Congenital stenosis of external auditory canal with cholesteatoma and skin fistulae or sinuses / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features, differential diagnosis and management of congenital stenosis of external auditory canal (CSEAC) with cholesteatoma.</p><p><b>METHODS</b>The clinical information for 10 cases of CSEAC with cholesteatoma was retrospectively reviewed.</p><p><b>RESULTS</b>The patients' ages ranged from 4.75 to 22 years (average 12 years). The diameter of the external auditory canal (EAC) was < 2 mm. All 10 ears had a history of postural fistulae or sinuses. Bone erosion of EAC was distinctly shown in high-resolution computed tomography (HRCT) of all cases, as well as soft tissue masses, which led to enlargement of the bony canals. All patients underwent canaloplasty; eight ears received hearing reconstructions at the same time. Cholesteatoma in EACs was confirmed during the operations, accompanied by compression and destruction of the post-superior and/or inferior bony wall. Postoperative pathologic examinations proved the diagnosis of cholesteatoma, and excluded any tissue of bronchial cleft cyst or fistula. After a follow-up 1 to 3 years, no recurrent cholesteatoma was found in any of the 10 cases. All reconstructed EACs were clean and smooth. The hearing levels in the eight ears that received hearing reconstructions improved 20 - 35 dBHL.</p><p><b>CONCLUSIONS</b>In CSEAC with cholesteatoma, the bony wall of EAC is most commonly involved. This involvement will lead to bone erosion of the EAC and may subsequently lead to the formation of postural or cervical sinuses. HRCT of temporal bone can show characteristic signs of soft tissue mass in EAC, with adjacent bone erosion.</p>

Long-term results and an analysis of surgically related factors in myringoplasty with sandwich method / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of the prognostic factors on long-term surgical outcome in myringoplasty.</p><p><b>METHODS</b>Retrospective cohort 205 patients (223 ears) with sandwich temporal fascia myringoplasty were analyzed using the multiple logistic regression analysis. The charts of inpatients had undergone myringoplasty before at least 2 years between January 1999 and November 2003 at Beijing Tongren Hospital. Postoperative follow-up rate was 78.2%. Their ages ranged from 12 to 65 years (mean = 34. 3 years). Their durations of disease ranged from 1 month to 25 years (mean = 16.07 months). The effect of prognostic factors on myringoplasty were investigated by variables noted from patients' files such as age, sex, causes of disease, duration of disease, period of dry ear of disease, operation types, places of tympanic membrane perforation, size of tympanic membrane perforation, status of middle ear and status of eardrum.</p><p><b>RESULTS</b>There were 11 ears with re-perforation of eardrum at the last follow-up. Successful closure of the tympanic membrane perforation was obtained in 95.1% of the ears (212 ears) with 2 to 5 years follow-up. There were 26 ears with other complications at the last follow-up. Operations were successful in 186 patients. The overall take rate of the myringoplasty was 83.4%. Multiple logistic regression analysis (ward) was subsequently carried out on these prognostic factors on overall take rate of the myringoplasty and yielded the following classification. Relative importance of the predictive variables was as follows: size of tympanic membrane perforation (OR = 1.900), duration of disease (OR = 1.003) and period of dry ear of disease (OR = 0.908). Hearing outcomes: the average air-bone gap improvement was 7.0 dB and the average air conduction improvement was 6.8 dB for all 175 myringoplasty procedures.</p><p><b>CONCLUSIONS</b>A long term follow-up was important. Late atelectatic pocket was a late complication and a cause of failure. A relatively smaller tympanic membrane perforation, a relatively shorter duration of disease and a relatively longer period of dry ear of disease were found to be significant prognostic factors positively influencing the success rate of myringoplasty.</p>

Long-term surgical results for congenital aural atresia and hearing reconstruction / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the stability of hearing results and complications in long-term following-up who underwent reconstruction surgery.</p><p><b>METHODS</b>Six hundreds and seventy five cases (700 ears) of congenital aural atresia were reviewed from January 1984 to January 2001 at the Department of Otorhinolaryngology Head and Neck Surgery, Tongren hospital. Except 40 ears undone hearing reconstruction, 635 cases (660 ears) underwent long-term following-up for 3 to 19 years, with an average of 7.9 years.</p><p><b>RESULTS</b>Stenosis and recurrent infection of the external auditory canal (EAC) were the most frequent complications. Stenosis was seen in 120 ears, and 2 ears re-atresia, with an incidence of 18.48% (122/660). Recurrent infection of the cavity and canal skin happened in 6 ears. Closure of the air-bone gap (ABG) post-operation were gained in all cases, and ABG gains 20 dB or more occurred in 512 ears (77.57%), but 30 dB or more in 231 ears (35%). Following-up results: Stable hearing results gained in 450 ears over the length of following-up; the hearing worsened than that of 3 weeks postoperatively occurred in 160 ears, including 2 ears with sensorineural hearing loss. Hearing deteriorated more than 20 dB happened in 35 ears, and 10-15 dB in others cases but still be improved compared with that of preoperation.</p><p><b>CONCLUSIONS</b>Atresiaplasty surgery in individuals with congenital aural atresia can yield reliable, lasting hearing results in 68.2% (450/660), with a low incidence of complications; the initial improved hearing deteriorated gradually over the first 6 months post-operation, which are related with the stenosis and infection of canal. Cavity adhesion, bony EAC re-growth, ossicular chain re-fixation or displace may affect the hearing results in some cases. Even unilateral aural atresia may benefit from the reconstruction surgery and achieve serviceable hearing results.</p>