The safety of posterior tympanotomy in otitis media with effusion during cochlear implantation: clinical retrospective cohort study.

BACKGROUND: Posterior tympanotomy (PT) is an important step in cochlear implant (CI) surgery, as it is the main access to the round window. Some CI candidates, especially children, may have concomitant otitis media with effusion (OME) which may result in technical issues during PT. There is still a debate whether to wait for OME resolution preoperatively or to proceed to surgery with suspected difficulties. AIMS/OBJECTIVE: To evaluate the safety of PT during CI surgery in patients with OME. MATERIAL AND METHODS: we included 102 consecutive pediatric candidates in this retrospective study with an age range of 12 months to 6 years. All the patients underwent CI surgery using trans-mastoid, PT to access round window (RW) area. We investigated the effect of the pathology caused by OME on the operative procedure in PT and post-operative consequences. THE RESULTS: out of 102 patients included in this study, there were 22 patients with OME who had unilateral cochlear implantation with no major operative or post-operative events. Nevertheless, some minor intra operative events and difficulties were encountered. CONCLUSION AND SIGNIFICANCE: The presence of OME in CI surgery indicates possible surgical challenges such as difficult PT, minor intra-operative risks and with no major post-operative events.

Tinnitus: Evaluation of Intratympanic Injection of Combined Lidocaine and Corticosteroids.

BACKGROUND: Tinnitus is an annoying problem and until now there is no consensus on its treatment. AIMS: In this prospective study, we evaluated the effectiveness of intratympanic lidocaine and dexamethasone (ITLD) injections for the management of subjective idiopathic tinnitus (SIT). METHODS: Forty patients with SIT attended the Department of Otorhinolaryngology, Tanta University Hospital, Egypt, between May 2013 and May 2014. The patients were categorized into two groups: group A included 20 patients treated with ITLD injection, and group B included 20 patients treated with intratympanic saline injection as a control. Intratympanic injections were performed four times within 4 weeks in a double-blind manner. At the end of the treatment program, we analyzed the improvement and worsening rates of tinnitus using the following parameters: tinnitus questionnaires, Tinnitus Handicap Index (THI), and loudness matching test. RESULTS: The effectiveness rates of the ITLD group reported in the tinnitus questionnaires, the THI and the loudness matching test were 74.3% in all tests, compared to 26.7, 40.0 and 26.7%, respectively, in the saline group. There was a statistically significant difference between the groups within 2 months after injection. To analyze the therapeutic effect of ITLD on tinnitus of 6 months duration, the improvement rates reported in the tinnitus questionnaires, the THI and the loudness matching test were 78.5% in all tests in the ITLD group, compared to 40.0, 40.0 and 30.0%, respectively, in the saline group. CONCLUSION: There were statistically significant differences between both groups. ITLD seems to be effective for idiopathic tinnitus.

Use of a Foley catheter balloon as a tool during endoscopic frontal sinus surgery in a resource-poor environment.

OBJECTIVE: This study aimed to evaluate the non-Food and Drug Administration-approved off-label use of a 10F Foley catheter as a tool during endoscopic frontal sinus surgery. METHOD: A cohort of 40 patients with chronic frontal rhinosinusitis was prospectively evaluated using the Sino-Nasal Outcome Test (SNOT-22), computed tomography (CT) imaging, and endoscopic examination. Endoscopic sinus surgery (ESS) was performed in the usual fashion, however, when approaching the frontal sinus, a 10F Foley catheter was inserted and the balloon inflated in the frontal outflow. Patients were assessed postoperatively with SNOT-22, CT imaging, and endoscopic assessment at 6 months. RESULTS: Successful intraoperative dilation of the frontal recess was achieved in 62 of 69 frontal sinuses (90%). No cerebrospinal fluid leak or orbital entry occurred. Six months postoperative, SNOT-22 scores showed significant improvement, whereas endoscopic assessment revealed patent frontal recess in 55 of 62 (89%) frontal sinuses. Computed tomography imaging was completed in 25 patients comprising 41 operated frontal sinuses with no mucosal thickening seen in 37 of 41 (90%). CONCLUSION: The 10F Foley catheter is an effective tool to dilate the frontal recess by compression of edema during ESS. It may be a safe and cost-effective alternative to high-cost commercially available sinus balloons, especially in resource-poor environments.