Un cuerpo extraño inusual de cianoacrilato en el oído. Presentación de un caso clínico y revisión de la literatura / An unusual cyanoacrylate foreign body in the ear. Presentation of a clinical case and literature review

El pegamento basado en cianoacrilato posee una gran capacidad de adherencia a los tejidos, representando un problema cuando se encuentra en el oído externo debido a sus características anatómicas particulares. Se presenta un caso clínico de cuerpo extraño de cianoacrilato que ocluye el conducto auditivo externo y el tímpano, alterando la audición. Se describen los hallazgos y los intentos de extracción utilizando las alternativas terapéuticas descritas en la literatura, sin obtener resultados positivos, debiendo recurrir a la extracción quirúrgica. Además, se presentan detalles del procedimiento y los resultados. El paciente recupera la audición y la normalidad anatómica.

Cyanoacrylate-based glue has a great capacity for adhering to tissue, which is a problem when it is placed in the ear canal due to the anatomy of this structure. A clinical case of a cyanoacrylate foreign body occluding the external auditory canal and the tympanic membrane is presented. The therapeutics alternatives described in the literature used in the case failed, so, it was surgically removed by drilling the glue. Details of the procedure and results are presented. The patient recovers the hearing and anatomical normality.

Quiste epidermoide en conducto auditivo externo: reporte de caso / Epidermoid cysts of the external auditory canal: case report

Resumen El quiste epidérmico es una lesión benigna y común de la piel. Se desarrolla por un bloqueo de la unidad pilosebácea, con la consecuente proliferación de células epiteliales y secuestro de queratina. El 7% se desarrollan en cabeza y cuello, sin embargo, son infrecuentes en canal auditivo externo. Su patrón de crecimiento es lento y progresivo durante años, siendo asintomáticos. Al aumentar de tamaño causan sintomatología variable, acorde a su localización; en el canal auditivo tienen un comportamiento obstructivo que genera síntomas como otalgia e hipoacusia. Se presenta caso de una paciente de 69 años, con acúfeno e hipoacusia progresiva derecha. Durante la otoscopia se observó una neoformación obstructiva del 100% de la luz del conducto. Se realizaron estudios de imagen que reportaron tumoración de características quísticas de conducto auditivo derecho, bien circunscrita, sin erosión ósea. Para el diagnóstico definitivo, se realizó resección quirúrgica y biopsia reportando quiste epidérmico. Durante el seguimiento posoperatorio sin hallazgos de recidiva.

Abstract The epidermal cyst is a common and benign lesion of the skin. It develops due to a blockage of the pilosebaceous unit, with the consequent proliferation of epithelial cells and keratin sequestration. Seven percent develop in the head and neck; however, they are infrequent in the external auditory canal. Its growth pattern is slow and progressive over the years, being asymptomatic. As they increase in size, they cause variable symptoms, according to their location. In the ear canal they have an obstructive behavior that generates symptoms such as earache and hearing loss. A case of a 69-year-old female with tinnitus and progressive right hearing loss is presented. At otoscopy, a 100% obstructive neoformation of the canal lumen was observed. Imaging studies showed a well circumscribed, cystic tumor of the right ear canal, without bone erosion. For the definitive diagnosis, a resection and biopsy were performed, reporting an epidermal cyst. During follow up there was no recurrence of tumor.

Using the external auditory canal skin graft of the healthy side to treat unilateral congenital aural atresia: preliminary results of clinical research / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate whether the contralateral normal external auditory canal (EAC) skin graft can maintain the ear canal health after EAC reconstruction in unilateral congenital aural atresia (CAA) cases. Methods: A Zelen design randomized controlled study was used to collect unilateral CAA patients for EAC reconstruction prospectively (clinical trial registration number: ChiCTR2000032103). The patients were randomly divided into the control group and the trial group. The trial group used the contralateral normal EAC skin graft group (transplant part of the contralateral normal EAC skin to repair the atresia side for unilateral CAA patients), the control group all used scalp blade thick skin. We observed the EAC health and hearing results of the two groups after EAC reconstruction. Results: A total of 13 cases were enrolled from July 2020 to August 2021. There were eight patients in the trial group, including six males and two females, with an average age of 22.3 years (14-36 years). There were two patients with CAA on the left and six patients on the right. The average follow-up time was 8.8 months (4-14 months). There were five patients in the control group, all cases were male with an average age of 16.2 years (12-20 years). There were four patients with CAA on the left and one patient on the right. The average follow-up time was 7.0 months (2-14 months). In the trial group, eight cases of reconstructed EAC epithelium were healthy, one patient had cicatricial stenosis of EAC opening and lateralization of the tympanic membrane. The other patient had cicatricial stenosis of reconstructed EAC, this case also had scar hyperplasia of the contralateral EAC opening but recovered after soft packing and triamcinolone acetonide injection treatment. The healthy side EAC of the rest trial group had no scarring stenosis or local bone hyperplasia during long-term follow-up. In the control group, one patient was lost to follow-up and the other four patients had dry ears of reconstructed EAC, but easily to form crusts and needed to be cleaned repeatedly, one patient had lateralization of the tympanic membrane, the EAC epithelium was not healthy for long-term follow-up. The incidence of complications related to EAC reconstruction was lower than previous studies (χ²=5.55, P=0.018), and the average postoperative Air-Bone Gap increased (18.8±10.0)dB. Conclusion: By optimizing the EAC reconstruction technology, the health of the reconstructed EAC is improved compared with the previous study. After active intervention and treatment, there should be no scarring stenosis or local bone hyperplasia on the contralateral side EAC.

Resolução cirúrgica de pólipo inflamatório em ouvido médio de felino através da técnica de avulsão e tração por abordagem lateral: relato de caso / Surgical resolution of feline middle ear inflammatory polyp by lateral approach traction and avulsion technique: case report

O objetivo desse trabalho foi descrever um caso de pólipo inflamatório em ouvido médio de um felino e sua resolução cirúrgica através da avulsão e tração da massa após abordagem lateral. Um felino, fêmea, de 2 anos de idade, foi atendido no Hospital Veterinário Professor Sylvio Barbosa Cardoso, apresentando prurido intenso, dor e secreção fétida em região auricular. Pelo exame físico foi possível observar um nódulo em região de ouvido médio esquerdo. Associado a isso, o animal apresentava "headtilt" (inclinação da cabeça para o lado afetado). Foram solicitados exames hematológicos, radiografia de crânio e citologia da massa. O animal foi encaminhado para cirurgia de extirpação da massa. Foi feita uma incisão na pele sob o canal auditivo vertical palpável. A cartilagem foi liberada até o nível da junção entre as cartilagens auricular e anular. Com o auxílio de um fórceps, o pólipo foi agarrado e delicadamente girado até ser completamente extirpado de sua origem. A cartilagem e o subcutâneo foram fechados com material de sutura monofilamentar 4-0 e a pele foi fechada em um padrão de sutura subdérmica usando o mesmo material. A peça foi encaminhada para exame histopatológico, pelo qual confirmou-se a suspeita de pólipo inflamatório, através da observação de epitélio colunar ciliado. Utilizando a técnica cirúrgica TALA (avulsão e tração após abordagem lateral) foi possível obter melhora do quadro clínico do animal referido, rápida recuperação pós-cirúrgica e sem nenhuma complicação decorrente da técnica. Essa técnica, portanto, se mostrou satisfatória, melhorando significativamente a qualidade de vida do animal.

The aim of this study was to describe a case of inflammatory polyp in the middle ear of a cat and its surgical resolution through avulsion and mass traction after lateral approach. A female feline, two year old, was admitted at the Hospital Veterinário Professor Sylvio Barbosa Cardoso, presenting intense itching, pain and fetid discharge in the ear region. Physical examination revealed a nodule in the left middle ear region. Associated with this, the animal presented head tilt (inclination of the head to the affected side). Hematological examinations, skull radiography and mass cytology were requested. The animal was referred for polyp removal surgery. A skin incision was made under the palpable vertical ear canal. The cartilage was released to the level of the junction between the auricular and annular cartilages. With the help of a forceps, the polyp was grasped and gently rotated until completely removed from its origin. The cartilage and subcutaneous tissue were closed with 4-0 monofilament suture material and the skin was closed in a subdermal suture pattern using the same material. The piece was referred for histopathological examination, which confirmed the suspicion of inflammatory polyp by observing ciliated columnar epithelium. Using the TALA surgical technique (avulsion and traction after lateral approach) it was possible to obtain improvement of the clinical 3 picture of the referred animal, rapid postoperative recovery and without any complications resulting from the technique. This technique therefore proves satisfying, significantly improving the quality of life of the animal.

Influencia auditiva de la pared posterosuperior del conducto auditivo externo, en la hipoacusia de conducción postimpanomastoidectomía / Hearing influence of the posterior ear canal wall, in the conductive hearing loss after tympanomastoidectomy

RESUMEN Introducción: El tratamiento de la otitis media crónica (OMC) colesteatomatosa es quirúrgico, cuyo objetivo es erradicar la enfermedad, evitar complicaciones y prevenir recurrencias. El gold standard es la timpanomastoidectomía con canal wall down (TCWD). Estudios en cadáver han definido que TCWD disminuye la audición 1-5 dB en frecuencias <1.000 Hz y 0-10 dB entre 1.000 y 3.000 Hz. De aquí nuestro interés por definir la influencia acústica de la pared posterosuperior del conducto auditivo externo (CAE). Objetivo: Determinar en cuantos decibeles se corrige la audición al reconstituir pared posterior del CAE pos-TCWD. Material y método: Trabajo experimental. A pacientes pos-TCWD se reconstituye de manera transitoria la pared posterior del CAE, realizándose audiometría pre y posprocedimiento. Resultados: 23 pacientes (25 oídos), promedio 48,8 años (18-72 años). En 96% existió una diferencia favorable al reconstruir la pared posterior, presentando una mejoría auditiva entre 1,2 y 10,6 dB (4,2 ± 2,8 dB). En frecuencias <1.000 Hz la mejoría fue de 6,0 dB (p <0,001), entre 1.000-3.000 Hz fue 2,6 dB (p <0,001) y >3.000 Hz no hubo diferencia. Considerando PTP de vía aérea la mejoría fue 4,6 dB (p <0,001). Conclusión: Nuestro estudio demuestra que existe mejoría auditiva en la gran mayoría de oídos evaluados al reconstituir la pared posterosuperior del CAE, alcanzando 6 dB en frecuencias <1.000 Hz y 2,6 dB en frecuencias medias. Si consideramos los PTP de vía aérea la mejoría es de 4,6 dB en presencia de pared posterior.

ABSTRACT Introduction: Cholesteatomas treatment is surgical and the goals are complete resection of it, to prevent complications and recurrences. The gold standard operative technique is canal wall down tympanomastoidectomy (CWDT), which reduces the recurrence rate lower than 2%. Studies on human temporal bones have defined that CWDT causes a decrease of 1 to 5 dB at frequencies below 1000 Hz and 0 to 10 dB between 1000 and 3000 Hz. Aim: To determine how many decibels the hearing is improved by reconstituting the posterior wall of the ear canal (EC) in patients after CWDT. Material and method: Experimental study. In patients after CWDT, the posterior wall of EC was reconstructed temporarily. Audiometry was performed before and after the procedure. Results: 23 patients were enrolled (25 ears evaluated). Average age 48.8 years (range 18 to 72 years). In 96% of the ears there was a difference after the procedure with a hearing improvement of 4.2 ± 2.8dB. In frequencies below 1000 Hz, hearing improvement was 6.0 dB (p<0.001), between 1000-3000 Hz, the improvement was 2.6 dB (p<0.001) and >3000 Hz there was no difference. When considering the airway-conduction pure tone average (PTA), the difference was a 4.6 dB improvement (p<0.001). Conclusions: Our study shows that there is a hearing improvement in the vast majority of ears that were evaluated by reconstituting the posterior wall of the EC, reaching a gain of 6 dB at frequencies <1000 Hz and 2,6 dB at mid frequencies. Considering the airway PTA, the improvement is 4.6 dB in the presence of posterior canal wall.

Transcanal endoscopic myringoplasty: a case series in a university center / Miringoplastia endoscópica transcanal: série de casos em um serviço universitário

ABSTRACT INTRODUCTION: Transcanal myringoplasty has the advantages of demanding lower operative time and minimal external incisions. It can be performed using the microscopic or endoscopic approach. In the last decade, the use of endoscopes in ear surgery has increased significantly. This technique may allow "around the corner" visualization of small recesses, through narrow spaces, without the aid of canalplasty in unfavorable ear canals. OBJECTIVE: To describe a case series of transcanal endoscopic myringoplasty performed in a university service. The characteristics, advantages, and disadvantages of this technique are also discussed. METHODS: A case series study, based on the chart review of patients submitted to transcanal endoscopic myringoplasty in the period from January of 2012 to October of 2014. RESULTS: Data from 22 patients were analyzed. Tympanic perforation closure three months after surgery was observed in 86.4% of all patients. There was statistically significant improvement in pure tone average thresholds after surgery (p < 0.001). CONCLUSION: Transcanal endoscopic myringoplasty is a feasible, safe, and effective procedure; it can be an alternative to microscopic surgery.

Resumo Introdução: A miringoplastia realizada por via transcanal possui como vantagens a maior rapidez do procedimento e menor incisão externa, podendo ser realizada com auxílio de microscópio ou endoscópio. Na última década tem sido observado um aumento do uso de endoscópios na cirurgia otológica. Essa técnica pode permitir melhor visibilização de espaços encobertos e estreitos, sem necessidade canaloplastia em meatos desfavoráveis. Objetivo: Descrever uma série de casos de miringoplastia endoscópica transcanal, em um serviço universitário, discutindo suas particularidades, vantagens e desvantagens. Método: Estudo de série de casos, baseado na revisão de prontuários dos pacientes submetidos a miringoplastia com uso exclusivo de endoscópio rígido, no período de Janeiro de 2012 a Outubro de 2014. Resultados: Foram analisados os dados de 22 pacientes. Na otoscopia pós-operatória, foi observado fechamento da perfuração timpânica em 86,4% dos pacientes, após 3 meses da intervenção. Para a amostra estudada, foi observada melhora funcional estatisticamente significante da média dos limiares tonais (PTA) após a cirurgia (p < 0,001). Conclusão: A miringoplastia endoscópica transcanal é um procedimento seguro, factível e efetivo, podendo ser realizado como alternativa à cirurgia microscópica.

External auditory canal atresia: surgical correction compared with bone anchored hearing device

The study evaluates the hearing result, complication rate and parental satisfaction following two different approaches in the management of external auditory canal atresia. A retrospective chart review of 30 patients with external auditory canal atresia was conducted. Twenty of them underwent external canal atresia surgery and 10 had Bone Anchored Hearing Aid [BAHA]. Hearing results, pre- and post-intervention, complications, parental satisfaction rate and speech improvement were measured. Closure of the air-bone gap [ABG] to 30 dB was seen in less than 50% in the surgery group. The BAHA group had closure of the ABG to less than 15 dB. Parental satisfaction was higher in BAHA group. The most common complications in the surgical and BAHA groups were group was soft tissue stenosis and adverse skin reactions for the BAHA group. In the treatment of auditory canal atresia, BAHA provides superior hearing results, greater parental satisfaction and fewer complications as compared to surgery

Amiloidosis asociada a diálisis en el conducto auditivo externo, presentación de un caso clínico y revisión de la literatura / Oialysis related amiloydosis of the external auditory canal, case report and review of the literature

La amiloidosis asociada a diálisis es una patología causada por depósito de fibrillas amiloides constituidas por la proteína beta 2 microglobulina1-5. Es una complicación seria y excepcional que ocurre en pacientes sometidos a hemodiálisis de larga data. El caso que presentamos corresponde a un paciente de 56 años en hemodiálisis hace 36 añ os, con amiloidosis del conducto auditivo externo bilateral. Sólo 13 casos de amiloidosis en el conducto auditivo externo, incluido éste han sido reportados en la literatura66-14. Este corresponde al tercercaso de amiloidosis asociada a diálisis del conducto auditivo externo reportado en la literaturaf6,10.

Dialysis related amyloidosis is a disorder caused by deposition of amyloid fibrils formed by beta-2 microglobulin1-5. It is a serious and exceptional complication in patients undergoing longterm hemodialysis. The present case involved a 56 years old man who had been on hemodialysis for 36 years with bilateral amyloidosis of the external auditory canal. Only 13 cases of amyloidosis in the ear canal, including the present case have been reported in the literature66-14. This is the third reported case of dialysis related amyloidosis of the ear canal6,10.

Método prático de obtenção de amostras de meato acústico externo e membrana timpânica para estudo histológico e imunohistoquímico / Method for removal of samples of ear canal and tympanic membrane for histologic and immunhistochemical study

Ossos temporais humanos constituem valiosas fontes de estudo das doenças relacionadas à orelha. Apesar dos vários métodos existentes para obtenção de amostras de ossos temporais de cadáveres, geralmente estes métodos não são descritos em detalhes nos artigos envolvendo pesquisa. OBJETIVOS: Descrever um método prático e rápido para obtenção de amostras de meato acústico externo e membrana timpânica, e verificar sua viabilidade para estudo histológico e imunohistoquímico. MATERIAL E MÉTODO: Para este estudo experimental, foram obtidas 31 amostras de meato acústico externo e membrana timpânica de cadáveres com a utilização de furadeira convencional e broca do tipo serra copo. O material foi dissecado para obtenção de amostras em bloco contendo o meato acústico externo e a membrana timpânica. Estas amostras foram analisadas por histologia e imunohistoquímica. RESULTADOS: Foi possível a remoção de amostras de pequeno volume e de boa qualidade, o que facilitou a obtenção de amostras contendo todo o meato acústico externo e membrana timpânica. Em todas as amostras, foi possível realização de estudo histológico e imunohistoquímico. CONCLUSÃO: O método aqui descrito foi facilmente exequível, reprodutível e produziu amostras de boa qualidade, seja para treinamento ou pesquisa experimental. Todas as amostras foram viáveis para a realização de estudo histológico e imunohistoquímico.

Temporal bones are valuable resources to study ear diseases. Although there are several methods for removing temporal bones from cadavers, such methods are not usually described in enough details in experimental research papers. OBJECTIVES: To describe a simple and rapid method for ear canal and tympanic membrane removal, and to evaluate its viability for histologic and immunohistochemical studies. MATERIALS AND METHODS: In this experimental study, we obtained 31 ear canal and tympanic membrane samples from cadavers, with a conventional power drill and plug cutter. The material was dissected and samples containing ear canals and tympanic membranes were obtained in blocks. The samples were analyzed by histology and immunohistochemistry. RESULTS: Removal of small and good quality samples containing entire ear canals and tympanic membranes. In all the samples, it was possible to perform both histological and immunohistochemical analyses. CONCLUSION: This method was easily achievable, reproducible and yielded good quality samples, both for training purposes and for experimental research. All the samples were viable for histological and immunohistochemical analyses.

Anatomia do osso temporal de ovelhas sob aspectos didáticos / Lambs' temporal bone anatomy under didactic aspects

É difícil encontrar ossos temporais humanos para o ensino de cirurgia otológica. Ossos temporais de ovelhas podem representar uma possível alternativa. MATERIAIS E MÉTODOS: Os ossos temporais de ovelhas foram dissecados em um programa convencional de dissecação de osso temporal no laboratório. Incluímos mastoidectomia, abordagens endaurais, mas também analisamos a aparência externa, o meato acústico externo e o hipotímpano. Algumas etapas são diferentes das preparações de ossos humanos. Os resultados morfométricos foram comparados à anatomia conhecida de humanos para verificar se o osso temporal de ovelhas seria utilizável para o ensino de cirurgia otológica. RESULTADOS: O osso temporal de ovelhas parece menor do que o humano. Encontramos uma área bolhosa se estendendo ao hipotímpano abaixo do meato acústico externo. A membrana timpânica é muito semelhante à humana. O meato acústico externo é menor e mais curto. A cadeia ossicular exibe analogias para com a humana. DISCUSSÃO: Esse estudo mostra que especificamente o ouvido médio, a membrana timpânica e o conduto auditivo externo são morfologicamente semelhantes às suas contrapartidas encontradas nos ossos temporais humanos. A ovelha parece ser um modelo viável para o ensino da anatomia do ouvido. A menor escala de algumas estruturas, especialmente dos componentes externos do osso temporal representa uma desvantagem. CONCLUSÕES: A ovelha parece representar uma alternativa viável no ensino de cirurgia otológica.

Human temporal bones in teaching ear surgery are rare. The lamb's temporal bone might be a possible alternative. MATERIAL AND METHODS: Temporal bones of the lamb were dissected with a typical temporal bone lab drilling program. We included a mastoidectomy, endaural approaches, but also analyzed the outer appearance, the external ear canal and the hypotympanon. Some steps differed from preparation done in humans. The morphometric results were compared to the known anatomy of human in order to verify the lambs' temporal bone for suitability in otosurgic training. RESULTS: The lambs' temporal bone appears smaller than the human one. We found a bullous extended hypotympanon located under the external ear canal. The tympanic membrane is very similar to the human one. The external ear canal is smaller and shorter. The ossicular chain shows analogies to human one. DISCUSSION: This study shows, that especially the middle ear, the tympanic membrane and the external ear canal are morphologically equal to the structures found in human temporal bones. The lamb seems feasible for teaching the anatomy of the ear. The smaller scales of some structures, especially the outer components of the temporal bone are a disadvantage. CONCLUSIONS: The lamb seems to be an alternative in teaching ear surgery.

Morphological aspects of tympanic bulla after ventral osteotomy in cats / Aspectos morfológicos da bulla tympanica de gatos após osteotomia ventral

PURPOSE: To evaluate tympanic bulla healing after experimental ventral osteotomy in cats. METHODS: Twenty adult cats were submitted to unilateral ventral bulla osteotomy and divided into two groups: cats of A1 group (n=10) were euthanized at 8 weeks and cats of A2 group (n=10), at 16 weeks postoperative. RESULTS: Signs of Horner's syndrome or damage to the inner ear were not found. Open-mouth radiographs taken in the immediate postoperative showed interruption in the contour of the larger compartment of the operated bulla. The result of Mcnemar'test was significant in A2 group (*p=0.0156). Macroscopic exams revealed that the operated bullae were similar to the normal ones, with preservation of the tympanic cavity. Connective tissue at the osteotomy site of the larger compartment was significantly found in the operated bullae in both groups (McNemar test: A1 p=0.0020*; A2 p=0.0078*). Histomorphometric analyses showed that the connective tissue length at the osteotomy site was shorter in A2 group than in the A1 group (Mann-Whitney test: p=0.0021*). CONCLUSIONS: Experimental ventral osteotomy did not alter significantly the tympanic bulla conformation and complete regeneration of tympanic bulla frequently did not occur before 16 weeks of postoperative period.

OBJETIVO: Avaliar a morfologia da bulla tympanica de gatos após osteotomia ventral unilateral. MÉTODOS: Foram utilizados 20 gatos distribuídos em dois grupos de 10 animais cada, de acordo com o período de observação: A1 (8 semanas) e A2 (16 semanas). RESULTADOS: Nenhum animal apresentou síndrome de Horner ou lesão do ouvido interno. Nas radiografias em projeção com a boca aberta realizadas no pós-operatório imediato observou-se a interrupção do compartimento maior da bulla tympanica operada, resultado significante no grupo A2 (McNemar, p=0,0156*). Os exames macroscópicos revelaram que a bulla tympanica operada apresentava conformação semelhante a da bulla tympanica normal, com preservação da cavidade timpânica. Na maioria das bullae tympanicae operadas observou-se a presença de tecido conjuntivo na área de osteotomia. O resultado do teste de McNemar foi significante em ambos os grupos (A1, p=0,0020*; A2, p=0,0078*). Os exames histomorfométricos demonstraram que a extensão de tecido conjuntivo presente no local da osteotomia do compartimento maior era menor nas bullae tympanicae operadas do grupo A2 (Mann-Whitney, p=0,0021*). CONCLUSÕES: A osteotomia ventral não alterou de maneira significativa a conformação da bulla tympanica. A regeneração total da bulla tympanica geralmente não ocorreu antes de 16 semanas de pós-operatório.

Colesteatoma de conduto auditivo externo: relato de caso / Cholesteatoma of external auditory canal: a case report

Os autores apresentam um caso de colesteatoma de conduto auditivo externo (CCAE) com extensa invasão da mastóide, mas estando preservadas a membrana timpânica e a cadeia ossicular. Como único sintoma apresentava otorréia crônica. O diagnóstico da lesão foi clínico, sendo o seu estadiamento e planejamento cirúrgico realizados através da tomografia computadorizada. Como tratamento procedeu-se a mastoidectomia radical modificada associada à meatoplastia. O CCAE, por seu caráter insidioso e correlacão topográfica com estruturas nobres, deve ser sempre lembrado no diagnóstico diferencial das lesões do conduto auditivo externo. O relato deste caso tem o objetivo de revisar alguns aspectos clínicos e cirúrgicos no tratamento do CCAE e expor nossa conduta em um caso bastante evoluído da doenca.

Surgical management of congenital aural atresia

A prospective study was done on 11 pediatric patients with congenital aural atresia [CAA] with or without macrotia of the ear. The use of early audiological evaluation [using auditory brain stem response [ABR] and pure tone audiometry] and strict radiologic and clinical criteria for surgical candidates was necessary. The surgical reconstruction of their congenital aural atresia was reviewed for hearing improvement, cosmetic improvement, safe ear and complications. The aim of the surgery was to create a patent skin lined external auditory canal and improvement of hearing threshold. Functional hearing was obtained in 54% of cases with safe ear. Congenital cholesteatoma was found in two ears. The split thickness skin graft was associated with minimal complications. The main complications were recurrent infection [45%], stenosis of the canal [36%], failed graft [27%] and keloid of the wound [18%]. Though, the improvement of postoperative results for CAA requires an experienced otologic surgeon, long-term follow up together with control of infection through strict asepsis. Also, improved personal hygiene is mandatory

Concho - meatoplasty technique in tympanoplasty

A Concho-meatoplasty technique is described which has proved successful in creation of a wide meatus when it is used in tympanoplasty with open mastoidectomy. The technique is described in details and the results are mentioned with a discussion of the technique in accordance to the otologic surgery literature

Preservación de la función auditiva en la cirugía de los tumores del conducto auditivo interno y el ángulo pontocerebeloso / Preservation of the auditive function in the tumors surgery of external ear canal and cerebellopontine angle

Las lesiones tumorales a nivel del conducto auditivo interno y el ángulo pontocerebeloso son casi siempre benignas y su predominio está dado primariamente por los neurinomas (schwannomas) del nervio acústico con origen en su rama vestibular, los meningiomas originados en las envolturas meníngeas adyacentes y los colesteatomas provenientes del hueso temporal. Inicialmente, cuando los tumores son pequeños, estos crecen en el conducto auditivo interno y en el espacio real es el ángulo pontocerebeloso, sin dar mayores manifestaciones clínicas. En estas etapas iniciales puede haber o no, pérdidas auditivas moderadas, sensación de inestabilidad corporal y acúfenos. Estos tumores, por ser de poca manigtud, puede pasar desapercibidos para el paciente y peor aún, para el médico quien puede restarle importancia por su poca consistencia. Al crecer estos tumores, los síntomas se hacen evidentes por la compresión neural, terminado en síntomas severos como hipertensión endocraneana, etaxia y muerte. El alto índice de sospecha clínica que conduzca a un diagnóstico precoz, es la base fundamental para la detección temprana de estos tumores. En la actualidad, se cuenta con una batería de pruebas otoneourológicas, tales como el examen audiológico completo y el examen vestibular, destacando la audiometría de tallo cerebral por potenciales evocados, exploración de alta fidelidad para el diagnóstico de una lesión retrococlear. Pero fundamentalmente con la imagen por resonancia magnéctica que permite diagnósticar precozmente lesiones hasta de 2mm de diámetro. El desarrollo de minuciosas técnicas microquirúrgicas a nivel del conducto auditivo interno y ángulo pontocerebeloso, permite hoy en día al otoneurocirujano, abordar quirúrgicamente estos tumores cuando aún no han producido un déficit neurológico significativo y preservar la función cada vez en un mayor porcentaje de casos. El abordaje quirúrgico por la vía de la fosa craneana media y por la vía retrosigmoidea, permiten en la actualidad, preservar la función auditiva al no tocar el oido interno. El rsultado satisfactorio está supeditado a una muy buena selección del caso y al logro de la preservación de la vascularización del oido interno. Este trabajo comenta las exploraciones clínicas más adecuadas para un diagnóstico precoz, las vías de abordaje quirúrgico con sus posibilidades y limitaciones, y analiza las probabilidades de lograr la preservación de la función.

Cura de atresia del conducto auditivo externo: experiencia en el Hospital San Juan de Dios / Cure of atresia of the external auditory canal: experience in the Hopital San Juan de Dios

Se presentan los resultados obtenidos en 16 intevenciones para corrección de atresia del conducto auditivo externo, realizadas por el autor en el Hospital San Juan de Dios entre los años 1989 a 1995. De los casos, 14 fueron correcciones primarias y de exploraciones en segundo tiempo. Se consideraron las variaciones edad quirúrgica, sexo, presencia de colesteatoma, audiometría tonal pre y post quirúrgicas, hallazgos operatorios y complicaciones. De los datos obtenidos se concluye que el procedimiento realizado, en manos entrenadas, es seguro y aporta resultados predecibles. La adecuada evaluación preoperatoria de los pacientes permite conocer el pronóstico de la intervención.