Laryngotracheal separation surgery for intractable aspiration: our experience with 12 patients.

OBJECTIVE: Laryngotracheal separation surgery (LTS) was performed as a treatment for recurrent or intractable aspiration pneumonia in 12 pediatric patients. The effectiveness of LTS surgery for preventing aspiration pneumonia, and the complications of this procedure were investigated. METHODS: A retrospective chart review, conducted at a tertiary academic hospital in conjunction with a private practice, was used to identify children who underwent Laryngotracheal Separation Surgery (LTS) from September 2001 to July 2007. The main outcome measure was the number of hospital admissions for pneumonia in the pre LTS and post LTS period. A student's t-test was used for statistical analysis. RESULTS: LTS surgery decreased the frequency of pulmonary infections and respiratory events in all patients, resulting in far fewer hospitalizations. These patients experienced an average of 5 hospital admissions for pneumonia in the 2 years prior to LTS surgery, and an average of 1.1 hospital admissions for pneumonia after the LTS surgery. There were no major complications related to the surgery. Several minor complications following surgery were easily and effectively dealt with in the perioperative period. CONCLUSIONS: LTS surgery is an effective and safe procedure in children with intractable aspiration. Parents do not perceive the care of the LTS stoma as burdensome. This procedure should be considered as an option in the surgical intervention for the management of chronic aspiration pneumonia in severely neurologically impaired children.

Ossicular chain reconstruction using titanium versus hydroxyapatite implants.

OBJECTIVES: Compare the efficacy of total and partial ossicular chain reconstruction using hydroxyapatite (HA) implants versus titanium (Ti) implants. DESIGN: Case series with chart review. SETTING: Academic tertiary referral center and private practice. SUBJECTS AND METHODS: 404 patients underwent ossiculoplasty using either Ti or HA implants from June 1996 to September 2008. Patient data were collected retrospectively from the senior author's electronic database of surgical cases. RESULTS: The change in air-bone gap (ΔABG) (defined as the difference between the means of preoperative and postoperative ABG) was 9.9 dB for the HA group that received partial ossicular reconstruction prosthesis (PORP), 9.5 dB for the Ti PORP group, 12.3 dB for the Ti group that received total ossicular reconstruction prosthesis (TORP), and 10.0 dB for the HA TORP group. There was no statistically significant difference between the HA and Ti groups. There was no significant difference in hearing results between canal wall up (CWU) and canal wall down (CWD) cases in which mastoidectomy was performed. Four confounding factors (preoperative otorrhea, preoperative perforation, cholesteatoma, mastoidectomy performed) were analyzed using regression analysis. In the Ti PORP group, the presence of cholesteatoma was found to have a significant negative bias for hearing results. CONCLUSION: No statistically significant differences in hearing results were found between the HA and the Ti partial and total ossiculoplasty prostheses. No outcome difference was found between CWU versus CWD mastoidectomy groups for any type of implant used. A randomized, prospective study is necessary for a more definitive comparison of efficacy between HA and Ti OCR implants.