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At least 1,693 records · Page 94Linked to original sources
PubMed2000

Efficacy of ondansetron for prevention of postoperative nausea and vomiting after outpatient ear surgery under local anesthesia.

OBJECTIVE: To assess the efficacy and safety of intravenous ondansetron (4 mg) for the prevention of nausea and vomiting after middle ear surgery under local anesthesia. SETTING: The study was conducted by Division of Otorhinolaryngology in Prince of Wales Hospital, which is a tertiary referral center and teaching hospital for The Chinese University of Hong Kong. STUDY DESIGN: A double-blind randomized controlled trial. PATIENTS: Fifty-eight Chinese patients undergoing tympanoplasty under local anesthesia from July 1995 to June 1997 were recruited. The mean age of patients was 42.8 years (range 18-71 years). INTERVENTION: Patients were randomly allocated to receive a single dose of intravenous ondansetron (4 mg) (n = 29) or placebo (n = 29) immediately before surgery. MAIN OUTCOME MEASURES: Patients were assessed for severity and frequency of postoperative nausea and vomiting at the 1st, 2nd, 4th, 8th, and 24th hours after middle ear surgery. RESULTS: Female patients showed a higher prevalence of postoperative nausea and vomiting. Twenty-eight percent of the patients experienced postoperative nausea, of whom 14% also experienced vomiting. Although the ondansetron group demonstrated a lower prevalence of postoperative nausea and vomiting (PONV) (24% nausea and 10% vomiting) than the placebo group (31% nausea and 17% vomiting), significant reduction in postoperative vomiting only occurred in the first postoperative hour (p = 0.038). No complications or adverse side effects were found to be associated with the use of ondansetron. CONCLUSIONS: Single-dose ondansetron (4 mg) given intravenously preoperatively significantly reduces postoperative vomiting in patients after tympanoplasty under local anesthesia and causes no adverse effects.

Adolescent↗
PubMed2000

Tympanic membrane Patcher: a new device to close tympanic membrane perforations in an office setting.

OBJECTIVE: To assess a new device intended to cover tympanic membrane (TM) perforations in an office setting. STUDY DESIGN: Not all patients with TM perforations require or choose tympanoplasty surgery. Alternatives to surgery (e.g., paper and plastic onlay) have limitations that prompted a need for an alternative method. A new, simple device, designed to be inserted into the perforation, is made out of a very soft silicone in the shape of a sealed tympanostomy tube. The TM Patcher is self-stabilizing without adhesives. SETTING: An outpatient office. PATIENTS: Twenty-nine patients with 30 consecutive dry TM perforations, who volunteered to participate in the study. Patients with known cholesteatomas or persistent drainage were excluded. INTERVENTIONS: In the office, patients had the Patcher inserted into their dry TM perforation. No anesthetics were needed. MAIN OUTCOME MEASURES: Hearing was tested before and after patching by conventional audiometry. The ears were assessed for Patcher position, perforation status, and infection. RESULTS: Patients with normal ossicular chains had immediate improvement of hearing. No patient experienced hearing loss. Twenty-six of 30 patients (87%) were free of infection. Two patients (7%) with persistent drainage were taken to surgery and were found to have mastoid disease (cholesteatoma or granulation tissue). Three patients (10%) had rare otorrhea after patching and were treated by drops or temporary removal of the Patcher. Two of these three ears subsequently became dry and then healed. Small perforations often healed or became smaller (46% of 3-mm perforations) despite failure of tympanoplasty or conventional office patching with a flat piece of paper or plastic. Perforations >5 mm did not heal; however, these patients simply continued wearing their Patcher and benefited by protection of their middle ear, typically with improved hearing and resolution of tinnitus. Occasional spontaneous lateralization was allowed to occur in the small perforations, which often later healed. In larger perforations, the Patcher was simply repositioned. CONCLUSIONS: The Patcher is a safe and effective alternative for office patching of dry perforations when surgery is contraindicated or is refused by the patient. New materials should increase healing rates when applied to a Phase II Patcher.

Adolescent↗
PubMed2001

[One-stage surgery of middle ear cholesteatoma in adults: apropos of 180 cases].

OBJECTIVES: In order to evaluate the results of tympanoplasty in one stage middle ear cholesteatoma surgery, a retrospective study of 180 consecutive cholesteatomas operated on was undertaken. METHODS: 150 single procedures and 30 revision surgeries realized between 1992 and 1997 were analysed by studying anatomical and functional results with a mean follow-up of 24 months. RESULTS: Among the 150 adult patients, 85 (57%) were previously operated on in other centres and presented a recurrence of cholesteatoma. Closed technique was performed in 110 cases (61%) and opened one in the remaining cases (41%). Ossiculoplasty was made in 101 cases (56%) with different materials (15 incus autografts, 14 teflon prosthesis, 35 hydroxyapatite (HA) composite prosthesis and 37 all in HA prosthesis): 91 cases in a one-stage procedure but 10 worse functional results required a closed revision procedure. Twenty cases were also revised after one year of follow up at least: six recurrences of cholesteatoma were operated on by using canal down mastoidectomy (4%), 14 limited residual cholesteatomas (9.3%) had a revision closed technique procedure. CT Scan followed up all the patients operated on by a closed technique. Postoperative air-bone gap (ABG) was 20 +/- 11.3 dB and 27 +/- 10.1 dB in closed and opened techniques, respectively (p < 0.05). ABG was 20 +/- 9.2 dB and 26 +/- 13 dB in type II and type III tympanoplasty, respectively (p < 0.05). CONCLUSION: If the tympanic and posterior cavities are reasonably safe, middle ear cholesteatoma in adults can be well cured by a one-stage procedure including ossicular chain reconstruction with hydroxylapatite prosthesis covered with cartilage graft who achieved a valuable hearing restoration.

Adult↗
PubMedDate not supplied

[Dural bone defects and encephalocele associated with chronic otitis media or its surgery].

OBJECTIVES: We investigated the incidence of dural bone defects and encephalocele following radical mastoidectomy or open cavity tympanoplasty. PATIENTS AND METHODS: We retrospectively evaluated 190 operations of 182 patients (97 males, 85 females; mean age 30.6 years; range 9 to 70 years) who underwent radical mastoidectomy (n=89) or open cavity tympanoplasty (n=101). Follow-up examinations included otomicroscopy. Patients with documented dural bone defects on examination or operation records were further evaluated by axial and coronal computed tomography scans of the temporal bone. Those with suspected encephalocele were studied by magnetic resonance imaging. RESULTS: Dural bone defects were detected in 17 patients perioperatively. Of these, 14 defects were associated with chronic otitis media. Three iatrogenic bone defects were induced during obliteration of lateral sinus thrombosis. The mastoid tegmen was the most common site of defects (41%) and the most common etiologic factor was cholesteatoma (84%). Encephalocele was detected in one patient in whom radical mastoidectomy with lateral sinus obliteration was performed due to lateral sinus thrombophlebitis. Encephalomalasia was found nearby the defect area in two patients. CONCLUSION: Dural bone defects associated with chronic otitis media are not rare, the most common cause being cholesteatoma. Repair of dural lacerations requires watertight closure to prevent the occurrence of encephalocele.

Adolescent↗
PubMed2001

[Application of posterior canal wall reconstruction and mastoid obliteration].

OBJECTIVE: To explore the obliteration of the old mastoid cavity and reconstruction of the posterior canal wall after radical mastoidectomy. METHOD: Posterior canal wall reconstruction and mastoid obliteration of 11 ears of 10 patients with old mastoid cavity for 1 to 6 years after radical mastoidectomy were done using the pedicle postauricular composite skin flap (PPCSF), and their tympanoplasty were performed at the same time. Follow-up was performed at 3 to 30 months. RESULT: All PPCSFs survived. The old mastoid cavity of 11 ears vanished and reconstructed posterior canal wall remained in normal position without retraction. The drying ear time took 2 to 3 weeks postoperatively, and the symptoms of the radical cavity disease after radical mastoidectomy were cleared up nearly, and the average hearing threshold decreased 13.6 dB HL. The otorrhea and perforation of tympanic membrane resulted from infection happened to 1 of 11 ears three month after the operation. CONCLUSION: The PPCSF is an effective method in the obliteration of old mastoid cavity and reconstruction of the posterior canal wall. It can reduce drying ear time postoperatively, treat the radical cavity disease after radical mastoidectomy and is beneficial to the tympanoplasty at the posterior external at the same time.

Adolescent↗
PubMed2001

[One stage otoplasty treatment for congenital malformations of the auricle and middle ear].

OBJECTIVE: To investigate the application of one stage otoplasty for congenital atresia of the external acoustic canal and malformations of the middle ear and the auricle. METHOD: Patients with the ear malformations were given surgical reconstruction of one stage otoplasty. The auricle was reconstructed with the rib which was encapsulated with the superthin temporal flap. According to the malformations of the middle ear in patients, I style tympanoplasty and III style tympanoplasty were carried out respectively. All patients were performed myringoplasty with temporal fascia and reconstructed the external acoustic canal with full thickness skin-grafting. RESULT: A long term follow-up (4-6 years) demonstrated that 11 ears were survival of which 8 ears figuration were ideal. The hearing improvement was observed in all patients. CONCLUSION: One stage otoplasty is effective for treatment of the congenital malformations of the external and middle ear.

Adult↗
PubMed1992

Autograft tragal and conchal palisade cartilage and perichondrium in tympanomastoid reconstruction.

Since Utech's introduction of cartilage as a columella in ear surgery in 1969, we have used tragal and conchal autografts for reconstruction of the tympanic membrane and the auditory canal wall in 13,000 cases. As large pieces of cartilage can twist in later years, we place palisaded cartilage fragments with perichondrium parallel to the manubrium of the malleus in type I tympanoplasties and in type II or III procedures parallel to the long process of the incus. The "annulus-stapes plate" in type III tympanoplasties replaces the function of the incus (and malleus), crossing the promontory and reducing adhesions. A "tunnelplasty" keeps the eustachian tube entrance open with the semiring of cartilage ("simmering") apposed to the inside of the annulus, reconstructing the tympanomeatal niche. The "architrave" created rests on the tensor tympani while the palisaded epitympanum and antrum plasty allows ventilation of the antrum. Mastoid obliteration is performed with an autogenous perichondrial transplant to which the palisaded incised cartilage portions adhere, adapting to the underlying structure.

Cholesteatoma↗
PubMed1977

[Middle ear pressure after rhinoplasty surgery (author's transl)].

Middle ear pressure after rhinoplasty surgery was determined by tympanometry. Measurings were done in 94 patients (total of 177 ears) before the rhinoplasty operation and during the following 6 days respectively in special cases up to three weeks. In 153 ears normal middle ear pressure was found before the operation. After the rhinoplasty in about 2/3 of all cases negative pressure up to 300 mm Ws developed. This negative pressure was equalized in the vast majority of cases (84.3%) after the tamponade was removed. In some cases negative pressure persisted for 6 days after the operation (9.8%); in few cases (5.9%) up to three weeks. In 13 out of 24 patients having negative middle ear pressures together with rhinomanometrically objectified impaired nasal ventilation rhinoplasty led to normal middle ear pressure. Reasons for the development of negative pressures in the middle ear are discussed. The results of the investigations lead to consequences concerning tympanoplasty in connection with rhinoplasty operations. Rhinoplasty and tympanoplasty should not be performed on the same day--there should be an intervall of 4--6 days between these operations. Negative pressure in the middle ear in cases of impaired nasal ventilation can be improved by rhinoplasty.

Airway Obstruction↗
PubMed1992

[Exposure of the facial recess through the ear canal. Value in posterosuperior retraction pockets (initial results)].

19 patients had surgery for progressive [17] and/or symptomatic [2] posterior attic retraction pockets involving the facial recess. Exposition of the suprapyramidal region was obtained after endaural incision by thinning the posterior wall of the ear canal and removing the posterior-superior portion of the tympanic sulcus. This technique is less complicated than intact canal wall tympanoplasty with mastoidectomy. Yet gives similar functional results. After a mean follow-up of 20.3 months, we have observed no residual cholesteatoma and no recurrent retraction pockets. Unlike posterior tympanoplasty, this technique makes it possible to meticulously remove the osteitic bone invariably found in the facial recess when there is infection of the retraction pocket.

Adolescent↗
PubMed2004

[Operative therapy of the adhesive otitis media].

OBJECTIVE: To study the operative indications and treatment for adhesive otitis media (AOM). METHODS: Sixty-nine cases of AOM were undergone tympanoplasty between 1995 to 2000. Preoperative average air-bone gap(A-B gap) were (43.7 +/- 3.9) dB. Forty-one cases could be postoperative followed up for more than one year. Preoperative average A-B gap of this group were (43.8 +/- 4.2) dB. The adhesive ear drum and the other processes in middle ear were inserted and reconstructed with cartilage. RESULTS: The postoperative average A-B gap after one month(69 cases) and one year(41 cases) were (23.7 +/- 8.6) dB and (27.9 +/- 10.7) dB. In the long-time follow-up group, the A-B gap of 18 cases (43.9%) were less than 20 dB. Twenty-four cases (58.5%) become a nearly normal tympanum. CONCLUSION: The AOM can treatment with tympanoplasty. But the indication must be carefully selected. The cartilage was a good material for reconstruction of the ear drum to treatment the AOM. The influence factor were analyzed.

Adult↗
PubMed1990

Surgical treatment of cholesteatoma: a comparison of three techniques.

The debate regarding the surgical technique for the management of cholesteatoma still continues. The resolution of this issue will only come with the study of the long term results of well controlled series. In this paper long term follow-up on three groups of patients is reported. The groups underwent combined approach tympanoplasty (CAT), mastoid tympanoplasty with obliteration (MOT), and modified radical mastoidectomy (MRM) respectively for cholesteatoma. The factors studied included frequency of required review, condition of the external canal/cavity, and hearing status. The meatal cross-sectional areas and cavity volumes were also measured for the MRM and MOT groups. Analysis of the data showed no significant difference between the groups in either frequency of review or cavity status. The hearing results showed an initial improvement in all groups, however, over the prolonged follow-up period the air conduction threshold gradually increased. In conclusion this data supports the view that a one-stage canal wall down procedure provides maximum long term patient benefit.

Cholesteatoma↗
PubMed1989

Cholesteatoma in 3-D.

1. In Shambaugh's primary acquired cholesteatoma, the surgical approach of choice is the direct endaural transcanal modified radical mastoidectomy and tympanoplasty in continuity. 2. In Shambaugh's classification of the secondary acquired cholesteatoma developing in a previously pneumatic mastoid with the infection of short duration, the postauricular transcortical mastoidectomy and facial recess approach and tympanoplasty in continuity is worthy of consideration if there is a reasonable possibility that the eustachian tube function may return to normal. 3. In Shambaugh's classification of a secondary acquired cholesteatoma in a large mastoid with the infection of long duration, there is probably cicatricial stenosis of the eustachian tube with a postauricular transcortical mastoidectomy and facial recess approach. It is probably a futile procedure because of the high incidence of recurrent attic retraction cholesteatoma requiring a secondary modified radical mastoidectomy. 4. Recurrent attic retraction cholesteatoma is subject to external reinfection and may cause a subperiosteal abscess or other complications many years after the primary surgery. 5. Residual cholesteatoma is the "bug bear" of any closed technique. This self-contained cyst is slow growing and may not become apparent for many years. Since it is not subject to reinfection, it is an insidious, destructive, silent lesion which may ultimately present itself as a postauricular pitting mass, erosion of the canal wall, facial paralysis, or a fistula in the labyrinth. 6. In invasive cholesteatoma and in long-standing secondary acquired cholesteatoma, the attempted preservation of the canal wall is a futile process and the surgeon is able to perform more accurate surgery with the direct primary transcanal approach to the mastoid.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholesteatoma↗
PubMed1978

[Reconstruction of the ossicular chain (author's transl)].

197 consecutive tympanoplasties involving reconstruction of the ossicular chain were analyzed. After a one-year followup, the interposition of a homologous ossicle between the mobile stapes and the long process of the malleus with intact anterior half of the drum has given a satisfactory result in 93% of the patients. Unsatisfactory results were obtained in 50% of those patients presenting with only the stapes or its footplate intact. Reasons for the failures were: graft lateralisation, fixation, atrophy or displacement of the homologous ossicle used. The twostage tympanoplasty with utilisation of John Shea's TORP prosthesis has considerably improved the hearing result achieved in the second category of patients. One has to await, however, long-term results in order to assess whether or not the TORP Plastipore prosthesis should be recommended in middle ear surgery.

Ear Ossicles↗
PubMed1984

[Fibro-adhesive otitis: nosology and treatment].

The term fibro-adhesive otitis is considered to correspond to filling of the middle ear with fibro-inflammatory tissue with an intact drum. When the fibrous tissue is very thin, that is to say when the mucosa is replaced by malpighian epithelium, the term epidermization or retraction pocket is preferred, this corresponding to different surgical problems, even though the roles of tubal insufficiency and seromucous otitis are probably the same in the etiology of fibro-adhesive otitis and epidermizations of the middle ear. Fibro-adhesive otitis presents as two different stages: a fibro-inflammatory phase in which the middle ear is filled with fibrous tissue and contains cystic spaces full of mucus; a fibro-adhesive phase when the whole middle ear is full of fibrous tissue and contains cholesterol granulomata but no cystic spaces. A study was conducted on 37 ears (8 at the fibro-inflammatory and 29 at the confirmed fibro-adhesive stage). Small cholesteatomas were associated in 15 ears and a posterior retraction pocket in 4. Results were frankly very poor for one-stage operations (exploration of the tympanic cavity with silastic and mastoidectomy (3 cases), tympanoplasty using a closed technique (1 case), and tympanoplasty using an open technique with obliteration (4 cases). Best results were obtained by a two-stage operation with prolonged inclusion of silastic between the two stages.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Five-year report on partial ossicular replacement prostheses and total ossicular replacement prostheses.

Although much progress has been achieved in the functional restoration of ears damaged by chronic suppurative otitis media since the introduction of tympanoplasty 30 years ago, adequate hearing improvements in ears with loss of the stapedial arch have been the most elusive. It is now recognized that such ears present the surgeon with numerous associated problems that require control for a satisfactory outcome; the problem of establishing an efficient link between the tympanic membrane and oval window has proved the most difficult. The introduction of biocompatible materials was heralded as a possible solution. In order to evaluate the claims for these new materials, the five-year results obtained with one of these, porous polyethylene, were evaluated. The one-year success rate with partial ossicular replacement prostheses was 64%; the five-year success rate was 43%. With total ossicular replacement prostheses the success rate was 59% at one year and 22% at five years. These poor results, coupled with evidence of digestion of porous polyethylene, give little justification for the continued use of this material in tympanoplasty.

Ear Ossicles↗
PubMed1981

Ossicular chain reconstruction with plastipore prostheses.

Proper reconstruction of the ossicular chain is a fundamental prerequisite for good hearing results in staged tympanoplasties. The history of modern middle ear surgery shows that various synthetic materials have been proposed in past years for sound conducting mechanism reconstruction but all gave discouraging results and were soon abandoned. Plastipore is a new plastic material that seems to be well tolerated in the middle ear, and it is commercially available as pre-formed prostheses. We are reporting our experience with 140 cases operated on in our clinic (92 TORPs and 48 PORPs). Two groups of patients are reviewed: the first group consists of the cases in which the prosthesis is in direct contact with the tympanic graft; the second one includes the cases with interposition of cartilage between the head of the prosthesis and the tympanic graft. The purpose is to see whether extrusion rate differences exist in the two groups. Functional results (evaluated after at least six months show an air-bone gap of less than 15 dB in 57 percent of cases and an air-bone gap of less than 25 dB in 82 percent of cases. Five extrusions are reported (3.57 percent). We believe that staged tympanoplasties and tympanic reconstruction with molded heterograft can explain the excellent hearing results and the low extrusion rate of the prosthesis.

Cochlear Implants↗
PubMed1981

Choice of treatment for chronic suppurative otitis media.

Many otolaryngologists appear to be confused regarding the indications for tympanoplasty and the choice of procedure for tympanoplasty, particularly if there is associated mastoid disease. This paper presents one otolaryngologist's approach to the patient with chronic suppurative otitis media and describes the indications for surgery and choice of surgical procedure based on a simple classification of the disease process.

Cholesteatoma↗
PubMed1981

Experiences with the homograft tympanic membrane.

Forty-three patients who underwent tympanoplasty with the use of a homograft tympanic membrane are reviewed. These procedures were performed by 10 different surgeons over a period of six years. The success rate of tympanic membrane closure, hearing results, and incidence of complication were studied. Results were examined to determine possible factors contributing to failure. The success rate and lack of complications suggest that homograft tympanic membrane tympanoplasty is a useful procedure, particularly where the blood supply to the tympanic remnant is felt to be in jeopardy.

Hearing↗