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Ethanol ablation for the treatment of thyroid cysts has been well documented in the literature as a safe, effective treatment option in the elective setting. This study demonstrates the use of ethanol ablation in the emergency setting.
Methods
Three patients presenting with airway-threatening compressive symptoms secondary to a thyroid cyst were treated with ethanol ablation within 24 hours of presentation to hospital.
Results
All patients had symptom resolution at a median of nine months follow up post procedure. Sixty-six per cent of patients required only one treatment. There was a median of 100 per cent radiological resolution of the cystic component. The median Glasgow Benefit Inventory score was +27.7, similar to that for tonsillectomy.
Conclusion
Ethanol ablation is a safe, cost-effective and efficient treatment option for thyroid cysts in the acute setting.
Tonsillectomy is one of the most common otolaryngological procedures. Nonetheless, there is still no universally approved ‘gold standard’ technique.
Objective
To compare the safety and efficacy of argon plasma coagulation and coblation techniques in tonsillectomy.
Methods
A multi-institutional, retrospective cohort study was conducted, comprising 283 patients who underwent bilateral tonsillectomies performed by a single surgeon between 2014 and 2017. The outcome measures included: operative time, intra-operative blood loss, post-operative pain and post-operative haemorrhage.
Results
In the argon plasma coagulation group, mean operative time and post-operative haemorrhage rate were significantly reduced, p = 0.0006 and p = 0.003 respectively. There was no statistically significant difference between the two groups in terms of post-operative pain and intra-operative blood loss.
Conclusion
The argon plasma coagulation technique is easy, safe and efficacious. Argon plasma coagulation tonsillectomy seems cost-effective compared to coblation tonsillectomy: the single-use disposable electrode tip and wand used in this study cost AUD$76.50 and AUD$380 respectively. Argon plasma coagulation appears to be a favourable alternative to current modalities such as coblation.
Coblation tonsillectomy can be controversial. This study assessed post-tonsillectomy haemorrhage outcomes for patients operated on by a single experienced coblation-trained ENT surgeon.
Study design:
A retrospective audit of coblation tonsillectomies was performed using the Flinders modification of Stammberger criteria for post-tonsillectomy haemorrhage.
Method:
Case note review, interview and database interrogation were utilised to obtain the dataset. Haemorrhage results were compared to reports in the current literature.
Results:
Of those who underwent coblation tonsillectomy, 3.4 per cent were readmitted to hospital with haemorrhage and 1.3 per cent returned to the operating theatre (0.4 per cent primary haemorrhage and 0.9 per cent secondary haemorrhage). Younger children had a lower risk of returning to the operating theatre than older children or adults (0.3 per cent under the age of 12 years vs 2.0 per cent aged 12 years or older).
Conclusion:
Coblation can be a safe method for tonsillectomy with low complication rates when performed by an experienced ENT surgeon. The Flinders modification of the Stammberger criteria for post-tonsillectomy haemorrhage provides a simple system for data comparison.
To assess the effectiveness and safety of coblation in relieving inferior turbinate hypertrophy in children.
Methods:
An observational cohort study was undertaken. The severity of allergic rhinitis and the severity and degree of nasal obstruction were assessed using subjective and clinical symptom grading tools, a visual analogue scale, and endoscopy. Any post-operative complications were noted at 1 week, and at 1, 3, 6 and 12 months post-operatively. Data from extended follow-up periods were included when available. The statistical significance of changes in parameter values was assessed using the Wilcoxon signed-rank test.
Results:
Thirty-two patients were recruited (mean age, 11.28 years; range, 6–17 years). Significant post-operative improvement (p < 0.001) was noted in the severity and degree of nasal obstruction. This improvement was maintained after a mean follow-up period of 10.5 months (range, 1 month to 4 years). No mucosal ulceration or adhesion was encountered. Minimal crusting was noted in 8.57 per cent of patients at 1-week follow up. Allergic rhinitis symptoms improved significantly.
Conclusion:
Inferior turbinate reduction by coblation is an effective and safe procedure in children aged six years and older. The positive outcomes seem to be long-lasting.
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