Stapes surgery: comparison between microdrill and footplate perforator

The study goal was to compare the effect of using footplate perforator and the microdrill on the postoperative hearing results and complications rate during stapes surgery. 70 ears with otosclerosis have been operated upon using microdrill to perforate the footplate in 34 ears and microperforator in 36 ears. All operations were operated upon at the Department of Otolaryngology, Mansoura University Hospitals from 2005 to 2007. The audiological results and complications rate of both groups were compared. There were statistically significant decrease of postoperative air and bone conduction in both groups. There was significant decrease in the mean post operative bone conduction in the microdrill group as compared to the perforator group. The mean postoperative air bone gap [500-4000Hz] was 7.8 dB and 9.3 dB for the microdrill group and the perforator group, respectively, which was statistically insignificant there was no significant SNHL in the microdrill group, while there was one ear [2.7%] had it in the perforator group. Stapedotomy using microdrill or footplate perforator provides good results, however, the use of microdrill may be useful as it is easy, safe and less traumatizing to the inner ear

Temporalis fascia versus composite cartilage perichondrial graft in the reconstruction of total and subtotal tympanic membrane perforations

Objective: The purpose of this study was to compare between temporalis fascia and composite cartilage perichondrium grafts in reconstruction of the total and subtotal tympanic membrane perforations

Study Design: Prospective study consisted of ninety five consenting patients with chronic inactive suppurative otitis media with total and subtotal perforations. The patients were classified into two groups; group A [75 ears in 75 patients] in whom cartilage graft was used and group B [20 ears in 20 patients] in whom temporalis fascia was used

Results: For group A tymapanic membrane closure was achieved in 71 patient [94.6%] while in group B tympanic membrane closure was achieved in 7 patients [35%]. The hearing results showed that, there was highly significant postoperative improvement in pure tone averages as well as air bone gap averages. In group A the air bone gap was closed to less than 10 dB in 21.7% and from 10 to 25 dB in 73.9% and to more than 25 dB in 4.4 %, on the other hand the air bone gap was closed to less than 10 dB in 16.7 % and from 10 to 25 dB in 66.6 % and to more than 25 dB in 16.7 % in group B. In this study, the average pre and postoperative air bone gap [500-4000 Hz] were 26.8 dB and 13 dB respectively, for cartilage group and 25.1 dB and 12.3 dB for fascia group

Conclusions: This study revealed that Composite cartilage perichondrial grafts are excellent graft material for total and subtotal perforations. The palisade technique is an effective and straight forward technique with high success rate and good hearing results with no postoperative complications

Cartilage tympanoplasty: a technique to combat eustachian tube dysfunction

This study included 199 cases suffering from inactive chronic suppurative otitis media and operated up on at the Otorhinolaryngology Department Mansoura University from 2000 to 2003. Patients were divided into 3 groups according to their Eustachian tube function [good, fair and poor]. Tympanoplasties were done using 3 types of graft materials [full thickness cartilage graft, partial thickness cartilage graft and temporalis fascia graft]. The take rate was better with good Eustachian tube function than poor Eustachian tube function in the 3 groups, in fascia group there was a significant difference between good and poor Eustachian tube function. There was no significant difference in hearing results between the fascia group and cartilage groups. Type A tympanogram was obtained in partial thickness cartilage graft and temporalis graft more than the full thickness cartilage graft. According to our results the use of cartilage is the preferred graft material for tympanoplasty in cases with poor Eustachian tube function

Stapedial decapitation technique: as a management procedure for stapedial otosclerosis

Objective: The aim of this study is to compare between two surgical maneuvers in the management of stapedial type of otosclerosis, small fenestra stapedotomy and decapitation procedure as a new technique

Subjects and Methods: prospective study that included 21 consenting patients, 9 males and 12 females subjected to small fenestra stapedotomy operation and 22 consenting patients, 10 males and 12 females operated upon by decapitation technique

Results: Hearing sensitivity and air bone gap of the two groups before and after Operations were analyzed. The mean hearing threshold level [500-4000Hz] of preoperative versus post operative was compared. There was no significant statistical difference between the two techniques used in this study for both improvement of the hearing threshold and air bone gap closure after operations

Discussion: In this study, there were no significant statistical differences between the two groups in the management of the hearing loss due to stapedial type of otosclerosis. The improvement in air bone gap was not different between the two groups of the study. However, the decapitation technique was found to be easier. it has less manipulation around the stapedial footplate and this will minimize the incidence of floating footplate and postoperative vertigo, it also preserves the stapedial tendon and superstructure. It is to be noted that, the decapitation technique cannot be done with narrow oval window niche

Conclusion; The effectiveness and safety of both techniques are the same with the advantages of decapitation technique of providing the same hearing results, saving time and preserve the stapedial tendon in comparison with the small tenestra stapedotomy technique

Pneumatic balloon dilatation in achalasia: the optimum size of the balloon

Background: Pneumatic dilatation is considered to be the first line therapy for achalasia, but long-term outcome studies are scarce and limited by their retrospective design. There is also no consensus on the Optimal method for performing pneumatic dilation as regard to balloon diameter, amount and the rate inflation pressure

Aim: To address these questions in a large long-term prospective study

Methods: Over a period of 10 Years 262 achalasia patients referred to Mansoura Gastroenterology Surgical Center and Ear, Nose and Throat department, Mansoura University were enrolled. All patients underwent a pre-treatment clinical evaluation and were followed every 6 months. The first 62 patients [group A] underwent dilatation with initial use of a 35 mm balloon with inflation pressure of 10 psi in 10 seconds [5]. In group B [200 patients] we initially used a 30 mm balloon with inflation pressure of 10 psi in 30 s. Dilatation was repeated with incrementally larger balloons [35 and 40 mm] in case of relapse. We used rigiflex balloon and maintained pressure for 60 s after inflation in both groups

Results: Three perforations occurred in group A whereas no perforation took place in Group B. The cumulative proportional remission rate with single dilatation in groups A and B decreased from 83 and 75% in 6 months to 60 and 57% after 30 months of therapy respectively, the differences did not reach statistical significance. In patients who had undergone further dilatations the probability of remaining in remission at 1 year after the first and the second dilatation was 38 and 88% in group A, 20 and 89% in group B respectively. The probability of remaining in remission for 2 years increased from 20% after the first dilatation to 70% after the second dilatation

Conclusion: Graded pneumatic balloon dilatation with 30 mm diameter and slower rate of balloon inflation is an effective and safe initial method of therapy for achalasia. The duration of remission can be extended by repeated dilatation with larger size balloon

Stapes surgery: comparison between different prostheses

Four hundred and fifty ears with otosclerosis have been operated upon using 3 different types of prostheses [Teflon piston in 217 ears, Teflon platinum in 133 ears and House prostheses in 100 ears]. Greater hearing gains were obtained with the use of Teflon piston and Teflon platinum than House prostheses with statistically significant advantage at 2000-4000 Hz. The mean postoperative air-bone gap was not statistically significant with the use of the 3 prostheses but at 2000 and 4000 Hz the ABG was significantly larger with the use of House prostheses. According to our results, we conclude that Teflon piston and Teflon platinum provide better results than house prostheses and are considered the prostheses of choice for otosclerosis surgery