Joshua Danino

Tracheotomy Complications: A Retrospective Study of 1130 Cases

BACKGROUND: Tracheotomy is one of the most frequently performed surgical procedures in the critically ill patient. It is frequently performed as an elective therapeutic procedure and only rarely as an emergency procedure. Complications occur in 5% to 40% of tracheotomies depending on study design, patient follow-up, and the definition of the different complications. The mortality rate of tracheotomy is less than 2%. Numerous studies demonstrate a greater complication and mortality rate in emergency situations, in severely ill patients, and in small children. METHODS: A retrospective study of 1130 consecutive tracheotomies performed during 1 decade (January 1987 through December 1996) is presented. We studied the indications for surgery, the major complications of tracheotomy, and their treatment and outcome. We also noted the overall mortality rate and the specific complications that led to these deaths. RESULTS: In total, 1130 tracheotomies were performed. Major complications occurred in 49 of the cases, and 8 deaths were directly attributed to the tracheotomy. The most common complication was tracheal stenosis, which occurred in 21 cases. Hemorrhage was the second most common complication, which occurred in 9 cases. CONCLUSION: This is one of the largest series of consecutive tracheotomies compiled. We found a relatively low overall complication and mortality rate compared with other large series. Tracheal stenosis was the most common complication in contrast to other series. Our opinion is that this may reflect tracheal damage originally caused by prolonged intubation before the tracheotomy. We believe that all other complications of tracheotomy may be prevented or minimized by careful surgical technique and postoperative tracheotomy care. (Otolaryngol Head Neck Surg 2000;123:495-500.)

Plastipore Implants in the Surgical Treatment of Atrophic Rhinitis: Technique and Results

BACKGROUND Atrophic rhinitis is a distressing and socially crippling disease. Surgical treatment has been used for patients with severe disease that is unresponsive to medical therapy. METHODS Eight patients with primary atrophic rhinitis were treated surgically by narrowing of the nasal fossae with implantation of 2 Plastipore plates per affected side into submucosal pockets into the floor of the nose and septum, thus reducing the volume of the nasal fossae. RESULTS Excellent results were obtained in 6 patients, with complete resolution of symptoms and good results and only minor crusting in 2 patients. One implant was extruded spontaneously 18 months after implantation and was reimplanted. Results in this patient before and after reimplantation were excellent. There were no cases of infection and no other complications. CONCLUSION We implanted Plastipore, a high-density polyethylene sponge with micropores, which enables tissue ingrowth, anchoring the implants to the surrounding tissue. The surgical technique is performed with the patient under local anesthesia and is relatively easy and avoids complicated flap procedures, allogeneic bone harvesting, and the discomfort of nostril closure for prolonged periods.

T cell lymphoma of the ear presenting as mastoiditis

Mastoiditis is a complication of otitis media characterized by suppuration and destruction of air cell septa in the mastoid and petrous pyramid. Diagnosis is made by clinical findings and computerized tomography (CT) of the temporal bone. We present a patient initially diagnosed by CT as having chronic mastoiditis who was subsequently shown to have an unusual large-cell malignant lymphoma of T cell type.

Malignant external otitis in an infant

Ten cases of malignant external otitis in children have been reported hitherto. These are reviewe, and an eleventh case, a three-month-old infant associated with genetic granulocytopenia, is presented. On the grounds of the reported paediatric cases, the erudition in childhood is compared with the more common form in the adult, and is found to be much less linked with diabetes mellitus and to have a far better prognosis, with practically no mortality.

Temporal bone fracture following blunt trauma caused by a flying fish.

Blunt trauma to the temporal region can cause fracture of the skull base, loss of hearing, vestibular symptoms and otorrhoea. The most common causes of blunt trauma to the ear and surrounding area are motor vehicle accidents, violent encounters, and sports-related accidents. We present an obscure case of a man who was struck in the ear by a flying fish while wading in the sea with resulting temporal bone fracture, sudden deafness, vertigo, cerebrospinal fluid otorrhoea, and pneumocephalus.

Predictive value of an adherence test for acute otitis media.

The predictive value of an in vitro adherence test of the bacterium Streptococcus pneumoniae for the development of recurrent otitis media was calculated 5 years after the initial test. Nasopharyngeal cells from 56 children suffering from acute otitis media (AOM) and from healthy children were tested for adherence of a standard pneumococcal type (capsular serotype 6). The average adherence of the bacteria to epithelial cells from the group suffering from AOM was greater than the average adherence in the control group (p < 0.005), both when adherence was counted microscopically and radioactively. Subjects were followed up periodically over a 5-year period. Four out of 5 healthy children who had high mean adherence values experienced AOM during the 5 years, and 1 child classified as AOM-prone was found to be healthy. Based on the retrospective data, the positive predictive value of this test was 98.2%, and the negative predictive value was 90.7%.

Antioxidants: A new armament in the treatment of idiopathic sudden hearing loss

Abstract Problem: Assuming that superoxide anion radicals (-O2) may play a role in damage to the inner ear hair cell, this study investigated the possible benefit of vitamin E as an antioxidant in the treatment of idiopathic sudden hearing loss (ISHL). Methods: A prospective, double-blind study was conducted on a total of 66 patients with the diagnosis of ISHL of less than 7 days’ duration during the years 1998–2001. All patients were treated with bed rest, steroids, magnesium intravenously, and carbogen inhalation. In addition, the study group patients received vitamin E. Results: The recovery rate, calculated as hearing gain in the affected ear following treatment divided by the difference in hearing level between the affected and the unaffected ear multiplied by 100, was better than 75% in 41 of the 66 patients (66.1% of the patients). This rate was achieved in 26 patients (78.8%) from the study group treated with vitamin E, as compared with 15 patients (45.5%) in those patients who were not treated with vitamin E. Conclusion: Patients with ISHL treated with the addition of vitamin E achieved better recovery rate than did those who did not get this additional treatment. Further studies should be directed toward a better understanding of the role of antioxidants in the treatment of ISHL, and the most effective antioxidant and its optimal dose should be determined. Significance: The results of this study seem to open a new direction in the investigation of another mechanism involved in the etiology of ISHL. Antioxidants should be considered as an additional treatment in the armamentarium of treatments for patients with ISHL. Support: No grants and no support

The surgical treatment of ozena with plastipore implants

Objective: Ozena (atrophic rhinitis), although not fatal, remains a distressing and socially crippling disease. Various surgical treatments have been used for patients with severe disease that is unresponsive to medical therapy. These techniques include temporary closure of the nostrils and the surgical implantation of various materials to narrow the internal dimensions of the nasal fossae. Over the years many different materials have been implanted, such as iliac bone, acrylics, cartilage, Ivalin sponge, and Triosite with fibrin glue. The major problems of their use are bone resorption, implant rejection, leakage, and chronic infection of the implant. We implanted Plastipore, a high-density, inert polyethylene sponge with micropores, which enable tissue ingrowth, anchoring the implants to the surrounding tissue. The surgical procedure is relatively simple and is performed with the patient under local anesthetic, reducing the cost and duration of hospital stay. Methods: Eight patients suffering from primary atrophic rhinitis were surgically treated by narrowing of the nasal fossae by the implantation of 2 Plastipore plates per affected side into submucosal pockets in the nasal floor and septum, thus reducing the volume of the nasal fossae. Results: The results were excellent with complete resolution of symptoms in 6 patients and good with only minor posterior crusting in 2 patient. One implant was spontaneously extruded 18 months after implantation and was reimplanted. Results in this patient before and after extrusion were excellent. There were no cases of infection and no other complications. Conclusion: We found the results of this series to be encouraging. The material Plastipore lends itself well to this procedure. It is readily available and inexpensive. The Plastipore implant is inert and yet is enveloped by the surrounding tissue due to its micropores and additional macropores. The surgical procedure is relatively simple to perform.