Is Hospitalization Necessary after Ear Surgery? A National Survey and Retrospective Review of Postoperative Events.

Objective First, to survey our national otolaryngology colleagues on their postoperative care habits (hospitalization vs day surgery) after elective middle ear surgery. Second, to evaluate the necessity of hospitalization and safety of day surgery after these procedures. Methods A national survey regarding postoperative habits after elective middle ear surgery was launched. Then, the cases of all patients having undergone these surgical procedures at our center between 2010 and 2016 were reviewed. They were divided into 2 groups: hospitalization and day surgery. Postoperative events during hospitalization and rate of consultation/readmission for day surgery were recorded. Results Heterogeneity in postoperative habits for most elective otologic surgery exists among otolaryngologists. For tympanoplasty, however, day surgery was uniformly favored. At our institution, 88.6% of hospitalization patients had no complications during their stay. Complications noted for others were nausea (7.2%), bleeding (3.1%), hematoma (0.5%), and sensorineural hearing loss (0.5%). In the day surgery group, 3.0% consulted within 48 hours following their procedure, and the readmission rate was 1.3%. Nausea was the only cause for readmission, and stapes surgery accounted for 100% of readmissions. Discussion Most elective middle ear surgery can be safely performed as day care. Hospitalization does not provide care that could not have been provided at home in the majority of cases. Overnight hospital stay may be considered for stapes surgery. Implications for Practice Day surgery for elective middle ear surgery is sufficient for most cases. Transferring these cases to day care should lower costs to our health care system and increase bed availability.

Mental practice in postgraduate training: a randomized controlled trial in mastoidectomy skills.

BACKGROUND: Mental practice, the cognitive rehearsal of a task in the absence of overt physical movement, has been successfully used in teaching complex psychomotor tasks including sports and music, and recently, surgical skills. The objectives of this study were, 1) To develop and evaluate a mental practice protocol for mastoidectomy 2) To assess the immediate impact of mental practice on a mastoidectomy surgical task among senior Otolaryngology─Head & Neck Surgery (OHNS) residents. METHOD: Three expert surgeons were interviewed using verbal protocol analysis to develop a mastoidectomy mental practice script. Twelve senior Residents from Canadian training programs were randomized into two groups. All Residents were video-recorded performing a baseline mastoidectomy in a temporal bone lab. The intervention group received mental practice training, while the control group undertook self-directed textbook study. All subjects were then video-recorded performing a second mastoidectomy. Changes in pre- and post-test scores using validated expert ratings, the Task Specific Evaluation of Mastoidectomy and the Global Evaluation of Mastoidectomy, were statistically analyzed. RESULTS: A mental practice script was successfully developed based on interviews of three expert surgeon-educators. Task Specific Evaluation and Global Evaluation scores increased in both the mental practice and textbook study groups; there was no significant difference between the two groups in the change in scores post-intervention. There was a high and statistically signficant correlation between evaluators on the outcome measures. CONCLUSIONS: We were not able to demonstrate a significant difference for the benefits of mental practice in mastoidectomy, possibly due to the sample size. However, mental practice is a surgical education tool which is portable, accessible, inexpensive and safe.

Tinnitus.

INTRODUCTION: Up to 18% of people in industrialised societies are mildly affected by chronic tinnitus, and 0.5% report tinnitus having a severe effect on their daily life. Tinnitus can be associated with hearing loss, acoustic neuromas, drug toxicity, ear diseases, and depression. Tinnitus can last for many years, and can interfere with sleep and concentration. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for chronic tinnitus? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 33 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acamprosate, acupuncture, antidepressant drugs, benzodiazepines, carbamazepine, electromagnetic stimulation, ginkgo biloba, hearing aids, hypnosis, psychotherapy, tinnitus-masking devices, and cognitive behavioural therapy plus tinnitus-masking device (tinnitus retraining therapy).

Effects of tensor tympani muscle contraction on the middle ear and markers of a contracted muscle.

OBJECTIVES/HYPOTHESIS: Many otologic disorders have been attributed to dysfunction of the tensor tympani muscle, including tinnitus, otalgia, Meniere's disease and sensorineural hearing loss. The objective of this study was to determine adequate stimuli for tensor tympani contraction in humans and determine markers of the hypercontracted state that could be used to detect this process in otologic disease. STUDY DESIGN: Multiple types of studies. METHODS: Studies included 1) measuring middle ear impedance changes in response to orbital puffs of air, facial stroking, and self-vocalization; 2) measuring changes in stapes and eardrum vibrations and middle ear acoustic impedance in response to force loading of the tensor tympani in fresh human cadaveric temporal bones; 3) measuring changes in acoustic impedance in two subjects who could voluntarily contract their tensor tympani, and performing an audiogram with the muscle contracted in one of these subjects; and 4) developing a lumped parameter computer model of the middle ear while simulating various levels of tensor tympani contraction. RESULTS: Orbital jets of air are the most effective stimuli for eliciting tensor tympani contraction. As markers for tensor tympani contraction, all investigations indicate that tensor tympani hypercontraction should result in a low-frequency hearing loss, predominantly conductive, with a decrease in middle ear compliance. CONCLUSIONS: These markers should be searched for in otologic pathology states where the tensor tympani is suspected of being hypercontracted.

Listening to the cochlea with high-frequency ultrasound.

We have developed a high-frequency pulsed-wave Doppler ultrasound probe as a promising minimally-invasive technique for measuring intracochlear mechanics without damaging the cochlea. Using a custom high-frequency ultrasound system, we have measured dynamic motion of intracochlear structures by recording the pulsed-wave Doppler signal resulting from the vibration of the basilar and round window membranes. A 45 MHz needle-mounted Doppler probe was fabricated and placed against the round window membranes of eight different fresh human temporal bones. Pulsed-wave ultrasonic Doppler measurements were performed on the basilar membrane and round window membrane during the application of pure tones to the external ear canal. Doppler vibrational information for acoustic input frequencies ranging from 100-2000 Hz was collected and normalized to the sound pressure in the ear canal. The middle ear resonance, located at approximately 1000 Hz, could be characterized from the membrane velocities, which agreed well with literature values. The maximum normalized mean velocity of the round window and the basilar membrane were 180 µm/s/Pa and 27 µm/s/Pa at 800 Hz. The mean phase difference between the membrane displacements and the applied ear canal sound pressure showed a flat response almost up to 500 Hz where it began to accumulate. This is the first study that reports the application of high frequency pulsed wave Doppler ultrasound for measuring the vibration of basilar membrane through the round window. Since it is not required to open or damage the cochlea, this technique might be applicable for investigating cochlear dynamics, in vivo.

The role of vestibular caloric tests in cochlear implantation.

OBJECTIVE: Vestibular function tests are often undertaken before cochlear implantation, in part to help select the side of surgery. The authors aim to determine whether implantation on the side of better vestibular function leads to greater perception of dizziness by patients than implantation on the side of worse or similar function. STUDY DESIGN: Historical cohort study. SETTING: Tertiary cochlear implantation center. SUBJECTS AND METHODS: The records of 177 adult recipients of a unilateral cochlear implant were reviewed retrospectively in 2 groups. Group A included patients with an implant in the ear with worse or similar caloric responses. Group B included patients with an implant in the ear with the stronger caloric response. All patients underwent preoperative bithermal caloric testing: a clinically significant difference was defined by a 20% lateral canal paresis. They were assessed postoperatively by the Dizziness Handicap Inventory and supplementary questions. RESULTS: Fifty-seven percent of both groups reported dizziness in the first 7 days postoperatively. At 2 months, 20% of group A and 34% of group B experienced some dizziness. Fourteen percent of group A and 10% of group B felt that cochlear implantation had resulted in impaired balance. The Dizziness Handicap Inventory scores of 86% of group A (median score 0) and 76% of group B (median score 10) corresponded with low handicap. None of these results differed significantly between groups A and B. CONCLUSION: Although cochlear implantation may result in dizziness, it is almost always short-lived and mild, even when the ear with the stronger caloric response is implanted.

Tinnitus.

INTRODUCTION: Up to 18% of people in industrialised societies are mildly affected by chronic tinnitus, and 0.5% report tinnitus having a severe effect on their daily life. Tinnitus can be associated with hearing loss, acoustic neuromas, drug toxicity, ear diseases, and depression. Tinnitus can last for many years, and can interfere with sleep and concentration. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for chronic tinnitus? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 29 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acamprosate, acupuncture, antidepressant drugs, benzodiazepines, carbamazepine, cinnarizine, electromagnetic stimulation, ginkgo biloba, hearing aids, hypnosis, psychotherapy, tinnitus-masking devices, and tinnitus retraining therapy.

Tinnitus.

INTRODUCTION: Up to 18% of people in industrialised societies are mildly affected by chronic tinnitus, and 0.5% report tinnitus having a severe effect on their daily life. Tinnitus can be associated with hearing loss, acoustic neuromas, drug toxicity, ear diseases, and depression. Tinnitus can last for many years, and can interfere with sleep and concentration. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for chronic tinnitus? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 27 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acamprosate; acupuncture; antidepressant drugs; benzodiazepines; carbamazepine; cinnarizine; electromagnetic stimulation; ginkgo biloba; hearing aids; hypnosis; psychotherapy; tinnitus-masking devices; and tinnitus retraining therapy.

Tinnitus.

INTRODUCTION: Up to 18% of people in industrialised societies have mild tinnitus, which severely affects daily life in 0.5% of people. Tinnitus can be associated with hearing loss, acoustic neuromas, drug toxicity, ear diseases, and depression. Tinnitus can last for many years, and can interfere with sleep and concentration. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for chronic tinnitus? We searched: Medline, Embase, The Cochrane Library and other important databases up to December 2006. (BMJ Clinical evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 37 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: acamprosate, acupuncture, antidepressant drugs, baclofen, benzodiazepines, carbamazepine, cinnarizine, ear-canal magnets, electromagnetic stimulation, ginkgo biloba, hearing aids, hyperbaric oxygen, hypnosis, lamotrigine, nicotinamide, psychotherapy, tinnitus-masking devices, tinnitus retraining therapy, zinc.

Allergic rhinitis: an update.

Allergic rhinitis is extremely common and a global health problem. One study has quoted a prevalence of 16% and, as with asthma, it seems to be increasing. This increase and association with asthma have raised concerns about appropriate treatment. Fortunately, with new knowledge of the pathophysioLogic mechanisms, newer and better treatment strategies have been developed. This short review of allergic rhinitis highlights its prevalence, pathophysiology, clinical presentation, investigation and management. A new classification and recommendations by the World Health Organization's guidelines 'Allergic Rhinitis and its Impact on Asthma' are also discussed.

An alternative to a postnasal pack for the arrest of perioperative hemorrhage following curettage adenoidectomy.

Controlling bleeding with standard postnasal packing following curettage adenoidectomy is only occasionally warranted. Children find the packing experience unpleasant, and removal of the packing usually requires general anesthesia. We describe a simple technique for packing the nasopharynx with bilateral nasal tampons via an anterior approach. The tampons are much easier to insert than standard packing, they are well tolerated while in place, and they can be easily removed with perhaps only some light sedation rather than general anesthesia.

Fish bones in the vallecula and tongue base: removal with the rigid nasal endoscope.

The tongue base and vallecula are common anatomical sites for impaction of inadvertently swallowed fish bones. Many techniques for their removal have been described but this apparently simple procedure can still pose a surgical challenge. We describe a previously unreported technique using rigid endoscopy with the 4 mm 30 degree Hopkins' rod as a visual aid for transoral removal of the impacted bone. The technique has proved to be very well tolerated by the patient and more acceptable in terms of morbidity, time and resources than either flexible endoscopy or rigid endoscopy under general anaesthetic.