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At least 235 records · Page 13Linked to original sources
PubMed1998

Cause of posterior canal wall retraction after surgery from the viewpoint of mastoid conditions.

OBJECTIVE: To determine the relationship between preservation of the mastoid mucosa during ear surgery and retraction of the attic or posterior wall of the external auditory canal (EAC) and mastoid aeration after surgery. METHODS AND DESIGN: Retraction of the posterior EAC wall and mastoid aeration were evaluated after surgery in 48 individuals (50 ears) with cholesteatoma, adhesive otitis media, or chronic suppurative otitis media, in whom the posterior bony EAC walls were removed with or without preservation of mucosa and reconstructed with soft tissues alone (EAC skin and temporal fascia) during surgery. RESULTS: Postoperative computed tomography showed that in ears with notable retraction of the posterior EAC wall appearing like an open mastoid cavity, there was no air in the mastoid, whereas in ears with no or only slight retraction there was computed tomographic evidence of mastoid aeration. Second, notable retraction of the posterior EAC wall occurred in a significantly smaller percentage of ears in which at least the epitympanic mucosa had been able to be preserved during surgery than in those that had undergone removal of all mucosa (mastoidectomy). CONCLUSIONS: These results indicate that 1) preservation of epitympanic mucosa during surgery is an important factor for prevention of retraction of the posterior EAC wall and for reaeration of the mastoid after surgery, and 2) the intact canal wall technique seems to be indicated whenever at least the epitympanic mucosa can be preserved, and when no mucosa can be preserved the canal wall down procedure seems to be indicated.

Adult↗
PubMed1997

The role of surgery in tuberculous mastoiditis: appropriate chemotherapy is not always enough.

We present a case of tuberculous otitis media in which a facial palsy occurred after the start of appropriate chemotherapy. To our knowledge this circumstance has not been described previously. It has been argued that radical surgery is completely unnecessary if chemotherapy is commenced early in the disease. We would suggest that this is not always the case, and would advocate a more measured approach.

Adult↗
PubMedDate not supplied

Surgery of the mastoid in ears with middle ear effusion.

It has been demonstrated that in most ears with middle ear effusion the mastoid air cells may be involved as well. The mucosal changes and the secretion extends into all cavities of the ear including the mastoid air cells. In most ears insertin of a ventilating tube through the tympanic membrane is adequate for proper aeration of the middle ear as well as of the mastoid air cell system. The draining usually stops and the mucosa gradually changes into its normal condition. In a small percentage of these, the ear will continue to drain and the mastoid will not clear up. Antibiotics and decongestants fail to cure the ear. Surgical intervention of the mastoid may be indicated in the rare cases where conventional treatment fails to control the condition. The aim of this report is to 1) focus attention to the fact that the mastoid is an integral part of the middle ear cavity; 2) discuss the pathogenesis in stubborn ears with middle ear effusion; and 3) demonstrate the surgical procedure commonly used in our department in order to reestablish aeration of the mastoid air cell system. Early recognition and proper treatment of ears with middle ear effusion will hopefully reduce the incidence of stubborn cases and also decrease the number of those cases which end up with chronic otitis media and cholesteatoma. It is hoped that the screening programs involving school and even preschool children, as well as new preventative programs, will diminish the frequency of cases which need extensive surgery as discussed in this paper.

Ear, Middle↗
PubMed1999

Factors affecting recovery of mastoid aeration after ear surgery.

Fifty-six patients after tympanomastoid surgery were examined to determine recovery of mastoid aeration and various pre- and intraoperative factors such as eustachian tube (ET) function, how the mastoid mucosa had been treated during surgery and whether or not a large silastic sheet had been placed in the middle ear or a ventilation tube used. Mastoid aeration recovery was confirmed by computed tomography in 27 of the 57 cases (47%) within 12 months of surgery. Among the factors examined, preservation of the epitympanic mucosa was found to be most important in mastoid aeration recovery. Use of a large silastic sheet to cover the area from the bony ET and tympanic cavity to epitympanum, aditus ad antrum or antrum was found to be of some help in recovery mastoid aeration after complete resection of the mucosa and mastoid air cells. Preoperative ET function, anterior tympanotomy and use of a ventilation tube did not influence recovery.

Adolescent↗
PubMed2006

Indications for surgery in acute mastoiditis and their complications in children.

OBJECTIVE: To review the clinical charts of 45 paediatric patients treated for acute otomastoiditis at the ORL Department of the University of Brescia (Italy) between January 1994 and March 2005 and to discuss the diagnostic workup and the outcome of treatment. METHODS: Twenty-six males and 19 females were admitted with acute mastoiditis and subperiosteal abscess. Thirteen of them (28.9%) presented an intracranial complication. Only three of them were not operated upon; one received a ventilation tube (VT); all the others underwent a mastoidectomy within 48-72 h. Twenty out of 32 uncomplicated mastoiditis were treated conservatively and the remaining 12 underwent myringotomy+/-VT, associated with a mastoidectomy in 9 cases. RESULTS: Antibiotics alone or with VTs achieved a full recovery in 28 out of 32 uncomplicated cases. Mastoidectomy resolved the disease in 13 patients (9 with complications). In severe complications, a canal wall down (CWD) (n=2) or an intact canal wall (ICW) mastoidectomy (n=7) were preferred, based on the extent of the lesions and the degree of hearing loss. All children recovered completely at 1 year follow-up. In the uncomplicated cases that were operated upon, the mean hospital stay was 7.8 days (versus 4.3 days for the conservative group). In children with intracranial complications the mean hospital stay was 12.8 days, significantly less than the four non-surgical patients, who remained hospitalized for an average of 18 days. CONCLUSION: Acute mastoiditis can fully recover with conservative treatment or myringotomy+VTs. Immediate surgical treatment is indicated for intracranial complications, if the neurological conditions are not critical. A simple mastoidectomy+/-tympanoplasty is warranted in: (1) exteriorization, if the child is older than 30 months or >15 kg of weight, (2) intracranial complications (combined with a neurosurgical procedure as needed) and (3) cholesteatoma or granulation tissue.

Abscess↗
PubMedDate not supplied

[Causes of failure in radical surgery of the mastoid].

We review the surgical findings of 85 revisional radical mastoidectomies for recurrent otic discharge, with the purpose to determinate the causes of surgical failure. Cholesteatoma was found in 38.8% of the cases. The other causes were unexentered cells and granulation tissue in the sinodural angle, mastoid tip, tegmental cells and root of the zygoma. The facial recess was the place of residual cholesteatoma in 47% and the supratubal recces in 40% of the cases. We emphasized the big importance of a good meatoplasty, this was the cause of failure in 62.4% of cases. A dry ear was obtained in 94% of the cases. The mean following up period was three years.

Adolescent↗
PubMed1985

[The "old radical" surgery. History and development of surgery of the mastoid].

After a brief historical outline of the radical operation of the ear, the possibilities are presented which are at our disposal to construct a mastoid cavity after removal of the posterior bony wall of the auditory canal, thus keeping the problems for the patient at a minimum. At best, a small self-cleansing well-designed cavity is formed under favourable conditions. Important prerequisites for the construction of such a cavity are: A good overview obtained by smoothening of the cavity walls; widening of the auditory canal entrance (cartilage excision); removal of excess bone covering the facial nerve; and reducing the size of the cavity by means of a Palva flap while preserving the postauricular artery and its larger branches. Postoperative management (and cleansing) must be done with an operation microscope.

Cholesteatoma↗
PubMed1997

Gas exchange function through the mastoid mucosa in ears after surgery.

Gas exchange function through the mastoid mucosa was investigated in ears after surgery using nitrous oxide. Increase in the mastoid pressure was assessed by a micropressure sensor placed in the mastoid cavity during the second-stage revision operation performed under general anesthesia using 67% nitrous oxide, 33% oxygen, and sevoflurane on 14 ears with chronic adhesive otitis media or cholesteatoma as well as on seven ears without inflammation as controls. All seven control ears showed pressure increase in the mastoid in various degrees. In the 14 postoperative ears, nine of the 10 ears on which the mastoid mucosa had previously been able to be preserved in various degrees showed pressure increase in the mastoid, but none of the remaining four ears, which had previously had mastoidectomy, showed any pressure increase. The presence or absence of the mastoid pressure increase of those ears was also found to be correlated well with the presence or absence of mastoid aeration on computed tomography examined just before the second-stage operation. These results appear to indicate that, in ears after surgery, recovery of both the gas exchange function and aeration in the mastoid is expected only when the mastoid mucosa can be preserved even partially.

Adolescent↗
PubMed1981

The positive pressure of cholesterol granuloma idiopathic blue eardrum. differential diagnosis.

The purpose of this presentation is to demonstrate the positive middle ear pressure in cholesterol granuloma, the so-called idiopathic blue drum or chocolate ear. Because of this positive middle ear pressure the patients with idiopathic blue eardrum do not tend to develop the retraction pockets or subsequent cholesteatoma and therefore this is rarely a destructive disease. Since the symptoms are minimal and there is no destruction, probably the best treatment of the idiopathic blue eardrum is no treatment at all. In cholesterol granuloma, chronic secretory otitis media, and chronic serous mastoiditis the results of surgery are dubious because the entire air cell system of the temporal bone, including the petrous apex, cannot be completely exenterated and therefore these cells continue to secrete and exert the positive pressure. Dubious surgical results in patients with positive pressure of cholesterol granuloma are illustrated by cases with open cavities and incomplete mastoid surgery, intact canal wall techniques with complete surgery and ablation, extensive radical mastoid surgery with closure of the canal and retention blue domed cysts forming in the cavities of modified radical, and fenestrations of the horizontal semicircular canal.

Adult↗