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This study aimed to compare the efficacy of endoscopic type I tympanoplasty/myringoplasty with (ETMFE) or without tympanomeatal flap elevation (ETMFNE).
Methods
A thorough search of the PubMed, Embase and Cochrane Library databases was executed. The Review Manager 5.4 software was used for synthesising data, with forest plots illustrating the results for each outcome. Assessment of potential publication bias was conducted using funnel plots and Egger’s test.
Results
The meta-analysis included data from seven studies with 839 patients. The results demonstrated no significant difference in graft success rates (risk ratio = 1.01; 95 per cent confidence interval: 0.98–1.04; p = 0.54) or air–bone gap improvement (mean difference = –0.08; 95 per cent confidence interval: –2.02–1.85; p = 0.93) between the ETMFE and ETMFNE groups. However, the ETMFE group showed a pronounced increase in operation time (mean difference = 19.50; 95 per cent confidence interval: 10.75–28.25; p < 0.0001).
Conclusion
ETMFNE could be a preferable option for tympanic membrane perforation, offering similar efficacy to ETMFE but with reduced surgical time, particularly in appropriately selected cases.
This brief review summarises the efficacy of the treatments for post-irradiation otitis media with effusion.
Method
Literature review.
Results
Studies suggest that tympanocentesis is recommended for patients with post-irradiation otitis media with effusion The efficacy of balloon dilatation Eustachian tube for post-irradiation otitis media with effusion remains unclear.
Conclusion
The efficacy of different treatments for post-irradiation otitis media with effusion is unclear. Therefore, there are no recognised clinical guidelines, and long-term clinical research with a large sample size is needed.
There is limited evidence on the optimal management of nasal septal haematoma and abscess. This systemic review aims to summarise the management and outcomes and identify gaps in the literature.
Method
A systematic search of Embase, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and CINAHL was done. We included all studies on management of paediatric and adult patients with nasal septal haematoma or nasal septal abscess.
Results
Seventeen articles were included (15 retrospective and 2 prospective) totalling 503 patients. Prophylactic antibiotics generally are used in nasal septal haematoma. Most septal collections were drained under general anaesthetic, and incision and drainage used in all. Quilting sutures, drains, nasal packing or a combination of these surgical techniques were described. Re-collection occurred in 18 of the 503 (3.6 per cent) patients.
Conclusion
Low rates of re-collection following incision and drainage are reported. There is a lack of well-designed studies that stratify outcomes and morbidity of nasal septal abscess and nasal septal haematoma based on mode of treatment.
Sublingual ranulas present diagnostic and therapeutic challenges due to their heterogenous clinical presentations. This systematic review and meta-analysis aims to synthesise treatment outcomes and proposes a new classification for this condition.
Methods
Following PRISMA guidelines, a thorough literature search identified studies on patients with sublingual ranulas receiving medical or surgical treatment. Proportion meta-analysis compared success rates among studies using a random-effects model.
Results
Forty-two studies were included, covering 686 endoral ranulas, 429 plunging ranulas, and 16 ranulas extending into the parapharyngeal space. Sublingual sialoadenectomy with or without pseudocyst wall excision showed low heterogeneity and the highest success rates. Consequently, a new classification system is proposed categorising ranulas by intraoral (Type 1), cervical (Type 2) or parapharyngeal space (Type 3) extension.
Conclusion
This study confirms the role of sublingual gland resection as standard of care and highlights the need for a revised classification to improve patient outcomes.
Confidence among surgeons is required for complex decision-making and surgical ability. However, surgical trainees’ confidence is decreasing. This systematic review aims to explore factors that affect the confidence of surgical trainees.
Methods
A systematic review was performed following the PRISMA guidelines. Pubmed®, Embase™, Scopus, ClinicalTrials.gov and grey literature were searched for primary research on factors affecting surgical trainee confidence.
Results
Eleven studies were included. Key factors positively impacting trainee confidence were receiving regular positive feedback, working with a supportive trainer and having a calm working environment and effective team dynamic. The main factors negatively impacting trainee confidence were experiencing undermining behaviour from trainers and stressful, time-pressured environments. Female gender was also associated with reduced confidence. Greater confidence was associated with higher perceived performance.
Conclusion
This work assimilates the factors impacting surgical trainees’ confidence, which could guide training programmes to improve trainee self-confidence and therefore patient care.
To compare two high-resolution computerised tomography based pre-surgical planning software in measuring the cochlear dimensions, which can aid in designing/choosing customised cochlear implant electrodes.
Methods
A cross-sectional-observational study was conducted in a tertiary care centre using high-resolution computerised tomography–supported software Otoplan and curved multi-planar reconstruction to find cochlear duct length’s maximum and minimum width/diameter and height in 110 ears (55 subjects). Measurements and the time taken by both techniques were compared.
Results
There were no significant differences in the measurements taken with the two software; however, the time taken for analysis was significantly higher for curved multi-planar reconstruction than with Otoplan.
Conclusion
The steep learning curve, the need for an expert radiologist and the difficulty of use are factors that significantly limit the use of curved multi-planar reconstruction. Otoplan requires less time and can be operated even by someone with less expertise in measuring cochlear dimensions for pre-surgical planning and research.
Congenital hearing loss is a chronic condition which occurs worldwide. In the past, investigations focused on testing the most common genes associated with hearing loss (such as Connexin 26-related hearing loss). Targeted testing of specific genes was requested only when a particular syndrome was suspected. Recent advances have led to the development of a large gene panel which utilises next-generation sequencing to simultaneously test for pathogenic variants in many genes associated with hearing loss.
Aim
This review article aims to highlight the changes in the approach to congenital hearing loss in the context of the R67 gene panel, and how its use may increase the efficiency of the diagnosis and management of this condition.
Conclusion
The use of this large gene panel has revolutionised the approach to hearing loss. Uptake of this large gene panel has resulted in prompter diagnosis and therefore more appropriate clinical management.
Radiomics refers to converting medical images into high-quality quantitative data. This review examines applications of radiomics in vestibular schwannomas and future considerations for translation into clinical practice.
Methods
The review was pre-registered on Prospero (ID: CRD42024579319). A comprehensive systematic review-informed search of the Ovid Medline, Embase and Global Health online databases was undertaken using the keywords ‘acoustic neuroma’ or ‘vestibular schwannoma’ or ‘cerebellopontine angle tumour’ or ‘cerebellopontine tumour’ or ‘head and neck cancer’ were combined with ‘radiomic’ or ‘signature’ or ‘machine learning’ or ‘artificial intelligence’.
Results
The studies (n = 6) were categorised into two groups: radiomics for pre-operative decision-making (n = 1) and radiomics for treatment outcomes (n = 5). Radiomic features were significantly associated with clinical outcomes. Radiomics-based predictive models were superior to expert vision.
Conclusion
Radiomics has potential for improving multiple aspects of vestibular schwannoma care, but lack of studies inhibited firm conclusions. Prospective studies are required to progress this field.