Influence of minor ear surgery on infrared tympanic thermometry

BACKGROUND: Infrared tympanic thermometry (ITT) is often used for postoperative recovery room monitoring regardless of recent minor otologic surgery. OBJECTIVE: To evaluate the use of ITT in pediatric patients who have undergone bilateral myringotomy with insertion of pressure-equalizing tubes. DESIGN: A prospective cohort study. SETTING: Tertiary care academic medical center. PATIENTS: Consecutive patients of a staff pediatric otolaryngologist (M.A.R.): (1) ear surgery group, children aged 10 years or younger undergoing bilateral myringotomy with insertion of pressure-equalizing tubes and (2) non-ear surgery group, children aged 10 years or younger undergoing bilateral tonsillectomy with or without adenoidectomy. INTERVENTIONS: Immediate preprocedure temperature measurements included right and left ear ITT. Immediate postprocedure temperature measurements included right and left ear ITT and thermistor probe rectal temperature. MAIN OUTCOME MEASURES: The average difference between the preprocedure and postprocedure tympanic temperature in the ear surgery group was compared with that in the non-ear surgery group. The average difference between postprocedure rectal and ear temperature in the ear surgery group was compared with that in the non-ear surgery group. RESULTS: There were 20 patients (40 ears) in the ear surgery group and 20 patients (40 ears) in the non-ear surgery group. In the ear surgery group, the average difference between the preprocedure and postprocedure tympanic temperature (0.55 degrees C) was not significantly different from that (0.62 degrees C) in the non-ear surgery group (P =.66, 1-way analysis of variance). In the ear surgery group, the average difference between postprocedural rectal and ear temperature (1.94 degrees C) was not significantly different from that (1.89 degrees C) in the non-ear surgery group (P =.76, 1-way analysis of variance). CONCLUSION: Recent minor ear surgery (bilateral myringotomy with insertion of pressure-equalizing tubes) does not have a significant effect on ITT measurements in pediatric patients.     

A technique for concurrent procedure of mastoid obliteration and meatoplasty after canal wall down mastoidectomy

Objective

To present a simple technique for concurrent procedure of mastoid obliteration and meatoplasty after canal wall down mastoidectomy, and to assess the efficacy and the surgical results of this technique.

Methods

Retrospective clinical study of a consecutive series of procedures from 2004 to 2008. One hundred thirteen patients undergone canal wall down mastoidectomy with tympanoplasty and concurrent procedure of mastoid obliteration and meatoplasty that uses an anteriorly based musculoperiosteal flap and a horizontal skin incision on the concha were included. Preoperative diagnoses were classified into cholesteatoma, adhesive otitis media, and chronic suppurative otitis media. The mean duration of follow-up was 38 months, with a range of 12–75 months. We analyzed control of suppuration and creation of a dry mastoid cavity according to the Merchant's grading system for evaluation of the efficacy of this technique, and hearing outcome. We evaluated postoperative complications including development of recurrent or residual cholesteatomas and duration of the mastoid cavity achieving a complete healing.

Results

Seventy-two patients had cholesteatoma, whereas 27 patients had adhesive otitis media and 14 patients had chronic suppurative otitis media. Eighty-three percent of all patients, in 86% of patients with cholesteatoma, in 78% of patients with adhesive otitis media, and in 78% of patients with chronic suppurative otitis media were achieved a dry and self-cleaning mastoid and complete control of infection. Duration of the mastoid cavity achieving a dry and self-cleaning mastoid ranged from 4 weeks to 24 weeks and the mean time of the complete epithelialization was 11.1 ± 4.6 weeks. The average ABGs were 32.4 ± 13.8 dB preoperatively and 23 ± 13.2 dB postoperatively. There were 5 patients with failure of control of infection postoperatively and 3 patients of recidivistic cholesteatoma.

Conclusion

The efficacy of our technique to make a dry and healthy mastoid cavity after a canal wall down mastoidectomy is satisfactory, and the rate of complication is acceptably low. We believe that our technique could be a convenient method to prevent cavity problems after canal wall down mastoidectomy.     

Chronic ear surgery in irradiated temporal bones

OBJECTIVE: To analyze outcomes of chronic ear surgery in patients with irradiated temporal bones. STUDY DESIGN: Retrospective case review. METHODS: Fifteen patients who received radiation involving the temporal bone underwent 21 surgical procedures from 1977 to 1997. Intraoperative findings, long-term complications, and hearing outcomes were analyzed. RESULTS: Over 50% of cases involved abnormal intraoperative findings including facial nerve dehiscence, labyrinthine fistulas, or dural exposure. Audiologic data revealed that these patients suffered from conductive, mixed, and sensorineural hearing loss. Long-term complications included tympanic membrane perforation and recurrent cholesteatoma. All patients had dry, non-draining ears at the end of the study. CONCLUSIONS: Irradiated temporal bones present difficult intraoperative anatomy and often require multiple procedures to cure otologic disease. Although radiation significantly reduces vascularity and hampers healing, vascularized reconstruction flaps are not necessary for good outcomes.     

Assessment of visualization of structures in the middle ear via Tos modified canal wall-up mastoidectomy versus classic canal wall-up and canal wall-down mastoidectomies

OBJECTIVE: The aim of this prospective study is to evaluate the differences in the ability to view structures in the middle ear between Tos modified canal wall-up mastoidectomy and classic canal wall-up (CWU) and canal wall-down (CWD) mastoidectomies. METHODS: Eighteen temporal bones of 10 cadaver heads were used. Six bones were randomly selected for each surgical technique (Tos' technique, CWU and CWD mastoidectomies) and fixed on an operating table. In the Tos' technique: (1) transmeatal posterior tympanotomy with drilling of the supero-posterior bony annulus, (2) transmeatal atticotomy with preservation of the bony bridge and (3) cortical mastoidectomy were performed. In the classic CWU mastoidectomy, cortical mastoidectomy and posterior atticotympanotomy (facial recess approach) were performed. Incus and posterior half of the tympanic membrane were removed from all temporal bones. An independent specialist performing otologic surgery evaluated all of the temporal bones and approved the proper extent of dissections. Two another independent observers blinded to the purpose of the study were asked to point five anatomic structures and locations (sinus tympani, anterior attic, posterior crus, lateral attic and the Eustachian tube orifice) in two different sessions. Observers were allowed to rotate the operating table as it has been done during otologic surgery, and the line of view for the observers was both transmastoid and transcanal. The ability to view these structures was recorded as "correct/visible" or "incorrect/invisible". These records were also verified after removing the posterior and superior walls of the outer ear canal in temporal bones of the Tos and CWU groups at the end of the study. RESULTS: Significant differences were found in the ability to view middle ear structures between the Tos' technique and CWU mastoidectomy as well as between CWU and CWD mastoidectomies, with the Tos' and CWD techniques almost equally showing superiority to CWU (p<.0001). Of the five locations, sinus tympani and anterior attic were observed more frequently with the Tos' technique versus CWU (p=.001). Sinus tympani (p<.005), anterior attic (p=.001) and posterior crus (p<.05) were observed more frequently with CWD versus CWU. There was no significant difference in the ability to observe lateral attic and the Eustachian tube orifice among the three techniques. In addition, there was no significant difference in the ability to visualize all the five locations between the Tos' and CWD technique. CONCLUSIONS: Statistical analysis showed good reproducibility of this randomised, blinded study. Tos' modified CWU mastoidectomy, in which most part of the canal wall is intact, showed similar advantage of the CWD in viewing structures in the middle ear. The Tos' technique and CWD mastoidectomy provided better visualization of sinus tympani and anterior attic that are the most frequent places of residual cholesteatoma in the classic CWU mastoidectomy.     

耳内镜手术在国内的发展现状及未来趋势

随着近10年来国际和国内耳内镜技术的学术交流不断深入,耳内镜技术在国内方兴未艾,尤其在基层和年轻医生中的应用更为普及,随着耳内镜手术经验不断积累、手术技术日趋成熟,手术逐渐向广度、深度、难度方向扩展,不断创造出新的微创手术径路,并向着侧颅底以及颅底中线深入.耳内镜手术在国内具有广阔的发展前景和应用潜力.     

Brain abscess secondary to the middle ear cholesteatoma: a report of two cases

We experienced two cases of brain abscess secondary to middle ear cholesteatoma. One, a 61-year-old woman, presented with left otalgia, appetite loss and nausea. The computed tomography obtained on admission revealed a middle ear cholesteatoma. The magnetic resonance image showed the presence of a brain abscess in the cerebellum. The brain abscess was drained and the cholesteatoma was removed using the canal down procedure under general anesthesia. Part of the cholesteatoma invaded the posterior cranial fossa was could not be removed from the otological surgical field. The patient has been under observation as an outpatient for 6 months already and no abnormal signs have been detected.

The other patient, a 55-year-old man, was admitted to our hospital for a detailed examination because he had right otalgia and progressive headache. The examination of spinal fluid obtained by lumbar puncture showed marked elevation of the white blood cells count. Computed tomography revealed a middle ear cholesteatoma. The magnetic resonance image obtained on admission showed an area of low-intensity encapsulated by an area of high-intensity in the right temporal lobe. The abscess was drained and the cholesteatoma was removed using the canal down procedure under general anesthesia. The patient has been under observation for 1 year already and has presented no signs of recurrence.     

Posterior canal wall reposition for management of cholesteatoma: Technique and results

Objective

The main goal of surgery in acquired middle ear cholesteatomas is the complete eradication of the disease with an ear free of discharge. This can be performed either by open or closed techniques with their benefits and drawbacks. We present the technique of reposition of the posterior canal wall for the management of cholesteatoma cases and its results and outcome.

Bezold's abscess arising with recurrent cholesteatoma 20 years after the first surgery: with a review of the 18 cases published in Japan since 1960

The classic Bezold's abscess was described as a deep neck abscess arising from an acute mastoiditis. With the pervasive use of antibiotics, the incidence of otitic suppurative complications including Bezold's abscess has dramatically decreased today. This decreased incidence has led to decreased familiarity and a subsequent increased delay in diagnosis. Otolaryngologists must recognize that intervening in benign processes such as cholesteatoma can lead to unforeseen serious complications. A case of Bezold's abscess arising in a 25-year-old man with recurrent cholesteatoma 20 years after his first surgery is presented. In this patient despite the prior canal wall down tympanoplasty, granulation tissue blocked the pathway from the mastoid to the external auditory meatus. A cholesteatoma formed in this obstructed space became secondarily infected and filled the mastoid cavity with pus. This recent clinical presentation of Bezold's abscess is described and the Japanese literature reviewed to renew familiarity with this rare complication.     

Endoscopic excision of a tympanic paraganglioma: Training the next generation of ear surgeons

Tympanic paragangliomas are uncommon vascular tumors of neural crest origin. Classically these lesions have been surgically managed via a transcanal or transmastoid approach using binocular microscopy. We describe a case in which a tympanic paraganglioma was removed via a transcanal approach, using the endoscope exclusively. Endoscopic ear surgery enhances visualization, helping to ensure complete tumor removal, while reducing unnecessary dissection and its associated morbidity. For small middle ear neoplasms, a purely endoscopic approach is feasible, with excellent results. Resident education in ear surgery has also been enhanced by the use of endoscopes. The wide field of view provided by the endoscope helps trainees understand the intricate three-dimensional anatomy of the middle ear cleft.     

Prevention of nausea and vomiting after middle ear surgery: granisetron versus ramosetron

OBJECTIVE/HYPOTHESIS: Middle ear surgery is associated with a relatively high incidence of postoperative nausea and vomiting. This study was undertaken to compare the efficacy of ramosetron with granisetron for preventing nausea and vomiting after middle ear surgery. STUDY DESIGN: Prospective, randomized, double-blind study. METHODS: In a randomized, double-blind manner, 100 ASA I patients (69 women), aged 23 to 65 years, received either ramosetron 0.3 mg or granisetron 3 mg intravenously (n = 50 of each) immediately before the induction of anesthesia. A standard general anesthetic technique and postoperative analgesia were used. Postoperative nausea and vomiting and safety assessments were performed continuously during the first 24 hours (0-24 h) and the next 24 hours (24-48 h) after anesthesia. RESULTS: A complete response, defined as no nausea and vomiting and no need for another rescue medication, during the first 24 hours after anesthesia (0-24 h) occurred in 90% of patients receiving ramosetron and in 86% of patients receiving granisetron, respectively (P = .379); the corresponding incidence rates in the second 24 hours after anesthesia (24-48 h) were 90% and 66% (P = .003). No clinically important adverse events were observed in either group. CONCLUSION: Prophylactic use of ramosetron is more effective than granisetron for long-term prevention of nausea and vomiting after middle ear surgery.     

单纯放疗和手术结合放疗治疗中耳癌的Meta分析

目的:用Meta分析方法评估中耳癌手术切除结合放疗和单纯放疗对患者生存率的影响。方法:查询筛选合格病例对照研究文献5篇,Meta分析采用Review Manager5.0统计软件,对文献结果进行定量综合分析。结果:5项中耳癌手术结合放疗和单纯放疗对中耳癌患者生存率影响的对照研究具有同质性,可以合并结果;合并效应量的检验z=0.29,P>0.05,合并效应量OR采用固定效应模型。OR合并值为0.91[95%(0.49～1.70)],菱形分布在垂直线的两侧。结论:单纯放疗和手术结合放疗对于中耳癌治疗的生存率差别并不大。我们认为早期中耳癌的治疗应以单纯放疗为首选。     

17例中耳术后迟发性面瘫的临床特征分析

目的 探讨中耳手术后迟发性面瘫出现的可能病因、处理措施及结果。 方法 收集自2017年1月至2018年12月接受中耳手术病例资料1 124例,回顾性分析迟发性面瘫发生时间、相关因素、治疗经过及恢复情况。 结果 1 124例中耳手术术后出现迟发性面瘫17例,发生率为1.51%;术后3~20 d出现迟发性面瘫,平均(10.00±4.11)d;按照各术式分布如下:鼓室成形术Ⅰ型(8/348, 2.30%),鼓室成形术Ⅱ型(4/247,1.62%),开放式乳突切开+鼓室成形术(5/529,0.95%),各术式之间迟发性面瘫发生率差异无统计学意义;按照面神经骨管情况分布如下:面神经骨管部分缺失348例,术后迟发性面瘫(5/348, 1.44%),面神经管完整776例,术后迟发性面瘫(12/776, 1.55%),面神经骨管是否完整,术后迟发性面瘫发生率差异无统计学意义;1例发生术后术腔感染,细菌培养提示铜绿假单胞菌感染,对症处理感染控制后,行面神经探查、耳大神经切取面神经吻合术,术后1年面神经功能恢复至Ⅲ级;其余16例全部予以激素等保守治疗,治疗后0.5~3个月后功能完全恢复。 结论 中耳术后迟发性面瘫与手术方式、面神经是否裸露等因素无关,保守治疗效果好。     

Canal wall reconstruction and preservation in the surgical management of cholesteatoma in children with Down's syndrome

Introduction

Down's syndrome is associated with poor Eustachian tube function, and an increased incidence of cholesteatoma. The only previously published case series suggests that ‘canal wall preserving’ procedures are only rarely suitable for the management of cholesteatoma in this population.

Methods

We conducted a retrospective review of the hospital's clinical records database to identify patients with Down's syndrome and cholesteatoma. These patients’ notes were then reviewed.

Results

We identified nine patients with Down's syndrome who had undergone surgical management of cholesteatoma over a twelve year period. Three patients had bilateral disease, meaning twelve ears were treated. Seven ears were initially treated with ‘canal wall down’ procedures. Four out of five of the remaining ears were successfully treated using ‘canal wall preservation’ or ‘canal wall reconstruction’, with one ear requiring subsequent conversion to a ‘canal wall down’ approach.

Conclusion

Canal wall preservation/reconstruction is feasible in patients with Down's syndrome, even when cholesteatoma extends into the mastoid.     

Evolution and safety of day-case major ear surgery

AimsTo study the evolution of middle-ear surgery in 2019 in relation to the French Health Authority target of 66% day-surgery by 2020.Material and methodsA single-center retrospective observational study included all patients undergoing otologic surgery between January 2014 and December 2018 in a university hospital center. 1064 of the 1368 patients were scheduled for outpatient surgery: 309 for otosclerosis, 355 for tympanoplasty with or without ossiculoplasty, 376 for cholesteatoma and 24 for other procedures. Two groups were constituted: day-surgery and conventional, according to hospital stay. Surgery time, follow-up duration, number of crossovers to conventional admission, number of emergency postoperative consultations, number of readmissions and data from the phone-call systematically made the day after surgery were analyzed. The main objective was to evaluate the safety of outpatient surgery for major middle-ear interventions compared to a control group managed under conventional admission during the same period.Results27 patients (2.5%) required crossover, mainly due to disabling vertigo (57.7%). 53 patients (4.9%) consulted before the scheduled 8th day consultation, because of severe pain (23.5%) or dizziness (34.0%). Only 10 patients required emergency readmission.ConclusionProvided that the inclusion criteria are met, all major middle-ear surgery procedures can be performed as day-surgery under satisfactory safety conditions.     

Middle ear effusions and structure of the tympanic membrane

OBJECTIVE: To study the effect of various middle ear effusions on the structure of the lamina propria of the tympanic membrane. METHODS: Sterile and infective middle ear effusions were induced by obstruction of the eustachian tube in specific pathogen-free (SPF) rats and in rats with upper airway infections (URI), respectively. The condition of the tympanic membrane was monitored at regular intervals. After varying survival times, the animals were killed and the tympanic membranes processed for light and electron microscopy. RESULTS: Sterile effusions always resulted in tympanosclerotic lesions. These lesions did not develop in the presence of primary-infected effusions. These effusions had a severe destructive effect on the lamina propria, followed by fibrosis. Generally, secondary infection did not markedly affect preexisting tympanosclerotic lesions. Moreover, calcification disappeared when re-aeration of the middle ear occurred, but the abnormal collagen depositions persisted. CONCLUSIONS: Both sterile and infective effusions result in comprehensive irreversible changes in the lamina propria of the pars tensa. The development of tympanosclerosis is confined to sterile effusions. Mechanical injury and compromised vascularization of the lamina propria are likely to be important etiological factors in the development of tympanosclerosis.     

Middle ear status – structure,function and pathology: A scoping review on middle ear status of COVID-19 positive patients

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic is the latest public health emergency that has presented challenges globally. Limited evidence exists on the association between COVID-19 and middle ear pathologies, regardless of the respiratory nature of some of the core symptoms.ObjectiveThis scoping review aimed at exploring evidence on the effects of COVID-19 on middle ear functioning as part of symptom mapping and preventive planning for ear and hearing care.MethodElectronic bibliographic databases, including Medline, ProQuest, PubMed, Science Direct, ERIC and Scopus, were searched to identify peer reviewed publications, published in English, between December 2019 and January 2022, related to the effects of COVID-19 on middle ear functioning. The keywords used as MeSH terms included ‘middle ear pathology’, ‘middle ear disorder’, ‘otitis media’, ‘hearing loss’, ‘hearing impairment’, ‘audiology’ and ‘COVID-19’ or ‘coronavirus’.ResultsFrom eight studies that met the inclusion criteria, the findings revealed that middle ear pathologies occur in this population, with the occurrence ranging from 1.15% to 75%. Tympanic membrane structural changes, otitis media and conductive hearing loss (CHL) were commonly reported. The current findings must be interpreted with caution given that most of the studies reviewed had extremely small sample sizes or were case studies or series, thus limiting generalisability.ConclusionThe findings highlight the value of strategic research planning to collate data during pandemics, ensuring that future studies use appropriate and well-designed methodologies. Trends and patterns of middle ear pathologies in this population must also be established to determine the need for periodic monitoring.     

Effect of adenotonsillectomy on middle ear status in children

OBJECTIVE: To determine the effects of adenotonsillectomy as compared with watchful waiting on the middle ear status of children. STUDY DESIGN: Randomized controlled trial. METHODS: We recruited 300 children between 2 and 8 years of age who were selected for adenotonsillectomy according to current medical practice. Excluded from the trial were children with very frequent throat infections (more than 6 per year) or obstructive sleep apnea. Participants were randomly assigned to either adenotonsillectomy or watchful waiting. Main outcome measure was the percentage of children with unilateral or bilateral otitis media diagnosed at the scheduled follow-up visits according to an algorithm combining tympanometry and otoscopy. RESULTS: The percentages of children in the adenotonsillectomy and watchful waiting group diagnosed with otitis media at baseline and at 3, 6, 12, 18, and 24 months were 27.7 versus 30.5, 16.8 versus 25.2, 18.3 versus 21.2, 12.3 versus 15.2, 17.6 versus 15.5, and 14.7 versus 10.3%, respectively (P < .10). In the subgroup of children selected for adenotonsillectomy predominantly because of recurrent or persistent otitis media, hearing loss, or recurrent upper respiratory tract infections (n = 111) and in the subgroup of children diagnosed with otitis media at inclusion (n = 82), the occurrence of otitis media did not differ significantly between the adenotonsillectomy and watchful waiting group during the entire follow-up period. CONCLUSION: We conclude that in a large proportion of children selected for adenotonsillectomy according to current medical practice, including those with otitis media or related complaints, no beneficial effect of adenotonsillectomy on middle ear status is to be expected.     

颞骨高分辨率CT在中、内耳手术中的应用

目的分析颞骨高分辨率CT在中、内耳手术中的应用。方法回顾分析近3年的600例中、内耳手术前颞骨CT和术中病变情况。结果术前CT诊断慢性化脓性中耳炎、中耳胆脂瘤、中耳炎后遗症(包括鼓膜穿孔、粘连性中耳炎、鼓室硬化症)、耳硬化症和中耳畸形及恶性肿瘤的符合率分别为98.7%(221/224耳)、94.4%(319/302耳)、94.1%(32/38耳)、66.7%(16/24耳)和100%(12/12耳)。结论颞骨CT提供了大量关于中、内耳的信息,临床医师术前应该认真阅读分析颞骨CT片,充分利用CT提供的信息,做好手术的个体化设计,提高治疗质量。