What's New | Decker

Discussion of the management of aortic endograft infections, which are increasing in incidence and prevalence and represent a particularly technically challenging subset of aortic graft infections (AGIs)
Discussion of the management of aortoenteric fistula, with special attention paid to the disastrous effects of gastrointestinal complications
Updated review of the various methods of arterial reconstruction for AGI, with updated summary of outcomes

The pneumococcal conjugate and influenza vaccines have been found to decrease the incidence of acute otitis media
Oral antibiotics are associated with a higher rate of OME resolution; however, there is insufficient evidence regarding hearing and speech outcomes.
Adenoidectomy should be considered with tympanostomy tube placement in children 4 years of age or older

Medical treatment of peritonsillar abscesses has been shown to be a safe and oft preferred alternative to surgical drainage.
2015 Adult Sinusitis CPG recommends 10 days of observation before antibiotics for uncomplicated sinusitis.
Viral upper respiratory tract infections represent the leading diagnosis for inappropriate antibiotic prescription in the United States.

Genomic medicine will lead to exciting new treatments for genetic causes of hearing loss.
Cochlear implantation has been studied showing improved speech recognition and improved outcomes
Cytomegalovirus -associated hearing loss treatment is controversial. Treatment with antivirals has risks and benefits and is currently in a multicenter clinical trial.

Robot assisted hair transplantation: Robotic follicular unit extraction is a technique that is gaining popularity to more quickly and accurately harvest follicular units for transplantation.
Novel drug treatments for hair loss: There are multiple novel drug treatments being developed and studied that have the potential to revolutionize hair loss treatment.
Adjuvant therapies: Adjuvant treatments such as platelet-rich plasma, lasers, and stem cells have shown some benefit for hair loss.

High resolution manometry: A technology that facilitates topographic evaluation of esophageal motility.
Wireless pH monitoring: A technique for pH monitoring that does not require an in-dwelling catheter, thought it requires endoscopic placement and does not provide impedance information
Eosinophilic Esophagitis: A diagnosis of increasing frequency that causes dysphagia in pediatric and adult populations
Transnasal esophagoscopy: A methodology for esophagoscopy that facilitates evaluation of the pharynx, larynx and pharyngoesophageal segment in contrast to traditional transoral esophagoscopy. Additionally, this can be done in office without sedation.

The otic capsule violating versus otic capsule sparing classification system of temporal bone trauma has been gaining traction
While typical protocols rely on a single EnOG facial nerve study between 3-14 days following the injury, serial ENoG may offer additional clinical information to guide surgical decision making in facial nerve palsy beyond two weeks after temporal bone trauma.
The role of facial nerve decompression following temporal bone trauma remains an area of active inquiry with data in the literature reporting both promising outcomes and outcomes worse than control following surgical intervention.
There is emerging interest in the use of endoscopic techniques in surgical facial nerve decompression for temporal bone trauma.
The use of cochlear implantation to treat posttraumatic sensorineural hearing loss among patients who meet audiologic implant criteria is supported by the literature in temporal bone fractures with or without involvement of the otic capsule, as well as in cases of otic concussion without fracture.

Computed tomographic angiography (CTA) has the advantage of being noninvasive, but there are very limited data to compare a CTA approach with the current standard diagnostic approach. A methodological review supported CTA in patients presenting within 48 hours of symptoms and with a neurologically intact examination. CTA has not replaced the current approach but has gained more acceptance; its use is center specific and more prevalent in continued management than initial diagnosis. CTA sensitivity decreases with aneurysms less than 4 mm in size and carries the risk of contrast-induced nephropathy, especially if digital subtraction angiography is performed after CTA.
Current data suggest that very short courses of antifibrinolytics may reduce rebleeding without causing ischemia. Rapid diagnosis of SAH and early definitive repair probably remain the best strategy for prevention. Fibrinolytics should be used in consultation with the neurosurgeon and may be most beneficial in instances of delayed definitive repair.
The mortality from aSAH appears to have declined in industrialized nations over the past 25 years. The case-fatality rate for aSAH, although still high worldwide, appears globally to be minimally on the decline despite significant regional differences in reporting of mortality.

General Surgery