Reconstruction of the Posterior Canal Wall with Proplast

1984 ◽  
Vol 92 (3) ◽  
pp. 329-333 ◽  
Author(s):  
John J. Shea ◽  
Bruce T. Malenbaum ◽  
William H. Moretz
Keyword(s):  
Retrospective Study ◽  
Surgical Technique ◽  
Success Rate ◽  
Ossicular Chain ◽  
Cell System ◽  
Canal Wall ◽  
Radical Mastoidectomy ◽  
Posterior Canal ◽  
Modified Radical Mastoidectomy ◽  
Made In

Many ears with prior radical or modified radical mastoidectomy operations can be rehabilitated by reconstruction of the posterior canal wall with the porous biocompatible implant material Proplast. Many techniques have been advanced for reconstruction of the posterior canal wall and/or obliteration of the mastoid bowl. We prefer reconstruction of the posterior canal wall to obliteration of the mastoid bowl on the theoretical grounds that with obliteration you lose the pneumatic buffer of the mastoid air cell system and you might be burying infection and/or cholesteatoma in the depths of the mastoid. In this article we shall present our results with elimination of the open mastoid bowl by reconstruction of the posterior canal wall with Proplast. A retrospective study of 83 consecutive patients who underwent reconstruction of the posterior canal wall with Proplast during the 5-year period 1974 to 1978 was undertaken. The surgical technique consisted of rebuilding the tympanic membrane, when necessary, repairing the ossicular chain, when necessary, and reconstructing the posterior canal wall. The overall success rate for the posterior canal wall reconstructions was 46% (38 of 83). However, after modifications were made in the technique, especially in the use of thicker fascia and/or perichondria and periosteum over the Proplast, the success rate increased dramatically to 68% (19 of 28).

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.

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.

Management of childhood cholesteatoma

1991 ◽  
Vol 105 (5) ◽  
pp. 343-345 ◽  
Author(s):  
R. P. Mills ◽  
N. D. Padgham
Keyword(s):  
Retrospective Study ◽  
Residual Disease ◽  
Open Cavity ◽  
Hearing Level ◽  
Radical Mastoidectomy ◽  
Hearing Thresholds ◽  
Modified Radical Mastoidectomy ◽  
The Mean ◽  
Low Incidence

AbstractWe report a retrospective study of 54 children with 57 involved ears who underwent surgery for cholesteatoma before their sixteenth birthdays. The majority of these underwent open cavity operations (modified radical mastoidectomy, radical mastoidectomy or atticotomy). The incidence of residual disease was only 6 per cent and overall 70 per cent of ears have been free of chronic discharge. The post-operative hearing thresholds were disappointingly low, though overall no worse than those recorded before surgery. The mean post-operative hearing level for the group was 39 dB and the mean air-bone gap was 29 dB. Open cavity surgery is the method of choice for childhood cholesteatoma, mainly because of the low incidence of residual disease.

scholarly journals A rare case of Bezold’s abscess presenting as parapharyngeal abscess

2015 ◽  
Vol 1 (1) ◽  
pp. 48 ◽  
Author(s):  
Ameya Bihani ◽  
Jyoti P. Dabholkar
Keyword(s):  
Otitis Media ◽  
Rare Complication ◽  
Chronic Suppurative Otitis Media ◽  
Canal Wall ◽  
Radical Mastoidectomy ◽  
Suppurative Otitis Media ◽  
Incision And Drainage ◽  
Parapharyngeal Abscess ◽  
Modified Radical Mastoidectomy ◽  
Anterior Belly

<p class="abstract"><span lang="EN-US">Bezold’s abscess is a very rare complication of unsafe chronic suppurative otitis media. The diagnosis of Bezold’s abscess is clinched by the presence of inflammation which is tracking down the anterior belly of digastrics and sternocleidomastoid. Surgery constituting incision and drainage of abscess with canal wall modified radical mastoidectomy is treatment of choice. We hereby present a case of 42 year male presenting with parapharyngeal abscess (Bezold’s abscess) which was secondary to unsafe chronic suppurative otitis media.</span></p>

Surgery of the ‘only hearing ear’ with chronic ear disease

1992 ◽  
Vol 106 (9) ◽  
pp. 793-798 ◽  
Author(s):  
Mario Sanna ◽  
Coyle M. Shea ◽  
Roberto Gamoletti ◽  
Alessandra Russo
Keyword(s):  
Memorial Hospital ◽  
Canal Wall ◽  
Radical Mastoidectomy ◽  
Experienced Surgeon ◽  
Modified Radical Mastoidectomy ◽  
The Subject ◽  
The University ◽  
Extreme Care ◽  
Relative Scarcity ◽  
Open Tympanoplasty

AbstractThe management of chronic ear disease affecting the only hearing ear is a controversial subject. The relative scarcity of literature on the subject prompted us to prepare a questionnaire which was sent to European and American otologists and to review 19 cases operated at the ENT Clinic of the University of Parma, Italy, and 16 cases operated at The Baptist Memorial Hospital, Memphis, U.S.A. Surgery of cholesteatoma involving the only hearing ear is advised by all the interviewed otologists without exception, even in the presence of a labyrinthine fistula. The cases from the University of Parma were managed as follows: a classic modified radical mastoidectomy was performed in 10 cases, a staged intact canal wall tympanoplasty was done in four cases, an open tympanoplasty in three and a radical mastoidectomy in the remaining two cases. The cases from The Baptist Memorial Hospital were managed with an intact canal wall tympanoplasty (ICWT) in nine and with an open procedure in seven cases. All the otologists interviewed agreed that surgery of the only hearing ear requires particular attention and experience, and should be performed with extreme care by a very experienced surgeon.

Performance of ionomeric cement (Ionocem®) in the reconstruction of the posterior meatal wall after curative middle-ear surgery

1997 ◽  
Vol 111 (12) ◽  
pp. 1130-1136 ◽  
Author(s):  
G. Geyer ◽  
S. Dazert ◽  
J. Helms
Keyword(s):  
Surgical Technique ◽  
Middle Ear Surgery ◽  
Soft Tissue Coverage ◽  
Canal Wall ◽  
Radical Mastoidectomy ◽  
Ear Surgery ◽  
Bone Replacement Material ◽  
Persistent Inflammation ◽  
Secondary Closure

AbstractThe hybrid bone-substitute ionomeric cement is suitable for restoring the original anatomy of the posterior canal wall. During a four-year period the posterior meatal wall was rebuilt with ionomeric cement in 74 patients. The canal wall was totally rebuilt in38 patients, two-thirds rebuilt in 22 cases, and one-third rebuilt in14 cases. On the meatal side, the canal wall was covered by a musculo-periosteal (Palva) flap. In the majority of cases, the drum was closed with (cartilage)-perichondrium. Revisions were performed in 27 patients (due partially to cholesteatoma, and/or poor visualization of radical mastoidectomy cavities). The ears were non-infected at thetime of operation.Permanent epithelialization of the bone replacement material was achieved in 57 cases, with secondary closure of a cutaneous defect of the meatal wall being required in six cases. The auditory canal wall had to be removed in 17 patients owing to deficient soft-tissue coverage, persistent inflammation, and/or partial adhesive processes with development of cholesteatoma. In terms of surgical technique, utilization of the material over a follow-up period of maximally seven years proved it to be a sophisticated procedure for reconstructing themeatal wall. Despite the finesse of the surgical technique employed, the overall failure rate of 31 per cent was inadmissibly high. Implantation of the material should therefore be restricted to middle ears with permanent ventilation and no trace of infection.

The unsafeness of ‘safe’ ears

1984 ◽  
Vol 98 (1) ◽  
pp. 23-26 ◽  
Author(s):  
G. G. Browning
Keyword(s):  
Otitis Media ◽  
Chronic Otitis Media ◽  
Cell System ◽  
The Other ◽  
Radical Mastoidectomy ◽  
Intracranial Abscess ◽  
Retraction Pocket ◽  
Mucosal Disease ◽  
Modified Radical Mastoidectomy ◽  
Brain Abscesses

AbstractActive chronic otitis media affects 0.5 per cent of adults and has two main variants. The first is when there is a squamous epithelial retraction pocket or cholesteatoma. The second variant is when the disease is primarily of the mucosa of the middle ear and mastoid air-cell system. Classically a cholesteatoma is considered ‘unsafe’ because of the risk of complications, particularly intracranial infectioa Mucosal disease, on the other hand, is considered ‘safe’ because complications are thought to be rare. Surgery in the form of a modified radical mastoidectomy is considered to make active chronic otitis media ‘safe’.A retrospective review of 26 consecutive brain abscesses considered secondary to active chronic otitis media revealed that a cholesteatoma was present in 12 (46 per cent), mucosal disease in 10 (38 per cent) and a modified radical mastoidectomy had been performed in four (15 per cent). Mucosal disease and a modified radical mastoidectomy should no longer be considered ‘safe’. However, the risk of developing an intracranial abscess from any type of active chronic otitis media is low, in the region of one in 3,500.

scholarly journals A Rare Case Report and Literature Review of External Auditory Canal Cholesteatoma with Circumferential Destruction of Canal Wall Exposing Facial Nerve

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Leison Maharjan ◽  
Pabina Rayamajhi
Keyword(s):  
Case Report ◽  
External Auditory Canal ◽  
Rare Case ◽  
Rare Condition ◽  
Canal Wall ◽  
Radical Mastoidectomy ◽  
Modified Radical Mastoidectomy ◽  
Aural Polyp ◽  
Rare Case Report ◽  
External Auditory Canal Cholesteatoma

External auditory canal cholesteatoma (EACC) is a rare condition with an estimated incidence of 1.2 per 1000 new otological patients. It is often mistaken with keratosis obturans. We discuss an extensive primary EACC with an aural polyp in a male which was managed by modified radical mastoidectomy.

scholarly journals Relation between Ossicular Erosion and Destruction of Facial and Lateral Semicircular Canals in Chronic Otitis Media

2016 ◽  
Vol 21 (03) ◽  
pp. 239-242 ◽  
Author(s):  
Suphi Bulğurcu ◽  
İlker Arslan ◽  
Bünyamin Dikilitaş ◽  
İbrahim Çukurova
Keyword(s):  
Facial Nerve ◽  
Otitis Media ◽  
Chronic Otitis Media ◽  
Semicircular Canals ◽  
Ossicular Chain ◽  
Facial Canal ◽  
Canal Wall ◽  
Radical Mastoidectomy ◽  
Canal Wall Down ◽  
Canal Wall Up

Introduction Chronic otitis media can cause multiple middle ear pathogeneses. The surgeon should be aware of relation between ossicular chain erosion and other destructions because of the possibility of complications. Objective This study aimed to investigate the rates of ossicular erosion in cases of patients with and without facial nerve canal destruction, who had undergone mastoidectomy due to chronic otitis media with or without cholesteatoma. Methods We retrospectively analyzed three hundred twenty-seven patients who had undergone tympanomastoidectomy between April 2008 and February 2014. We documented the types of mastoidectomy (canal wall up, canal wall down, and radical mastoidectomy), erosion of the malleus, incus and stapes, and the destruction of facial and lateral semi-circular canal. Results Out of the 327 patients, 147 were women (44.95%) and 180 were men (55.04%) with a mean age 50.8 ± 13 years (range 8–72 years). 245 of the 327 patients (75.22%) had been operated with the diagnosis of chronic otitis media with cholesteatoma. FNCD was present in 62 of the 327 patients (18.96%) and 49 of these 62 (79.03%) patients had chronic otitis media with cholesteatoma. The correlation between the presence of FNCD with LSCC destruction and stapes erosion in chronic otitis media with cholesteatoma is statistically significant (p < 0.05). Conclusion Although incus is the most common of destructed ossicles in chronic otitis media, facial canal destruction is more closely related to stapes erosion.

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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