Preliminary outcomes of endoscopic middle-ear surgery in 103 cases: a UK experience

AbstractBackgroundTotally endoscopic ear surgery and endoscope-assisted microsurgery are still new concepts, with relatively few centres in the UK performing them. Advantages include better visualisation of difficult to reach areas, such as the sinus tympani, and limited external incisions. This paper reports our short-term outcomes for endoscopic middle-ear surgery.MethodsA prospective review was conducted of the first 103 consecutive patients undergoing totally endoscopic ear surgery or endoscope-assisted microsurgery in 1 centre performed by 1 operator. The outcomes assessed were: tympanic membrane healing, audiological data and complications.ResultsTwenty-five patients underwent endoscope-assisted microsurgery, while 78 had totally endoscopic ear surgery. There were no reported cases of dead ear or permanent facial nerve palsy. The average air–bone gap following stapedectomy was 7.38 dB. The tympanic membrane healing rate was 89 per cent.ConclusionOur results confirm that endoscopic middle-ear surgery is safe, and the short-term outcomes are comparable with conventional surgery.

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Endoscopic ear surgery: a hot topic?

The Journal of Laryngology & Otology ◽

10.1017/s0022215116009828 ◽

2017 ◽

Vol 131 (2) ◽

pp. 117-122 ◽

Cited By ~ 17

Author(s):

S Mitchell ◽

C Coulson

Keyword(s):

Middle Ear ◽

Descriptive Analysis ◽

Relevant Literature ◽

Heat Exposure ◽

Middle Ear Surgery ◽

Endoscopic Ear Surgery ◽

Ear Surgery ◽

Potential Factors ◽

Negative Impacts ◽

Published Research

AbstractObjectives:To summarise published research investigating maximal temperatures associated with endoscopes used in otology. Possible thermal issues surrounding the use of endoscopes in middle-ear surgery are discussed, and recommendations regarding the safest ways to use endoscopes in endoscopic ear surgery are made.Methods:A non-systematic review of the relevant literature was conducted, with descriptive analysis and presentation of the results.Results:There are currently no reports of any temperature-related deleterious effects in patients having undergone endoscopic ear surgery. There is debate regarding heat issues in endoscopic ear surgery, with a limited body of work documenting potential negative impacts of middle-ear heat exposure from endoscopes. The diameter of endoscope, type of light source used, distance from endoscope tip and duration of exposure are highlighted potential factors for high temperatures in endoscopic ear surgery.Conclusion:There is a trend towards endoscopes being used routinely in ear surgery. Simple practice points are recommended to minimise potential thermal risks.

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Factors that have an influence on bone conduction thresholds changes after otosurgery in the patients operated on due to the perforation of the tympanic membrane with the preserved ossicular chain

Otolaryngologia Polska ◽

10.5604/01.3001.0010.2245 ◽

2017 ◽

Vol 71 (4) ◽

pp. 26-33

Author(s):

Maciej Wiatr ◽

Agnieszka Wiatr ◽

Sebastian Kocoń ◽

Jacek Składzień

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Negative Impact ◽

Positive Impact ◽

Round Window ◽

Bone Conduction ◽

Ossicular Chain ◽

Middle Ear Surgery ◽

Ear Surgery ◽

Study Objective

Introduction: The aim of the middle ear surgery is to eliminate abnormalities from the mucous, ensure the due airing of the postoperative cavity and reconstruct the sound-conducting system in the middle ear. Numerous reports can be found in literature on the changes to bone conduction as a consequence of middle ear surgery. Study objective: The aim of the work is to define the factors that affect bone conduction in the patients operated on due to the perforation of the tympanic membrane with the preserved and normal mobile ossicular chain. Material and method: A prospective analysis of patients operated on due to diseases of the middle ear in 2009–2012 was carried out. The cases of patients operated on for the first time due to chronic otitis media were taken into consideration. The analysis encompassed the patients who had undergone myringoplasty. The patients were divided into several groups taking into account the abnormalities of the mucous observed during otosurgery. Results: A significant improvement of bone conduction was observed in the patients with dry perforation, without other lesions in the middle ear. The appropriate pharmacological treatment before otosurgery in patients with permanent discharge from the ear resulted in significant bone conduction improvement. The elimination of granulation lesions turned out to be a positive factor for the future improvement of the function of the inner ear. Conclusions: The lack of abnormalities on the mucous of the middle ear (e.g. granulation,) and discharge has a positive impact on improvement of bone conduction after myringoplasty. Adhesions in the tympanic cavity, especially in the niche of the round window, have a negative impact on improvement of bone conduction in patients after myringoplasty.

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Cholesteatoma Medial to an Intact Tympanic Membrane in 34 Young Children

PEDIATRICS ◽

10.1542/peds.74.2.236 ◽

1984 ◽

Vol 74 (2) ◽

pp. 236-240

Author(s):

Richard H. Schwartz ◽

Kenneth M. Grundfast ◽

Bruce Feldman ◽

Richard E. Linde ◽

Karen L. Hermansen

Keyword(s):

Hearing Loss ◽

Young Children ◽

Tympanic Membrane ◽

Otitis Media ◽

Middle Ear ◽

Early Stage ◽

Middle Ear Surgery ◽

Ear Surgery ◽

Simple Excision ◽

Otoscopic Examination

Thirty-five cholesteatomas medial to intact eardrums were treated in 34 children between 1976 and 1982. Six (18%) children had never had a documented episode of otitis media. Seventeen (50%) children, in whom the lesion was diagnosed at an early stage, underwent simple excision of the cholesteatoma without the need for extensive middle ear surgery. Findings from postoperative audiograms were normal for all such children. Cholesteatoma has recurred in eight (23%) children to date. Most recurrences were diagnosed 15 months or less after surgery. Routine careful otoscopic examination is essential in order to discover cholesteatoma at an early stage and to avoid hearing loss and the need for extensive otomastoid surgery. In order to perform an accurate examination of the eardrum, a halogen-illuminated otoscope and pneumo-otoscopy should be used by the pediatrician routinely. Particular attention should be paid to the posterior-superior quadrant of the tympanic membrance where a cholesteatoma is usually located.

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Evaluation of Taste Disturbance in Pre and Post Mastoid Surgery Patients

Journal of BP Koirala Institute of Health Sciences ◽

10.3126/jbpkihs.v2i2.27851 ◽

2019 ◽

Vol 2 (2) ◽

pp. 4-11

Author(s):

Sriti Manandhar ◽

ST Chettri ◽

DR Kandel

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Analytical Study ◽

Middle Ear Surgery ◽

Chorda Tympani ◽

Chorda Tympani Nerve ◽

Ear Surgery ◽

Taste Disturbance ◽

Duration Of Operation ◽

Mastoid Surgery

Background: Mastoid surgery is one of the commonest surgeries in Otolaryngology & Head & Neck department. Surgeons are less aware of preserving chorda tympani nerve (CT). Injury to the chord tympani nerve is common in middle ear surgery as the course of CT runs between ossicles and close to tympanic membrane. It makes the surgeon difficult to preserve it during the surgery. The study was done to observe frequency of taste disturbances (TD) in all patients undergoing mastoid surgery and to correlate between intra operative status of CT and type of intra operative status of CT injury with postoperative taste disturbances. Methods: A prospective analytical study was conducted in patients who underwent mastoid surgery. The intra operative status of CT was studied, different forms of injury to the nerve were noticed and its impact on taste disturbances was assessed subjectively with questionnaire. The patients with taste disturbances were followed till twelve weeks. Result: None of the patients had taste disturbances prior to surgery. Out of 65 patients, only 15 patients became symptomatic in second postoperative day and the taste disturbances were in the form of altered taste (26.66%), dry mouth (26.66%) and numbness (46.66%). Symptoms like altered taste and numbness were present till the eighth week of surgery and disappeared by the twelfth week except one patient in whom numbness persisted till twelfth week. The symptoms did not correlate with the intra operative status of CT. The symptoms disappeared with duration of operation and it was significant. Conclusion: None of the patients voluntarily complained regarding taste disturbances until they were specifically asked. Only 15 patients had taste disturbances; 7 had numbness, 4 dryness of mouth and 4altered taste. The taste disturbances did not correlate with the type of intra operative status of CT. CT was not identified in 9 patients and only 3 (33.3%) became symptomatic and CT was cut with micro scissors in 26 patients but only 4 (15.38%) patients were symptomatic.

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Stapes surgery under local anaesthesia

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13511609954932 ◽

2013 ◽

Vol 95 (1) ◽

pp. 37-39 ◽

Cited By ~ 6

Author(s):

JA Lavy ◽

HRF Powell

Keyword(s):

General Anaesthesia ◽

Middle Ear ◽

Local Anaesthetic ◽

Local Anaesthesia ◽

Stapes Surgery ◽

Middle Ear Surgery ◽

Ear Surgery ◽

Hearing Results ◽

Accepted Practice ◽

The Uk

In the UK, stapes surgery is performed almost universally under general anaesthesia. In 1984 there was consensus that local anaesthesia should be the technique of choice in stapes surgery. Despite reports of successful use of local anaesthesia for middle ear surgery, this is still not widely accepted practice in the UK. We describe the senior author’s technique for local anaesthetic stapes surgery and present the hearing results for a series of 100 consecutive cases.

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Clinical Implications of Poloxamer 407 as Packing Material in an Animal Model

Audiology and Neurotology ◽

10.1159/000500661 ◽

2019 ◽

Vol 24 (2) ◽

pp. 100-108

Author(s):

Ji Eun Choi ◽

Jae-Hun Lee ◽

So-Young Chang ◽

Min Young Lee ◽

Jae Yun Jung

Keyword(s):

Animal Model ◽

Tympanic Membrane ◽

Middle Ear ◽

Packing Material ◽

Poloxamer 407 ◽

Gelatin Sponge ◽

Control Group ◽

Endoscopic Ear Surgery ◽

Ear Surgery ◽

Middle Ear Mucosa

Background: Endoscopic ear surgery has recently increased, but it is still inconvenient and time-consuming to place packing material in the middle ear with one hand. Poloxamer 407 (P407) is a thermo-reversible gel that can be easily administered with one hand into the middle ear cavity in liquid form. Upon warming to body temperature, the gel form of P407 can support the graft in the target position and is known to prevent postsurgical tissue adhesion. Objectives: We aim to investigate the feasibility of P407 as packing material in an animal model. Male Hartley guinea pigs (350 and 400 g) were utilized in this study. Method: The animals were randomly divided into 3 groups according to the packing material: the control group, the P407 group, and the gelatin group. To assess the role of packing material on bacterial colonization, left ears were inoculated with Streptococcus pneumoniae through the tympanic membrane using a 0° endoscope. Five days after inoculation, the middle ear cavity was packed through a transbullar approach using 18% P407 or gelatin in both ears. In the control group, no ear pack was inserted. The tympanic membrane was examined every week using a 0° 1.9-mm endoscope until 6 weeks. Half of the animals in each group were sacrificed 6 weeks after placement of the packing materials. Results: Compared with the absorbable gelatin sponge, the P407 group showed little inflammation or fibrosis in the tympanic membrane and middle ear mucosa regardless of bacterial inoculation. The gelatin group showed severe otorrhea or perforation until 2 weeks in the right ear (2 of 4) and the left ear (1 of 4). Even though the endoscopic findings were similar between both packing groups at 6 weeks, histological analysis showed persistent packing material, inflammatory cells, and fibrosis in the gelatin group compared to the P407 group. Conclusions: This study suggested that P407 is feasible as a packing material to handle with one hand and to prevent adhesion, especially in infected middle ear mucosa. Although there is a lack of data on how well P407 supports grafts, we suggest that P407 could be a candidate for packing material in endoscopic ear surgery.

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The Homograft Tympanic Membrane after 12 Years

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948209100513 ◽

1982 ◽

Vol 91 (5) ◽

pp. 533-537 ◽

Cited By ~ 10

Author(s):

Roger E. Wehrs

Keyword(s):

Surgical Technique ◽

Tympanic Membrane ◽

Ethyl Alcohol ◽

Middle Ear ◽

Middle Ear Surgery ◽

Ear Surgery ◽

Hearing Results ◽

Ossicular Reconstruction ◽

The Past ◽

Graft Take

The homograft tympanic membrane has been utilized in reconstructive middle ear surgery since 1968. Previous reports describing its preservation and use were published in 1971, 1972, 1976 and 1978. Throughout this time the same preservative of 70% ethyl alcohol and the same surgical technique of covering the transplant with canal skin or fascia has been employed. These transplants have been used to supplement, not replace, other grafting tissues, and to improve the graft-take rate and hearing results. The graft-take rate has averaged over 90% for the past 12 years and 98% for the past 5 years. The hearing results have been satisfactory in 69 to 95% of the cases depending on the associated ossicular reconstruction. Furthermore these results have been consistent and have not deteriorated with the passage of time.

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