The Rate of Eustachian Tube Dysfunction in Adult Patients With Chronic Inflammatory Middle Ear Disease Is Low.

OBJECTIVE: To assess the rate of dilatory (chronic obstructive) eustachian tube dysfunction (ETD) in adult patients scheduled for surgery for chronic inflammatory middle ear disease. PATIENTS: We included adult patients with chronic inflammatory middle ear disease (chronic suppurative otitis media, adhesive otitis media [middle ear atelectasis], cholesteatoma). We excluded patients with pathologies that do not stem from ETD (e.g., noninflammatory chronic middle ear disease [e.g., otosclerosis], tumors, solely external auditory canal conditions), patients scheduled for implantable electronic hearing devices independent of disease, patients with otitis media with effusion and scheduled paracentesis or ventilation tubes only, patients with previous radiotherapy or previous balloon eustachian tuboplasty, and children and patients unable to complete questionnaires. INTERVENTIONS: We evaluated ETD with Valsalva maneuver and in case of negative or unclear Valsalva with the eustachian tube score (ETS). A negative Valsalva maneuver and an ETS score of 5 or lower were used to define dilatory (chronic obstructive) ETD. MAIN OUTCOME MEASURES: Rate of ETD in the included patients. RESULTS: From a total of 482 consecutive patients, 350 patients had positive Valsalva maneuver or ETS score higher than 5. From the 193 patients with negative or unclear Valsalva maneuver, 77 patients had an ETS score of 5 or lower, and 55 rejected further diagnostics with ETS. CONCLUSIONS: Based on a large cohort of adult patients with chronic inflammatory middle ear disease scheduled for middle ear surgery, the majority (82%) seems to have no dilatory (chronic obstructive) ETD that can be detected with current routine clinical methods and tubomanometry. Common pathophysiological explanations should be questioned critically, especially in the context of communication with patients.

[Diagnostics and Surgical Therapy of Otosclerosis - Part 2: Indication, Surgical Procedure and Postoperative Treatment]. / Diagnostik und operative Therapie der Otosklerose.

After approximately 100 years of development and stepwise improvement, stapes surgery is a succesful strategy of managing hearing loss in otosclerosis, although challanges remain. Contraindications include too poor speech understanding (not enough inner ear reserve), and acute or chronic inflammation of the external ear and middle ear. Stapes surgery in the last hearing ear can today be indicated in exceptional cases, especially if the contralateral ear was supplied with a cochlear implant. In case of simultaneous occurrence of pronounced external auditory canal exostoses, a staged procedure may be useful.The surgical principle is to mechanically replace the fixed stapes with a piston-shaped implant under perforation or partial removal of the stapes footplate. Laser-assisted stapes surgery has proven itself in practice and the laser is used regularly today. In regard to revision surgery the increased risk of hearing loss or deafness and vertigo has to be considered. Revisions are made in the event of complications and persistent or newly occurring conductive components. In the case of insufficient hearing rehabilitation, alternative options should be considered, e. g. the combination of a stapes plastic with an active middle ear implant, or a cochlear implant.

[Diagnosis and operative therapy of otosclerosis - Part 1: Basics, Diagnostics and Differential Diagnosis]. / Diagnostik und operative Therapie der Otosklerose.

Otosclerosis is an important condition for the otorhinolaryngologist, and often in (differential) diagnosis and therapy challenging disease. Although a causal therapy option does not exist until today, if the diagnosis is correct, an operative or apparative hearing rehabilitation with very high chances of success can be promised. In addition to hearing aids surgical treatment with passive implants as a standard therapy, and in special cases also the implantation of active middle ear implants or cochlear implants, in advanced otosclerosis with significant involvement of the inner ear, are of importance. Knowledge of the definition, pathogenesis, diagnostics and in particular of the differential diagnosis as well as the current conservative and operative therapeutic limits are indispensable for the indication and selection of the optimal treatment path.In a two-part presentation, the current specialist medical knowledge of the disease in diagnosis and therapy is summarized. In addition to modern diagnostic procedures, aspects of therapy and prognosis are considered in a second article. This article therefore primarily refers to continuing education for residents in training and for young specialists.

Reconstruction of the mastoid using a titanium cage.

OBJECTIVES: Evaluate reconstruction of the posterior canal wall, including the mastoid cavity after canal wall-down cholesteatoma removal. METHODS: A titanium mesh metal cage was used to rebuild the posterior auditory canal wall and mastoid cell system in 12 patients undergoing cholesteatoma removal. The cage was then covered with pieces of cartilage to reconstruct the soft tissue surface. RESULTS: All reconstructions epithelialized completely. There was no denudation of the titanium material or signs of extrusion. Recurrences of cholesteatoma occurred twice according to the condition of the underlying disease, not related to the material. CONCLUSION: The titanium cage showed good biocompatibility in the middle ear space and the potential for rebuilding the mastoid cell system, making it a versatile tool for primary cases with large defects and in revision cases where soft tissue with cartilage-only reconstructions failed. Reconstruction of the posterior canal wall and mastoid by means of a titanium cage can be used in situations where adhesive tensions need a more stable construction and support of the posterior canal wall.