Topical use of tranexamic acid versus epinephrine to optimise surgical field during exploratory tympanotomy

Effects of Tranexamic Acid on Intraoperative Bleeding and Surgical Field Visualization During Middle Ear Surgery: A Narrative Review

“…Table 1 shows the general characteristics of the 3 included studies. 5 - 7 All of them were double-blind, placebo-controlled, randomized trials written in English between 2019 and 2020. They included a number of participants of 50, 69, and 60, respectively, with a mean age between 28.5 and 33.5 years.…”

“…The 3 studies used different inclusion criteria: Das et al 5 included patients undergoing endoscopic ear procedures (27 endoscopic tympanoplasties, 6 endoscopic mastoidectomies, 11 endoscopic ossiculoplasties, and 6 endoscopic stapedotomies), while Ziaei et al 6 included only microscopic mastoidectomies and Hamed and Hamed 7 only exploratory tympanotomies.…”

Efficacy of Topical Epinephrine in Tympanoplasty

“…Resource constraints prevented us from evaluating the efficacy of more dilute TE concentrations, but this should be done. TE concentrations used in ear surgery range from as high as 1:1,000 21,22 to as low as 1:200,000 23 …”

“…TE concentrations used in ear surgery range from as high as 1:1,000 21,22 to as low as 1:200,000. 23 One of the most serious drivers for reducing the TE concentration is the potential for life-threatening complications with inadvertent soft tissue infiltration of TE. 5,6 The literature on this topic is amazingly sparse.…”

Effect of Topic Epinephrine on Opioid Consumption in Ear Surgery

“…Epinephrine added to local anesthetic in a low concentration (usually 1:50.000, 1:100.000 or 1:200.000) is able to prolong the duration of analgetic effect of the local anesthetic by vasoconstriction, thus lowering blood flow and slowing down the drug elimination [1,2]. Even these very low concentrations can impair inner ear perfusion though not causing any relevant clinical complications [3,4]. Besides that epinephrine can be applied superficially on the bleeding tissue in a high concentration (1:1.000) to diminish or stop bleeding in situations when surgical hemostatic methods fail or are technically not feasible, such es endoscopic or microscopic ear surgery [5][6][7][8].…”