Objective: To identify trends in the quality of otology studies published in general otolaryngology journals over a 20-year period. Study Design: Retrospective analysis. Methods: Otologic and neurotologic papers from 1997, 2007, and 2017 were identified in the three general otolaryngology journals with the highest Eigenfactor scores: the Laryngoscope, European Archives of Otorhinolaryngology, and Otolaryngology–Head and Neck Surgery. The studies were reviewed and assigned level of evidence (LoE) based on standards set by the Centres for Evidence Based Medicine (CEBM). One-way analysis of variance were calculated with a 95% bootstrap sensitivity analysis performed. Results: A total of 786 otology articles were reviewed for level of evidence, of which 557 (70.8%) were original, clinical research, eligible for LoE assignation. Total publications increased for each year in all three journals. Both the absolute number and proportion of high evidence studies (level of evidence 1 and 2) increased with respect to time in all three journals. Lower evidence studies (level of evidence 3, 4, or 5) made up 66.8% of total publications in 2017. There was a reduction in average level of evidence (towards higher quality evidence) by 0.431 units from 1997 to 2017 (Diff = –0.431 between 1997 and 2017, p < 0.001). There was no significant difference in rate of change of level of evidence between 1997 and 2007 and 2007 and 2017 (0.033, p = 0.864). Conclusion: Over a 20-year period the number of total publications increased with time. The majority of otology publications in 2017 were lower evidence studies, though significant increases in the number and proportion of high evidence studies in general otolaryngology journals were observed throughout the study period.
BACKGROUND Parotidectomy 1 is a routinely undertaken procedure by general surgeons and ENT surgeons; however, the risk of facial nerve injury and further deformity is a scare of the patient and nightmare of the operating surgeon, thus obtaining consent for the surgery is a difficult task of the surgeon. Most patients are happy after surgery; however, a depressed facial contour is a point of significant dissatisfaction for the patient. Another point of concern after superficial or total parotidectomy is Frey syndrome, 2 which is seen in almost 80%, 2 but becomes noticed or symptomatic only in about 10%-12%. 2 Many a number of attempts have been made with fascia lata, dermal fat, platysma, temporalis fascia, sternocleidomastoid muscle and submuscular aponeurotic sheath of the face to overcome these disabling issues. The sternocleidomastoid muscle flap with its superiorly based perfusion from occipital artery and superior thyroid artery is an effective tool in preventing Frey syndrome and avoiding a pitted deformity in the periauricular region, thus achieving facial symmetry. The advantage of this muscle over the other alternatives described is that it has lower chance of necrosis and it provides cover over a larger area and its design is easier. The objective of the study was to assess the cosmetic and functional outcome of primary sternocleidomastoid muscle flap undertaken on post parotidectomy patients with reference to the cosmetic outcome, occurrence of Frey syndrome and sensation to the ear lobe. MATERIALS AND METHODS This descriptive study was undertaken on 22 patients, among whom 14 underwent superficial parotidectomy and 8 total conservative parotidectomy. RESULTS Among the 22 patients who underwent the procedure after parotidectomy, 4 were males and 18 were females. There were 14 superficial parotidectomy and 8 total conservative parotidectomy. The histopathology report was malignancy in 6 patients, pleomorphic adenoma in 14 patients and Warthin's tumour in 2. Satisfactory cosmetic outcome was possible in 21 patients. One patient had marginal necrosis of the flap and a pitted scar (post radiation patient) requiring PMMC (pectoralis major myocutaneous flap) cover. Frey syndrome occurred in one patient in spite of the flap. Ear lobule sensation was preserved in 20/22 patients. CONCLUSION Partial thickness superiorly based on sternocleidomastoid flap 3,4 provides exemplary cosmetic outcome following either superficial or total conservative parotidectomy and it significantly lowers the incidence of Frey syndrome.
Objectives: Carotid interventions, either carotid endarterectomy (CEA) or carotid artery stenting (CAS), in octogenarians remains controversial. Our goal was to compare the perioperative outcomes of CEA and CAS in octogenarians. Methods: Patients greater than 80 years of age who underwent CAS or CEA between 2007 and 2017 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Multivariable logistic regression analyses were used to predict postoperative stroke, cardiac complications, 30-day mortality, major adverse cardiovascular events (MACE), and readmission. Results: There were 180,082 patients who underwent CEA and 348 patients underwent CAS. CAS was more common with nonwhite race (13.8% vs 8.7%), American Society of Anesthesiologists class III to V (29.3% vs 19.8%), partial or total functional dependence (10.1% vs 6.0%; P ¼ .002), chronic obstructive pulmonary disease (14.7% vs 10.0%), bleeding disorder (53.7% vs 22.9%), absence of coronary artery disease (93.1% vs 84.4%), and absence of a history of previous stroke (19.0% vs 26.0%) compared with CEA (P < .01). Patients undergoing CAS had higher rates of postoperative stroke (3.5% vs 1.9%; P ¼ .032), cardiac complications (3.2% vs 1.8%; P ¼ .048), MACE (8.1% vs 4.1%; P < .001), and readmission (12.1% vs 7.5%; P ¼ .001) compared with CEA. The 30-day mortality was similar in both groups. On multivariable analyses, CAS compared with CEA was predictive for postoperative stroke (OR, 1.82; 95% CI, 1.01-3.29; P ¼ .047), and MACE (OR, 1.82; 95% CI, 1.22-2.72; P ¼ .004). However, CAS did not significantly impact the incidence of postoperative cardiac complications, 30-day mortality, or readmission. Conclusions: The results of this study demonstrate that CAS predicts a higher risk of postoperative stroke and MACE compared with CEA in octogenarians. These findings suggest that CEA should be favored over CAS in this vulnerable patient population if an intervention is performed. However, owing to potential selection bias, this finding requires further investigation and currently enrolling randomized trials are expected to clarify these findings.
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