Literature Review: A Roundup of Important Recent Studies

Study design: This questionnaire-based study was conducted retrospectively on 335 patients and included patients undergoing both tonsillectomies and adenotonsillectomies. The incidence of hemorrhage and post-operative pain were evaluated retrospectively. Pain was graded using a visual analog scale at five time points and with five grades of severity.

Setting: Academic medical center in Klagenfurt, Austria.

Synopsis: Post-operative pain severity and duration were clustered into five levels of pain types. Hemorrhage included any episode of bleeding. Pain type V (very high or increasing pain for two weeks after surgery) had a statistically significant risk of hemorrhage (41 percent versus 18 percent for pain type I). There was also a strong relationship between indications for surgery and post-operative pain, with patients with recurrent tonsillitis and adult patients having higher pain levels. Children tended to have pain type I, whereas adults had pain types III-V.

Bottom line: This is the first study that has described an important association between post-operative tonsillectomy pain and bleeding. It is a well-conducted study that has emphasized the importance of paying close attention to the patient who complains of increasing pain one week following surgery.

Reference: Sarny S, Habermann W, Ossimitz G, Stammberger H. Significant post-tonsillectomy pain is associated with increased risk of hemorrhage. Ann Otol Rhinol Laryngol. 2012;121:776-781.

—Reviewed by Natasha Mirza, MD

Tissue-Engineered Regeneration of Mastoid Air Cells Improves Eustachian Tube Function

Can regenerated mastoid air cells (MACs) restore normal gas exchange function and contribute to improved Eustachian tube (ET) function?

Background: Most cases of chronic otitis media (OMC) are associated with poor development of the MACs and poor ET function. A common treatment for OMC is tympanoplasty with mastoidectomy; however, this procudure does not aim directly for the recovery of MACs and ET function. Further, recurrence of OMC after the procedure is common.

Study design: Clinical trial with control.

Setting: Department of Otolaryngology, The Foundation for Biomedical Research and Innovation, Kobe; Department of Otolaryngology-Head and Neck Surgery, Medical Research Institute, Kitano Hospital, Osaka; Department of Otolaryngology, Shizuoka General Hospital, Shizuoka; Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto; Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan.

Synopsis: Seventy-six patients with cholesteatoma, adhesive otitis media or OMC received tympanoplasty with mastoidectomy and MAC regeneration in a two-stage operation. During the first stage, artificial pneumatic bones and/or autologous bone fragments were implanted into the opened mastoid cavity. During the second stage, a nitrous oxide (N2O) gas study was performed in five patients with good MAC regeneration and five patients with poor MAC regeneration to measure middle ear pressure. For the control group, middle ear pressure was measured in five patients with well-developed MACs during cochlear implantation or facial nerve decompression. ET function was also measured twice in each patient, before the first operation and six months after the second.