New method for packing the external auditory canal, middle ear space, and mastoid cavities after otologic surgery.

Since its introduction in 1945, an absorbable gelatin sponge, Gelfoam, has long been a staple used for packing in otologic surgery. The present method commonly employed at the University of Manitoba teaching hospitals requires that operating room nurses carefully prepare extremely small pieces of both compressed and noncompressed Gelfoam. These pieces are then selectively soaked in an antibiotic solution and carefully placed, one by one, into the appropriate position. We describe a new paste preparation of Gelfoam powder, Thrombostat, acetic acid, and Bacitracin ointment, which can very quickly be injected from a syringe into the operated cavity. Our preliminary study indicates that this preparation reduces operating time, while making the process of packing easier for the surgeon. In addition, it ensures a more evenly packed cavity while still fulfilling the requirements of middle ear packing. Postoperatively, it was found to be easier to debride from the operative cavity in the office, decreasing patient discomfort and procedure time. Reported below is a preliminary clinical patient series report comparing this new method to the old method.

Ocular torsion monitoring in chemical labyrinthectomy.

OBJECTIVE: To study the usefulness of ocular torsion analysis as an adjunct to examining central vestibular compensation. DESIGN: Prospective evaluation. SETTING: The Vestibular Disorders Clinic, University of Manitoba Health Sciences Centre. METHODS: Seven patients with intractable Meniere's disease underwent elective transtympanic gentamycin labyrinthectomy. Serial examination of patient progress was performed using fundus photography, subjective visual vertical estimations, electronystagmography, and audiometry. RESULTS: Ocular torsion analysis reveals unexpected initial and early contraversive torsion behaviour in some patients, which may represent an early irritative phenomenon stemming from either the gentamicin or the Meniere's disease itself. CONCLUSION: Despite the sensitivity of the ocular torsion measures, there appears to be no useful predictive correlation between ocular torsion and audiometric functioning that might predict impending hearing loss. Nevertheless, ocular torsion analysis reveals subtle changes in vestibular system functioning and may provide useful adjunctive information in the assessment of vestibular ototoxicity.

Cholesteatoma: diagnosis and staging by CT scan.

Chronic otitis media is frequently seen in otolaryngologic practice. Cholesteatoma is less common and can present a diagnostic challenge. Temporal bone imaging studies are often used both to support the clinical diagnosis of cholesteatoma and to ascertain the extent of the disease. The exact role of CT in patients with cholesteatoma is unclear. This retrospective study compares CT with the operative findings in 44 patients operated on for cholesteatoma. Results show that while CT can detect abnormalities in the temporal bone, its ability to diagnose cholesteatoma is poor. We conclude that CT should be used selectively in those patients presenting diagnostic dilemmas or when other concomitant pathology (i.e., complications, recurrent disease, etc.) is suspected.