Abstract
Objectives
The aim of this study is to confirm the effect of adjuvant intralesional triamcinolone acetonide injections (TRIAM) for the treatment of an infected preauricular sinus (PAS).
Methods
The medical charts of 103 patients diagnosed with PAS from March 2013 to December 2015 were reviewed and documented. The mean duration of treatment and postoperative follow-up period were compared between patients who received TRIAM and patients who received conventional treatment.
Results
Fifteen patients received TRIAM. The mean duration of treatment was 12.5 ± 11.0 days in patients treated with TRIAM, which was significantly shorter than patients without TRIAM (25.5 ± 25.7 days, p = 0.010). In addition, the percentage of patients experiencing early recovery (within 10 days) was 4.15 times higher with TRIAM (95% confidence interval: 1.07–16.13, p = 0.040). The mean postoperative follow-up period revealed a similar tendency; patients treated with TRIAM required a shorter follow-up period (8 ± 2.6 days) than patients not treated with TRIAM (13.5 ± 7.4 days). However, this difference was not significant ( p = 0.242).
Conclusion
Although the sample was small, patients with PAS infections who were treated with TRIAM as an adjuvant therapy required a significantly shorter treatment duration than patients receiving conventional treatment alone. This finding suggests a beneficial effect of TRIAM for the short-term control of PAS infections. Clinicians should consider TRIAM as an adjuvant treatment option.
1
Introduction
The preauricular sinus (PAS), which was first described by Van Heusinger in 1864, is one of the most common preauricular benign congenital legions . The incidence of PAS varies from 0.1% to 10% according to the enrolled country and ethnicity . In general, PAS is more common among black and Asian populations (than white) and has a slight female preponderance. Bilateral PAS also has a genetic association between parents and children, but not unilateral PAS .
For the management of PAS, the only way to eradicate its recurrence or prevent complications is complete surgical excision. However, surgery is usually performed after the PAS infection is resolved . Most clinicians first consider appropriate antibiotics use. If an abscess is present, incision and drainage (I & D), or other draining procedures, such as the insertion of a lacrimal probe, may be performed according to the clinicians’ experience . If edema and inflammation due to the PAS infection cannot be controlled by these treatments, a wide excision or figure 8 incision with extended fistulectomy may be considered .
Triamcinolone, which is an intermediate-acting glucocorticoid, has potent anti-inflammatory and immune suppression effects . Intralesional triamcinolone acetonide injections (TRIAM) have been implemented for the treatment of various otolaryngology pathologies, including benign vocal fold lesions, oral lichen planus, allergic rhinitis, and nasal polyposis. The injections allow for a high concentration of steroids to be applied locally with lower systemic toxicity . Thus, the TRIAM treatment became very frequently utilized for dermatologic, ophthalmologic, and rheumatologic diseases .
We hypothesized that TRIAM as an adjuvant therapy would also be effective and applicable for the treatment of PAS infections and other inflammatory diseases and that TRIAM might result in a faster recovery. Here, we conducted a retrospective cohort study to test our hypotheses.
2
Materials and methods
2.1
Patients
We thoroughly reviewed the medical charts of 103 patients who had visited the otolaryngology clinic at a university hospital complaining of acute preauricular swelling or pain during the period from March 2013 to December 2015. Patients were excluded if they visited the hospital only for the purpose of elective surgery or had no acute lesions; if the opening did not exist near the anterior margin of the ascending limb of the helix; if patients did not visit the outpatient clinic at least two times or a loss to follow-up occurred during treatment; or their medical records were insufficiently documented. The institutional review board of the university hospital approved this study (IRB number: 2016-01-009).
2.2
Treatment protocol
Throughout the whole study period, antibiotics were prescribed to all enrolled patients until the abscess or cellulitis was controlled. I & D was performed at the most fluctuating point. Local anesthesia (1% lidocaine) was administered, and 1:100,000 epinephrine was also administered if an abscess was suspected. Surgical excision of the PAS was performed in patients whose acute infection was completely controlled and if they were willing to have surgery. In addition to these conventional treatments, beginning in August 2014, we also treated patients with 0.1 mL of triamcinolone acetonide (Shin Poong Pharm Co., Seoul, South Korea) as an adjuvant therapy via an injection into the swelling in the vicinity of the infected preauricular opening. The injection was made placed in the center of the preauricular swelling without local anesthesia, using a 1 mL syringe with a 26-gauge needle. To avoid injecting vessels or unintended complications, a single injection was performed superficially, once. TRIAM was administered to all patients except those who had contraindications for steroid use due to medical conditions or those who were unwilling.
2.3
Outcome assessment
As a primary outcome measure, the mean duration of treatment was defined as the length of time from the initial visit to the final visit in which the symptoms or signs of preauricular cellulitis or abscess totally disappeared before surgery. If the duration did not exceed 10 days, we classified it as early recovery. We also documented the length of the postoperative follow-up period.
2.4
Statistical analyses
The Shapiro–Wilk test was performed to test the assumption of normality. Continuous variables between the two groups were compared using the Mann–Whitney U test and independent t-test. Nominal variables were compared using Chi-square analysis and two-tailed Fisher’s exact test. All statistical analyses were performed using SPSS software (version 22.0; SPSS Inc., Chicago, IL). A p value <0.05 was considered significant.
2
Materials and methods
2.1
Patients
We thoroughly reviewed the medical charts of 103 patients who had visited the otolaryngology clinic at a university hospital complaining of acute preauricular swelling or pain during the period from March 2013 to December 2015. Patients were excluded if they visited the hospital only for the purpose of elective surgery or had no acute lesions; if the opening did not exist near the anterior margin of the ascending limb of the helix; if patients did not visit the outpatient clinic at least two times or a loss to follow-up occurred during treatment; or their medical records were insufficiently documented. The institutional review board of the university hospital approved this study (IRB number: 2016-01-009).
2.2
Treatment protocol
Throughout the whole study period, antibiotics were prescribed to all enrolled patients until the abscess or cellulitis was controlled. I & D was performed at the most fluctuating point. Local anesthesia (1% lidocaine) was administered, and 1:100,000 epinephrine was also administered if an abscess was suspected. Surgical excision of the PAS was performed in patients whose acute infection was completely controlled and if they were willing to have surgery. In addition to these conventional treatments, beginning in August 2014, we also treated patients with 0.1 mL of triamcinolone acetonide (Shin Poong Pharm Co., Seoul, South Korea) as an adjuvant therapy via an injection into the swelling in the vicinity of the infected preauricular opening. The injection was made placed in the center of the preauricular swelling without local anesthesia, using a 1 mL syringe with a 26-gauge needle. To avoid injecting vessels or unintended complications, a single injection was performed superficially, once. TRIAM was administered to all patients except those who had contraindications for steroid use due to medical conditions or those who were unwilling.
2.3
Outcome assessment
As a primary outcome measure, the mean duration of treatment was defined as the length of time from the initial visit to the final visit in which the symptoms or signs of preauricular cellulitis or abscess totally disappeared before surgery. If the duration did not exceed 10 days, we classified it as early recovery. We also documented the length of the postoperative follow-up period.
2.4
Statistical analyses
The Shapiro–Wilk test was performed to test the assumption of normality. Continuous variables between the two groups were compared using the Mann–Whitney U test and independent t-test. Nominal variables were compared using Chi-square analysis and two-tailed Fisher’s exact test. All statistical analyses were performed using SPSS software (version 22.0; SPSS Inc., Chicago, IL). A p value <0.05 was considered significant.
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