The importance of early evaluation by a neurotologist in patients with infective endocarditis treated with systemic gentamicin and its impact on the patients’ quality of life was evaluated. This is a longitudinal retrospective cohort study of 29 patients who received intravenous gentamicin for the treatment of infective endocarditis. Patients were classified into two groups: group A, before a neurotologist was included in the treatment protocol, and group B, after the inclusion of a neurotologist. The frequency of the different symptoms in each group was measured, and the gain of the vestibulo-ocular reflex (VOR) and its relationship with the presence of oscillopsia. In total, 13 and 16 patients were assigned to groups A and B, respectively. The mean gain of the VOR measured using the video head impulse test in group A was 0.44 in the best side and 0.39 in the worst side. In group B, the mean gain was 0.71 (best side) and 0.64 (worst side) (p < 0.0001). The patients who complained about oscillopsia had a main gain of 0.41 in the best side and 0.35 in the worst side. Evaluation of vestibular function should be included in the infective endocarditis treatment protocol, including the adverse effects of systemic gentamicin.
Introducción y objetivo: La parálisis bilateral del nervio laríngeo recurrente (PBNLR) es una complicación con gran morbimortalidad en la cirugía de tiroides, aunque infrecuente. La identificación visual del nervio laríngeo recurrente (NLR) continúa siendo el patrón oro en el manejo. El objetivo es evaluar si la neuromonitorización intraoperatoria (NMIO) reduce el riesgo de PBNLR durante TT (tiroidectomía total), mediante revisión sistemática y metanálisis. Método: Revisión sistemática de artículos que incluían series de TT con y sin NMIO para la identificación del NLR, sin restricción de fecha o idioma en PubMed, BVS, Cochrane, Clinicaltrials y WoS. Se evaluó la prevalencia de PBNLR. Se realizó estudio descriptivo de las variables incluidas y metanálisis según modelo de efectos aleatorios. Resultados: Se seleccionaron 45 estudios, y se analizaron dos subgrupos: series retrospectivas (31 estudios) y series prospectivas (14 estudios); con un total de 197161 pacientes. Las series prospectivas resultaron homogéneas y con bajo sesgo de publicación, con un total de 11149 pacientes. En los estudios prospectivos, la diferencia observada del riesgo de PBNLR con y sin NMIO equivale a una reducción absoluta del riesgo (RAR) del 2.1‰ y un número necesario de técnica para realizar (NNT) de 487.15. Conclusiones: La NMIO aporta una reducción del riesgo de PBNLR.
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