Hearing and Facial Function After Surgical Removal of Cholesteatomas Involving Petrous Bone

OBJECTIVES: The purpose of this study was to inspect the clinical characteristics, surgical approaches, functional preservation, and complications of petrous bone cholesteatoma and to propose appropriate surgical approaches based on long-term follow-up cases and previous reports in the literature. METHODS: The medical records of 31 patients who underwent surgery for petrous bone cholesteatoma between 1990 and 2011 at two tertiary referral hospitals were retrospectively analyzed with regard to the classification, type of surgical approach, preservation of facial and auditory function, and recurrence. RESULTS: Of 31 cases, 16 were supralabyrinthine (class I), 1 was infralabyrinthine-apical (class III), 13 were massive (class IV), and 1 was apical (class V). Facial nerve palsy was found in 35.5% of the cases (11 cases). Hearing was preserved in 11 of 22 patients who had better than a 50-dB hearing level of bone conduction pure tone average preoperatively. Preoperative hearing was preserved in only four of the patients in class I (supralabyrinthine). Facial function was preserved or improved in 29 patients (93.5%). CONCLUSION: Complete removal of cholesteatoma of petrous bone can be achieved by choosing the appropriate approach based on location and extent. Facial function was preserved postoperatively in most reviewed cases. Auditory function could not be preserved postoperatively in some cases, but preserving residual hearing levels can be accomplished mostly in supralabyrinthine cholesteatomas with the appropriate surgical approach.

Improving Compliance for Continuous Positive Airway Pressure Compliance and Possible Influencing Factors / 대한이비인후과학회지

Though continuous positive airway pressure (CPAP) is the primary treatment modality and improves mortality and quality of life for moderate to severe obstructive sleep apnea syndrome (OSAS), its compliance is surprisingly low and limits its overall effectiveness in OSAS treatments. This paper is focused on examining a multiplicity of possible factors associated with compliance to CPAP. Recent studies revealed that factors that influence compliance to CPAP include disease severity, patient characteristics, equipment-related, psychological and social factors, and side effects. Relative scarcity of evidence about the effect of upper airway problem on compliance is also noted. In consideration of multi-factorial nature, multidisciplinary approach is needed for enhancing CPAP compliance.

Clinical Characteristics and Suggested Diagnostic Criteria of Obliterative Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Obliterative otitis media is a condition in which the entire middle ear cavity is filled up with fibrous tissue and with intact tympanic membrane. The aim of this study was to define the clinical features and analyze the treatment outcomes of this disease. SUBJECTS AND METHOD: Between January 2000 and August 2011, 16 patients consistent with the criteria of obliterative otitis media were analyzed retrospectively. RESULTS: All patients had intact but thickened eardrum, with mixed hearing loss of mild to moderate degree. The video pneumatic otoscopic examination revealed very limited mobility of eardrum. Myringotomy did not reveal any air-filled spaces or fluid in the tympanic cavity. There was no significant improvement of hearing after myringotomy or ventilation tube insertion. CONCLUSION: Obliterative otitis media is a discrete clinical entity and should not be confused with otitis media with effusion or adhesive otitis media.