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1.
J Stroke Cerebrovasc Dis ; 29(10): 105184, 2020 Oct.
Article in English | MEDLINE | ID: mdl-32912560

ABSTRACT

AIM: We aimed to describe otogenic lateral sinovenous thrombosis (OLST), a rare, potentially life-threatening complication of otomastoiditis. METHODS: Children diagnosed with OLST in a tertiary-care Hospital from 2014 to 2019 was retrospectively selected. Clinical and radiological features, timing of diagnosis, treatment and outcome are reported. RESULTS: Seven children (5 males) were studied. Fever and neurological symptoms (headache, lethargy, diplopia, dizziness and papilledema) were always present. Otalgia and/or otorrhea were found in 6 children; none had signs of mastoiditis. Diagnosis was reached after 7 days (median) from clinical onset. Brain CT-scan was performed in 5 children being diagnostic for 3. Venography-MRI detected OLST and mastoiditis in all cases without parenchymal lesions. Treatment was based on intravenous rehydration, antibiotic and low-molecular weight heparin; acetazolamide was added in 3 children. Mastoidectomy and ventriculoperitoneal-shunting were selectively performed. Patients were discharged after 26 days (median). Follow-up neuroimaging showed sinus recanalization after a median time of 6 months. CONCLUSION: A multidisciplinary approach is needed to optimize diagnostic-therapeutic protocols of pediatric OLST.


Subject(s)
Cerebrospinal Fluid Otorrhea/complications , Earache/complications , Lateral Sinus Thrombosis/etiology , Mastoiditis/complications , Adolescent , Age Factors , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Carbonic Anhydrase Inhibitors/therapeutic use , Cerebrospinal Fluid Otorrhea/diagnosis , Cerebrospinal Fluid Otorrhea/therapy , Child , Child, Preschool , Earache/diagnosis , Earache/therapy , Female , Fluid Therapy , Humans , Lateral Sinus Thrombosis/diagnostic imaging , Lateral Sinus Thrombosis/therapy , Male , Mastoidectomy , Mastoiditis/diagnosis , Mastoiditis/therapy , Retrospective Studies , Treatment Outcome , Ventriculoperitoneal Shunt
2.
J Zhejiang Univ Sci B ; 20(2): 156-163, 2019.
Article in English | MEDLINE | ID: mdl-30666849

ABSTRACT

OBJECTIVE: To describe the characteristics of the clinical presentation, diagnosis, surgical methods, and outcomes of patients with otogenic cerebrospinal fluid (CSF) leakage secondary to congenital inner ear dysplasia. METHODS: A retrospective review was performed of 18 patients with otogenic CSF leakage secondary to inner ear dysplasia who underwent surgery in our group from 2007 to 2017 and had a follow-up of at least 4 months. The average length of follow-up was three years. The characteristics of the clinical presentations of all patients, such as self-reported symptoms, radiographic findings, surgical approaches and methods of repair, position of the leakage during surgery, and postoperative course, including the success rate of surgery, are presented. RESULTS: The patients presented mostly with typical symptoms of meningitis, severe hearing impairment, and CSF otorrhea or rhinorrhea. All 18 patients had at least one previous episode of meningitis accompanied by a severe hearing impairment. The preoperative audiograms of 17 patients showed profound sensorineural hearing loss, and one patient had conductive hearing loss. Twelve patients presented with an initial onset of otorrhea, and two had accompanying rhinorrhea. Six patients complained of rhinorrhea, two of whom were misdiagnosed with CSF rhinorrhea and underwent transnasal endoscopy at another hospital. High-resolution computed tomography (HRCT) images can reveal developments in the inner ear, such as expansion of a vestibular cyst, unclear structure of the semicircular canal or cochlea, or signs of effusion in the middle ear or mastoid, which strongly suggest the possibility of CSF otorrhea. The children in the study suffered more severe dysplasia than adults. All 18 patients had CSF leakage identified during surgery. The most common defect sites were in the stapes footplates (55.6%), and 38.9% of patients had a leak around the oval window. One patient had a return of CSF otorrhea during the postoperative period, which did not re-occur following a second repair. CONCLUSIONS: CSF otorrhea due to congenital inner ear dysplasia is more severe in children than in adults. The most common symptoms were meningitis, hearing impairment, and CSF otorrhea or rhinorrhea. HRCT has high diagnostic accuracy for this disease. The most common fistula site was around the oval window, including the stapes footplates and the annular ligament.


Subject(s)
Cerebrospinal Fluid Otorrhea/etiology , Ear, Inner/abnormalities , Adolescent , Adult , Cerebrospinal Fluid Otorrhea/diagnosis , Cerebrospinal Fluid Otorrhea/therapy , Child , Child, Preschool , Humans , Infant , Middle Aged , Retrospective Studies , Young Adult
3.
Diagn Interv Imaging ; 100(1): 3-15, 2019 Jan.
Article in English | MEDLINE | ID: mdl-29910174

ABSTRACT

Cerebrospinal fluid (CSF) leaks are extracranial egress of CSF into the adjacent paranasal sinus or tympanomastoid cavity due to an osteodural defect involving skull base. It can be due to a multitude of causes including accidental or iatrogenic trauma, congenital malformations and spontaneous leaks. Accurate localization of the site of the leak, underlying causes and appropriate therapy is necessary to avoid associated complications. In this paper relevant anatomy, clinical diagnosis, imaging modalities and associated findings are discussed along with a brief mention about management.


Subject(s)
Cerebrospinal Fluid Otorrhea/diagnostic imaging , Cerebrospinal Fluid Rhinorrhea/diagnostic imaging , Multimodal Imaging , Cerebrospinal Fluid Otorrhea/etiology , Cerebrospinal Fluid Otorrhea/therapy , Cerebrospinal Fluid Rhinorrhea/etiology , Cerebrospinal Fluid Rhinorrhea/therapy , Encephalocele/diagnostic imaging , Humans , Iatrogenic Disease , Intramolecular Oxidoreductases/metabolism , Lipocalins/metabolism , Skull Base/anatomy & histology , Skull Fractures/diagnostic imaging , Sphenoid Sinus/anatomy & histology , Transferrin-Binding Protein B/metabolism
4.
Article in English | WPRIM (Western Pacific) | ID: wpr-1010449

ABSTRACT

OBJECTIVE@#To describe the characteristics of the clinical presentation, diagnosis, surgical methods, and outcomes of patients with otogenic cerebrospinal fluid (CSF) leakage secondary to congenital inner ear dysplasia.@*METHODS@#A retrospective review was performed of 18 patients with otogenic CSF leakage secondary to inner ear dysplasia who underwent surgery in our group from 2007 to 2017 and had a follow-up of at least 4 months. The average length of follow-up was three years. The characteristics of the clinical presentations of all patients, such as self-reported symptoms, radiographic findings, surgical approaches and methods of repair, position of the leakage during surgery, and postoperative course, including the success rate of surgery, are presented.@*RESULTS@#The patients presented mostly with typical symptoms of meningitis, severe hearing impairment, and CSF otorrhea or rhinorrhea. All 18 patients had at least one previous episode of meningitis accompanied by a severe hearing impairment. The preoperative audiograms of 17 patients showed profound sensorineural hearing loss, and one patient had conductive hearing loss. Twelve patients presented with an initial onset of otorrhea, and two had accompanying rhinorrhea. Six patients complained of rhinorrhea, two of whom were misdiagnosed with CSF rhinorrhea and underwent transnasal endoscopy at another hospital. High-resolution computed tomography (HRCT) images can reveal developments in the inner ear, such as expansion of a vestibular cyst, unclear structure of the semicircular canal or cochlea, or signs of effusion in the middle ear or mastoid, which strongly suggest the possibility of CSF otorrhea. The children in the study suffered more severe dysplasia than adults. All 18 patients had CSF leakage identified during surgery. The most common defect sites were in the stapes footplates (55.6%), and 38.9% of patients had a leak around the oval window. One patient had a return of CSF otorrhea during the postoperative period, which did not re-occur following a second repair.@*CONCLUSIONS@#CSF otorrhea due to congenital inner ear dysplasia is more severe in children than in adults. The most common symptoms were meningitis, hearing impairment, and CSF otorrhea or rhinorrhea. HRCT has high diagnostic accuracy for this disease. The most common fistula site was around the oval window, including the stapes footplates and the annular ligament.


Subject(s)
Adolescent , Adult , Child , Child, Preschool , Humans , Infant , Middle Aged , Young Adult , Cerebrospinal Fluid Otorrhea/therapy , Ear, Inner/abnormalities , Retrospective Studies
5.
Int J Pediatr Otorhinolaryngol ; 109: 36-39, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29728181

ABSTRACT

OBJECTIVE: To demonstrate the safety and effectiveness of topical 2% mupirocin ointment as an adjunctive therapy for tympanostomy tube otorrhea (TTO) caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: We treated children with community-acquired MRSA TTO by aural suctioning and culture-directed systemic antibiotics (+/- ototopical drops) alone (control group) or with the addition of single 1 ml dose of mupirocin ointment applied to the tube and ear canal (mupirocin group). Patient age, laterality, response to treatment, associate hearing loss, duration of follow-up, and recurrence of infection by MRSA or by other organisms were compared. RESULTS: 29 children (37 ears) with MRSA TTO were included. 8 children (12 ears) received adjunctive topical mupirocin ointment - 21 children (25 ears) did not. 8 of 12 ears in the mupirocin group received concomitant systemic antibiotics - 4 ears were treated with topical mupirocin alone. The mean duration of follow-up of the mupirocin group was 7 months (with 95% C.I of 7 ±â€¯7). The control group was 24 months (with 95% C.I of 24 ±â€¯9). Recurrence of MRSA TTO in the mupirocin and control groups were 0/12; 0% and 10/25; 40%, by ear, respectively (p = 0.015). Recurrence of non-MRSA TTO in the mupirocin and control groups were 6/12; 50% and 9/25; 36%, by ear, respectively (p = 1.0). There were no sensorineural hearing losses in the mupirocin-treated children. CONCLUSION: In this small series, a single application of topical mupirocin in combination with mechanical debridement, controlled infection by CA-MRSA without evidence of local reaction or subsequent hearing loss. Its role in treatment of MRSA TTO merits further investigation.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Cerebrospinal Fluid Otorrhea/therapy , Methicillin-Resistant Staphylococcus aureus , Middle Ear Ventilation , Mupirocin/administration & dosage , Staphylococcal Infections/drug therapy , Administration, Topical , Case-Control Studies , Cerebrospinal Fluid Otorrhea/microbiology , Child, Preschool , Combined Modality Therapy , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Female , Humans , Male , Ointments , Staphylococcal Infections/microbiology
6.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 31(20): 1617-1621, 2017 Oct 20.
Article in Chinese | MEDLINE | ID: mdl-29797964

ABSTRACT

Spontaneous cerebral spinal fluidotorrhea (SCSFO) is a type of CSF otorrhea without obvious causes including previous trauma, surgery, infection or neoplasm. The etiology of SCSFO remains unclear, the diagnosis can be overlooked because of the untypical clinical features. In this paper, we reviewed etiology, clinical features, diagnosis and therapy of SCSFO from recent relative literatures.


Subject(s)
Cerebrospinal Fluid Otorrhea/diagnosis , Cerebrospinal Fluid Otorrhea/therapy , Cerebrospinal Fluid Otorrhea/etiology , Humans
7.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 30(8): 627-629; 632, 2016 Apr 20.
Article in Chinese | MEDLINE | ID: mdl-29871093

ABSTRACT

Objective:To analyze the etiology and clinical symptoms and to investigate the therapeutic strategies of cerebrospinal fluid otorrhea. Method:A retrospective analysis of 37 cases of patients with cerebrospinal fluid otorrhea.The clinical symptoms, auxiliary examination, intraoperative findings, surgical methods and postoperative follow-up were analyzed. Result:In 37 cases, 35 patients underwent the plugging surgery once and cured, 1 patient with inner ear malformation underwent another operation and cured, 1 patient didn't have the operation. No cerebrospinal fluid leakage or meningitis recurrence was reported by the followed up from 1 months to 7 years after operation. Conclusion:Surgical repair is an effective method to treat the cerebrospinal fluid otorrhea. It is significant to take appropriate surgical approach to expose and to find the leak, according to the etiological factor and imaging examination.


Subject(s)
Cerebrospinal Fluid Otorrhea , Cerebrospinal Fluid Otorrhea/diagnosis , Cerebrospinal Fluid Otorrhea/therapy , Cerebrospinal Fluid Rhinorrhea , Humans , Meningitis , Recurrence , Retrospective Studies
8.
J Laryngol Otol ; 129(8): 817-9, 2015 Aug.
Article in English | MEDLINE | ID: mdl-26244424

ABSTRACT

OBJECTIVE: This paper reports a rare case of cerebrospinal fluid leak due to a Hyrtl's fissure and discusses the non-operative management of the case. Background and case report: Cerebrospinal fluid otorrhoea is a rare phenomenon arising from an abnormal communicating tract between the subarachnoid space and middle ear. Affected patients are at a higher risk of developing meningitis and other neuro-otological complications. There are four common congenital causes of cerebrospinal fluid otorrhoea in the region of a normal labyrinth. This paper describes a case of cerebrospinal fluid in the middle ear resulting from a Hyrtl's fissure, which resolved spontaneously. CONCLUSION: A literature search indicated this to be the first case with such a resolution without the need for any intervention.


Subject(s)
Cerebrospinal Fluid Otorrhea/diagnosis , Cerebrospinal Fluid Otorrhea/therapy , Ear, Middle/abnormalities , Ear, Middle/pathology , Remission, Spontaneous , Subarachnoid Space/abnormalities , Subarachnoid Space/pathology , Acoustic Impedance Tests , Audiometry, Pure-Tone , Cerebrospinal Fluid Otorrhea/congenital , Child , Humans , Male , Tomography, X-Ray Computed
9.
Cochlear Implants Int ; 15(3): 179-84, 2014 May.
Article in English | MEDLINE | ID: mdl-24660749

ABSTRACT

OBJECTIVES: To share our experience of cerebrospinal fluid (CSF) gusher in cochlear implantation. METHODS: Demographic, radiological, and surgical results of patients with CSF gusher in 523 consecutive cochlear implant recipients including children and adults as well as our management technique were evaluated and a review of the literature has been included. RESULTS: Fifteen (2.87%) cases had CSF gusher. Two patients (13.3%) were adults with post-lingual hearing loss and the rest 12 (86.7%) were children with congenital hearing loss. Twelve patients (80%) had various types of inner ear malformation. Three patients (20%) had no predictable risk of CSF gusher from history or pre-operative imaging. In all patients, CSF gushers were controlled with our technique of packing the electrode entrance site with no additional measures. CONCLUSION: CSF gusher may occur with post-lingual hearing loss and in children with apparently unremarkable imaging and history. Thus, surgeons should always be ready to manage it. Management of CSF gusher can be mainly performed during the initial surgery by precise tight packing of the electrode entrance site. Furthermore, non-surgical or surgical measures are rarely required to stop a persistent leak. Our results show that our management technique may be recommended as well.


Subject(s)
Cerebrospinal Fluid Otorrhea/etiology , Cochlear Implantation/adverse effects , Adolescent , Adult , Cerebrospinal Fluid Otorrhea/therapy , Child , Child, Preschool , Cochlear Implantation/mortality , Ear, Inner/abnormalities , Ear, Inner/diagnostic imaging , Electrodes, Implanted , Female , Humans , Male , Middle Aged , Radiography , Round Window, Ear
10.
World Neurosurg ; 81(5-6): 842.e11-6, 2014.
Article in English | MEDLINE | ID: mdl-23313234

ABSTRACT

BACKGROUND: Otorrhagia is an uncommon but severe symptom of patients with large glomus jugulare tumors that erode through the tympanic membrane. In this case report we describe the use of transarterial embolization for long-term palliative management of otorrhagia in a patient with an unresectable glomus jugulare tumor. CASE DESCRIPTION: A 53-year-old woman presented with intermittent otorrhagia 10 years after subtotal resection of a glomus jugulare tumor. Follow-up magnetic resonance imaging showed progressive enlargement of the tumor with significant extension into the posterior fossa. Resection was thought to be impractical; therefore, transarterial embolization was offered as a palliative measure to help reduce the frequency and severity of bleeding episodes. RESULTS: Long-term control of otorrhagia was achieved after three rounds of intra-arterial embolization. In round one, the tumor was embolized from multiple external carotid artery feeding branches by the use of polyvinyl alcohol particles. In round two, the internal carotid artery was sacrificed by embolizing the cavernous and petrous segments with coils. In round three, persistent feeders from the cervical internal carotid artery were embolized with Onyx. In 6 years of clinical follow-up, the patient has had no otorrhagia or new neurological deficits. Serial magnetic resonance imaging revealed there has been no significant interval tumor growth. CONCLUSION: Long-term control of otorrhagia from glomus jugulare tumors can be safely achieved by intravascular embolization with Onyx.


Subject(s)
Dimethyl Sulfoxide , Embolization, Therapeutic/methods , Glomus Jugulare Tumor/therapy , Glomus Jugulare/pathology , Polyvinyls , Cerebrospinal Fluid Otorrhea/pathology , Cerebrospinal Fluid Otorrhea/therapy , Female , Glomus Jugulare Tumor/pathology , Glomus Jugulare Tumor/surgery , Humans , Middle Aged , Palliative Care/methods , Retreatment , Treatment Outcome
11.
Acta otorrinolaringol. esp ; 64(3): 191-196, mayo-jun. 2013. graf, ilus
Article in Spanish | IBECS | ID: ibc-112683

ABSTRACT

Introducción: Las fístulas de líquido cefalorraquídeo en el oído derivan de una comunicación anormal entre el espacio subaracnoideo y el timpanomastoideo, la mayoría de etiología traumática. Tienen gran interés desde el punto de vista clínico por el potencial riesgo de meningitis, directamente relacionado con la etiología. Nuestro objetivo es mostrar nuestra experiencia en el manejo de dicho proceso. Métodos: Presentamos un total de 17 pacientes diagnosticados y tratados de fístulas de líquido cefalorraquídeo en el oído desde el año 2003 hasta el 2011. Resultados: En nuestro estudio el mayor porcentaje de casos correspondían a otolicuorreas de tipo espontáneo, con una presentación clínica variada. El diagnóstico se basó en la determinación de la beta-2-transferrina y en estudios de imagen, especialmente importantes por su valor localizador del defecto. El tratamiento quirúrgico fue el de elección. Conclusiones: Las fístulas de líquido cefalorraquídeo en el oído constituyen una entidad rara en la patología otorrinolaringológica. Su diagnóstico se sospecha por signos característicos como la otolicuorrea, pérdida auditiva y sensación de plenitud ótica, mientras que la tomografía computarizada y la resonancia magnética nos ayudan a su localización. La cirugía es la técnica de elección, y su éxito se basa en la técnica multicapas con 2 o más materiales de soporte (AU)


Introduction: Cerebrospinal fluid otorrhea results from an abnormal communication between the subarachnoid space and tympanomastoid compartment; most of them are of traumatic aetiology. They have clinical interest due to the potential risk of meningitis, directly related to the aetiology. Our aim was to show our experience in the management of this process. Methods: A total of 17 patients diagnosed and treated for cerebrospinal fluid otorrhea from 2003 to 2011. Results: In our study, the highest percentage of cases was spontaneous cerebrospinal fluid otorrhea, with a wide clinical presentation. The diagnosis was based on the determination of beta-2-transferrin and radiological studies, especially important for its locator value. The treatment of choice was surgery. Conclusions: Cerebrospinal fluid otorrhea is a rare entity in otorhinolaryngological pathology. Its diagnosis is suspected through otorrhea, hearing loss and aural fullness, while computed tomography and magnetic resonance help us to locate the defect. Surgery is the preferred technique, and its success is based on multilayer technology with 2 or more support materials (AU)


Subject(s)
Humans , Cerebrospinal Fluid Otorrhea/therapy , Subdural Effusion/therapy , Mastoid/surgery , Maxillary Sinus/surgery , Transferrins/analysis , Risk Factors , Meningitis/prevention & control
13.
Rev Med Liege ; 68(1): 6-10, 2013 Jan.
Article in French | MEDLINE | ID: mdl-23444821

ABSTRACT

Mr G, sixty-seven years old, was admitted to our hospital for a liver transplant. He suffered from a cirrhosis due to an HBV infection, complicated by an hepatocellular carcinoma. During the perioperative care, a left otorrhea was discovered. According to the clinical history, this otorrhea had been present for six weeks and followed the completion of a myringotomy. The myringotomy had been performed with a view to place a transtympanic ventilation tube for the treatment of a serous otitis media inducing a conductive hearingloss. Clinical, biological, and radiological explorations revealed a CSF leak caused by the fact that the myringotomy had been done in a temporal meningo-encephalocele. A conservative treatment allowed to stop the otorrhea. We present a short discussion about temporal meningoencephalocele and, more generally, about CSF otorrhea.


Subject(s)
Cerebrospinal Fluid Otorrhea/diagnosis , Cerebrospinal Fluid Otorrhea/therapy , Acinetobacter Infections/diagnosis , Acinetobacter Infections/therapy , Acinetobacter baumannii/isolation & purification , Acinetobacter baumannii/physiology , Aged , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/surgery , Cerebrospinal Fluid Otorrhea/etiology , Deafness/diagnosis , Deafness/etiology , Hepatitis B, Chronic/complications , Hepatitis B, Chronic/surgery , Humans , Liver Neoplasms/complications , Liver Neoplasms/surgery , Liver Transplantation/adverse effects , Male , Meningitis, Bacterial/complications , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/therapy , Postoperative Complications/diagnosis , Postoperative Complications/therapy
15.
Childs Nerv Syst ; 28(12): 2033-40, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22832790

ABSTRACT

BACKGROUND: Head injuries constitute one of the leading causes of pediatric morbidity and mortality. Most injuries result from accidents involving an acceleration/deceleration mechanism. However, a special type of head injury occurs when the children sustain a traumatism whose main component is a static load in relation to a crushing mechanism with the head relatively immobile. PATIENTS AND METHODS: We report a series of children who sustained a craniocerebral injury of variable severity produced by head crushing. We also analyze epidemiological and clinical data, and biomechanics in these injuries. RESULTS: Mean age of the group (13 boys/6 girls) was 4.1 years. All patients showed external lesions (scalp wounds or hemorrhage from the nose, ears, or throat). Eleven children were initially unconscious. Six children presented cranial nerve deficits in addition to impaired hearing. Skull base fractures were seen in most cases with extension to the vault in 11 instances. Fourteen patients had an associated intracranial lesion, including two with diffuse axonal injury. Surgery was performed in three instances. Only seven patients were left with sequelae. DISCUSSION AND CONCLUSIONS: The observed skull, brain, and cranial nerve lesions corresponded to a mechanism of bilateral compression of the children's heads mainly occasioned by a static load, although an associated component of dynamic forces was also involved. The skull and its covering and the cranial nerves were the most severely affected structures while the brain seemed to be relatively well preserved. Most crush injuries appear to be preventable by the appropriate supervision of the children.


Subject(s)
Craniocerebral Trauma/pathology , Craniocerebral Trauma/therapy , Accidents, Home , Accidents, Traffic , Automobiles , Biomechanical Phenomena , Brain/pathology , Cerebrospinal Fluid Otorrhea/etiology , Cerebrospinal Fluid Otorrhea/therapy , Cerebrospinal Fluid Rhinorrhea/etiology , Cerebrospinal Fluid Rhinorrhea/therapy , Child , Child, Preschool , Craniocerebral Trauma/epidemiology , Critical Care , Diffuse Axonal Injury/etiology , Diffuse Axonal Injury/pathology , Female , Glasgow Coma Scale , Humans , Infant , Intracranial Pressure/physiology , Length of Stay , Male , Skull Base/pathology , Skull Fractures/pathology , Tomography, X-Ray Computed , Treatment Outcome
16.
Otol Neurotol ; 33(6): 983-7, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22772000

ABSTRACT

INTRODUCTION: Most clinical studies on adverse effects and extrusion rates of tympanostomy tubes have been conducted with children undergoing treatment because of recurrent acute otitis media or chronic otitis media with effusion. Little is known, however, about post tympanostomy complications and extrusion rates in healthy middle ears. In this study, we analyzed extrusion rates and adverse effects of fluoroplastic, titanium, and gold ventilation tubes of different sizes in adult patients with Ménière's disease. METHODS: Clinical record study including 108 patients. RESULTS: Otorrhea occurred in 18% of fluoroplastic tubes but only 4% of titanium tubes. Permanent occlusion was observed in 22% of fluorplastic but only 4% of titanium tubes. No statistical difference was seen for transient dysfunction and tube extrusion rates. Granulations and chronic perforations were not observed. DISCUSSION: The low rate of infections and permanent occlusions for titanium tubes as well as the lack of granulations and chronic perforations for all tubes might be due to the fact that our patients were adults with healthy middle ears. Furthermore, a better biocompatibility of titanium in the middle ear compared with gold or synthetic materials has been observed for protheses used to rebuild the sound conductive apparatus of the middle ear. CONCLUSION: Titanium tubes might be the better choice for adult patients lacking Eustachian tube dysfunction and otitis media with effusion. Ventilation tubes in adults with healthy middle ears seem to be less associated with adverse effects compared with ventilation tubes in children with otitis media with effusion or recurrent otitis media.


Subject(s)
Biocompatible Materials , Middle Ear Ventilation/adverse effects , Middle Ear Ventilation/instrumentation , Titanium , Adult , Aged , Cerebrospinal Fluid Otorrhea/therapy , Ear Diseases/epidemiology , Female , Fluorocarbons , Gold , Humans , Infections/epidemiology , Kaplan-Meier Estimate , Male , Meniere Disease/surgery , Middle Aged , Otitis Media with Effusion/surgery , Prosthesis Failure , Survival Analysis
19.
Otolaryngol Clin North Am ; 43(4): 945-54, 2010 Aug.
Article in English | MEDLINE | ID: mdl-20599097

ABSTRACT

The introduction of the endoscopic endonasal approach for the management of lesions of the skull base has produced a paradigm shift in the way complicated lesions of this complex anatomic location are managed. The endonasal approach provides the most direct route to the anterior cranial base and adjacent skull base locations. This article presents the 10 most important tenets that have proved useful to the authors regarding postoperative patient management and surgical practice.


Subject(s)
Endoscopy/methods , Otorhinolaryngologic Surgical Procedures/methods , Skull Base/surgery , Cerebrospinal Fluid Otorrhea/therapy , Cerebrospinal Fluid Rhinorrhea/therapy , Debridement , Endoscopy/adverse effects , Fluorescein/administration & dosage , Fluorescent Dyes/administration & dosage , Humans , Injections, Spinal , Intracranial Pressure , Intraoperative Period , Magnetic Resonance Imaging , Medical Errors/prevention & control , Neurosurgical Procedures , Otorhinolaryngologic Surgical Procedures/adverse effects , Postoperative Care , Postoperative Complications/prevention & control , Prostheses and Implants , Skull Base/diagnostic imaging , Surgery, Computer-Assisted , Surgical Flaps , Tomography, X-Ray Computed , Ultrasonography, Doppler
20.
Acta Otolaryngol ; 130(11): 1214-9, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20438397

ABSTRACT

The standard current treatment of an otogenic brain abscess is drainage via neurosurgical burr hole or complete excision, followed by an otological procedure to eradicate the primary pathology ­ often at a later date. We describe the drainage of otogenic brain abscess via a transtemporal approach. We present a retrospective study of six cases, five children and one adult. All the children had acute middle ear disease while the adult patient had a petrous apex cholesteatoma. All cases had an otogenic intracranial abscess either in the posterior cranial fossa or in both posterior and middle cranial fossae. Diagnosis was confirmed by computed axial tomography (CT) scan. All the patients were treated by mastoidectomy and needle aspiration to drain the abscesses. In all cases the brain abscess and the ear pathology were successfully treated by a single stage transmastoid approach. The five paediatric patients had an extended cortical mastoidectomy approach to both intracranial pathology and ear disease except one patient who required a burr hole to drain a posteriorly located subdural posterior fossa abscess. The adult patient underwent petrosectomy, followed by transtemporal abscess drainage. There was postoperative pus recollection in one patient who required further aspiration. We conclude that transtemporal drainage of an otogenic brain abscess can successfully treat otological and intracranial pathology in a single operation. It has a low complication rate and avoids the need for a craniotomy or subsequent operations.


Subject(s)
Brain Abscess/therapy , Cholesteatoma/complications , Drainage/methods , Otitis Media/complications , Otologic Surgical Procedures , Anti-Bacterial Agents/therapeutic use , Brain Abscess/etiology , Cerebrospinal Fluid Otorrhea/etiology , Cerebrospinal Fluid Otorrhea/therapy , Child , Child, Preschool , Cholesteatoma/therapy , Female , Humans , Male , Mastoid/surgery , Middle Aged , Otitis Media/therapy , Retrospective Studies , Temporal Bone/surgery
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