Patterns of online information use prior to middle-ear surgery: a retrospective cohort study.

OBJECTIVE: This study aimed to identify what proportion of middle-ear surgery patients utilise the internet for information and to characterise which resources and media formats are used and for what durations. METHOD: A single-arm, retrospective cohort study was performed using an online survey of English-speaking patients who underwent middle-ear surgery over a three-year period across two otology practices. RESULTS: Of 260 invitees, 165 responded. A total of 122 used online resources: 9.8 per cent used online resources for less than 15 minutes, 27.0 per cent used them for 15 to 29 minutes, 27.0 per cent used them for 30 to 59 minutes and 36.1 per cent used them for 60 minutes or more. Of online users with complete responses (108 of 122), the most used resources (used for 12 minutes or more) were: written information (73.1 per cent); surgeons' websites (55.6 per cent); pictures, diagrams or photos (42.6 per cent); videos (37.0 per cent); and social media (10.2 per cent). CONCLUSION: At least 46.9 per cent of patients undergoing elective ear surgery use online resources. Most time is spent using written information, pictures, diagrams, photos and videos. Therefore, it is increasingly essential that accurate and informative resources in these formats are readily available online.

The protympanum, protiniculum and subtensor recess: an endoscopic morphological anatomy study.

OBJECTIVES: An anatomical study was performed to describe the endoscopic anatomy and variations of the protympanum, including classification of the protiniculum and subtensor recess. METHODS: A retrospective review was conducted of video recordings of cadaveric dissections and surgical procedures, which included visualisation of the protympanum, across 4 tertiary university referral centres over a 16-month period. A total of 97 ears were used in the analysis. RESULTS: A quadrangular conformation of the protympanum was seen in 60 per cent of ears and a triangular conformation in 40 per cent. The protiniculum was type A (ridge) in 58 per cent, type B (bridge) in 23 per cent and type C (absent) in 19 per cent. The subtensor recess was type A (absent) in 30 per cent, type B (shallow) in 48 per cent and type C (deep) in 22 per cent. CONCLUSION: The protympanum is an area that has been ignored for many years because of difficulties in visualising it with an operating microscope. However, modern endoscopic equipment has changed this, providing detailed anatomical knowledge fundamental to ensuring the safety of endoscopic surgical procedures in the region.

Direct cost comparison of totally endoscopic versus open ear surgery.

OBJECTIVE: Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting. METHODS: A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques. RESULTS: Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy. CONCLUSION: Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.

Dynamic cine imaging of the Eustachian tube using four-dimensional computed tomography.

BACKGROUND: Imaging the Eustachian tube has proven difficult as it has an anatomical orientation that is not aligned with standard planes. In addition, the Eustachian tube is a dynamic structure, opening briefly during a variety of physiological manoeuvres. CASE REPORT: A 54-year-old healthy and asymptomatic man underwent computed tomography utilising an area detector scanner. Multiplanar reconstruction was performed at 1 mm intervals. In addition, dynamic clips were constructed to demonstrate air and its movement in the field. Images and video were acquired whilst a Valsalva manoeuvre was being performed. CONCLUSION: Although imaging techniques have been able to visualise the Eustachian tube well in the closed state, it may be more useful to have it imaged whilst open. Area detector computed tomography scanners can be used to acquire four-dimensional images. This allows dynamic imaging of the region, to assist in the diagnosis of various types of Eustachian tube dysfunction.

Transtympanic balloon dilatation of the eustachian tube: systematic review.

OBJECTIVE: To investigate the evidence for balloon dilatation of the eustachian tube using a transtympanic approach. METHODS: A systematic search of several databases was conducted (using the search terms 'dilation' or 'dilatation', and 'balloon' and 'eustachian tube'). Only studies that used a transtympanic approach for the procedure were included. These studies were then assessed for risk of bias. RESULTS: Three studies were included. Each of these studies was a limited case series, with two performed on human subjects and one on human cadavers. Results of safety and efficacy are conflicting. There is a high risk of bias overall. CONCLUSION: At present, there is a very narrow evidence base for transtympanic balloon dilatation of the eustachian tube. There are a number of advantages and disadvantages of the technique. Previously identified and theoretical safety concerns will need to be addressed thoroughly in future studies prior to wider clinical use.

The use of benzodiazepines for tinnitus: systematic review.

OBJECTIVES: To investigate the effectiveness of benzodiazepine use for subjective tinnitus and to consider this in the context of the concomitant side effects. METHODS: A systematic search of several databases using the terms 'tinnitus' and 'benzodiazepines' was conducted to find clinical trials of benzodiazepines and comparators in tinnitus patients. These studies were then assessed for risk of bias. RESULTS: Six clinical trials were included. Clonazepam was found to be effective in three studies, but these studies had limitations regarding adequate blinding. The effectiveness of alprazolam was equivocal. Diazepam was not effective in two studies and oxazepam was effective in one study. CONCLUSION: Benzodiazepine use for subjective tinnitus does not have a robust evidence base. Clonazepam has the most evidence to support its use and is relatively less likely to lead to abuse because of its longer half-life, but caution is still needed given the other serious side effects.