Tympanometric volume: a predictor of success of tympanoplasty in children.

OBJECTIVES: To determine if preoperative tympanometric volumes have any predictive value in the success of pediatric tympanoplasty. STUDY DESIGN AND SETTING: Retrospective chart review in a tertiary referral center. MAIN OUTCOME MEASURES: Success was defined as no evidence of tympanic membrane perforation via otoscopic examination and normal aeration of the middle ear. METHODS: Fifty-eight pediatric patients who underwent tympanoplasty between 1996 and 2004 were studied; reviewed factors included recent discharge from the ear, perforation size, disease of the contralateral ear, age, gender, middle ear findings, and location of perforation. RESULTS: The overall success rate was 59 percent. The success rate was 89 percent for patients with a large preoperative tympanometric volume compared with 34 percent for patients with a small volume. Multivariate analysis demonstrated that disease of the contralateral ear and a large tympanometric volume were statistically significant. CONCLUSION AND SIGNIFICANCE: A large tympanometric volume may be an important factor when considering tympanoplasty in children. In addition, disease of the contralateral ear may be a prognostic indicator.

Diagnosis and management of spontaneous cerebrospinal fluid otorrhea.

OBJECTIVE: To describe the clinical presentation, diagnosis, surgical management, and outcome of patients with spontaneous cerebrospinal fluid otorrhea. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. METHODS: The authors conducted a chart review of all previously unreported cases of surgically confirmed cerebrospinal fluid otorrhea at their institution between September 1996 and February 2005. Acquired cases were excluded from this study. Eleven cases of spontaneous cerebrospinal fluid otorrhea were identified among 10 patients. RESULTS: Nine of the 10 patients presenting with spontaneous cerebrospinal fluid otorrhea were women. Ages ranged from 34 to 79 years. Eight patients presented with serous otitis media, and two women presented with meningitis. High-resolution computed tomography demonstrated a tegmen defect with a sensitivity of 80%. Nine tegmen defects were repaired using a transmastoid approach without recurrence. One patient with a contracted mastoid and a meningoencephalocele herniating from the tegmen tympani into the attic required the temporal craniotomy approach for definitive repair. Another patient with a tegmen tympani defect developed a recurrence of cerebrospinal fluid otorrhea 8 years after a transmastoid repair using only fascia and fibrin glue. A recurrent tegmen defect in this patient was repaired using a transmastoid approach and a multilayered closure technique. CONCLUSION: The diagnosis of spontaneous cerebrospinal fluid otorrhea requires clinical suspicion in the setting of persistent serous otitis media. High-resolution computed tomography can confirm the diagnosis. The authors' findings indicate that repair through a transmastoid approach is effective if the tegmen defect can be widely visualized. The authors advocate a multilayered closure technique.