James P. Bonaparte

Postoperative management in the prevention of complications after septoplasty: a systematic review.

The purpose of this article is to assess the relative rates of septal hematomas, synechiae, and septal perforations associated with methods commonly used to manage the nasal septum after septoplasty. As a secondary objective, we assessed the relative contribution of each method of septal management with respect to pain and patient discomfort.

Prospective clinical trial of gelatin‐thrombin matrix as first line treatment of posterior epistaxis

To evaluate the effectiveness of gelatin‐thrombin matrix for first line treatment of posterior epistaxis. Secondarily, we evaluated discomfort during treatment and the cost savings of treatment with gelatin‐thrombin matrix compared to posterior packing, endoscopic, or endovascular treatment at our institution.

A double-blind randomised controlled trial assessing the efficacy of topical lidocaine in extended flexible endoscopic nasal examinations

Clin. Otolaryngol. 2011, 36, 550–557

Management of the radial forearm free flap donor site using a topically applied tissue expansion device

BACKGROUND The purpose of this study was to prospectively assess clinical outcomes in patients undergoing a new method of donor site management for radial forearm free flaps. METHODS 177 patients underwent reconstruction of ablative defects of the head and neck using a radial forearm free-flap. All patients had topical tissue expansion tapes applied to their forearms preoperatively. Closure rates, healing time and complications associated with the technique were assessed. RESULTS Ninety-five percent of patients had their donor sites closed primarily with a locally harvested full thickness skin graft. Complications related to the tissue expansion device included a loss of device adhesion (19.3%) requiring reapplication and minor pruritic reactions (4.1%). CONCLUSIONS This system of donor site management has resulted in a significant reduction in the requirement of a split thickness skin graft for coverage of the donor site in a radial forearm free flap without any significant economic cost or patient morbidity.

Skin Biomechanical Changes after Injection of Onabotulinum Toxin A: Prospective Assessment of Elasticity and Pliability.

Objective This study aimed to test the hypothesis that the administration of onabotulinum toxin A will result in an increase in skin pliability and elasticity. Study Design A prospective case series with planned data collection in which patients were treated with onabotulinum toxin and assessed at baseline, 2 weeks post-injection, and 2 months post-injection. Setting A private cosmetic surgery clinic associated with a tertiary academic hospital. Subjects and Methods Forty women were prospectively enrolled to receive onabotulinum toxin A into their glabella, forehead, and lateral orbit. Outcomes were assessed at baseline, 2 weeks posttreatment, and 2 months posttreatment using the Cutometer MPA 580. Skin pliability (Uf) and the elastic recoil (Ua/Uf) were recorded as the 2 primary outcome measures. Results There was a significant effect of onabotulinum toxin on skin elasticity (f = 47.8, P = .001) with a mean (+/– SE) increase in elastic recoil of 20% (4.4%) for the glabellar region (P < .001) and 18% (4.0%) for the lateral orbit (P < .0001). There was a significant effect of the treatment on skin pliability (f = 46.9, P < .001) with a mean (+/– SE) increase of 26% (5.4%) for the lateral orbit (P = .001) and 52% (8.3%) for the glabellar region (P < .001). Conclusion Injection of onabotulinum toxin into the lateral orbital, forehead, and glabellar regions results in skin that has increased pliability as well as increased elastic recoil. Although this study demonstrates the positive effect of onabotulinum toxin on biomechanical parameters, it is unclear what specific histological changes are occurring within the skin.

Cost-effectiveness of a topically applied pre-operative tissue expansion device for radial forearm free flaps: a cohort study.

Clin. Otolaryngol. 2011, 36, 345–351

A Comparative Assessment of Three Formulations of Botulinum Toxin Type A for Facial Rhytides: A Systematic Review with Meta-Analyses.

Background: Three formulations of botulinum toxin are available for facial rhytides. It is unclear which formulation offers the greatest balance of benefits and harms. The objective of this study was to conduct a systematic review with meta-analyses to compare formulations of botulinum toxin for reduction of facial rhytides at the glabella. Methods: The authors’ protocol was registered with the International Prospective Register of Systematic Reviews (CRD4201200377). A systematic literature search was performed identifying double-blind studies. The authors assessed 1-, 3-, and 4-month follow-up. The authors performed pairwise meta-analyses using random effects models to compare response rates among the three botulinum formulations and a network meta-analysis. Results: A total of 18 studies (3082 patients) were included. At 30-, 90-, and 120-day follow-up, all medications with available data showed statistically significantly increased treatment response versus placebo. Only high-dose onabotulinum toxin (compared to standard-dose onabotulinum toxin) offered additional benefit at 30 days. Exploratory analysis using network meta-analysis mostly suggested insufficient evidence of incremental benefits when comparing specific formulations. Conclusions: Evidence supporting benefits versus placebo of the different formulations was clear over time. Comparisons between active formulations were rare and typically based on single trials of small to moderate sample size. The data suggest some gains with high-dose onabotulinum toxin (relative to standard dose), whereas exploratory indirect comparisons between active formulations were largely associated with inconclusive findings. Future studies should undertake head-to-head comparisons of the different formulations and ensure longer follow-up to best inform the accumulating evidence base. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

A comparison of Locacorten-Vioform and clotrimazole in otomycosis: A systematic review and one-way meta-analysis

The goal of this systematic review was to compare the efficacy and ototoxicity of Locacorten‐Vioform (Paladin Labs Inc., Montreal, Quebec, Canada) and clotrimazole in the treatment of patients with otomycosis.

The Role of Helicobacter pylori in Laryngopharyngeal Reflux A Systematic Review and Meta-analysis

Objective The primary objective was to determine the prevalence of Helicobacter pylori among patients with laryngopharyngeal reflux. The secondary objective was determining if H pylori eradication leads to greater symptom improvement in patients with laryngopharyngeal reflux as compared with standard proton pump inhibitor therapy alone. Data Sources EMBASE, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, World Health Organization International Clinical Trials Registry Platform, European Union Clinical Trials Register, Cochrane Library databases of clinical trials, and ClinicalTrials.gov. Review Methods A systematic review was performed of studies assessing the diagnosis or treatment of H pylori among patients with laryngopharyngeal reflux. Randomized controlled trials, cohort studies, case-control studies, and case series were included. A meta-analysis of prevalence data and assessment of heterogeneity was performed on relevant studies. Results Fourteen studies were analyzed in the review, with 13 eligible for the meta-analysis. We determined that the prevalence of H pylori among patients with laryngopharyngeal reflux was 43.9% (95% confidence interval, 32.1-56.5). The heterogeneity of studies was high, with an overall I 2 value of 92.3%. We were unable to quantitatively assess findings for our secondary outcome, since H pylori identification and treatment were not the primary focus of the majority of studies. Conclusion There is a high rate of H pylori infection among patients with laryngopharyngeal reflux. The infection rate in North America and Western Europe has not been adequately studied. There is insufficient evidence to make a recommendation regarding the testing and treatment of H pylori infection among patients with laryngopharyngeal reflux.

Determining a Successful Nasal Airway Surgery: Calculation of the Patient-Centered Minimum Important Difference

Objective Determine whether the patient-identified minimum important difference (MID) in Nasal Obstruction Symptom Evaluation (NOSE) score differs from a statistically calculated estimate of MID in patients with septal deviation undergoing nasal airway surgery. Study Design Prospective cohort. Setting Tertiary academic referral center. Subjects Patients with nasal obstruction due to septal deviation. Methods Patients completed the NOSE questionnaire preoperatively and indicated the change from their baseline score that they would consider the minimum improvement required to define the septoplasty with turbinate reduction as successful. A previously published distribution-based approach was used to estimate the MID based on baseline NOSE scores. Scores were reported both as a raw score and as a percentage of patients’ baseline scores. One-sample t test was used to compare the statistically estimated MID to the patient-reported MID. Results Seventy-six patients were included. The mean (SD) baseline NOSE score was 12.9 (4.03). The mean (SD) patient-identified MID was 5.3 (2.1), corresponding to a 41.1% change (95% confidence interval, 37.2-41.3) from baseline. The statistically estimated MID was 5.2 points (40.3% reduction from baseline scores). The estimated MID was not significantly different from the patient-identified MID (P = .4). Conclusion In patients with septal deviation, an improvement of approximately 40% in their nasal obstructive symptoms as assessed by the NOSE questionnaire is required to define a nasal airway surgery as successful. The patient-identified and the statistically calculated MIDs were similar. Furthermore, this MID can be used to guide research, improving the ability to use the NOSE score as a dichotomous scoring measure (treatment success/failure) and estimating sample size.