Preservation of conductive hearing in approaches to tumors of the jugular foramen.

OBJECTIVE: Surgical approaches to the jugular foramen, most often used for the resection of glomus jugulare tumors, may include removal of the external auditory canal wall and overclosure of the meatus, resulting in maximal conductive hearing loss. Modifications have been described that maintain hearing by preserving the canal wall at the price of decreased exposure and are, therefore, suitable only for small and favorably located tumors. Our technique for removal and then reconstruction of the canal wall with hydroxyapatite cement allows for complete anterior translocation of the facial nerve as far proximal as the geniculate ganglion, giving uncompromising exposure of even the most extensive tumors, with the potential for preservation of normal hearing. The purpose of this study was to describe and report our experience with this technique. STUDY DESIGN: : Retrospective review. SETTING: Private otology practice. PATIENTS: Between 2000 and 2005, seven patients between the ages of 34 and 77 years were identified who underwent procedures using this technique. INTERVENTION: Surgical management of jugular foramen tumors. MAIN OUTCOME MEASURES: Successful anatomical reconstruction of the external auditory canal and middle ear. Preoperative and postoperative audiograms are compared, and facial nerve function is reported. Complications are discussed. RESULTS: All seven patients had successful reconstruction of the external auditory canal. Complications were minor and did not require additional surgical intervention. Postoperative pure-tone average differed from the preoperative average by a mean of 7.5 dB. Facial nerve function ranged from House-Brackmann Grades I to III when checked at least 7 months after surgery. CONCLUSION: This study reveals that this technique of external auditory canal reconstruction using hydroxyapatite cement allows complete anterior translocation of the facial nerve, while safely and reliably preserving the potential for normal hearing, without any compromise in exposure of the jugular foramen in the setting of an infratemporal fossa approach.

Ossiculoplasty using incus interposition: hearing results and analysis of the middle ear risk index.

OBJECTIVE: To determine the immediate hearing result and the long-term stability of sculpted incus interposition in ossiculoplasty and evaluate the utility of the middle ear risk index in predicting hearing outcome in these cases. PATIENTS: One hundred thirty-seven surgical patients. STUDY DESIGN: Review of 137 patients who underwent ossiculoplasty using autologous or homologous sculpted incus interposition. INTERVENTIONS: Ossiculoplasty using autologous or homologous sculpted incus interposition. METHODS: Retrospective chart review, using the guidelines delineated by the Committee on Hearing and Equilibrium of the Academy of Otolaryngology-Head and Neck Surgery for the evaluation of results for the treatment of conductive hearing loss. RESULTS: The mean preoperative air bone gap was 26.8 dB, and the mean postoperative gap was 18.6 dB. Twenty-seven percent of patients were closed to within 10 dB, and 66.4% were brought to within 20 dB of the postoperative bone conduction line. Average time to the last postoperative audiometric testing was 15.8 months, with a range of 2 to 62 months. A mean air bone gap change of -0.2 dB was noted. Four patients had more than a 10 dB deterioration in conductive hearing loss. There were no cases of graft extrusion. Each ear operated upon in our series was fully scored using the middle ear risk index, and an index total was calculated. No statistical associations could be demonstrated in any group between the postoperative air bone gap and the middle ear risk index subcategories or total. CONCLUSIONS: Sculpted autologous or homologous incus interposition provides hearing success comparable with current allograft prosthesis studies, has a very low extrusion rate, and remains stable over time. We were not able to demonstrate an association between the middle ear risk index and hearing results in this subset of patients.

Experiences in cochlear implantation

Os autores relatam a experiência com implantes cocleares no "Eye and Ear Hospital" de Pittsburgh (USA), nos últimos cinco anos. Dezoito pacientes foram operados. Os implantes utilizados foram o "House - 3M single channel" e o "Melbourne-Nucleous multichannel". Os critérios para a seleçäo dos pacientes, a técnica cirúrgica e os resultados pós-operatórios säo apresentados em detalhe