Stapedectomy following tympanoplasty.

The aim of this study was to evaluate the success of stapedectomy in patients who have previously had a tympanoplasty because of chronic otitis media (COM). Fourteen patients from a private otology practice had undergone tympanoplasty for COM and subsequently underwent stapedectomy. Measurements were taken of the air-bone gap (ABG) closure and pure tone average (PTA) which showed hearing improvement. Patients had a mean 36.9 dB PTA hearing gain with 79 per cent closing the ABG to within 20 dB. The need for stapedectomy alone is a rare occurrence for patients with a history of COM requiring a tympanoplasty. Hearing improvement following stapedectomy in these cases was significant, although somewhat less than following traditional stapedectomy in otosclerosis alone.

Ossiculoplasty in canal wall down mastoidectomy.

OBJECTIVE: The aim of this study was to evaluate the initial and longer term success of closing the air-bone gap (ABG) to 20 dB in ossiculoplasty with canal wall down mastoidectomy. METHODS: This study was conducted at a private otologic practice. Patients included those who underwent ossiculoplasty from 1989 to 1996 with canal wall down mastoidectomy, whether primary or revision (33 from a total of 387 tympanomastoidectomies). Outcome measures included ABG closure, long-term hearing stability, mastoid appearance, extrusion, and sensorineural hearing loss. RESULTS: Almost 64% of ABGs were closed to within 20 dB. The mean pure-tone average improvement was 12.3 dB. The mean PTA hearing decline in the years after surgery was slightly less than 1 dB/year. CONCLUSION: Hearing improvement with a stable long-term hearing result is possible with canal wall down mastoidectomy. The potential for hearing gain is greatest for patients having larger preoperative ABGs.

Cavum major tympano-ossiculoplasty.

OBJECTIVE: To evaluate the success of tympano-ossiculoplasty in patients with previous canal wall down mastoidectomy. STUDY DESIGN: A retrospective review of 79 patients who underwent cavum major tympano-ossiculoplasty from a total of 1,910 tympanomastoidectomies from 1976 to 1998. OUTCOME MEASURES: The results of air-bone gap closure, surgical findings, and revision surgery are presented. RESULTS: In 63% of patients, the air-bone gap closed to within 20 dB with a mean gain of 14.7 dB. CONCLUSION: A significant percentage of patients will gain substantial improvement in their hearing after cavum major tympano-ossiculoplasty with minimal risk.

Otosclerosis in the 1960s, 1970s, 1980s, and 1990s.

EDUCATIONAL OBJECTIVE: The focus of this paper is on the changing patterns of presentation of otosclerosis over the past 37 years. STUDY DESIGN: Retrospective chart review. SETTING: Private otology practice. PATIENTS: Randomized selection of 400 patients (100 per decade) from 15,372 who underwent stapedectomy over the past four decades. OUTCOME MEASURES: Extent of cochlear involvement, bilaterality of disease, length of history, degree of hearing loss, and pathological findings are noted. RESULTS: The decreasing incidence of footplates necessitating drillouts is discussed. Changing audiometric patterns at presentation such as decreased pure-tone average hearing thresholds and smaller air-bone gaps are also reviewed. CONCLUSION: This review demonstrates the changing patterns of presentation of otosclerosis over the past 37 years and will help guide the stapes surgeon into the year 2000.

Goitre presenting as an oropharyngeal mass: an unusual finding in the elderly.

Thyroid goitre presentation in the neck with extension inferiorly to the mediastinum is well-known. Extension superiorly into the retropharyngeal space is very rare and may be accompanied by change in voice and/or airway compromise. A case is described of a patient with change in voice and mild airway compromise secondary to a goitre presenting in the oropharynx. Computed tomography (CT) and physical findings are discussed with the need to recognize this rare entity.

Use of intranasal endoscopic surgery to relieve ostiomeatal complex obstruction in fibrous dysplasia of the paranasal sinuses.

The use of endoscopic nasal surgery for debulking ethmoidal fibrous dysplasia, blocking the right ostiomeatal complex is presented. Removal of the obstructing bony mass was done by ear curette and drills. The procedure was limited to the ostiomeatal complex in order not to violate the orbital contents. The advantages of this method over the external approach are outlined in this paper.

Transnasal endoscopic drainage of a medial subperiosteal orbital abscess.

The exact incidence of orbital complications due to sinusitis in children is unknown. However, a medial subperiosteal orbital abscess is the most common serious complication to occur. Surgical intervention is mandatory whenever antibiotic treatment fails. Most authors prefer open surgical procedures such as external ethmoidectomy, while others recommend transnasal endoscopic drainage as the first attempt at sinus decompression. Five out of 12 children with proven subperiosteal orbital abscess and sinusitis on computed tomographic scans failed antibiotic treatment and required surgical drainage. Transnasal endoscopic drainage of the abscess was performed on four patients, while one child underwent external ethmoidectomy. Our experience with endoscopic surgery in these four cases is discussed, along with a brief review of the advantage of this procedure over external surgery.

Recovery from repeated sudden hearing loss with corticosteroid use in the presence of an acoustic neuroma.

Sensorineural hearing loss of sudden onset may be the presenting symptom in up to 14% of patients with acoustic neuroma. We present the first reported case of sudden hearing loss in an only hearing ear with recovery to normal levels after steroid therapy on four separate occasions. Evaluation revealed a 1.5-cm acoustic neuroma. After middle cranial fossa decompression, a fifth episode with recovery after steroid use was documented. A review of the recent literature is presented, emphasizing the possible causation of sudden sensorineural hearing loss with recovery to normal in patients with acoustic neuroma. Modalities of therapy for the dilemma of the acoustic neuroma in an only hearing ear are discussed, including surgery, radiotherapy, and chemotherapy. An aggressive approach to the evaluation of the cause of sudden hearing loss is suggested.

Management of tracheocutaneous fistula.

Management of large tracheocutaneous fistulas is not well described in the otolaryngology literature. Some authors have focused on the excision of the fistula tract with or without the use of a strap muscle or sternocleidomastoid flap. Others have proposed staged closures over a period of months to allow secondary healing to occur in order to avoid complications of dehiscence, pneumomediastinum, and infection. We describe a simple technique that utilizes the fistula tract to facilitate closure of a large tracheocutaneous fistula. By using this technique, the surgeon avoids the complications generally associated with the closure of such defects and also the morbidity of waiting for secondary closure to occur.