This study had the following objectives: (i) To determine the accuracy of determination of Vibrant Soundbridge position in the spectrum of typically implanted sites in the middle ear. (ii) To assess inter-observer agreement between 3 observers with different levels of radiology experience. (iii) To determine the suitability of cone-beam computed tomography (CT) to be used as the baseline radiological assessment post implantation, confirm ferromagnetic transducer (FMT) position.

Prospective research study. Using 4 fresh human cadaveric heads, different types of vibroplasty were performed. After each step, cone-beam CT was performed for each of the 4 cadaveric heads.

University hospital (ENT and Neuroradiology).

Four fresh cadaveric heads of human donors were operated and analyzed by radiological imaging.

There are different ways of coupling an FMT to the anatomical structures of the middle and inner ear. Possibilities of differentiation between these coupling variants should be presented.

The individual reconstruction view was significantly different from a standardized view for each observer (observer 1: p = 0.003; observer 2: p = 0.001; observer 3: p = 0.002) for all coupling variants combined as well as for each individual coupling variant (overall correct diagnosis: 100% vs. 60%). Regarding the frequency of correct diagnosis, no significant differences were found between the 3 observers (p > 0.500) for each individual coupling variant as well as for all coupling variants combined. The worst rates of correct diagnosis were found in the standardized view for incus (42%), stapes (0%), and TORP (17%) vibroplasty.

Cone-beam CT as a radiological control for Vibrant Soundbridge is safe and adequately sensitive and reliable and is therefore suitable for clinical investigation. The position of the FMT in the middle ear and the presence or absence of an additional coupler could be determined in this study. Therefore, cone-beam-CT is useful for the assessment of device failure when there has been gross displacement of the FMT (or smaller displacements in case of a baseline postoperative cone-beam CT). Regarding the quality of imaging, cone-beam CT produced accurate results with different observers with widely varying radiological experience.

This article is protected by copyright. All rights reserved.

To compare the efficacies of a thermosensitive poloxamer and Merogel in preventing adhesion applied after the removal of nasal packing in endoscopic sinus surgery as a non-inferiority trial.

Randomized, multicenter, single-blind, active-controlled, matched-pair study.

Yonsei University Gangnam Severance Hospital, Korea University Guro Hospital.

A total of 70 patients were enrolled and underwent endoscopic sinus surgeries. Four of the patients did not complete their follow-up. Analysis of the 66 enrolled patients having completed postoperative assessment was performed. The severity of rhinosinusitis was graded with a Lund-McKay CT score, and only those with bilateral disease and a CT score difference ≤2 between sinuses were included.

An independent rhinologist from a third institution through a blinded assessment with digital photoendoscopy of the middle meati bilaterally taken postoperatively.

In the blinded assessment, thermosensitive poloxamer (anti-adhesion rate: 92%) was similar to Merogel (anti-adhesion rate: 89%). Evaluation of the presence and grade of adhesion, edema, and infection in the middle meatus revealed no significant differences between the thermosensitive poloxamer group and the Merogel group at all postoperative periods.

Anti-adhesive effects of thermosensitive poloxamer are similar to those of Merogel. Therefore, thermosensitive poloxamer can be considered a safe alternative to Merogel for preventing adhesion in patients undergoing endoscopic sinus surgeries and further evaluation of thermosensitive poloxamer as an anti-adhesive and primary packing material compared to the control using no packing is needed.

This article is protected by copyright. All rights reserved.

Patients with peripheral facial palsy frequently complain of fluid leakage and food retention during meals. We investigated oral function during eating in adults with peripheral facial palsy.

a prospective two-phase controlled observational study.

Data were collected at the ENT clinic in Nihon University Itabashi Hospital (patients) and Nihon University Dental Hospital (controls) between September 2009 and August 2011 and analyzed at the Department of Oral Diagnostic Sciences in Nihon University School of Dentistry.

Fourteen patients with acute idiopathic facial palsy and 14 controls completed Study 1. Sixteen patients with acute idiopathic facial palsy and 16 controls completed Study 2.

In Study 1, oral vestibular cleansing capability was assessed by measuring the amount of rice remaining in the oral vestibule after mastication. In Study 2, masticatory efficiency was evaluated by measuring glucose eluted from gummy jelly during chewing. These oral functions were observed at the first visit and final visit (after patients with facial palsy had recovered).

Oral vestibular cleansing capability at the first visit was significantly decreased by facial palsy (p<0.001 vs healthy volunteers and p<0.001 vs contralateral side) but recovered as facial muscular function improved (p=0.034). There was a significant correlation between improvement in paralysis and decreased food retention (r=−0.528, p=0.010). At the first visit, masticatory efficiency on the affected side was significantly lower than that of controls (p=0.002) but had mostly recovered after resolution of facial palsy (p=0.033).

Oral functions were decreased by peripheral facial palsy. Oral vestibular cleansing capability was more significantly associated than masticatory efficiency with facial muscle function. Our data suggest that peripheral facial palsy impairs eating and worsens oral hygiene, which may result in oral disease.

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Mitomicin C has recently been used to prevent nasal synerchiae and sinus ostium stenosis after endoscopic sinus surgery.

To compare nasal synerchiae rate between topical Mitomicin C and saline or no treatment.

MEDLINE, SCOPUS, and Cochrane Register of Controlled Trials databases were used to identify studies up to January 2013.

Data were independently extracted by two reviewers (PN and KT). Studies which compared topical Mitomicin C with control where the outcomes of interest were nasal synerchiae or sinus ostium stenosis were included. Baseline study characteristics, quality of study, numbers of patients between treatment and control groups, outcomes, and adverse events were extracted. A multivariate meta-analysis was separately applied for each outcome (nasal synerchiae and maxillary sinus ostium stenosis).

Among 11 included studies, most studies used Mitomicin C dose of 0.4 to 0.5 mg/mL 1 to 5 mL in the middle meatus for 5 minutes duration. Eight studies reported synerchiae with 281 and 281 nasal cavities received Mitomicin C and saline, respectively. For outcome of nasal synerchiae, a multivariate meta-analysis suggested that Mitomicin C was associated with a 66% (RR = 0.34, 95% CI: 0.18-0.65) lower risk of nasal synerchiae with moderate heterogeneity (I²=43%, 95% CI: 0-77%). Subgroup analyses by age and history of revision could reduce the degree of heterogeneity. Mitomicin C benefits were found in subgroups of age ≤ 40 years (RR = 0.27, 95% CI: 0.05-1.50) and patients without any history of revision (RR = 0.19, 95% CI: 0.06-0.58). Five studies with 134 and 140 nasal cavities for Mitomicin C and saline were included in pooling of maxillary sinus ostium stenosis. Mitomicin C was associated with 74% (RR = 0.26, 95% CI: 0.12-0.54) lower risk of maxillary sinus ostium stenosis when compared with saline with low heterogeneity (I2=5%, 95% CI: 0-85%). There was no evidence of publication bias for both poolings.

Applying Mitomicin C topically after endoscopic sinus surgery could reduce the risk of nasal synerchiae and maxillary sinus ostium stenosis in short term by 66% and 74%, respectively. The treatment effects may be more beneficial in patients aged 40 years or younger or in patients without history of revision. However, our results were based on pooling trials with questionable methodological quality. Further trials with good research methodology and long term follow up should be conducted to confirm our results.

© 2013 Blackwell Publishing Ltd

To evaluate a new composite cartilage-perichondrium graft (button graft) for repair of small-sized tympanic membrane perforations and to compare its success rate with that of the underlay and overlay techniques with temporal fascia or tragal perichondrium.

Prospective, sequential allocation of surgical technique study.

Tertiary care university hospital.

One hundred ninety-seven patients aged 14 to 42 years old with central, uncomplicated tympanic membrane perforations with completely visualised margins affecting less than 25% of the tympanic membrane, distributed in 3 groups; 1 (underlay), 2 (overlay) and 3 (button graft).

Patients were allocated in sequence to;1 Underlay graft, 2 Overlay graft, 3 Cartilage tympanoplasty with button graft technique. Patients were operated on under local anaesthesia.

Postoperative status of the tympanic membrane, hearing improvement, and incidence of complications at 12 months postoperative.

Group 1 had 66 patients; group 2, 65; and group 3, 66. Success was defined as the complete closure of the tympanic membrane one year after the operation. The success rates were 98.5% [ 65 of 66], 97% [63of 65] and 98.5% [65 of 66] cases and the mean air-bone gap gains were 10.18 (+5.4) dB, 8.5 (+6.5) dB and 9.1(+5.1) dB for groups 1, 2, and 3, respectively. No bone conduction threshold or speech discrimination score worsening was noted. The mean durations of the operative procedure were 35± 8.4, 42± 6.8, and 23± 6.3 minutes for groups 1, 2, and 3, respectively (P=.02). Tympanic membrane retraction in 3 cases in group 1 and tympanic membrane cholesteatoma pearls occurred in 2 cases in group

The button graft technique is an effective and fast alternative for the repair of small tympanic membrane perforations if complete visualisation of the margin is possible. The shorter time taken with the button grafts is mainly due to the non requirement for a skin incision. The results are comparable to those of the underlay and overlay techniques.

© 2013 Blackwell Publishing Ltd

To compare bleeding rates and severity between recipients of NSAIDs versus placebo or opioid analgesics for tonsillectomy.

Two authors independently searched electronic databases including PubMed, OVID, EMBASE and Cochrane Review from inception to July 2012. The keywords used included: Adenotonsillectomy, Tonsillectomy, Analgesia, Bleeding, Perioperative and Postoperative. These were then combined in various combinations with specific NSAIDs.

A systematic review and meta-analysis of all randomised control trials comparing bleeding rates and severity between NSAIDs versus placebo or opioids post-tonsillectomy.

A total of 36 studies met our inclusion criteria including 1747 children and 1446 adults. When all of the studies were combined in a meta-analysis using the most severe outcome, there was no increased risk of bleeding in those using NSAIDs after tonsillectomy. Use of NSAIDs in general [1.30 (0.90–1.88)] or in children [1.06 (0.65–1.74)] was not associated with increased risk of bleeding in general, most severe bleeding, secondary haemorrhage, readmission or need of reoperation due to bleeding. Similarly, there was no increased bleeding risk for specific NSAIDs in adults. In the studies looking at paediatric subjects, the overall odds ratio of bleeding was even lower than in the general population and not significant. This result is based on 18 studies, six of which had zero outcomes in either treatment arm. Similar to the general population analysis, there was no significant difference in any of the subanalyses: bleeds treated with reoperation, readmission or bleeds in children that could be managed conservatively. There were also no significant differences in the subanalyses of individual NSAIDs. Similarly, there was no significant difference in rates of bleeding in the subanalysis of studies that gave NSAIDs multiple times, for instance, both before and after surgery.

These results suggest that NSAIDs can be considered as a safe method of analgesia among children undergoing tonsillectomy.

Retrospective national re-evaluation study of patient records 1993–2007 and make comparison with the original ICD codes.

All ENT departments at university hospitals and one large county hospital department in Sweden.

A total of 1966 records were reviewed for patients with ICD codes for in-patient treatment of acute (529), chronic (44) and unspecified mastoiditis (21) and acute otitis media (1372).

ICD codes were reviewed by the authors with a defined protocol for the clinical diagnosis of acute mastoiditis. Those not satisfying the diagnosis were given an alternative diagnosis.

Of 529 records with ICD coding for acute mastoiditis, 397 (75%) were found to meet the definition of acute mastoiditis used in this study, while 18% were not diagnosed as having any type of mastoiditis after review. Review of the in-patients treated for acute media otitis identified an additional 60 cases fulfilling the definition of acute mastoiditis. Overdiagnosis was common, and many patients with a diagnostic code indicating acute mastoiditis had been treated for external otitis or otorrhoea with transmyringeal drainage.

The internal validity of the diagnosis acute mastoiditis is dependent on the use of standardised, well-defined criteria. Reliability of diagnosis is fundamental for the comparison of results from different studies. Inadequate reliability in the diagnosis of acute mastoiditis also affects calculations of incidence rates and statistical power and may also affect the conclusions drawn from the results.

Prospective, before–after trial.

Tertiary referral centre.

A total of 191 patients who underwent primary rhinoplasty between 2006 and 2009 were included. The study population was separated into two groups: non-deviated (patients with an external nasal deformity of less than 5⁰) and deviated nose (patients with an external nasal deformity of more than 5⁰).

The angles of deviations were measured from the pre- and postoperative photographs by an image analysis software program. Patient satisfaction and quality of life were measured by Rhinoplasty outcome evaluation and European Quality of Life-5 Dimension questionnaires before and after surgery.

Eighty-one cases had deviated nose deformity; on the other hand, 110 cases had nasal deformities other than deviated nose deformity. The objective analysis of surgical outcome demonstrated a statistically significant improvement in the favour of postoperative results in both non-deviated (P = 0.0004) and deviated (P = 0.0002) nose groups. In addition, Rhinoplasty outcome evaluation and European Quality of Life-5 Dimension questionnaires demonstrated remarkable improvement in both non-deviated and deviated nose groups after rhinoplasty. However, the comparison of pre- and postoperative change between non-deviated and deviated nose groups demonstrated statistically significant differences in almost all questions (except family and friends' satisfaction with appearance P = 0.069) and total score (P < 0.001) of Rhinoplasty outcome evaluation questionnaire, European Quality of Life-5 Dimension index (P < 0.001), European Quality of Life-5 Dimension visual analogue scale (P = 0.036) and living quality index (P < 0.001) with lower scores in deviated nose group.

Rhinoplasty can provide an objective improvement, high satisfaction and positive impact on quality of life. However, the degree of satisfaction and improvement in quality of life in patients with deviated nose deformity are less than patients with non-deviated nose deformity.

A prospective and multicentre study.

Tertiary care referral medical centre.

A total of 202 patients with suspected acute supraglottitis were enrolled. All patients underwent CT to confirm the presence of abscess.

The patients' characteristics, symptoms at presentation, laryngoscopic findings of epiglottic swelling and arytenoid swelling by scope classification and initial laboratory finding were analysed.

Of 202 patients, 158 (78%) had acute supraglottitis and 44 (22%) had epiglottic abscess. There was no significant difference in age between the acute supraglottitis group and the epiglottic abscess group. Men were significantly more frequent in the epiglottic abscess group than females (P = 0.042). When comparing the symptom at presentation, the patients with epiglottic abscess complained of voice change more frequently (P = 0.003). Moderate or severe epiglottic swelling in scope classification was significantly associated with epiglottic abscess (P < 0.001). In logistic regression analysis, voice change [OR = 2.64, 95% CI = 1.29–5.40, P = 0.008] and moderate or severe epiglottic swelling in laryngoscopic findings [OR = 3.94, 95% CI = 1.63–9.53, P = 0.002] were independent predictive factors for epiglottic abscess. The positive predictive values of voice change and moderate or severe epiglottic swelling were 33% and 30%, respectively. The negative predictive values of voice change and moderate or severe epiglottic swelling were 15% and 9%, respectively.

Routine CT might be suggested for diagnosis of epiglottic abscess in the patients with acute supraglottitis, because of the poor predictive values of symptoms and signs.

Speech and language delay is a common developmental disorder. Persistent delay may lead to adverse effects on literacy, educational achievement and psychosocial development. Affected children are commonly referred to the otolaryngologist; hence, a structured management approach is required to facilitate diagnosis and allow for early intervention and improved outcomes.

A literature search was performed on 05 November 2012 using the MEDLINE, EMBASE and Cochrane databases with the search terms paediatric, children, speech, language, delay, disorder, investigation and management. Relevant references from selected articles were reviewed after reading the abstract.

Speech and language delay may be primary, meaning there is no associated comorbidity to account for the delay, or secondary, where it can be attributed to another condition or syndrome. Secondary causes include hearing loss and syndromes such as Down syndrome amongst many others. Speech and language therapy has been shown to be effective for primary disorders. If the delay is found to be secondary in nature, onward referral to an appropriate healthcare professional is required.

The outpatient consultation for a child with speech and language delay should consist of a structured history and examination with the aim of identifying whether the delay is primary or secondary in nature. Relevant targeted investigations should lead to a correct diagnosis of the delay and enable appropriate treatment. This often requires a multidisciplinary approach and always requires full cooperation from the child's parents.