Literature Review: A roundup of important recent studies

Study design: Retrospective, controlled study.

Setting: Quaternary referral center.

Synopsis: A retrospective chart review identified 69 patients who flew on the first post-operative day after a tympanoplasty. They were compared with 100 patients matched for age, sex, side of operation, size of perforation, surgical approach, graft material and grafting technique. All patients had middle ear and ear canal packing with absorbable gelatin sponge as part of the standard tympanoplasty technique, and all followed the same post-operative protocol of oral antibiotics and ototopical drops. All patients were evaluated at 30 days. Of the flight group, six (13 percent) had graft failure. Of the non-flight group, 12 (12 percent) had graft failure.

Bottom line: Early commercial air travel after tympanoplasty can be considered a relatively safe option. Packing of the middle ear and ear canal likely adds sufficient stability to the tympanic membrane graft.

Reference: Konishi M, Sivalingam S, Shin SH, et al. Effects of early commercial air travel on graft healing rates after tympanoplasty. Ann Otol Rhinol Laryngol. 2012;121(2):110-112.

—Reviewed by Larry Lundy, MD

 

Patients with PVCM Aren’t Homogeneous

Is paradoxical vocal cord motion (PVCM) strictly a psychological disorder, or is it multifactorial?

Background: PVCM is descriptive for inappropriate adduction of the larynx during respiration. The etiology is unclear but has long been hypothesized to be psychological or a psychological conversion reaction. Because of similarity in presentation, PVCM is frequently misdiagnosed as refractory asthma.

Study design: Prospective study and psychological testing of subset.

Setting: Department of Otolaryngology, Ohio State University College of Medicine, Columbus, Ohio; Department of Social Sciences and Humanities, Spokane Community College, and Spokane Valley Ear, Nose and Throat, Spokane, Washington.

Synopsis: Of 170 patients older than 18 years, 117 were shown in the prospective study to be diagnosed by video laryngoscopy with PVCM.

A subset of 47 newly diagnosed PVCM patients underwent psychological analysis, which showed that PVCM demonstrated a conversion disorder pattern but not an anxiety disorder or a correlation with stress.

Noting that the etiology of PVCM appears to be multifactorial, the authors said that while PVCM is a classic conversion disorder for the majority of patients, there appears to be a subset of 25 percent of the patients with normal psychological testing. They said comorbid factors such as asthma, reflux and laryngeal sicca can exacerbate the symptoms.

Bottom line: The etiology of PVCM can be separated into primary PVCM (75 percent psychologically based) and secondary PVCM (25 percent divided into laryngeal hyperactivity disorders and neurological).