Surgery For Chronic Ear Disease Research Articles

Bone Cement for Ossicular Chain Defects

Abstract Background: The discontinuity of ossicular chain most commonly affects the incudostapedial joint in 80% of patients an absent incus, or an absent incus and stapes superstructure. This discontinuity leads to a conductive hearing loss of different degrees. The goals of surgery for chronic ear disease are eradication of the disease and reconstruction of a sound transformer mechanism, but reconstructing this defect is a challenging procedure for the surgeon with different treatment options such as total ossicular chain prosthesis, a partial ossicular chain prosthesis, incus interposition, or bone cement utilization. Extrusion of the prosthesis is still a challenge in ossiculoplasty with alloplastic materials, especially in patients with poor eustachian tube function. Bone cement is cost effective, because it is cheaper than other ossiculoplasty materials, and this cost-effectiveness plays an important role in the decision the surgeon has to make, and bone cement has a promising role in this so, there is a rising interest in the otologic surgical field to use bone cement because of its biocompatible profile, its easy application, its suitable cost, and its low extrusion rate. Also, it may have a potentiality of neo-osteogenesis. Aim of Study: To evaluate the post-operative results and usefulness of bone cement application in repairing ossicular chain defects, to discuss surgical technique, and to compare pre-operative and post-operative ABG. Patients and Methods: This study was carried out in the ORL-HNS Department, Hearing and Speech Institute, from April 2015 to March 2018, on 30 patients with ossicular chain defect. Bridging of ossicular discontinuity was done by glass monomer bone cement in all patients. Results: In this study, successful hearing restoration could be achieved in 96% of the patients represented, as 52% of the patients had hearing improvement (dB gain) of more than or equal 10 dB, and 26% of patients had hearing im-provement (dB gain) more than 20 dB, and 18% of patients had hearing improvement (dB gain) of more than 40 dB, after 12 months.Conclusion: Incudostapedial joint rebridging ossiculo-plasty with ionomeric bone cement is a reliable method for ossicular reconstruction that is cost effective and offers satisfactory hearing results in selected patients.

Association of Tympanostomy Tubes With Future Risk of Advanced Ear Surgery-A Population Study.

To investigate future surgery for chronic ear disease in children who underwent tympanostomy tube (TT) placement, compared with non-surgically treated patients and healthy controls. Retrospective population-based cohort study. All hospitals in the Canadian province of Ontario. Of children aged 18 years and younger, three cohorts were constructed: 1) TT: patients who had undergone at least one TT procedure (n = 193,880), 2) No-TT: patients with recurrent physician visits for middle ear concerns who did not undergo TT (n = 203,283), and 3) Control: an age-sex matched control group who had not had TT or physician visits for recurrent middle ear concerns (n = 961,168). Risk, and odds ratios (ORs) of surgery for chronic ear disease. The TT cohort had a higher risk of tympanoplasty (OR 9.50 versus No-TT, p < 0.001; OR 207.90 versus Control, p < 0.001), ossiculoplasty (OR 3.22 versus No-TT, p < 0.001; OR 84.13 versus Control, p < 0.001), atticotomy (OR 4.41 versus No-TT, p < 0.001; OR 44.78 versus Control, p < 0.001), and mastoidectomy (OR 3.22 versus No-TT, p < 0.001; OR 89.12 versus control, p < 0.001). This study describes the population risk of subsequent ear surgeries in TT patients. These TT patients have a significantly higher risk of surgery for chronic ear disease versus those patients with recurrent middle ear disease that did not undergo TT, and age-sex matched controls.

Site of eustachian tube obstruction in chronic ear disease.

Assess the patency of the proximal and distal segments of the Eustachian tube in patients undergoing surgery for chronic ear disease. Case study with control group. All consecutive patients presenting for surgery for chronic ear disease in our practice over 14 months underwent preoperative Valsalva computed tomography (CT), and an attempt was made intraoperatively using angled rigid scopes to evaluate obstruction of the protympanic segment of the Eustachian tube. Endoscopic examination of the same segment in 19 cadaver ears served as a control group. Preoperative Valsalva CT showed patency of the distal one-third of the Eustachian tube in 51 of 53 ears. Intraoperative endoscopy allowed visualization of the protympanic opening of the Eustachian tube in 31 of 53 ears; 21 of 31 ears showed obstruction of the protympanic opening of the Eustachian tube. A clear obstruction was more likely to be present in the protympanic opening of the Eustachian tube in the patient population undergoing surgery for chronic ear disease than in the cadaver control group, and was equally likely to be present in the distal cartilaginous tube in patients as in the control population. 4.

Quality-of-Life Assessment After Primary and Revision Ear Surgery Using the Chronic Ear Survey

To measure subjective outcomes after primary and revision surgery for chronic ear disease. Prospective questionnaire-based outcome study. Tertiary referral center. Adults with chronic otitis media with or without cholesteatoma. Primary or revision surgery for chronic ear disease. The Chronic Ear Survey, a disease-specific outcome survey, was administered preoperatively and at 1 year after surgery. We analyzed the total score and the activity restriction, symptom, and medical resource utilization subscale scores. Scores were averaged on the basis of the number of questions included in each category. Differences in preoperative and postoperative scores were analyzed within and between the 2 groups. We also assessed audiometry, postoperative complications, and the clinical condition of the operated-on ear. Twenty-one patients were enrolled in the primary surgery group, and 20 were enrolled in the revision surgery group. Significant improvements in the total score and each subscale score were observed in both groups at the 1-year postoperative survey. Improvements in the total score and symptom subscale scores were greater in the primary surgery group than in the revision surgery group (P < .05). The air conduction thresholds and any postoperative clinical problems were correlated with the total score and subscale scores in the primary group but not in the revision surgery group. Comparable objective outcomes are achieved after primary and revision surgery for chronic ear disease, but the improvement in quality of life is greater in the primary surgery group.

Use of Titanium in Repair of External Auditory Canal Defects

Canal wall defect repairs commonly result from cholesteatoma, surgery for chronic ear disease, or exostosis and also from congenital deformities. Reconstructions of these defects are often difficult and unstable. This article reports the use of titanium sheeting to repair external auditory canal wall defects. Titanium sheeting was used to repair a variety of wall defects. The sheeting was used as a support material, lying deep to the wall defect, which was sealed with an autograft cartilage layer that was fitted to fill the defect. Middle temporal or temporalis fascia vascular flaps were used to cover large-defect repairs to promote rapid healing. The sheeting was used in 56 external auditory canal defect cases, including 35 deep canal defects, 4 lateral bony wall repairs, 12 open-cavity reconstructions, and 5 anterior wall repairs. There were no evident biomaterial complications, and infection was absent from the series. The sheeting was simpler touse than ceramics, being easily shaped and bent to fit the individual case. Second-look cavity reinspections were simpler than when ceramics or autografts had been used for reconstructions. Titanium sheeting has been proven an effective method of canal wall repair when combined with the supplementary techniques used with biomaterials in this role (cartilage cover and vascular flaps). Its ease of use, versatility, and reliability are superior to previous organic or ceramic methods.

Surgery for chronic ear disease in a non-university hospital: open cavity, obliteration and intact canal wall techniques

The long-term results of surgery for chronic suppurative middle ear disease at a non-university ENT-clinic (Vasa Central Hospital, Finland) are reported. The material consisted of 273 ears, 65 of which had been operated on by open cavity techniques, 178 by the original Palva obliteration method, and 30 by the intact canal wall method. Post-operative cholesteatoma occurred equally frequently with the two canal wall down methods (7.7 and 7.3%, respectively) but was more frequent after intact canal wall surgery (23.3%). Hearing was better and the infection rate lower with obliteration than with open cavity techniques. Post-operative infection was the least frequent and the hearing result best in the intact canal wall ears, but compared to the other two groups the extent of disease found at surgery was considerably less in this group. The obliteration operation proved to be a safe method in the hands of a practising otologist outside university clinics.

Chronic Ear Surgery in Patients With Syndromes and Multiple Congenital Malformations

The propensity for the development of chronic ear disease in patients with certain congenital syndromes is well described. Little is known about the efficacy of surgery in the management of such patients. This paper will review an institutional experience with the surgical management of chronic ear disease in patients with congenital syndromes or multiple major malformations associated with high rates of ear disease. Retrospective chart review. Charts were reviewed to identify patients diagnosed with either a congenital syndrome or multiple major malformations with a known association with the development of chronic ear disease who underwent ear surgery for chronic ear disease (excluding tympanostomy tube placement). Syndromes encountered, surgeries performed, operative outcomes, complications, and the efficacy of ossicular chain reconstruction is reported. Forty-three patients with 14 different syndromes or malformations were identified. These patients underwent 66 surgical procedures on 56 ears. Seventy-nine percent of patients had undergone an ear procedure prior to presentation. Disease eradication was achieved in 64% of ears with a single procedure, and 89% of ears were controlled with two surgeries or less. Thirty-two percent of surgeries involved a canal wall down procedure, a rate similar to that seen for all patients in our practice over the past decade. When used, ossicular chain reconstruction significantly reduced the air-bone gap, resulting in hearing improvement. Results for patients with Down syndrome, Turner syndrome, and conotruncal cardiac abnormalities are discussed. Only minor complications were encountered. Syndromic patients and those with a major congenital malformation may present with significant chronic ear disease. Appropriate surgical management can yield successful eradication of disease with low complication rates.

High incidence of complications encountered in chronic otitis media surgery in a U.S. metropolitan public hospital

Objectives: To examine the incidence and nature of complicating factors in surgery for chronic otitis media (COM) in a metropolitan public hospital in the United States. Methods: A retrospective review was performed over 2 years in a metropolitan public hospital to identify cases of surgery for chronic ear disease with the following complicating factors: intracranial or extracranial abscess, labyrinthine fistula, dural dehiscence with or without associated encephalocele or meningocele, or extensive involvement of the facial nerve by cholesteatoma with or without paralysis. Results: Thirty-three of 90 consecutive operations for COM (37%) met criteria for complicated chronic otitis media (CCOM). The majority (85%) of patients had cholesteatoma involvement. Most patients (73%) were managed by an extended modified radical mastoidectomy. An additional 31 procedures were required in these 33 patients for control of complications. There was no iatrogenic sensorineural hearing loss or facial paralysis. Conclusions: The incidence of CCOM in this large, U.S. metropolitan public hospital is similar to that observed in developing nations. CCOM significantly complicates chronic ear surgery and substantially increases the use of resources. Maintaining functional hearing is possible, but difficult, and should be considered secondary to prevention of further complications and eradication of disease. Access to health care and proper follow-up are crucial in prevention of CCOM. (Otolaryngol Head Neck Surg 2001;125:623-7.)

Chronic suppurative otitis media and cholesteatoma. Vanishing diseases among Western populations?

A population-based survey of patients who had undergone surgery for chronic ear disease over the past 30 years in northern Finland revealed that the number of new surgical cases of both chronic suppurative otitis media and cholesteatoma has declined sharply after a peak in 1971-1974 and is now almost non-existent in contrast to the number of patients being operated on for chronic dry perforations, which has remained more or less the same. Most of the patients with chronic suppurative otitis media and cholesteatoma had had chronic ear trouble as early as the 1940s or 1950s. Moreover, if an active chronic otitis media developed in these cases, it started at a younger age than in cases with an onset after the 1950s. These facts may indicate that the decrease seen in this population is in close connection with the introduction of antimicrobials in the treatment of acute otitis media in the mid-1950s in the area.

Results of bone conduction following surgery for chronic ear disease.

Preoperative and postoperative bone conduction thresholds were compared in 181 chronic ears operated on over a 5-year period between 1990 to 1994. In the majority (92%) of cases the bone conduction thresholds remained unchanged (+/-10 dB). Nine ears (5%) showed better thresholds after surgery, with improvements ranging from 11 dB to 25 dB. This improvement was especially noted in ears with severe tympanic pathology. One ear with a large labyrinthine fistula became totally deaf after surgery. In 5 ears (3%) bone-conduction thresholds deteriorated, but remained measurable at all frequencies tested. In these latter cases this impairment ranged from 11 dB to 27 dB. Cholesteatomatous ears having intact ossicular chains were found to be at the highest risk of inner ear damage when "canal wall-down" mastoidectomies were performed. Methods for prevention of sensorineural hearing loss following chronic ear surgery are discussed.

Lasers In Surgery For Chronic Ear Disease

This article describes specific situations in which the laser has been found to be useful in surgery for chronic ear disease. In the opinion of the authors, the most important application is the atraumatic removal of cholesteatoma from a mobile stapes. Additional uses include precise and hemostatic removal of diseased tissue (polyps, granulations, adhesions) and manipulations upon an intact ossicular chain without induction of vibrational trauma. Potential complications such as facial nerve and inner ear injury are considered.

Endoscopic Otologic Surgery

In this article, various otologic and neurotologic procedures, including middle ear exploration, chronic ear disease surgery, second-look mastoidectomy, acoustic neuroma surgery, and vestibular neurectomy, are reviewed for the usefulness of minimally invasive endoscopic techniques.

Facial nerve monitoring and stimulation during surgery for chronic ear disease

Facial nerve monitoring and stimulation during surgery for chronic ear disease

Surgery for chronic ear disease in a non-university hospital: open cavity, obliteration and intact canal wall techniques

The long-term results of surgery for chronic suppurative middle ear disease at a non-university ENT-clinic (Vasa Central Hospital, Finland) are reported. The material consisted of 273 ears, 65 of which had been operated on by open cavity techniques, 178 by the original Palva obliteration method, and 30 by the intact canal wall method. Post-operative cholesteatoma occurred equally frequently with the two canal wall down methods (7.7 and 7.3%, respectively) but was more frequent after intact canal wall surgery (23.3%). Hearing was better and the infection rate lower with obliteration than with open cavity techniques. Post-operative infection was the least frequent and the hearing result best in the intact canal wall ears, but compared to the other two groups the extent of disease found at surgery was considerably less in this group. The obliteration operation proved to be a safe method in the hands of a practising otologist outside university clinics.

The hypotympanum and infralabyrinthine cells in chronic otitis media

Despite the localization implied by the term "chronic otitis media," little attention has been paid to the role of the hypotympanum in chronic active otitis media. Most authors have emphasized the role of recurrent cholesteatoma or unexenterated cells in the mastoid cell system as causes of recurrent disease. Seven cases are reported in which clinical evidence indicated that recurrent chronic otitis media was limited to the hypotympanum and infralabyrinthine cell system. In the five cases in which revision surgery was done, exenteration of this area resulted in an asymptomatic ear. The anatomy, radiographic evaluation, and surgical approach to the hypotympanum are reviewed. Careful inspection of the hypotympanum in primary surgery for chronic ear disease and exenteration of the hypotympanic and proximal infralabyrinthine cell tract are advocated when these regions contain cholesteatoma or extensive granulomatous disease.

Surgery for Chronic Ear Disease in Children

This paper describes a retrospective study of 44 children (50 ears) whose first ear operation was performed during the past four years.The most common disease was acquired cholesteatoma (27 cases), followed by 15 ears with simple chronic infection and 6 with cholesterol granulomas.On the basis of the analysis of cholesteatomas, the authors emphasize that cholesteatomas in children under the age of six years are more progressive and destructive, so early diagnosis and early operation are essential.The operative procedures for each disease and the postoperative results are discussed briefly.

Preservation of the lenticular process of the incus in surgery for chronic ear disease.

The LaryngoscopeVolume 93, Issue 10 p. 1362-1363 How I Do It Section “How I Do It” — Otology and Neurotology. A Specific Issue and Its Solution Preservation of The Lenticular Process of The Incus In Surgery for Chronic Ear Disease† Tauno Palva M.D., Tauno Palva M.D. Helsinki, Finland.Search for more papers by this author Tauno Palva M.D., Tauno Palva M.D. Helsinki, Finland.Search for more papers by this author First published: October 1983 https://doi.org/10.1002/lary.1983.93.10.1362Citations: 4 Send Reprint Requests to Tauno Palva, M.D., Haartmaninkatu 4E, 00290 Helsinki 29, Finland. †From the Department of Otolaryngology, University of Helsinki, Finland. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume93, Issue10October 1983Pages 1362-1363 RelatedInformation

Why does middle ear cholesteatoma recur?

Mucosal biopsy specimens were taken from 75 ears undergoing surgery for chronic ear disease. The specimens were studied for squamous epithelium under the operation microscope, and findings during surgery were recorded for comparison with the results of the histologic examination. In 13 ears (17.3%) the histologic study disclosed squamous epithelium in the biopsy specimens that had been clinically judged to be free of such epithelium. Most specimens contained full-thickness squamous epithelium with some surface keratin. In some specimens up to 3 mm long strips of squamous epithelium without granular cell layer were observed. These areas represented the advancing front of squamous epithelium capable of producing mature squamous epithelium. The positive specimens were all well separated from the clinical cholesteatoma and were either extensions over the perforation edges or from the cholesteatoma epithelium in the middle ear or mastoid. Apparently, this unrecognized and nonremoved squamous epithelium is the main reason for the high incidence of cholesteatoma recurrence reported by some surgeons.

Surgical technique for open mastoid procedures.

In mastoid surgery for chronic ear disease (with or without cholesteatoma), the removal of the posterior canal wall does not necessarily insure a "safe" ear. Open procedures are subject to many of the same complications that are associated with the more controversial closed technique. In addition, if the canal wall down procedure is not performed with great care and under strict guidelines, the postoperative ear can be a continual nuisance to the patient. The author has reached these conclusions based upon 20 years' experience in dealing with "problem cavities" created by himself and others. The purpose of this paper is to define the "problem cavity" and how to prevent it.

Chronic ear infection in the immunodeficient patient.

In the immunodeficient patient, surgery for chronic ear disease is often unsuccessful. Early recognition of the immune deficiency is of paramount importance in minimizing bacterial infection within the postoperative surgical field. The intravenous administration of immunoglobulins via plasma transfusions, intramuscular injections of gamma-globulin, and the selective use of immunoglobulin applied directly to the healing wound seem useful in achieving beneficial surgical results by containment of infection.