Late effects of topical anesthetics on the healing of guinea pig tympanic membranes after myringotomy.

BACKGROUND: The optimal local anesthetic for myringotomies or the insertion of tympanostomy tubes in adults should be easy and rapid to use, be painless during application, provide good anesthesia, be reversible, be inexpensive, and not cause any long-term damage to the tympanic membrane (TM). OBJECTIVE: To evaluate the histologic effects of topical anesthetic agents on the healing of the TM after myringotomy. METHODS: Sixty male albino guinea pigs were randomly assigned to 1 of 5 groups. Of the 5 groups, 2 were used as controls: one group underwent a myringotomy and the other group did not. The remaining 3 groups had both TMs treated with a topical anesthetic (phenol, tetracaine base, and eutectic mixture of lidocaine and prilocaine in a cream) prior to myringotomy. All TMs were inspected periodically and then harvested at 3 months or 6 months postoperatively for histologic examination. RESULTS: The TMs of the group treated with tetracaine appeared the most normal at 6 months (P=.001). However, histologic evaluation failed to demonstrate any significant differences in the thickness of the TM or the lamina propria (P=.45), the amount (P=.80) and orientation (P=.07) of collagen, or the number of infiltrating lymphocytes (P=.70). CONCLUSION: Based on the histologic findings, all 3 topical anesthetic agents appear to cause equivalent changes to the TM when used for a myringotomy.

Uvulopalatopharyngoplasty versus sequential uvulopalatoplasty for surgical treatment of snoring.

Military personnel serving on active duty suffering from loud, bothersome snoring often require surgical treatment. This elective treatment should not disrupt the command and should have minimal impact on military readiness. Major drawbacks of the standard procedure, uvulopalatopharyngoplasty, include postoperative pain requiring convalescent leave, postoperative bleeding, and velopharyngeal incompetence. In addition, the surgery consumes limited operating room time for what many consider elective surgery. Sequential uvulopalatoplasty was developed as an alternative. This is performed with a carbon dioxide laser under local anesthesia in a clinic setting, but it requires cumbersome laser precautions and expensive laser equipment. Standard electrocautery can be used instead of a laser for this procedure. This avoids additional expense, special precautions, and equipment but is equally safe and effective. We compare time lost from work, duration and level of pain experienced, number of days until regular diet resumed, and effectiveness between uvulopalatopharyngoplasty and sequential uvulopalatoplasty. We found sequential uvulopalatoplasty to have less impact on military readiness while being as effective as uvulopalatopharyngoplasty for snoring. This makes it an ideal treatment modality for patients desiring surgical correction of snoring.

Electrocautery versus carbon dioxide laser for uvulopalatoplasty in the treatment of snoring.

Laser-assisted uvulopalatoplasty is a popular method for reducing snoring. Drawbacks are the large initial expense of the laser unit and related equipment and required safety precautions. The equipment required for electrocautery for cautery-assisted uvulopalatoplasty is significantly less expensive to obtain and operate compared with the carbon dioxide laser. Ninety-eight patients were randomly assigned to one of two treatment groups to undergo uvulopalatoplasty: one performed with the carbon dioxide laser and the other with electrocautery. We compared postoperative pain, time off work, efficacy, and the number of treatments required to achieve a satisfactory result. We found no statistically significant difference in any of these parameters between the two treatment groups (P > 0.05). Our data show that the use of the carbon dioxide laser offers no advantage over electrocautery in performing uvulopalatoplasty to treat snoring.