Objective There are gaps within current meta-analyses looking at the effects of tranexamic acid on sino-nasal surgery. This study aimed to update and summarise all current available evidence on the use of tranexamic acid in sino-nasal surgery. Method A literature search was performed using four medical databases, Cochrane Library, Embase, Medline and PubMed. Data analysis was performed using dedicated meta-analysis software Review Manager (Revman). Results Thirteen studies were included in the meta-analysis. The amount of blood loss and duration of surgery in tranexamic acid groups was statistically lower than placebo for both sinus and nasal surgery. Tranexamic acid improves the surgical field quality in sinus surgery but worsens the field in nasal surgery. Topical or intravenous administration of tranexamic acid in sinus surgery reduces blood loss, duration of surgery and improves the quality of the surgical field. Conclusion This study suggests that the use of tranexamic acid in sinus surgery reduces blood loss, decreases surgical duration and improves surgical field quality.

The nontoxic deoxyribonuclease NucB was effective in releasing more microorganisms from biofilms on tracheoesophageal speech valves. This reflects its potential ability to break up and disperse these biofilms. Future studies will aim to develop NucB as a novel agent to prolong the life span of tracheoesophageal speech valves, thus reducing health care costs.

unusual layered structure. Samples consisted of endogenous mucin-rich layers with occasional pockets of bacterial cells, which were found throughout the biofilm. A commercially available surfactant was used to disperse the upper layers of mucin to allow penetration by the nuclease into the deeper bacterial biofilm. In vitro studies with the nuclease against model organisms also showed effective breakup of biofilms. Conclusion:We have shown that characteristic tenacious sinus "biofilm" has an unusual microscopic structure. Bacteria appeared to be localized in foci and may have been responsible for stimulating a host response. We are developing methods to remove sinus biofilms using a microbial nuclease that breaks down DNA holding the biofilm together. Rhinology/Allergy

Conclusion: Normative vagal and RLN data is presented. The mean amplitude of the RLN was greater than the vagus nerve. The mean latency of the left vagus is longer than the right side. The threshold of stimulation is well below the standard stimulation current of 1 to 2 milliamps. Head and Neck Surgery AntiBiofilm Molecules on Tracheoesophageal Speaking ValvesAdam Shakir (presenter); Grant Burgess; Nick Jakubovics; Robert Shields; Mohamed Reda El-Badawey, MBChB, FRCS Objective: The collection of biofilms on tracheo-esophageal speaking valves (TESV) detrimentally shortens their lifespan. A novel nontoxic enzyme (NucB) was discovered in the University of Newcastle and proved effective for dispersing marine biofilms. We propose to ascertain the effect of NucB on disrupting and removing mixed organism biofilms on TESVs. Method:We designed a case control study of ex-vivo TESVs, with build up of biofilms. Each TESV was divided into 2 equal parts. One half was treated with NucB and the other half with a nonactive control solution. Outcomes are measured by microscopy and culture of biofilm organisms.Results: Ten TESVs were collected for our analysis in the microbiology laboratory. The more efficient our agent is in dispersing biofilms, the more organisms are released that can be cultured. With aerobic growth mediums, more organisms were cultured in 9 samples (90%, 95% CI 57-99%). With the use of growth mediums favouring fungal organisms, more organisms were cultured in 6 samples (60%, 95% CI 31-83%). The macroscopic appearances of TESVs were noticeably improved after treatment with NucB, with less visible contamination compared to control treated valves. Conclusion:NucB, which is a nontoxic nuclease, was effective in the dispersion of the biofilms matrix collecting on TESVs. The treatment effect was greater for aerobic bacteria than fungal organisms. Our aim would be to use this agent to prolong the lifespan of TESVs and thus reduce costs. Head and Neck SurgeryAssociation of DNA Copy Number and miRNA Expression in OSCC Nicholas Anthony Serrano (presenter); Chang Xu; John Houck; Pei Wang; Wenhong Fan; Yan Liu; Pawadee Lohavanichbutr, MD Objective: Better understand possible mechanisms involved in the dysregulation unique to OSCC metastasis, we examined whether DNA copy number aberrations (CNAs) are associated with differential expression of miRNA that are found in OSCC metastasis.Method: Tumor cells were laser capture microdissected from 17 nonmetastatic primary tumors and 20 metastatic lymph nodes. CNAs and gene expression profiles were previously determined using Affymetrix 250K Nsp I SNP Arrays and HU133 plus 2.0 expression profiles. MiRNAs were interrogated with Exiqon's Ready-to-use PCR Panels. Results:We found 155 miRNAs expressed in >80% of metastatic or nonmetastatic samples with 31 of them differentially expressed in metastatic tumor cells (FDR<0.4; 27 over-expressed, 4 underexpressed). We found the expression of 11 miRNAs to be significantly associated with their DNA copy numbers (p < 0.5) and 7 of these were a...