Objectives/Hypothesis To investigate whether radiologist‐produced imaging reports containing the terms mastoiditis or mastoid opacification clinically correlate with physical examination findings of mastoiditis. Additionally, to investigate whether and how often otolaryngology was unnecessarily consulted and inappropriate antibiotic therapy was initiated. Study Design Retrospective chart review within a large community hospital setting. Methods A retrospective review of 160 patients who had imaging tests performed for nonotolaryngology indications from January 2011 to March 2017 at our facility. Indications, patient demographics, otolaryngology consultations, and new antibiotics started were recorded. Physical examinations were documented. Results Physical examination revealed that only 14 of 160 patients (8.8%) had clinical evidence of otologic disease. However, of the 160 patients meeting the inclusion criteria, 18 (11.3%) received an otolaryngology consultation, and 18 (11.3%) had antibiotics started. Eleven of the 18 patients in each group (61.1%) had a normal physical examination, two (11.1%) had serous otitis media, one (5.6%) had chronic otitis media, and four (22.2%) had acute otitis media. No patients were found to have clinical mastoiditis. χ2 analysis revealed no significance in the radiologic diagnosis of mastoiditis versus mastoid opacification in relation to physicians requesting otolaryngology consultations (P = .241) or starting patients on antibiotics (P = .951). Conclusions This study highlights the prevalence of incidental but clinically insignificant opacification of the mastoid cavity. We believe that nonotolaryngology physicians are, overall, competent to correlate such radiologic findings clinically and to prevent unnecessary consultations and inappropriate treatment, which add significant costs to our overstretched healthcare system. Level of Evidence 4 Laryngoscope, 129:852–857, 2019

Background Pistol caliber gunshot wounds (PC GSW) are the most common mode of firearm injury treated in the civilian emergency setting, but there is a paucity of data guiding best practice treatment. The goal of this study was to examine the effect of bedside positive pressure irrigation (PPI) on removal of gross debris from PC GSW. Methods Fourteen bovine shanks were prepared with metal impregnated fabric placed in front of the impending impact zones to mimic radio-opaque clothing-like material. They were then shot with a 9 mm bullet from a distance of 3 meters. Specimens were imaged three separate times with standardized computer tomography: immediately after impact, after 250 ml irrigation, and after a total of 750 ml of irrigation. Scanned images were examined for change in radio-opaque contamination at both the entry site and within the wound cavity. Results No samples demonstrated a decrease of debris contamination within the cavity of the wound after 250 ml of irrigation and only one did after 750 ml. Six (42.86%) samples demonstrated a shift of debris without decrease in cavity contamination after 250 ml of irrigation and ten after 750 ml total irrigation. Five samples demonstrated decrease in debris at the entry site of the gunshot projectile wound after 250 ml of irrigation and two showed further superficial decrease with additional irrigations up to 750 ml. No statistically significant differences were found between 250 ml and 750 ml PPI treatments in both superficial and cavity contamination categories. Conclusion Positive pressure irrigation with up to 750 ml of 0.9% normal saline at a rate of 20 ml/sec has limited effect on the removal of gross debris within the cavity of pistol caliber gunshot wounds. The data within this study bring into question the benefits of attempted removal of pistol caliber gunshot wound contaminants utilizing bedside positive pressure irrigation.

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