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Results for “MASTOID SURGERY”

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PubMed1996

The bone anchored hearing aid (BAHA) in chronic suppurative otitis media (CSOM).

Bone anchored hearing aids are gaining wide acceptability in the treatment of patients with congenital ear problems, chronic suppurative otitis media (CSOM) and in some cases otosclerosis. To date little information on the effect of the bone anchored hearing aid on the symptoms of chronic suppurative otitis is available. This retrospective study based on notes review and telephone interviews was to assess the outcome of bone anchored hearing aid surgery in patients with CSOM in terms of: ear discharge; surgical techniques and complications; the number of hours the aid is worn compared with the previous aid. One hundred and forty-two patients were fitted with bone anchored hearing aids without additional prostheses in Birmingham between 1989 and 1995. Sixty-nine (48.5 per cent) of these were for chronic suppurative otitis media, 45 of these were female and 24 were male with a mean age of 58 years. Most (85 per cent) had undergone previous ear surgery with 65 per cent having mastoid surgery. Ninety-eight per cent of this patient group had undergone single stage surgery and 65 per cent under local anaesthetic as a day case. A variety of techniques for soft tissue reduction were employed. The mean follow-up time for these patients was 24 months (range one month to seven years). No patients experienced worse discharge following their BAHA and 84 per cent had significantly reduced discharge, 16 per cent had no change. Complications included skin reactions, 15; failure to integrate, one; late loss of fixture, three. Seventy-three per cent wore their bone anchored hearing aid more than eight hours per day and 58 per cent were more satisfied with their bone anchored hearing aid than their previous aid.

Aged↗

PubMed1996

A contemporary analysis of acute mastoiditis.

BACKGROUND: Acute mastoiditis persists as a serious infection despite a dramatic decline in incidence coincident with the introduction of antibiotic therapy. OBJECTIVE: To assist the contemporary practitioner in the recognition and management of acute mastoiditis through the assessment of a large series of patients. DESIGN: Retrospective case series comprising 124 patients with acute mastoiditis. SETTING: Pediatric and adult otology referral center. MAIN OUTCOME MEASURES: Selected clinical parameters. Risk factors for necessity of surgical intervention and for increased length of hospitalization were analyzed by a stepwise logistic regression model. RESULTS: A history of antecedent acute otitis media was absent in 45% of patients. Pain (98%) was the most common presenting symptom. Physical signs included an abnormal-appearing tympanic membrane (88%), fever (83%), a narrowed external auditory canal (80%), and postauricular edema (76%). Streptococcus pneumoniae was the most commonly isolated organism. Mastoid surgery was required in 62% of the patients. An elevated white blood cell count (relative risk [RR], 7.4; P < .01), proptosis of the auricle (RR, 4.5; P = .03), and fever on admission (RR, 7.3; P = .05) were risk factors for surgical intervention. All 33 patients with complications (27%) proceeded to surgical intervention. The average length of hospital stay was 7.9 days. The strongest predictor for an increased length of hospital stay was whether the patient required surgery (RR, 3.7; P = .002). CONCLUSIONS: Acute mastoiditis remains a potentially serious otologic infection. Not all patients present with a classic history or physical examination. Therapeutic mastoidectomy is often required.

Acute Disease↗

PubMed1995

Mastoidectomy audit: results of the Royal College of surgeons of England comparative audit of ENT surgery.

This paper presents the results of a national comparative audit of mastoid surgery, retrospectively analysing 611 operations by 55 consultants. Confidentiality for both patient and surgeon was assured. For cholesteatoma 80% of mastoidectomies performed were open cavity procedures and for other middle ear disease 58% used an intact canal wall technique. Thirty-two surgeons used only an open cavity mastoidectomy for cholesteatoma during the period of the audit. There was a statistically significantly greater number of wet ears with open cavities than with closed cavities, but the frequency of the operator did not correlate with the dry ear rate. Ten serious complications (facial palsy and dead ear) were recorded. All occurred in open cavity mastoidectomies. The post-operative hearing status was unknown in 40% of patients.

Cholesteatoma↗

PubMed2002

Mastoid subperiosteal abscess management in children.

The management of a mastoid subperiosteal abscess has traditionally required mastoidectomy. With the improvement of antibiotic therapy current literature supports the treatment of uncomplicated acute mastoiditis with myringotomy and intravenous antibiotics. Treatment of a mastoid subperiosteal abscess with tympanostomy tube insertion, intravenous antibiotics, and postauricular incision and drainage of the abscess avoids the morbidity and potential complications of mastoid surgery in young children. Three patients diagnosed with a mastoid subperiosteal abscess were managed in this way. The outcome of their treatment has been documented with lengthy otologic follow-up. Complete resolution of the acute infectious process was achieved in all cases with no evidence of recurrent disease.

Abscess↗

PubMedDate not supplied

Bone wax foreign body granuloma in the mastoid.

The sue of bone wax is commonly used to control bleeding during mastoid surgery. An unusual case of bone wax granuloma in the mastoid, with sigmoid sinus thrombosis, is reported. Although the use of bone wax in and around the mastoid is generally considered safe with few complications, caution should be exercised, particularly in infected fields and in patients known to have general immunohypersensitivity.

Adult↗

PubMed2002

Ossicular fixation caused by bone dust after saccus decompression surgery.

HYPOTHESIS: To highlight the clinical and histologic features of ossicular fixation produced by bone dust during mastoid surgery. BACKGROUND: Bone dust deposition in the middle ear may occur during temporal bone surgery, but the ossicular fixation that may result from it remains underreported. METHODS: A case is reported of delayed conductive hearing loss after saccus decompression surgery resulting from ossicular fixation by bone dust deposition. RESULTS: Six months after the initial surgery, the patient experienced a 45 dB conductive hearing loss. The findings on second-look tympanotomy were stapes fixation and round window niche occlusion by newly formed tissue. Histologic examination of the latter showed fibrosis and new bone formation in reaction to particles of bone dust. New bone formation is a frequent concomitant of fibrosis in the middle ear and is probably not a growth from the bone dust. CONCLUSION: The use of high-speed drilling of bone in temporal bone surgery carries the risk of bone dust particle deposition in the middle ear. Measures are discussed that can be used to prevent this complication.

Audiometry, Pure-Tone↗

PubMed2002

Hearing preservation in patients with labyrinthine fistulae.

INTRODUCTION: Labyrinthine fistula is the most common complication of chronic middle ear disease with cholesteatoma. We present a series of cases of labyrinthine fistula found during the surgical procedures carried out for cholesteatoma in a district hospital setting, over 11-year period. MATERIALS AND METHODS: This is retrospective study based on case notes and author's database for the period of 1987 to 1999. During this period 382 operations were performed and 25 (6.54%) patients found to have labyrinthine fistulae. We looked at the incidence, clinical presentation, surgical technique and hearing outcomes. A standard fistula classification system has been used in order to compare the pre and post-operative hearing. RESULTS: Records were available in 22 cases, which were 12 men, and 10 women with mean age of 45.2 years at presentation. Only one-third had presented with vertigo. Lateral semicircular canal was the most affected site (95%). Fistulae classified as types: I = 8 (36.3%), II-a = 1 (4.5%), II-b = 5 (22.9%) and III = 8 (36.3%). All patients had a standard open technique mastoidectomy. In 5 ears the hearing was lost pre-operatively (1 type II-b and 4 type III fistulae), and in remaining 17 the bone conduction thresholds remained unchanged in 15 (88 per cent) ears. Two dead ears directly related to the surgery and both were of type III fistula. CONCLUSIONS: One-staged mastoid surgery can be the treatment of choice in these cases. Meticulous surgical technique with adequate sealing of the fistula helps to preserve the hearing. An appropriate classification system is an essential tool in presentation and comparison of results.

Adult↗

PubMedDate not supplied

Cholesteatoma surgery: residual and recurrent disease. A review of 1,024 cases.

This is an analysis of 1,024 primary cases of mastoid surgery for cholesteatoma operated upon during a ten-year period at the Otologic Medical Group, Inc. Our philosophy of management of the mastoid in these cases has been as follows: 1) avoid an open mastoid cavity when possible; 2) perform the operation in two stages if necessary; 3) reexplore the mastoid and middle ear for residual cholesteatoma when indicated. One-third of 380 revised cases had residual cholesteatoma, disease left by the surgeon. In 260 cases in which the surgeon felt it unlikely that there was residual disease he found it in 23%. In 4% this residual cholesteatoma was found in the mastoid. The incidence of residual cholesteatoma was higher in children and in planned, as opposed to unplanned, revisions. Residual cholesteatoma was detected in the middle ear more frequently than in the epitympanum, and in the epitympanum more frequently than the mastoid. Indications for, and timing of, the reexploration are discussed. Recurrent cholesteatoma refers to a retraction pocket and must be differentiated from residual cholesteatoma; the causes, prevention and treatment are different. Recurrent cholesteatoma was detected in 5%. The most common complication of the disease was a labyrinthine fistula (10%). Operative facial nerve damage occurred in one case. The most common postoperative complication was graft failure (3%). Intact canal wall tympanoplasty with mastoidectomy should be performed as a two-stage procedure in most cases when used in the treatment of aural cholesteatoma.

Adolescent↗

PubMed1988

Transmastoid encephaloceles. A case report.

Encephaloceles are uncommon abnormalities occurring in the pediatric age group. For the otolaryngologist they are usually encountered in the nasopharynx or nose, but may also be found in other sites adjacent to the brain. Encephaloceles usually develop as a result of prior mastoid surgery, trauma, or infections; but it is extremely rare for large encephaloceles to occur congenitally in the mastoid. It is even more uncommon for there to be a second mastoid defect which would allow the brain to present as a subcutaneous postauricular mass. The case history of a child with congenital subcutaneous transmastoid encephalocele is presented and the management discussed. In this child, the right temporal lobe of the brain herniated through a congenital defect in the tegmen and then through the mastoid cavity to exit through a lateral wall defect in the mastoid cortex. It then presented as a postauricular subcutaneous mass. The initial diagnosis was a subperiosteal abscess. The correct diagnosis was not made until surgery despite a normal preoperative CT evaluation. The world literature is reviewed and similar diagnostic and therapeutic problems are discussed.

Child, Preschool↗

PubMed1990

Revision mastoidectomy.

The objectives of modern otologic surgery are elimination of disease and restoration of hearing. Persistent drainage and recurrent infection after mastoid surgery hallmark failure at achieving these goals. Medical management consisting of meticulous aural toilette and attention to accompanying medical disorders will often yield resolution; however, a significant number of patients will still require surgical revision. While intact canal wall procedures have reduced the chronic difficulties associated with open cavities, they are prone to failure. Careful assessment of the disease process and development of a surgical approach that is both flexible and complete will maximize success in revision surgery. Disease persistence after revision should be considered in the spectrum of complications, even though at times it is nearly impossible to avoid. We describe the reasons for failure of mastoid procedures, common areas of retained disease, and review key concepts of revision.

Anti-Bacterial Agents↗

PubMed1979

Extramastoid cholesteatoma in chronic ear disease: a report of two cases.

Two patients who had undergone radical mastoid surgery developed an isolated focus of cholesteatoma embedded in the sternomastoid muscle just below the mastoid tip. In one instance the etiology was felt to be iatrogenic implantation of squamous epithelium. In the second, unrecognized extension from the mastoid tip probably occurred. The purpose of this paper is to describe and discuss in detail the clinical and pathological features of these two cases.

Adolescent↗

PubMedDate not supplied

Prognostic factors in complicated and uncomplicated chronic otitis media.

PURPOSE: The aim of the present study was to determine the factors that make a patient of chronic suppurative otitis media more susceptible to the development of a complication. MATERIALS AND METHODS: A prospective study of 125 patients of both complicated and uncomplicated cases of chronic suppurative otitis media who underwent mastoid surgery was undertaken to study the percentage proportion of various complications and to correlate various variables, such as age, sex, duration of ear discharge, otoscopy, operative findings, state of pneumatization, and microbiology of the ear. RESULTS: It was found that patients with complicated ear disease had ear discharge for a shorter duration compared with those without complications. The difference was statistically significant (P < .05). There was no significant difference in the otoscopic findings in both the groups. At surgery, presence of granulation tissue was significantly seen in the group with complications (P < .05). Radiologically, degree of mastoid pneumatization had no significant difference in the two groups, except the presence of lytic lesion in patients more than 15 years of age in the group with complications. Bacteriological examination showed significant isolation of anaerobes in patients with complications (P < .01). CONCLUSION: A history of ear discharge for a short duration in a younger patient less than 15 years of age, the presence of anaerobes in the ear discharge, and granulation tissue at surgery increase the probability of development of a complication in patients with chronic suppurative otitis media.

Adolescent↗

PubMed1991

Role of surgery in tuberculous mastoiditis.

A study was undertaken in 43 patients to determine the role of surgery in tuberculous mastoiditis. Cortical mastoidectomy was performed on five patients (Group I). Incision and drainage of a post-auricular abscess, removal of sequestrum and meatoplasty in eight (Group II). Thirty patients had no ear surgery (Group III). Of the 17 patients with facial palsy, three were in Group I, two in Group II, 12 in Group III. The patients in all three groups were treated with anti-tuberculous drugs for a period of no less than six months. The average time taken for the otorrhoea to subside and granulation tissue to resolve completely was two months in all three groups. The facial nerve recovery in the non-operated ears (Group III) was 92 per cent and in the operated ears (Group I and II) 80 per cent. The conclusion is that chemotherapy is the management of choice in tuberculous mastoiditis. The only role of surgery is incision and drainage of a post-auricular abscess and removal of sequestrum if present.

Adolescent↗

PubMed1999

Relevant issues in revision canal-wall-down mastoidectomy.

The role of canal-wall-down (CWD) versus intact-canal-wall (ICW) mastoidectomy in the treatment of chronic otitis media with or without cholesteatoma remains a debated issue. Although past conventional wisdom has held that CWD mastoid surgery leads to a "safe" ear and is technically less demanding than the more controversial ICW mastoidectomy, this is often not the case. Although our preference is an ICW technique when possible, 47 of 109 (43%) mastoid procedures for chronic otitis media performed between January 1993 and June 1996 involved a CWD mastoid cavity. More than two thirds of these procedures (32 of 47) represented revision surgery, the most common indication being a poorly contoured, preexisting CWD mastoidectomy with persistent otorrhea. A dry, well-epithelialized ear was obtained in 90% of cases. Our preferred method of ossicular reconstruction (double cartilage block ossiculoplasty) is detailed, and hearing results according to American Academy of Otolaryngology Head and Neck Surgery guidelines are reported.

Adolescent↗

PubMedDate not supplied

The prognostic value of Eustachian tube function measurements in tympanoplastic surgery.

The Eustachian tube function was tested preoperatively by sonotubometry and by the negative pressure equalization test in 87 ears subjected to simple myringoplasty, tympanoplasty alone, or tympanoplasty combined with mastoid surgery. The relations between tubal function test results and healing were analysed on average 10 months after the operation. The results indicating absent or partial pressure equalization ability were poorly correlated with the successful outcome of surgery, while sonotubometry showed a good correlation. Pressure equalization may produce such an unphysiological underpressure that many test results are erroneously negative. Sonotubometry is an entirely physiological method and has in this Department replaced the pressure equalization test for routine evaluation of the Eustachian tube function.

Adolescent↗

PubMed2000

Hearing results after primary cartilage tympanoplasty.

OBJECTIVES/HYPOTHESIS: Cartilage-perichondrium grafting of the tympanic membrane has been used in an effort to reduce recurrence or progression of middle ear disease. The rigidity of cartilage has obvious benefit in preventing tympanic membrane retraction, but concern has been raised regarding its sound conduction properties Few studies in the literature address hearing results after cartilage tympanoplasty. The purpose of this study was to investigate the hearing results after primary cartilage tympanoplasty and compare them with results after primary tympanoplasty with temporalis fascia. STUDY DESIGN: A retrospective review of all ear surgeries using cartilage between 1994 and 1999 was performed. METHODS: Only primary cases in which the ossicular chain was intact and no mastoid surgery was performed were included. Indications for surgery included tympanic membrane perforation, retraction, and cholesteatoma Pre- and postoperative speech reception thresholds and air-bone gaps at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz were compared. RESULTS: Eleven patients comprised the cartilage study group, and there were 11 age- and temporally matched control subjects. The mean improvement in speech reception threshold for both the study group and the control group was 10 dB. The majority of patients in both groups had ABG closure to within 10 dB at all frequencies examined. There were no statistically significant differences in speech reception threshold improvement or air-bone gap closures between the two groups. CONCLUSIONS: These results demonstrate that hearing results after cartilage tympanoplasty are comparable to those after temporalis fascia tympanoplasty. Therefore, when indicated, a cartilage-perichondrium graft can be used for prevention of disease recurrence or progression without fear of impairing hearing.

Adolescent↗

PubMedDate not supplied

Microbiology of chronic suppurative otitis media in children.

The aerobic microorganisms present in 51 middle ears of 36 children with chronic suppurative otitis media without cholesteatoma were evaluated. Specimens were taken directly from the middle ear through a patent perforation or tympanostomy tube and cultured using standard techniques. Twenty-three microbiologic species were identified, with Pseudomonas aeruginosa being the most prevalent (67% of ears) and the only organism in 31% of ears. The initial treatment of all patients was intravenous administration of an antimicrobial selected on the basis of culture and susceptibility reports; this treatment was successful in all but four children, who subsequently required tympanomastoid surgery. These results indicate that medical therapy, based on the results of culture and susceptibility studies, provides a viable alternative to major mastoid surgery in the management of chronic suppurative otitis media without cholesteatoma.

Adult↗

PubMed2000

[A century in the history of chronic ear surgery].

Although some advocated surgery of the tympanic membrane and stapes as early as early as the end of the nineteenth century, it took a long time for widespread development. Mastoid surgery had just been born and was to be greatly improved over the next century. Preservation of the tympano-ossicular its later reconstruction gradually came into use with the creation of the tympanomeatal flap and the recent development of middle ear surgery, followed by posterior tympanotomy and myringoplasty, thus allowing closed tympanoplasty. Likewise, the ventilation tube, forgotten for more than half a century, has found an important place in the treatment of chronic otitis with a closed ear drum.

Chronic Disease↗