The result, he said, is similar to what is seen with an adenoidectomy. “We’ve realized this is a technology we’ve stumbled on that’s performing an adenoidectomy inside the lumen of the Eustachian tube,” he said. “It’s just another extension of what we all do.”
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March 2017The results of a 22-center randomized trial—more details from which will be published soon, he said—showed a tympanogram normalization rate of 52% in the balloon-plus-steroid group, compared to 14% in a steroid-only group. For inclusion, patients needed to have evidence of more than 90 days of persistent or continuous Eustachian tube dysfunction, along with failed treatment with a nasal steroid spray or a week of oral steroids. The study was stopped early because of the striking disparity between the groups.
No complications were seen in the study, but anterolateral wall lacerations and false passage are those that have been most commonly seen in other studies, he said.
Vagal Nerve Monitoring during Thyroidectomy
Greg Randolph, MD, the Claire and John Bertucci Endowed Chair in Thyroid Surgical Oncology at Harvard University and director of the Massachusetts Eye and Ear Infirmary General Thyroid and Parathyroid Endocrine Surgical Division, talked about the merits of continuous vagal nerve monitoring during bilateral thyroidectomy procedures.
Vocal cord paralysis after thyroid surgery represents a significant problem, Dr. Randolph said. A systematic review from several years ago found recurrent laryngeal nerve paralysis after 9.8% of thyroidectomies.
Electromyography (EMG) testing after the procedure on the first side can avoid the mistake of moving on to the second side despite injury, a move that could lead to an airway emergency if there is bilateral nerve injury.
Intraoperative, continuous assessment through vagal nerve monitoring could prevent injury, Dr. Randolph said. Research has found that the combination of a slower nerve response and decreased amplitude, or a reduced number of fibers participating in a response, is a clear sign that a nerve is becoming injured.
Work by Dr. Randolph and others has found an EMG threshold that seems to work to identify an impending threat of nerve injury but at which damage can often be avoided when corrective action is taken (Gland Surg. 2016;5:607-616). Approximately 72% of the time, when irregular EMG activity was seen intraoperatively, the activity returned to normal once the surgical procedure associated with the EMG activity was adjusted in response, Dr. Randolph said. In cases where the EMG activity dropped to silence, though, the reversibility rate was just 17%, he said.