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At least 127 records · Page 7Linked to original sources
PubMed2005

[The diagnosis and therapy for cholesterol granuloma of middle ear].

OBJECTIVE: To explore the diagnosis for cholesterol granuloma of middle ear, and discuss the effect of middle ear surgery for this disease. METHOD: The files of 18 patients (19 ears) with cholesterol granuloma of middle ear were reviewed in a retrospective study. All patients received middle ear and mastoid surgery, and all involved tissues were verified as cholesterol granuloma by pathologic examination. RESULT: The patients undergoing ventilation tube insertion were extubated 1-3 months after surgery and the eardrums healed well. The eardrums of the patients without ventilation tube insertion became normal 1-2 months after surgery. The hearing threshold after surgery of all patients improved. Beside one patients with eustachian tube obstructed had ventilation tube inserted with long term, no patient had symptoms recurred. CONCLUSION: The cholesterol granuloma of middle ear results from the bleeding, occlusion of ventilation and disturbance of drainage of the air cavity because of the middle ear inflammation. The diagnosis depends on the pathological examination. The middle ear and mastoid surgery, removing the diseased tissues completely, creating a ventilation system of mastoid-tympani-Eustachian are the key

Adolescent↗
PubMed1996

Pre-operative information in mastoidectomy: what about the facial nerve and hearing loss?

Facial nerve palsy and hearing impairment are accepted risks of mastoid surgery. However, at present there are no guidelines as to whether a patient must be informed of the potential risk to the facial nerve and hearing during mastoid surgery. Currently the law states that the surgeon should do what a 'reasonable doctor' would do under similar circumstances but exactly what this entails is not clear. A recent publication established that 16 per cent of British surgeons did not tell their patients about the risk to the facial nerve and 13 per cent about the risk of hearing loss. A survey of South African surgeons showed a different picture with only 57 per cent of surgeons informing their patients of possible facial nerve injury and 71 per cent about hearing loss. One of the reasons stated was that this information might deter the patient from having a necessary operation. This raises the question of excessive information disclosure and its possible legal consequences if excessive information leads a patient into making an unbalanced judgment owing to his/her lack of medical training, prejudices or personality. In this survey 25 per cent of South African surgeons have had patients refuse surgery after being informed of the risk to facial nerve and hearing. The decision whether to inform the patient about these risks should be individualized for every patient after the surgeon has audited his/her results and assessed the patients prejudices, personality and level of education.

Facial Nerve Injuries↗
PubMed1983

Mini-craniotomy for management of CSF otorrhea from tegmen defects.

CSF otorrhea arising from defects in the tegmen and middle fossa dura may be congenital or acquired. It may be spontaneous or secondary to trauma, chronic ear disease, tumor or surgical treatment. In the six cases presented, the tegmen defect and associated CSF leak were secondary to chronic ear disease in two cases, to mastoid surgery in two cases, to temporal bone fracture and congenital origin in one case each. The successful management of these patients utilizing a mini-craniotomy in conjunction with mastoid surgery is described. Mini-craniotomy facilitates precise extradural, intracranial placement of an autogenous graft over the tegmen defect which can be technically difficult in the transmastoid approaches, yet avoids the morbidity and potential complications of a full middle fossa craniotomy. It does not significantly add to the length of the mastoid procedure or its complications.

Cerebrospinal Fluid Otorrhea↗
PubMed2002

The role of computerized tomography in the preoperative assessment of chronic suppurative otitis media.

Twenty patients awaiting mastoid surgery for chronic suppurative otitis media underwent preoperative high resolution computerized tomography (CT) of the temporal bones. The CT scans were compared with the intraoperative findings. CT was helpful in determining the anatomy of the middle ear and mastoid, and accurately predicted the extent of the disease process in the sinus tympani and facial recess. However, it was unable to distinguish between cholesteatoma, mucosal disease and fluid, and it contributed little to the surgical management of the patients. This suggests that routine preoperative CT scanning of patients before uncomplicated virgin mastoid surgery is of questionable value.

Chronic Disease↗
PubMed1992

Experimental studies on the acoustic properties of mastoid cavities.

This study investigated the effects of open-mastoid surgery upon ear canal resonance. In particular an attempt was made to alter resonant properties by obliterating each cavity with silastic foam. The results from this study showed that open-mastoid surgery significantly decreased resonant frequency without producing an effect upon either the peak amplitude or the quality of the resonant peak as defined by the Q-factor. Restoring the natural resonance properties of an operated ear, if indicated, is likely to be a difficult objective to achieve in surgical terms.

Acoustics↗
PubMed1990

Acute mastoiditis: clinical, microbiological, and therapeutic aspects.

The charts of 73 children (31 girls, 42 boys) aged 4 months to 14 years (mean 4.5 years) with acute mastoiditis managed during a 16-year period were reviewed. Of the patients 36% were less than 24 months old. Retro-auricular swelling was described in 63 of the 73 children, tenderness in 59, erythema in 58, and protrusion of the auricle in 45. A pathological tympanic membrane was noted in 33% of the patients and fever in only 29%. Apart from local inflammation, the most frequent complaints and symptoms were otalgia (n = 42), recent upper respiratory tract infections (n = 22), and fever alone (n = 22). A subperiosteal abscess was found in 36 patients, and CNS involvement in 5. Nearly half of the patients (48%) were on antibiotic therapy at admission. The isolation rates in bacterial cultures from subperiosteal aspirated (81%) and from mastoid mucosa (68%) were considerably higher than from blood cultures (14%) and were not influenced by previously administered antibiotics. Pneumococci (9/32) and Staphylococcus epidermidis (6/32) were the agents most often isolated. The incidence of the bacteria isolated from patients pre-treated with antibiotics differed from the incidence in patients not previously treated. In 24 patients (33%) the lesion healed with antibiotic therapy without mastoid surgery. Myringotomy and the insertion of a ventilation tube is indicated initially, if acute otitis media with effusion is found. In the absence of a subperiosteal abscess and of CNS involvement, a 48-hour trial of intravenous antibiotic therapy, directed also against staphylococci, is justified before mastoid surgery is considered.

Abscess↗
PubMed2006

Should we use ossicular remnants in ossicular reconstruction following cholesteatoma removal?

The remnants of the acoustic ossicles have been used in ossicular reconstruction during mastoid surgery for many decades. The present study assessed the status of the acoustic ossicles in 114 patients (57 with cholesteatoma and 57 without) during surgery for chronic otitis media using the operating microscope. In 52 cases, the ossicles (malleus and/or incus) were assessed using both the surgical and scanning electron microscope in order to reveal any erosions and compare the findings. From the 57 operated ears with cholesteatoma, 45 (79%) had ossicular erosion whereas 12 (21%) did not. In the group of 57 operated ears with chronic otitis media without cholesteatoma, 33 (58%) had ossicular erosion whereas 24 (42%) did not. This difference was statistically significant (p = 0.02). With regard to the 52 operated cases who were studied with both microscopes, in the cholesteatoma patients the surgical microscope was not able to reveal any ossicular erosions in 39% of the cases, whereas the scanning electron microscope revealed moderate or severe erosions in the same ears. This suggests that the operating microscope is not reliable enough to determine if ossicular remnants can be used in ossicular reconstruction following cholesteatoma surgery. There is a considerable risk that epithelia or other cholesteatoma particles remain in the areas of erosions that cannot be seen with the operating microscope. The use of such ossicular remnants may lead to cholesteatoma recurrence and failures in mastoid surgery. Therefore, autoclaving or alternative prosthesis may be considered in such cases.

Adult↗
PubMed2006

Virtuosity with the Mallet and Gouge: the brilliant triumph of the "modern" mastoid operation.

The development of mastoid surgery can be traced through the past 4 centuries. Once used as a means of evacuating a postauricular abscess, it has evolved to become a method for gaining entry into the middle ear for diagnostic purposes, to control chronic ear disease, or for otologic and neuro-otologic procedures. Earlier works led the way to the Wilde postauricular incision, which gave rise to Schwartze mastoidectomy. Stacke's technique of mastoidectomy was practiced for some time before Bondy, Heath, and Bryant introduced the modified radical mastoidectomy. By the 1930s, the mastoidectomy had evolved into a generally accepted otologic procedure. Endowed with a rich history, the future of mastoid surgery promises to be equally momentous.

History, 15th Century↗
PubMed2005

[Acute mastoiditis in children, a retrospective analysis about a period of 25 years].

BACKGROUND: During the last years the classical signs of the acute mastoiditis have changed. Aim of the following study was to examine the change of symptoms as well as the change of incidence. METHODS/PATIENTS: The records of 113 children who received mastoid surgery due to acute mastoiditis were retrospectively investigated. Data covered a regional group of patients during a period of 25 years (1979 - 2003). RESULTS: Considering the drop of the birthrate from 1991 in the East German countries, there was a significant increase of the incidence of acute mastoiditis. The patients had a mean age of 2,5 years. The classical symptoms like "retroauricular swelling, tenderness and protrusion of the auricle" were only noted by 47 children (41.6 %). Preoperative complications appeared as facial palsy, abscess and septic lateral sinus thrombosis in 11 children. Bacterial cultures, taken during surgery yielded in 55.7 % Streptococcus pneumoniae. The therapy contained a surgical intervention combined with antibiotics. CONCLUSIONS: An early surgical treatment by mastoidectomy or antrotomy supported by antibiotics represents the safest method to avoid complications.

Acute Disease↗
PubMed1997

An account of the quality of life of patients after treatment for non-functioning pituitary tumours.

OBJECTIVE: Studies assessing quality of life in GH-deficient adults have shown varying results. This may be due to a number of factors including varying causes of GH deficiency, the use of radiotherapy in treatment and patient selection. We aimed to assess whether anterior pituitary hormone deficiency or external pituitary radiotherapy influenced the quality of life of patients with non-functioning pituitary tumours. PATIENTS: We studied 48 patients treated and under follow-up for non-functioning pituitary tumours on standard hormone replacement therapy excluding GH. There were 21 females and 27 males with a mean age of 59 +/- 12 years. We also studied 42 control patients who had undergone mastoid surgery and were followed at least annually. There were 17 females and 25 males with a mean age of 61 +/- 14 years. DESIGN: All patients attended a research clinic and completed the Short Form 36 (SF36) and General Well Being Schedule (GWBS) to assess quality of life. Thyroid function tests, IGF1 and IGFBP3 were measured on all patients. Gonadotrophin and cortisol measurements were made on the patients with pituitary disease where appropriate. RESULTS: IGF1 and IGFBP3 levels were lower in the pituitary patients compared with controls: 104 +/- 98 vs 143 +/- 37 micrograms.l (P < 0.0001) and 2.9 +/- 0.75 vs 3.3 +/- 0.52 mg/l (P < 0.004). There were no significant differences in the quality of life scores between the pituitary patients and the control subjects. There was also no difference in quality of life between pituitary patients with two or more hormone deficiencies (n = 29) compared with controls. Patients who had received radiotherapy (n = 18), when compared with controls, had a decreased mental health score using the SF36 71 +/- 21 vs 81 +/- 17 (P < 0.05) and decreased total GWBS score 70 +/- 20 vs 82 +/- 17 (P < 0.05). Subscore analysis of GWBS showed this to be due to depression and decreased control of emotions. CONCLUSIONS: We found that the quality of life of patients treated and under follow up for non-functioning pituitary tumours was similar to that of patients treated by mastoid surgery and under similar follow up. The pituitary patients deficient in two hormones and thus most likely to be GH deficient were also similar to the controls. These results suggest that adding GH replacement in this patient group may not be routinely indicated for improvement in quality of life and needs careful assessment. Patients who had received radiotherapy were more depressed and anxious than controls. Further investigation into the psychological and psychomotor effects of radiotherapy in this group of patients is required.

Aged↗
PubMed1981

Ear surgery and mastoid air cell system.

Opinion differ whether simple myringoplasty should be combined with mastoidectomy, which is claimed to provide a large air reservoir for the middle ear. Data are reported on 61 ears, 55 of which had reasonably normal tympanic mucosa but distinct chronic mastoid or epitympanic ear disease. Obliteration of the cavity was performed, combined with tympanoplasty, and the patients were followed up for an average of three years. Normal aeration of the middle ear was seen in all cases with normal middle ear mucosa regardless of whether the posterior canal wall was saved or reconstructed in connection with obliteration. It is concluded that there is no reason for mastoidectomies in small mastoid cell systems in simple myringoplasties.

Air↗
PubMed1999

[Postoperative treatment after ear surgery].

The paper gives an overview on postoperative treatment after ear surgery, especially tympanoplastic, mastoid-surgery and stapes-surgery. Suggestions for treatment are given according to the different post-operative stages and situations. Careful cleaning of the ear canal, using the operative microscope, removal of debris, granulations and polyp and drying of the canal are most important.

Ear↗
PubMed1996

Small cavity mastoidectomy--5 year review.

It has been recognized that the traditional method of open mastoid surgery often produces a larger mastoid cavity than necessary. Small cavity mastoidectomy is advocated to reduce the size of the mastoid cavity by exteriorizing the cholesteatoma from the epitympanum backwards. When this operation is performed in a sclerotic mastoid bone, the resulting cavity is very small. The 5 year review of 39 ears with small cavity mastoidectomy is presented. Not only were the mastoid cavities small, they remained stable and trouble-free. It also enabled the patients to enjoy swimming and minimizing wax accumulation within the cavities. The hearing results after 5 years were comparable to that of the closed technique. Formation of cholesterol granuloma behind the concho-meatal flap was an uncommon complication.

Cholesteatoma↗
PubMed1979

Mastoid obliteration.

Mastoid obliteration is recommended as a routine procedure in all mastoid surgery. Bone chips from the mastoid tip, bone paté from the cortical bone and lyophilized dura can all be employed effectively to fill the epitympanic space and Traumann's triangle. The former annulus is reconstructed using lyodura and periost-bearing bone and the canal wall is fortified and the cavity filled with the metally based postauricular musculoperiosteal flap. Any remaining cavity is filled with bone chips and bone paté.

Bone Transplantation↗
PubMed2000

A systematic approach to interpretation of computed tomography scans prior to surgery of middle ear cholesteatoma.

The foundation of mastoid surgery for cholesteatoma has traditionally been a thorough knowledge of the anatomy and familiarity with landmarks, constant alertness to detect unsuspected complications and the experience to tailor the surgery to the pathology encountered. Whilst not indispensable, computed tomography (CT) scanning is a useful adjunct whose potential predictive value is only truly appreciated by skilled interpretation. We present a guide to analysis to maximize the value of pre-operative radiology.

Cholesteatoma, Middle Ear↗