- TARGET TARGET (Trial of Alternative Regimens in Glue Ear Treatment) is a multicentre UK randomized controlled trial (RCT) comparing treatment in persistent otitis media with effusion (OME). Three armed trial: observation, short-stay ventilation tube or ventilation tubes with adjuvant adenoidectomy.
Summary: There is a moderate-to-large overall benefit from adjuvant adenoidectomy on URTI and from ventilation tubes on super-added recurrent AOM. Adjuvant adenoidectomy doubles benefit from short-stay ventilation tubes by extending better hearing through the second year in children
- Cochrane review of grommets for OME (Browning et al.) Meta analysis to assess the effectiveness of grommet insertion compared with myringotomy or non-surgical treatment in children with OME.
Summary: The effect of grommets on hearing appears small and diminishes after six to nine months with virtually no improvement in development. There is a discrepancy between parental and clinical observation of a beneficial treatment effect
- Temporal Bone Fractures (Brodie et al.) Management of complications from 820 temporal bone fractures.
Summary: 100% of delayed facial nerve palsies improved to at least a grade 2 house brackmann. If timing of facial nerve palsy unknown, then these should be managed as immediate. Increased risk of infection in CSF leaks that persisted longer than 7 days, therefore advocate repair after 7-10 days.
- Salvage intratympanic steroids for sudden sensorineural hearing loss (SSNHL) (Ng et al.).A meta-analysis of 5 RCTS for salvage IT steroids in SSNHL.
Summary: Statistically significant improvement in the hearing loss as compared to controls. Dexamethasone better than methylpredinosolone
- Primary intratympanic steroids for sudden sensorineural hearing loss (SSNHL) (Garavello et al.).A meta-analysis of 11 RCTS for primary IT steroids in SSNHL.
Summary: Intratympanic steroid therapy seems to confer a certain degree of benefit as a salvage but not as a primary treatment of SSNHL
- Scottish Bell's Palsy Study (Sullivan et al.).Double-blind, placebo-controlled, randomized, factorial trial involving patients with Bell's palsy who were recruited within 72 hours after the onset of symptoms. Patients were randomly assigned to receive 10 days of treatment with prednisolone, acyclovir or both agents.
Summary: Early treatment with prednisolone significantly improves the chances of complete recovery at 3 and 9 months. There is no evidence of a benefit of acyclovir given alone or an additional benefit of acyclovir in combination with prednisolone.
- Swedish facial palsy study (Engstrom et al.).Randomised, double-blind, placebo-controlled, multicentre trial on adults presenting within 72 h of onset of acute, unilateral, peripheral facial palsy.
Summary: Prednisolone shortened the time to complete recovery in patients with Bell's palsy, whereas valaciclovir did not affect facial recovery.
- Sunnybrook Bell's palsy study (de Almeida et al.).Systematic review and meta-analysis of treatment of Bell's palsy looking at oral steroid alone vs steroid with anti-virals.
Summary: In Bell palsy, corticosteroids are associated with a reduced risk of poor recovery. Antiviral agents with corticosteroids may be associated with additional benefits (although was not statistacly significant)