Post-tonsillectomy Bleeding as a Stochastic Process

Post-tonsillectomy Bleeding as a Stochastic Process

P72 Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008 surgical therapy were more likely to report harm or adverse events (odds rati...

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Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008

surgical therapy were more likely to report harm or adverse events (odds ratio 1.46, p⫽ 0.046) than medical therapy. CONCLUSIONS: Harm and adverse events are under-reported and poorly described in otolaryngology journals, with about 1/3 of clinical research not mentioning adverse events at all. Most authors do not explicitly describe harm or adverse events (53%), or the methodology behind collecting adverse events data (76%). Under-reporting is more likely when a therapeutic effect is found to be beneficial. Post-tonsillectomy Bleeding as a Stochastic Process Brian W Blakley, MD, PhD, FRCSC (presenter) OBJECTIVE: 1) Establish an acceptable post-tonsillectomy bleeding rate from the literature, and 2)provide a literaturebased comparator for institutional bleed rates. METHODS: A MEDLINE literature search entering the keyword “tonsillectomy” identified 4,610 papers for all available years. The abstracts were loaded into a database and searched to identify the incidence of bleeding if reported. The weighted mean, standard deviation and 95% confidence intervals were calculated for those papers. For papers that compared a new technique to a control technique, only the control group rate was used. The definitions of bleeding rate were those used by the original authors of the papers. RESULTS: 63 papers reported post-tonsillectomy bleeding rates. The mean (4.5%) plus 2 standard deviations (9.4%) suggests a maximum “expected” sustained bleeding rate of 13.9%. Even in this literature which should reflect optimum results, there were 3 reports of bleed rates in the 18-20% range. CONCLUSIONS: Post-tonsillectomy bleeding rates of about 5% are typical. Rates above 14% justify monitoring, and sustained rates over 20% occur at times. Transient increases greater than 20% may occur.

Rhinology An Adjustable Implant for the Nasal Valve: 3-Year Experience Charles G Hurbis, MD (presenter) OBJECTIVE: 1) Measure the effectiveness of the Monarch implant in correcting nasal valve dysfunction. 2) Determine the longevity of effectiveness. METHODS: This study consists of a prospective, cumulative, three-year experience with the Monarch adjustable nasal implant for correcting nasal valve dysfunction in a total of 46 patients. Implantation success was determined by the use of acoustic rhinomanometry and a subjective NOSE-type quality of life scale. Data was subjected to the student-t test. RESULTS: In the series of 46 patients spanning 36 months there is a mean 150% improvement in the internal nasal valve

areas at 3 years as measured by acoustic rhinomanometry (p⬍.0001). Using a NOSE-type questionnaire, patients also noted significant improvements in daytime (p⬍.0004) and nighttime (p⬍.0002) nasal airways, a decrease in apnea (p⬍.01) and snoring (p⬍.05), and a decrease in the propensity for daytime oral breathing (p⬍.0002). CONCLUSIONS: The Monarch Implant provides a simple, consistent, adjustable and apparently long-term correction of the nasal airway in patients suffering from nasal valvular dysfunction. Association of Vitamin D Levels and Chronic Rhinosinusitis Jayant Pinto, MD (presenter); John Schneider; Rosanne Perez; Marcy L De Tineo, BSN; Fuad M Baroody, MD; Robert M Naclerio, MD OBJECTIVE: Vitamin D decreases the risk of chronic illnesses and has been implicated in asthma, allergic rhinitis, and anaphylaxis. We questioned whether vitamin D levels might be associated with chronic rhinosinusitis (CRS), using a casecontrol sample. METHODS: Serum 25(OH)-vitamin D (25(OH)D) levels were measured in African-American (n⫽65) and Caucasian (n⫽89) adults with and without CRS, recruited at an urban, tertiary care, academic hospital. Case definition met consensus diagnostic criteria and included endoscopy and imaging, with normal imaging studies in controls. Data were stratified by sex, race, season, and body-mass index (BMI), factors known to affect levels. RESULTS: There were no significant differences in 25(OH)D levels between Caucasian cases and controls in either sex, including when analyzed by season. Levels in African-Americans with CRS were significantly lower than controls (males: cases 15.4 ⫾ 2.1 ng/mL, controls 26 ⫾ 2.6, P?0.01; females: cases 13.5 ⫾ 2.0, controls 20.8 ⫾ 2.6, P?0.03). Accounting for season, African-Americans with CRS continued to show significantly lower 25(OH)D levels as compared to controls (winter: males: cases 22.3 ⫾ 3.3 ng/mL, controls, P?0.03; females: cases 8.5 ⫾ 0.96, controls 17.4 ⫾ 2.5, P?0.003), with similar but nonsignificant trends in summer. Demographics were similar across comparisons (age, BMI). CONCLUSIONS: Our data suggest that low levels of vitamin D may be involved in CRS in African-Americans, a role that is biologically plausible, given its immunologic effects and its putative association with susceptibility to viral infections and other related diseases. Further study of this phenomenon may provide novel hypotheses for the development of CRS. Bacterial Flora of Normal Maxillary Sinuses in Adults Walid M Abou Hamad, MD (presenter); Nayla E. Matar, MD; Michelle Elias;