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Objective: Compare serum calcium changes following thyroid and nonthyroid/parathyroid neck surgery., Study Design: Controlled historic cohort study of 190 patients undergoing total thyroidectomy (TT, n = 97), completion thyroidectomy (CT, n = 27), and lateral neck dissection (ND, n = 66)., Results: Each group experienced significant corrected serum calcium drop pre-op to POD #1 (mean change (mg/dL) TT = 0.97, CT = 0.79, ND = 0.46; all P < 0.001) with significantly greater drop in TT and CT (P < 0.0001). TT and ND had significantly greater calcium drop from pre-op to PACU than CT (0.54, 0.43, 0.15; P = 0.04). TT and CT experienced significantly greater calcium drop from PACU to POD #1 than ND (0.45, 0.53, 0.05; P < 0.0001). No significant difference in hypocalcemia rate between TT and CT., Conclusions: Perioperative calcium drop in nonthyroid neck surgery is likely hemodilutional, occurring intraoperatively, whereas in thyroid surgery it likely results from both hemodilution and parathyroid dysfunction with the latter manifesting after PACU. Postoperative calcium monitoring should be similar following total and completion thyroidectomy due to similar rates of hypocalcemia and mean calcium drops., Ebm Rating: B-3b.

Objectives: To determine whether meta-analysis supports the use of corticosteroids to reduce post-tonsillectomy pain for pediatric patients., Methods: A systematic review of currently available randomized controlled trials using a single-dose, intravenous corticosteroid during pediatric tonsillectomy was performed. Visual analog pain scale (VAS) data was extracted with reviewers blinded to results. Meta-analysis was performed with weighted mean difference and random-effects model using Revman 4.2 software., Results: Eight randomized trials were included in analysis of post-tonsillectomy pain. A statistically significant reduction in pain as measured by VAS on postoperative day 1 was noted (mean VAS difference = -0.97; CI 95 % = -1.74,-0.19; P = 0.01)., Conclusions: A single, intraoperative dose of dexamethasone may reduce post-tonsillectomy pain on postoperative day 1, by a factor of 1 on a 10-point pain scale. As the side effects and cost of dexamethasone dose appear negligible, consideration of routine use seems reasonable.

Objective: To determine the efficacy of thyroid hormone suppressive therapy (THST) to decrease benign thyroid nodule volume., Design: Meta-analysis., Methods: Systematic search using electronic databases (PubMed, Medline, Cochrane Library) through August 2004, paper review, and contacting experts and drug manufacturers. Only randomized controlled studies of THST vs no treatment or placebo, for reduction of benign thyroid nodule volume, were included. Exclusion criteria were: <6-month treatment, lack of ultrasound volume measurement, and region of endemic goiter. Primary outcome was clinically relevant nodule volume reduction (>50%), with a random effects model (RevMan4.2)., Results: Nine randomized trials were included (609 subjects). Subjects were 88% more likely to experience >50% nodule volume reduction with THST than placebo or no treatment (relative risk = 1.88; 95% CI = 1.18-3.01; P = 0.008). However, 8 subjects must be subjected to the risk of cardiac and skeletal side effects from THST, for one to benefit from therapy (number needed to treat = 8, risk difference = 0.13; 95% CI = 0.06-0.19; P = 0.0003). Sensitivity analysis reveals that 15 null studies would have to have been missed to reverse statistical significance (fail-safe N = 15). Review of the only study with long-term treatment (5 years) suggests no significant difference in nodule volume reduction between THST and placebo. Further, studies with follow-up after THST withdrawal demonstrate rapid increase in thyroid nodule and goiter volumes., Conclusion: THST appears more likely than placebo or no treatment to significantly reduce benign thyroid nodule volume, but long-term treatment may be less effective and regrowth is likely following cessation of therapy. Given the risks of THST, routine use is not recommended for benign nodules.

Objective: To determine the efficacy of proton-pump inhibitor (PPI) therapy for chronic laryngo-pharyngitis treated with lifestyle modification., Study Design and Methods: Double-blind, randomized trial comparing two-month Rabeprazole (20 mg b.i.d.) to placebo control., Results: Compared to baseline, both PPI and control patients had significant improvement in total reflux symptoms (P = 0.002 and P = 0.03 respectively), with significant improvement in "laryngo-pharyngeal" but not "typical" reflux symptoms. No significant difference was noted for change in reflux symptoms between PPI-treated and control patients (P = 0.44). Significant global improvement was noted by 50% of control and 53% of PPI-treated patients (P = 1.0). No significant differences were noted within or between treatment groups for change in health status or videostrobolaryngoscopy grade. Lifestyle modification compliance correlated significantly with global improvement., Conclusion: Compared to baseline, lifestyle modification for 2 months significantly improved chronic laryngo-pharyngitis symptoms. When compared to control, treatment with a PPI failed to demonstrate significantly greater improvement in reflux symptoms, health status, or laryngeal appearance.