Inflammatory myofibroblastic tumor involving ear lobule

We present herein an extremely rare case of an inflammatory myofibroblastic tumor (IMT) of the ear lobule with its management. A 50-year-old woman presented with a wart-like mass between the ear lobule and the facial skin. She had been accidentally lacerated her left ear lobule and visited our clinic. The mass had been incidentally found by the patient 1 year before the trauma and growing slowly without pain. Surgical excision and primary closure was performed. Histopathologic examination demonstrated ill-defined margined nodular proliferation of spindle cells in deep dermis with focal stromal hyalinization and lymphoplasmacytic infiltration compatible with the IMT. The patient showed no evidence of recurrence 6 months after surgery. To our knowledge, this is the first report of an IMT occurred in the external ear. Auricular IMT of our case was not aggressive in clinical nature and treated optimally with surgical excision.     

Giant cholesteatoma of the external ear canal after myringoplasty

Cholesteatoma are specially localized in middle ear and mastoid process, although sometimes is the external ear canal which shows the disorder. Usually its a appearance is spontaneous. We report a rare case of gigantic cholesteatoma which origin was the previous otologic surgery done because of the inclusion of a bit of epithelial tissue inside the surgical incision. Similar outcomes justify periodical checking after ear surgery with outlining a tympanomeatal flap.     

Endoscopic vs microscopic myringoplasty: a different perspective

The objectives of this study were to ascertain the feasibility of transcanal endoscopic underlay myringoplasty using temporalis fascia and compare the results with microscopic myringoplasty. This prospective randomized trial included 60 patients with mucosal chronic otitis media with tympanic membrane perforations of all sizes and locations apart from posteriorly based small or moderate sized perforations. In the endoscopy group, 30 patients underwent exclusive transcanal myringoplasty using tympanomeatal flap elevation with underlay graft placement. In the microscopy group, 30 patients underwent myringoplasty using the postaural approach. Intra-operative variables compared were canalplasty and canal wall curettage for assessment of ossicular status. Graft uptake, hearing outcomes using pure tone audiometry and subjective cosmetic outcomes were assessed 24 weeks post-operatively and compared in the two groups. Resident feedback on the feasibility of endoscopic myringoplasty was obtained using a questionnaire. In the microscopy group, 5/30 patients required canalplasty due to canal overhangs and 4/30 required canal wall curettage for ossicular assessment, whereas none of the patients in the endoscopy group required these procedures. A graft uptake rate of 83.3 % was observed in both groups post-operatively after 24 weeks. Mean air-bone gap pre- and post-operatively in the endoscopy group was 28.5 and 18.13 dB, respectively, whereas these values were 32.4 and 16.9 dB, respectively, in the microscopy group. Subjective cosmetic outcomes were better in the endoscopy group. Resident feedback on endoscopic myringoplasty was positive. Endoscopic myringoplasty appears to be an effective alternative to microscopic myringoplasty and results in excellent hearing with good cosmetic outcomes.     

Primary B-cell lymphoma presenting as bilateral ear lobule swelling

We report a rare case of primary B-cell lymphoma presenting as bilateral ear lobule swelling. A 56-year-old white man presented with a one-year history of painless swelling of both ear lobules. An excision biopsy confirmed B-cell lymphoma. Detailed systemic investigation confirmed the primary nature of the tumour. This tumour is rare in the ear lobule. A review of the English literature revealed no previously reported case of bilateral primary ear lobule involvement. Clinicians should be aware that this tumour can present as a primary in the ear lobules.     

Management of ear lobule keloids using 980-nm diode laser

The objective of the study was to evaluate the 980-nm diode laser in conjunction with corticosteroids in the treatment of ear lobule keloids. Several methods have been described for the treatment of keloid scars, but none of them have been 100% successful. Advances in laser techniques have enabled surgeons to define the most appropriate lasers for use in the treatment of different scar types. The diode laser pulses are delivered interstitially in a single repeated mode in non-overlapping sites using a bare optical fiber, followed by intralesional triamcinolone acetonide injection. The number of sessions varies between two to five for the management of more than 75% of keloid size, with a total success rate of 75% and no recurrence in the follow-up of 12 months. The technique used proved to be effective in the treatment of ear lobule keloids.     

Tri-adcortyl ointment ear dressing in myringoplasty: an analysis of outcome

In a retrospective study of patients who had undergone myringoplasty at our department within a 12-month period, we assessed the graft take rate using tri-adcortyl ointment (TAO) as ear dressing. Data including age, site and size of perforation, grade of surgeon, surgical approach, use of postoperative ear dressings, complications and audiometric outcome was collected from the patient notes and analysed. The overall success rate of the operation (with success being defined as an intact tympanic membrane at 6 months) was noted. Seventy-seven patients were operated, but data were complete on 64 patients and these constituted the study population. TAO was used in 95% of the patients and BIPP gauze pack in the remaining 5%. Age ranged from 8 to 63 years (mean 34 years). Mean follow-up period was 13 months. Most of the operations (72.88%) were carried out by consultants with a success rate of 89% and the remaining patients were operated by trainees with a success rate of 88% (P = 1.000). The overall success rate was 89, 90.16% for TAO and 66.66% (2 out of 3) for BIPP (P = 0.298), 95% for small and 86% for subtotal perforations (P = 0.573), 85% for anterior and 100% for posterior perforations (P = 0.240), 91% for adult patients and 88% for children (P = 1.000). TAO is a suitable ear dressing in myringoplasty. Routine use of TAO did not affect the success rate of myringoplasty at our centre.     

颞肌筋膜重建鼓膜厚度对中耳传声的影响——有限元模型研究

目的　研究颞肌筋膜重建鼓膜厚度对中耳传声的影响。方法　依据1名成年男性颞骨标本的Micro-CT扫描数据,利用Mimics软件、ANSYS软件建立正常成人中耳有限元模型后,再依据该模型建立从0.05～2.00 mm共9种厚度鼓膜的有限元模型,分别计算不同厚度鼓膜对鼓膜及镫骨底板振动的影响,从而反应不同厚度重建鼓膜对中耳传声的影响。结果　当90 dB SPL刺激鼓膜时,所建模型于鼓膜脐部、镫骨底板中央处振幅在文献报道颞骨实验测量结果的范围之内。依据该正常结构中耳有限元模型,建立9种厚度颞肌筋膜重建鼓膜的有限元模型。计算结果显示：当重建鼓膜厚度＞0.4 mm时,鼓膜脐部振幅逐渐减低,尤其是当鼓膜厚度＞1.0 mm时,影响最明显;当鼓膜厚度为0.05 mm和0.1 mm时,镫骨底板振幅在0.6 kHz以下轻度增强,提高镫骨底板振幅约2 dB,但0.6～8.0 kHz均降低约2.5 dB;当鼓膜厚度为0.2、0.4与0.6 mm时,于约3.0 kHz以下镫骨底板振幅水平下降,幅度约＜5.0 dB;当鼓膜厚度为0.6、0.8与1.0 mm时,于3.0 kHz以下镫骨底板振幅减小明显,于0.8 kHz以下约达-10 dB;而当鼓膜厚度为1.5 mm与2.0 mm时,镫骨底板振幅于1.0 kHz以下降低最明显,于0.8、1.0 kHz处分别达-16 dB和-22 dB。另外,于共振峰约3.2 kHz处,9种厚度重建鼓膜对镫骨底板影响最大约-5 dB。共振峰3.2～8.0 kHz之间,镫骨底板均有明显降低,约于5.0 kHz处最大达约-10 dB。结论　颞肌筋膜重建后的鼓膜厚度影响鼓膜本身及镫骨底板的振动,当重建鼓膜厚度超过1.0 mm时对中耳传声影响显著增加。     

Day-case pediatric middle ear surgery: From myringoplasty to bilateral cochlear implantation

Objective

In the English speaking literature there is very little evidence demonstrating safe and effective tympanomastoid day case surgery in pediatric practice. At a time when there is ongoing pressure for trusts to meet financial government targets and our care provision revolves around a patient centred approach, could otolaryngologists perform more pediatric middle ear surgery on a day case basis? We report our experience with a series of 52 pediatric middle ear day cases.

Method

Prospective study from a London tertiary referral centre of 52 consecutive children undergoing tympanomastoid surgery. There were 6 categories of surgical procedure, ranging from myringoplasty to cochlear implantation. Post-operative recovery was monitored. The duration of anaesthesia was compared with the length of post-operative ward stay.

Results

The correlation co-efficient r = −0.2203, showing that there was no association between length of anaesthetic and duration of post-operative ward stay.

Conclusions

Despite minor post-operative problems including pain, bleeding, and nausea and vomiting all patients in this series were discharged on the day of surgery. For tympanoplasty our series adds weight to already available evidence. It is the first series showing that mastoid surgery, whether combined approach, traditional mastoidectomy or cochlear implantation can be performed safely as day cases in a pediatric population.     

Iatrogenic ear lobule ischemic injury from pressure dressing as an unusual complication of parotidectomy

The use of compressive dressing is usually spread to enhance neovascularization of the dissected facial flap by elimination of dead space between the flap and the dermis in parotid surgery through facelift incision. The author reports a clinical case of compressive dressing after parotidectomy that was inappropriately performed to folding of the ear lobule, leading to ischemic injury. This iatrogenic complication resulted in the development of contracture of ear lobule and deformity of auricle. Consequently, careful compressive dressing after parotidectomy through facelift incision must be applied; and the wound must be inspected daily for early detection and prompt treatment of local complications.     

Anterosuperior anchoring myringoplasty using cyanoacrylate glue can prevent packing gelfoam in the middle ear cavity

ObjectivesAlthough a number of methods have been attempted to improve securing the graft, packing gelfoam in the middle ear cavity cannot be avoided, which could obstruct the tympanic ostium of the Eustachian tube and affect inner ear function. Myringoplasty using tissue adhesive has gained traction because tissue adhesives can effectively stabilise the graft and act as scaffolding to improve the graft uptake. The aim of this prospective study was to explore myringoplasty using cyanoacrylate glue with no packing in the middle ear cavity for the repair of subtotal tympanic membrane (TM) perforations.MethodsBetween March 2014 and November 2015, 71 patients with subtotal TM perforations were randomly and prospectively divided into a glue group and a control group. Two securing techniques were performed using only cyanoacrylate glue or using only filling gelfoam in the middle ear cavity, respectively, during an anterosuperior anchoring myringoplasty operated by a single surgeon.ResultsAt a 6-month follow-up, the graft uptake rate was 87% in the glue group and 89% in the control group. A significant hearing improvement was found in both groups postoperatively when compared to the preoperative values (P < 0.05 for both). There was no significant difference in the graft uptake rate and hearing improvement between the 2 groups (P > 0.05). Similar complications were found in each group.ConclusionCyanoacrylate glue is a helpful material for graft stabilisation and can substitute for filling gelfoam in the middle ear cavity during anterosuperior anchoring myringoplasty for subtotal TM perforation.     

Pursestring closure of radial forearm fasciocutaneous donor sites

BACKGROUND: The radial forearm fasciocutaneous free flap has become one of the most common methods of reconstructing defects after head and neck ablative surgery. The fasciocutaneous flap is an excellent replacement for the tissue that has been removed. Unfortunately, donor site morbidity remains a problem. Donor site morbidity is primarily related to poor skin graft take, cosmesis, and neural dysfunction. Decreasing the size of the donor site defect may allow for improved cosmesis with decreased morbidity. MATERIAL AND METHODS: Prospective evaluation of a pursestring closure of radial forearm fasciocutaneous donor sites over a 16-month period. RESULTS: Seventy-one radial forearm free flaps were used. Sixty-seven had a pursestring closure of the donor site. After flap elevation the mean size of the defect was 61 cm2 (range, 28-140 cm2). Pursestring closure decreased the mean of the defect to 34 cm2 (range, 10-104 cm2) (P <.0001). Defect size was decreased by a mean of 44.5% (range, 24.5%-66.7%) (P <.0001). COMPLICATIONS: The rate of skin graft loss (>25%) (9% of patients) was less than that reported in the literature. No patient required a second surgical procedure. Neural morbidity was equal in both groups. Cosmesis was much improved. CONCLUSIONS: Pursestring closure allowed for a significantly decreased donor defect, associated with better cosmesis and less skin graft loss.     

A comparative study of endoscope assisted myringoplasty and micrsoscope assisted myringoplasty

Objective  To determine the advantages and disadvantages of the endoscope as compared to the microscope in myringoplasty surgery and to compare the results of both groups. Methods  Between January 2003 and September 2006, 100 patients underwent myringoplasty, 50 were endoscope assisted and 50 were microscope assisted. Results of surgery were compared at the end of six months post operation. Results  In the endopscope group 82% of patients had a successful outcome and in the microscope group 86% of patients had a successful outcome. Conclusion  In myringoplasty surgery the endoscope has several advantages and a few disadvantages. The surgical outcome of endoscope assisted myringoplasty was comparable to the conventional microscope assisted myringoplasty, but in terms of cosmesis and post operative recovery patients in the endoscope group had better results.     

Calcium-binding sites in the inner ear after pure-tone stimulation

Summary Five guinea pigs were exposed to an interrupted 90 dB SPL pure tone of 3.2 kHz for a total application time of 5 min. Following sound application all animals were decapitated and the cochleae were removed. After that, calcium-binding sites were located by the potassium pyroantimonate precipitation method. Another three animals served as control animals and did not receive the sound treatment. Findings confirmed previous studies showing the spatial arrangements of precipitate rich regions in the inner ear's two acellular structures (the basilar membrane and tectorial membrane) and the two cellular structures (the inner hair cells and Huschke's teeth). By using semiquantitative evaluation we found a relative diminution of precipitable calcium in inner hair cells and in Huschke's teeth of sound-exposed animals when compared to untreated animals.     

内外植法与内植法鼓膜成形术的近期对比分析

目的:探讨内外植法修补鼓膜的成功率和对听力的影响.方法:回顾性分析2002年以来行内植法鼓膜成形术且术后随访6个月以上的74例(77耳)患者,A组44例(45耳)采用传统的内植法,B组30例(32耳)将移植膜放置在残余鼓膜与锤骨柄之间(内外植法),比较2组患者术后3个月时的听力.结果:A组鼓膜1次修补成功40耳(89.0%),语言区平均听阈改善≥10 dB者23耳,手术成功率57.5%.B组鼓膜修补1次愈合28耳(87.5%),语言区平均听阈改善≥10 dB者23耳,手术成功率71.9%.并发症:A组再穿孔2耳(5.9%),鼓膜内陷8耳(17.8%);B组再穿孔2耳(6.25%),钝角愈合3耳(9.38%),鼓膜内陷2耳(6.25%).结论:将移植膜放置在残余鼓膜与锤骨柄之间可避免术后鼓膜和锤骨柄脱离,减少移植膜与鼓岬发生粘连.对鼓膜较大穿孔患者听力的改善明显优于移植膜放置在锤骨柄内侧者.