Journal of Laryngology and Otology

Tranexamic acid in ENT

20-12-2019 – Fishman, Jonathan,Hussain, Musheer,Fisher, Edward

Tranexamic acid has no advantage in head and neck surgical procedures: a randomised, double-blind, controlled clinical trial

18-11-2019 – Thakur, A,Gupta, S,Thakur, J S,Minhas, R S,Azad, R K,Vasanthalakshmi, M S,Sharma, D R,Mohindroo, N K

Journal Article

Objective
To assess the effect of tranexamic acid in head and neck surgical procedures.
Methods
A prospective, double-blind and randomised, parallel group, placebo-controlled clinical trial was conducted. Ninety-two patients undergoing various head and neck surgical procedures were randomised. Subjects received seven infusions of coded drugs (tranexamic acid or normal saline) starting at the time of skin closure. Haematological, biochemical, blood loss and other parameters were observed by the staff, who were blinded to patients’ group allocation (case or control).
Results
Patients were analysed on the basis of type of surgery. Fifty patients who had undergone surgical procedures, including total thyroidectomy, total parotidectomy, and various neck dissections with or without primary tumour excision, were included in the first group. The second group comprised 41 patients who had undergone hemithyroidectomy, lobectomy or superficial parotidectomy. There was no statistical difference in blood parameters between both groups. There was a reduction in post-operative drain volume, but this was not significant.
Conclusion
Although this prospective, randomised, placebo-controlled clinical trial found a reduction in post-operative drain volume in tranexamic acid groups, the difference was not statistically significant between the various head and neck surgical procedure groups.

Does tranexamic acid improve intra-operative visualisation in endoscopic ear surgery? A double-blind, randomised, controlled trial

13-11-2019 – Das, A,Mitra, S,Ghosh, D,Kumar, S,Sengupta, A

Journal Article

Objective
To assess the effect of tranexamic acid on intra-operative bleeding and surgical field visualisation.
Methods
Fifty patients undergoing various endoscopic ear surgical procedures, including endoscopic tympanoplasty, endoscopic atticotomy or mastoidectomy, endoscopic ossiculoplasty, and endoscopic stapedotomy, were randomly assigned to: a study group that received tranexamic acid or a control group which received normal saline. The intra-operative bleeding and operative field visualisation was graded using the Das and Mitra endoscopic ear surgery bleeding and field visibility score, which was separately analysed for the external auditory canal and the middle ear.
Results
The Das and Mitra score was better (p < 0.05) in the group that received tranexamic acid as a haemostat when working in the external auditory canal; with respect to the middle ear, no statistically significant difference was found between the two agents. Mean values for mean arterial pressure, heart rate and surgical time were comparable in both groups, with no statistically significant differences.
Conclusion
Tranexamic acid appears to be an effective haemostat in endoscopic ear surgery, thus improving surgical field visualisation, especially during manipulation of the external auditory canal soft tissues.

Human immunodeficiency disease in new diagnoses of head and neck squamous cell cancer: are we testing?

11-11-2019 – McNamara, K J,Fernandez, C,Saunders, T F C,Ahsan, F

Journal Article

Background
Human immunodeficiency virus infected patients have a three-fold increased risk of head and neck squamous cell carcinoma. The British HIV Association recommends human immunodeficiency virus testing in all new diagnoses of head and neck squamous cell carcinoma.
Objectives
This observational study aimed to examine the current routine practice of human immunodeficiency virus testing in patients with newly diagnosed head and neck squamous cell carcinoma, and to address the importance of this test in promoting the early diagnosis and treatment of human immunodeficiency virus.
Methods
All head and neck cancer multidisciplinary teams in England were questioned on their protocol for human immunodeficiency virus testing in new diagnoses of head and neck squamous cell carcinoma.
Results
Only 1 out of 30 hospitals leading head and neck multidisciplinary teams (3.3 per cent) routinely offered human immunodeficiency virus testing in this high-risk patient group.
Conclusion
This observational study highlights that head and neck specialists are not aware of, and are consequently not complying with, routine human immunodeficiency virus testing as recommended by the British HIV Association guidelines.

Interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma

12-11-2019 – Hamdan, A-L,Khalifee, E,Jaffal, H,Ghanem, A

Journal Article

Objectives
To report on the efficacy and adverse effects of interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma.
Methods
A retrospective chart review was conducted of eight patients with vocal process granuloma resistant to anti-reflux therapy who underwent interarytenoid botulinum toxin A injection. The mean dosage of botulinum toxin A injected was 6.56 U.
Results
Fifty per cent of patients had complete regression of the lesion and 50 per cent had partial regression. The main side effects were breathiness (n = 4), voice breaks (n = 1) and aspiration (n = 1).
Conclusion
Interarytenoid botulinum toxin A injection for the treatment of vocal process granuloma is an effective mode of therapy, with transient vocal and swallowing side effects.

The effects of resection of the peripheral branches of the posterior nasal nerves in the inferior turbinate, with special focus on olfactory dysfunction

04-11-2019 – Suzuki, M,Yokota, M,Ozaki, S,Murakami, S

Journal Article

Objective
There are few detailed studies about peripheral branch resection of the posterior nasal nerves in the inferior turbinate; thus, this study aimed to investigate this.
Methods
Patients who underwent submucosal turbinoplasty with or without resection of the peripheral branches of posterior nasal nerves in the inferior turbinate were included.
Results
The resection of the posterior nasal nerves with turbinoplasty significantly reduced detection and recognition thresholds on olfactory testing. The rhinorrhoea severity, detection threshold and recognition threshold were significantly lower after resection of the posterior nasal nerves with turbinoplasty than after turbinoplasty alone, although there were no significant differences between the two groups before surgery.
Conclusion
This is the first study to show that the resection of the peripheral branches of the posterior nasal nerves in the inferior turbinate with turbinoplasty more effectively inhibits allergic symptoms compared with turbinoplasty alone. It also showed that the resection of the peripheral branches of the posterior nasal nerves can inhibit olfactory dysfunction.

A study of the use of post-operative opioid analgesics following rhinology surgery in 35 patients

14-11-2019 – Dodhia, S,Patel, S,Beghal, G,Pandey, K,Hopkins, C

Journal Article

Objective
Opioid analgesics are often prescribed following rhinology surgery. This study aimed to evaluate whether the quantity of opioid analgesics prescribed is justified.
Methods
Patients were asked about their pain management post-operatively. Parameters recorded included: current pain (using a 10-point Likert scale); type of operation; the opioid analgesics prescribed; and the quantity of opioid tablets taken and other methods of pain relief used.
Results
Thirty-five patients were successfully contacted. The median pain score at one week post-operation was 1 (interquartile range, 0–3). Of these 35 patients, 16 were prescribed opioids, whilst 19 were not. Patients prescribed opioids took a median of 8 tablets (interquartile range, 0.8–10.5) out of the 28 tablets prescribed.
Conclusion
The study shows that the quantity of post-operative opioid analgesics prescribed does not compare with the amount consumed by patients to relieve pain, resulting in a surplus of opioid medication which has the potential to be abused.

Soft tissue head and neck sarcoma: experience of a tertiary referral centre over a 15-year period

29-11-2019 – Harrison, L,McCulloch, T,Beasley, N

Journal Article

Background
Head and neck soft tissue sarcoma is uncommon. It is both histologically and clinically heterogeneous, ranging from an indolent, locally destructive tumour, to a locally aggressive neoplasm with metastatic potential.
Methods
A retrospective review was conducted of all adult head and neck soft tissue sarcomas, including cases of malignant soft tissue sarcoma and all intermediate type tumours, diagnosed between 1997 and 2012.
Results
Sixty-eight cases were identified in this series from the sarcoma multidisciplinary team. Seventeen different histological subtypes of sarcoma were identified. Neither age, gender nor tumour size were significant prognostic indicators for survival in this series.
Conclusion
Prognosis is dependent on histological subtype, underscoring the importance of histological classification. Some histological subtypes occur only once or twice in a decade, even within a large regional referral centre. An accumulation of evidence from relatively small case series is key in the long-term development of treatment strategies.

Effects of nasal lavage with and without mupirocin after endoscopic endonasal skull base surgery: a randomised, controlled study

27-11-2019 – Ng, B H K,Tang, I P,Narayanan, P,Raman, R,Carrau, R L

Journal Article

Background
Nasal lavage with mupirocin has the potential to reduce sinonasal morbidity in endoscopic endonasal approaches for skull base surgery.
Objective
To evaluate the effects of nasal lavage with and without mupirocin after endoscopic endonasal skull base surgery.
Methods
A pilot randomised, controlled trial was conducted on 20 adult patients who had undergone endoscopic endonasal approaches for skull base lesions. These patients were randomly assigned to cohorts using nasal lavages with mupirocin or without mupirocin. Patients were assessed in the out-patient clinic, one week and one month after surgery, using the 22-item Sino-Nasal Outcome Test questionnaire and nasal endoscopy.
Results
Patients in the mupirocin nasal lavage group had lower nasal endoscopy scores post-operatively, and a statistically significant larger difference in nasal endoscopy scores at one month compared to one week. The mupirocin nasal lavage group also showed better Sino-Nasal Outcome Test scores at one month compared to the group without mupirocin.
Conclusion
Nasal lavage with mupirocin seems to yield better outcomes regarding patients’ symptoms and endoscopic findings.

The utility of lateral neck radiographs in the management of fish bones

19-11-2019 – Pitts-Tucker, T,Biggs, T C,Patel, N N

Journal Article

Background
Lateral neck radiographs are commonly used in the investigation and management of patients presenting with suspected fish bone impaction. The effectiveness of these is questioned, as many fish do not have radio-opaque bones.
Objective
This study evaluated the utility of lateral neck radiographs in the management of patients presenting with fish bones retained in the upper aerodigestive tract, with the creation of a treatment algorithm to guide further management.
Methods
An audit of practice was undertaken at the University Hospital of Southampton, identifying all patients admitted with potential fish bone impaction in the upper aerodigestive tract. Following analysis, a treatment algorithm was constructed for use by junior doctors.
Results
In total, 34 per cent of patients with a normal radiograph were subsequently found to have a fish bone present under local or general anaesthetic assessment. The sensitivity of radiographs in the detection of fish bones was found to be 51.6 per cent.
Conclusion
Lateral neck radiographs have limited value in the management of suspected fish bone impaction, and should only be used following detailed clinical examination of the upper aerodigestive tract.

Impact of platelet-rich fibrin therapy in tympanoplasty type 1 surgery on graft survival and frequency-specific hearing outcomes: a retrospective analysis in patients with tympanic membrane perforation due to chronic otitis media

18-11-2019 – Gökçe Kütük, S,Özdaş, T

Journal Article

Objective
To evaluate the impact of platelet-rich fibrin therapy in tympanoplasty type 1 surgery on graft survival and frequency-specific hearing outcomes.
Methods
Patients who underwent tympanoplasty type 1 surgery were randomised into temporal fascia graft alone (n = 55) and temporal fascia graft plus platelet-rich fibrin therapy (n = 36) groups. Graft survival and hearing outcomes were recorded.
Results
Graft survival rates were significantly higher in the temporal fascia graft plus platelet-rich fibrin therapy group than in the temporal fascia graft alone group at one (100.0 vs 85.5 per cent, p = 0.020), three (97.2 vs 80.0 per cent, p = 0.024) and six months post-operatively (94.4 vs 74.5 per cent, p = 0.031). The difference in hearing gain between groups was not significant.
Conclusion
Our findings revealed that the use of a platelet-rich fibrin plus temporal fascia graft for type 1 tympanoplasty was associated with more favourable post-operative outcomes than the use of temporal fascia alone, both in terms of tympanic membrane healing and graft survival; hearing restoration outcomes were similar.

Canal wall down mastoidectomy with obliteration versus canal wall up mastoidectomy in primary cholesteatoma surgery

18-11-2019 – Wilkie, M D,Chudek, D,Webb, C J,Panarese, A,Banhegyi, G

Journal Article

Objective
This study sought to compare disease recidivism rates between canal wall up mastoidectomy and a canal wall down with obliteration technique.
Methods
Patients undergoing primary cholesteatoma surgery at our institution over a five-year period (2013–2017) using the aforementioned techniques were eligible for inclusion in the study. Rates of discharge and disease recidivism were analysed using chi-square statistics.
Results
A total of 104 ears (98 patients) were included. The mean follow-up period was 30 months (range, 12–52 months). A canal wall down with mastoid obliteration technique was performed in 55 cases and a canal wall up approach was performed in 49 cases. Disease recidivism rates were 7.3 per cent and 16.3 per cent in the canal wall down with mastoid obliteration and canal wall up groups respectively (p = 0.02), whilst discharge rates were similar (7.3 per cent and 10.2 per cent respectively).
Conclusion
Our direct comparative data suggest that canal wall down mastoidectomy with obliteration is superior to a canal wall up technique in primary cholesteatoma surgery, providing a lower recidivism rate combined with a low post-operative ear discharge rate.

Soft-tissue outcomes following implantation of different types of bone conduction hearing devices in a single centre

29-11-2019 – Ray, J,Lau, K,Moraleda, J,Yardley, M,Dawoud, M,Dimitriadis, P A

Journal Article

Objective
To compare soft-tissue complications following implantation of different bone conduction hearing devices.
Methods
Adults who underwent implantation of different bone conduction hearing devices, between January 2008 and December 2016, were included in the study. Five groups were identified depending on the soft-tissue approach: (1) split-thickness skin flap with use of dermatome; (2) Sheffield ‘S’-shaped incision with skin thinning; (3) linear incision without skin thinning (hydroxyapatite-coated abutment); (4) ‘C’-shaped full-thickness incision for passive transcutaneous bone conduction hearing devices; and (5) post-aural incision for active transcutaneous bone conduction hearing devices. The main outcome measures were different soft-tissue complications.
Results
The study comprised 120 patients (group 1 = 20 patients, group 2 = 35, group 3 = 35, group 4 = 20, and group 5 = 10). Soft tissue related problems were encountered in 55 per cent of patients from group 1, 26 per cent in group 2, 3 per cent in group 3, and 0 per cent in groups 4 and 5.
Conclusion
There was a reduction in soft tissue related complications with reduced soft-tissue handling. In addition, there was a shift from an initial skin-penetrating (percutaneous) approach to a non-skin-penetrating (transcutaneous) approach.

Reliability of diffusion-weighted magnetic resonance imaging in differentiation of recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy

18-11-2019 – Allam, H S,Abdel Razek, A A K,Ashraf, B,Khalek, M

Journal Article

Objective
To assess the reliability of diffusion-weighted magnetic resonance imaging in differentiating recurrent cholesteatoma from granulation tissue after intact canal wall mastoidectomy.
Methods
A prospective study was conducted of 56 consecutive patients with suspected cholesteatoma recurrence after intact canal wall mastoidectomy who underwent diffusion-weighted imaging and delayed contrast magnetic resonance imaging of the temporal bone. The final diagnosis was recurrence in 38 patients and granulation tissue in 18 patients.
Results
Cholesteatoma detection on diffusion-weighted imaging based on two sets of readings had sensitivity of 94.7 and 94.7 per cent, specificity of 94.4 and 88.9 per cent, and accuracy of 94.6 and 92.8 per cent, with good intra-observer agreement (Κ = 0.72, p = 0.001). Cholesteatoma detection on delayed contrast magnetic resonance imaging had sensitivity of 81.6 and 78.9 per cent, specificity of 77.8 and 66.7 per cent, and accuracy of 80.4 and 75.0 per cent, with fair intra-observer agreement (Κ = 0.57, p = 0.001). The mean cholesteatoma diameter on diffusion-weighted imaging was 7.7 ± 1.8 and 7.9 ± 1.8 mm, with excellent intra-observer agreement (Κ = 0.994, p = 0.001).
Conclusion
Diffusion-weighted imaging is a reliable method for differentiating recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy.

Outcomes of definitive radiotherapy for early laryngeal cancer in terms of survival and patterns of failure

03-12-2019 – Adeel, M,Faisal, M,Rashid, A,Rasheed, S,Hussain, R,Malik, K I,Hameed, M Y,Jamshed, A

Journal Article

Background
Early laryngeal cancer treated with definitive radiotherapy or surgery has a high cure rate. This study evaluated the patterns of treatment failure and long-term results of early laryngeal cancers treated with definitive radiotherapy.
Method
From January 2002 to December 2014, a total of 242 patients with early-stage laryngeal cancers were treated with radical radiotherapy.
Results
All patients had squamous cell carcinoma of the larynx (92 per cent male and 8 per cent female). Median follow-up was 4.5 years. The majority of patients were smokers (57.4 per cent). Local failure was seen in 12.5 per cent of stage I patients and 22.8 per cent of stage II patients. The 5-year overall survival and disease specific survival were 84 per cent and 91 per cent, respectively.
Conclusion
In summary, radiotherapy is a suitable treatment modality for patients with early-stage laryngeal cancer, with an overall locoregional control rate of 84 per cent. Patients who fail radiotherapy may still undergo salvage laryngectomy.

The effects of everted or inverted edges on healing of traumatic-induced tympanic membrane perforations

03-12-2019 – Lou, Z-C

Journal Article

Objectives
To evaluate the healing and hearing outcomes related to the everted or inverted edge area on slap- and fist-induced large tympanic membrane perforations.
Methods
A total of 120 patients with slap- or fist-induced tympanic membrane perforations, with inverted or everted edges, affecting 50–75 per cent of the entire tympanic membrane, were randomly divided into 2 groups: an edge approximation group and a spontaneous healing group. The edge approximation group was divided into subgroups A and B based on the reversed edge area (reversed edge was more or less than 50 per cent of the total perforation, respectively). Healing outcomes and hearing improvements at six months were compared.
Results
The data of 118 patients were analysed. The closure rate of perforations in subgroup A, subgroup B, and the spontaneous healing group was 90.9 per cent, 92.1 per cent and 84.5 per cent, respectively; the difference between the three groups was not significant (p = 0.393).
Conclusion
The area of reversed edges for slap- or fist-induced tympanic membrane perforations did not seem to affect healing and hearing outcomes, regardless of edge approximation and everted or inverted edges.

Normalisation of voice parameters in patients with unilateral vocal fold palsy: is it realistic?

03-12-2019 – Kumar, R,Banumathy, N,Sharma, P,Panda, N K

Journal Article

Background
Disorders of voice can limit an individuals participation and impair social interaction, thus affecting overall quality of life. Perceptual and objective evaluations can provide the clinician with detailed information regarding voice disorders.
Methods
This study comprised 40 subjects aged 34–46 years, 20 of whom (10 male, 10 female) had unilateral vocal fold palsy. Data were obtained for all participants from: the Voice Handicap Index, the grade, roughness, breathiness, asthenia and strain (‘GRBAS’) scale, acoustic voice analysis, electroglottography, and voice range profiles.
Results
The voice evaluations revealed statistically significant (p < 0.05) differences between the controls and study group, both in males and females, pre- and post-therapy.
Conclusion
Despite the normalisation of vocal parameters, acoustic, perceptual and self-rated assessments revealed statistically significant differences after therapy. Hence, acoustic measures, namely electroglottographic perturbation, and voice frequency and intensity range, are recommended prior to termination of therapy.

Analysis of the relationship between changes in the auditory brainstem response and prognosis in patients with sudden hearing loss

03-12-2019 – Bang, J,Lee, H,Choi, H,Lee, D,Kim, Y,Kim, D-K

Journal Article

Objective
To analyse how the auditory brainstem response changes in patients with sudden sensorineural hearing loss.
Method
Data were collected via retrospective medical chart review.
Results
Forty-three patients were included in this study. The mean latency of auditory brainstem response wave 1 was significantly longer for the affected side than for the unaffected side (p = 0.003). The mean latency of auditory brainstem response wave 1 was significantly shorter, and the mean amplitude of auditory brainstem response wave 1 was significantly larger, in the good response group compared to the poor response group. In forward conditional logistic regression analysis, auditory brainstem response wave 1 latency was an independent predictor of a good response (odds ratio = 34.37, 95 per cent confidence interval = 1.56–757.15, p = 0.025).
Conclusion
In patients with sudden sensorineural hearing loss, the latency of wave 1 of the auditory brainstem response was significantly increased and was related to prognosis.

Promontory osteoma mimicking otosclerosis: case report

27-09-2019 – Gülşen, S

Journal Article

Objective
This case report presents a middle-ear osteoma mimicking otosclerosis that was located at the promontory. The osteoma was successfully excised using an endoscopic transcanal approach without any complication.
Case report
A 21-year-old man presented with a 4-year history of progressive conductive hearing loss (47 d
B with a 30-d
B air–bone gap) with intermittent tinnitus of recent onset in his right ear. Endoscopic transcanal middle-ear exploration showed that an osteoma located on the promontory was restricting the mobility of the stapes by affecting the anterior crus of the stapes. After transcanal resection of the osteoma, pure tone audiometry improved to 23 d
B with a 5-d
B air–bone gap. Tinnitus resolved spontaneously without any additional treatment.
Conclusion
Promontory osteomas, a rare and usually asymptomatic clinical entity, should be taken into consideration in the differential diagnosis in patients with progressive conductive hearing loss and tinnitus with intact stapedial reflexes and normal otoscopic findings.

Ear Surgery Illustrated: A Comprehensive Atlas of Otologic Microsurgical Techniques R K Jackler Thieme, 2019 ISBN 978 1 68420 110 5 pp 504 Price €179.99 US$199.99 £160.50

03-12-2019 – Flood, L M

Controversies in Skull Base Surgery A S Little, M A Mooney Thieme, 2019 ISBN 978 1 62623 953 1 pp 352 Price €174.99 US$199.99 £167.50

13-11-2019 – Flood, L M

Handbook of Otolaryngic Allergy C B Franzese, C C Damask, S K Wise, M W Ryan Thieme, 2019 ISBN 978 162623 906 7 pp 304 Price €69.99 US$79.99 £65.00

11-11-2019 – Flood, L M

“Critical Issues in Head and Neck Oncology: Key Concepts from the Sixth THNO Meeting J B Vermorken, V Budach, C R Leemans, J-P Machiels, P Nicolai, B OSullivan (eds) Springer, 2018 ISBN 978 3 31998 853 5 pp 363 Price €124.79 £109.99”

22-08-2019 – Bradley, P J

Comprehensive Management of Vestibular Schwannoma M L Carlson, M J Link, C L W Driscoll, B A Neff, J J Van Gompel, K D Flemming . Thieme, 2019 ISBN 978 1 62623 331 7 eISBN 978 1 62623 332 4 pp 576 Price €174.99 US$199.99 £163.00

18-09-2019 – Flood, L M

Pocket Tutor Otolaryngology 2nd ednA Bhattacharyya, S Ifeacho, H Zhang JP Medical Publishers, 2019 ISBN 978 1 90983 688 4 pp 280 Price £14.95

27-11-2019 – Flood, L M

A Treatise on Otosclerosis and its Treatment R A Tange Kugler Publications, 2019 ISBN 978 9 06299 279 9 pp 363 Price €125.00 US$140.00

28-11-2019 – Flood, L M

JLO volume 133 issue 12 Cover and Front matter

20-12-2019 –

JLO volume 133 issue 12 Cover and Back matter

20-12-2019 –