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Otolaryngology--head and Neck Surgery :... Dec 2016Despite evidence that therapeutic mastoidectomy does not improve outcomes in noncholesteatomatous chronic otitis media, it remains widely performed. An up-to-date... (Review)
Review
OBJECTIVE
Despite evidence that therapeutic mastoidectomy does not improve outcomes in noncholesteatomatous chronic otitis media, it remains widely performed. An up-to-date systematic review is undertaken and conclusions drawn regarding the best evidence-based practice of its management.
DATA SOURCES
PubMed, Google Scholar, Medline Embase, Cochrane, and Web of Science.
REVIEW METHOD
A combination of the following words was used: chronic otitis media, chronic suppurative otitis media, COM, CSOM, mastoidectomy, tympanoplasty, atelectasis, retraction, tympanic perforation, and therapeutic.
RESULTS
From 1742 studies, 7 were selected for full analysis with respect to the benefit of mastoidectomy in the management of active and inactive mucosal chronic otitis media. Most were retrospective studies, with 1 prospective randomized controlled trial available. Overall, there was no evidence to support routine mastoidectomy in conjunction with tympanoplasty in chronic otitis media. For ears with sclerotic mastoids, the evidence suggested that there may be some benefit as a staged procedure. Two studies were analyzed for the benefit of mastoidectomy in addition to tympanoplasty for the management of the atelectatic ear (inactive squamous chronic otitis media). The conclusion was also that mastoidectomy added no benefit.
CONCLUSIONS
Examination of the available literature supports the notion that therapeutic mastoidectomy does not lend any additional benefit to the management of noncholesteatomatous chronic otitis media. This has implications for patient care, both clinically and financially. Further research, ideally in the form of a prospective, multi-institutional, geographically wide, ethnically diverse, randomized controlled trial, is needed to further support this notion.
Topics: Cholesteatoma, Middle Ear; Chronic Disease; Costs and Cost Analysis; Diagnosis, Differential; Evidence-Based Medicine; Humans; Mastoid; Otitis Media, Suppurative; Randomized Controlled Trials as Topic; Treatment Outcome; Tympanoplasty; United States
PubMed: 27484233
DOI: 10.1177/0194599816662438 -
Otolaryngology--head and Neck Surgery :... Oct 2016We sought to assess the complication rates following cochlear implantation in canal wall down mastoid cavities in adults and children. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We sought to assess the complication rates following cochlear implantation in canal wall down mastoid cavities in adults and children.
DATA SOURCES
A systematic review of English articles from PubMed, Web of Science, EMBASE, and the Cochrane Library. Additional studies were identified by reviewing the reference lists of the originally identified studies.
REVIEW METHODS
Studies were included that reported on surgical outcomes following cochlear implantation in canal wall down mastoid cavities. Two authors, using predefined data fields, independently reviewed all articles while tabulating study quality indicators. A meta-analysis of proportions was conducted on select cohorts to determine weighted complication rates.
RESULTS
Forty-two articles were included that accounted for 424 patients and described surgical outcomes following cochlear implantation in canal wall down mastoid cavities. In a comparison of the postoperative complication rates, overclosing the external auditory meatus had significantly fewer global complications than did maintaining a canal wall down mastoid cavity (P = .027). In a comparison of the complication rates (1) between staging the cochlear implantation and performing external auditory meatus overclosure simultaneously with cochlear implantation and (2) between pediatric and adult cochlear implantation recipients with external auditory meatus overclosure, there were no significant differences (P = .085 and P = .92, respectively).
CONCLUSION
Overclosing the external auditory meatus at the same time of cochlear implantation leads to significantly fewer complications when compared with maintaining a canal wall down mastoid cavity with soft tissue coverage of the electrode array.
Topics: Cochlear Implantation; Cochlear Implants; Humans; Mastoid; Postoperative Complications
PubMed: 27221577
DOI: 10.1177/0194599816651239 -
The Cochrane Database of Systematic... Feb 2016Undifferentiated acute respiratory infections (ARIs) are a large and heterogeneous group of infections not clearly restricted to one specific part of the upper... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Undifferentiated acute respiratory infections (ARIs) are a large and heterogeneous group of infections not clearly restricted to one specific part of the upper respiratory tract, which last for up to seven days. They are more common in pre-school children in low-income countries and are responsible for 75% of the total amount of prescribed antibiotics in high-income countries. One possible rationale for prescribing antibiotics is the wish to prevent bacterial complications.
OBJECTIVES
To assess the effectiveness and safety of antibiotics in preventing bacterial complications in children aged two months to 59 months with undifferentiated ARIs.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 7), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1950 to August week 1, 2015) and EMBASE (1974 to August 2015).
SELECTION CRITERIA
Randomised controlled trials (RCTs) or quasi-RCTs comparing antibiotic prescriptions with placebo or no treatment in children aged two months to 59 months with an undifferentiated ARI for up to seven days.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and extracted and analysed data using the standard Cochrane methodological procedures.
MAIN RESULTS
We identified four trials involving 1314 children. Three trials investigated the use of amoxicillin/clavulanic acid to prevent otitis and one investigated ampicillin to prevent pneumonia.The use of amoxicillin/clavulanic acid compared to placebo to prevent otitis showed a risk ratio (RR) of 0.70 (95% confidence interval (CI) 0.45 to 1.11, three trials, 414 selected children, moderate-quality evidence). Methods of random sequence generation and allocation concealment were not clearly stated in two trials. Performance, detection and reporting bias could not be ruled out in three trials.Ampicillin compared to supportive care (continuation of breastfeeding, clearing of the nose and paracetamol for fever control) to prevent pneumonia showed a RR of 1.05 (95% CI 0.74 to 1.49, one trial, 889 selected children, moderate-quality evidence). The trial was non-blinded. Random sequence generation and allocation concealment methods were not clearly stated, so the possibility of reporting bias could not be ruled out.Harm outcomes could not be analysed as they were expressed only in percentages.We found no studies assessing mastoiditis, quinsy, abscess, meningitis, hospital admission or death.
AUTHORS' CONCLUSIONS
There is insufficient evidence for antibiotic use as a means of reducing the risk of otitis or pneumonia in children up to five years of age with undifferentiated ARIs. Further high-quality research is needed to provide more definitive evidence of the effectiveness of antibiotics in this population.
Topics: Acute Disease; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Child, Preschool; Humans; Otitis; Pneumonia; Randomized Controlled Trials as Topic; Respiratory Tract Infections; Suppuration
PubMed: 26923064
DOI: 10.1002/14651858.CD007880.pub3 -
Otolaryngology--head and Neck Surgery :... Apr 2016The mastoidectomy with facial recess approach (MFRA) is considered the reference standard for cochlear implantation. The suprameatal approach (SMA) was developed more... (Review)
Review
OBJECTIVE
The mastoidectomy with facial recess approach (MFRA) is considered the reference standard for cochlear implantation. The suprameatal approach (SMA) was developed more recently and does not require mastoidectomy, which could influence postoperative outcomes. We aim to identify the optimal operative approach for cochlear implantation based on postoperative complications and hearing preservation in children and adults.
DATA SOURCES
PubMed, EMBASE, Scopus, and Google Scholar.
REVIEW METHODS
Studies comparing MFRA and SMA in children and adults were eligible for inclusion. Original reports with moderate relevance and validity were included. Relevance and validity were assessed with a self-modified critical appraisal tool. This review was reported in accordance to PRISMA guidelines.
RESULTS
We retrieved 294 citations. Only retrospective nonrandomized studies were identified (level III evidence). Six articles were selected for full-text inclusion and 4 articles for data extraction. No article found a significant difference between MFRA and SMA with respect to postoperative complications in children and adults. One study found a significantly (P < .023) higher pediatric MFRA mastoiditis rate; however, meta-analysis did not indicate an overall effect. Hearing preservation was reported only in adults, and outcomes between techniques did not differ.
CONCLUSION
No evidence was noted for lower complication rates or improved hearing preservation between the MFRA and SMA for cochlear implantation in children and adults. Pediatric data were available for children implanted above the age of 24 months only. Level I evidence is needed to resolve the uncertainty regarding differences in postoperative outcomes of pediatric and adult MFRA and SMA.
Topics: Adult; Child; Cochlear Implantation; Cochlear Implants; Humans; Outcome Assessment, Health Care; Postoperative Complications
PubMed: 26884363
DOI: 10.1177/0194599815627146 -
Clinical Otolaryngology : Official... Dec 2015Otogenic paediatric cerebral venous sinus thrombosis (CVST) is rare but has potential clinical sequelae. Its management has long been debated mainly concerning the role... (Review)
Review
BACKGROUND
Otogenic paediatric cerebral venous sinus thrombosis (CVST) is rare but has potential clinical sequelae. Its management has long been debated mainly concerning the role of surgery and the use of anticoagulant therapy.
OBJECTIVE OF REVIEW
To review the current literature and examine the medical and surgical management of paediatric otogenic CVST and its clinical and radiological outcome.
TYPE OF REVIEW
Systematic review.
SEARCH STRATEGY
The electronic databases (MEDLINE, EMBASE, Cochrane) were searched from inception to November 2014 using text words 'cerebral venous sinus thrombosis OR cerebral venous thrombosis OR lateral sinus thrombosis OR sigmoid sinus thrombosis' AND 'otogenic OR mastoiditis OR otitis media' AND 'children OR paediatric OR pediatric'.
EVALUATION METHOD
Inclusion criteria were applied by two reviewers and data extraction was carried out. The type of otological surgery (conservative versus extensive) and the use of anticoagulants with their clinical and radiological outcomes were tabulated.
RESULTS
Thirty-six studies (15 case reports and 21 case series) were included with a total of 190 patients. A total of 92.1% of patients underwent otological surgery, and 69.5% had conservative surgery and 30.5% extensive otological surgery. Anticoagulants were used in 59%. A total of 79.2% of patients were reported to have had a good clinical outcome. Within this group, 56% had conservative surgery and anticoagulants. Follow-up scans were documented in 61.6% of patients and complete recanalisation was observed in 51%. Complete recanalisation was observed in 47% of those who had been anticoagulated and 55% of those who received no anticoagulation.
CONCLUSIONS
Conservative otological surgery with the combination of anticoagulation was the most common treatment modality found in the group of patients with good clinical outcome. However, given the current low level of evidence, a multicentre collaborative study is needed to help establish the optimum surgical approach and the role of anticoagulation in managing paediatric otogenic CVST.
Topics: Anticoagulants; Disease Management; Humans; Lateral Sinus Thrombosis; Otitis Media
PubMed: 26769686
DOI: 10.1111/coa.12504 -
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 -
The Laryngoscope Nov 2015Inflammatory pseudotumor (IPT) of the lateral skull base is a rare nonneoplastic inflammatory process of unknown cause often mistaken for malignancy or infection. This... (Review)
Review
OBJECTIVE
Inflammatory pseudotumor (IPT) of the lateral skull base is a rare nonneoplastic inflammatory process of unknown cause often mistaken for malignancy or infection. This systematic review aims to analyze all reported cases of lateral skull base IPT to date in order to provide insight into the management of this uncommon lesion.
DATA SOURCES
MEDLINE/PubMed database.
REVIEW METHODS
The MEDLINE/PubMed databases were searched for articles related to lateral skull base IPT. A bibliography review of the search results was then performed for additional articles. Demographics, presentation, radiographic findings, treatment, follow-up, and outcome were analyzed.
RESULTS
Thirty articles describing 39 patients were reviewed. The most common presenting symptom was hearing loss (53.8%). The mastoid bone had the highest incidence of IPT (61.5%). Computed tomography (CT) was the most utilized imaging modality. The lesion appeared isointense on T1-weighted magnetic resonance imaging (MRI) (75.0%) and hypointense on T2-weighted MRI (62.5%). Histopathological analysis showed fibrosis (96.9%) with inflammatory cell infiltration (100.0%). Surgical resection (alone or in combination with other treatments) was the most common treatment modality (92.3%), producing the greatest number of disease-free patients overall (96.0%). The mean follow-up time was 21.6 months, at which point 34.4% of patients showed improvement and 31.3% were completely disease-free.
CONCLUSION
This review is the most comprehensive analysis of lateral skull base IPT to date. A thorough workup including clinical exam, imaging, and biopsy is essential for diagnosis. Surgical excision is the most common and most successful treatment modality, followed by surgery with corticosteroids.
Topics: Bone Diseases; Earache; Granuloma, Plasma Cell; Hearing Loss; Humans; Magnetic Resonance Imaging; Skull Base; Tomography, X-Ray Computed
PubMed: 25892586
DOI: 10.1002/lary.25308 -
Journal of Neurosurgery Apr 2015Dural arteriovenous fistulas (DAVFs) of the hypoglossal canal (HCDAVFs) are rare and display a complex angiographic anatomy. Hitherto, they have been referred to as... (Meta-Analysis)
Meta-Analysis Review
Dural arteriovenous fistulas (DAVFs) of the hypoglossal canal (HCDAVFs) are rare and display a complex angiographic anatomy. Hitherto, they have been referred to as various entities (for example, "marginal sinus DAVFs") solely described in case reports or small series. In this in-depth review of HCDAVF, the authors describe clinical and imaging findings, as well as treatment strategies and subsequent outcomes, based on a systematic literature review supplemented by their own cases (120 cases total). Further, the involved craniocervical venous anatomy with variable venous anastomoses is summarized. Hypoglossal canal DAVFs consist of a fistulous pouch involving the anterior condylar confluence and/or anterior condylar vein with a variable intraosseous component. Three major types of venous drainage are associated with distinct clinical patterns: Type 1, with anterograde drainage (62.5%), mostly presents with pulsatile tinnitus; Type 2, with retrograde drainage to the cavernous sinus and/or orbital veins (23.3%), is associated with ocular symptoms and may mimic cavernous sinus DAVF; and Type 3, with cortical and/or perimedullary drainage (14.2%), presents with either hemorrhage or cervical myelopathy. For Types 1 and 2 HCDAVF, transvenous embolization demonstrates high safety and efficacy (2.9% morbidity, 92.7% total occlusion). Understanding the complex venous anatomy is crucial for planning alternative approaches if standard transjugular access is impossible. Transarterial embolization or surgical disconnection (morbidity 13.3%-16.7%) should be reserved for Type 3 HCDAVFs or lesions with poor venous access. A conservative strategy could be appropriate in Type 1 HCDAVF for which spontaneous regression (5.8%) may be observed.
Topics: Central Nervous System Vascular Malformations; Cerebral Angiography; Drainage; Endovascular Procedures; Humans; Occipital Bone
PubMed: 25415064
DOI: 10.3171/2014.10.JNS14377 -
Otolaryngology--head and Neck Surgery :... Dec 2014The inconsistent measures used to report outcomes after mastoidectomy to treat cholesteatoma make it impossible for clinicians to compare results and apply them... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The inconsistent measures used to report outcomes after mastoidectomy to treat cholesteatoma make it impossible for clinicians to compare results and apply them appropriately to patient care. We sought to identify and assess the type and relative frequency of the reported measures.
DATA SOURCES
PubMed, EMBASE, the Web of Science.
REVIEW METHODS
We searched 3 independent databases for articles that reported outcomes of middle ear cholesteatoma treated with mastoidectomy. Articles were assessed for eligibility using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and data were extracted by 2 independent investigators. Observational studies and randomized controlled trials from the past 30 years were included. Articles with less than 50 subjects and nonsurgical studies were excluded. The measures used by each study were recorded, and the relative frequency of each measure was calculated.
RESULTS
Forty-three of 380 articles met criteria. Time to follow up was inconsistent. Most articles reported on preoperative qualitative parameters (77%); however, few reported on the severity of disease (19%) or formally staged the disease (12%). Not all studies reported on the presence of recurrent or residual disease (88%) or the postoperative audiogram results (70%). Only 12% presented results as a Kaplan-Meier disease-free curve. Most studies reported on complications (70%).
CONCLUSION
Reported measures were inconsistent among the studies, which makes comparisons between studies unreliable. Standardization will optimize future reporting and will allow for the establishment of best practices.
Topics: Cholesteatoma, Middle Ear; Female; Follow-Up Studies; Humans; Male; Mastoid; Otologic Surgical Procedures; Postoperative Complications; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Treatment Outcome
PubMed: 25193517
DOI: 10.1177/0194599814549547 -
Otolaryngology--head and Neck Surgery :... Sep 2014Acute mastoiditis is an uncommon but challenging condition when it occurs in children with cochlear implant. The literature is scarce as to the management of this... (Review)
Review
OBJECTIVE
Acute mastoiditis is an uncommon but challenging condition when it occurs in children with cochlear implant. The literature is scarce as to the management of this condition with regards to explantation. The objective of the study is to determine the need for explantation in patients with cochlear implants who suffer from acute mastoiditis.
DATA SOURCES
Online medical databases-PubMed, Ovid Medline, Ovid Medline in process, Embase, Cochrane Library, CINAHL, Biosis, Google Scholar, and Scopus.
REVIEW METHODS
A systematic review of all publications addressing the treatment of mastoiditis in cochlear implant children prior to November 2013 was conducted. Data were collected from online medical databases-PubMed, Ovid Medline, Ovid Medline in process, Embase, Cochrane Library, CINAHL, Biosis, Google Scholar, and Scopus. The review was performed in 3 phases; an initial screening review of abstracts was performed, followed by a detailed review of full articles based on inclusion and exclusion criteria, and lastly a final review to extract data from selected articles.
RESULTS
Twelve articles were found eligible for this systematic review including a total of 43 patients. Subperiosteal abscess was present in 14.3%. All patients received intravenous antibiotics as an initial treatment, and if needed, surgical intervention was performed. Only 1 patient required explantation (2.3%).
CONCLUSION
Prompt, aggressive medical and if needed surgical therapy can help in saving the implant and result in a favorable outcome.
Topics: Acute Disease; Anti-Bacterial Agents; Child; Child, Preschool; Cochlear Implantation; Cochlear Implants; Combined Modality Therapy; Drainage; Female; Humans; Incidence; Male; Mastoiditis; Prognosis; Prosthesis-Related Infections; Risk Assessment
PubMed: 24898070
DOI: 10.1177/0194599814536686