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Otology & Neurotology : Official... Jul 2023Although rare in etiology, anterior bony wall defects of the external auditory canal (EAC) accompanied by temporomandibular joint herniation may cause various otologic... (Review)
Review
OBJECTIVES
Although rare in etiology, anterior bony wall defects of the external auditory canal (EAC) accompanied by temporomandibular joint herniation may cause various otologic symptoms. Surgical treatment can be considered based on symptom severity because many previous case reports have highlighted its efficacy. This study aimed to review the long-term results of surgical treatment of EAC anterior wall defect and to suggest a stepwise approach when creating a treatment plan.
METHODS
We performed a retrospective review of 10 patients who underwent surgical management to address the EAC anterior wall defect and its associated symptoms. Medical records, temporal bone computed tomography scans, audiometry, and endoscopic examination findings were analyzed.
RESULTS
The primary repair of the EAC defect was the first to be surgically addressed in most cases, excluding one case with a severe combined infection. Of the 10 cases, 3 patients exhibited either postoperative complications or symptom recurrence. Six patients had resolved symptoms consequent to primary surgical repair, and four patients underwent revision surgery undergoing a more invasive procedure, such as canalplasty or mastoidectomy.
CONCLUSION
Primary repair of the anterior wall defect of the EAC seems to be overpromoted for lasting results but is not as promising as previously noted. We therefore propose to create a novel treatment flowchart regarding the surgical treatment of anterior wall defects of the EAC based on clinical experience.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Ear Canal; Hernia; Temporomandibular Joint; Temporomandibular Joint Disorders; Retrospective Studies
PubMed: 37231533
DOI: 10.1097/MAO.0000000000003900 -
Indian Journal of Otolaryngology and... Apr 2023Our study aimed to find the incidence of fallopian canal dehiscence during surgery for cholesteatoma, to compare this incidence with a homogenous control group...
AIMS
Our study aimed to find the incidence of fallopian canal dehiscence during surgery for cholesteatoma, to compare this incidence with a homogenous control group (otosclerosis) and to find the incidence of a labyrinthine fistula if fallopian canal dehiscence is present.
MATERIAL AND METHODS
Prospective case control study design was used in the setting of a tertiary care referral center. Subjects included 60 patients. 30 patients diagnosed with cholesteatoma were taken as cases and 30 patients with conductive or mixed hearing loss suspected of otosclerosis were taken as controls. The method was identification of bony dehiscence under operating microscope. In case of finding of dehiscence of fallopian canal, presence of labyrinthine fistula was searched. The cases underwent modified radical mastoidectomy and controls underwent exploratory tympanotomy after giving a written informed consent. Institutional ethics committee clearance was obtained.
RESULTS
Fallopian canal dehiscence was recorded in all subjects. 50% of cases and 3.3% of controls showed presence of fallopian canal dehiscence. This correlation was statistically significant (p < 0.001). Also 26.7% cases with fallopian canal dehiscence had a semicircular canal fistula (4 out of 15),but this finding was not significant (p = 0.100).
CONCLUSION
From our study it was evident that there were very high chances of finding a fallopian canal dehiscence in cases of cholesteatoma than in cases undergoing exploratory tympanotomy. Also, presence of labyrinthine fistula with fallopian canal dehiscence was likely but not significant.
PubMed: 37206839
DOI: 10.1007/s12070-022-03217-8 -
Indian Journal of Otolaryngology and... Apr 2023Purpose: To compare the two common approaches of cochlear implantations i.e., mastoidectomy with posterior tympanotomy approach (MPTA) and modified veria technique and...
UNLABELLED
Purpose: To compare the two common approaches of cochlear implantations i.e., mastoidectomy with posterior tympanotomy approach (MPTA) and modified veria technique and to know whether veria technique and its later modifications are as efficacious as the classic approach in terms of duration of procedure, gain in hearing and acquisition and incidence of complications if any. Methods: A prospective comparative study was undertaken at a tertiary care teaching institute. 30 children were selected and randomised into 2 groups who then underwent surgery from the same surgeon after proper evaluation but with 2 different approaches. Their outcomes were then observed and compared in terms of surgical technique and complications and hearing outcomes. Results: 30 children were operated with 15 in each group. In the study, patients under Group A (MPTA) had mean surgical duration of 139.67 ± 16.53 min while Group B (modified Veria) had of 84.67 ± 11.72 min, which was statistically significant (p < 0.05). 1 patient in Group A suffered House Brackman grade 4 facial nerve injury that recovered over 3 months and another had discolouration of the skin flap. No complications were observed in group B. During follow-up CAP and SIR scores were compared and were found to be statistically non-significant between the 2 groups (p value > 0.05), but the paired differences within each group showed statistical significance (P value- <0.001). Conclusion: Veria Technique (and its later modifications) for cochlear implantation is a simple, safe and easy procedure, which is as efficacious as MPTA with added benefits of consuming lesser surgical duration.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12070-022-03399-1.
PubMed: 37206821
DOI: 10.1007/s12070-022-03399-1 -
Indian Journal of Otolaryngology and... Apr 2023The functional aspect of preservation of every healthy anatomical structure, particularly the ossicles, non-diseased mastoid cortex and middle ear mucosa, and to achieve...
The functional aspect of preservation of every healthy anatomical structure, particularly the ossicles, non-diseased mastoid cortex and middle ear mucosa, and to achieve this by transacanal endoscopic dual hand approach to middle ear, aditus and mastoid antrum with minimal posterior atticotomy and proximal aditotomy. The prospective study has been conducted over a period of 12 years from 2009 to 2021 in the Jorhat Medical College, Assam Medical College and Niramoy Hospital, Jorhat, Assam. Follow up was for a minimum of 4 years. The current study was a prospective hospital based study, carried out from May 1st, 2009 to April 30th, 2021 involving 157 subjects from 18 to 65 years with mean age of 38 + 2.5. Graft uptake rate of 93.6%. Minimal atticotomy with proximal aditotomy offers a clear view of the antrum with angled scopes of 30 degree and 45 degree and if any disease is located it can be removed through the transcanal approach with angled instruments and aditus patency can be confirmed by visual inspection. Hence, decreasing the need of unnecessary bone drilling as done with cortical mastoidectomy to create a parallel view.The endoscopic ear surgeries done with "dual hand endo-holder" were uneventful and much more comfortable as compared to the single hand technique. Functional approach by minimizing bone drilling, reestablishment of ventilation pathways and preservation of ossicles with disease clearance give better postoperative results in long term follow-up.
PubMed: 37206818
DOI: 10.1007/s12070-022-03450-1 -
Indian Journal of Otolaryngology and... Apr 2023Sigmoid sinus and transverse sinus thrombosis may occur as intracranial complications of chronic otitis media. Central venous sinus thrombosis typically presents with...
Sigmoid sinus and transverse sinus thrombosis may occur as intracranial complications of chronic otitis media. Central venous sinus thrombosis typically presents with picket fence fever along with otalgia, otorrhea, and altered mental status. CT and MRI are investigations of choice for diagnosis. Once diagnosed, one should be started on empiric antibiotics. The use of anticoagulants has been debatable. From a surgical point of view, the current trend is to perform a mastoidectomy with the removal of inflammatory tissue from the sinus walls.
PubMed: 37206785
DOI: 10.1007/s12070-023-03486-x -
Indian Journal of Otolaryngology and... Apr 2023A cadaveric study to know the anatomical and radiological correlation between the mastoid air cell system in relation to its volume and morphology. This is a rare and...
A cadaveric study to know the anatomical and radiological correlation between the mastoid air cell system in relation to its volume and morphology. This is a rare and one of its kind of cadaveric study on temporal bone in which comparison of pre dissection and post cortical mastoidectomy dissection on x-ray mastoid in relation to their dimensions. To study the anatomical and radiological correlation of mastoid air cell system in relation to its morphology using pre and post dissection x-ray measurements and dissection method. 30 adult cadaveric, temporal bone cortical mastoidectomy dissections were performed and X-ray mastoid with a pre and post mastoid dissection measurements using vernier caliper was done. Further 3-D analysis of volume of mastoid cavity compared with a post dissection digital radiographic measurements was carried out. On statistical analysis, mean surface area of MACS, shortest length between sigmoidsinus and posterior wall of EAC, also shortest distance between dural plate and mastoid tip, in pre and post dissection x-ray mastoid and in direct mastoid cavity measurements were not found to be significant. Mastoidectomy being the treatment of choice in day to day practise in many cases this study hopes to add up to the present understanding for the MACS dynamics and assesses the possible anatomical variations that can exist. This study helps us to find the approximate time required for surgery to perform cortical mastoidectomy.
PubMed: 37206784
DOI: 10.1007/s12070-022-03341-5 -
Indian Journal of Otolaryngology and... Apr 2023Otomycosis is a fungus-causing superficial infection of the external auditory canal that is common in otolaryngology practice. Though it is a worldwide infection, but is...
INTRODUCTION
Otomycosis is a fungus-causing superficial infection of the external auditory canal that is common in otolaryngology practice. Though it is a worldwide infection, but is more prevalent in warm and humid regions. There has been rise in the occurrence of otomycosis in the last few years because of the extensive usage of antibiotic eardrops. Other influencing reasons for the occurrence of otomycosis is swimming, an immunocompromised host (e.g.: DM, AIDs) pregnancy, post-canal wall down mastoidectomy, tympanic membrane perforation, hearing aids and self-inflicted injuries.
METHODS
Approval from the institutional ethics committee and penned informed agreement from all patients involved in the examination were obtained. 40 patients were included in the study, starting from 1stAugust to 30th September 2021, which emphasized on otomycosis infection with central tympanic membrane perforation. Physical findings such as whitish ear discharge and the presence of hyphae in the EAC, the ear drum, the middle ear mucosa were used to diagnose otomycosis.
RESULT
20 patients of patched group and 20 patients of non-patched group did not visit for follow up. Data here is for patients who followed-up for 3 weeks. Any significant observation regarding statistical variation in the age, size of perforation, mycological analysis and pure tone audiometry among the two groups were not seen.
CONCLUSION
To conclude, we state that treatment with clotrimazole solution in patched group is safe in managing otomycosis with tympanic membrane perforation. Otomycosis is a fungus causing surface infection of the external auditory canal that otolaryngologists routinely diagnose by medical examination. In acute otomycosis, overgrowth of the fungus in the external auditory canal is due to increased humidity.
PubMed: 37206775
DOI: 10.1007/s12070-022-03132-y -
Indian Journal of Otolaryngology and... Apr 2023The indications for revision middle ear surgery are inter-linked to the objectives of surgery and needs of the patient. Revision middle ear surgery is often...
The indications for revision middle ear surgery are inter-linked to the objectives of surgery and needs of the patient. Revision middle ear surgery is often challengingly arduous not only for the patient but for the surgeon as well. This study concentrates on the causes of failures of primary ear surgery, indications, techniques, outcomes and lessons learned in revision ear surgery. This retrospectivedescriptive study included 22 cases (12.29%) of revision surgery,with a follow up of at least one year, out of total 179 cases of middle ear surgeries performed over a period of 5 years.These revision cases included tympanoplasty, cortical mastoidectomy and modified radical mastoidectomy alongwith ossiculoplasty and scutumplasty, wherever required. Hearing improvement, closure of perforation, and prevention of recrudescence were the main outcome parameters. The overall morphologic success of revision surgery in our series was 90.90%.There was one graft failure, one attic retraction and the main complication observed was post-operative worsening of hearing.Mean postoperative pure-tone average air -bone gap (ABG) was 20.86 ± 11.29 dB compared with preoperative ABG of 29.64 ± 10.63 dB and the difference was statistically significant ( < 0.05) with value 0.0112 on paired t-test. Detailed knowledge and anticipation of the cause of failure is a must in preventing another failure in revision ear surgeries. Hearing preservation must be considered in a pragmatic perspective and accordingly surgical indications must complement the realistic and reasonable expectations of the patients.
PubMed: 37206742
DOI: 10.1007/s12070-022-03456-9 -
Indian Journal of Otolaryngology and... Apr 2023Chronic Otitis Media-Squamosal type is an erosive process, which when confined to ossicular chain causes varying degrees of hearing impairment. As the disease progresses...
Chronic Otitis Media-Squamosal type is an erosive process, which when confined to ossicular chain causes varying degrees of hearing impairment. As the disease progresses to involve surrounding vital structures, it causes various complications like facial palsy, vertigo, mastoid abscess, which are more common than the other intracranial complications, and require a definitive surgical intervention i.e., mastoidectomy at the earliest. A retrospective study on 60 patients who had been operated for squamosal type were analysed for the demographics, symptomatology, intraoperative extent of cholesteatoma, type of mastoidectomy done, various graft materials used for reconstruction, post operatively for graft uptake, hearing improvement and the results were analysed using ChOLE classification of cholesteatoma. Although Intact Canal Wall mastoidectomy had improved post op PTA values, there was no significant difference in the Air-Bone gap closure when Intact Canal Wall mastoidectomy was compared to Canal Wall Down Mastoidectomy.
PubMed: 37206730
DOI: 10.1007/s12070-022-03386-6 -
Indian Journal of Otolaryngology and... Apr 2023Endoscopic Ear surgery is evolving day by day and there is need for constant improvement in terms of instrumentation with efficient, quicker, with clear bloodless...
UNLABELLED
Endoscopic Ear surgery is evolving day by day and there is need for constant improvement in terms of instrumentation with efficient, quicker, with clear bloodless surgical field and good postoperative outcome and results. The application of Dr Ahila's Endoscopic Ear Surgery Chisel and Mallet are presented. This innovation will provide limited and adequate bone removal in a faster way than drill in endoscopic mastoidectomy and stapedotomy surgeries. Surgical instruments represent a major financial asset to the health care facilities. The use of Dr Ahila's Endoscopic Ear Surgery straight 1 mm or 2 mm Chisel and Mallet is presented. Dr Ahila's Endoscopic Ear Surgery Chisel and Mallet, this innovation will provide faster bone removal than drill or curette without bone dust formation, fogging, irrigation in Endoscopic mastoidectomy and stapedotomy. This instrument is essential to avoid costly replacement, surgeon satisfaction, reduce cost and delays in the operating room and in safe and trained hands enhance patient safety.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12070-023-03629-0.
PubMed: 37200899
DOI: 10.1007/s12070-023-03629-0