Polyethylene implants in nasal septal restoration.

IMPORTANCE: Numerous techniques have been described to repair nasal septal perforations (SPs). However, many are technically challenging, with varying degrees of success. OBJECTIVE: To evaluate the use of polyethylene (Medpor; Porex Technologies) implants in the closure of nasal SPs. DESIGN AND SETTING: Prospective cohort study in an academic research setting. PARTICIPANTS: Fourteen patients with a nasal SP were identified between March 1, 2008, and February 1, 2011. INTERVENTION: Each patient underwent repair of the nasal SP with a polyethylene orbital sheet implant. After measuring the size of the SP, the implant was trimmed and shaped to fit appropriately. The implant was then placed between bilateral mucoperichondrial flaps using an endonasal approach. MAIN OUTCOME AND MEASURE: Successful closure of the nasal SP with an intact polyethylene graft and complete remucosalization by the 1-year follow-up visit. RESULTS: The most common initial symptoms of SPs were nasal obstruction, crusting, and epistaxis. The SPs ranged from 0.5 to 4.0 cm in diameter. Thirteen of 14 patients (93%) who underwent repair of their nasal SPs with a polyethylene implant had successful closure. CONCLUSION AND RELEVANCE: The use of polyethylene implants is effective and technically easy and is associated with low patient morbidity because it does not require the harvesting of tissue from other donor sites. LEVEL OF EVIDENCE: 4.

Evidence-based practice: management of adult sensorineural hearing loss.

Sensorineural hearing loss is a complex disease state influenced by genetics, age, noise, and many other factors. This article reviews our current knowledge regarding the causes of sensorineural hearing loss and reviews the more challenging clinical presentations of sensorineural hearing loss. We have reviewed the latest medical literature in an attempt to provide an evidence-based strategy for the assessment and management of sudden sensorineural hearing loss, rapidly progressive sensorineural hearing loss, and asymmetric/unilateral sensorineural hearing loss.

Impact of newer generation multidetector computed tomography on the diagnosis of abscesses in the head and neck.

OBJECTIVE: To understand how newer generation multidetector computed tomographic (NGCT) scanner technology (≥ 16 slices) has affected the imaging characteristics of head and neck abscesses. DESIGN: Retrospective chart review. SETTING: Tertiary referral centre. METHODS: Forty-eight patients with a head and neck abscess who underwent a soft tissue neck computed tomographic (CT) scan were identified from September 1, 2001, to December 1, 2008. The degree of rim enhancement, delta (Δ), was graded using mean Hounsfield units (HU) from five peripheral points and five central points from a representative CT slice. The difference was then calculated and compared between older generation computed tomography (OGCT; < 16 slices) and newer generation multidetector computed tomography (NGCT; ≥ 16 slices) using the Student t-test. A p value < .05 was considered significant. RESULTS: Forty-eight patients met our inclusion criteria. Of these, 20 were scanned with OGCT and 28 were scanned with NGCT. The mean peripheral point values were OGCT  =  78 HU (95% CI 71-86 HU), NGCT  =  74 HU (95% CI 68-80 HU); p  =  .3. The mean central point values were OGCT  =  24 HU (95% CI 21-28 HU), NGCT  =  26 HU (95% CI 21-31 HU), p  =  0.7. The mean delta values (mean peripheral HU--mean central HU) were OGCT  =  52 HU (95% CI 43-61 HU), NGCT  =  46 HU (95% CI 41-52 HU), p  =  .2. CONCLUSION: There is no significant difference between OGCT and NGCT in the amount of rim enhancement seen on CT scans of head and neck abscesses.

Effectiveness of the heat-activated nitinol smart piston stapes prosthesis in stapedectomy surgery.

OBJECTIVE: To compare the SMart piston stapes prosthesis to a standard manual crimp prosthesis on operative time and air-bone gap (ABG) closure in stapedectomy. DESIGN: Retrospective chart review. SETTING: Tertiary referral centre. METHODS: The charts of patients undergoing stapedectomy for otosclerosis were analyzed. We compared the results of 76 patients (80 ears) who received the autocrimping SMart piston prosthesis to those of 21 patients (21 ears) who received the conventional manual crimp Fisch-type prosthesis. Data were analyzed using t-test, chi-square, or two-way analysis of variance where appropriate. MAIN OUTCOME MEASURE: Operative time with ABG closure as a secondary outcome measure. RESULTS: There was a significant difference in operative time between the Fisch-type prosthesis and the SMart piston prosthesis groups. The operation required 28.9 ± 3.2 minutes when using the Fisch-type prosthesis, whereas 21.2 ± 2.4 minutes were needed when using the SMart piston (p < .001). There was a significant improvement in postoperative ABG for both the Fisch-type piston (28.1 ± 3.1 to 9.0 ± 1.4, p < .001) and the SMart piston (25.1 ± 3.7 to 8.2 ± 2.5, p < .001) groups. CONCLUSIONS: Use of the SMart piston prosthesis results in ABG closure similar to that of the traditional Fisch-type prosthesis but offers the added advantage of reduced operative time.

Identification of bacterial contaminants in sinus irrigation bottles from chronic rhinosinusitis patients.

OBJECTIVE: To determine if sinus irrigation bottles from patients with chronic rhinosinusitis (CRS) harbour bacterial contaminants. DESIGN: Patients with symptoms of CRS who showed no mucopurulent infection and had no history of surgery were enrolled in the study. Patients were instructed on the proper use and cleaning of sinus irrigation bottles and were asked to return their rinse bottle during follow-up visits. METHODS: Bacterial contaminants were cultured from the inner surface of the sinus irrigation bottles obtained from patients. Genomic deoxyribonucleic acid (DNA) was isolated from purified colonies and used to polymerase chain reaction (PCR) amplify the 16S ribosomal ribonucleic acid (rRNA) genes. PCR products were sequenced and analyzed in the Human Oral Microbiome Database (HOMD) for genus and species identification based on 16S ribosomal DNA (rDNA) sequence comparisons. MAIN OUTCOME MEASURES: The outcomes included the recovery of bacterial contaminants and their subsequent identification. RESULTS: In total, 142 bacterial isolates were cultured and identified. The organisms included known oral flora bacteria, as well as pathogens of the upper respiratory tract and sinuses. Thirty-two different bacterial species were identified from 11 patients. There was no correlation between the length of bottle use and the degree of contamination. CONCLUSION: This study highlights the risk of bacterial contamination of sinus irrigation bottles and the potential for patient reinoculation.