Ointment granuloma complications after cosmetic and otologic surgery.
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Accidents, Traffic↗
Biomedical subjects
K X McKennan
Publications and source records attributed to K X McKennan.
Endoscopic 'second look' mastoidoscopy to rule out residual epitympanic/mastoid cholesteatoma.
Endoscopic mastoidoscopy is ideally suited for patients who have undergone an intact canal wall mastoidectomy for primary acquired cholesteatoma confined to the epitympanum and mastoid. The use of an endoscopic technique significantly decreases the morbidity of the second-look procedure. Visualization of the pertinent anatomy can be reliably, quickly, and safely accomplished.
Cholesteatoma↗
Menière's syndrome: an atypical presentation of giant cell arteritis (temporal arteritis).
The authors discuss three patients with biopsy-proven giant cell arteritis (GCA) who experienced significant auditory and vestibular symptoms. Two of the patients who presented with audiovestibular symptomatology died as a direct result of GCA affecting the vertebral arteries. Postmortem findings are reported. This report illustrates the importance of maintaining a high index of suspicion of GCA in elderly patients who present with the acute onset of audio-vestibular symptoms. These symptoms can be a herald of brain stem infarction if giant cell arteritis is the underlying cause. High-dose prednisone and rheumatologic/neurologic consultation is required.
Aged↗
Endoscopic transcutaneous mastoidoscopy for evaluation of residual epitympanic/mastoid cholesteatoma.
It is generally agreed that patients subjected to an intact canal wall mastoidectomy to excise mastoid/epitympanic cholesteatoma should undergo a "second-look" operation to rule out residual cholesteatoma. The morbidity of this second operation can be significantly reduced with endoscopic mastoidoscopy, when compared to the traditional postauricular (open) incision approach. Details, benefits, and limitations of endoscopic mastoidoscopy are discussed.
Adult↗
Endoscopy of the internal auditory canal during hearing conservation acoustic tumor surgery.
Hearing conservation acoustic neuroma surgery is technically demanding. This is attributable primarily to the formidable anatomic obstacles. The axis of the internal auditory canal (IAC) is oriented at an obtuse angle relative to the posterior petrous ridge. In addition, the labyrinth blocks the view of the lateral 2 to 3 mm of the IAC. These two factors prohibit an unobstructed view of the fundus of the IAC with a standard operating binocular microscope. However, angled rigid endoscopes (30 and 70 degrees) offer excellent views of the lateral portion of IAC. The facial nerve, cochleovestibular nerve, transverse crest, and vertical crest (Bill's bar) can be seen endoscopically. Neuroendoscopic examination is helpful to ensure complete tumor removal in the lateral IAC during acoustic tumor surgery. It is also helpful in visually verifying the continuity of the facial and cochlear nerves at the end of the operation.
Adult↗
Traumatic external auditory canal atresia.
Gunshot injuries in the periauricular region can result in massive tissue distortion and destruction. The soft tissue effects can be so dramatic that otologic abnormalities can be initially overlooked, especially by non-otolaryngologists. Delayed stenosis or complete closure of the external auditory canal can occur. We present two cases of post-traumatic ear canal atresia that were initially overlooked by non-otolaryngologists, until secondary plastic reconstructive operations were performed in which preauricular skin incisions entered into large canal cholesteatomas. These canal cholesteatomas resulted from total obstruction of the external auditory canal after trauma.
Adolescent↗
Facial paralysis in temporal bone trauma.
A retrospective review of 36 patients with delayed-onset (19 patients) and immediate-onset (17 patients) traumatic facial paralysis was performed. We hypothesized that traumatic delayed-onset facial paralysis does not necessitate surgical decompression under any routine circumstances. Of 19 patients in this group, normal recovery (House grade 1) occurred in 94 percent of the patients without surgical intervention. The small percentage (6%) of these patients who failed to recover completely demonstrated mild degrees of weakness and synkinesis (House grade 2). Immediate-onset paralysis occurred in 17 patients. It has a much poorer prognosis. Seven patients with penetrating wounds had facial nerve transections, usually of the vertical portion of the facial nerve. Closed head injured patients with immediate-onset facial paralysis sustained injuries usually to the horizontal and perigeniculate portion of the facial nerve. For those cases in which surgical exploration of the traumatized facial nerve is indicated, the operating surgeon should have the capacity to enlarge the exposure with a translabyrinthine or middle-fossa dissection.
Adolescent↗
Neurofibromatosis type I--a rare case resulting in conductive hearing loss.
Notwithstanding the many similarities, there are important differences between NF1 and NF2. NF1-related neurofibromas, which can number in the hundreds, can occur all over the body. Unique clinical situations, such as the case described here, can occur that test the ingenuity of the physician. Once the presenting problem has been ameliorated, genetic counseling is imperative in this common and at times devastating genetic disease.
Adolescent↗
Neurofibromatosis type 2: report of a family and review of current evaluation and treatment.
Significant advances during the past decade have greatly improved our understanding of neurofibromatosis type 2, a genetic disease which results in bilateral acoustic neuromas. The emergence of gadolinium-enhanced magnetic resonance imaging has allowed early detection of minute intracanalicular eighth-nerve tumors, less than 1 cm in diameter. Recombinant DNA studies have clarified the genetics that underlie neurofibromatosis type 2 and separate it from a variety of related conditions, such as von Recklinghausen's neurofibromatosis. Early diagnosis and surgical removal of these tumors may offer the only hope of preserving hearing and facial nerve function. A report of the evaluation and treatment of a family with multiple affected individuals will exemplify these conclusions.
Adolescent↗
A 5-month-old born with a complete facial paralysis.
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Facial Nerve↗
Cholesteatoma: recognition and management.
A cholesteatoma is an abnormal collection of viable and desquamated squamous epithelium in the middle ear or mastoid air spaces. Early recognition and treatment are important. Unlike chronic middle ear effusion or recurrent otitis media, a cholesteatoma inexorably destroys the middle and inner ear. Delayed diagnosis increases the chance of otologic complications, such as permanent hearing loss, permanent balance dysfunction, infection and facial paralysis. Initial management includes careful cleansing of the ear and topical and oral antibiotics. Definitive treatment requires surgical excision.
Cholesteatoma↗
Long-term results of labyrinthectomy.
Ten years after labyrinthectomy, 38 patients responded to a questionnaire. There was a slight decline in relief of vertigo from 93% to 76%. Symptoms following the procedure are discussed. It is believed that the reason for the decline is secondary to the age of the patients, the occasional bilateral nature of Meniere's disease, and possibly postsurgical neuroma formation. The ramifications of this study are discussed with respect to hearing-conservation procedures.
Ear, Inner↗
"Tissue welding" with the argon laser in middle ear surgery.
Over the past 10 years the argon laser has been recognized as a valuable adjunct to middle ear surgery. It has been used to vaporize and cut tissue and to coagulate microbleeding. It has been used by many other surgical specialties to "weld" adjacent tissues together. This welding process appears to have a limited but helpful role in middle ear surgery. A pilot study of 30 surgical cases in which argon laser "tissue welding" has been used are reported. The benefits, limitations, and possible future implications are discussed.
Adolescent↗
Recurrent hemangioma of the external auditory canal.
Hemangiomas of the external auditory canal rarely occur. These lesions have been reported to involve men in their sixth decade. This case report represents the fourth such lesion reported in the literature and the first to be seen in a woman. The clinical presentation, surgical therapy, and pathology are discussed. This tumor represents an unusual cause of hearing loss.
Ear Canal↗
Anchoring device for the Xomed Audiant At-The-Ear bone conductor.
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Bone Conduction↗
Post-traumatic cholesteatoma.
Cholesteatoma can develop as a late complication of fracture of the temporal bone. The otologist must be wary of it since the growth of the cholesteatoma resulting from a temporal bone fracture can be undetected for years allowing for invasive and extensive growth. Three illustrative cases are presented.
Adult↗
False negative MRI scan in an acoustic neuroma.
The clinical picture determines the workup of the patient. The referring physicians' high index of suspicion for an acoustic tumor compelled them to persist with the evaluation and referral of this patient, despite a normal MRI. No one can argue that MRI is a technological breakthrough, but it has its limitations like any other test. The quality of the MRI study depends on the cooperation of the patient, and the capabilities of both the machine and physicians. The fact that it depends on completely different physical and chemical properties than conventional radiography suggests to us that it will be an important adjunct rather than a replacement for CT scanning.
False Negative Reactions↗
Primary adenocarcinoma of the middle ear and temporal bone.
Primary adenocarcinoma of the temporal bone is a rare disorder. Fewer than 40 cases have been reported in the English literature, most of these being single case reports. Exclusion of metastatic adenocarcinoma is imperative. Adenocarcinomas must be differentiated from benign adenomas. Adenocarcinomas are best managed by aggressive surgical resection, with postoperative irradiation used in cases of incomplete resection or high-grade tumors.
Adenocarcinoma↗