ABSTRACT
OBJECTIVE: To determine the safety of Earigate™ as an ear wax softening product. STUDY DESIGN: Prospective, controlled animal study. METHODS: Bilateral wide myringotomies were performed in eleven chinchillas. In each animal, Earigate™ was delivered to a randomly selected experimental ear canal as 2 puffs twice a day. Auditory brainstem response (ABR) was used to assess the hearing of the animals before, 3 days and 10 days following the local application of Earigate™. The ABR threshold shifts were compared for both experimental and control ears. RESULTS: The mean hearing threshold shifts in the experimental animals were comparable at all frequencies and at days 3 and 10. No statistically significant differences were observed in the mean threshold shifts for all of the frequencies evaluated, between the control and experimental ears. CONCLUSIONS: The administration of Earigate™ to the middle ear of chinchillas did not cause any ototoxicity as assessed by ABR.
Subject(s)
Cerumen/drug effects , Cerumenolytic Agents/toxicity , Disease Models, Animal , Hearing/drug effects , Tympanic Membrane Perforation/complications , Animals , Chinchilla , Evoked Potentials, Auditory, Brain Stem/physiology , Female , Prospective StudiesABSTRACT
OBJECTIVE: To establish whether outpatient thyroid surgery is safe. DESIGN: Prospective, observational cohort. SETTING: Two tertiary care centres. METHODS: Although there is currently a trend toward ambulatory surgery in many domains, thyroidectomy has traditionally remained an inpatient procedure. We present our 200-case experience of total and partial thyroidectomy in an outpatient setting. Consecutive patients were prospectively recruited between May 2009 and October 2010. Surgeries were performed by four surgeons. A postoperative parathyroid hormone (PTH) level was obtained in the recovery room and used to guide the prescription of calcium and calcitriol oral supplements according to our institutional protocol. MAIN OUTCOME MEASURES: Postoperative complications, admission and readmission rates, patients' satisfaction, and feeling of security on a 10-point scale. RESULTS: A total of 171 patients, for a total of 200 surgical procedures: 100 hemithyroidectomies, 34 completion hemithyroidectomies, and 66 total thyroidectomies (including 14 with central compartment dissection). Immediate admission was decided in 12% of cases due to peroperative findings (15 patients), anesthetic considerations (7 patients), bilateral vocal fold paralysis noted in the recovery room (1 patient), and surgery late in the afternoon (1 patient). Two patients were readmitted for surgical site infections and one due to hypocalcemia. Temporary symptomatic hypocalcemia or decreased PTH level occurred in 10% (20 patients). On average, patients' satisfaction and feeling of security reached 9.3 on a 10-point scale. CONCLUSION: Outpatient thyroid surgery is a safe and desirable option.
Subject(s)
Ambulatory Surgical Procedures , Patient Satisfaction , Thyroid Diseases/surgery , Thyroidectomy/methods , Adolescent , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: To investigate possible ototoxic effects of a one-time application of oxymetazoline drops in a chinchilla animal model with tympanostomy tubes. Study Design. A prospective, controlled animal study. SETTING: The Research Institute of the Montreal's Children Hospital, McGill University Health Centre. SUBJECTS AND METHODS: Ventilation tubes were inserted in both ears of 12 animals. One ear was randomly assigned to receive oxymetazoline drops (0.5 mL). The contralateral ear did not receive any drops, serving as a control ear. OUTCOME MEASURES: Distortion product otoacoustic emissions were measured bilaterally for a wide range of frequencies (between 1 and 16 kHz) before and 1 day after the application of oxymetazoline in the experimental ears. Two months later, the animals were sacrificed and all cochleae were dissected out and processed for scanning electron microscopy. RESULTS: In this established chinchilla animal model, the measured distortion product otoacoustic emission amplitudes and the morphological appearance on scanning electron microscopy were similar for both control and experimental ears. CONCLUSION: Oxymetazoline did not cause ototoxicity in a chinchilla animal model 2 months after a single application via a tympanostomy tube.
Subject(s)
Cerebrospinal Fluid Otorrhea/prevention & control , Middle Ear Ventilation/adverse effects , Otoacoustic Emissions, Spontaneous/drug effects , Oxymetazoline/toxicity , Administration, Topical , Animals , Cerebrospinal Fluid Otorrhea/etiology , Cerebrospinal Fluid Otorrhea/pathology , Chinchilla , Disease Models, Animal , Dose-Response Relationship, Drug , Female , Follow-Up Studies , Microscopy, Electron, Scanning , Nasal Decongestants/administration & dosage , Nasal Decongestants/toxicity , Oxymetazoline/administration & dosage , Postoperative Complications , Prospective Studies , Rabbits , Scala Vestibuli/drug effects , Scala Vestibuli/ultrastructureABSTRACT
In this prospective controlled animal study, the authors investigated the potential ototoxic effects of ototopical application of nystatin through a tympanostomy tube, using their established chinchilla animal model. Each of the 10 animals used had ventilation tubes inserted in both ears; 1 ear was randomly assigned to receive nystatin suspension, whereas the other ear did not receive any medication, serving as control. Distortion product otoacoustic emissions (DPOAEs) were measured in each animal before application of nystatin and at 45 and 60 days after application. Each cochlea was also processed for scanning electron microscopy (SEM) at the end of the experiment. There was no significant difference in the DPOAEs and SEM appearances of the experimental and control ears over the 60-day period of the experiment. The authors conclude that transtympanic nystatin did not produce any long-term ototoxic effects detectable by DPOAEs or SEM.
Subject(s)
Cochlea/drug effects , Nystatin/toxicity , Tympanic Membrane/drug effects , Administration, Topical , Animals , Chinchilla , Cochlea/pathology , Disease Models, Animal , Female , Immunohistochemistry , Microscopy, Electron, Scanning , Middle Ear Ventilation , Nystatin/pharmacology , Otoacoustic Emissions, Spontaneous/drug effects , Random Allocation , Reference Values , Sensitivity and SpecificityABSTRACT
OBJECTIVE: Ototoxicity is currently the most frequent dose-limiting side effect of cisplatinum chemotherapy. To date, there is no protocol to prevent dose-related ototoxicity, despite its prevalence and predictability. Previous animal studies have found lactate to be effective in the prevention of cisplatinum-induced ototoxicity. The objective of this study was to test the protective benefits of transtympanic Ringer's lactate in the prevention of cisplatinum-induced ototoxicity. STUDY DESIGN: A randomized prospective controlled trial was conducted in an animal model. SETTING: Animal care research facilities of The Montreal Children's Hospital Research Institute. SUBJECTS AND METHODS: A total of 44 chinchillas were exposed to systemic cisplatinum injected intraperitoneally in divided cycles to reach the targeted cumulative dosage of 16 mg/kg. Ototopical application of Ringer's lactate solution 0.2 mL twice per day during the chemotherapy cycles was performed. Each animal had one experimental (Ringer's) and one control ear. Distortion product otoacoustic emissions (DPOAEs) were collected for a wide range of frequencies (between 1 and 16 kHz), and scanning electron microscopy was performed to evaluate the protective effects of Ringer's lactate. RESULTS: Ototopical application of Ringer's lactate solution in our established chinchilla animal model did not provide an otoprotective effect as measured by the DPOAE response and electron microscopy. CONCLUSION: In our study, the intratympanic application of Ringer's lactate solution through a tympanostomy ventilation tube did not provide an otoprotective effect. Further studies are needed to better assess the otoprotective or ototoxic effects of Ringer's lactate and other antioxidants on animal and human hearing.
Subject(s)
Antineoplastic Agents/adverse effects , Cisplatin/adverse effects , Ear Diseases/chemically induced , Ear Diseases/prevention & control , Isotonic Solutions/administration & dosage , Otoacoustic Emissions, Spontaneous/drug effects , Animals , Chinchilla , Cochlea/drug effects , Cochlea/pathology , Cochlea/physiopathology , Disease Models, Animal , Ear Diseases/diagnosis , Female , Hair Cells, Auditory/drug effects , Middle Ear Ventilation , Ringer's LactateABSTRACT
UNLABELLED: The use of earwax softeners and cerumenolytics to unblock the external auditory canal is increasing. Although reports on their effectiveness are available, data about their effect on hearing are limited. OBJECTIVE: To assess the effect of ototopic triethanolamine polypeptide oleate condensate 10% (Cerumenex) on hearing. STUDY DESIGN: Prospective, randomized, controlled trial in a chinchilla animal model. METHODS: Tympanostomy tubes were inserted in five chinchillas, and hearing was assessed with distortion product otoacoustic emissions (DPOAE) between 1 and 9 kHz prior to application and at days 1, 4, 30, and 100 postototopic application of Cerumenex. One ear received Cerumenex; the other ear served as control. Postmortem scanning electron microscopy was performed to assess the cochlear hair cells. RESULTS: A reduction in the mean DPOAE signal was shown in the ears treated with Cerumenex from the first day after treatment and throughout the study. Almost all tested frequencies were affected. Swelling, crusting, and fluid were observed in four of the five experimental ears. One animal also developed facial paralysis in the experimental side. Electron microscopy showed damage of the outer and inner hair cells in the Cerumenex-treated ears. CONCLUSIONS: In the chinchilla, when a tympanic perforation is present, Cerumenex causes a reduction in DPOAE signal and damage to the cochlear hair cells. Caution should be observed when prescribing this agent if the status of the tympanic membrane is unknown. Furthermore, its use without medical prescription should be discouraged because of the risk of ototoxicity and severe inflammatory reaction.
Subject(s)
Chlorobutanol/adverse effects , Ear Diseases/chemically induced , Ethanolamines/adverse effects , Peptides/adverse effects , Animals , Chinchilla , Drug Combinations , FemaleABSTRACT
OBJECTIVE: Ciprofloxacin is currently the only proven nonototoxic topical antibiotic. However, its widespread use has resulted in the emergence of antimicrobial resistance. There are also concerns that there is currently no safe alternative to ciprofloxacin for patients with a nonintact eardrum. We thus wished to evaluate whether a moxifloxacin solution is ototoxic when used topically in chinchilla ears in the presence of a pressure-equalizing tube (PET). STUDY DESIGN: A prospective, randomized, controlled trial was conducted in an animal model. METHODS: Twenty chinchillas were included in this study. After bilateral insertion of PETs, four drops of a moxifloxacin solution were delivered twice daily for 7 days in the randomly assigned experimental ear. The control ear received an equal amount of a solution of Ringer's lactate. Distortion product otoacoustic emissions (DPOAE) were recorded at baseline (after PET insertion) and at days 1, 3, 7, 14, and 28 after treatment initiation. RESULTS: When baseline DPOAE measurements were compared with the final measurements at day 28, moxifloxacin caused a statistically significant (P < .05) hearing loss (HL) in the experimental ears for the frequencies between 3.7 and 15 kHz. There was no significant change in hearing in the control ears. CONCLUSION: This represents the first study on the ototoxicity of topical moxifloxacin. Our results demonstrate that moxifloxacin causes HL when used with a nonintact tympanic membrane in a chinchilla animal model.
Subject(s)
Anti-Infective Agents/toxicity , Aza Compounds/toxicity , Cochlea/drug effects , Quinolines/toxicity , Administration, Topical , Animals , Anti-Infective Agents/administration & dosage , Antitubercular Agents , Aza Compounds/administration & dosage , Chinchilla , Cochlea/physiopathology , Disease Models, Animal , Evoked Potentials, Auditory, Brain Stem/drug effects , Female , Fluoroquinolones , Moxifloxacin , Otitis/drug therapy , Otitis/physiopathology , Quinolines/administration & dosageABSTRACT
El dorso nasal representa una de las sub-unidades nasales que mayor peso tiene al momento de considerar una nariz armónica o estéticamente ideal, reflejando en conjunto con la proyección de la punta nasal el carácter del perfil facial. Se realizó un estudio prospectivo de un grupo seleccionado de 56 pacientes, con criterio para la realización de rinoplastia primaria, que presentaran cúpulas óseo cartilaginosas prominentes. Se utilizaron como métodos de evaluación la comparación de los parámetros estéticos ideales en los estudios fotográficos preoperatorios y postoperatorios. A un total de 56 pacientes se les realizó resección conservadora de la cúpula óseo cartilaginosa prominente en dos tiempos, a través de la técnica de rinoplastia abierta; a 23 pacientes les fueron practicadas osteotomías medias oblicuas y osteotomías laterales como único procedimiento, en 33 pacientes de manera concomitante se utilizaron injertos separadores en la bóveda cartilaginosa, 32 pacientes recibieron injertos de cartílago desmenuzado septal en el rádix y 41 pacientes recibieron injertos de cartílago desmenuzado en la unión cóndro-ósea. Los autores proponen una escisión conservadora de la cúpula óseo cartilaginosa y abogan por una reconstrucción de la misma en casos seleccionados, además de hacer énfasis en la importancia de establecer inicialmente la altura y proyección de la punta nasal a fin de mantener dorsos nasales altos y dentro de parámetros estéticos ideales.
Subject(s)
Humans , Male , Adult , Female , Mandibular Fractures , Nose , Rhinoplasty , Otolaryngology , VenezuelaABSTRACT
Las fracturas mandibulares representan un reto tanto desde el punto de vista de diagnóstico como manejo terapéutico para el otorrinolaringólogo moderno. El presente estudio presenta la experiencia en el manejo quirúrgico de las fracturas de ángulo mandibular en 56 pacientes adultos evaluados en el Servicio de Otorrinolaringología del Hospital Universitario de Caracas entre agosto de 1998 y agosto de 2003 de estos 54 pacientes pertenecientes al sexo masculino (98 por ciento) y 2 pacientes pertenecientes al sexo femenino (2 por ciento). Las causas mas frecuentes de fractura fueron accidentes automovilísticos (46 por ciento), violencia interpersonal (30 por ciento), accidentes laborales (15 por ciento), caídas (7 por ciento) y otras (2 por ciento). La evaluación clínica de los pacientes demostró que presentaban antecedentes de trauma facial, signos de maloclusión dental, anestesia o parestesia del labio inferior y cambios del contorno facial. A todos los pacientes les fueron practicados estudios radiológicos simples tipo panorámica dental, proyecciones simples de cara y tomografía computada de nariz y senos paranasales. Los pacientes fueron tratados quirúrgicamente a través de reducción quirúrgica temprana abierta a través de un abordaje extraoral con placas de compresión de titanio del Sistema Martin, de 2,0 mm. y con fijación intermaxilomandibular a cuatro puntos o mediante arcos de alambre. La tasa de complicaciones fue de 7 por ciento relacionados con la presencia de infección y seromas de la herida operatoria
Subject(s)
Male , Female , Adult , Humans , Accidents, Occupational , Accidents, Traffic , Malocclusion , Mandibular Fractures , Mandibular Injuries , Radiography, Panoramic , Otolaryngology , VenezuelaABSTRACT
Las perforaciones representan un enigma peculiar para el cirujano reconstructivo nasal y un problema para el paciente. Técnicas como colgajo de mucosa nasal, colgajos cutáneos pediculados, colgajos cutáneos libre, dermis, pericondrio, cartílago, dura craneal y fascia han sido empleados con resultados favorables, sin embargo, una irrigación sanguínea inadecuada llevan frecuentemente a la falla de las técnicas mencionadas anteriormente. Se presenta un estudio prospectivo de un grupo seleccionado de nueve pacientes, cinco de sexo masculino y cuatro de sxo femenino, con edad promedio de 26 años, portadores de perforaciones septales anteriores, sintomáticas, con criterio de reparación quirúrgica, con un promedio de 2 cms, de diámetro, de diversas etiologías, en los cuales se empleó la técnica de rinoplastia abierta como abordaje quirúrgico yla rotación de colgajo pediculado miomucoso del interior de la mucosa del labio superior, con un éxito en el cierre de las mismas de un cien por ciento y una muy baja morbimorbilidad. El abordaje de Rinoplastia abierta acompañado de la rotación de colgajo pediculado miomucoso horizontal labial representa una opción quirúrgica técnicamente sencilla, con una mínima rata de disconfort para el paciente y un éxito elevado en pacientes seleccionados portadores de perforaciones septales anteriores sintomáticas
Subject(s)
Female , Humans , Rhinoplasty , Surgical Flaps , Otolaryngology , VenezuelaABSTRACT
Las fracturas mandibulares se presentan como consecuencias comunes de los traumatismos faciales. El presente estudio presenta la experiencia en el manejo quirúrgico de las fracturas mandibulares sinfisiales y parasinfisiales en 76 pacientes adultos evaluados en el Servicio de Otorrinolaringología del Hospital Universitario de Caracas entre agosto de 1998 y agosto de 2003. De estos, 67 pacientes masculinos (88 por ciento) y 9 femeninos (12 por ciento) las causas mas frecuentes de fractura fueron violencia interpersonal (78 por ciento) y accidentes automovilísticos (20 por ciento). A todos los paciente les fué practicado una evalución otorrinolaringológica completa, de manera complementaria se realizaron estudios radiológicos simples tipo: radiografía panorámica dental y proyecciones simples de macizo facial, se indicó además tomografía computarizada de naríz y senos paranasales y cuello en casos selleccionados. Los pacientes fueron tratados con reducción quirúrgica abierta temprana con placas de compresión de titanio del Sistema Martin de 2,0 mm y con fijación inter-maxilo mandibular a cuatro puntos en casos seleccionados. La tasa de compliciones fue de 8 por ciento relacionados con procesos infecciosos locales en la herida operatoria