Endoscopic stapedotomy: Merits and demerits

A one-year-old baby girl with one-month history of recurrent pus fluid exuding from her left preauricular sinus orifice, who failed multiple courses of surgical drainage of the abscess and persistent debridement for the wound, presented with MRSA infection. The patient was treated with linezolid for three days. Her pain and paresthesia resolved, and C-reactive protein decreased to normal.     

Endoscopic transcanal stapedotomy: how I do it

Current paper presents a surgical technique and preliminary results of the first eight consecutive fully endoscopic transcanal stapedotomies. All eight procedures were performed under local anesthesia by the same surgeon using rigid endoscopes of 3-mm diameter, 14-cm length, 0° and 30°. A posterior tympanomeatal flap was elevated transmeatally with the 0° endoscope and then transposed anteriorly. Stapes fixation was confirmed, the stapes tendon was cut with curved micro-scissors, and the stapes was separated from the incus in the incudo-stapedial joint. The anterior and posterior stapedial crus were carefully fractured, and the superstructure was removed. The hole in the foot-plate was created with a Skeeter microdrill using a 0.5-mm-diameter diamond burr. A platinum/fluoroplastic piston prosthesis (0.4-mm diameter) was placed into this hole and fitted along the long process of the incus. The tympano-meatal flap was repositioned, and the external auditory canal was filled with Gelfoam^®. The chorda tympani nerve was preserved in all cases. A 4.5-mm prosthesis was used in six cases and a 4.75-mm prosthesis in two. Pure tone audiograms demonstrated improved air- and bone-conduction threshold averages across the three speech frequencies (0.5–1.2 kHz) 6 months after surgery (64 vs. 29.8 dB and 30.6 vs. 25.1 dB, respectively). The average postoperative air-bone gap was within 10 dB in six ears and between 10 and 15 dB in the other two ears. Our preliminary results indicate that transcanal fully endoscopic stapedotomy is a feasible and safe technique for surgical management of hearing loss associated with otosclerosis.     

Safe thyroidectomy: Our view point

Thyroid surgery by an Head & Neck surgeon can only be “Safe” when there is no morbidity. Identification and preservation of Recurrent laryngeal Nerve (RLN) and Parathyroids is absolutely necessary to ensure a Safe Thyroidectomy. Thorough knowledge of anatomy will guide the surgeon to the important landmarks.     

Reliability of microdrill stapedotomy: comparison with pick stapedotomy.

OBJECTIVE: To assess the hearing outcomes and complications of the microdrill and pick stapedotomy techniques. PATIENTS: We assessed 123 primary otosclerosis operation in 103 patients who had more than 1 year follow-up (71 microdrill; 52 pick stapedotomies). There were 87 women and 36 men in the study group (mean age, 44 +/- 11.2 years) at surgery. INTERVENTION: Stapedotomy for otosclerosis. MAIN OUTCOME MEASURES: Pure tone hearing thresholds and clinical evaluation for complications. RESULTS: In the microdrill group, preoperative mean air conduction was 61 dB, and mean bone conduction was 27 dB, postoperatively, these values improved to 31 dB and 16 dB, respectively. In the pick group, mean air conduction was 61 dB, and mean bone conduction was 27 dB, which improved postoperatively to 33 dB and 18 dB, respectively. Postoperative hearing gains were similar in both groups (p > 0.005). The mean postoperative gain in bone conduction was significant (p < 0.001) in each group: 11 dB in the microdrill group and 9 dB in the pick group, with no significant difference between the two groups. The preoperative air-bone gap was 34 dB in both groups, and improved to 15 dB in both. Complication rates were similar. CONCLUSION: The microdrill and pick stapedotomy techniques produced similar hearing results and complication rates. Within the limitations of the present study, we found no evidence of microdrill-induced acoustic trauma. The microdrill can be a useful technique in performing a stapedotomy and seems to produce similar results to those associated with pick stapedotomy.     

Craniofacial dysjunction: otolaryngological point of view

Since Le Forte's experiments in the 19th Century, craniofacial dysjunction (Le Forte III fracture) has been recognized as a serious facial injury. A multidisciplinary approach to the management of these patients is often required by concurrent injuries to the eye, brain, chest, abdomen and extremities. The otolaryngologist is particularly equipped to deal with the problems of hemorrhage and upper airway distress, as well as with the functional and cosmetic repair these injuries require. This paper reports the management of craniofacial dysjunction in 26 patients during a three-year period. Facial damage in the majority of cases was more extensive than that originally described and classified by Le Forte as Type III. Most cases resulted from automobile collisions. Males in the third decade of life predominated. Four patients died before care could be instituted. All patients had severe epistaxis, midfacial flattening and malocclusion, and six required emergency tracheostomy. Marked comminution of the nasal bones and septum was present in all. Fractures of the maxillary sinus were common and 16 of 22 survivors sustained nasofrontal injury, with pseudohypertelorism noted in all. Abrasions and lacerations to the face occurred in 12. Frontal sinus fractures were present in 15 cases and mandibular fractures in six. Other findings included seven with skull fractures, eight with fractured teeth, three with lacrimal sac and duct tears, two with severe intraocular damage, six with CSF rhinorrhea and 15 with diplopia. Repair of the facial fractures was initiated within the first 10 days following injury. All patients required intermaxillary fixation of the dental arches. No instance of delayed malocclusion resulted. When feasible, internal cranial suspension was employed, but in three severely comminuted fractures, external traction utilizing a special head cap was necessary. Frontal sinus obliteration with fat by osteoplastic technique was necessary in 10 patients. Fifteen patients had orbital floor explorations. Delayed findings included epiphora in two cases, diplopia in one, pseudohypertelorism and a flattened nose in three; jagged facial scarring in one, and CSF rhinorrhea in one. Individual follow-up periods varied from one year to three years. It is the management of these delayed findings during the long follow-up period that this paper particularly emphasizes.     

Endoscopic medialization with Vox implant: our experience

OBJECTIVE: The purpose of this work is to analyze our preliminary results on the endoscopic vocal cords medialization by Bioplastique. MATERIAL AND METHOD: This was a retrospective study on 39 cases of unilateral laryngeal paralysis, treated with the injection of Vox-implant between May 2004 and August 2006. The evolution of the swallowing disorders was followed by video fluoroscopy. The phoniatric evaluation was based on an auto evaluation questionnaire: Voice Handicap Index 10 (VHI-10). RESULTS: Of the 19 patients who presented with swallowing disorder, 18 gave a normal video fluoroscopy test. In only one case, a second injection, one year later was necessary to completely cure the patient from fluid aspirations. Thirty two patients were satisfied with the post-operative vocal results. The Wilcoxon matched pairs test gave a statistically significant difference between pre and post-operative VHI-10 (p< 0,001). The voice handicap improved approximately 53%. CONCLUSION: Bioplastic Vox-lmplant profits from a simple injection technique, it is well tolerated and gives a good voice quality. It allows moreover a fast and simple resolution of the problem, can be repeated, and in case of failure or insufficiency a thyroplasty remains possible.     

Tongue thrust: a point of view.

The purpose of the present paper is to present evidence to support the following hypotheses: (1) there is a relationship between tongue thrust and malocclusion, and it is probably a reciprocal one; (2) tongue thrust may yield spontaneously to non-thrusting patterns; (3) if tongue thrust does not yield spontaneously to nonthrusting patterns, some form of treatment should be considered; (4) if myofunctional therapy is the treatment of choice, its timing with respect to patient age, developmental factors, and orthodontic treatment should be an individual matter. The need for more definitive research is described. In order for such research to be meaningful, a standard definition of tongue thrust is required. Such a definition is proposed.     

Results after erbium:YAG-laser stapedotomy

BACKGROUND: The analysis of postoperative results after Erbium : YAG-Laser stapedotomy in patients with otosclerosis. METHODS: For all operations the microscope-integrated Erbium : YAG-Laser Twin ER (Zeiss, Oberkochen) was used by different surgeons. Data of 53 patients who were operated on between October 1993 and May 1999 were analysed. The mean follow-up time was 17 months. Postoperative bone-conduction and air-conduction thresholds and the presence of postoperative tinnitus and vertigo were analysed. The data were analysed according to the guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (1994). RESULTS: In 49 patients unchanged preoperative minus postoperative pure tone bone conduction averages at 1, 2, and 4 kHz were observed. In 4 patients a slight deterioration between 10 and 20 dB was seen. In 2 patients a new postoperative tinnitus was observed. No patient suffered from vertigo at the time of evaluation. In 22 patients the postoperative air-bone gap was between 0 and 10 dB, in 25 patients between 11 and 20 dB, and in 6 patients between 21 and 30 dB. No patient had a postoperative air-bone gap of more than 30 dB. CONCLUSIONS: The Erbium : YAG-Laser stapedotomy is a safe technique. Good postoperative hearing results may be achieved in patients with otosclerosis.