Study of mastoid pneumatization and attic blockage in patients with chronic otitis media with effusion using computed tomography and tympanometry

Otitis media with effusion is a leading cause of counductive hearing loss. The organic Sequale of otitis media with effusion are changes in the tympanic membrane such as atrophy, retraction, and tympanosclerosis and changes in the mastoid, middle ear and inner ear. Prolonged otitis media with effusion carries the risk for further progression into adhesive otitis media, chronic supprative otitis media, and cholesteatoma. The development of mastoid air cell system taking place during the first years of life, is disturbed by episodes of acute otitis media and secretory otitis media and the result is hypocellularity, which, accordingly, must be regarded as a sequels to pathologic influence on the middle ear. This study was carried out on 30 patients, with persistent chronic otitis media with effusion. Tympanometry and computerized tomography [CT] scan of the temporal bones were done for all patients pre-operatively. Axial CT, 2 mm slice thickness and 2mm interval were taken preoperatively for assessment of tympanomastoid pneumatization and the condition ofaditus ad antrum. Ventilation tube [VT] insertion with or without adenoidectomy or adenotonsillectomy was performed to the unimproved patient. Every patient was followed up for 6 months with otoscopy and Tympanometry. The first visit was in the first week post operatively, the second visit was in the third month post operatively and the third visit was in the sixth month post operatively. In each visit we check up the presence and patency of each grommet tube by tympanometry [GSI auto Tymp] to measure the postoperative compliances. The result of our study showed that patient with otitis media with effusion [OME] have significant sclerotic mastoid and the ear with high initial and or gradual increase in physical volume test [PVT] with time can be considered one of the prognostic factor in improvement in pathology of the middle ear mastoid. It has been stated that RST decreased the mastoid size and approximately half of the ear with chronic otitis media with effusion in adult have residual soft tissue density [RST] in mastoid cavity. Because of the degree of mastoid preumatization is thought to reflect the gas exchange function of the mastoid cavity the middle ear pressure regulation through the infected mucosa might be impaired and retraction of the tympanic membrane occurred and insertion of V.T equalize the middle ear pressure and reversible mucosal changes are improved

Myringoplasty in children: predictive value of preoperative assessment of Eustachian tube function

Our aim was to determine the value of preoperative Eustachian tube [ET] function assessment in predicting the results of myringoplasties in children. One hundred children suffering from inactive chronic suppurative otitis media were enrolled in this study. All children had undergone preoperative evaluation of the ET function using pressure equalizing test. Children were classified into three groups according to the ET function. The patients were operated at ORL Departments, Mansoura and Banha University hospitals between 2003 and 2006. Tympanic membrane perforations were reconstructed by autogenous temporalis fascia graft using underlay technique. Success was defined as no evidence of tympanic membrane perforation via otoscopic examination at the end of 6th month and air bone gap less than 20 dB. A success rate of 91.6% in terms of graft uptake and hearing improvement of 95.4% was seen in good ET function, compared to 36.4% graft uptake and 62.5% hearing improvement in poor ET function. This study revealed that preoperative assessment of ET function is an important factor when considering myringoplasty in children

use of bioglass in closure of recurrent oroantral fistula

Oroantral fistula is a commonly encountered clinical problem. As the meter of the bony deficiency and elevated air pressure on one or both of the wound are main factors involved in healing of OAF it was in this study to investigate the effects of the use of Bioglass for the treatment of recurrent oroantral fistula after surgical closure. The study conducted on. 14 patients having a history suggesting oroantral fistula after tooth extraction with recurrence after previous surgical closure. A coronal CT scan was performed to assess the maxillary sinus and to evaluate the fistula. The Caldwell-Luc operation was performed endscopically for the existing sinus pathology. After the treatment of sinus pathology, a palatal, buccal or buccopalatal flap was created. Scar tissue and osteitis were removed from the fistulous tract. The track was then closed using a piece of Bioglass plate. The piece of the used bioglass as sculptured using a sharp scalpel or a diamond burr until it becomes nearly fitted to the track then it was placed inside the track, If there is any space between the piece of the Bioglass and the outer wall of the sic. The mucoperiosteal palatal flap is rotated across over the defect. After 3 months the fistula closed by new bone of nearly the same density of the a.4jacent bone in 12 patients. Postoperative radiographs showed clear sinuses in 12 patients with mildly thickened mucosa at the floor and adjacent parts of the medial and lateral walls. In 2 patients the operation was considered as failed. One of those two patients was diabetic. In the diabetic patient, there was extrusion of the bioglass after 7 days from the wound which healed partially. The sinus drained purulent discharge from the wound. The flaps were edematous and swollen at the site of the fistula. In the other patient the there was marked pain at the site of the operation, non healing of the flap above the site of the track. The bioglass plate was loose and got clown easily from the wound. Culture of the purulent discharge of both patients revealed aerobes [Gm positive streptococci and staphylococci.] while in the other diabetic patient, there was mixture of aerobes and anaerobes. In conclusion. The use of bioglass can be helpful in closure of large recurrent oroantral fistula. It acts as a barrier preventing oral and maxillary sinus epithelium to cover the track. It abolishes the elevated pressure in the sinus or oral cavity which may be a factor of failure of healing of soft tissue closure. It is not only beneficial for closure of the fistula by new bone formation but also provides sufficient. bone in the alveolar region which may be beneficial for further placement of osseo-integrated implant and conventional prosthetic rehabilitation