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PubMed1998

[On surgical strategies in the treatment of patients with chronic purulent otitis media with different nature of pathology of the middle ear].

Long-term outcomes of surgery have been analysed for 684 patients with OMCP in terms of possible implications of the severity and kind of pathological processes in the middle ear as well as the operative procedure on functional and anatomic results of tympanoplasty. Early surgical interventions in OMCP are preferable because they allow "closed" tympanoplasty. Maximal removal of hypertrophic inflammation-affected parts of the tympanic mucosa promotes functional effectiveness of the operation in view of higher position of the stapes achieved with the help of combined prostheses. The "open" variant of the operation performed because of cholesteatoma is made with maximal removal of the posterior bone wall of the external acoustic meatus in order to revise facial and tympanic sinuses and to enable better conditions for cavity to exercise postoperative self-cleaning.

Chronic Disease↗
PubMed2006

Analysis of mastoid findings at surgery to treat middle ear cholesteatoma.

OBJECTIVES: To analyze mastoid findings, such as facial nerve dehiscence (FND), labyrinthine fistula, and dural exposure; to review its incidence at cholesteatoma surgery; to analyze its association with semicircular canal fistula; and to elucidate its relationship with dural exposure. DESIGN: One hundred fifty-two patients (65 males and 87 females; 155 ears) were enrolled in a retrospective study of tympanoplasty with or without mastoidectomy. SETTING: Medical university center hospital. RESULTS: The incidence of FND after exenteration of disease was 29.7% (46/155 ears) for total surgical procedures, 29.7% (43/145 ears) for initial procedures, and 30% (3/10 ears) for revision procedures. The prevalence of FND in the tympanic segment only was 87%, with 8.7% in the vertical segment only and 4.3% in both segments. Three patients (2.0%) developed facial palsy postoperatively, with 8 lateral semicircular canal fistulas (5.2% of total ears operated on), half of these with concomitant FND. The incidence of dural exposure of the mastoid tegmen in the entire surgical group was 16.8% (26 ears), 38.5% with concomitant FND. CONCLUSIONS: The overall incidence of FND in our sample was high at 29.7%, with rates of lateral semicircular canal fistula and dural exposure of 5.2% and 16.8%, respectively. The relationship between FND incidence and presence of lateral semicircular canal fistula was positive in our study. The surgeon should bear in mind that the location of FND with cholesteatoma coincides with the most common area of iatrogenic facial nerve injury during otologic surgery.

Adolescent↗
PubMed1976

Homograft tympanic membrane myringoplasty.

During a six-year period, homograft tympanic membranes have been used successfully for myringoplasty or tympanoplasty in 85% of 175 cases. This percentage is not as high as might be expected with fascia, and the homografts have not been as dependable in the wet, draining ear. However, the results do show that the homograft is an acceptable grafting material. The eardrums are not suggested as substitutes for fascia, but should be available for difficult cases. Their use is indicated in large or total defects to restore the natural anatomical conical shape of the eardrum, particularly in congenital atresia. The prime indication for their use is a missing malleus, and the malleus handle can be included within the transplant. The eardrum's rigid properties and the possibility of inclusion of ossicles make the homografts valuable in reconstruction of the old mastoid cavity.

Ear Deformities, Acquired↗
PubMed1981

Ear surgery and mastoid air cell system.

Opinion differ whether simple myringoplasty should be combined with mastoidectomy, which is claimed to provide a large air reservoir for the middle ear. Data are reported on 61 ears, 55 of which had reasonably normal tympanic mucosa but distinct chronic mastoid or epitympanic ear disease. Obliteration of the cavity was performed, combined with tympanoplasty, and the patients were followed up for an average of three years. Normal aeration of the middle ear was seen in all cases with normal middle ear mucosa regardless of whether the posterior canal wall was saved or reconstructed in connection with obliteration. It is concluded that there is no reason for mastoidectomies in small mastoid cell systems in simple myringoplasties.

Air↗
PubMed1986

A specific curriculum in facial plastic surgery. Effect on residency training.

There has been a dramatic change in the degree of exposure to facial plastic surgery by the otolaryngology resident in the past decade. The amount of this exposure and the method of presentation of aesthetic concepts and procedures varies. We favor a specific curriculum in facial plastic surgery for the residency training program. The effect of this curriculum is measured by statistical analysis of resident-generated aesthetic surgery cases in one year following the introduction of this curriculum into the teaching program. These data are compared with the same period one year prior to the initiation of the program. Tympanoplasty, mastoidectomy, and tonsillectomy case numbers served as controls for statistical comparison over the same time period. These data serve as a guide to residency programs in determining the most effective means of providing optimum facial plastic surgery exposure to their trainees.

Curriculum↗
PubMed1978

Function of the Eustachian tube related to surgical management of acquired aural cholesteatoma in children.

A group of 12 children with acquired cholesteatoma had the ventilatory function of the Eustachian tube assessed by the inflation-deflation technique. All had varying degrees of functional rather than mechanical obstruction of the Eustachian tube. In these children, the pathogenesis of acquired cholesteatoma appeared to be the result of the following sequence of events: functional Eustachian tube obstruction, high negative middle ear pressure, atelectasis of the tympanic membrane-middle ear, a retraction pocket in either the posterosuperior or attic portion of the tympanic membrane, and adhesive otitis media. Tympanoplasty in these children was not successful. It is suggested that when the middle ear-mastoidectomy cavity is allowed to remain open, then the bony portion of the Eustachian tube should be surgically closed to prevent postoperative reflux of nasopharyngeal secretions.

Adolescent↗
PubMed1994

Surgical management of congenital aural atresia.

Congenital aural atresia is a relatively common anomaly in otology. It requires an early assessment of hearing status and an early evaluation of the degree of atresia. Its surgical management is aimed at obtaining hearing gain and at establishing appropriate auditory canal status for the application of hearing aids. The authors analyzed the preoperative otologic findings, surgical findings, postoperative complications, and postoperative hearing results of 25 ears in 21 patients with congenital aural atresia. From January 1987 to February 1992, 24 of these ears were surgically corrected by anterior approach; the remaining 1 was corrected by transmastoid approach. Postoperative audiologic follow-up ranged from 8 months to 4 years (N = 21). A new modification of anterior approach is introduced. The final average air-bone gap was 30 dB, in contrast to preoperative 53 dB (N = 21). The final air-bone gap was improved to a level within 30 dB in 52% of the patients. Meatal stenosis was the most frequent postoperative complication and was seen in 12 patients in primary operation (N = 25). There was no postoperative facial nerve palsy and no sensorineural hearing loss. There was little difference in postoperative hearing among the various types of congenital aural atresia and the type of tympanoplasty that had been performed.

Abnormalities, Multiple↗
PubMed1990

Progressive fatal dementia (Creutzfeldt-Jakob disease) in a patient who received homograft tissue for tympanic membrane closure.

We report the case history of a 54-year-old man who developed a fatal neurological disorder 4 years after a successful tympanoplasty with homograft pericardium. The final diagnosis of this case was Creutzfeldt-Jakob disease. This infectious spongiform encephalopathy is probably caused by a slow virus that can be transmitted by transplantation materials. The possible accidental transmission of Creutzfeldt-Jacob disease by the use of homograft materials in otologic surgery is discussed.

Cerebral Cortex↗
PubMed1981

Late hearing results after paraffinplasty or silastic sheeting.

The long-term hearing results are presented for 135 ears operated on radically. In 59 of the ears temporary paraffin filling of the tympanic cavity was employed after the removal of the tympanic mucosa ot operation. The filling material was removed, and the ossiculoplasty was performed about 6 months later. In 76 ears a one-stage operation with tympanoplasty and Silastic sheeting was employed. There were no statistical differences between the groups of ears mentioned according to hearing results early (1 year) or late (5-15 years) postoperatively or in the deterioration of the air-bone gaps after the first postoperative year (P greater than 0.05). The late change in the air-bone gap was significant in both groups (paraffin group: 6.1 dB; Silastic sheeting group: 5.7 dB; P less than 0.05). The total improvement of hearing late after surgery (as compared to the preoperative hearing) was significantly better in the paraffin group than in ears with Silastic sheeting (P less than 0.05). Paraffinplasty seems to be a suitable way to avoid tympanic adhesions.

Adolescent↗
PubMed1991

Anaesthesia for Treacher Collins syndrome using a laryngeal mask airway.

Patients with Treacher Collins syndrome pose a serious problem to anaesthetists in maintaining their airway because of retrognathia. Two patients with Treacher Collins syndrome undergoing tympanoplasty are reported in whom a laryngeal mask was used in place of an endotracheal tube for airway maintenance.

Anesthesia, Inhalation↗
PubMed2003

[Anaphylactic cardiocirculatory failure after intraoperative application of dipyrone].

CASE REPORT: In our case, a 48-year-old healthy woman undergoing elective tympanoplasty under general anesthesia received an infusion of 2 g dipyrone in 100 ml 0.9% sodium chloride solution for pain prophylaxis. After receiving 1 g dipyrone within 5 min, the patient exhibited a cardiocirculatory failure and cyanosis and had to be resuscitated. After 20 min of cardiopulmonary resuscitation and administration of 3mg epinephrine and 2 mg norepinephrine, a stable circulation was reestablished. After exclusion of a fulminant pulmonary embolism and a primary cardiac event by computer tomography, electrocardiogram and enzyme diagnostics, the patient was transferred to an intensive care unit where she was mechanically ventilated for a period of 6 h. After 2 days of intensive monitoring, she was transferred to a peripheral ward,where she exhibited a normal neurological status and stable cardiocirculatory condition. A postoperatively performed allergy testing revealed a type I sensitization to dipyrone, which was responsible for the intraoperative cardiocirculatory failure due to a massive anaphylactic reaction. However, in this case, the typical symptoms of allergic reactions such as erythema, edema or bronchospasm were missing, which did not allow for an immediate diagnosis. CONCLUSION. Regarding the frequent perioperative use of dipyrone and the severity of anaphylaxis observed in this case, it should be considered that this analgesic should be applied intravenously only if adequate safety measures such as emergency therapy option and patient monitoring are guaranteed as recommended by the German drug regulation authority since 1982.

Anaphylaxis↗
PubMed2004

[New surgical techniques for the treatment of auricular atresia].

The rehabilitation of patients having severe malformation of the auricle with congenital auricular atresia requires plastic surgery and audiologic treatment. After classifying these malformations, various options involving hearing aids and surgery are presented. The main focus is on our new technique of combined auricular reconstruction with construction of the external ear canal and tympanoplasty, the so-called atresia-operation. It is characterised by three steps combining plastic and otologic surgery with prefabrication of the tympanic membrane and the external ear canal. Finally, our current rehabilitation concept for these patients is presented.

Abnormalities, Multiple↗
PubMed2005

[Reconstruction of the tympanic membrane applying cartilage: indications, techniques and results].

Autogenous cartilage-perichondrium-composite-grafts have become essential and well established transplant materials in reconstructive middle ear surgery. They have proven to be particularly appropriate for surgical situations which benefit from the bradytrophy and stiffness of the cartilage (adhesive otitis, retraction pockets, subtotal tympanic membrane defects, revision tympanoplasty). Of the numerous techniques available, the perichondrium-island technique and the palisade-cartilage technique are described in detail in this review, also regarding modifications and comments in the literature. Both methods show good functional and morphological results and should be chosen according to individual surgical requirements. The data of experimental investigations are involved in the decision which technique should be favored.

Cartilage↗
PubMed2006

Otomycosis: subdermal growth in calcified mass.

Reports on clear identification of fungi in subdermal tissue in chronic fungal external otitis are rare in recent years. Our patient was an immunocompetent adult male with an 8 year history of chronic otitis externa who presented with pustules on the external auditory canal (EAC) and necrosis and perforation of the tympanic membrane. Type I tympanoplasty was performed, but wound healing was delayed and swelling of the EAC occurred. Incision biopsy and staining (Gomori-Grocott and PAS) revealed fungal hyphae within small, calcified, subepidermal masses. A 3 month course of oral itraconazole was effective in healing the lesion. Calcification, a rarely reported finding in otomycosis, may represent a protective reaction against topical use of antifungal drugs.

Biopsy↗
PubMed1985

Total reconstruction of the ear with auditory function: a two stage procedure.

The rational treatment of severe microtia or anotia should be to restore not only the form but also the auditory function of the ear. To achieve this aim it is obvious that plastic surgeons must co-operate closely with an otologist: yet this degree of co-operation is seldom seen. This paper describes a two-stage procedure for total ear reconstruction with auditory function. In stage I, a tympanoplasty is performed before transplantation of the carved cartilage framework. Stage II consists of elevation of the reconstructed auricle and transplantation of a full-thickness skin graft to the post-auricular defect. Certain modifications of the operative techniques that we have found useful are discussed in detail.

Ear Canal↗
PubMed1991

Problems in diagnosis and treatment of cholesteatoma in children.

Our clinical study includes 56 cases of cholesteatoma in children aged 3-14 years, treated in a 6-year period. Cholesteatoma was localized in attic (6 cases), in middle ear (6 cases), in attic plus middle ear (16 cases) and in attic + middle ear + mastoid (28 cases or 50% of the total number). In the surgical treatment combined approach tympanoplasty (intact canal wall technique) was used in 76.8%, radical tympanomastoidectomy in 16.1%, and other techniques in 7.1%. Intact ossicular chain was found in 25%. Reconstruction of the ossicular chain (including autograft, homograft and allograft material) was done in 59%, and the remaining 16% were treated by classic radical surgery. Hearing results: unchanged, 48%; improved, 45%; slightly worsened, 7%; and no dead ear. Recurrency in 31% is considerably higher as compared to 15% in adults found in another comparable study by us.

Adolescent↗