Objective Tonsillectomy is the most common operation performed in the otolaryngologic fields. Efforts have been made to reduce postoperative complications, and one of these is intracapsular tonsillectomy and adenoidectomy (ICTA), which leaves the tonsillar tissue with tonsillar capsule. This study aimed to evaluate intracapsular tonsillectomy compared with classical extracapsular tonsillectomy in terms of efficacy of the technique for managing obstructive sleep apnea (OSA) and reducing postoperative complications. Data Sources We performed a literature search using PubMed, EMBASE, and the Cochrane Library through December 2016. Review Methods Summarized risk ratio (RR), risk differences (RDs), and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated by summarizing the risk estimates of each study using random-effects models that considered both within- and between-study variations. Results Our search included 15 randomized controlled studies. The RRs for postoperative bleeding and residual tonsils were, respectively, 0.44 ( P = .01) and 6.02 ( P = .0002). There were significant differences in postoperative pain ( P = .0022), need for analgesics ( P < .0001), days to normal diet ( P = .006), and days to normal activity ( P < .00001) between intracapsular tonsillectomy and extracapsular tonsillectomy. Conclusions Intracapsular tonsillectomy can effectively reduce postoperative pain and bleeding, which shortens the time required to return to normal life. There was no difference between microdebrider and coblator in intracapsular tonsillectomy regarding postoperative pain and bleeding. It can increase the risk of remnant tonsils; however, it does not increase the risk of recurrent infection.
To understand better the pathogenesis of inner ear (IE) damage caused by otitis media (OM), the round window membrane(RWM) structure was investigated in a rat model for pneumococcal otitis media (POM). The RWM of 25 rats were evaluated light and electron microscopically on 1 day, 3 days, 6 days, 10 days, and 20 days after the unilateral inoculation of type 3 pneumococcus suspension into their middle ear cavities. The thickness of the RWM increased in various stages of the pneumococcus-evoked otitis media, compared with that of the normal. The thickening was most pronounced on day 1, being about 4 to 5 times greater than that of the normal RWM. All layers of the RWM were affected by the pneumococcal infection, but the major changes were confined to the subepithelial space close to the basement membrane (BM). Together with alterations to the BM, the most distinct pathological features were characterized by an increase and hypertrophy of fibroblasts in association with abundant collagen fibers. Elastic fibers observed close to the inner mesothelial layer under a high power magnification also increased during the experiment. These results will be relevant to a better understanding of the histologic implication of RWM in stages of acute otitis media involving pneumococcus-evoked otitis media.
When acupuncture at PC6 (neiguan) was used to prevent PONV after pediatric tonsillectomy, the risk ratio was significantly lower compared to that of conventional drug therapy. Although further randomized controlled trials are needed, acupuncture at PC6 is considered an economic and effective treatment for emesis after pediatric tonsillectomy. Laryngoscope, 126:1761-1767, 2016.
Pneumolabyrinth is an uncommon condition in which air is present in the vestibule or cochlea. It is rarely found, even with fractures violating the otic capsule or with transverse fractures of the temporal bone. In addition, its bilateral occurrence is extremely rare. In this article, we describe a case of bilateral pneumolabyrinth presenting as sudden, bilateral deafness, without temporal bone fracture, an occurrence which has not previously been reported.
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