Drains in thyroid and parathyroid surgery. Are they necessary?

OBJECTIVE: To assess the postoperative complications in patients who underwent elective thyroid or parathyroid surgery without postoperative drainage. DESIGN: During a 6-year period all patients who met study criteria were prospectively evaluated. SETTING: General community and tertiary referral center. PATIENTS: Fifty-seven patients undergoing thyroid surgery and eight patients undergoing parathyroid surgery were evaluated. Twenty-four patients were excluded because drains were placed postoperatively. Reasons for exclusion included presence of a large dead space, substernal goiter, extensive neck dissection for malignant neoplasm, and large goiters. RESULTS: Major complications consisted of a hematoma requiring reexploration in one patient, and a recurrent nerve palsy in one patient. Minor complications consisted of temporary hypocalcemia (three), seroma (one), and superior flap edema that resolved in 3 months (20). CONCLUSION: Routine prophylactic drainage in a select patient population is unnecessary after uncomplicated thyroid or parathyroid surgery.

Correlation between the American Academy of Otolaryngology-Head and Neck Surgery five-minute hearing test and standard audiologic data.

The American Academy of Otolaryngology-Head and Neck Surgery recently developed a questionnaire called the "Five-Minute Hearing Test" and distributed it to many primary care physicians. Our literature review suggests that the test characteristics (i.e., sensitivity and specificity) of this screening instrument have not been published. The purpose of this study was to examine the validity of the test by correlating the "Five-Minute Hearing Test" results to various audiologic results obtained for the same patients and to analyze the test characteristics with pure-tone measures as a standard criterion. An original version of the "Five-Minute Hearing Test" was administered to 70 patients older than 55 years, and a revised version of the test was administered to additional 74 elderly patients. The "Five-Minute Hearing Test" scores in both original and revised versions significantly correlated with all audiologic measures, especially with the pure-tone measures. However, the American Academy of Otolaryngology-Head and Neck Surgery's recommended cutoff score for a referral yielded a high false-positive rate. If the cutoff score were changed, the "Five-Minute Hearing Test" would be a reliable hearing screening tool for identification of hearing loss among the elderly population. Specific recommendations include adjustment of the cutoff score to at least 15 and revision of a few selected test items.

Intracranial pressure changes during bilateral radical neck dissections.

The management of the contralateral neck in patients with head and neck cancer who have undergone a radical neck dissection (RND) is controversial. A number of these patients will require a second RND. Sacrifice of both internal jugular veins (IJV) has been felt to lead to increased intracranial pressure (ICP) with subsequent neurologic sequelae. From 1987 to 1991 four patients had staged bilateral RNDs at the West Virginia University. In these patients a subarachnoid bolt was placed to directly monitor ICP. Jugular bulb, mean arterial, pulmonary artery, and central venous pressures were monitored. Electroencephalographic (EEG) monitoring was also performed. All patients demonstrated elevations in ICP immediately on head rotation. Further marked elevations were noted immediately after IJV ligation with a maximum peak at 30 minutes. Pressure levels of greater than 40 mm Hg were observed in three of four patients. Systemic hypertension was observed in response to elevated ICP (Cushing's reflex). All patients studied recovered from surgery without significant sequelae. Within 24 hours the ICP had returned to normal in all patients. Three patients required intraoperative intervention to lower their ICP. We demonstrate that even in a staged second RND there are significant rises in ICP. These are to a level that suggests emergency medical intervention is required. We feel that when the second IJV is sacrificed an increase in ICP should be anticipated, monitored, and treated accordingly.