Surgical and Audiologic Outcomes in Endoscopic Stapes Surgery across 4 Institutions.

OBJECTIVES: To investigate intra- and postoperative outcomes of endoscopic stapes surgery. STUDY DESIGN: Case series with chart review. SETTING: Four tertiary care otologic centers. SUBJECTS AND METHODS: Sixty-five subjects 18 years and older who underwent endoscopic stapes surgeries were analyzed. Variables analyzed included surgical techniques and intraoperative findings. Outcomes measured included postoperative hearing and complications to date. RESULTS: Fifty-one patients met inclusion and exclusion criteria. The average patient age was 48.1 years (range, 26-87 years), with 60.0% female patients. Patients had a median follow-up of 5.13 months (range, 0.8-57.4 months). Of the subjects, 71.7% required scutum removal. The chorda tympani nerve was manipulated in 94.0% of subjects and transected in 12.0%. At last follow-up visit, the median air-bone gap decreased from 34.5 dB hearing level (HL) preoperatively to 9.0 dB HL postoperatively (P < .0001). Ninety percent of subjects had closure of their air-bone gap ≤20 dB HL. Intraoperative complications included tympanic membrane tears in 8.0% of subjects, all of which resolved at first follow-up. Postoperatively, 10.0% of subjects complained of altered taste. CONCLUSIONS: The present multicentered study of endoscopic stapes surgery demonstrates similar audiometric and postoperative outcomes previously published in the literature, with a median postoperative air-bone gap of 9.0 dB HL. Future prospective endoscopic stapes surgery studies, addressing the need for scutum removal, postoperative taste changes, and pain scores, are merited.

Case studies in the surgical management of pediatric nasal airway obstruction.

The authors present two case studies on pediatric nasal obstruction that highlight the consequences of a delayed diagnosis and the complexities of managing obstructed lesions in children.

Novel compact laptop-based image-guidance system: preliminary study.

OBJECTIVES: To describe a novel portable laptop-based image-guidance system and its preliminary navigational results. METHODS: An optic-based, specially developed navigational system and a life-size endoscopic sinus anatomic model were used. The model was submitted to computer tomography (CT), and predefined anatomic landmarks were used to test the image-guidance accuracy according to the real model. RESULTS: All anatomic landmarks were identified by the image-guidance system and all matched with endoscopic or eye views. CONCLUSIONS: This novel compact navigation device was shown to be fast and reliable. A larger series, involving more models, cadavers, and patients, with the evaluation of multiple anatomic points needs to be done before we can reliably determine the overall accuracy of this novel device. However, this new system is promising, and in the future it can be part of the armamentarium of otolaryngologists' personal equipment in order to perform low-cost image-guided surgeries in different places with the same equipment.

Closure of large skull base defects after endoscopic transnasal craniotomy. Clinical article.

OBJECT: The authors describe the utility of and outcomes after endoscopic transnasal craniotomy and skull reconstruction in the management of skull base pathologies. METHODS: The authors conducted a observational study of patients undergoing totally endoscopic, transnasal, transdural surgery. The patients included in the study underwent treatment over a 12-month period at 2 tertiary medical centers. The pathological entity, region of the ventral skull base resected, and size of the dural defect were recorded. Approach-related complications were documented, as well as CSF leaks, infections, bleeding-related complications, and any minor complications. RESULTS: Thirty consecutive patients were assessed during the study period. The patients had a mean age of 45.5 +/- 20.2 years and a mean follow-up period of 182.4 +/- 97.5 days. The dural defects reconstructed were as large as 5.5 cm (mean 2.49 +/- 1.36 cm). One patient (3.3%) had a CSF leak that was managed endoscopically. Two patients had epistaxis that required further care, but there were no complications related to intracranial infections or bleeding. Some minor sinonasal complications occurred. CONCLUSIONS: Skull base endoscopic reconstructive techniques have significantly advanced in the past decade. The use of pedicled mucosal flaps in the reconstruction of large dural defects resulting from an endoscopic transnasal craniotomy permits a robust repair. The CSF leak rate in this study is comparable to that achieved in open approaches. The ability to manage the skull base defects successfully with this approach greatly increases the utility of transnasal endoscopic surgery.