-
Medicina (Kaunas, Lithuania) Jun 2023: Postoperative nausea and vomiting (PONV) is a common adverse effect of general anesthesia, especially in middle ear surgery. Remimazolam is a newer benzodiazepine... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of Postoperative Nausea and Vomiting Incidence between Remimazolam and Sevoflurane in Tympanoplasty with Mastoidectomy: A Single-Center, Double-Blind, Randomized Controlled Trial.
: Postoperative nausea and vomiting (PONV) is a common adverse effect of general anesthesia, especially in middle ear surgery. Remimazolam is a newer benzodiazepine recently approved for use in general anesthesia. This study aimed to compare the incidence rate of PONV after tympanoplasty with mastoidectomy between using remimazolam and sevoflurane. : This study included 80 patients undergoing elective tympanoplasty with mastoidectomy. The patients were randomly assigned to either the remimazolam or sevoflurane group. The primary outcome was the incidence rate of PONV 12 h after surgery. The secondary outcomes were the incidence rate of PONV 12-24 and 24-48 h after surgery, severity of PONV, incidence rate of vomiting, administration of rescue antiemetics, hemodynamic stability, and recovery profiles. : The incidence rate of PONV 0-12 h after tympanoplasty with mastoidectomy was significantly lower in the remimazolam group compared with that in the sevoflurane group (28.9 vs. 57.9%; = 0.011). However, the incidence rate of delayed PONV did not differ between the two groups. PONV severity in the early periods after the surgery was significantly lower in the remimazolam group than in the sevoflurane group. The incidence rate of adverse hemodynamic events was lower in the remimazolam group than in the sevoflurane group, but there was no difference in the overall trends of hemodynamic data between the two groups. There was no difference in recovery profiles between the two groups. : Remimazolam can significantly reduce the incidence rate of early PONV after tympanoplasty with mastoidectomy under general anesthesia.
Topics: Humans; Postoperative Nausea and Vomiting; Sevoflurane; Incidence; Tympanoplasty; Mastoidectomy; Benzodiazepines; Double-Blind Method
PubMed: 37512009
DOI: 10.3390/medicina59071197 -
European Archives of... Feb 2024The opportunities for surgical training and practice in the operating room are in decline due to limited resources, increased efficiency demands, growing complexity of... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
The opportunities for surgical training and practice in the operating room are in decline due to limited resources, increased efficiency demands, growing complexity of the cases, and concerns for patient safety. Virtual reality (VR) offers a novel opportunity to enhance surgical training and provide complementary three-dimensional experience that has been usually available in the operating room. Since VR allows viewing and manipulation of realistic 3D models, the VR environment could enhance anatomical and topographical knowledge, in particular. In this study, we explored whether incorporating VR anatomy training improves novices' performance during mastoidectomy over traditional methods.
METHODS
Thirty medical students were randomized into two groups and taught mastoidectomy in a structured manner. One group utilized a VR temporal bone model during the training while the other group used more traditional materials such as anatomy books. After the training, all participants completed a mastoidectomy on a 3D-printed temporal bone model under expert supervision. Performance during the mastoidectomy was evaluated with multiple metrics and feedback regarding the two training methods was gathered from the participants.
RESULTS
The VR training method was rated better by the participants, and they also needed less guidance during the mastoidectomy. There were no significant differences in operational time, the occurrence of injuries, self-assessment scores, and the surgical outcome between the two groups.
CONCLUSION
Our results support the utilization of VR training in complete novices as it has higher trainee satisfaction and leads to at least as good results as the more traditional methods.
Topics: Humans; Mastoidectomy; Prospective Studies; Otolaryngology; Simulation Training; Clinical Competence; Virtual Reality
PubMed: 37505263
DOI: 10.1007/s00405-023-08143-1 -
Ear, Nose, & Throat Journal Jul 2023The clinical diagnosis and treatment, including information such as age, history, clinical symptoms, signs, audiology, imaging examination, mode of operation, and...
The clinical diagnosis and treatment, including information such as age, history, clinical symptoms, signs, audiology, imaging examination, mode of operation, and postoperative follow-up, of a patient with suppurative temporomandibular arthritis caused by chronic suppurative otitis media were analyzed. As conservative drug treatment and drainage surgery were ineffective, the patient was treated with microscopic open radical mastoidectomy, tympanoplasty, the plasty of the cavity of auricular concha, facial nerve decompression, coarctation of the mastoid cavity combined with otoendoscpic resection of the lower temporomandibular lesions, and standard anti-inflammatory treatment after surgery. The patient appeared to be cured at the 3-month follow-up. The ear canal was dry, without any preauricular swelling, purulent ear discharge, otalgia, limitation of mouth opening, or other symptoms. A clear diagnosis by defining the scope of the lesions, analysis of the transmission route of the lesions, and standard conservative treatment, local drainage, and surgical resection, if necessary, are recommended for patients with suppurative temporomandibular arthritis.
PubMed: 37491883
DOI: 10.1177/01455613231185020 -
Otology & Neurotology : Official... Sep 2023To compare the three-dimensional (3D) footswitch-operated robotic arm exoscope with the operating microscope (OM) in cochlear implant surgery.
OBJECTIVE
To compare the three-dimensional (3D) footswitch-operated robotic arm exoscope with the operating microscope (OM) in cochlear implant surgery.
STUDY DESIGN
Matched case-control study.
PATIENTS
Cochlear implantation was performed with the exoscope on unselected patients with normal temporal anatomy. The control group that underwent cochlear implantation with the OM was case matched with respect to age, anatomy, surgical technique, and type of anesthesia.
INTERVENTIONS
Cochlear implantation performed with the 3D exoscope.
MAIN OUTCOME MEASURES
Surgical time, occupation of the operation theater, surgical results, and user experience evaluated by a questionnaire.
RESULTS
Eleven patients (13 ears) were successfully operated on with the exoscope. In the exoscope group, we observed one minor intraoperative complication, where the middle dura was exposed during mastoidectomy. Although no clear preference was evident for either device in the overall rating, the subdomain rating revealed that the exoscope's image quality was deemed inferior, especially at higher magnifications where pixelation became noticeable. The exoscope received higher scores for usability, particularly excelling in terms of surgeon's ergonomic and comfortability. There was a statistically significant difference in mean surgical time, 146 and 129 min for the exoscope and OM group, respectively.
CONCLUSIONS
Cochlear implant surgery was found to be feasible with a 3D exoscope. However, there is a learning curve to overcome regarding handling and the different quality of the image. The exoscope provides better ergonomics for the surgeon.
Topics: Humans; Cochlear Implantation; Cochlear Implants; Case-Control Studies; Feasibility Studies; Robotic Surgical Procedures; Neurosurgical Procedures
PubMed: 37464472
DOI: 10.1097/MAO.0000000000003952 -
Journal of Clinical Medicine Jun 2023Bone conduction implants (BCIs) and middle ear implants (MEIs) are promising options for individuals with persistent chronic inflammation of the middle or outer ear....
Bone conduction implants (BCIs) and middle ear implants (MEIs) are promising options for individuals with persistent chronic inflammation of the middle or outer ear. However, the structure of the middle ear is often altered in patients who undergo mastoidectomy or posterior wall removal for refractory otitis media, leaving uncertainty regarding the efficacy of hearing devices. Only a few studies have examined auditory outcomes based on the etiology of hearing impairment. We investigated hearing outcomes, including speech audiometry, in patients who underwent implantation after surgery for refractory otitis media. Our findings indicated that patients who received BCIs or MEIs achieved favorable hearing outcomes. Furthermore, a correlation was observed between the preoperative bone-conduction threshold at 1 kHz in the better ear and the sound-field threshold at 1 kHz with BCIs, whereas no correlation was observed between the preoperative bone-conduction threshold and the sound-field threshold with MEIs. This study highlights the positive impact of BCIs and MEIs in patients who undergo implantation after surgery for refractory otitis media. Additionally, our study identified parameters that predict postoperative efficacy.
PubMed: 37373778
DOI: 10.3390/jcm12124086 -
BMC Surgery Jun 2023This clinical study was performed to analyze the characteristics of cholesterol granuloma (CG) and evaluate our results in children.
OBJECTIVE(S)
This clinical study was performed to analyze the characteristics of cholesterol granuloma (CG) and evaluate our results in children.
METHODS
The clinical records of children diagnosed with CG were retrospectively reviewed.
RESULTS
The total of 17 children (20 ears) with CGs were included in this study. Endoscopy revealed pars flaccida retractions and lipoid tissue deposition behind the intact blue tympanic membrane (TM). CT scan revealed bony erosion and extensive soft tissue in the middle ear and mastoid. No ossicular chain destruction was found. All 20 ears underwent canal wall-up mastoidectomy and ventilation tube (VT) insertion, 3 sets of VT were performed in 5 ear and 2 sets in one. The residual perforation was seen in 2 ears following VT. The CT revealed well-pneumatized antra and tympanic cavities at postoperative 12-24 months.
CONCLUSION(S)
The CG should be suspected for the patients with yellow lipoid deposition behind the blue TM. CT of CG usually revealed bony erosion and extensive soft tissue in the middle ear and mastoid. Mastoidectomy combined with VT insertion and etiological treatment have a favorable prognosis for CG in children.
Topics: Humans; Child; Retrospective Studies; Tympanic Membrane; Ear, Middle; Granuloma; Cholesterol
PubMed: 37312115
DOI: 10.1186/s12893-023-02069-5 -
Indian Journal of Otolaryngology and... Jun 2023To provide a systematic review on the use of additional anticoagulation in the management of otogenic sigmoid sinus thrombosis when compared with the cohort not...
To provide a systematic review on the use of additional anticoagulation in the management of otogenic sigmoid sinus thrombosis when compared with the cohort not receiving the anticoagulation. A systematic review until 2021 was done and relevant studies were screened. Based on a selective criteria, a database is constituted which were then rearranged and studied. 16 articles were selected with 113 patients. The group who received anticoagulation had more complications (23.33%) in comparison (21.74%), whereas the recanalization was successful in the anticoagulated group, 76.67%, as against 39.13%. In 74/90 patients who underwent mastoidectomy with anticoagulation, the recanalization and complication were 72.97% and 25.68% respectively. The second group with 16/90 patients who received conservative treatment, the recanalization and complication rates were 93.75% and 12.50% respectively. The third group with 23 patients were treated with mastoidectomy and antibiotics but didn't receive anticoagulants in which the recanalization achieved in 39.13% with a complication rate of 21.74%. For those patients who underwent mastoidectomy with concurrent anticoagulation, 44 showed radiological evidence of recanalization, and in sixteen patients that received the same treatment, no recanalization was achieved whereas in patients who received conservative treatment with anticoagulation, 12 patients showed recanalization and finally, for the patients underwent surgery without anticoagulation, five patients achieved recanalization and 7 did not become recanalized (14.29%). Recanalization seems more pronounced in those who were anticoagulated, but, did not seem to influence the clinical outcome. Complications were more in those who were undergone surgery with or without anticoagulation.
PubMed: 37275038
DOI: 10.1007/s12070-022-03289-6 -
Revista Espanola de Quimioterapia :... Oct 2023Tuberculous otitis media (TOM) is a rare affectation in our environment that represents a challenge in its diagnosis due to the non-specific symptoms that it usually... (Review)
Review
Tuberculous otitis media (TOM) is a rare affectation in our environment that represents a challenge in its diagnosis due to the non-specific symptoms that it usually presents. This paper presents our experience in the diagnosis of a case of TOM in a 66-year-old woman with hearing loss and chronic otorrhea of more than 6 months of evolution that did not respond to conventional treatments. In addition, a review of the cases published in the last 20 years (2000-2022) in countries of the European Union (EU) is carried out. The most common symptoms were otorrhea (n=43; 100%), hearing loss (n=37; 86.05%), eardrum perforation (n=19; 44.18%), facial paralysis (n=12, 27,91%) and ear pain (n=13; 30,23%). The most used sample for diagnosis was the biopsy obtained by mastoidectomy (n=34; 79.06%). All patients were given antituberculous therapy for a mean duration of 8.11 months (range, 6-12 months). The most frequent aftereffect was hearing loss (n=28; 65.12%). TOM should be included in the differential diagnosis of chronic suppurative otitis, since early diagnosis and treatment reduce the probability of suffering irreversible sequelae.
Topics: Female; Humans; Aged; Tuberculosis; Otitis Media; Facial Paralysis
PubMed: 37265448
DOI: 10.37201/req/011.2023