Modified intact canal wall mastoidectomy — long term results in hearing and healing

Introduction

The classic intact canal wall (ICW) mastoidectomy with tympanoplasty (combined approach tympanoplasty) [1, 2] has anatomic constraints for clearance of disease from the anterior attic and sinus tympani leading to high recidivism. Farrior [3, 4] described the modification of this technique and senior author (AM) has been using it with further modifications since 1973.

Materials and methods

We report our long-term experience in hearing and healing in 126 cases with special reference to the age (pediatric versus adults), ossicle status (presence or absence of stapes suprastructure) and type of cholesteatoma (Attic versus posterior-superior versus secondary acquired cholesteatoma).

Results

All the patients had unsafe CSOM and underwent Modified ICW mastoidectomy with primary ossiculoplasty except five where the procedure was staged.

Conclusion

Modified ICW technique is a one-stage procedure with the lowest recidivism rate when compared to various other ICW techniques. There is no significant difference in relation to age of the patient or type of cholesteatoma if the operative cases are selected judicially.     

Krabbe disease: unusual MRI findings

We present the MRI findings in a case of infantile-onset Krabbe disease. Enlargement of the intracranial optic nerves and cervical cord were detected in addition to more typical changes in the cerebral white matter and thalami. We also review the proton MR spectroscopic findings in Krabbe disease.     

Role of Live/Real Time Three‐Dimensional Transesophageal Echocardiography in the Percutaneous Epicardial Closure of the Left Atrial Appendage

We are reporting the use of three‐dimensional transesophageal echocardiography as a supplement to two‐dimensional transesophageal echocardiography in the percutaneous suture closure of the left atrial appendage.     

Does type of mesh used have an impact on outcomes in laparoscopic inguinal hernia?

Background

Theoretically, a lighter and softer mesh may decrease nerve entrapment and chronic pain by creating less fibrosis and mesh contracture in laparoscopic inguinal hernia repair.

Methods

We performed a telephone survey of patients who underwent laparoscopic inguinal hernia surgery between 2001 and 2007. We recorded patient responses for chronic pain, foreign body sensation, recurrence, satisfaction, and return to work, and then studied the effect of type of mesh (polypropylene vs polyester) on these factors.

Results

Of 109 consecutive patients surveyed (mean age, 54.5 y), 67 eligible patients underwent 84 transabdominal extraperitoneal procedures and 2 transabdominal preperitoneal procedures. Patients with polypropylene mesh had a 3 times higher rate of chronic pain (P = .05), feeling of lump (P = .02), and foreign body perception (P = .05) than the polyester mesh group. Our overall 1-year recurrence rate was 5.9%. The recurrence rate was 9.3% for the polypropylene group and 2.9% for the polyester group (P = .26).

Conclusions

A lightweight polyester mesh has better long-term outcomes for chronic pain and foreign body sensation compared with a heavy polypropylene mesh in laparoscopic inguinal hernia repair. We also saw a trend toward higher recurrence in the polypropylene group.     

Sudden Sensorineural Hearing Loss: An Otologic Emergency

The study purpose was to determine the efficacy of steroids, volume expanders and antivirals in the management of idiopathic sudden sensory neural hearing loss and to establish importance of early medical intervention. In this prospective study, thirty-four patients presenting with idiopathic sudden hearing loss of 30 db or more were enrolled in study group between 2005 and 2009. Patient variables as they related to recovery were studied and include patient age, time to onset of therapy, status of contralateral ear, presence of diabetes, severity of hearing loss, pattern of hearing loss in audiogram and presence of associated symptoms, (tinnitus, vertigo). Treatment protocol with intravenous hydrocortisone, intravenous dextran and oral anti-viral agent was followed. Pre-treatment and post-treatment pure tone average was analyzed. With combination therapy the overall improvement in pure tone threshold was seen in 27 patients (79.4%). A statistically significant association was found between the time at which medical intervention was started and hearing improvement. Early intervention in patients presenting before 3 days has given 77.8% complete type 1 recovery Idiopathic sudden sensory neural hearing loss is a medical emergency. It should not be misdiagnosed. Early detection and management with volume expanders, steroids and antivirals will improve the chances of complete recovery.