Head Bandage Research Articles

Magnet Dislocation: An Increasing and Serious Complication Following MRI in Patients with Cochlear Implants

Cochlear implantation (CI) represents the gold standard in the treatment of children born deaf and postlingually deafened adults. Initial magnetic resonance imaging (MRI) was contraindicated in CI users. Meanwhile, there are specific recommendations concerning MRI compatibility depending on the type of CI system and the device manufacturer. Some CI systems are even approved for MRI with the internal magnet left in place. The aim of this study was to analyze all magnet revision surgeries in CI patients at one CI center and the relationship to MRI scans over time. Between 2000 and 2013, a total of 2027 CIs were implanted. The number of magnet dislocation (MD) surgeries and their causes was assessed retrospectively. In total 12 cases of MD resulting from an MRI scan (0.59 %) were observed, accounting for 52.2 % of all magnetic revision surgeries. As per the labeling, it was considered safe to leave the internal magnet in place during MRI while following specific manufacturer recommendations: MRI intensity of 1.5 Tesla (T) and compression head bandage during examination. A compression head bandage in a 1.5 T MRI unit does not safely prevent MD and the related serious complications in CI recipients. We recommend a Stenvers view radiograph after MRI with the internal magnet in place for early identification of MD, at least in the case of pain during or after MRI examination. MRI in CI patients should be indicated with restraint and patients should be explicitly informed about the possible risks. Recommendations regarding MRI compatibility and the handling of CI patients issued with MRI for the most common CI systems are summarized.

Magnetic Resonance Imaging in Patients with Neurofibromatosis Type 2 and Auditory Brainstem Implants

Objective: Magnetic resonance (MR) imaging is the primary imaging modality used to monitor patients with neurofibromatosis type 2 (NF2). Until recently, it has been contraindicated in auditory brainstem implant (ABI) recipients due to concerns over internal magnet displacement and image distortion effects. This study investigates the use of compression head bandaging and head positioning in minimizing these risks and patients' experiences of them.

Are mastoid pressure dressings necessary after otologic surgery to prevent postoperative hematomas?

Are mastoid pressure dressings necessary after otologic surgery to prevent postoperative hematomas?

The Use of Tissue Glue in Prominent Ear Correction Surgery

Cyanoacrylate tissue glues have been used for many years in otoplasty and specific indications for its use are as described. As well as being an effective means of dressing the postauricular suture line, its use in gluing the pinna back to the postauricular skin may negate the use of the head bandage in the postoperative period.

Cochlear Implants as a Paediatric Day Surgery Service

Cochlear implantation is an evolving and innovative field, with advances being made all the time in the auditory rehabilitation of profoundly deaf patients. Throughout the different fields of surgery there is a drive to carry out procedures as day cases. Paediatric cochlear implantation has been shown to be a cost-effective healthcare intervention in profoundly hearing impaired young children (O’Neill et al., 2000), as well as for older children and adults. It has traditionally been considered an inpatient procedure, and to our knowledge there are no reports in the literature from units with a policy of day surgery cochlear implants. The procedure requires a 2to 3-hour general anaesthetic, and a head bandage is usually applied for 24 hours postoperatively. There is also an association with postoperative nausea and vomiting (PONV), and for these reasons patients conventionally have a 1or 2-night admission. Our aim in this pilot study was to describe the day surgery service which we provide, and to demonstrate that it is possible to provide a day case facility for paediatric patients undergoing cochlear implantation.

The Berger rhythm: potential changes from the occipital lobes in man, by E.D. Adrian and B.H.C. Matthews (From the Physiological Laboratory, Cambridge). Brain 1934: 57; 355-385.

In a series of papers dating from 1929, Hans Berger has described ‘a rhythmic oscillation of potential at a frequency of 10 cycles per second … detected in the human subject by electrodes applied to the head … present when the subject lies quietly with eyes closed and disappearing when attention is fully occupied’. Because Dr Berger finds that the waves are larger if needles reaching the periosteum lie over foramina in the skull rather than the intact cranium, he concludes that this remarkable effect derives from the cerebral cortex, and that it reflects a fundamental activity of the brain. But there are unresolved issues, and Professor (Lord) Adrian and Dr (Sir Bryan) Matthews intend to repeat Berger’s experiments: to show whether or not these potentials do indeed arise from the cortex; to reveal their nature and the structures from which they arise; to characterize the type of activity that they represent; and to reconcile the emerging results with their prior failure to record comparable activity from the exposed surface of the animal cortex. ‘To anticipate … we regard the effect as due to spontaneous rhythmic activity of … cortical cells in … the occipital lobe … [that] beat synchronously when … undisturbed … but visual activity or wide-spread non-visual activity in the brain breaks up the rhythm by exposing the cells to a mosaic of excitations which makes synchronous action impossible … localization is the only important point on which our results seem to differ [from Dr Berger].’ Their method is to detect potentials using lint-covered squares of copper gauze soaked in saline. These make good contact with the scalp and, contained by a tight head bandage, are not inferior to the implanted needle electrodes used by Berger. The subject remains quiet and physically relaxed during the recording. The …

Pressure dressing after excision of preauricular sinus: suture transfixion of silicone sheets

After excision of a preauricular sinus, a head bandage compressive dressing is usually used to reduce dead space and to decrease the risk of recurrence. However, such use of a head bandage may cause various problems. We assessed a new method of compressive dressing, using suture transfixion of silicone sheets to the former sinus tract, following preauricular sinus excision. This retrospective study reviewed the medical records of patients undergoing preauricular sinus excision in a tertiary referral centre over a five-year period. After excision of the preauricular sinus, patients underwent suture transfixion of silicone sheets. Post-operative outcomes were analysed. The new dressing method was performed on 50 ears of 37 patients. The post-operative incidence of recurrence and haematoma formation was 4 and 2 per cent, respectively. Other problems possibly caused by head bandaging, such as headache, facial flushing, and nausea and/or vomiting, were not observed. Compressive dressing by suture transfixion of silicone sheets is safe and effective following preauricular sinus excision.

Mastoid pressure dressing for cochlear implantation—Is it necessary?

Objectives Mastoid pressure dressing (MPD) with circumferential head bandage after middle ear surgery and cochlear implantation (CI) is used to minimize the postoperative hematoma and thus provides a good wound covering. But such dressing is usually uncomfortable for patients and may lead to other unpredictable complications. This study was aimed to evaluate the need for MPD following CI. Methods Retrospective chart analysis of 92 consecutive patients who underwent CI. Results The 92 patients had a median age of 4.3 years. All patients were categorized into those receiving either MPD or simple gauze dressing (SGD). Six MPD patients and five SGD patients had minor surgical-site complications (9.1% and 6.3%, respectively), a statistically insignificant difference. The key to preventing hematomas is careful tissue handling and minimally invasive techniques. MPD alone rarely provides enough pressure to prevent hematoma. Conclusions This study found no clinically significant benefits for use of MPD following CI. We suggest abandoning the use of compression bandages after uncomplicated CI.

Twenty-four hours or 10 days? A prospective randomised controlled trial in children comparing head bandages following pinnaplasty

Twenty-four hours or 10 days? A prospective randomised controlled trial in children comparing head bandages following pinnaplasty

Treatment of pinna haematoma with compression using Leonard buttons

The standard treatment of a pinna haematoma involves drainage and compression to prevent recurrence and subsequent disfigurement. Compressive methods can be non-invasive or invasive, utilising a head bandage or through and through sutures, respectively, to keep compression in place. Leonard buttons are effective alternative compressive devices. They are simple to use and easily available.

Twenty-four hours or 10 days? A prospective randomised controlled trial in children comparing head bandages following pinnaplasty

The perceived benefits of bandaging for 10 days following pinnaplasty have been questioned by previous studies. The problems arising from these dressings are many [Powell BWEM. The value of head dressings in the postoperative management of the prominent ear. Br J Plast Surg 1989;42:692-4. Bartley J. How long should ears be bandaged after otoplasty? J Laryngol Otol 1998;112:531-2. Wong MC, Sylaidis P. Head dressings for pinnaplasty: a tradition not supported by evidence. Br J Plast Surg 2001;54:81-2], including their slippage [Powell BWEM. The value of head dressings in the postoperative management of the prominent ear. Br J Plast Surg 1989;42:692-4. Bradbury ET, Hewison J, Timmons MJ. Psychological and social outcome of prominent ear correction in children. Br J Plast Surg 1992;45:97-100. Jeffery SLA. Complications following correction of prominent ears: an audit review of 122 cases. Br J Plast Surg 1999;52:588-90]. Eighty children were recruited into a prospective randomised controlled trial comparing the use of a head bandage for only 24 h with a standard practise of a 10-day head bandage. A preoperative measurement of the lateral ear projection (LEP) was made. The outcome measures recorded during the two planned postoperative visits at 10 days (visit 1) and 2 months (visit 2) were: patient satisfaction score, LEP, complications and any unscheduled hospital visits associated with the surgery. There was no significant difference in LEP and patient satisfaction between the two groups at both the scheduled postoperative visits. Differences between the groups in the number of unscheduled visits (p=0.21) did not reach statistical significance. The findings indicate that it is safe and effective to use head bandage for only 24 h following surgical correction of prominent ears. This study shows no benefit from the application of a formal head bandage for any longer than 1 day.

Visible markers of brain injury influence attributions for adolescents’ behaviour

Primary objective: Experiments investigated whether attributions for a brain-injured person's behaviours were affected by markers of injury. People misattribute behaviours that result from brain injury to personality or life stages (e.g. adolescence), particularly when there are no visible markers of the injury.Research design: Scenarios presented a photograph of an adolescent boy, who either wore or did not wear a head bandage. The boy was described as suffering a brain injury and showing four changes in his behaviour, relating to sleep, anger, self-confidence and motivation.Methods and procedures: For each behaviour, students (n = 100) rated attributions to the brain injury and adolescence.Outcomes and results: When there was no bandage, participants attributed the behaviours to adolescence more than brain injury, whereas with the head bandage they invoked both causes equally.Conclusions: When actions resulting from brain injury are attributed to causes other than the injury, this misattribution hinders accurate diagnosis and treatment. Data on effects of injury and individual levels of pre-morbid behaviours lead to accurate attributions.

Unconventional treatment methods in Turkish migraine sufferers

We wanted to document Turkish migraine sufferers’ unconventional therapy methods learnt from their social environment and discuss the historical background and possible action mechanisms of these methods. Unconventional therapy methods were documented among 482 migraine patients who consulted Kocaeli University Medical Faculty, Neurology Department’s “Headache outpatient clinic”. Among 482 migraine patients, 154 sufferers (31.9%) had been using unconventional therapy methods. Among these patients, the most frequently used methods were using a head bandage (25.9%), applying cold water to head (23.4%), massage (16.2%), applying ice to head (15.6%), taking a hot or warm bath (10.4%) and inserting sliced vegetables under the head bandage (7.8%). However, our data may not represent all Turkish migraine sufferers as our sample was drawn from a clinical sample living in the most western part of Anatolia, the city of Kocaeli bordering Istanbul. Determining the efficacy of these methods was beyond our aim; however, a more systematic study about the given case may be even more interesting.

An open, randomized comparison of alfentanil, remifentanil, and alfentanil followed by remifentanil in anaesthesia for craniotomy

We studied 52 adults undergoing elective craniotomy, allocated randomly to one of three opioid treatments: alfentanil 50 micrograms kg-1 followed by 0.833 microgram kg-1 min-1 until dural closure (group Alf.); alfentanil 50 micrograms kg-1 followed by 0.833 microgram kg-1 min-1 for 2 h, then remifentanil 0.25 microgram kg-1 min-1 (group Alf.-Remi.); or remifentanil 1 microgram kg-1 followed by 0.5 microgram kg-1 min-1 reducing to 0.25 microgram kg-1 min-1 after craniotomy (group Remi.). Anaesthesia was maintained with infusion of propofol and 66% nitrous oxide in oxygen. Infusions of propofol and remifentanil were stopped at head bandaging. Group Remi. had the least intraoperative haemodynamic responses and group Alf. the most (P < 0.05). Times to tracheal extubation and obey commands were similar in all groups. In all patients in group Alf.-Remi. and group Remi., the trachea was extubated 27 min from the end of anaesthesia; three patients in group Alf. were slower to recover. Use of analgesia in the recovery room and time to transfer to the neurosurgical unit were similar in the three groups.

An open, randomized comparison of alfentanil, remifentanil and alfentanil followed by remifentanil in anaesthesia for craniotomy

We studied 52 adults undergoing elective craniotomy, allocated randomly to one of three opioid treatments: alfentanil 50 micrograms kg-1 followed by 0.833 microgram kg-1 min-1 until dural closure (group Alf.); alfentanil 50 micrograms kg-1 followed by 0.833 microgram kg-1 min-1 for 2 h, then remifentanil 0.25 microgram kg-1 min-1 (group Alf.-Remi.); or remifentanil 1 microgram kg-1 followed by 0.5 microgram kg-1 min-1 reducing to 0.25 microgram kg-1 min-1 after craniotomy (group Remi.). Anaesthesia was maintained with infusion of propofol and 66% nitrous oxide in oxygen. Infusions of propofol and remifentanil were stopped at head bandaging. Group Remi. had the least intraoperative haemodynamic responses and group Alf. the most (P < 0.05). Times to tracheal extubation and obey commands were similar in all groups. In all patients in group Alf.-Remi. and group Remi., the trachea was extubated 27 min from the end of anaesthesia; three patients in group Alf. were slower to recover. Use of analgesia in the recovery room and time to transfer to the neurosurgical unit were similar in the three groups.

How long should ears be bandaged after otoplasty?

A firm head dressing is usually applied after otoplasty. Some surgeons recommend that the patient should wear the bandage for up to 10 days after surgery. However, these bandages are frequently displaced or come off. Patients complain of reduced hearing, itch and the smell of old blood in the bandages. A case series of 52 patients undergoing bilateral otoplasty who had a head bandage on for only 24 hours was audited prospectively. Minor complications occurred in two patients. A head bandage does not need to remain on for more than 24 hours after otoplasty.

Head bandaging following otoplasty—how we do it

One of the most common problems following otoplasty is that the bandage applied at the time of surgery slips prematurely, falling over the patient's eyes and thereby requiring replacement. We present a simple technique which prevents this from occurring.

Pressure exerted by head bandages used in otological surgery

The pressure exerted by head bandages at the operation site following ear surgery was measured using a balloon catheter and pressure transducer. The initial pressures achieved, their diminution with time and the relationship of pressure to the induction of headache in the patient were studied. The principal findings were that the standard otological head bandage is rarely tight enough to prevent haematoma formation, bandages have lost their efficacy after the first hour and headaches are associated with a significantly higher initial bandage pressure.

Fractionation of the cataleptic bracing response in rats

In haloperidol-treated rats, bracing, i.e., resistance to displacement along a horizontal surface, was found to involve four components: gripping by the digits, extension by the limbs, stiffening of the body axis and arching the vertebral column towards the displacing force. Labyrinthectomy weakened the bracing of the forequarters as did application of a head bandage. Labyrinthectomy, when combined with head bandage, completely abolished all forequarter bracing responses. Neither manipulation affected the bracing responses of the hindquarters. The hindquarter bracing reaction was abolished by application of an abdominal bandage, which left most of the forequarter responses intact. Isolation of fore- and hindquarter bracing responses revealed that whereas gripping by the digits and extension by the limbs could occur independently in either part of the body, stiffening of the body axis and arching of the vetebral column originated in the hindquarters. However, although these latter components of bracing originate in the hindquarters, as evidenced by their abolition with application of an abdominal bandage, their recruitment into the anterior of the body only occurred when the bracing of the forequarters was unimpaired. Either labyrinthectomy or head bandage prevented stiffening and arching of the vertebral column from occurring in the forequarters, even though these procedures had no effect on the hindquarters. Labyrinthectomy, head bandage and abdominal bandage all fractionated the bracing response over a wide range of haloperidol dosages (0.5, 1.0, 2,5, 5,0 and 7.5 mg/kg).

The distribution of intracranial forces in acute and chronic hydrocephalus

A set of equations has been derived to describe the distribution of intracranial pressure and tension during the development of acute obstructive hydrocephalus. Theoretical predictions correlate with clinical and pathological observations. Biomechanical and experimental considerations indicate that in the first few hours after acute outflow obstruction, the ventricles expand at the expense of easily-displaced intracranial fluid compartments, and destructively high brain tension is concentrated in periventricular areas. Once displaceable fluids are exhausted, the rigidity of the skull becomes the dominant factor. If the skull is rigid, brain tension drops to very low values, intracranial pressure becomes uniform, and ventricular expansion is essentially halted. If the skull is soft and plastic, as in an infant, brain tension remains high and ventricular expansion continues, though its course may eventually be modified by pressure changes and by the geometric factors illustrated in Fig. 4. Experimentally, this formulation seems accurate for adult mammals. The clinical course of infants with hydrocephalus is well known; but Epstein, Hochwald and Ransohoff (1973) have recently shown that restrictive head bandaging will prevent skull expansion and limit neurological damage in infants as well. There is little reason to suppose that the mechanical forces in normal-pressure hydrocephalus are substantially different, despite the presence of free communication between the ventricular system and the lumber subarchnoid space.