Development of a novel biodegradable drug-eluting ventilation tube for chronic otitis media with effusion.

OBJECTIVES/HYPOTHESIS: To develop a novel drug-eluting biodegradable ventilation tube (VT), to evaluate in vitro sustained release and antibacterial adherence of ofloxacin-loaded biodegradable VT on Pseudomonas aeruginosa, and to evaluate in vivo biodegradation of VT in guinea pig ears. STUDY DESIGN: A randomized animal study. METHODS: In vitro drug release and degradation of ofloxacin-loaded VT were studied in water for 3 months. Bacterial adherence was evaluated by inoculating the VT with P aeruginosa suspension for 6 days. Scanning electron microscopy (SEM) was used for morphologic analysis. Guinea pigs were assigned to three groups: commercial Mini Shah VT, biodegradable unloaded VT, and biodegradable ofloxacin-loaded VT. Myringotomy and VT insertion were performed. SEM of VTs and histology were performed at 2, 4, 10, and 18 weeks. RESULTS: A total of 81.7% of ofloxacin in VT was eluted over 3 months. Biodegradable VTs had smoother surfaces and less bacteria adherence compared to Mini Shah VTs. VTs with ofloxacin had the least bacteria adherence. VTs resulted in neither inflammation nor otorrhea 18 weeks postinsertion in guinea pigs. Histology showed the new VTs were biocompatible. The VTs were still functioning and patent after 18 weeks postinsertion but had started degrading. CONCLUSIONS: The first novel biodegradable ofloxacin-loaded VT with sustainable drug release technology and antibacterial adherence property was studied. Patency beyond 4.5 months allowed an adequate period of ventilation. The complete degradation of the VT warrants further studies to evaluate the duration of VT resorption in situ and healing of the ear drum.

Vibrant Soundbridge middle ear implantations: experience at National University Hospital Singapore.

Vibrant Soundbridge (VSB) has been recommended for both adults and children with all types of hearing loss. The aim of this study was to evaluate the objective and subjective benefits with VSB and the difference in benefits for patients with different types of hearing loss. A retrospective case review was conducted on seven consecutive patients who had received VSB implantations at the National University Hospital of Singapore from March 2006 to November 2009. Patients were divided into the Sensorineural Hearing Loss (SNHL) Group and Conductive Hearing Loss (CHL)/Mixed Hearing Loss (MHL) Group. Surgical complications were evaluated, and objective and subjective results were compared between the two groups. No major complications were observed during the follow-up of up to 4 years. Greater objective and subjective benefits were observed in the CHL/MHL Group. Subjective benefits were consistent with objective improvements. Pre-operative counseling for realistic expectations is important, especially for patients with SNHL.

Simultaneous Vibrant Soundbridge Implantation and 2nd Stage Auricular Reconstruction for Microtia with Aural Atresia.

Aural atresia and severe microtia are associated malformations that result in problems with hearing and cosmesis, associated speech and language difficulties and diminished self-esteem. In cases where middle ear ossiculoplasty and aural atresia canalplasty are expected to give poor hearing outcomes that would eventually require the use of hearing aids, bone anchored hearing aids or active middle ear implants may be better options. This case report describes a simultaneous Vibrant Soundbridge implantation and 2(nd) stage auricular reconstruction with rib graft cartilage for an 11-year-old boy with grade III microtia and aural atresia 8 months after the 1(st) stage reconstruction. Audiometric results of the Vibrant Soundbridge aided ear were comparable to that of the contralateral hearing aid aided ear.

Pseudocyst of the auricle: a histologic perspective.

OBJECTIVE: The aim of the study is to describe the histologic spectrum in the pseudocyst of the auricle and to identify any consistent histologic features of this condition. STUDY DESIGN: A prospective study was performed in which the tissue specimen from patients with pseudocyst of the auricle treated at the Department of Otolaryngology, Singapore General Hospital during a 1-year period was sent for histology. METHODS: Consecutive patients with pseudocyst of the auricle who were treated had their tissue specimen sent for histology. These specimens were independently reviewed by one consultant pathologist. RESULTS: All 16 specimens revealed an intracartilaginous cyst devoid of epithelial lining. Interestingly, there were consistent perivascular mononuclear infiltrates of lymphocytes evident in the connective tissue layer just superficial to the anterior segment of the cartilage. CONCLUSION: Pseudocyst of the auricle is a benign condition predominantly affecting young Asian males. Histology characteristically reveals an intracartilaginous cyst devoid of epithelial lining, and there are no pathognomonic features. We postulate that an inflammatory response is crucial to the development of this condition on the basis of a consistent perivascular inflammatory response seen in all our specimens.

Parotid gland surgery: 4-year review of 118 cases in an Asian population.

BACKGROUND: To determine the presentation and management of parotid lesions requiring excision in a largely Chinese Asian population. METHODS: Retrospective study of 118 consecutive parotidectomies. RESULTS: Thirty-seven percent were Warthin's tumor (WT), 33% pleomorphic adenoma (PA), 21% other benign disease (OBD), and 9% malignant tumor (MT). Mean age was significantly different between benign (51 years) and malignant (40 years) lesions. MT decreased above 50 years, but increased five times with pain and two times with a noninferior pole lesion. Sensitivity of fine-needle aspiration (FNA) for differentiating benign from MT = 78%, for WT =5 8%, for PA =82%, for OBD = 28%, and for MT = 38%. CT scans did not alter WT management. Facial nerve (FN) paresis was not associated with histology, tumor size, site, or parotidectomy type. CONCLUSIONS: This is the first report documenting that most benign parotid tumors are WT and not PA. MT risk is greater in those less than 50 with pain and a noninferior pole lesion. Cystic lesions such as WT require great care in the evaluation of FNA findings.