Postauricular Approach Research Articles

Diagnosis and Management of Paradoxical Cerebrospinal Rhinnorhea in Mondini's Dysplasia.

To highlight a case of unilateral Mondini's dysplasia and it's potential to manifest as paradoxical cerebrospinal fluid (CSF) rhinorrhoea and recurrent meningitis in an adult. A single case report with presentation and management of a patient with left sided Mondini's Dysplasia who presented with watery nasal discharge in the background of recurrent meningitis. We review the differential diagnoses and the importance of a multi-disciplinary approach to management. Post-auricular approach was taken and the leak was identified at the footplate of Stapes and sealed with fascia lata. The middle ear was obliterated and blind sac closure was done. The patient made a good recovery. The online version contains supplementary material available at 10.1007/s12070-024-04903-5.

Assessment of oncologic and cosmetic outcomes of robotic elective neck dissection in early-stage tongue cancer

BackgroundRobotic neck dissection is emerging as an alternative to conventional open neck dissection. However, the oncologic safety of robotic elective neck dissection (END) and its indications in early-stage tongue cancer are unclear. MethodsWe retrospectively reviewed the data of 78 patients who underwent transoral excision for T1, T2 squamous cell carcinoma of tongue with simultaneous ipsilateral END. Patients were assigned to two groups: the robotic group (n = 32)—postauricular face-lift —and the conventional group (n = 46)— transcervical incision. We compared the survival, clinical, pathologic and cosmetic outcomes of the two groups, and evaluated the number of retrieved lymph nodes and robot console time in the robotic group. ResultsThe mean age was lower in the robotic group (43.6 ± 12.8 vs. 55.8 ± 14.0, p < 0.001) and the conventional group had more T2 patients (p = 0.01). The mean operation time was significantly longer in the robotic group than the conventional group (178.81 ± 33.9 vs. 92.28 ± 16.7, p < 0.001). The mean number of retrieved lymph nodes was not significantly different between the two groups (19.22 ± 8.51 vs. 20.7 ± 11.4, p = 0.41). The 5-year disease-free survival rate was not significantly different between the two groups (93.6 % vs. 82.9 %, p = 0.59). Overall scar satisfaction assessed by VAS score, the robotic group showed significantly better results compared to the conventional group (8.38 vs. 5.86, p = 0.033). ConclusionRobotic END by a postauricular facelift approach is a feasible and safe approach for early-stage tongue cancer.

Natural orifice trans-oral, trans-vestibular endoscopic thyroidectomy: Surgical steps and technique.

Natural orifice scarless cosmetic surgeries are becoming a reality with increasing experience of advanced laparoscopic surgeries and availability of modern energy sources. Many techniques of minimally invasive video-assisted thyroidectomy through cervical and extra-cervical routes such as chest wall, trans-axillary, sub-mental, post-auricular and trans-luminal approach have been attempted. However, trans-oral trans-vestibular endoscopic thyroidectomy with its excellent cosmetic effect has become the more popular option among the surgical community with advantages such as decreased hospital stay and minimal complications. In this case report, we describe natural orifice trans-oral, trans-vestibular endoscopic thyroidectomy approach (NO-TOTVET) and add to literature the technique in which NO-TOTVET can be utilised, thus adding to the repertoire of the operating surgeon.

COMPARATIVE STUDY OF SURGICAL OUT COME OF INTERLAY TYMPANOPLASTY AND UNDERLAY TYMPANOPLASTY IN TERMS OF HEARING IMPROVEMENT AND GRAFT UPTAKE

Introduction: Perforation of the tympanic membrane primarily results from middle ear infections, trauma or iatrogenic causes. Up to 80% of these perforations heal spontaneously; for the remaining, surgical repair, known as myringoplasty, is usually proposed. The principal indications are recurrent otorrhea, the desire to swim without having to waterproof the ear and to improve conductive hearing loss. Several factors may affect surgical outcome such as the surgical approach (endaural, postaural) and technique (underlay vs. overlay), site of perforation and type of graft utilized. Material &amp;Methods: This study was carried out from January 2018 to October 2019. Detailed history and examination were carried out the patient of Chronic Otitis Media with Inactive mucosal disease in large central perforation. Out of 50 patients, 25 patients were operated by underlay technique and rest 25 patients were operated by interlay tympanoplasty. In both the techniques of myringoplasty post auricular approach and temporalis fascia was used as a graft material and operated under general or local anesthesia. Conclusion: Thus in present study as far as resolution of air bone gap is concerned, Interlay technique showed a statistically better outcome as compared to the underlay group. The findings in present study showed a better graft up take in Interlay method which coupled with a better postoperative air bone gap provided a better overall outcome. Key words: Tympanoplasty , Interlay Tympanoplasty, Underlay Tympanoplasty, CSOM,

Robot‐assisted resection of lateral neck cysts using a postauricular approach

Robot‐assisted resection of lateral neck cysts using a postauricular approach

A Case of Middle Ear Adenomatous Neuroendocrine Tumors: Proposal of a Staging System

A 49-year-old man visited a local otolaryngology clinic with left hearing loss. He was diagnosed as left middle ear tumor and referred to us. The tumor was protruding from the left tympanic membrane. Computed tomography (CT) revealed thickening of the tympanic membrane, space-occupying lesions in the middle ear cavity and mastoid air cells, and no bone destruction in the left middle ear. Magnetic resonance imaging confirmed the CT findings, and the lesions were hyperintense on T1- and T2-weighted imaging. He was diagnosed as middle ear adenomatous neuroendocrine tumor (MEANT) with a pathological result. The patient underwent postauricular approach and canal wall-down mastoidectomy. The tumor occupied the mastoid air cells and extended into the middle ear mucosa. To prevent perilymphatic fistula, the tumor was excised as extensively as possible, while preserving the tumor around and adjacent to the stapes footplate. MEANT is extremely rare and long-term follow-up is necessary due to be potential for tumor regrowth or recurrence. Herein, we propose a new staging system for MEANT.

Myringoplasty - A Rewiev of 438 Cases.

The medical records of 438 patients who underwent myringoplasty followed up for a minimum of one year in the period of 1980 and 2015 were revised. Examination under otomicroscope was done of the ear to be operated. This was carried out with a speculum under the operating microscope to be reliably asses the tympanic membrane, site of perforation, to rule out any other pathology and assess the status of ossicular chain. All the patients submitted primary myringoplasty surgery were operated under postauricular, endaural and transcanal approach with overlay, underlay and inlay methods. In the study the patients were divided into three groups depending upon the technique utilized to repair the tympanic membrane. When we compared overlay technique group with underlay technique group, it was observed that overlay technique was no statistically significant difference between these three groups in term of age wise distribution, gender wise distribution, duration of disease and cause of disease, due to matching at the time of selection. In this study the outcome in terms of graft uptake rate was slight better in the overlay technique (94%) as compared to the underlay technique (86.2%), though the difference was statistically insignificant, P>0.05. Patients selection may have had a role in the high success rate in the present study as patients presenting with middle ear pathology were excluded. The complications rate in the present study was quite low, no case in inlay group, three cases of graft lateralization in underlay group, and 19 cases in overlay group. In this study, better results were achieved with overlay technique may probably be due to less surgical manipulation and faster healing process.

Canalplasty using osteotome in a unilateral ear auditory exostoses (EAE) without cold water exposure: a case report

Background: Ear auditory exostoses (EAE) or surfer’s ear is a slow benign bony growth within the external auditory canal (EAC). The exact etiology of EAE remains unclear but it is commonly associated with chronic exposure to cold water or wind. The technique of surgery can be transcanal, endaural, or postauricular approach, based on the surgeon's experience. To our knowledge, this is the first documented report of a patient with recurrent EAE without cold water exposure. The purpose of this study is to present a rare case report about a woman with unilateral EAE without cold water exposure with transcanal osteotome surgical approach. Case presentation: A 29-years-old woman was referred to the Ear, Nose, and Throat Department, West Nusa Tenggara General Hospital, Mataram, Indonesia with left ear fullness since one week ago. The patient was told that she had a lump within the ear canal since 2013 but she had no symptoms. There was no history of recurrent ear infection or participating in water activities. Otoscopy of the left ear revealed a lump rising from EAC that covers 90% of EAC. We could not visualize the left tympanic membrane. The CT scan of her temporal bone demonstrated a hard density mass in the left EAC. The patient was done surgically with a transcanal approach. Indication for this patient was the occlusion of more than 80% of EAC. Transcanal with osteotome was chosen because of its less complication than others. Conclusion: It is unusual that our patient developed EAE without the usual precipitating factor. The surgery was done with a transcanal approach with an osteotome to prevent complications postoperative. Future experimental studies should be performed.

Surgical Outcomes of Tympanoplasty with Various Graft Materials in Chronic Otitis Media: A Retrospective Cohort Study

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neoTM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability.

Outcomes of Endoscopic Stapedectomy: Systematic Review.

Introduction Stapes surgery was traditionally performed with the use of microscopy either through postauricular, endaural or transcanal approaches. Endoscopic stapedectomy ushered a revolution as a new technique with less complications. Objective To review the outcomes of endoscopic stapes surgery with an emphasis on intraoperative and postoperative clinical and audiological results. Data Synthesis A literature review on the PubMed, Web of Science, Scopus, the Cochrane Library, and Embase databases was conducted. Endoscopic stapes surgery or stapedotomy were the main keywords used, and we searched for studies and research published from January 2015 to October 2021. Articles on endoscopic stapes surgery were included, and qualitative and descriptive analyses of the studies and outcomes data regarding audiometric changes and postoperative complications were conducted. Articles including patients with cholesteatoma were excluded. A total of 122 studies were retrieved for qualitative and descriptive analyses and to measure the outcomes of endoscopic stapedotomy; only 12 studies met the inclusion criteria, and the rest was excluded. The meta-analysis revealed a statistically significant difference in hearing improvement. The gain in air-bone gap ranged from 9 dB to 16 dB. A low rate of operative and postoperative complications was reported. Conclusions Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with shorter operative times, low complication rate, and significant hearing improvement. The endoscopic technique enabled a better visualization and less scutum drilling, which was confirmed by all included studies.

Evaluation of the validity and reliability of a self-assessment questionnaire for cosmetic outcomes after thyroidectomy: a cross-sectional validation study.

The Self-Assessment Questionnaire for Cosmetic Outcomes (SAQCO) was developed by us to evaluate the cosmetic outcome of patients after thyroidectomy. This study aimed to examine the reliability and validity of SAQCO. We analyzed the cosmetic outcomes of 368 patients who underwent thyroidectomy and completed the SAQCO 1 year after surgery. The one-dimensionality, reliability, and validity of SAQCO were assessed using factor analysis models, Cronbach's alpha, and test-retest statistics. The differences in cosmesis indices between patient characteristics and surgical parameters were analyzed through comparative and regression analyses. The unidimensional convergence of SAQCO was examined. A Cronbach's alpha of 0.91, strong item-total correlation values (from 0.77 to 0.89), and a test-retest correlation value of 0.86 indicated the internal consistency and reliability of the SAQCO. The cosmesis index was significantly highest in the transoral (92.3 points) and transaxillary groups (90.9 points), followed by the postauricular (84.8 points) and transcervical groups (76.4 points). This study examined the reliability and validity of the SAQCO and showed that it is a suitable questionnaire for assessing cosmetic satisfaction of patients after thyroidectomy. The transoral and transaxillary approaches yield significantly superior cosmetic results compared to the conventional transcervical and postauricular approaches.

Gland preservation with postauricular sulcus approach for benign parotid tumors

An observational longitudinal investigation encompassed 46 patients undergoing gland-preserving surgery for benign parotid tumors via the postauricular sulcus incision approach. Patient assessments included cosmetic contentment, functional repercussions, and disease management throughout the follow-up. Predominantly, tumors were situated in the superficial lobe, with successful application observed in 8 instances (17%) within the deep lobe. Notably, no tumor recurrences were detected during the follow-up period. Postoperative pain remained minimal, accentuated by high patient satisfaction regarding the incision scar and facial symmetry. Furthermore, preservation of facial nerve functionality and salivary secretion was observed. Gland-preserving surgery via the postauricular sulcus incision technique exemplifies advantageous functional and cosmetic outcomes when addressing benign parotid tumors. This approach presents a secure and efficient alternative, facilitating effective local management.

Auricular Protrusion After the Postauricular Approach: A Review of the Current Literature.

The postauricular approach is a widely adopted surgical technique for the ear due to its unique access to the middle ear, mastoid, and other internal structures, while adeptly concealing the surgical incision for aesthetic superiority. Despite its advantages, concerns have emerged regarding the potential for auricular protrusion following the procedure. While the exact mechanisms underlying this phenomenon remain under debate, it is worth noting that comprehensive literature on this topic is scant. Nevertheless, available studies predominantly indicate no association between the postauricular approach and lasting auricular protrusion. In the few reports that do note its occurrence, the protrusion appears transient, resolving over time. These findings suggest that surgeons should continue using the postauricular approach without concerns regarding auricular protrusion. Nonetheless, it is recommended to take all precautionary measures, including appropriate patient selection, engagement of an experienced surgeon, and meticulous postoperative dressing.

Comparison between classic ‘Fisch’ and ‘corner-tag’ meatoplasty techniques after canal wall down tympanomastoidectomy

PurposeTo compare outcomes of two different methods of meatoplasty following Canal Wall-Down tympanomastoidectomy. MethodsA retrospective case review study of 48 patients with non-complicated unsafe chronic suppurative otitis media candidate for post-auricular canal wall-down tympanomastoidectomy via a post-auricular approach at Otolaryngology department, Benha university hospitals from January 2021 to January 2023, all were operated for the first time, and divided into 2 groups each of 24 patients. Group A submitted for classic ‘Fisch’, and group B ‘Corner-Tag’ meatoplasty. ResultsThe mean age was 28.88 ± 13.26 years in group A and 33.33 ± 16.04 years in group B. Only one patient (4.2 %) in each group developed wound infection and none in both groups developed perichondritis. Two patients (8.3 %) in group B compared to only one patient (4.2 %) in group A had granulations on the meatal incision. One patient (4.2 % of group A) needed revision meatoplasty. Group B needed more time for epithelization (mean 7.33 ± 0.96 weeks) than group A (mean 6.5 ± 0.88 weeks; P = 0.003*) also resulted in wider mean new meatus in group B (mean 10.50 ± 1.02 mm) than in group A (mean 9.63 ± 1.41 mm; P = 0.02*). ConclusionBoth techniques had comparable post-operative complications. ‘Corner-Tag’ technique needed more time for healing and epithelization but gave a wider new meatal diameter than ‘Fisch’ meatoplasty after one year of follow-up.

Successful Myringoplasty - Do The Site &amp; Size Of TM Perforation Matter?

Objective: To determine the success rate of myringoplasty based on the site and size of tympanic membrane perforation. Study Design: Cross sectional, Descriptive Study Settings: ENT Department Fauji Foundation Hospital, Rawalpindi Study Duration: 30 July 2019 to 29 December 2021. Material and Methods: After approval of Hospital Ethical Committee, a sample size of 100 patients was calculated by using WHO sample size calculator. Patients were selected through Non probability convenient sampling. Informed consent was obtained from all the patients. All the patients were operated upon through post auricular approach using underlay technique and temporalis fascia was used as a graft in all the cases. Success of myringoplasty was assessed one month after surgery. Myringoplasty was considered successful upon complete closure of the defect as assessed under surgical microscope. Data analysis was done for frequencies and percentages using SPSS version 24. Results: There were 52% males and 48% females. Mean age of patients was 35.5 years and they ranged between 17 to 48 years. Overall myringoplasty was successful in 71% patients. Regarding the size of perforation, it was successful in 100% pinhead size perforations, in 86.7% small sized, 89.5% medium sized, 42% large and 6.7% subtotal sized perforations. Regarding site of the perforations, myringoplasty was successful in 96% anterior, 100% posterior, 40% inferior, 40% middle and 8% subtotal/ large perforations. Conclusion: Myringoplasty is an effective surgery for sealing Tympanic Membrane perforations resulting in better quality of life. Success rate of myringoplasty has a definite association with size and site of perforation. The smaller the perforation, the higher would be the success rate. Similarly, anterior and posterior perforations heal better as compared to inferior and mid position perforations. Key words: Myringoplasty, Size and site of Tympanic membrane perforation, Tympanic membrane, Chronic Suppurative Otitis Media.

Comparison of subcutaneous soft tissue versus temporalis fascia as a tympanoplasty graft material: a retrospective cohort study.

This research compares the efficacy of subcutaneous soft tissue and temporalis fascia in tympanic membrane grafting for large tympanic membrane perforations. A retrospective cohort study compared tympanic membrane graft success rate and hearing outcomes in 248 patients who underwent tympanoplasty using subcutaneous soft tissue (n = 118) or temporalis fascia (n = 130) via the post-auricular approach. Comparable results were observed in both groups. Tympanic membrane graft success rate was 98.3 per cent (116 ears) in the subcutaneous soft tissue group and 98.5 per cent (128 ears) in the temporalis fascia group. The rate of air-bone gap closure within 20 dB was 54.2 per cent (64 ears) and 60.0 per cent (78 ears) in the soft tissue and temporalis fascia groups, respectively (p = 0.360). Subcutaneous soft tissue is a reliable and readily available tympanic membrane graft material in both revision and primary tympanoplasty for large tympanic membrane perforations.

Long-Term Results of Tragal Cartilage Type 1 Tympanoplasty

Aim: Tympanoplasty is one of the most frequently performed operations by ear, nose, and throat specialists. Surgical treatment of tympanoplasty aims to obtain a healthy ear membrane and minimise hearing loss. The purpose of this study was to evaluate the success of the graft and functional hearing outcomes of patients applied with tragal cartilage type 1 tympanoplasty operation in our clinic. Materials and Methods: This study included 43 patients who underwent tragal cartilage type 1 tympanoplasty operation between January 2016 and November 2020. A retrospective evaluation was made of the preoperative pure tone audiometry (PTA) values and the operative findings. In the follow-up examination, the graft status and PTA results were recorded. The graft success and improvements in hearing were evaluated in all the patients. Results: A total of 43 patients were evaluated, comprising 24 males and 19 females with a mean age of 31.2 years (range, 13-58 years). The operation was performed on the right ear of 22 patients and the left ear of 21. The tympanoplasty operation was performed with an endaural approach in 6 cases and a postauricular approach in 37. The mean follow-up period was 20.8 months (range, 12-39 months). The rate of graft success of all the patients was 88.4%. The mean air conduction threshold, air-bone gap, and bone conduction threshold values at 500, 1000, 2000, and 4000 Hz were determined to have statistically significantly decreased postoperatively in comparison with the preoperative values (p&amp;lt;0.05). Conclusion: In tragal cartilage type 1 tympanoplasty operations, high rates of graft success were obtained and a dramatic gain in hearing postoperatively.

Double-layer fascial grafts in Type I tympanoplasty for subtotal perforation: A case–control study

Objective: The objective of this study was to assess the double-layer temporalis fascia grafting for myringoplasty for subtotal tympanic membrane (TM) perforation regarding graft uptake and hearing gain. Patients and Methods: The study included 60 patients with subtotal TM perforation attributed to tubotympanic suppurative otitis media. Myringoplasty was done through a postauricular approach using the underlay technique by two layers of the temporalis fascia grafts in the study group and one layer of the temporalis fascia graft in the control group. The procedure was considered successful if there was no residual TM perforation within the follow-up period. Results: Within included 60 patients, 30 patients in the study included 60 patients, 30 patients in the study group (11 males and 19 females) and 30 patients in the control group (9 males and 21 females). The success rate of TM healing was 100% in the case group and 87.7% in the control group with significant difference (P = 0.038). The hearing gains (>10 dB) were reported in 96.7% in the case group while it was 70% in the control group which is significantly better (P = 0.00558). Conclusion: The double-layer temporalis fascia graft is effective for both postoperative graft taking and hearing improvement for subtotal (Grade 4) TM perforation.

Study On The Outcome Of Endoscopic Tympanoplasty Versus The Conventional Method.

BACKGROUND : Endoscopic tympanoplasty is an minimally invasive surgery for the repair of tympanic membrane with complete graft survival and hearing outcomes to the conventional microscopic surgery. This study was aimed to evaluate the success rate of endoscopic trans-canal closure of tympanic membrane perforation compared to the conventional post auricular approach using temporalis fascia and tragal cartilage as a graft. METHODS: Our study consisted of 50 patientswith chronic otitis media,with dry ear for last 2 months and all patients were between 18-50yrs of age.All selected patients were subjected to pre operative oto endoscopicand audiological assessment and underwent endoscopic trans canal tympanoplasty using temporalis fascia in some and tragal cartilage in some. RESULTS: Trans canal endoscopic surgery resulted in the successful healing of 97% whereas in conventional method successful healing was only up-to 92%. The average hearing gain was also significantly improved in endoscopic surgery compared to that of conventional method. When the operative time was considered the mean time in endoscopic method was lesser. All patients were followed up for a period of 3 months. CONCLUSION: Comparisons between these 2 groups focused on the surgical outcomes and restoration of hearing, including the duration of surgery. All patients were followed up for a period of 3 months. Using this method not only improves the cosmetic outcome but also reduces the post operative morbidity with shorter operative time. KEYWORDS: Endoscopic Tympanoplasty, Conventional Tympanoplasty, Tympanoplasty

Surgical Steps of Gasless Transaxillary Endoscopic Thyroidectomy: From A to Z.

In the past 30 years, the incidence of differentiated thyroid cancer (DTC) has been increasing rapidly and has become one of the most common malignant tumors in females. Currently, the main surgical treatment for DTC is standard open thyroidectomy (SOT) via a traditional Kocher mid-cervical incision, but postoperative neck scarring was associated with significantly worse health-related quality of life (HRQOL) scores. To offer better cosmesis, robotic/endoscopic thyroidectomy via cervical, axillary, anterior chest, breast, postauricular, or transoral approaches have been developed over the past 20 years. In general, gasless transaxillary endoscopic thyroidectomy (GTET) has advantages in terms of convenience, clarity of vision, and aesthetic incision. The current work aims to provide a step-by-step description of GTET, supported by a high-quality, pictorial guide.