Surgical Treatment of Tympanic Membrane Retractions

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P59-P60
Author(s):  
Venkat R Srinivasan ◽  
Mihirangi Shamane Rubasinghe ◽  
Christopher Low
Keyword(s):  
Tympanic Membrane ◽  
Modified Technique ◽  
Exact Test ◽  
High Incidence ◽  
Before And After ◽  
Severe Group ◽  
The Mean ◽  
The Difference ◽  
Age Range

Objective To report a modified technique of cartilage reinforcement tympanoplasty. To assess the safety and efficacy of this technique for symptomatic tympanic membrane retractions. Methods Retrospective analysis of patients with Pars Tensa retractions treated surgically between 2001 and 2007. The indications were discharge and hearing loss. Surgery involved excision of retracted segment, exposure of facial recess, removal of keratin and reinforcement with thinned tragal cartilage graft (cartilage thinned by cartilage cutter) and temporalis fascia. Paired T test was used to compare the mean ABG before and after surgery. Results 34 ears were operated on in 33 patients with an age range of 8 to 66 (mean 38). Full extent of the retraction was visible (Moderate) in 12 ears and not visible in 22 ears (Severe). Cholesteatoma was found in 10 ears (all in Severe group) and ossicular erosion was noticed in 29 ears. Follow-up ranged from 12 to 66 months (mean of 36 months). The success rate was 97% with recurrence of retraction in 1 ear. Air-bone gap improved in 31 ears, remained the same in 1 ear, and worsened in 2 ears. The pre- and postoperative mean ABG values were 24.3 (SD 9.5) and 17 (8.7). The difference was 7.3 p<0.0001(95% CI=4.8,9.9). Cholesteatoma recurred in 1 patient. Cholesteatoma presence and severity of retraction did not have any influence on the recurrence rate (Fisher's Exact Test). Conclusions High incidence of per-operative discovery of cholesteatoma (30%) in our series supports early, aggressive management of symptomatic retractions. Thinned cartilage is more effective with less chances of migration.

scholarly journals An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy

2021 ◽  
Vol 14 (3) ◽  
pp. 383-387
Author(s):  
Faried Wagdy ◽  
◽  
Hisham Elsorogy ◽  
Ahmed Alnagdy ◽  
Dina Abd Elfattah ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Open Angle Glaucoma ◽  
Implant Surgery ◽  
Late Failure ◽  
Group I ◽  
The Mean ◽  
The Difference ◽  
One Year ◽  
Age Range

AIM: To compare the outcome of an Ex-Press implant and subscleral trabeculectomy (SST) in the management of glaucoma after previous trabeculectomy on a fibrotic bleb. METHODS: This randomized prospective study included 28 eyes from 28 patients (age range: 42-55y) with primary open angle glaucoma (POAG) presented with elevated intraocular pressure (IOP) with fibrotic bleb despite previous SST for more than 4mo. The eyes enrolled in the study were divided into two groups: group I (subjected to Ex-Press implant surgery) and group II [subjected to SST with mitomycin C (MMC)]. The follow-up continued one year after surgery to evaluate IOP, visual acuity (VA), visual field (VF), and postoperative complications. RESULTS: A significant decrease in IOP was found in both groups with a higher reduction in Ex-Press implant surgery with the mean IOP of 14.50 mm Hg (P=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg (P=0.001) after one year. However, the difference between the two groups in terms of the decrease in IOP was insignificant. Fewer postoperative complications were recorded in the Ex-Press implant surgery and more cases requiring further anti-glaucomatous medications were seen in the SST group. Both groups showed stability in terms of VA and VF. CONCLUSION: Ex-Press implant surgery and SST with MMC are two surgical alternatives for controlling IOP in late failure that occurs more than 4mo after previous SST with a fibrotic bleb. However, Ex-Press shunt is a safer surgery with fewer complications.

scholarly journals Investigation of Olfactory Function Following Septorhinoplasty in Iranian Population by Rapid Smell Test (RST)

2020 ◽  
pp. 1-6
Author(s):  
Amir Yarahmadi ◽  
Kamran Kamrava ◽  
Ali Shafee ◽  
Maryam Milanifard ◽  
Mohammad Aghajanpour ◽  
...  
Keyword(s):  
Social Sciences ◽  
Olfactory Function ◽  
P Value ◽  
Clinical Tool ◽  
Smell Test ◽  
Before And After ◽  
The Mean ◽  
The Difference ◽  
Smell Identification

Introduction: All surgical procedures on nose affect the olfactory function to some extent. There are different viewpoints about olfactory function after septorhinoplasty. We aim to investigate smell perception changes in patients following septorhinoplasty. In this study the use of Rapid Smell Test (RST) as a fast and reliable clinical tool was investigated. Methods: A prospective cohort study was done in Rasool Akram teaching hospital in 2018 and 2019. Group of 74 septorhinoplasty candidates aged over 18 was selected by convenience. Persian Smell Identification Test (PSIT) and rapid smell test (RST) was obtained from patients before surgery and one month after, if needed three months after and six months after. In addition for patients with dysfunction in any of follow up periods (one month, 3 months and 6 months after surgery) smell magnitude test (SMT) was used. All data were analyzed using Statistical Package for Social Sciences, version 24.0 (IBM SPSS Statistics Inc., Chicago, IL, USA). Results: Out of 74 patients participating in this study 67 were female. Mean age of 25.68±5.18 years was recorded for participants. All patients before surgery had PSIT score more than 19 and the mean PSIT score before operation was 22.63±1.39. Also all patients scored 5 out of 5 in RST before surgery. Mean PSIT score one month after surgery decreased to 22.21±2.20 but still 93 percent (69 patients) of participants were in range for normal olfactory function. We recorded this to be significant (p value = 0.044). RST after one month showed the same results. The difference between RST before and after surgery was also significant (p value = 0.024). For those 5 patients with abnormal olfactory function PSIT and RST were done 3 months after operation which determines normal olfactory function for all of them. As well as PSIT, RST also shows the same results and five participants recorded 5 out of 5 three months after surgery. Conclusion: This study showed changes in olfactory function after septorhinoplasty will resolve at most 3 months after surgery and it is safe to say there is no effect on olfactory function three months after operation. Also we demonstrated that RST can be a fast and reliable tool for assessing patients’ olfactory function in clinical setting.

Intracranial pressure before and after cranioplasty: insights into intracranial physiology

2020 ◽  
Vol 133 (5) ◽  
pp. 1548-1558 ◽  
Author(s):  
Alexander Lilja-Cyron ◽  
Morten Andresen ◽  
Jesper Kelsen ◽  
Trine Hjorslev Andreasen ◽  
Lonnie Grove Petersen ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Decompressive Craniectomy ◽  
Cerebral Metabolism ◽  
Neurosurgical Procedure ◽  
Pulse Wave Amplitude ◽  
Before And After ◽  
Rehabilitation Period ◽  
The Mean ◽  
The Difference

OBJECTIVEDecompressive craniectomy (DC) is an emergency neurosurgical procedure used in cases of severe intracranial hypertension or impending intracranial herniation. The procedure is often lifesaving, but it exposes the brain to atmospheric pressure in the subsequent rehabilitation period, which changes intracranial physiology and probably leads to complications such as hydrocephalus, hygromas, and “syndrome of the trephined.” The objective of the study was to study the effect of cranioplasty on intracranial pressure (ICP), postural ICP changes, and intracranial pulse wave amplitude (PWA).METHODSThe authors performed a prospective observational study including patients who underwent DC during a 12-month period. Telemetric ICP sensors were implanted in all patients at the time of DC. ICP was evaluated before and after cranioplasty during weekly measurement sessions including a standardized postural change program.RESULTSTwelve of the 17 patients enrolled in the study had cranioplasty performed and were included in the present investigation. Their mean ICP in the supine position increased from –0.5 ± 4.8 mm Hg the week before cranioplasty to 6.3 ± 2.5 mm Hg the week after cranioplasty (p < 0.0001), whereas the mean ICP in the sitting position was unchanged (–1.2 ± 4.8 vs –1.1 ± 3.6 mm Hg, p = 0.90). The difference in ICP between the supine and sitting positions was minimal before cranioplasty (1.1 ± 1.8 mm Hg) and increased to 7.4 ± 3.6 mm Hg in the week following cranioplasty (p < 0.0001). During the succeeding 2 weeks of the follow-up period, the mean ICP in the supine and sitting positions decreased in parallel to, respectively, 4.6 ± 3.0 mm Hg (p = 0.0003) and –3.9 ± 2.7 mm Hg (p = 0.040), meaning that the postural ICP difference remained constant at around 8 mm Hg. The mean intracranial PWA increased from 0.7 ± 0.7 mm Hg to 2.9 ± 0.8 mm Hg after cranioplasty (p < 0.0001) and remained around 3 mm Hg throughout the following weeks.CONCLUSIONSCranioplasty restores normal intracranial physiology regarding postural ICP changes and intracranial PWA. These findings complement those of previous investigations on cerebral blood flow and cerebral metabolism in patients after decompressive craniectomy.

scholarly journals Study of Effect of Nd:YAG Capsulotomy on Corneal Endothelium: A Teaching Hospital Based Prospective study

2021 ◽  
Author(s):  
Amit Hemant Pathak ◽  
Ajit Kamalakar Joshi ◽  
Sai Divya Nellutla
Keyword(s):  
Endothelial Cell ◽  
Nd:Yag Laser ◽  
Cell Damage ◽  
Specular Microscopy ◽  
Endothelial Cell Damage ◽  
Nd:Yag Laser Capsulotomy ◽  
Before And After ◽  
The Mean ◽  
The Difference

Introduction: Posterior Capsular Opacification (PCO) is a condition which develops months or years after cataract surgery. The Neodymium Yttrium Aluminium Garnet (Nd:YAG) laser capsulotomy is the procedure of choice for PCO and its adverse effects include intraocular pressure elevation, cystoid macular oedema, corneal endothelial cell damage, retinal detachment and Intraocular Lens (IOL) pitting. Aim: To assess the corneal endothelial structure and function before and after Nd:YAG laser capsulotomy in patients with PCO using specular microscopy. Materials and Methods: This was a prospective observational study carried out in Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli, Maharashtra, India on 50 eyes of 50 patients having PCO. This study was conducted in the time period between October 2020 to February 2021 for four months. Patients were subjected to Nd:YAG laser capsulotomy in the affected eye and were followed-up at one week and one month postprocedure. Specular Microscopy was used to evaluate the Endothelial Cell Density (ECD), Coefficient of Variation (CV) and Hexagonality of endothelial cells before and after laser capsulotomy. Statistical Package for Social Sciences (SPSS) version 26.0 was used for the statistical analysis. Chi-square test and ANOVA test are the tests of significance applied in this study. Results: Forty-five patients (90%) gained Best Corrected Visual Acuity (BCVA) of >6/18 after one week and 47 patients (94%) gained BCVA of ≥6/18 after one month postprocedure. Mean ECD prelaser was 2356.76 cells/mm2, which decreased to 2231.8 cells/mm2 at one week and 2199.2 cells/mm2 at one month follow-up. The difference between prelaser ECD and at one week and one month was 124.96 cells/mm2 and 157.56 cells/mm2, respectively, which was statistically significant at one month (p<0.0001). The mean CV prelaser was 33.74, at one week was 35.58 and at one month it was 37.22. The difference in CV from prelaser status to one month was statistically significant (p<0.0001). The mean hexagonality at baseline was 65.34% which decreased to 62.02% at one week and 60.42% at one month follow-up. The difference in hexagonality between one month and baseline was statistically significant (p<0.0001). Conclusion: Nd:YAG laser capsulotomy is a safe, effective and non invasive method for the treatment of PCO. However, it causes structural and functional corneal endothelial cell damage.

scholarly journals Unilateral lateral rectus recession is an effective surgery for intermittent exotropia in young children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Oriel Spierer ◽  
Abraham Spierer
Keyword(s):  
Young Children ◽  
Success Rate ◽  
Lateral Rectus ◽  
Intermittent Exotropia ◽  
Age At Surgery ◽  
Surgical Methods ◽  
Before And After ◽  
The Mean ◽  
Consecutive Esotropia

Abstract Background Different surgical methods have been suggested for the correction of intermittent exotropia. Unilateral lateral rectus recession has been described as a surgical alternative for small and moderate-angle exotropia. In general, previous studies did not focus on the outcomes of unilateral lateral rectus recession in young children with intermittent exotropia. The purpose of this study is to evaluate the surgical outcomes of unilateral lateral rectus recession in the treatment of moderate-angle exotropia (≤ 25 PD (prism diopters)) in children. Methods The charts of all patients younger than 12 years of age with moderate-angle exotropia (up to 25 PD) who were operated during the years 2006–2018 were retrospectively reviewed. Fifty-eight patients underwent unilateral lateral rectus recession and had a minimum follow up of 6 months. The angle of exotropia (PD) before and after surgery and the success rate were documented. Results Mean age at surgery was 6.4 ± 1.9 (range 3.5–11.0) years. Exotropia improved from a preoperative angle of 21.4 ± 4.0 PD to 3.5 ± 5.9 PD postoperatively (p < 0.001). Success rate, defined as deviation of ≤ 10 PD, was achieved in 86.2%. There were 2 (3.4%) cases of overcorrection (consecutive esotropia). There were no intra- or postoperative complications. The mean follow-up duration after surgery was 2.3 ± 1.7 years. Conclusions In children with moderate angle exotropia, good postoperative success rate was achieved by performing unilateral lateral rectus recession.

scholarly journals Comparative study between fat plug and inlay butterfly cartilage grafts for myringoplasty in adults

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Ahmed Gamal Khafagy ◽  
Mohamed El-Begermy ◽  
Marwa Mohamed El-Begermy ◽  
Pretty O. Afifi
Keyword(s):  
Tympanic Membrane ◽  
Chronic Otitis Media ◽  
Fat Graft ◽  
Cartilage Graft ◽  
Tympanic Membrane Perforations ◽  
Number Of Patients ◽  
Significant Difference ◽  
Hearing Outcomes ◽  
Age Range

Abstract Background This study aims to compare the graft uptake rate and hearing improvement of fat graft versus inlay butterfly tragal cartilage in the repair of perforations in chronic otitis media mucosal in adults. In this retrospective study, twenty-eight patients were included with small dry anteroinferior tympanic membrane perforations (less than 1/3 of the tympanic membrane). The age range was 18 to 44 years old. Myringoplasty was done under general anesthesia for 8 patients with a fat graft (FG) and 20 patients with inlay butterfly cartilage graft (IBCG). Six months postoperatively, a follow-up evaluation was done for successful graft uptake and hearing outcomes. Results The success rate of graft uptake in the first group (fat graft) was 6/8 cases (75%) while in the second group (IBCG) was 19/20 (95%) with no statistically significant difference (P = 0.0148). Also, there was no statistical difference between the two groups as regards postoperative ABG, improvement changes in ABG, and number of patients with improved hearing. Conclusions Inlay butterfly cartilage graft is a useful graft in repairing small tympanic membrane perforations as regard graft take and hearing outcomes.

The role of exudation in chronic subdural hematomas

2007 ◽  
Vol 107 (2) ◽  
pp. 290-295 ◽  
Author(s):  
Mehmet Tokmak ◽  
A. Celal Iplikcioglu ◽  
Sirzat Bek ◽  
Cem Atilla Gökduman ◽  
Mustafa Erdal
Keyword(s):  
Outer Membrane ◽  
Clinical Status ◽  
Ct Scans ◽  
Subdural Hematomas ◽  
The Mean ◽  
Grade 3 ◽  
Age Range ◽  
Exudation Rate

Object Chronic subdural hematomas (SDHs) are a local inflammatory process that causes the formation of a granulation tissue often referred to as the external or outer membrane. This membrane has abnormally permeable macrocapillaries. Therefore, exudation from the macrocapillaries in the outer membrane of chronic SDH may play an important role in the enlargement of chronic SDH. In this study the authors investigated the role of exudation in chronic SDH. Methods The authors examined 24 patients (16 men and eight women; age range 38–86 years [mean age 61.4 years]) with 27 chronic SDHs. The clinical status of the patients was evaluated according to the classification described by Markwalder. The diagnosis was established on computed tomography (CT) scans in all cases. The authors also used the Nomura Classification for judging the lesion's appearance on CT scans. Immediately after the diagnosis, all patients were administered 20 mCi (740 mBq) technetium-99m human serum albumin. Four hours later, blood and SDH samples were taken and radioactivity levels were measured in each. The ratio of activity of the samples taken from chronic SDH to the radioactivity of blood was determined as a percentage and defined as the exudation rate. On the follow-up CT scan obtained on postoperative Day 20, subdural collections thicker than 5 mm were determined to be a reaccumulation. Results The correlations between the exudation rate and age of the patients, clinical grades, CT appearances, and amount of reaccumulation were investigated. In this series the average exudation rate was 13.24% (range 2.05–28.88%). The mean exudation rates according to the clinical grades assigned to patients were as follows: Grade 0, 8.67 ± 5.64% (three patients); Grade 1, 5.07 ± 1.43% (eight patients); Grade 2, 17.87 ± 3.73% (seven patients); and Grade 3, 19.65 ± 7.67% (six patients). Exudation rates in patients with Grades 2 and 3 were significantly higher than those in Grades 0 and 1 (p < 0.05). The mean exudation rates according to the lesion's appearance on CT scans were found as follows: hypodense appearance, 6.55 ± 4.52% (eight patients); isodense appearance, 11.07 ± 6.32% (five patients); hyperdense appearance, 19.47 ± 13.61% (three patients); and mixed-density appearance, 17.40 ± 5.80% (nine patients). The differences among the groups were significant (p < 0.05). The average exudation rate was statistically higher in the patients with reaccumulation (16.30 ± 8.16%) than that in the patients without reaccumulation (9.96 ± 6.84%) (p < 0.05). Conclusions The exudation rate in chronic SDH is correlated with a higher clinical grade (Markwalder Grade 2 or 3), mixed-density CT appearance, and reaccumulation. Therefore, exudation from macrocapillaries in the outer membrane of chronic SDH probably plays an important role in the pathophysiology and the growth of chronic SDH.

scholarly journals Computed Tomography and Bronchoscopy in Endobronchial Tuberculosis

2003 ◽  
Vol 10 (8) ◽  
pp. 445-448 ◽  
Author(s):  
Halil Yanardag ◽  
Cüneyt Tetikkurt ◽  
Seza Tetikkurt ◽  
Sabriye Demirci ◽  
Tuncer Karayel
Keyword(s):  
Computed Tomography ◽  
Retrospective Study ◽  
Therapeutic Response ◽  
Histopathological Examination ◽  
Computed Tomographic ◽  
Before And After ◽  
Endobronchial Tuberculosis ◽  
Age Range

BACKGROUND: The therapeutic response to endobronchial tuberculosis is usually evaluated by bronchoscopy. Currently, there are no published studies investigating the use of computed tomography for the evaluation of therapeutic response in endobronchial tuberculosis.OBJECTIVE: A retrospective study was performed to evaluate the bronchoscopic and computed tomographic features of endobronchial tuberculosis before and after treatment. The aim of this study was to investigate the usefulness of computed tomography for the assessment of treatment.METHODS: The clinical, pathological and bronchoscopic features of endobronchial tuberculosis were evaluated in 55 patients. The age range of the patients was 21 to 52 years. Computed tomography and bronchoscopy were performed before and after treatment.RESULTS: Diagnosis of tuberculosis was confirmed by culture and histopathological examination. Bronchoscopic examination revealed 89 endobronchial lesions of various types in 55 patients. The exudative type was the most common. Follow-up bronchoscopy revealed that exudative-, ulcerative- and granular-type lesions healed completely. Computed tomography performed after treatment correlated well with the follow-up bronchoscopic findings.CONCLUSION: The results suggest that follow-up computed tomography is useful for the evaluation of therapeutic response and complications associated with endobronchial tuberculosis, and may replace bronchoscopy.

scholarly journals Influence of Apical Patency and Cleaning of the Apical Foramen on Periapical Extrusion in Retreatment

2013 ◽  
Vol 24 (5) ◽  
pp. 482-486 ◽  
Author(s):  
Marili Doro Andrade Deonizio ◽  
Gilson Blitzkow Sydney ◽  
Antonio Batista ◽  
Roberto Pontarolo ◽  
Paulo Ricardo Bittencourt Guimarães ◽  
...  
Keyword(s):  
Material Removal ◽  
Filling Material ◽  
Mean Values ◽  
Filtration System ◽  
Root Canal Retreatment ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
The Difference ◽  
Removal Technique

This study evaluated the influence of apical patency, root filling removal technique and cleaning of the apical foramen, concerning the amount of debris extruded during root canal retreatment. Forty mandibular incisors were randomly assigned to 4 groups - GIM (n=10), GIIM (n=10), GIPT (n=10) and GIIPT (n=10), which were named according to leaving (I) or not (II) apical patency during canal preparation and filling removal technique (manual - M or ProTaper system - PT). After filling material removal, each specimen of each group had the apical foramen cleaned by sizes 15, 20 and 25 instruments, generating 12 subgroups: GIM15, GIM20, GIM25, GIIM15, GIIM20, GIIM25, GIPT15, GIPT20, GIPT25, GIIPT15, GIIPT20 and GIIPT25. Extruded filling debris was collected by a Milipore filtration system, an HV-durapore, 0.45 µm pore filter with a 25 mm diameter. The filters were weighed before and after the collection on an analytical scale (10–5 g), and the difference was calculated. The mean weight of extruded filling debris was analyzed statistically by Kruskal-Wallis and Friedman ANOVA tests (α=0.05). The mean values found in the groups (in mg) were: GIM (0.95±0.94), GIIM (0.47±0.62), GIPT (0.30±0.31) and GIIPT (0.32±0.44). There was no statistically significant difference among any of the groups or subgroups (p>0.05). ProTaper provided the smallest amount of extruded filling material, regardless of presence or absence of apical patency, followed by manual technique, without and with apical patency. Additional amounts of debris were collected during cleaning of the apical foramen, regardless of the instrument, presence/absence of patency or root filling removal technique.

scholarly journals A report on an acute, in-hours, outpatient review clinic with ultrasonography facilities for the early evaluation of general surgical patients

2016 ◽  
Vol 98 (7) ◽  
pp. 468-474 ◽  
Author(s):  
TE Pidgeon ◽  
U Shariff ◽  
F Devine ◽  
V Menon
Keyword(s):  
Computed Tomography ◽  
Primary Outcome ◽  
Surgical Patients ◽  
Clinic Attendance ◽  
Early Evaluation ◽  
Admission Rates ◽  
Before And After ◽  
Age Range ◽  
Surgical Clinic

Introduction In 2013 our hospital introduced an in-hours, consultant-led, outpatient acute surgical clinic (ASC) for emergency general surgical patients. In 2014 this clinic was equipped with a dedicated ultrasonography service. This prospective cohort study evaluated this service before and after the introduction of ultrasonography facilities. Methods Data were recorded prospectively for all patients attending the clinic during 2013 and 2014. The primary outcome was patient destination (whether there was follow-up/admission) after clinic attendance. Results The ASC reviewed patients with a wide age range and array of general surgical complaints. In 2013, 186 patients attended the ASC. After the introduction of the ultrasonography service in 2014, 304 patients attended. In 2014, there was a reduction in the proportion of patients admitted to hospital from the clinic (18.3% vs 8.9%, p=0.002). However, the proportion of patients discharged after ASC review remained comparable with 2013 (30.1% in 2013 vs 38.8% in 2014, p=0.051). The proportion of patients undergoing computed tomography (CT) scans also fell (14.0% vs 4.9%, p<0.001). Conclusions The ASC assessed a wide array of general surgical complaints. Only a small proportion required hospital admission. The introduction of an ultrasonography service was associated with a further reduction in admission rates and computed tomography.

Sign in / Sign up

Export Citation Format

Share Document