Blue Ear Drum and its Management

1976 ◽  
Vol 85 (2_suppl) ◽  
pp. 293-295 ◽  
Author(s):  
Michael M. Paparella
Keyword(s):  
Middle Ear ◽  
Proper Treatment ◽  
Blood Products ◽  
Ventilation Tube ◽  
Radical Mastoidectomy ◽  
Long Period ◽  
Modified Radical Mastoidectomy ◽  
Ventilation Tubes ◽  
Serous Otitis Media ◽  
Mastoid Surgery

The “blue ear drum” generally refers to a condition in which blood or blood products are found in the middle ear. After all possible causes for hemotympanum, including blood dyscrasias and trauma are searched for and ruled out, the patient may have chronic serous otitis media accompanied by bloody effusion. Treatment for all of these patients is conservative, consisting of medical therapy and, if need be, myringotomy and insertion of ventilation tubes. In spite of proper treatment, rarely the condition may progress, over a long period of time, to a state of intractability. Characteristic findings are a hypocellular mastoid, hyperplastic and metaplastic mucoperiosteal lining, including the presence of glands and cysts and Cholesterin granuloma. The recommended procedure is a modified radical mastoidectomy, placement of silicone rubber sheeting in the middle ear and insertion of a ventilation tube. It is to be emphasized that mastoid surgery is rarely indicated for these patients and only after all else has failed.

scholarly journals Does Drilling Induce Hearing Loss after Modified Radical Mastoidectomy? A Retrospective Study

2020 ◽  
Vol 42 (3) ◽  
pp. 38-41
Author(s):  
Yogesh Neupane ◽  
Bijaya Kharel ◽  
Heempali Dutta
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Bone Conduction ◽  
Sensorineural Hearing ◽  
Radical Mastoidectomy ◽  
Modified Radical Mastoidectomy ◽  
The Mean ◽  
Sensory Neural ◽  
Mastoid Surgery ◽  
Sensory Neural Hearing Loss

Introduction Incidence of sensory neural hearing loss following mastoid surgery varies from 1.2 – 4.5%.There are various causes for postoperative sensorineural hearing loss during mastoid surgery. This study aims to identify whether there is any correlation between drilling and postoperative sensory neural hearing loss. MethodsA retrospective study was conducted in the Department of ENT from January 2018 to June 2019. A total number of 68 patients above five years of age who underwent modified radical mastoidectomy for chronic otitis media squamous were included. Revision surgery, preoperative sensorineural hearing loss, injury to the ossicular chain during surgery, patients with lack of follow up or doubtful reports in mentally challenged were excluded from the study. The average bone conduction threshold was calculated from 500, 1000, 2000, 4000 Hz and compared using the Wilcoxon signed-rank test. ResultsThere were 43 males and 25 females in the study with a median age of 23.5 years (16-55). The mean preoperative bone conduction threshold in the four frequencies of 500 Hz, 1kHz, 2kHz, 4kHz were -2.06dB, -2.06dB, 3.31dB, 4.63 dB respectively and the mean postoperative bone conduction thresholds were 1.03, 1.32, 5.29, 4.04 respectively. There was a decline of mean of 3.09 dB and 3.38dB only at the low-frequencies (500Hz and 1kHz) BC threshold respectively which were statistically significant, whereas at higher frequency there was no decline in average postoperative BC threshold. ConclusionThere is no definite role of drill in inducing hearing loss and if present other causes of hearing loss should be sought in postoperative sensorineural hearing loss.

Bondy's Modified Radical Mastoidectomy Revisited

1994 ◽  
Vol 73 (1) ◽  
pp. 15-18 ◽  
Author(s):  
Dennis G. Pappas
Keyword(s):  
Middle Ear ◽  
Disease Process ◽  
Ossicular Chain ◽  
Normal Hearing ◽  
The Body ◽  
Radical Mastoidectomy ◽  
Pars Tensa ◽  
Modified Radical Mastoidectomy

The original criteria for modifying a radical mastoidectomy were: (I) an intact pars tensa and a defective pars flaccid a with cholesteatoma; (2) normal or near normal hearing; and (3) an intact, functional ossicular chain. We propose a fourth criterion: that the cholesteatoma site be delineated lateral to the body of the incus. Control of the disease process is easily assured if the lesion is in that area. Our recommended fourth criterion is based on the results of a five-year study of fifty-two cases that met the original criteria. The cholesteatoma reoccurred in the middle ear in only one case. In six cases, periodic care is necessary because of retraction to the grafted attic area. The procedure and technique used in these patients and the excellent results are discussed in this article.

Cemented Titanium Ventilation Tube in the Chinchilla

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P99-P99
Author(s):  
Jeffery J Kuhn ◽  
Scott R Anderson ◽  
Barry Strasnick
Keyword(s):  
Bone Cement ◽  
Middle Ear ◽  
Medial Wall ◽  
Ventilation Tube ◽  
Novel Technique ◽  
Middle Ear Ventilation ◽  
Ventilation Tubes ◽  
Titanium Tube ◽  
Long Term Ventilation

Problem The use of long-term ventilation tubes in patients with chronic eustachian tube dysfunction is an acceptable form of initial surgical treatment. Despite improvements in composition and design, early extrusion, occlusion, and need for repeated procedures continue to be frequent problems encountered in the course of treatment. The purpose of this study was to develop a novel technique for establishing permanent middle ear ventilation. The study was conducted following the refinement of surgical techniques and long-term follow-up in a pilot group of animals. Methods Heat cautery myringotomy was used to expose the middle ear space in both ears of 15 chinchillas. A titanium ventilation tube was fixed to the medial wall of the hypotympanum in each ear using OtoMimix hydroxyapatite bone cement. At four months, both ears in 12 animals were re-explored and the integrity of the cemented tube was assessed clinically. One animal was euthanized and the temporal bones obtained for histopathologic analysis. Results A stable fixation of the titanium tube to the medial wall of the hypotympanum was demonstrated in 23 of 24 ears at four months re-exploration. The titanium tube-bone cement fixture was covered with healthy vascularized mucosa in all ears. Two ears showed mild mucosal inflammation adjacent to the fixed tube. The histologic findings will be reviewed. Conclusion The use of hydroxyapatite bone cement to permanently secure a titanium tube to the middle ear wall appears to have some promise as a technique for establishing long-term ventilation of the middle ear space. A prototype titanium tube is currently being developed for this purpose. Significance By incorporating the proven technologies of titanium implants and hydroxyapatite bone cement, this study provides a novel technique for establishing a permanent means of middle ear ventilation. Support The ventilation tubes (Gyrus ENT LLC) and bone cement (Walter Lorenz Surgical, Inc.) were supplied by their respective manufacturers.

Mastoid Surgery

1979 ◽  
Vol 88 (5) ◽  
pp. 701-707 ◽  
Author(s):  
J. H. T. Rambo
Keyword(s):  
Poor Quality ◽  
Open Cavity ◽  
Canal Wall ◽  
Radical Mastoidectomy ◽  
Closed Cavity ◽  
Cystic Formation ◽  
The Past ◽  
Modified Radical Mastoidectomy ◽  
Mastoid Surgery

Variation in the quality of healing in mastoid cavities has never been clearly understood. It is the author's contention that the factor responsible for the wide variation in healing, even though all chronic disease has been removed, is buried mucosa which leads to cystic formation. Over the past 20 years the author has followed the principle of removing all mucosa from the mastoid segment and has been rewarded with dry ears routinely in open cavity surgery. For the past 12 years he has removed cholesteatoma through tympanoplasty and modified radical mastoidectomy. These cases, also, have been consistently free of cavity problems. In the late 50s and early 60s closed cavity operations were tried in radical mastoidectomy, fenestration and tympanoplasty with mastoidectomy. Postoperative healing difficulties were encountered then that are similar to those being reported now with intact canal wall operation. No conclusions are drawn in the controversy between open and closed cavity techniques. The observation may be made, nevertheless, that the problems of closed cavity operations have not been solved. It is the thesis of this paper that the main objection to open cavity operations, ie, poor quality of healing, has been resolved.

scholarly journals Postoperative Controls of ventilation tubes in children - by general practitioner or otolaryngologist? Study protocol for a multicenter randomized non-inferiority study (The ConVenTu study)

2020 ◽  
Author(s):  
Bjarne Austad ◽  
Ann Helen Nilsen ◽  
Anne-Sofie Helvik ◽  
Grethe Albrektsen ◽  
Ståle Nordgård ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Evidence Based ◽  
Health Related Quality ◽  
Ventilation Tube ◽  
Related Quality ◽  
Ventilation Tubes ◽  
Health Related

Abstract Background: Otitis media with effusion is the major cause of acquired hearing problems in children. Some of the affected children need surgery with ventilation tubes in the tympanic membrane to reduce ear complaints and to improve hearing, middle ear function and health-related quality of life. This is one of the most common ambulatory surgeries performed on children. Postoperative controls are needed to assess that the tubes are functional, evaluate whether hearing loss has been improved, and to handle potential complications. The follow-up may continue for years and are usually done by otolaryngologists. Nevertheless: there exist no evidence-based guidelines concerning the level of expertise needed for postoperative controls of the ventilation tubes. The aim of this protocol is to describe the ConVenTu study that evaluates whether postoperative controls performed by general practitioners (GPs), represent a safe and sufficient alternative to controls performed by otolaryngologists. Methods/design: Multicenter randomized non-inferiority study conducted in clinical settings in seven hospitals located in Norway. Discharged children with ventilation tubes, aged 3-10 years are allocated randomly to receive postoperative controls by either an otolaryngologist at the hospital where they had ventilation tube surgery or their regular GP. Study participants are enrolled consecutively until 200 patients are included in each group. Two years after surgery we will compare pure tone average of hearing thresholds (primary endpoint) and middle ear function, complication rate, health-related quality of life and the parents’ evaluations of the postoperative care (secondary endpoints). Discussion: This protocol describes the first randomized non-inferiority study of GPs performing postoperative controls after surgery with ventilation tubes. Results from this study may be utilized for deriving evidence-based clinical practice guidelines of the level of postoperative controls after ventilation tube surgery which is safe and sufficient.

Extrusion Rate of Shah and Shepard Ventilation Tubes in Children

1992 ◽  
Vol 71 (6) ◽  
pp. 273-275 ◽  
Author(s):  
S. S. M. Hussain
Keyword(s):  
Otitis Media ◽  
Current Practice ◽  
Ventilation Tube ◽  
Extrusion Rate ◽  
Ventilation Tubes ◽  
Serous Otitis Media

Shah and Shepard ventilation tubes are the two most commonly used ventilation tube in current practice. In some centres these two tubes are used interchangeably, in others the Shepard is often used as the first ‘grommet’ of insertion and the Shah for subsequent insertions. A study was undertaken of extrusion rate of these ventilation tubes in 180 children who had surgery for Serous otitis media in 1987. Extrusion time was found to be very significantly different between these tubes. The Shah ventilation tube remains in situ 3 months longer than the Shepard. A case is made for the use of Shah ventilation tubes as the first “grommet” of insertion. Otorrhoea following insertion of ventilation tube did not affect the extrusion rate of ventilation tubes in this study. Nor has otorrhoea a predilection for any particular ventilation tube.

Comparison of the Hearing Histories of Children with and without Cleft Palate

1996 ◽  
Vol 33 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Patricia A. Broen ◽  
Karlind T. Moller ◽  
Jane Carlstrom ◽  
Shirley S. Doyle ◽  
Monica Devers ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Cleft Palate ◽  
Otitis Media ◽  
Middle Ear ◽  
Medical Records ◽  
Otitis Media With Effusion ◽  
Hearing Screening ◽  
Tube Placement ◽  
Ventilation Tube ◽  
Ventilation Tubes

Aggressive otologic management has been recommended for children with cleft palate because of the almost universal occurrence of otitis media with effusion (OME) in these children and the association of OME with hearing loss and possible language, cognitive, and academic delays. In this study, 28 children with cleft palate and 29 noncleft children were seen at 3-month intervals from 9 to 30 months to compare otologic treatment and management. Hearing and middle ear function were tested at each session; information on ventilation tube placement was obtained from medical records. Ventilation tubes were placed earlier and more often in children with cleft palate, but children with cleft palates failed the hearing screening more often. The correlation between age at first tube placement and frequency of hearing screening failures was significant for the children with cleft palate, indicating that the later tubes were first placed, the poorer the child's hearing.

Early Placement of Ventilation Tubes in Infants with Cleft Lip and Palate: A Systematic Review

2017 ◽  
Vol 158 (3) ◽  
pp. 459-464 ◽  
Author(s):  
Mark Felton ◽  
Jong Wook Lee ◽  
Darius D. Balumuka ◽  
Jugpal S. Arneja ◽  
Neil K. Chadha
Keyword(s):  
Middle Ear ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Data Sources ◽  
Tube Placement ◽  
Cochrane Central Register ◽  
Ventilation Tube ◽  
Tube Insertion ◽  
Ventilation Tubes ◽  
Palate Repair

Objective Studies have shown that the majority of cleft lip and palate (CLP) children have middle ear fluid present at the time of lip repair (3-4 months). Despite hearing loss, the majority of children do not undergo ventilation tube treatment if required until the time of palate repair (9-12 months). We aimed to examine the effectiveness and potential complications of early ventilation tube placement prior to palatoplasty in infants with cleft lip and palate. Data Sources Medline (1946-2015), Embase (1980-2015), and EBM Reviews (Cochrane Central Register of Controlled). Review Methods Data sources were searched for publications that described the results of early ventilation tube placement in children with CLP prior to cleft palate repair. Two independent reviewers appraised the selected studies. Results Of 226 studies identified, 6 studies met the inclusion criteria. Early ventilation tube insertion in CLP gave similar speech and audiology outcomes to non-CLP children undergoing ventilation tube insertion and better outcomes than those children with CLP having later ventilation tube insertion at or after the time of palate closure. The main reported side effect was otorrhea, being higher for children with CLP having early ventilation tube insertion (67% vs 33%), with a reduction in otorrhea with increasing age. Larger studies with longer-term outcome reporting are required to fully address the study objectives. Conclusion Published data are limited but appear to support early insertion of ventilation tubes in children with CLP to restore middle ear function and maximize audiologic and speech outcomes.

Should we aspirate middle-ear effusions prior to insertion of ventilation tubes?

2006 ◽  
Vol 120 (10) ◽  
pp. 818-821 ◽  
Author(s):  
V Laina ◽  
D D Pothier
Keyword(s):  
Middle Ear ◽  
Acoustic Trauma ◽  
Current Evidence ◽  
Cochrane Central Register ◽  
Ventilation Tube ◽  
Tube Insertion ◽  
Central Register ◽  
Increased Risk ◽  
Ventilation Tubes ◽  
Review Current

Background: Routine aspiration of middle-ear effusions prior to ventilation tube (grommet) insertion is practised by many surgeons. It has been suggested that removing the fluid from the middle ear improves immediate post-operative hearing levels and reduces the chance of the ventilation tube becoming obstructed. The potential adverse effects of applying suction to the middle ear include acoustic trauma and an increased risk of tympanosclerosis and otorrhoea. We undertook a review of the literature in order to determine the benefits or side effects associated with middle-ear aspiration prior to ventilation tube insertion.Objectives: To compare clinical outcomes associated with aspirating versus not aspirating the middle ear prior to ventilation tube insertion.Methods: The Cochrane ENT group trials register, DARE, the Cochrane central register of controlled trials (CENTRAL), MEDLINE (1960–2005) and EMBASE (1960–2005) were searched using relevant terms. Reference lists of selected studies were scanned for additional research material.Results: Seven studies were identified, of which three fitted the inclusion criteria of our review. Current evidence suggests that aspiration of middle-ear effusions prior to insertion of ventilation tubes is not associated with any improvement in clinical outcome, in terms of post-operative hearing levels, otorrhoea or rates of blockage of ventilation tubes. Significantly increased rates of tympanosclerosis were observed in one study and the development of acoustic trauma was observed; however, no significant association was confirmed. Although more research is needed, there is no evidence that aspiration of middle-ear effusion prior to grommet insertion confers any advantage.

Effect of Mastoid Cavity Modification on Middle Ear Sound Transmission

1982 ◽  
Vol 91 (5) ◽  
pp. 526-532 ◽  
Author(s):  
John T. McElveen ◽  
Chris Miller ◽  
Richard L. Goode ◽  
Stephen A. Falk
Keyword(s):  
Middle Ear ◽  
Computer Model ◽  
Sound Transmission ◽  
Mastoid Cavity ◽  
Canal Wall ◽  
Radical Mastoidectomy ◽  
Analog Model ◽  
Modified Radical Mastoidectomy ◽  
Temporal Bones ◽  
Intact Canal Wall Mastoidectomy

The modified radical mastoidectomy and intact canal wall mastoidectomy are the two most popular procedures used today for the treatment of chronic middle ear and mastoid disease. Their effects on the anatomy of the middle ear and mastoid cavity are quite different and it might also be expected that they would modify middle ear sound transmission in different ways. This paper describes experiments with human temporal bones and a middle ear computer analog model that attempt to define acoustic differences produced by cavity modifications in these two procedures. The temporal bone studies showed that blocking the aditus (as in modified radical mastoidectomy) produced improved sound transmission in the 1,500- to 4,000-Hz range and decreased transmission below 1,000 Hz when compared to the enlarged aditus and enlarged mastoid condition (as in intact canal wall mastoidectomy). The computer model showed better transmission at all frequencies with the intact canal wall mastoidectomy simulation.

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