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Ear, Nose, & Throat Journal Mar 2023usually infects people with impaired immune status and usually manifests in the lungs. Otomastoiditis caused by Nocardia infection is extremely rare, with only 4 cases...
usually infects people with impaired immune status and usually manifests in the lungs. Otomastoiditis caused by Nocardia infection is extremely rare, with only 4 cases reported to date. This report describes a case of otomastoid infection in an immunocompetent patient. The case was a 10-month-old immunocompetent infant who presented with an approximately 3-month history of right ear discharge for which treatment with various antibiotics had not resulted in significant improvement. Multiple cultures of secretions and pathologic examination failed to identify the causative organism. The patient then underwent right mastoidectomy. Finally, metagenomic next-generation sequencing identified the pathogen to be . The patient was infection-free at the 6-month follow-up but had developed labyrinthitis ossificans. Otomastoid Nocardia infection has characteristic clinical features, namely, formation of a large amount of granulation tissue and coexistence of bone destruction and new bone formation. Traditionally, Nocardia is challenging to diagnose. Metagenomic next-generation sequencing of lesions is helpful. Complete local debridement and free drainage are key to treatment.
PubMed: 36941739
DOI: 10.1177/01455613231165166 -
Frontiers in Surgery 2023A combined transpetrosal approach (CTP) is often used for large lesions in the posterior cranial fossa (PCF). Although CTP provides a wide surgical corridor, it has...
BACKGROUND
A combined transpetrosal approach (CTP) is often used for large lesions in the posterior cranial fossa (PCF). Although CTP provides a wide surgical corridor, it has complex and time-consuming bony work of mastoidectomy and cosmetic issues. Here, we describe a simple combined surgical technique to approach the supratentorial region, anterolateral surface of the brainstem, petroclival region, and foramen magnum by drilling only the petrous apex with a combination of retrosigmoid approach (RA).
CLINICAL PRESENTATION
A 27-year-old female was referred with extra-axial left cerebellopontine angle space-occupying epidermoid cyst extending to the prepontine cistern, anterior to the basilar artery, superior to the chiasma, and caudally to the foramen magnum. A one-stage surgical procedure using the anterior transpetrosal approach (ATP) and RA was performed after one-piece temporal-suboccipital craniotomy. These two approaches complemented each other well. Near-total removal was achieved.
CONCLUSION
A one-stage surgical procedure using ATP and RA provides the wider viewing and better visualization of the PCF with minimal technical difficulty.
PubMed: 36923374
DOI: 10.3389/fsurg.2023.1094387 -
Journal of Neurological Surgery. Part... Apr 2023Tegmen tympani or tegmen mastoideum defects involve dehiscence of the temporal bone that can be a source of cerebrospinal fluid (CSF) otorrhea. Herein, we compare a...
Tegmen tympani or tegmen mastoideum defects involve dehiscence of the temporal bone that can be a source of cerebrospinal fluid (CSF) otorrhea. Herein, we compare a combined intra-/extradural repair strategy with an extradural-only repair as it pertains to surgical and clinical outcomes. A retrospective review from our institution was performed of patients with tegmen defects requiring surgical intervention. Patients with tegmen defects who underwent surgery (combined transmastoid and middle fossa craniotomy) for repair of tegmen defects between 2010 and 2020 were inclined in this study. A total of 60 patients with 40 intra-/extradural (mean follow-up time: 1,060 ± 1,103 days) and 20 extradural-only (mean follow-up time: 519 ± 369 days) repairs were identified. No major differences in demographic factors or presenting symptoms were identified between the two cohorts. There was no difference in hospital length of stay between the two patient cohorts (mean: 4.15 vs. 4.35 days, = 0.8). In the extradural-only repair technique, synthetic bone cement was more frequently used (100 vs. 7.5%, < 0.01), whereas in the combined intra-/extradural repair, synthetic dural substitute was used more often (80 vs. 35%, < 0.01), with similar successful surgical outcomes achieved. Despite disparities in the techniques and materials used for repair, there were no differences in complication rates (wound infection, seizures, and ossicular fixation), 30-day readmission rates, or persistent CSF leak between the two treatment cohorts. The results of this study suggest no difference in clinical outcomes between combined intra-/extradural versus extradural-only repair of tegmen defects. A simplified extradural-only repair strategy can be effective, and may reduce the morbidity of intradural reconstruction (seizures, stroke, and intraparenchymal hemorrhage).
PubMed: 36895816
DOI: 10.1055/a-1757-0328 -
Surgical Neurology International 2023Several treatments for traumatic facial paralysis have been reported, but the role of surgery is still controversial.
BACKGROUND
Several treatments for traumatic facial paralysis have been reported, but the role of surgery is still controversial.
CASE DESCRIPTION
A 57-year-old man was admitted to our hospital with head trauma due to a fall injury. A total body computed tomography (CT) scan showed a left frontal acute epidural hematoma associated with a left optic canal and petrous bone fractures with the disappearance of the light reflex. Hematoma removal and optic nerve decompression were performed immediately. The initial treatment was successful with complete recovery of consciousness and vision. The facial nerve paralysis (House and Brackmann scale grade 6) did not improve after medical therapy, and thus, surgical reconstruction was performed 3 months after the injury. The left hearing was lost entirely, and the facial nerve was surgically exposed from the internal auditory canal to the stylomastoid foramen through the translabyrinthine approach. The facial nerve's fracture line and damaged portion were recognized intraoperatively near the geniculate ganglion. The facial nerve was reconstructed using a greater auricular nerve graft. Functional recovery was observed at the 6-months follow-up (House and Brackmann grade 4), with significant recovery in the orbicularis oris muscle.
CONCLUSION
Interventions tend to be delayed, but it is possible to select a treatment method of the translabyrinthine approach.
PubMed: 36895239
DOI: 10.25259/SNI_995_2022 -
Pharmaceutics Jan 2023Sonoporation using microbubble-assisted ultrasound increases the permeability of a biological barrier to therapeutic molecules. Application of this method to the round...
Sonoporation using microbubble-assisted ultrasound increases the permeability of a biological barrier to therapeutic molecules. Application of this method to the round window membrane could improve the delivery of therapeutics to the inner ear. The aim of this study was to assess the safety of sonoporation of the round window membrane in a sheep model. To achieve this objective, we assessed auditory function and cochlear heating, and analysed the metabolomics profiles of perilymph collected after sonoporation, comparing them with those of the control ear in the same animal. Six normal-hearing ewes were studied, with one sonoporation ear and one control ear for each. A mastoidectomy was performed on both ears. On the sonoporation side, Vevo MicroMarker microbubbles (MBs; VisualSonics-Fujifilm, Amsterdam, The Netherlands) at a concentration of 2 × 10 MB/mL were locally injected into the middle ear and exposed to 1.1 MHz sinusoidal ultrasonic waves at 0.3 MPa negative peak pressure with 40% duty cycle and 100 μs interpulse period for 1 min; this was repeated three times with 1 min between applications. The sonoporation protocol did not induce any hearing impairment or toxic overheating compared with the control condition. The metabolomic analysis did not reveal any significant metabolic difference between perilymph samples from the sonoporation and control ears. The results suggest that sonoporation of the round window membrane does not cause damage to the inner ear in a sheep model.
PubMed: 36839763
DOI: 10.3390/pharmaceutics15020442 -
Otolaryngologia Polska = the Polish... Dec 2022ntroductionIn all otologic surgeries, the facial nerve can be considered the most important structure that must be protected. The surgical damage risk of the facial...
ntroductionIn all otologic surgeries, the facial nerve can be considered the most important structure that must be protected. The surgical damage risk of the facial nerve will be increased in presence of facial canal dehiscence (FCD).AimIn this study, we aimed to evaluate the FCD and its associated situations in patients with chronic otitis media undergoing mastoidectomy.Materials and Methods850 patients who performed ear surgery were reviewed. Patients who did not perform mastoidectomy were excluded. In patients, the ratios, localization of FCD, and association of facial canal dehiscence with cholesteatoma were researched. Association between FCD and closed-cavity tympanomastoidectomy, open-cavity tympanomastoidectomy, and radical mastoidectomy procedures, and also an association between FCD and primary or revision surgery was evaluated. ResultsFacial canal dehiscence was found in 8.4% of patients. The relationship between dehiscence and cholesteatoma was found significant (p<0.001). In the comparison of radical mastoidectomy and closed-cavity tympanomastoidectomy, dehiscence was higher in the radical mastoidectomy group (p<0.03). In revision cases, dehiscence was seen more frequently (p<0.003). FCD incidence was higher in adult patients than in pediatric patients (p<0.001). Twenty of 468 patients who were operated on for cholesteatoma had congenital cholesteatoma. ConclusionFacial canal dehiscence can be seen especially in cases with cholesteatoma and when performing radical mastoidectomy and revision surgeries. Therefore, a detailed evaluation of the status of facial nerve and determination of situations in which occurrence of FCD is more likely both preoperatively and intraoperatively will minimalize potential complications.Keywords: Cholesteatoma, tympanic, radical mastoidectomy, oval window, tympanomastoidectomy.
Topics: Adult; Child; Humans; Cholesteatoma; Chronic Disease; Ear, Middle; Otitis Media; Mastoidectomy
PubMed: 36805516
DOI: 10.5604/01.3001.0016.1772 -
Cureus Jan 2023Introduction Unless specifically asked, many patients may be hesitant to discuss their experiences. Some people might not recall what happened right after surgery, but...
Introduction Unless specifically asked, many patients may be hesitant to discuss their experiences. Some people might not recall what happened right after surgery, but they might remember it 1-2 weeks later. We undertook the current study to estimate the incidence of awareness among patients under general anesthesia (GA). Methodology We conducted a cross-sectional, analytical study for three months. The study included patients who underwent functional endoscopic sinus surgery (FESS), septoplasty, mastoidectomy, or laparoscopic appendicectomy under general anesthesia. Patients who refused to take part and had low Glasgow Coma Scale (GCS) scores (less than 9) or didn't meet extubation criteria were all excluded from the study. We used a pre-validated semi-structured questionnaire for data collection. It had two sections. The first one includes demographic details, and the second section contains the modified Brice questionnaire. By using this questionnaire, we classified the patients as A, B, and C. Class A experiences are those that were remembered under anesthesia or surgery and were confirmed or disproved by the attending medical personnel present in the operating room. Class B, which stands for "potential awareness," was defined as a state in which the patient could not specifically recollect any occurrence that occurred during anesthesia or surgery but could have made connections between memories and the surgical procedure. We define Class C as a lack of recalled intraoperative events with probable memories of scenarios from the immediate pre- or postoperative period. We analyzed the data collected using IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Results About 240 patients took part in this study. Most of the people (68%) were men in the age group of 31 to 50 years. About 2% of the patient's experience awareness during general anesthesia. Only 2.5% of patients experienced dreaming. The association between awareness and comorbidity was statistically significant (P < 0.001). Conclusion It is about to know that our study results suggest that awareness had an association with comorbidity among the patients undergoing surgery under general anesthesia.
PubMed: 36779127
DOI: 10.7759/cureus.33567 -
Indian Journal of Otolaryngology and... Apr 2023We report the first case series utilizing the exoscope exclusively for bilateral simultaneous cochlear implant surgery and discuss the advantages, disadvantages, as well...
We report the first case series utilizing the exoscope exclusively for bilateral simultaneous cochlear implant surgery and discuss the advantages, disadvantages, as well as surgical outcomes in the Covid-19 era. The VITOM® 2D is compatible with enhanced PPE and draping techniques which can improve safety while providing comparable surgical outcomes.
PubMed: 36777926
DOI: 10.1007/s12070-023-03505-x -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Feb 2023To summarize and analyze the clinical data of sigmoid sinus thrombophlebitis and discuss its treatment strategy. The clinical manifestations, auxiliary examinations,...
To summarize and analyze the clinical data of sigmoid sinus thrombophlebitis and discuss its treatment strategy. The clinical manifestations, auxiliary examinations, surgical procedures and anticoagulant therapy of patients diagnosed with otosource sigmoid sinus thrombophlebitis in the Department of Otorhinolaryngology, People's Hospital of Xinjiang Uygur Autonomous Region from November 2014 to November 2021 were retrospectively analyzed. Five patients had a history of otorrhea and hearing loss for more than 5 years. They had headache during the acute episode, and 4 patients had drosive fever. They had severe complications, including brain abscess, sepsis, septic shock, intracranial hemorrhage, and hemorrhagic disseminated pneumonia. HRCT of temporal bone showed defects in the sigmoid sinus wall in 4 cases, and gas accumulation around and inside the sigmoid sinus in 3 cases. T1WI showed low signal, isosignal, and high signal in the sigmoid sinus area on MRI, and T2WI showed high signal in the sigmoid sinus area. The transverse sinus, sigmoid sinus and internal jugular vein were not developed in 2 cases, and the transverse sinus and sigmoid sinus were not developed in 1 case, and the internal jugular vein was thin. All 5 cases underwent radical mastoidectomy and resection of sigmoid sinus wall granulation or peritosinusitis abscess. The patients were followed up for 4-12 months and recovered well. For the cases of sigmoid sinus bone wall destruction accompanied by headache and fever by HRCT, it is necessary to be alert to the occurrence of sigmoid sinus thrombophlegitis, early diagnosis and early surgery to prevent the progression of the disease. Radical mastoidectomy combined with anti-infection therapy is the main treatment, and anticoagulation is necessary to achieve a better prognosis.
Topics: Humans; Otitis Media; Retrospective Studies; Thrombophlebitis; Cranial Sinuses; Brain Abscess
PubMed: 36756826
DOI: 10.13201/j.issn.2096-7993.2023.02.008 -
Medicine Feb 2023This study retrospectively investigated the reasons for failure to dry the ear after primary radical mastoidectomy for chronic otitis media. In this retrospective study,...
This study retrospectively investigated the reasons for failure to dry the ear after primary radical mastoidectomy for chronic otitis media. In this retrospective study, we analyzed the main causes of dry ear failure in 43 patients (46 ears) who underwent radical mastoidectomy. We found that inadequate exposure of the mastoid cavity, incomplete removal of pathological tissues, and poor drainage of the surgical cavity were the main reasons for failure of radical mastoidectomy. Lesions in the tympanic ostium of the eustachian tube and incorrect selection of surgical techniques could also cause dry ear failure. Revision surgery based on preoperative temporal bone computed tomography and intraoperative surgical findings could achieve dry ear in 100% of cases and no complications were observed. In patients who underwent tympanoplasty, there was a significant postoperative decrease in the decibel hearing level for the air conduction threshold and air-bone gap ( P < .05). Based on the reasons for failure, the corresponding treatment was undertaken to achieve dry ears during revision surgery.
Topics: Humans; Mastoidectomy; Retrospective Studies; Reoperation; Mastoid; Cholesteatoma, Middle Ear; Treatment Outcome; Chronic Disease
PubMed: 36749232
DOI: 10.1097/MD.0000000000032787