Optimizing Management of Otophyma: A Case Series Highlighting the Role of Surgical and Retinoid Therapy.

Otophyma is a rare condition that can result in conductive hearing loss. Current otophyma literature does not examine validated treatment outcomes for patients. Utilizing a medical and surgical approach to maintain a patent canal can lead to significant objective improvements. The aim of this case series is to describe a combined successful approach in 3 cases from an academic, multidisciplinary center. The main outcomes analyzed were pre and post air-bone gap audiogram analysis and disimpaction frequency. The results showed that post-management, patient 1 had substantial improvement in hearing, recovering 49 dB in his right ear and 25 dB in his left ear, demonstrating near complete air-bone gap closure. Patient 2 showed a similar dermatologic and functional improvement, although objective audiometric assessment related to otophyma could not be performed due to coexisting chronic otitis media and cholesteatoma. Patient 3, in the 12 months prior to comanagement, had 8 bilateral disimpactions, and following comanagement had 2 disimpactions in 23 months. All 3 patients were pleased with the resultant functional and physical appearance following comanagement. By presenting this approach and objective measures of treatment, we hope to improve future clinical decision-making in a rare condition.

[Experimental studies on the repair and restitution of cartilage by cartilage acellular extracellular matrix and adipose tissue-derived stem cells].

Objective: To investigate the effects of the repair and restitution of ear-shaped cartilage by adipose tissue-derived stem cells(ADSC) and cartilage acellular extracellular matrix. Methods: ADSC were extracted by digesting with collagenase type II from the adipose tissue from 32 patients with adiposity whose fats were drawn, and were cultured and subcultured in vitro. The natural biological scaffolds were prepared by acellular method using porcine ear cartilage, and then the second generation ADSC(5.0×10(7)/ml) were inoculated on the preformed natural bio-scaffold scaffold by culturing in vitro for 3 days to form a cell scaffold complex. 32 New Zealand white rabbits were randomly divided into the experimental groups, the control group A, the control group B and the control group C. All New Zealand white rabbits were modeled by ear cartilage defects. The cell scaffolds composite was implanted into the experimental group of the ear cartilage defects of rabbits, the ADSC were implanted into the control group A, the cartilage acellular extracellular matrix scaffold was implanted into the control group B and the control group C was modeled only by ear cartilage defects. After 16 weeks, the animals were sacrificed and the repair effect was observed by gross appearance and histological examinations including HE, Toluidine blue staining, Safranin O and typeⅡ collagen staining. Its were quantitatively analyzed by positive staining results of type Ⅱ collagen. Ear cartilage tissue elasticity was detected. SPSS 17.0 software was used to analyze the data. Results: The cartilage defects in the experimental group were repaired well by general shape observation and those in the control group was filled in with granulation tissue. There were significant differences between the experimental group and the control group in the wet weight(P<0.05). HE staining showed that cartilage cavities formed in articular cartilage defects, and only the fibrous tissue was filled with the ear cartilage defect in the control groups. In the repair area, Toluidine blue staining, Safranin O and type Ⅱ collagen staining were positive in the experimental group, and negative in the control groups. There was no significant difference between the experimental group and the normal ear cartilage in the ear cartilage elastic constant detection(P>0.05). Conclusions: The mechanics and histology of rabbit ear neonatal cartilage constructed by ADSC combined with cartilage acellular matrix are close to normal ear cartilage. Cartilage acellular matrix material combined with adipose-derived stem cells has good repair and reconstruction ability for ear cartilage defects, which possesses potential clinical application value.

Common postburn deformities and their management.

This article describes a practical, clinically based approach to classification of postburn deformities. Burn scar contractures are of either the broad diffuse type or linear band-like type. The former generally respond well to release and insertion of a skin graft or substitute, whereas the latter are generally repaired using a simple or modified Z-plasty or a transpositional flap technique. The pulsed dye laser is a promising technique used to reduce scar thickness and redness. Postburn deformities of the face, upper and lower extremities, and trunk are discussed, in addition to novel techniques for vascularized composite allotransplantation of the face.

Excision, skin grafting, corticosteroids, adjuvant radiotherapy, pressure therapy, and emancipation: the ESCAPE model for successful taming of giant auricular keloids.

The authors treated 24 giant auricular keloids (mean size, 11 cm) from January 2008 to July 2012 using a novel protocol consisting of complete excision, skin grafting, a 1-time intraoperative injection of triamcinolone, immediate radiotherapy, and sustained pressure therapy. At 1 year, the success rate was 87.5%.

Auricular keloids: combined therapy with a new pressure device.

OBJECTIVE: To develop a new, custom-made pressure device that can be used with established designs as an adjuvant therapy for optimized treatment of auricular keloids. METHODS: Seven patients (4 males, 3 females; mean [SD] age, 22.6 [8.3] years) were treated with surgical excision and corticosteroid injection followed by application of our new auricular pressure device. RESULTS: All patients tolerated the adjuvant therapy and wore the device overnight for 5 nights per week. Usage was not interrupted or cancelled. No recurrence was observed during the follow-up period (mean [SD] duration of follow-up, 24 [6] months). All patients were satisfied with the results; none described pruritus, pain, or dysesthesia. CONCLUSION: Overnight usage of the new pressure device seems to be a safe and effective extension of established auricular keloid therapy with the potential for prophylaxis of recurrence.

Effective, simple treatment for perichondritis and pinna haematoma.

OBJECTIVE: To describe a new treatment for perichondritis and haematoma of the pinna. At present, the existing treatment for these conditions is initially medical (which usually fails), followed by surgery (incision, drainage and compression to prevent recurrence) with accompanying medical management. However, the result is often a failure, resulting in partial or complete 'cauliflower ear' deformity. PROCEDURE: The described treatment involves draining the site of infection and irrigating with streptomycin solution. The cavity is then filled with a solution of streptomycin, hyaluronidase and triamcinolone. RESULT: The described treatment avoids the conventional surgical procedure, which is cumbersome for surgeons and harrowingly painful for patients. CONCLUSION: The new treatment may be recommended for universal use.

Management of external ear keloids using form-pressure therapy.

Keloids are a frequent finding after physical trauma. Keloids of the pinna (helix and antihelix) as a complication of ear-piercing are the most difficult cases. Clinicians have tended to avoid the surgical approach, preferring local conservative treatment with corticosteroids or other treatments. We report use of intrakeloid resection and a form-pressure device to treat pinna keloids and avoid recurrence. The purpose is to maintain the form of the folds of the pinna. The recommendation for this therapy is to maintain the pressure at 24-30 mmHg, and the duration of the form-pressure therapy in our patients was about 25 weeks.

Postoperative auricular perichondritis after an endaural approach tympanoplasty.

BACKGROUND: Postoperative auricular perichondritis is a problematic and embarrassing surgical complication after an endaural approach tympanoplasty. However, a search through the literature showed only a few papers regarding postoperative auricular perichondritis, and the reported treatment experience is scarce. This study reviews the clinical aspects of postoperative auricular perichondritis and the different treatment methods. METHODS: The medical records of 8 patients with postoperative auricular perichondritis over a 5-year period were reviewed. Five patients were treated using the wide excision method, 2 underwent tubal drainage, and 1 was placed on antibiotics alone. RESULTS: In 8 patients with postoperative auricular perichondritis after an endaural approach tympanoplasty, the time between the previous ear operation and the symptoms of infection ranged from 2 to 37 days, with a mean of 17.3 days. The wide excision method was performed after the abscess localized, an average of 8.4 days after initial antibiotic treatment. The culture results found fungus in 4 patients. Multiple excision procedures were required in 4 patients, and the mean number of surgical procedures was 2.6. The mean hospital stay of patients having wide excision was 15.2 days. Two patients had stenosis of the external auditory canal resulting from repeated excision procedures. Two patients underwent tubal drainage, and their mean hospital stay was 51 days. CONCLUSION: In postoperative auricular perichondritis after an endaural approach tympanoplasty, wide excision seems to be a better choice to treat this problem. Repeated limited excisions could result in ear deformity. Cartilage exposure during chronic ear surgery should be avoided, and early precautions after operation should be taken in order to prevent complications.

Splinting therapy for congenital auricular deformities with the use of soft material.

Congenital auricular deformities present serious esthetic problems. To avoid surgical correction, splinting during the early neonatal period has been attempted. We describe the results and follow-up of splinting therapy with a special soft material in 30 neonates, as compared with results in a control group of 20 untreated newborn infants. Good results were achieved in 85% of the patients and sufficient results in 15% when the treatment was continuous over the entire 4-week period. However, when treatment was partial or discontinuous, only 10% had good results. None of the infants in the control group showed spontaneous improvement during the period of study. Moreover, early initiation of treatment (first week of life) proved more effective than later treatment (second week of life). Strong parental cooperation and close follow-up are also important for success.

Pseudocisto do pavilhäo auricular / Pseudocyst of the auricle

Pseudocisto do pavilhäo auricular é entidade rara, de patologia ainda controversa. Os autores apresentam o caso de um paciente do sexo masculino, de 63 anos, com história prévia de eczema crônico, e que mostrou boa evoluçäo terapêutica. Uma revisäo de literatura é feita

Management of the acutely burned ear.

One hundred patients with burns of the ears were reviewed. Most had second-degree burns and did well. Loss of the external ear occurred in 15 patients, or 22 ears, due to the presence of very deep burn with full thickness injury. Chondritis developed in nine ears (5 per cent) with severe destruction of the ear in 8. Pseudomonas aeruginosa is an especially destructive organism to cartilage and was associated with all our cases of chondritis. Progression of deformity and development of infection can be minimized by avoidance of pressure, regular cleansing and application of topical antibiotics. Careful debridement and skin grafting of any third-degree burn areas are required and should be carried out as soon as possible.