Role of endoscopic control with canal wall down [CWD] in decreasing cholesteatoma recidivism

To evaluate the role of otoendoscope in conjunction with conventional otomicroscopic surgery of canal wall down technique; to inspect hidden areas and decrease rate of recidivism in cholesteatoma surgery. Also, to assess the role of partial obliteration of mastoid [leaving open attic] to decrease cavity problems of open technique. This study was conducted on 25 patients with cholesteatoma. Initial CWD technique was done for all cases in a trial to reduce recidivism. After complete removal of cholesteatoma matrix, otoendoscoy was used to inspect hidden areas, the incidence and sites of discovered cholesteatoma were recorded. Reconstruction of hearing mechanism and partial obliteration of mastoid were done. Follow up was done for 2 to 4 years and a C.T. scan was made after 1 to 2 years for every patient and a second look mastoidoscopy was carried out when needed. The incidence and site of recidivism was reported, and compared with the C.T. scan results. The use of otoendoscope after removal of cholesteatoma by otomicroscopic surgery lead to discover of residual cholesteatoma matrix in 9 patients [36%]. The highest incidence was in sinus tympani and facial recess and the least was in hypotympanum and round window niche. After partial obliteration of mastoid, cavity problems were encountered only in one patients [4%] and was successfully managed by local treatment. The second look mastoidoscopy revealed recidivism only in 1 patient [4%]. Otoendoscopy in cholesteatoma surgery improved visualization of hidden areas and decreased rate of recidivism. Also partial obliteration of lower mastoid in CWD technique lead to decrease complications of cavity problems

Atypical osteomyelitis of the skull Base

The authors reporetd six cases of atypical osteomyelitis of the skull base in diabetic patients. They were studied clinically, radiologically and pathologically. This disease may arise without intial temporal bone affection or may complicate incompletely treated malignant otitis externa. Spread of the disease may occur through vascular involvement of the skull bones and fascial planes rather than through the air cells. The ethmoid the sphenoid and occipital bones are affected beside the temporal bones and the petrous apex. Multiple cranial nerves may be affected including the 2nd, 3rd, 4th, 5th, 9th and 10th nerves and the disease may present as the jugular foramen or the orbital apex syndromes. The morbidity and the mortality of the disease is higher in patients without previous temporal bone affection because it is usually not promptly recognized and treated