling frequency of 102.4 kHz per channel. The magnitude of the noise transmitted to the cochlea was determined for a range of burrs. RESULTS: Maximum transmission of sound was 108 dBA at 4,000 Hz using a 6.5-mm burr on the cortical mastoid bone. The average results showed that the sound transmission tailed off at the higher frequencies dropping to 84 dBA at 8,000 Hz and 40 dBA at 16,000 Hz. CONCLUSION: The high-frequency hearing reduction noted in patients after mastoid surgery was shown not to be due to excessive high-frequency noise generated by drilling.

Collet-sicard syndrome from thrombosis of the sigmoid-jugular complex: a case report and review of the literature.

Purpose. Collet-Sicard syndrome is a very rare condition characterised by unilateral palsy of the IX-XII cranial nerves. It is distinguished from Villaret syndrome by lack of presence of sympathetic involvement. Current literature contains only two cases of Collet-Sicard syndrome due to idiopathic internal jugular vein thrombosis. Method and Results. We report the case of Collet-Sicard syndrome in a 30-year-old man who presented with delayed development of XIth nerve dysfunction, due to internal jugular vein-sigmoid sinus thrombosis. A multidisciplinary team approach was employed in the management of this patient. At three-month followup, he had significantly improved swallowing, and repeat computed tomography neck scan showed partial recanalisation of the right internal jugular vein. Conclusion. In suspected Collet-Sicard syndrome, a focal primary lesion or metastasis to the temporal bone must be excluded, and sigmoid-jugular complex thrombosis should be considered in the differential diagnosis. Early recognition and treatment may result in significant functional recovery.

Case studies in corporate compliance: putting the rubber to the road.

An interdisciplinary, proactive perspective allows providers to engage in productive, long-term collaborative relationships with corporations, while 1) maintaining patient care improvements; 2) maintaining legality; 3) enhancing technical and clinical innovation; and 4) providing fair compensation for work done. The case study approach is used to demonstrate an effective approach to compliant behavior.

Post-tonsillectomy hemorrhage: cold versus hot dissection.

OBJECTIVE: The aim of our study was to assess the rate of reactionary and secondary posttonsillectomy hemorrhage using "cold" dissection and bipolar diathermy and to determine whether there was any difference in the postoperative hemorrhage rate between the 2 methods. METHODS: This was a prospective study of all patients undergoing tonsillectomy between November 8, 1999 and November 7, 2000 in a tertiary medical centre. The data collected included patient identity, age, gender, date of surgery, method of operation, and complications (if any). The timing of reactionary or secondary posttonsillectomy hemorrhage and the treatment were recorded. We hypothesized no difference in posttonsillectomy hemorrhage rates using the 2 methods. Chi2 test was used for statistical analysis. RESULTS: A total of 349 patients underwent tonsillectomy in the period (134 males, 215 females, mean age was 16.7 years). Of these, 337 were bilateral procedures, 145 patients had tonsillectomy using cold dissection, and 192 patients had bipolar diathermy. Reactionary hemorrhage occurred in 1 patient (0.3%) and 31 patients (9.2%) developed secondary hemorrhage. The hemorrhage rates using cold dissection (n = 8) and bipolar diathermy (n = 24) were 5.5% and 12.5%, respectively ( P < 0.05). CONCLUSIONS: The primary and secondary posttonsillectomy hemorrhage rates were 0.3 and 9.2%, respectively. Tonsillectomy using bipolar diathermy has a statistically significant higher secondary hemorrhage rate than using cold dissection (12.5% vs. 5.5%, P < 0.05).

Post-tonsillectomy haemorrhage: reusable and disposable instruments compared.

The aim of this study was to determine if the introduction of disposable instruments for tonsillectomy resulted in a significant change in post-tonsillectomy haemorrhage rates. This is a prospective comparative study of haemorrhage rates for cold dissection (CD) tonsillectomy in adults using reusable instruments during 1999-2000 ( n=83) and disposable instruments between August and December 2001 ( n=111). Haemorrhage rates in children with reusable instruments ( n=156) and disposable instruments ( n=115) were also compared. Confidence intervals were established for the differences between study groups along with exact levels of significance. No difference was found in the overall reactionary haemorrhage rate [ P=0.32, Diff 0.9% (95% CI; -3.2 to +0.4)] or secondary haemorrhage rate [ P=1.00, Diff 3.4% (95% CI; -0.09 to +0.01)] between reusable and disposable instruments. The introduction of disposable instruments has not produced a statistically significant increase in post-tonsillectomy haemorrhage rates in our centre.

Effect of disposable instruments on paediatric post-tonsillectomy haemorrhage rates.

BACKGROUND: A government directive aiming to minimise the theoretical risk of acquiring variant Creutzfeld-Jacob disease from reusable instruments lead to tonsillectomy with disposable instruments becoming standard practice in the UK during 2001. A perceived increase in post-tonsillectomy haemorrhage followed soon after implementation of the directive. OBJECTIVE: To determine if the introduction of disposable instruments is associated with a statistically significant change in post-tonsillectomy haemorrhage rates in children. METHODS: A prospective audit of paediatric tonsillectomy with reusable instruments (n=156) had been undertaken (November 1999-November 2000). All children undergoing tonsillectomy with disposable instruments (n=115) were also studied prospectively (August 2001-December 2001) allowing the reactionary and secondary post-tonsillectomy haemorrhage rates for the two study periods to be compared. We hypothesised no difference in haemorrhage rates between reusable and disposable instruments. Statistical significance was calculated using Fisher's exact test and confidence intervals were established for the differences between study groups. RESULTS: Cold dissection was undertaken in 62 children with reusable instruments and in 76 children with disposable instruments with secondary haemorrhage rates of 3.2% (n=2) and 2.6% (n=2), respectively. Bipolar diathermy dissection was undertaken in 94 children with reusable instruments and in 39 children with disposable instruments with respective secondary haemorrhage rates of 6.4% (n=6) and 12.8% (n=5). No reactionary haemorrhages occurred with reusable or disposable instruments. No difference was found in the overall secondary haemorrhage rate between reusable and disposable instruments (P=0.93, difference 1.0% (95% CI; -7.4 to +4.6)). CONCLUSIONS: The introduction of disposable instruments has not produced a statistically significant increase in paediatric post-tonsillectomy haemorrhage rates in our centre.