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The Laryngoscope Aug 2013To describe the natural history of primary inner ear schwannomas (PIES) and evaluate management outcomes and relationship between PIES location, clinical presentation,... (Review)
Review
OBJECTIVES/HYPOTHESIS
To describe the natural history of primary inner ear schwannomas (PIES) and evaluate management outcomes and relationship between PIES location, clinical presentation, and time to diagnosis.
STUDY DESIGN
Retrospective chart review and systematic review of the literature.
METHODS
Vestibular schwannoma confined to or arising from the inner ear were included. PIES classification was based on anatomic subsite(s) involved. Detailed clinical history and outcomes were recorded.
RESULTS
In a systematic review (1933-2011), including 14 patients from the authors' institution (1999-2009), a total of 72 studies comprising 234 patients were evaluated. Mean follow-up was 32.8 ± 39.1 months (range, 0-183 months). The cochlea was the most commonly involved subsite (51%). Hearing loss was the most frequent presenting symptom (99%). Vertigo and abnormal balance were more common among tumors involving the vestibular system (P < .01). Average delay between symptom onset and diagnosis was 7.0 ± 8.0 years (median, 5 years; range, 0-40 years). Recent onset hearing loss was more likely to elicit an earlier diagnosis (P = .01). The majority of patients were observed without treatment (53%). Tumor progression was seen in 52% of patients.
CONCLUSIONS
PIES are rare tumors and most commonly involve the cochlea. Tumor location is often associated with clinical presentation and correlates with delay between symptom onset and diagnosis. A watch-and-scan approach is the management strategy of choice in the absence of intractable vertigo or extensive tumor growth. The majority of patients report stable or improved symptoms over time, regardless of treatment.
Topics: Adolescent; Adult; Aged; Cochlea; Ear Neoplasms; Ear, Inner; Female; Follow-Up Studies; Hearing Loss; Humans; Male; Middle Aged; Neurilemmoma; Retrospective Studies; Vertigo; Young Adult
PubMed: 23335152
DOI: 10.1002/lary.23928 -
Acta Otorhinolaryngologica Italica :... Jun 2014Traditional surgery for cholesteatoma of the middle ear is performed by microscopic approaches. However, in recent years endoscopic instrumentation, techniques and... (Review)
Review
Traditional surgery for cholesteatoma of the middle ear is performed by microscopic approaches. However, in recent years endoscopic instrumentation, techniques and knowledge have greatly improved, and in our opinion endoscopic surgical techniques will gain increasing importance in otologic surgery in the future. The aim of this study was to focus on outcomes obtained using endoscopic surgery for the treatment of middle ear cholesteatoma. A systematic review of the literature was performed. A total of 7 articles comprising 515 patients treated exclusively with endoscope or with a combined technique were found. During post-surgical follow-up, 48 (9.3%) patients showed a residual or recurrent pathology. Despite the small number of patients analyzed in our review, the outcomes of this technique appear to be promising. In particular, concerning the rates of recurrences and residual disease, endoscopic middle ear surgery appears to guarantee similar results in comparison to classic microscopic approaches with the advantage of performing minimally invasive surgery.
Topics: Cholesteatoma, Middle Ear; Endoscopy; Humans; Otologic Surgical Procedures; Treatment Outcome
PubMed: 24882923
DOI: No ID Found -
The Journal of Laryngology and Otology Aug 2015A systematic review was performed to evaluate the role and effectiveness of head bandages after routine elective middle-ear surgery. (Comparative Study)
Comparative Study Review
OBJECTIVE
A systematic review was performed to evaluate the role and effectiveness of head bandages after routine elective middle-ear surgery.
METHODS
Studies that compared the effectiveness of head bandage use after elective middle-ear surgery (e.g. myringoplasty, mastoidectomy and cochlear implantation) were identified using the following databases: Ovid Medline and Embase, the Ebsco collections, the Cochrane Library, PubMed, and Google Scholar. An initial search identified 71 articles. All titles and abstracts were reviewed. Thirteen relevant articles were inspected in more detail; of these, only five met the inclusion criteria. These included three randomised, controlled trials, one retrospective case series and one literature review.
RESULTS
The three randomised, controlled trials (level of evidence 1b) showed no statistically significant differences in post-operative outcomes (in terms of complications) associated with head bandage use in middle-ear surgery. This finding was supported by the retrospective case series involving patients undergoing cochlear implantation.
CONCLUSION
Current available evidence shows no advantage of head bandage use after middle-ear surgery. Head bandages may not be required after routine, uncomplicated middle-ear surgery.
Topics: Bandages; Cochlear Implantation; Ear, Middle; Elective Surgical Procedures; Humans; Mastoid; Myringoplasty; Postoperative Care; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 26134601
DOI: 10.1017/S0022215115001565 -
Facial Plastic Surgery : FPS Jun 2022Tear trough deformity is a popular target for the treatment with filler injections. The side effects are generally mild and transient. However, delayed complications may...
Tear trough deformity is a popular target for the treatment with filler injections. The side effects are generally mild and transient. However, delayed complications may occur. We aim to perform a thorough systematic review of the published literature related to delayed complications after tear trough filler injections. A search of published literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in June 2021 and included PubMed, ScienceDirect, and Embase databases. The Medical Subject Headings (MeSH) terms used included the following terms: delayed complications, nodules, granulomas, swelling, discoloration, dermal filler, hyaluronic acid (HA), polyacrylamide, calcium hydroxyapatite (CaHA), poly-L-lactic acid (PLLA), eyelid, periorbital, periocular, and tear trough. Twenty-eight articles consisting of 52 individual cases were included in the final analysis. 98% (51/52) of patients were female and had an average age of 48.3 years. HA was the most reported product (71.2%, 37/52), followed by PLLA (4/52, 7.7%), and CaHA (4/52, 7.7%). The most common delayed complication with any dermal filler was swelling (42.3%, 22/52) followed by lumps or nodules (25.0%, 13/52). Xanthelasma-like reaction (17.3%, 9/52), migration (7.7%, 4/52), discoloration (3%, 3/52) also occurred. The average time of onset of any complication was 16.8 months with xanthelasma-like reaction appearing soonest (mean: 10 months) and discoloration appearing latest (mean: 52 months). Most swelling cases were caused by HA. Semi-permanent fillers such as PMMA and synthetic fillers such as PLLA were more likely to be associated with lumps and nodules than other complications. It is important that clinicians who perform tear trough augmentation with dermal fillers have a thorough understanding of the risks of the procedure to diagnose and manage them promptly as well as provide patients with accurate information regarding the potential adverse effects.
Topics: Cosmetic Techniques; Dermal Fillers; Durapatite; Edema; Eyelids; Female; Humans; Hyaluronic Acid; Injections; Male; Middle Aged
PubMed: 34666405
DOI: 10.1055/s-0041-1736390 -
BMJ Clinical Evidence Sep 2007Changes in air pressure during flying can cause ear-drum pain and perforation, vertigo, and hearing loss. It has been estimated that 10% of adults and 22% of children... (Review)
Review
INTRODUCTION
Changes in air pressure during flying can cause ear-drum pain and perforation, vertigo, and hearing loss. It has been estimated that 10% of adults and 22% of children might have damage to the ear drum after a flight, although perforation is rare. Symptoms usually resolve spontaneously.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to prevent middle ear pain during air travel? We searched: Medline, Embase, The Cochrane Library and other important databases up to April 2007 (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 4 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: nasal balloon inflation, oral pseudoephedrine, and topical nasal decongestants.
Topics: Administration, Oral; Air Travel; Barotrauma; Ear, Middle; Earache; Humans; Incidence; Nasal Decongestants; Pain; Travel
PubMed: 19450303
DOI: No ID Found -
Journal of Oral and Maxillofacial... Feb 2019Otitis media with effusion and disturbed speech are highly prevalent in children after cleft palate repair. Although many techniques for palatal closure have been...
PURPOSE
Otitis media with effusion and disturbed speech are highly prevalent in children after cleft palate repair. Although many techniques for palatal closure have been described, no consensus has been reached on the most effective technique for these issues. The aim of this systematic review was to provide evidence-based information related to the effectiveness of different palatal closure techniques on middle ear and speech outcomes.
MATERIALS AND METHODS
A literature search in multiple electronic databases was performed: National Guidelines Clearinghouse, Trip Database, Cochrane Library, and Medline (PubMed). Potentially relevant articles were selected according to title and abstract and full-text eligibility. Then, quality control on the included articles was executed.
RESULTS
Twenty-three retrospective and prospective cohort studies were included in this systematic review. These studies compared at least 2 of the following techniques: von Langenbeck palatoplasty, 2-flap palatoplasty, Veau-Wardill-Kilner V-to-Y pushback technique, Kriens intravelar veloplasty, Sommerlad technique, Furlow double-opposing Z-plasties, and the Nadjmi modification of the Furlow palatoplasty. Their outcomes on the prevalence of otitis media with effusion, number of tympanostomy tubes placed, rates of hearing loss, and speech development were compared.
CONCLUSIONS
The Sommerlad and Furlow palatoplasties were associated with the lowest prevalence of otitis media with effusion and the smallest number tympanostomy tubes needed. For hearing outcomes, the Furlow palatoplasty generated the best audiometric outcome. For speech outcomes, the Sommerlad and Furlow palatoplasties were more beneficial than the 2-flap palatoplasty, the Veau-Wardill-Kilner V-to-Y pushback technique, and the von Langenbeck palatoplasty. Additional randomized controlled trials are recommended to obtain evidence that can support these findings.
Topics: Cleft Palate; Ear, Middle; Humans; Prospective Studies; Plastic Surgery Procedures; Retrospective Studies; Speech; Treatment Outcome
PubMed: 30367844
DOI: 10.1016/j.joms.2018.09.027 -
Otology & Neurotology : Official... Aug 2012To examine the safety and effectiveness of fully implantable middle ear devices in the treatment of hearing loss. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To examine the safety and effectiveness of fully implantable middle ear devices in the treatment of hearing loss.
DATA SOURCES
MEDLINE, EMBASE, The Cochrane Library, Web of Science, CINAHL, PsycINFO, and the Centre for Reviews and Dissemination were searched without date or language limits.
STUDY SELECTION
Titles and abstracts of 7,700 citations were screened, and 30 articles were selected for full review, of which, 7 articles on the Esteem and 13 on the Carina met the study's eligibility criteria.
DATA EXTRACTION
Information was extracted using a pretested data abstraction form, and study quality was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence.
DATA SYNTHESIS
Because of heterogeneity across studies, meta-analysis was not performed, and comparisons were made by structured review.
CONCLUSION
The majority of studies were quasi-experimental, prepost comparisons of aided and unaided conditions. Complication rates with the Esteem were higher than with the Carina, and most commonly included taste disturbance. However, device failure was common with the Carina, predominately related to charging difficulties. For both devices, clinically significant improvements in functional gain, speech reception, and speech recognition over the unaided condition were found. In studies comparing the Esteem or Carina to hearing aids, findings were mixed. Although improvements in functional gain were similar to those for hearing aids, speech recognition and quality of life were greater with the implants. Despite limited evidence, these devices seem to offer a relatively safe and effective treatment option, particularly for patients who are medically unable to wear conventional hearing aids.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Audiometry; Data Interpretation, Statistical; Evidence-Based Medicine; Female; Hearing Aids; Hearing Loss; Humans; Male; Middle Aged; Ossicular Prosthesis; Prosthesis Implantation; Quality of Life; Risk; Speech Perception; Speech Reception Threshold Test; Treatment Outcome; Young Adult
PubMed: 22772013
DOI: 10.1097/MAO.0b013e31825f230d -
Otology & Neurotology : Official... Aug 2014To systematically review the safety and efficacy of the 3 Food and Drug Administration-approved middle ear implant (MEI) systems currently in use for the rehabilitation... (Review)
Review
OBJECTIVE
To systematically review the safety and efficacy of the 3 Food and Drug Administration-approved middle ear implant (MEI) systems currently in use for the rehabilitation of sensorineural hearing loss.
DATA SOURCES
MEDLINE and Cochrane Library databases were systematically searched by 2 independent reviewers.
STUDY SELECTION
An initial search yielded 3,020 articles that were screened based on title and abstract. A full manuscript review of the remaining 80 articles was performed, of which 17 unique studies satisfied inclusion criteria and were evaluated.
DATA EXTRACTION
Variables including functional gain, speech recognition score improvement, audiometric threshold shift following surgery, adverse events, and patient reported outcome measures were recorded. Study quality was appraised according to author conflict of interest, prospective or retrospective study design, inclusion criteria, number of patients, proper use of study controls, outcome measures reported, length of follow-up, and level of evidence.
DATA SYNTHESIS
Heterogeneous outcome reporting precluded meta-analysis; instead a structured review was performed using best available data.
CONCLUSION
The majority of studies evaluating the safety and efficacy of MEIs are retrospective in nature with limited follow-up. To date, no prospective randomized controlled trial exists comparing contemporary air conduction hearing aid performance and MEI outcomes. Based on available data for patients with sensorineural hearing loss, functional gain and word recognition improvement seems similar between conventional hearing aids and MEIs, whereas patient-perceived outcome measures suggest that MEIs provide enhanced sound quality and eliminate occlusion effect.
Topics: Device Approval; Ear, Middle; Hearing Loss, Sensorineural; Humans; Ossicular Prosthesis; Retrospective Studies; United States; United States Food and Drug Administration
PubMed: 24643033
DOI: 10.1097/MAO.0000000000000341 -
Journal of Clinical Medicine Sep 2023Otolaryngological diagnoses, such as otitis media, are traditionally performed using endoscopy, wherein diagnostic accuracy can be subjective and vary among clinicians.... (Review)
Review
Otolaryngological diagnoses, such as otitis media, are traditionally performed using endoscopy, wherein diagnostic accuracy can be subjective and vary among clinicians. The integration of objective tools, like artificial intelligence (AI), could potentially improve the diagnostic process by minimizing the influence of subjective biases and variability. We systematically reviewed the AI techniques using medical imaging in otolaryngology. Relevant studies related to AI-assisted otitis media diagnosis were extracted from five databases: Google Scholar, PubMed, Medline, Embase, and IEEE Xplore, without date restrictions. Publications that did not relate to AI and otitis media diagnosis or did not utilize medical imaging were excluded. Of the 32identified studies, 26 used tympanic membrane images for classification, achieving an average diagnosis accuracy of 86% (range: 48.7-99.16%). Another three studies employed both segmentation and classification techniques, reporting an average diagnosis accuracy of 90.8% (range: 88.06-93.9%). These findings suggest that AI technologies hold promise for improving otitis media diagnosis, offering benefits for telemedicine and primary care settings due to their high diagnostic accuracy. However, to ensure patient safety and optimal outcomes, further improvements in diagnostic performance are necessary.
PubMed: 37762772
DOI: 10.3390/jcm12185831 -
BMJ Clinical Evidence May 2011In the UK, about 30% of children under 3 years of age visit their GP each year with acute otitis media (AOM), and 97% of these receive antibiotics. In the US, AOM is the... (Review)
Review
INTRODUCTION
In the UK, about 30% of children under 3 years of age visit their GP each year with acute otitis media (AOM), and 97% of these receive antibiotics. In the US, AOM is the most common reason for outpatient antibiotic treatment. Without antibiotics, AOM resolves within 24 hours in about 60% of children, and within 3 days in about 80% of children.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for AOM in children; and what are the effects of interventions to prevent recurrence? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2010 (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: analgesics, antibiotics, delayed antibiotics, immediate antibiotics, long-term antibiotic prophylaxis, longer courses of antibiotics, myringotomy, pneumococcal vaccination, tympanostomy with ventilation tubes, xylitol syrup or gum, and influenza vaccination.
Topics: Acute Disease; Administration, Oral; Anti-Bacterial Agents; Child; Evidence-Based Medicine; Humans; Middle Ear Ventilation; Otitis Media; Recurrence; Xylitol
PubMed: 21554768
DOI: No ID Found