Otolaryngology - Head and Neck Surgery
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Topical treatment options in chronic rhinosinusitis (CRS) are growing with our increased understanding of the inflammatory process. Additives to irrigation devices have become popular. Additives such as menthol provide little more than sensory feedback. However, glucocorticosteroids and antibiotics represent powerful pharmaceutical agents for which we have little knowledge regarding patient exposure and absorption. There is little data on fluid retained after nasal irrigation. The purpose of this study was to determine the residual volume and percentage of total nasal irrigation that is retained from a neti pot (NasaFlo) or squeeze bottle (Sinus Rinse).
Cross‐sectional study.
Tertiary rhinologic clinic.
Patients with CRS were already using saline irrigation in their treatment. Participants were divided into pre and post sinus surgery (ESS). Control irrigations on 17 healthy patients with no sinonasal complaints were collected. Nasal irrigation was performed with accurate collection of the excess to determine retained amount.
Overall retention of fluid was 2.5 ± 1.6 percent. This represents only 5.8 ± 3.8 mL for the 240‐mL irrigations. Squeeze bottle and neti pot were similar: 2.3 ±1.3 percent and 3.0 ± 2.2 percent, respectively (
Quantification of the residual volume has important implications for the treatment of inflammatory disease with saline, as well as for potentially novel topical therapies. The information helps to define the fluid dynamics during nasal irrigation. The data are important to address concerns regarding drug or salt exposure from a very common intervention.
From 1989 to 1993, “Oye, Amigos!” a combined group of hearing health and other medical professionals performed 18 humanitarian medical and audiologic trips to Tepic, Nayarit, Mexico. The group saw 1500 patients, issued over 800 hearing aids, and performed 150 surgeries on 123 patients. Our tympanoplasty success rate, defined as an intact tympanic membrane, was 41% during the first 2 years of the project but increased to 74% during the last 3 years. Two hundred eighteen patients who were candidates for surgery did not return for care. We present the lessons learned from the surgical care and overall management of this project, and present suggestions to improve future projects.
To provide a description of surface electromyography (sEMG) of spontaneous saliva swallowing (SSS) and monitoring of swallow rate in patients with salivary gland diseases.
Numbers of SSS obtained during 2 hours of sEMG monitoring were compared with sialometry data for healthy volunteers (n = 100), patients with Sjögren syndrome (n = 10), and patients after parotid gland (n = 15) and submandibular gland (n = 16) surgery.
Normative: 1 SSS every 2 minutes and 15 seconds; Sjögren: 1 SSS every 13 minutes (
The established normal rate of SSS makes this modality applicable for evaluating salivary flow for potentially identifying and ruling out abnormalities. Parotid gland surgery does not significantly affect salivary flow rate. Sialometry combined with sEMG monitoring give a clinician more reliable data to evaluate salivary gland disorders than sialometry alone.
B‐2
We evaluated the method of stapedectomy and hearing results in patients who have 50% or more of the footplate covered by a prolapsed facial nerve.
We conducted a retrospective review of 1497 primary stapedectomies performed between 1986 and 1995.
Twenty‐eight patients had 50% or more of the oval window covered by a prolapsed facial nerve. Twenty‐three patients in this group had adequate follow‐up and their hearing results were compared with a matched control group of 50 patients with normal facial nerve anatomy. Also, facial nerve outcomes and any other complications are reported.
In the patient group with facial nerve prolapse, closure of the postoperative air‐bone gap to 10 dB or less was achieved in 19 of 23 (83%) ears and 16 of 20 (80%) ears at 6 months and 1 year, respectively. At 6 months and 1 year, the postoperative air‐bone gap in 47 of 50 (94%) ears and 40 of 43 (93%) ears in the control group had closed to 10 dB or less. The average postoperative air‐bone gap was 5.1 dB at 6 months and 6.8 dB at 1 year for the group with facial nerve prolapse. In comparison, the average postoperative air‐bone gap in the control group was 3.5 dB and 3.9 dB, respectively. The difference in the hearing results for the 2 groups was not statistically significant.
When the facial nerve covered at least 50% of the oval window, the poststapedectomy hearing results at 6 months and 1 year were similar to those of a matched control group of stapedectomy patients with a normal facial nerve course. There were no short‐ or long‐term facial nerve complications in either group. In light of these results, we conclude that stapedectomy in patients with significant facial nerve prolapse can be performed safely with good hearing results.
A new, minimally invasive registration method was developed for image‐guided otologic surgery. We utilized laser‐sintered template of the patient's bone surface to transfer the virtual markers to the patient's bone intraoperatively and eliminated the necessity for preoperative marker positioning or additional CT scan.
Simulation surgeries and clinical application.
We measured registration errors in 10 trials using replicas and six ear surgeries (two cochlear implant insertions, four translabyrinthine acoustic tumor removals).
The target registration errors varied among the surgical targets. Errors were less than 1 mm near the cochlear implant insertion target both in phantom study and in actual surgeries.
Our newly developed method reduced the preoperative procedures for patients but did not reduce the accuracy in cochlear implant surgery. Our method would be a useful image‐guided surgery method in the field of otology, where both accuracy and noninvasiveness are required.
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