Ventilation Tube Research Articles

Ventilation tube (grommet) insertion in adult patients with stage III tympanic membrane atelectasis: A case report

Background: Effusion Otitis Media (OME) is a condition where there is an accumulation of fluid in the middle ear without signs of acute infection which can cause hearing loss and complications such as atelectasis. Even though it occurs more often in children, it does not rule out the possibility that OME can occur in adults, although it is less common, OME in adults can cause complaints such as decreased hearing, discomfort or a feeling of fullness in the ears. Management of OME includes conservative treatment with antibiotics, decongestants or topical corticosteroids as well as medic procedures such as installing grommet tubes as well as identifying underlying causative factors such as sinus infections or eustachian outflow disorders. Objective: To report a case of ventilation tube (grommet) insertion in adult patients with stage III tympanic membrane atelectasis Case Report: A 27 year old woman came with complaints of bilateral hearing loss, complaints accompanied by a feeling of fullness in the ears and tinnitus, especially in the left ear. From the results of the otoscopic examination, it was found that the tympanic membrane was retracted and tympanometry showed type B on both ears. Surgical procedure was then carried out for the installation of a ventilation pipe (grommet). Clinical question: How is the management of and adult patients with stage III tympanic membrane atelectasis with ventilation tube (grommet) insertion? Methods: Evidence-based literature study of ventilation tube (grommet) insertion in adult patients with stage III tympanic membrane atelectasis. Result: Grommet tube placement improved hearing in the left ear, with audiometry showing a reduction in hearing threshold from 42 dB to 37 dB. Conclusion: Installation of ventilation tubes (grommets) in adult patients with stage III tympanic membrane atelectasis has proven effective in reducing symptoms such as decreased hearing and a feeling of fullness in the ear and can prevent long-term complications. Grommet tube placement is an effective management option for adult patients with stage III tympanic membrane atelectasis who do not respond to conservative therapy.

User behavior during functional testing of the ventilator: analysis of the use of the QUICKcheck and detection of misconnected ventilation tubes

While patient safety during general anesthesia has improved in recent years, incidents still occur in anesthesia, particularly in the area of airway management and ventilation. In addition to amandatory daily system test before using aventilator, aQUICK check is recommended by the German Society of Anesthesiology and Intensive Care Medicine (DGAI) before connecting apatient; however, misconnections of breathing tubes are still possible and not necessarily detected by the device self-test. The aim of the present study was to analyze user behavior at modern anesthesia workstations regarding the verification and functionality of the QUICK check. Amonocentric prospective recording of user behavior in handling the QUICKcheck was carried out as part of amedical simulation training course as well as aprospective, multicenter, explorative, anonymous survey of anesthesiology staff in various German hospitals. Out of 30 participating physicians 93.3% (n = 28) carried out aQUICK check immediately before connecting the simulation patient to the ventilator. Only 1 (96.6%) of the physicians did not recognize the incorrect connection of the ventilation tubes during their QUICK check. Of the participating physicians, 80% did not use the separate bag valve mask despite persistent ventilation problems on the ventilator. The online survey was answered by n = 187 participants, 64.7% of the participants stated that they always carry out the QUICK check, 31.5% sometimes and 3.7% never. The presence of aseparate bag valve mask is always checked by 66.3% of respondents, by 29.8% sometimes and by 3.8% never. Of the physicians, 32% believed that the integrated self-test always recognizes amisconnection of the ventilation tubes. The present study reveals aheterogeneous picture of the application and understanding of the QUICK check as recommended by the DGAI. The lack of understanding of astandardized implementation of the check can be seen as further evidence of the importance of interdisciplinary training with afocus on human factors, communication and cooperation as opposed to a mere procedural implementation of established tools.

Postoperative course of Eustachian tube plug surgery with Kobayashi plug.

To investigate its effectiveness and safety and clarify the postoperative course of Kobayashi plug surgery for refractory patulous Eustachian tubes. This retrospective study included 83 patients diagnosed with a patulous Eustachian tube who received Kobayashi plug surgery at our hospital. At 1 month postoperatively, the success rate was 74.0 %; at 3 months, it was 67.1 %; at 6 months, it was 65.0 %; and at 12 months it was 65.2 %. At 6 months, otitis media with effusion (OME) was observed in 12.5 % of cases, and residual tympanic membrane perforation was observed in 5.0 %. Ventilation tube placement was performed in 10 cases, and eight cases required revision surgery. During the course, plugs were removed in four cases. Median values of patulous Eustachian Tube Handicap Inventory-10 (PHI-10) at 1, 3, 6, and 12 months postoperatively were 14, 16, 16, and 20, respectively. PHI-10 significantly improved at all the time points after surgery than before surgery (median 33). The Kobayashi plug surgery is safe and effective for refractory patulous Eustachian tubes over the long term. At 6 months postoperatively, there were few cases of OME, and the symptoms also stabilized.

Laryngeal Mask Airway Method for Minimally Invasive Surfactant Therapy in Neonates with Pneumothorax Complicating Respiratory Distress Syndrome

Background/Objectives: Pneumothorax is a common complication of neonatal respiratory distress syndrome, which is decreased by surfactant therapy. Rescue administration of surfactant in neonates with severe RDS complicated by pneumothorax requires management of the pneumothorax to optimize surfactant distribution while avoiding positive pressure ventilation to minimize iatrogenic exacerbation of the air leak. Methods: We retrospectively reviewed our center’s experience with neonates who had clinically significant pneumothorax complicating RDS, in whom we used a novel technique to administer surfactant through a laryngeal mask/supraglottic airway device without applying positive pressure ventilation. Results: In 13 of the 20 neonates in our cohort, subsequent invasive ventilation and chest tube insertion were avoided. There were no major complications or unfavorable outcomes. We describe our experience with this method and suggest an approach to individualize the management of neonates with pneumothorax preceding surfactant therapy. Conclusions: In our setting, laryngeal mask airway devices are now the preferred method to deliver surfactant in neonates with RDS and pre-existing pneumothorax. We believe this approach is readily applicable in most neonatal care settings.

Middle ear ventilation tubes and water precautions: A survey of otolaryngologists and pediatricians on their recommendations.

Introduction. Middle-ear ventilation tubes are commonly placed in pediatric patients because of the high frequency of otitis media. Although avoidance of water activity has been recommended to prevent otorrhea, studies indicate that exposure to water does not increase these episodes. However, a survey in the northwestern United States showed low adherence to these guidelines. This study evaluates the current recommendations of otolaryngologists and pediatricians on water exposure in patients with ventilation tubes. Population and methods. We surveyed 235 health professionals from Argentina, Brazil, Chile, and other countries, including general otolaryngologists, pediatric otolaryngologists, otologists, residents, and pediatricians. The questionnaire addressed tubing preferences, swimming recommendations, and depth limits. Results. A total of 87.62% of respondents preferred diabolos as ventilation tubes. Regarding swimming, 54% recommended protection, such as earplugs or caps, while 28.5% prohibited aquatic activity. Permissiveness varied according to age and specialty; residents and pediatricians were the most permissive. One-third allowed only shallow swimming, and 20% imposed no limits. Conclusion. Young professionals and pediatricians were the most permissive concerning water exposure. Within the subspecialties, pediatric otolaryngologists and pediatricians were the respondents who indicated the least restrictions on their patients.

Can the monocyte/HDL ratio predict ear effusion in adenoid vegetation patients?

BackgroundSince monocytes secrete cytokines, high monocyte counts may indicate subclinical inflammation. HDL-C, a significant component of total cholesterol, may reduce inflammation.ObjectivesThis study investigated whether the monocyte/HDL ratio (MHR) could be an independent predictive marker in patients with adenoid vegetation, both with and without otitis media with effusion (OME).MethodsThis cross-sectional study included patients diagnosed with adenoid vegetation, with or without OME, who underwent surgery. The groups consisted of patients who underwent adenoidectomy alone for adenoid vegetation and those who underwent adenoidectomy + ventilation tube for adenoid vegetation with OME (Group 2). Monocyte counts, HDL-C levels, and MHR values were calculated for both groups.ResultsThe mean age of Group 1 was 6.95 ± 2.77 years, while Group 2 had a mean age of 6.61 ± 2.98 years. No significant difference was found in monocyte count or percentage between the groups. The HDL-C ratios were lower in Group 2, which OME accompanied, and the difference between the groups was significant (p: 0.027). The MHR was not significantly different between Groups 1 and 2, with values of 10.47 (4.22–29.23) and 12.29 (5.43–99.6), respectively.ConclusionReduced MHR ratios may indicate elevated inflammatory levels in the body and may be linked to certain medical conditions. However, we found no significant difference in the parameters’ ability to predict OME in children with adenoid vegetation. Therefore, a simple, low-cost marker to predict middle ear effusion in children is needed.

Analysis and long-term outcomes of spontaneous cerebrospinal otorrhea repair via the middle cranial fossa approach

Background The incidence of spontaneous CSF otorrhea is increasing and knowledge about treatment management is growing. Objectives To analyse the cases operated via the middle cranial fossa approach (MCFA) for spontaneous CSF otorrhea in our clinic and to evaluate the long-term surgical results in the light of the literature. Methods Demographic data, presenting complaints, complications, hearing outcomes, recurrence rates and long-term success of patients operated with MCFA between 2012 and 2022 in our tertiary care centre were evaluated. Results The mean age of the 12 patients who met the inclusion criteria was 58.3 ± 13.4 years. Hearing loss and ear fullness in five patients and persistent otorrhea after ventilation tube insertion in three patients were the most common symptoms. The mean body mass index (BMI) was 35.03 ± 3.39. More than one defect was detected in seven patients. No perioperative or postoperative complications were observed in any patient. The mean airway hearing threshold (ASH)±SD was 40.6 ± 13 preoperatively and 24.4 ± 6.3 postoperatively, a statistically significant decrease (p = 0.003). The mean follow-up period was 80.8 ± 32.5 months and no recurrence was observed in any patient. Conclusion Our experience and results support the use of MCFA in the repair of spontaneous CSF otorrhea as safe, highly successful, and beneficial.

Can Neutrophil-to-Lymphocyte Ratio, Platelet Volume, and Platelet Distribution Width Be Used as Indicators of Delirium?

Background/Objectives: Postoperative delirium is a frequent complication in children undergoing general anesthesia. It has been suggested that inflammation and oxidative stress contribute to the pathophysiology of delirium. The aim of our study was to investigate the relationship between inflammatory markers and delirium. Methods: A total of 221 children in the ASA 1–3 risk group who underwent adenoidectomy, tonsillectomy, and/or ventilation tube application were included in our single-center, prospective, and observational study approved by the Ethics Committee, numbered E1-23-3197. Patients whose parental consent was obtained were either premedicated with oral midazolam preoperatively or taken to surgery without premedication, depending on the anesthesiologist’s preference. After induction with sevoflurane, rocuronium and fentanyl were administered intravenously. Sevoflurane and infusion of remifentanil were administered for maintenance. At the end of the operation, patients were transferred to the recovery unit and followed up for 30 min. They were evaluated with the Face, Legs, Activity, Cry, and Consolability (FLACC) Scale and Pediatric Anesthesia Emergence Delirium (PAED) Scale. Results: Delirium was observed in 80 patients. There was no significant difference between patients with and without delirium in terms of neutrophil/lymphocyte ratio, mean platelet volume, or platelet distribution volume. Lymphocyte count, PAED score, and FLACC score were statistically higher in patients with delirium (W = 4407.5, p-value = 0.006997; W = 0, p-value < 2.2 × 10−16; W = 9489, p-value < 2.2 × 10−16, respectively). Conclusions: No statistically significant relationship was found between hematologic inflammatory markers and delirium. Controlled studies with larger sample sizes are needed to determine whether these markers have strong predictive value.

Pediatric cochlear implantation in otitis media with effusion: Are ventilation tubes truly necessary?

We aimed to evaluate the clinical findings of our cochlear implant (CI) patients with otitis media with effusion (OME) and CI patients treated with ventilation tube (VT) for OME. The medical records of patients who underwent CI surgery at Hacettepe University, Department of Otorhinolaryngology, between November 1997 and March 2023 were reviewed. Patients who had OME or VT in the implanted ear at the time of surgery were included in the study. Perioperative findings, complication status, revision status, and reasons for revision were recorded. A total of 2945 ears were operated for cochlear implantation during this period. Of these cases, 169 (5.7%) had OME and 55 (1.86%) had VT at time of surgery (180 patients). There were no significant differences between the two groups regarding demographic parameters and follow-up time. None of the investigated parameters showed any significant differences between the two groups, except for revision status. The revision rate was significantly higher in the OME group than that in the VT group (10.65% vs. null, p=0.008). The total non-OME and non-VT patient cohort had a significantly lower revision rates than the OME group (5.29% vs. 10.65%, p=0.003). There is no significant difference in surgical difficulty and perioperative complications after CI between patients with VT and those with OME. The relationship between a higher rate of revision and OME in CI patients, and the optimal timing and necessity of VT insertion prior to CI surgery, should be further investigated.

Danish cohort study of tympanic membrane retractions and manifestations of Eustachian tube dysfunction

AbstractObjectivesOur objective is to evaluate the prevalence of tympanic membrane (TM) retractions and management of signs of Eustachian tube dysfunction (ETD) in both children and adults following type 1 tympanoplasty or myringoplasty. Furthermore, to identify potential risk factors for developing ETD and TM retractions.MethodsRetrospective cohort study of 423 patients (5–86 years of age) undergoing 452 procedures. We extracted data from electronic patient journals during scheduled consultations to calculate prevalences and relative risks. The project was reported to the Danish Data Protection Authority, and access to electronic patient journals was approved by the Institutional Board of Gødstrup Hospital.ResultsAt 1 year postoperative follow‐up, the prevalence of TM retractions was 12.7% and ETD manifestations without a concurrent TM retraction was 4.2%. The graft failure rate was 11.0%. Risk factors for developing TM retractions included preoperative myringosclerosis, history of ipsilateral ear surgery, posterior perforations, and use of perichondrium graft. Conversely, previous contralateral ear surgery and temporal fascia graft use were associated with decreased risk. ETD manifestations were significantly increased in cases of preoperative bilateral perforation, history of ipsilateral ventilation tube, and traumatic TM perforation.ConclusionsTM retractions accounted for 12.7%, ETD manifestations without a concurrent TM retraction 4.2%, and graft failure 11.0%. The dynamic nature of these complications necessitates diligent follow‐up strategies.Level of evidenceLevel 4.

Otologic Manifestations in Patients with Achondroplasia: A Multicenter Study.

Achondroplasia, the most prevalent form of skeletal dysplasia involving short stature, necessitates a multidisciplinary approach that includes otology and auditory rehabilitation. Despite this, the clinical characteristics of hearing loss and otologic manifestations in achondroplasia patients remain poorly defined. This study aimed to explore the prevalence and treatment outcomes of otologic disease in individuals with achondroplasia. A retrospective review of medical records was conducted for 70 patients who visited the otolaryngology clinic at 3 institutions in South Korea from 1999 to 2023. Demographic and clinical characteristics, including audiometric findings, imaging studies, treatment modalities, and outcomes, were analyzed. Among 53 patients who underwent audiometry, 26 showed conductive hearing loss, 2 had mixed-type hearing loss, and 4 had sensorineural hearing loss. Fifty-one patients (72.9%) had middle ear effusion at least once. Myringotomy or ventilation tube insertion was performed on 33 patients (47.1%), and 16 patients (22.9%) required multiple insertions. Eighteen patients (25.7%) had adenoid hypertrophy, and 16 (22.9%) underwent adenoidectomy. Temporal bone computed tomography (TBCT) scans were taken in 9 patients (12.9%) for middle ear evaluation. Computed tomography (CT) scans showed a high jugular bulb and rotated inner ear structures. Chronic otitis media with cholesteatoma was diagnosed in 2 patients (2.9%), in whom tympanomastoidectomy was performed. Half of the children with achondroplasia experienced hearing loss, most commonly due to conductive hearing loss. Threequarters of these children exhibited otitis media with effusions, often necessitating the insertion of a ventilation tube and adenoidectomy. Given the anatomical variations present in these children, such as a high jugular bulb and rotated structures of the inner ear and facial nerve, a cautious approach is essential when performing middle ear surgery.

Pressurized IntraThoracic Aerosol Chemotherapy (PITAC) directed therapy of patients with malignant pleural effusion and pleural metastasis.

Pressurized IntraThoracic Aerosol Chemotherapy (PITAC) has been suggested as a new therapy for patients with malignant pleural effusion (MPE) and/or pleural metastasis (PLM). The patients have a poor prognosis with a median survival of 3 to 12months. We present feasibility, patient safety, and cytological/histological response assessment in PITAC-treated patients with MPE and/or PLM. Patients eligible for PITAC and treated at Odense PIPAC Center were included. PITAC was performed in lateral decubitus or prone position under double-lumen endotracheal tube ventilation to allow exclusion of the lung if necessary. After positioning of the ultrasound-guided trocar, the second trocar is inserted by video-assisted thoracoscopy. MPE was evacuated and measured. Pleural lavage was performed if no or small amounts of MPE werepresent. MPE or pleural lavage fluid was analyzed cytologically. Visible PLM was biopsied and sent for histology assessment using a four-tiered Thoracic Regression Grading Score (TRGS). After a walkthrough of the safety checklist, the chemotherapy was nebulized followed by 30 min of passive diffusion. The chemotherapy and chemotherapy-saturated air was evacuated through a closed bag and ventilation system. We report data on 11 intended PITACs in five patients. Nine PITACs were completed and two PITACs werediscontinued due to intraoperative complications or technical reasons. Response evaluation was available in three patients: one showed complete response (TRGS 1) andanother stable disease (TRGS 2). Cytology was available from two patients: one showed conversion from malignant to benign. The 30-day mortality was zero. PITAC appears to be safe and feasible.

Current Practice for Management of Otitis Media with Effusion in Children – A Review

ABSTRACT Introduction: A common childhood disease known as otitis media with effusion (OME) is described as the presence of fluids in the middle ear without any features of an acute ear infection. OME in the pediatric age group often leads to manifestations of hearing loss and speech delay. Methods: The search for recent research articles on managment of otitis media with effusion was done with databases scopus, pubMed, medline, and google scholar. This review article discusses the epidemiology, etiopathogenesis, clinical features, and current management of OME in children. Results: Nasal balloon auto-inflation appears to be a promising technique with some benefits in selected cases of OME. Insertion of grommets or ventilation tubes in pediatric patients with OME and hearing impairment is helpful in case of failed watchful waiting. Grommet insertion is usually effective in restoring hearing thresholds. Adenoidectomy can be performed in addition to grommet insertion in children of OME with adenoid hypertrophy. A combination of ventilation tubes and adenoidectomy is broadly helpful to normalize the hearing and increasing nasal patency. Early treatment of OME is helpful to improve the quality of life and social and educational performance. Neither medical treatment nor complementary or alternative treatment has been proven for giving effective treatment of OME. In children of OME with hearing impairment benefit through the effective restoration of hearing by insertion of ventilation tubes (grommets). Adenoidectomy is helpful in the case of persistent OME. Conclusion: The combination of ventilation tubes and adenoidectomy in children with OME is beneficial in terms of hearing, respiratory, and development of the children.

IgG4-Related Disease Involving the Ear: A Case Report.

IgG4-related disease is a chronic inflammatory disease with widespread clinical presentation. It mimics various malignant, infectious, and inflammatory conditions, leading to confusion in diagnosis and management. Otological manifestations, though relatively rare, can lead to significant complications. A 45-year-old male with a recent history of ventilation tube placement in the right ear presented with a sensation of imbalance associated with profound hearing loss. He was managed in line of acute otitis media with labyrinthitis with steroids and antibiotics and removal of the ventilation tube. He returned in one week and presented with right-sided lower motor neuron-type facial paresis. Computed tomography images of the temporal bone showed a soft tissue density lesion in the right middle ear cavity extending to the mastoid antrum. He underwent a right cortical mastoidectomy with decompression of the facial nerve. Histopathology and immunohistochemistry of granulation tissues from the middle ear and the mastoid revealed evidence suggestive of probable IgG4 disease. IgG4-related disease is a relatively new entity, and its pathogenesis has not been properly understood. IgG4 subclass has been involved in this disease resulting in fibro-inflammatory conditions leading to tumor-like masses or fibrosis of the affected organs. Treatment includes glucocorticoids and immunosuppressant medications.

The evaluation of auditory processing skills and late latencies in children with ventilation tube history

Objective(s): This study aims to evaluate the changes in temporal auditory processing skills in children who underwent bilateral ventilation tube insertion (VTI) due to Otitis Media with Effusion (OME) and the effect of these changes on speech comprehension in noisy environments. MethodsThis is a case-control study. In total, 60 children were included in the study in two groups. The control group included 30 children aged 11 to 15, who had normal hearing thresholds and normal immitancemetric evaluation, and were not diagnosed with OME. The study group included 30 children, aged 11–15 who underwent bilateral VTI surgery after their diagnosis of OME during the ages of 3–10 and currently had normal hearing thresholds and normal immitancemetric values. Each group underwent the Turkish Matrix Test (TMT), Random Gap Detection Test (RGDT), Frequency Pattern Test (FPT), Duration Pattern Test (DPT), and Cortical Auditory Evoked Potential Test (CAEP). ResultsWhen the temporal processing tests (FPT, DPT, RGDT) were compared, a significant difference was obtained between the study group and the control group (p < 0.05). With the TMT, significantly lower scores were obtained in the study group compared to the control group (p < 0.01). In addition, the latency values in the cortical auditory evoked potential test were longer in the study group compared to the control group, but these results were not statistically significant (p > 0.05). ConclusionAs a result of the study, it is concluded that the central auditory processing skills were affected in children with a history of bilateral VTI due to OME. Temporal processing tests, Turkish Matrix Test and Cortical Auditory Evoked Potential tests can be recommended as reliable and easily applicable tests, together with traditional hearing test methods in children with a history of OME, in order to evaluate comprehension skills in classroom noise.

Endoscopic Cartilage Slice Reinforcement Technique for Anterior Perforation Repair with Anterior Canal Wall Protrusion.

Objective: To evaluate the outcomes and complications of the endoscopic cartilage slice reinforcement technique used on anterior margins for anterior perforation repair with anterior canal wall protrusion. Material and Methods: We conducted a prospective study on 38 cases of anterior perforation with anterior canal wall protrusion, treated using the endoscopic cartilage slice reinforcement technique from February 1, 2017 to August 29, 2023. The follow-up period was 6 months. Results: Of the 38 patients, medium perforations were present in 28.9%, large in 65.8%, and subtotal in 5.3%. The cause was mucosal chronic otitis media in 92.1%, traumatic perforation in 5.3%, and ventilation tube removal in 2.6%. The average operation time was 27.2 ± 4.6 minutes. The graft success rate was 94.7% (36/38) at 6 months postoperative. The average preoperative air-bone gap (ABG) was 19.8 ± 4.2 dB, and postoperative ABG was 8.6 ± 2.9 dB; this improvement was statistically significant (P < .001; paired-sample t-test). The ABG gain was 11.8 ± 5.1 dB, and the rate of successful surgery (postoperative ABG ≤ 20 dB) was 97.4% (37/38). No complications such as altered taste, vertigo, or tinnitus were reported, and no cases involved graft lateralization, significant blunting, graft atelectasis, graft adhesions, or effusion. However, myringitis was observed in 4 (10.5%) patients. Conclusion: The endoscopic cartilage slice reinforcement technique for anterior margins is a simple and effective method for repairing anterior perforations with anterior canal wall protrusion, achieving a high graft success rate, improved hearing, and minimal complications.

Clinical Characteristics of the Extensively Prolonged Hospitalization: A Retrospective Analysis at a Large Tertiary Medical Center

Background: Prolonged hospitalizations have contributed to the concentration of American healthcare spending in a small subset of patients. Research related to such events is scarce. Methods: The authors performed a retrospective analysis of hospitalizations at a tertiary care center between 2012 and 2022. Extensively prolonged hospitalization (EPH) was defined as an uninterrupted hospital stay of at least 183 days. Patient data, including past medical history, hospital complications, barriers to discharge, and long-term outcomes were collected. Results: Among 393,474 unique adult hospitalizations, mean length of stay was 5.49 days. There were 42 EPH, making up 0.01% of all admissions and 0.69% of hospital days. Patients with EPH were 62% male and had a median age of 58.5 years old. EPH featured a mean of 8.88 CTs and 2.12 MRIs. MRSA blood culture positivity was documented in 48% of cases. Mechanical ventilation and gastrostomy tube placement were performed in 88% and 71% of EPH, respectively. In 64% of cases, patients were medically stable for discharge and awaiting post-acute facility bed availability for at least three months. In-hospital death occurred in 31% of cases. Among patients who survived hospitalization, none were able to live independently, and median post-discharge survival was 94 days. At five-year follow-up, 1 patient (2%) was still alive. Conclusions: These findings emphasize the importance of non-medical barriers to discharge in EPH. While larger studies are needed, this study suggests that long-term outcomes in EPH are grim.

Perfusion Steroid via Ventilation Tube as Salvage Treatments for Sudden Sensorineural Hearing Loss.

Objectives: Intratympanic steroid injection (ISI) for sudden sensorineural hearing loss (SSNHL) is a relatively popular and effective method, but there is no standardized method for intratympanic steroids for the treatment of SSNHL and no consensus on how to deliver steroids to the middle ear. The purpose of this study was to compare 2 means of intratympanic steroid delivery as therapy for SSNHL. Methods: A retrospective chart review was performed for the period from November 2018 to October 2022 at our Department of Otorhinolaryngology-Head and Neck Surgery. Sixty patients with profound SSNHL who have failed initial steroid therapy were divided into the continuously transtympanic steroid perfusion (TSP) therapy and the intermittent ISI therapy. Results: Posttreatment pure-tone average was 60.3 ± 18.2 dB in the TSP group and 67.5 ± 22.6 dB in the ISI group, 70.0% of subjects in the TSP group, and 46.7% of subjects in the ISI group had improved by 15 dB or more after the therapy. The increased hearing threshold of the TSP group (24.6 ± 14.1 dB) was better than the ISI group (16.6 ± 14.9 dB), and the hearing recovery was significantly different (P < .05) in the 2 groups. Besides the hearing improvement was most obvious in low-frequency areas in the TSP group, the most significant hearing improvement was at 250 Hz, reaching 30.8 ± 3.3 dB. Conclusions: In SSNHL patients who have failed initial steroid therapy, TSP therapy via a ventilation tube can achieve good hearing outcomes and serve as a salvage therapy for patients with SSNHL.

Balancing Benefits and Risks: Short-term Ventilation Tubes in Pediatric Chronic Otitis Media with Effusion

Balancing Benefits and Risks: Short-term Ventilation Tubes in Pediatric Chronic Otitis Media with Effusion

Efficacy of slow negative pleural suction in thoracic trauma patients undergoing tube thoracostomy–A randomised clinical trial

IntroductionThoracic injuries are prevalent in polytrauma patients, with road traffic accidents being a major cause. In India alone, over 400,000 people were injured in such accidents in 2022. Rib fractures, haemothorax, and pneumothorax are common chest injuries, often managed with tube thoracostomy. While standard procedures for chest tube placement are established, consensus on post-insertion management, particularly regarding negative pleural suction, is lacking. Research on this topic mostly pertains to planned thoracotomies rather than trauma cases. This study seeks to compare outcomes of slow negative suction versus conventional drainage in blunt or penetrating thoracic trauma. MethodsThis single-centre, open-label, randomized controlled trial in a western Indian hospital from Jan 2021 to June 2022 included adult patients with thoracic trauma requiring intercostal drainage tubes. Patients needing emergency thoracotomy, mechanical ventilation, or bilateral chest tubes were excluded. Sample size (n = 64) was calculated based on prior studies. Patients were randomly assigned to experimental (slow negative pleural suction) or control (conventional water seal drainage) groups. Both groups received standard care. Primary outcome was time to chest tube removal; secondary outcomes included hospital stay length, complications, and need for further intervention. Data were analysed using SPSS. Significance was set at p < 0.05. ResultsDuring the study 64 patients were randomised into experimental (n = 32) or conventional (n = 32) groups. Most of the patients were males (88 %, n = 56). Both groups had similar baseline characteristics. Experimental group patients had shorter median chest tube duration (3 [IQR 2–3.75] vs. 5 [3–8.75] days, p < 0.001) and hospital stay (5 [4–8.75] vs. 10 [6–16.75] days, p = 0.004). No discomfort was reported with slow continuous negative pleural suction. Mortality was 1 (3 %) in the experimental group vs. 2 (6 %) in the conventional group. Four patients suffered retained haemothorax, with only one occurrence in the experimental group (3 %). ConclusionApplication of slow continuous negative pleural suction to chest tubes in patients of thoracic trauma can decrease the chest tube duration and the hospital stay. This study ought to be followed up with multicentric randomised clinical trials with larger sample sizes to better characterise the effects of slow continuous negative pleural suction.