ABSTRACT
Abstract Introduction The surgical management of jugulotympanic paragangliomas has remained challenging. They are the second most common type of tumor of the temporal bone after acoustic neuroma. It has been noticed by the authors that the jugulotympanic paragangliomas may have extensions to the epitympanum and aditus in addition to the mesotympanum and hypotympanum. The modified technique could be an alternative to the conventional facial recess technique for complete removal of the tumors. Objective To highlight the modified surgical technique for the surgical treatment of jugulotympanic paragangliomas. Methods This is a retrospective review of 34 cases of jugulotympanic paragangliomas treated in a tertiary center with respect to clinical presentation, diagnosis, and surgical treatment. Tinnitus and hearing loss were predominant symptoms. A modified technique of postauricular transcanal posterior tympanectomy with extended hypo-tympanic access was performed in 29 patients. Only two cases were operated with a classical transcanal approach. A canal wall down the mastoidectomy was required in three patients. Results The patients operated on with the modified technique had complete excision evident by absence of any lesion in computed tomography and the disappearance of tinnitus. However, two patients had recurrence of symptoms and presence of tumor in the follow-up period. These two patients underwent revision surgery. None of the patients required postoperative radiotherapy or gamma knife therapy. Conclusions Jugulotympanic paragangliomas can be effectively managed with the modified technique to ensure complete removal of the lesions. This technique has not been reported earlier in the literature.
ABSTRACT
OBJECTIVE: The purpose of this study was to collect parametric measures of TEOAEs in normal hearing children of various age-groups and to establish a normative baseline for Transient Evoked Otoacoustic Emissions (TEOAEs). METHODS: Sixty subjects were investigated in three age-groups: neonates, 0-1 month; infants, 1 month-1 year; and children, 1-6 years. Each group comprised of 20 subjects. All the subjects underwent medical examination by a pediatrician and an ENT surgeon. Screening for hearing was done by immittance testing, behavior observation and conditioned play audiometry. The TEOAEs were analyzed for the parameters of amplitude, cross-correlation (wave reproducibility) and signal-to-noise ratio (SNR). RESULTS: There was no difference between the mean amplitudes of the right and left ears in the groups. The females in the neonates group had higher emission amplitudes than the males. The mean amplitude of the subjects in the neonates group was significantly higher than the subjects in the infants or children groups. The cross correlation (wave reproducibility) was constant across the age. The mean SNR for all the subjects were well above 3 dB at frequencies 1.5 k, 2 k, 3 k and 4 kHz. The neonates group showed the lowest SNR ranging between 3.47 to 9.62 dB. The infants group showed the highest SNR ranging between 6.13 to 13.11 dB. CONCLUSION: The TEOAEs response measures of SNR and cross correlation, at frequency bands 1.5, 2, 3 and 4 kHz, may provide more reliable outcomes than TEOAEs amplitude. Subjects in the age range of 0-1 month show lower SNRs than those in higher age ranges. The values can be used as normative data for screening and diagnostic purposes in the pediatric population.
Subject(s)
Acoustic Impedance Tests , Acoustic Stimulation , Child , Child, Preschool , Evoked Potentials, Auditory , Female , Humans , Infant , Infant, Newborn , Male , Otoacoustic Emissions, Spontaneous/physiology , Reference ValuesABSTRACT
Our experience with the diagnosis and management of bilateral choanal atresia is presented. Four patients were treated by endoscopic transnasal approach followed by stenting with portex endotracheal tube for four to six weeks. Meticulous postoperative care particularly stent management is crucial for successful treatment of choanal atresia.