The Minimally Invasive Star-Shaped Incision Technique and the Linear Incision Technique With Tissue Preservation for Percutaneous Bone Conduction Devices: A Retrospective Cohort Study.

Purpose: To compare intra- and postoperative outcomes between the standard linear incision technique with tissue preservation (LITT-P) and the minimally invasive star-shaped incision (SSI). Study Design: A retrospective cohort study. Methods: Primary outcomes evaluated operative time, implant survival, and intra-operative complications. A secondary outcome evaluated soft tissue tolerability assessed by the Holger's classification. Results: A total of 38 implants were placed (19 LITT-P; 19 SSI). The median and mean surgical duration for the LITT-P group was statistically shorter than the SSI group (p = 0.0001). No intra-operative complications were reported for both surgical approaches. Five implants were lost during postoperative follow-up: one in the LITT-P and four in the SSI cohort. Both cohorts showed favorable soft tissue tolerability. Less Holgers 1 and 2 and more Holgers 3 soft tissue reactions were observed after the LITT-P compared to the SSI. Conclusion: The novel SSI approach could be an alternative option based on the theoretical benefits and found favorable (and similar) soft tissue outcomes. Implant loss and surgical time are aspects to investigate regarding long-term durability and warrant further research.

Management and Outcomes of Spontaneous Cerebrospinal Fluid Otorrhoea.

Objective: A cohort of patients with spontaneous cerebrospinal fluid (sCSF) otorrhoea. To report surgical outcome and discuss a treatment protocol. Materials and Methods: Between 2012 and 2018 all patients presenting with sCSF were collected and data assessment was performed including clinical symptoms (hearing loss, aural fullness, meningitis, recurrent otitis media), preoperative audiometry, CT and MRI scanning. According to the site and size of the dural defect, different surgical approaches were applied. Results: A total of 12 patients (14 operations) were included. Four of these had a history of meningitis. All beta-trace protein testings were positive. These patients were treated with different surgical approaches: middle fossa approach (MCF, seven patients), transmastoid approach (TMA) with bony obliteration of the cavity (three patients), and four patients underwent a subtotal petrosectomy (STP) procedure. Three cases underwent revision surgery (MCF or STP) due to residual disease (CFS leakage). After follow up duration of 13 months (6.5 months SD), no recurrence was observed. No severe adverse events such as cerebrovascular injury, meningitis, wound infection, or headache was observed in the postoperative course. Conclusion: Spontaneous aural cerebrospinal fluid leakage is a rare but manageable pathology with potential severe complications. Appropriate diagnosis, laboratory testing, and imaging is primordial to obtain optimal patient outcome.