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Background: Facial nerve palsy is a common intra-temporal complication of untreated chronic suppurative otitis media (CSOM) causing erosion of the fallopian canal and its pressure effects leading to facial weakness. There is a less favorable outcome in patients of CSOM with diabetes as they are more prone to neural degeneration. In such patients, early surgical decompression of the facial nerve helps in resolving facial palsy to some extent. In our study of 22 patients, we analyzed the prognosis and advantage of doing early surgical facial nerve decompression along with modified radical mastoidectomy in patients of unsafe CSOM with diabetes mellitus. Materials and Methods: We present a retrospective study of 22 patients with a squamosal type of CSOM with diabetes mellitus who came to the outpatient department, from June 2019 to March 2021, with complaints of ear discharge and facial palsy grades 3–5, in whom we did early surgical facial nerve decompression along with modified radical mastoidectomy. We observed the incidence of facial palsy and recovery after facial nerve decompression with limited use of steroids in patients with diabetes mellitus. Results: In our retrospective study of 22 patients with squamosal type of CSOM with diabetes mellitus with complaints of facial palsy, 10 were males and 12 were females. Patients were assessed clinically using House– Brackmann grading: 55% are of grade III, 31% are of grade IV, and 14% are of grade V. About 82% of the patients from our study had lesions at the tympanic segment, 9% patients had lesions at the vertical segment, 4.5% patients had lesion at the first genu, and 4.5% patients had lesion at the second genu. In our study, 95% of the patients from the study improved with early facial nerve decompression along with modified radical mastoidectomy, 55% of the patients improved to grade I, 36% of the patients improved to grade II, and 9% of the patients improved to grade III. Conclusion: In squamosal-type CSOM patients with facial palsy, early facial nerve decompression along with modified radical mastoidectomy within 12 weeks of development of facial palsy provides better results than just modified radical mastoidectomy as it increases recovery rate and reduces the need for post-operative steroids which is an advantage in diabetics.
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Background: Chronic Suppurative Otitis Media (CSOM) is one of the most common causes of preventable hearing loss especially in developing countries CSOM is a disease condition characterized by persistent perforation of tympanic membrane with recurrent or persistent mucopurulent Otorrhoea Aim: This study was undertaken to review the outcomes (hearing improvement) achieved by using various graft materials like temporalis fascia (TF), tragal cartilage (TC), Conchal cartilage (CC), autologous sculpted incus (I), autologous cortical bone (BG) in tympanoplasty surgery Material and methods: This study comprised of 14 males and 16 females patients with age ranging from 12 years to 55 years They were selected for surgery after adequate history taking, clinical, otoscopic and microscopic examination Type 1 tympanoplasty was done in 19 patients, Type 3 tympanoplasty + Modified Radical Mastoidectomy (MRM) was done in 11 patients by using various graft materials The results were evaluated in the form of rate of graft success, hearing gain, and the pre and post-operative Air Bone gap Results: Out of 30 patients, in 20 TF graft patients AB gap improvement seen in 14 patients, 5 patients did not show any change and 1 patient did not come for follow up In 2 TC graft patients, both showed improvement in AB gap In 1 patient where CC graft was used showed improvement in AB gap In 6 patients I graft was used, 2 patients showed improvement, 2 patients did not show any change, 1 patient did not come for follow up and in 1 patient AB gap worsened In 1 patient BG was used and no change in AB gap was seen Out of 30 cases graft uptake was seen in 25 cases and graft rejection was seen in 3 cases and 2 patients did not come for follow up Graft rejection was documented in one case where TF was used, one case where incus graft was used and in another case where BG was used Harinarayana N, Srikanth M A study on the outcome of tympanoplasty with various graft materials IAIM, 2018; 5(12): 77- 82 Page 78 Conclusion: Post-operative hearing gain obtained was found to be better in patients operated upon with tubotympanic disease than those operated upon with atticoantral disease The post-operative hearing improvement depends not only on the graft material used and the type of tympanoplasty but also on the pre-operative status of the ossicular chain
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Objective To investigate the clinical efficacy of open radical mastoidectomy (ORM) combined with ear cavity angioplasty and mastoid cavity obliteration in treatment of cholesteatoma otitis media (COM). Methods Eighty-two patients with COM were divided into 2 groups according to surgical approach: control group (41 patients undergoing simple ORM) and observation group (41 patients undergoing ORM combined with ear cavity angioplasty and mastoid cavity obliteration). The clinical efficacy and recurrence rate between the 2 groups were compared. Results The total effective rate, dry ear rate and eardrum healing survival rate in observation group were significantly higher than those in control group: 95.12% (39/41) vs. 78.05% (32/41), 97.56% (40/41) vs. 75.61% (31/41) and 90.24%(37/41) vs. 73.17% (30/41), and there were statistical differences (P0.05). The recurrence rate in observation group was significantly lower than that in control group:2.44%(1/41) vs. 14.63%(6/41), and there was statistical difference (P<0.05). Conclusions The application of ORM combined with ear cavity angioplasty and mastoid cavity obliteration in the treatment of COM has significant effect, with rapid postoperative dry ear and epithelialization, fewer complications and lower recurrence rate. It should be widely applied.
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Objective To explore the main anatomical factors for relapse in patients underwent radical mas-toidectomy and discuss the preventive measures .Methods A retrospective study was carried out 36 patients who had underwent radical mastoidectomy and 100 patients (100 ears) who had been cured underwent radical mastoidectomy during July 2011 toSeptember 2013 .The patients underwent axial and coronal temporal Computed Tomography (CT) .The incidence of low -lying middle cranial fossa ,high jugular bulb ,anterior locati(36 ears)on of sigmoid si-nus ,dehiscent tympani tegmen ,dehiscent of the facial nerve canal ,large sinus tympani ,low -lying horizontal facial nerve were recorded .Results The incidence of low -lying middle cranial fossa(36 .1% ) ,anterior location of sig-moid sinus(41 .7% ) ,dehiscent tegmen tympani (30 .6% ) ,dehiscent of the facial nerve canal (41 .7% ) ,large sinus tympani(25 .0% ) ,low -lying horizontal facial nerve(22 .2% ) were higher than those of in the normal group .There was no significant difference in high jugular bulb .Conclusion The main anatomical factors for relapse in patients un-derwent radical mastoidectomy were low -lying middle cranial fossa ,anterior location of sigmoid sinus ,dehiscent tegmen tympani ,dehiscent of the facial nerve canal ,large sinus tympani ,low -lying horizontal facial nerve .
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Objective To investigate the clinical effects of the surgery of mastoid muscle periosteum valvuloplasty after modified radical mastoidectomy treatment of cholesteatoma otitis media.Methods 52 cases (52 ears)cholesteatoma otitis media patients for the observation group were collected.The patients in the observation group were treated by mastoid muscle periosteum valvuloplasty after modified radical mastoidectomy.49 cases (49 ears) for the control group were treated by concomitant mastoidectomy and the classic conchaplasty cavity angioplasty.Results Patients were followed up for 1 year.38 ears were dry in control group(77.6％),8 ears were recurrenced(16.3％),regular clean-up of surgical cavity at least 3 months postoperative.50 ears were dry in observation group (95.2％),dry ear rate was significantly higher (x2 =12.374,P =0.000) ;1 ears was recurrenced(2.4％),the recurrence rate was significantly reduced (x2 =11.966,P =0.000) ; Operative cavity after complete epithelialization no longer need to be cleaned regularly; No postoperative complications (such as periosteal flap or pinna cartilage of the mastoid muscle necrosis,facial paralysis,dizziness)were occurred,the prognosis was good.Conclusion The surgery of mastoid muscle periosteum valvuloplasty after modified radical mastoidectomy treatment of otitis media with cholesteatoma is safe and effective,which is worthy of promotion.
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Objective To investigate the effects of neuromuscular blockade(NMB) by atracurium on facial nerve monitoring.Methods Twenty patients with chronic otitis media scheduled for radical mastoidectomy under general anesthesia were selected.Anesthetic inducement was made with sufentanil at 0.4 ?g/kg,lidocaine at 0.5~1 mg/kg,propofol at 2 mg/kg,and scoline at 1.5 mg/kg in their given order intravenously.After endotracheal intubation,mechanical ventilation was employed with an anesthetic machine.Intraoperative facial nerve minitorization was performed using the neuromuscular transmission monitor(TOF Guard) and the NMB level of right musculus adductor pollicis was assessed with the Nerve Integrity Monitoring System(Medtronic Inc.) simultaneously.No muscle relaxants were given until the electromyogram(EMG) of the facial nerve was induced.Propofol and sufentanil was administered intravenously to maintain the anesthesia.Minimal facial nerve stimulations(regarded as thresholds) causing EMG responses were measured during both nil NMB and 100% NMB by atracurium at 0.5 mg/kg.Results With propofol and sufentanil intravenously administered,the anesthesia was maintained successfully both before and after the administration of atracurium.The EMG of the facial nerve was induced even during the 100% NMB level by atracurium,but the thresholds were elevated significantly from 0.22?0.09 mA to 0.39?0.17 mA(t=-8.643,P=0.000).Conclusions Facial nerve monitoring can be performed even during the 100% NMB level by atracurium,with significant elevated stimulating thresholds.Propofol and sufentanil can be used to maintain adequate level of anesthesia without the need of muscle relaxants in radical mastoidectomy.
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Objective:To reconstruct middle ear structure for open mastoid antrum with external auditorycanal after radical mastoidectomy in one-stage. Method: 71 ears of post-mastoidectomy (discharging 53 ears anddried up 18 ears) were undergone with reconstruction of middle ear. The posterior wall of external auditorycanal, mastoid cavity and chain of ossicles were reconstructed with homologous costal cartilage. Result: 69 ears of71 cases were near normal structure followed up 6 months to 5 years after operations. The result showed hearingimprovement over 15 dB were 55 ears (77.5％) and under 15 dB were 11 cases (15.5％). Five cases (7.0％)were failed. Conclusion: Reconstruction of middle ear with homologous costal cartilage is a ideal surgery toreconstruct hearing structure and avoid infection of middle cavity after radical mastoidectomy.
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Cases of otitis media were reported after the campaign for treatment and prevention of otitis media at Buriram Hall on 23rd January, 1985. Of the total of 537 patients, 399 patients (74%) were otitis media, 38 patients (7%) were presented with other ear diseases and 100 patients (19%) were normal. Among the group of otitis media ear, and 136 patients (34%) with otitis media of both ears. Male otitis media patients were 256 patients (64%). Females otitis media patients were 143 patients (36%). The ratio of male and female otitis media patients were 1.8 : 1. Six patients (1.5%) had been transferred to Buriram Hospital for radical mastoidectomy.