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At least 19 recordsLinked to original sources
PubMed2000

Remifentanil-based anesthesia versus a propofol technique for otologic surgical procedures.

Otologic procedures require a still surgical field and are associated with a 50% incidence of emetic symptoms. Propofol reduces nausea and vomiting but not intraoperative movement. This study compares a remifentanil/propofol anesthetic to a propofol/fentanyl combination to determine which provides the best perioperative conditions for otologic microsurgery. Eighty healthy patients were randomly assigned to receive one of the anesthetic combinations. Demographic data, hemodynamic variables, movement, and bispectral index monitoring values in addition to anesthetic emergence, nausea, vomiting, pain, and other recovery variables were compared between groups with appropriate statistical methods. Both groups were similar. Times to eye opening (7.7 +/- 0.7 vs 12.4 +/- 1.2 minutes) and extubation (9.8 +/- 0.9 vs 12.4 +/- 1.0 minutes) were shorter with remifentanil. This group also had lower hemodynamic variables and movement (23% vs 65%) under anesthesia. Postoperative pain was mild in both groups, but remifentanil patients had more than the propofol group. All other postoperative parameters were similar. Remifentanil-based anesthesia produces better hemodynamic stability, less movement, and faster emergence after otologic surgery, with propofol's antiemetic effect, for the same cost.

Adolescent↗
PubMedDate not supplied

[Otologic surgical procedures in an Ear, Nose and Throat Department in Subotica from 1987 to 2001].

INTRODUCTION: This paper deals with otologic surgical procedures performed in a an Ear, Nose and Throat Department during a 15-year period. The authors compared the number of otologic surgical procedures with the number of laryngomicroscopies and procedures performed in Waldeyer's ring. RESULTS: From January 1, 1987 to December 31, 2001, 1184 patients underwent the following surgical procedures in total endotracheal anesthesia: 285 paracenteses, 473 ventilation tubes insertions, 175 antrotomies or mastoidectomies, 194 tympanoplasties, 34 radical mastoidectomies, 4 facial nerve decompressions, 5 exostoses or osteoma of the external auditory canal operations and 14 stapedectomies. DISCUSSION: Otologic surgical procedures are presented in table 1. In Yugoslav literature Topolac reports approximately 700 tympanoplasties in a 10-year period (1968-1978). Radonjić and associates report 2272 ear operations in the period 1975-1985. Distribution of operations is presented in table 2, whereas in table 3 we can see that the number of operated ears is much greater than the number of operated patients. CONCLUSION: We think that the number of operations is not bigger, because we operate only in critical cases. Our human and technical resources should provide advanced ear microsurgery, but only with financial and organizational support.

Hospital Departments↗
PubMed1999

Comparison of 3 different anesthetic techniques on 24-hour recovery after otologic surgical procedures.

Intravenous propofol anesthesia is better than inhalational anesthesia for otologic surgery, but cost and intraoperative movement make this technique prohibitive. This study compares a propofol sandwich anesthetic with a total propofol or inhalational anesthetic for otologic surgery to determine which produces the best perioperative conditions and least expense. One hundred twenty patients undergoing ear surgery were randomly chosen to receive an anesthetic with either isoflurane (INHAL), total propofol (TPROP), or propofol used in conjunction with isoflurane (PSAND). Postoperative wakeup and the incidence and severity of nausea, vomiting, and pain were compared among groups. Antiemetic administration and discharge times from recovery and the hospital were also compared. The groups were similar, but anesthesia times were longer in the INHAL group. Emergence from anesthesia after PSAND or TPROP was more rapid than after INHAL. Recovery during the next 24 hours was associated with less nausea and vomiting with PSAND than with INHAL. The cost of the PSAND anesthetic was similar to that of INHAL, and both were less than TPROP. PSAND anesthesia may be similar to TPROP and better than INHAL for otologic procedures. PSAND was less expensive than TPROP and produced a similar recovery profile and antiemetic effect in the 24-hour period after surgery.

Adult↗
PubMed1999

Efficacy of a eutectic mixture of local anesthetics as a topical anesthetic in minor otologic procedures.

A eutectic mixture of local anesthetics (EMLA), prepared as a cream, is an oil-in-water emulsion of 2 anesthetic agents lidocaine and prilocaine. Several clinical applications of EMLA cream, its effectiveness as a topical anesthetic, and its safety profile have been previously reported. We report our experience with EMLA cream in 17 adult and 24 pediatric patients. We find EMLA to be the preferred anesthetic for performing minor outpatient otologic procedures in adults. We also find EMLA to be a safe, well-tolerated alternative to general anesthesia in some pediatric patients. Potential cost savings of EMLA cream during pediatric myringotomies in the clinic are also discussed.

Adolescent↗
PubMed2005

[Minimally invasive otoplasty].

OBJECTIVE: We have further developed a method, first published in 1967 by Kaye but not widely used later, to correct protruding ears. To our knowledge, clinical experience with a closed otoplasty technique based on a large number of patients has not yet been published. SUBJECTS AND METHODS: Of 442 ears in 4.5 years, 385 (200 patients, 15 one sided) were corrected using the minimally invasive technique. The key part of this technique to such otoplasty is the creation of a naturally appearing antihelix by combining permanent buried sutures and a conservative cartilage-breaking technique, both applied without extensive skin incisions and excisions. RESULTS: A total of 154 of the patients (i.e., with six one sided corrections, 302 ears) could be examined at least 3 months after surgery. Complications were revisions for either a partial recurrence or a still insufficient correction in the opinion of the patient (30/302, 9.9%), reactions to the suture material (26/302, 9.3%), early infections (2/385, 0.7%), prolonged sensitivity (2/302, 0.7%) and one hypertrophic scar in the lobule (1/302, 0.3%). There was no bleeding, hematoma, hypesthesia, sensitivity to temperature or skin reactions in the auricle. CONCLUSIONS: Minimally invasive otoplasty is a surgical technique that allows the correction of most protruding ears. Very strong cartilage or a very high lateral conchal wall set the limits to such an approach. We found the cosmetic results and complication rates to match those of open methods. Since patient comfort seems to be higher, the method is better accepted.

Adolescent↗
PubMed2006

Clonidine for the prevention of emergence agitation in young children: efficacy and recovery profile.

BACKGROUND: Emergence agitation (EA) is a common postoperative problem in young children who have received sevoflurane and isoflurane for general anesthesia. This randomized, double-blinded study evaluated the efficacy of intraoperative clonidine in reducing EA, and describes its recovery profile. METHODS: With Institutional Review Board approval and informed consent, children undergoing brief, minimally painful procedures were studied. All children received preemptive analgesia with acetaminophen and ketorolac, sevoflurane for induction, and isoflurane for maintenance of anesthesia. Children received either 2 microg.kg(-1) clonidine or placebo intravenously (i.v.) following induction of anesthesia. Children were observed postoperatively for behavior and side effects, and their parents were telephoned the next day to determine postdischarge recovery characteristics. RESULTS: One hundred and twenty children were included in this study: 59 of whom received clonidine, and 61 placebo; 41% of those in the placebo group exhibited moderate-severe EA compared with only 22% of those in the clonidine group (P < 0.03). Compared with those who received placebo, children who received clonidine awakened more slowly (22 min vs 14 min), had a longer postanesthesia care unit stay (57 min vs 46 min), and experienced sleepiness more frequently after discharge (75% vs 39%; all comparisons significant at P < 0.03). There were no adverse cardiorespiratory events in either group. CONCLUSIONS: Findings demonstrate that i.v. clonidine administered after induction of anesthesia significantly reduces the incidence of EA in young children, but is associated with sleepiness postoperatively.

Adrenergic alpha-Agonists↗
PubMed1986

Comparative study of otologic surgery in outpatient and hospital settings.

The results of nine years' experience with 1,750 otologic surgical procedures are reviewed; 1,110 of these procedures were performed in an outpatient surgical setting and 640 procedures were performed in a general hospital. The results and complications are compared between these two settings. This study includes tympanoplasty, stapedectomy, mastoidectomy, labyrinthectomy, and other otologic procedures. The study is not concerned with minor procedures such as myringotomy. A detailed analysis of results for each type of procedure compares hearing results, graft take rates, and the occurrence of complications in both outpatient and inpatient settings. No significant differences are seen between the results or complications of outpatient and inpatient procedures, thus supporting the use of outpatient surgical settings for most standard otologic procedures.

Ambulatory Surgical Procedures↗
PubMed1980

Otogenic tetanus in Zaire.

Sixty-seven patients with tetanus of otogenic origin were hospitalized at the Mama Yemo hospital, Kinshasa, Zaire over the two-year period from 1975 through 1976. The care of these patients was the same as that for all 620 tetanus cases admitted during this period. No otologic surgical procedures were performed on this group; nor were any special ear procedures utilized. The survival rate in the otogenic tetanus group was 83%. The survival rate in the 620 tetanus admissions was 79%. All 67 patients had evidence of chronic otitis media. None of these patients had evidence of otologic complications before, during or for one month after developing tetanus, other than uncomplicated otorrhea. Tetanus antitoxin of 10,000 or 50,000 IU did not appear to affect survival rates. Mortality rates were not increased in the 18% of patients who did not receive tetanus antitoxin. Sedation sufficient to eliminate muscle spasms and maintain the patient sleeping seems to be important in increasing survival rates in tetanus. The need for tracheotomies appeared to be reduced with the increased sedation. Mortality rates increased among the patients who had tracheotomies. Otologic surgical procedures do not appear to be indicated in the management of patients with otogenic tetanus.

Adolescent↗
PubMed1989

Otologic surgery in the outpatient versus the hospital setting.

The results of 11 years experience with 1,577 otologic surgical procedures performed in The Ear & Nose-Throat Clinic, P.A. in Little Rock, Arkansas, a freestanding outpatient surgical setting, are analyzed and compared to 703 hospitalized inpatient cases performed during the same time period. This study includes tympanoplasty, stapedectomy, mastoidectomy, labyrinthectomy and other otologic procedures. Analysis of results in these cases compares hearing results, graft take rates and the occurrence of complications in both the outpatient and inpatient settings. No significant differences are seen between the results or complications in these settings, thus supporting the use of outpatient surgical settings for most standard otologic procedures.

Ambulatory Surgical Procedures↗
PubMed2005

Width of the extended facial recess: a numerical study of ultrahigh-resolution computed tomography and its implications in minimally invasive otologic surgery.

BACKGROUND: Methods of minimally invasive computer-assisted otologic surgery lag behind other fields. The reason seems to be the extremely small dimensions of the corridors between important structures in the temporal bone and the fact that these structures are encased in bony frameworks, are obscured before drilling, and are not movable. The extended facial recess is a surgical pass to the tympanic cavity. It is bounded medially by the facial nerve and laterally by the tympanic annulus, and varies among individuals. For computer-assisted, minimally invasive temporal bone surgery, high-resolution definition is critically important. AIMS: To determine the width of the extended facial recess and evaluate the computerized findings as a pre- and intraoperative aid to otologic surgery planning. METHODS: Bilateral temporal bone high-resolution computed tomographic images of 100 male and 100 female patients were measured twice at five levels (caudal to cephalic), first using a window-independent algorithm (extended facial recess, full-width at half-maximum), implemented in a computed tomographic image-processing workstation, and then manually with calipers on the same axial computed tomographic images. RESULTS: As expected, the extended facial recess, full-width at half-maximum method yielded the widest values superiorly (4.15 +/- 0.41 mm in the female patients and 4.32 +/- 0.54 mm in the male patients). From this level down, the extended facial recess, full-width at half-maximum method yielded values that tapered gradually to 2.50 +/- 0.56 mm in the female patients and 2.42 +/- 0.46 mm in the male patients at the most interior level. The manual method (extended facial recess, computed tomographic images) yielded a significantly higher value than that obtained with the objective, window-independent method at all levels, and at some levels was higher by as much as one-third. At Level 2, which corresponded roughly to the round window, the extended facial recess was 4.00 +/- 0.65 in the female study group and 4.11 +/- 0.67 mm in the male study group. CONCLUSION: Image processing methods such as extended facial recess, full-width at half-maximum method might lead to fine tuning and thus improvement of computer-assisted otologic surgery. Before clinical application and complete dependence on these automated methods during otologic surgery, their reliability should be further validated.

Adolescent↗
PubMed2005

Minimally invasive, image-guided, facial-recess approach to the middle ear: demonstration of the concept of percutaneous cochlear access in vitro.

HYPOTHESIS: Image-guided surgery will permit accurate access to the middle ear via the facial recess using a single drill hole from the lateral aspect of the mastoid cortex. BACKGROUND: The widespread use of image-guided methods in otologic surgery has been limited by the need for a system that achieves the necessary level of accuracy with an easy-to-use, noninvasive fiducial marker system. We have developed and recently reported such a system (accuracy within the temporal bone = 0.76 +/- 0.23 mm; n = 234 measurements). With this system, image-guided otologic surgery is feasible. METHODS: Skulls (n = 2) were fitted with a dental bite-block affixed fiducial frame and scanned by computed tomography using standard temporal-bone algorithms. The frame was removed and replaced with an infrared emitter used to track the skull during dissection. Tracking was accomplished using an infrared tracker and commercially available software. Using this system in conjunction with a tracked otologic drill, the middle ear was approached via the facial recess using a single drill hole from the lateral aspect of the mastoid cortex. The path of the drill was verified by subsequently performing a traditional temporal bone dissection, preserving the tunnel of bone through which the drill pass had been made. RESULTS: An accurate approach to the middle ear via the facial recess was achieved without violating the canal of the facial nerve, the horizontal semicircular canal, or the external auditory canal. CONCLUSIONS: Image-guided otologic surgery provides access to the cochlea via the facial recess in a minimally invasive, percutaneous fashion. While the present study was confined to in vitro demonstration, these exciting results warrant in vivo testing, which may lead to clinically applicable access.

Cochlea↗
PubMed1982

Sudden sensorineural hearing loss: operative complication in non-otologic surgery.

Sudden sensorineural hearing loss is a well recognized phenomenon in otologic practice with both viral and vascular etiologies being supported. However, sudden hearing loss as a complication of non-otologic surgical procedure is a seldom reported and rare phenomenon. Five cases of unilateral sudden sensorineural hearing loss which are time related and probably causally related to non-otologic surgery are presented. Two cases underwent open heart surgery and support previous reports of hearing loss secondary to cardiopulmonary bypass procedures. Three noncardiac cases are also reviewed. None of these patients had prior otologic disease which would predispose to a sudden hearing loss, and no intraoperative or postoperative complication was specifically noted as a cause of the hearing loss. The literature is reviewed and attention is drawn to the problem. We wish to encourage further reports and to recommend early identification and treatment in those cases related to cardiopulmonary bypass.

Adult↗
PubMedDate not supplied

[General intubation anesthesia in primates for experimental otoneurologic surgery].

INTRODUCTION: We report our experience in anaesthetic and surgical management of primates (M. fascicularis) in an experimental otoneurosurgical procedure. MATERIAL & METHODS: The VIII cranial nerve was bilaterally sectioned in a translabyrinthine approach in 21 adult primates. In 14 animals subsequently, a prototype of auditory brainstem implant was placed unilateraly within the brain stem for surface stimulation of cochlear nuclei. Premedication consisted in an intramuscular mixture of ketamine, midazolam and atropine. Surgical procedure was performed under intubated general anaesthesia, after propofol (1.5 mg/kg) administration and maintained with nitrous oxide and halotane. RESULTS: The mixture of ketamine, midazolam and atropine produced a deep anaesthesia in 4 +/- 1.7 minutes, permitting safe animal handling. Atraumatic nasotracheal intubation without muscle relaxing agents was easily achieved in all animals. Anaesthesia was adequately maintained with nitrous oxide and halotane. Animals did not present any relevant incidents during surgery, and were extubated 10 +/- 2.5 minutes after cessation of gas administration. Post-operatively, no relevant surgical complications occurred. CONCLUSIONS: We report an anaesthetic technique that provides an optimal restrain and anaesthesia for experimental otoneurosurgical procedures with primates. This technique offers a quick recovery and avoids the use of muscular relaxing agents for intubation, and thus could be safely used in other kind of surgical procedures.

Anesthesia, General↗
PubMed1990

Facial nerve monitoring in otologic surgery: clinical indications and intraoperative technique.

While identification of the intratemporal portion of the facial nerve is mandatory in most otologic surgical procedures, inadvertent instrumentation, traction, or thermal injury may still result from inaccurate delineation, purposeful avoidance, or false protection of this critical structure. Improved functional preservation of the facial nerve has been achieved in acoustic neuroma surgery through the monitoring of evoked facial electromyographic activity. This technique may also be used during otologic procedures in which facial nerve manipulation is anticipated in the management of recurrent cholesteatoma, temporal bone trauma, congenital deformity, or purposeful access for cochlear implantation. Potential indications for using facial nerve monitoring in contemporary otologic surgery are detailed through illustrative case presentations, and necessary instrumentation and techniques are briefly reviewed. Intraoperative monitoring can assist the surgeon in isolating the facial nerve when chronic inflammation, traumatic injury, or anomalous development has resulted in distortion or absence of microanatomic landmarks.

Adult↗
PubMed2005

Combined retrosigmoid retrolabyrinthine vestibular nerve section: results of our experience over 10 years.

OBJECTIVE: We aimed to evaluate the results of our experience in vestibular nerve sectioning (VN), which was performed using combined retrosigmoid-retrolabyrinthine approach. STUDY DESIGN: Medical records of 280 patients who were consecutively operated on for incapacitating peripheral vertigo were retrospectively evaluated, and 210 patients who completed 2 years follow-up and had adequate follow-up data were found to be suitable for inclusion in the study. METHODS: Hearing results, vertigo control rates, and complications of the retrosigmoid-retrolabyrinthine VN were evaluated. RESULTS: The patients were suffering from vertigo for a mean period of 32.2 months. Bilateral Meniere's disease occurred in 5.7% of the patients in the follow-up period. A complete or substantial vertigo control could be achieved in 94.4% of the patients (191 [90.1%] in Class A and 9 [4.3%] in Class B). Preoperative speech reception threshold, pure-tone average, and speech discrimination score of the patients were 56.5 dB, 47.4 dB, and 73.6%, respectively. Postoperative corresponding values were 62.2 dB, 43.4 dB, and 68.5%, respectively (p > 0.05). The complication rate was low (2.5%). Most common complication was abdominal hematoma, which was seen in 4.5%. CONCLUSION: VN performed using retrosigmoid-retrolabyrinthine approach has low complication and high vertigo control and hearing preservation rates. It can be applied as an initial surgery or reserved as the last step when the other surgical treatments have failed to control vertigo.

Adolescent↗
PubMed1977

Tympanic membrane keratoma (cholesteatoma) in children with no prior otologic surgery.

Three children whose eardrums appeared normal upon previous examinations, one with the otomicroscope, apparently developed tympanic membrane cholesteatomas that penetrated the fibrous layer of the pars tensa. Their histories all included episodes of acute otitis media, but no otorrhea. No otologic surgical procedures, including myringotomy, had been performed. These cases are thought to provide clinical support for the basal epithelial migration theory of cholesteatoma genesis. Rüedi's experiments suggest that cholesteatomas resulting from basal epithelial migration may not be visible for 18 to 30 days; thus, follow-up evaluations after acute otitis media should probably include examinations one and two months after the infection. Pediatricians and family physicians should be urged to seek otologic consultation for patients with even minor eardrum abnormalities, particularly those following infection.

Child, Preschool↗