ABSTRACT
BACKGROUND: The impact of tight stapes crimping on hearing is a matter of debate. Several studies postulate that tight crimping is essential for lifelong success, whereas others have debated whether firm attachment leads to incus necrosis. Several types of prostheses with different coupling mechanisms have been developed, and manual crimping remains the most frequently used technique. This study investigates whether tightness really does affect hearing outcome. METHODS: The hearing results of patients who underwent primary stapedotomies using three different titanium pistons were analysed. The surgeons categorised the firmness of the piston attachment into 'tight' and 'loose' crimping groups. Hearing outcome and reasons for revision surgical procedures were investigated. RESULTS: The mean post-operative air-bone gap for frequencies of 0.5-4 kHz was 8.80 dB for the tight crimping group (n = 308) and 9.55 dB for the loose crimping group (n = 39). No significant difference was found (p = 0.4650). Findings at revision procedures were comparable (1.6 per cent vs 5 per cent). CONCLUSION: Although firm crimping is strongly advised, a movable loop upon palpation does not lead to unsatisfactory hearing results, and does not mandate piston replacement or bone cement use.
Subject(s)
Ossicular Prosthesis , Otosclerosis , Stapes Surgery , Humans , Otosclerosis/surgery , Stapes Surgery/methods , Stapes , Hearing , Treatment Outcome , Retrospective StudiesABSTRACT
OBJECTIVE: We report a unique case of anatomical variation of the extracranial course of the optic nerve running in the floor of the sphenoid sinus. METHOD: Clinical and radiological findings are presented. RESULTS: A 39-year-old woman with Turner syndrome presented with severe headache associated with visual disturbances. Magnetic resonance imaging revealed a mass presumed to be a sella meningioma. Computed tomography of the paranasal sinuses was undertaken to help plan surgical removal via an endoscopic trans-sphenoidal approach; this scan revealed an atypical extracranial course of the optic nerve, running in the floor of the sphenoid sinus.
Subject(s)
Optic Nerve/anatomy & histology , Sphenoid Sinus/pathology , Adult , Endoscopy , Female , Humans , Magnetic Resonance Imaging , Meningioma/diagnosis , Optic Nerve/diagnostic imaging , Paranasal Sinus Neoplasms/diagnosis , Paranasal Sinuses/diagnostic imaging , Sphenoid Sinus/diagnostic imaging , Tomography, X-Ray Computed , Turner Syndrome/epidemiologyABSTRACT
The management of intractable posterior epistaxis is challenging for any physician. Nasal packing, often combined with use of an endonasal balloon system, is painful for the patient, and torturous to maintain for two to three days. If conservative treatment fails, the most commonly used treatment options are currently invasive procedures such as endoscopic coagulation of bleeding arteries, external ligation and, rarely, embolisation. This paper describes a simple, non-invasive technique of treating posterior epistaxis with hot water irrigation. Technical information is presented, and the benefits of the method are discussed.
Subject(s)
Epistaxis/therapy , Hemostatic Techniques , Hot Temperature/therapeutic use , Nasal Cavity , Therapeutic Irrigation/methods , Algorithms , Ambulatory Care , Balloon Occlusion , Edema , Humans , Nasal Mucosa/physiopathology , Therapeutic Irrigation/instrumentation , WaterABSTRACT
Congenital nasal pyriform stenosis can be a life threatening emergency in neonates which must be included in the differential diagnosis of nasal airway obstruction. We describe the case of a male child who developed symptoms 36 h after birth. As the conservative therapy was not successful surgery became necessary.
