scholarly journals Robot-Assisted Middle Ear Endoscopic Surgery: Preliminary Results on 37 Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Marine Veleur ◽  
Ghizlene Lahlou ◽  
Renato Torres ◽  
Hannah Daoudi ◽  
Isabelle Mosnier ◽  
...  
Keyword(s):  
Middle Ear ◽  
Bone Conduction ◽  
Case Series ◽  
Petrous Apex ◽  
Middle Ear Surgery ◽  
Type I ◽  
Type Ii ◽  
Robot Assisted ◽  
Ear Surgery ◽  
Type Iii

Background: Endoscopy during middle ear surgery is advantageous for better exploration of middle ear structures. However, using an endoscope has some weaknesses as surgical gestures are performed with one hand. This may trouble surgeons accustomed to using two-handed surgery, and may affect accuracy. A robot-based holder may combine the benefits from endoscopic exposure with a two-handed technique. The purpose of this study was to assess the safety and value of an endoscope held by a teleoperated system.Patients and Methods: A case series of 37 consecutive patients operated using endoscopic exposure with robot-based assistance was analyzed retrospectively. The RobOtol® system (Collin, France) was teleoperated as an endoscope holder in combination with a microscope. The following data were collected: patient characteristics, etiology, procedure type, complications, mean air and bone conduction thresholds, and speech performance at 3 months postoperatively. Patients had type I (myringoplasty), II (partial ossiculoplasty), and III (total ossiculoplasty) tympanoplasties in 15, 14, and 4 cases, respectively. Three patients had partial petrosectomies for cholesteatomas extending to the petrous apex. Finally, one case underwent resection of a tympanic paraganglioma. Ambulatory procedures were performed in 25 of the 37 patients (68%).Results: Complete healing with no perforation of the tympanic membrane was noted postoperatively in all patients. No complications relating to robotic manipulation occurred during surgery or postoperatively. The mean air conduction gain was 3.8 ± 12.6 dB for type I (n = 15), 7.9 ± 11.4 dB for type II (n = 14), and −0.9 ± 10.8 for type III tympanoplasties (n = 4), and the postoperative air-bone conduction gap was 13.8 ± 13.3 dB for type I, 19.7 ± 11.7 dB for type II and 31.6 ± 13.0 dB for type III tympanoplasty. They was no relapse of cholesteatoma or paraganglioma during the short follow-up period (<1 year).Conclusion: This study indicates that robot-assisted endoscopy is a safe and trustworthy tool for several categories of middle ear procedures. It combines the benefits of endoscopic exposure with a two-handed technique in middle ear surgery. It can be used as a standalone tool for pathology limited to the middle ear cleft or in combination with a microscope in lesions extending to the mastoid or petrous apex.

scholarly journals Cutting the chorda tympani: not just a matter of taste

2010 ◽  
Vol 124 (9) ◽  
pp. 999-1002 ◽  
Author(s):  
N Guinand ◽  
T Just ◽  
N W Stow ◽  
H Cao Van ◽  
B N Landis
Keyword(s):  
Middle Ear ◽  
Tertiary Care ◽  
Case Series ◽  
Salivary Flow ◽  
Middle Ear Surgery ◽  
Chorda Tympani ◽  
Tertiary Care Centre ◽  
Ear Surgery ◽  
Salivary Function ◽  
History Of

AbstractIntroduction:Chorda tympani injury as a complication of middle-ear surgery has been extensively studied with regard to its effects upon taste. However, the chorda tympani also carries parasympathetic fibres to the salivary glands of the oral cavity. To date, little has been reported about the effect of chorda tympani section upon salivary function.Setting:Tertiary care centre.Material and methods:We report a case series of three patients with bilateral chorda tympani lesions. Chorda tympani function was assessed using ‘taste strips’ and unstimulated sialometry. A careful history of oral symptoms was taken.Results:All patients showed transient or permanent bilateral ageusia of the anterior two-thirds of the tongue, and a decreased resting salivary flow rate. In addition, all patients suffered from transient or persistent, distressing xerostomia.Conclusion:Taste disorders may occur after middle-ear surgery but they are mostly transient, even when the chorda tympani nerves are sectioned bilaterally. In contrast, bilateral chorda tympani lesions may lead to severe, persistent and distressing xerostomia. Based on this neglected aspect of chorda tympani function, we emphasise the importance of preserving the chorda tympani whenever possible.

Are head bandages really required after middle-ear surgery? A systematic review

2015 ◽  
Vol 129 (8) ◽  
pp. 740-743 ◽  
Author(s):  
I Khan ◽  
S Mohamad ◽  
S Ansari ◽  
A Iyer
Keyword(s):  
Systematic Review ◽  
Middle Ear ◽  
Cochlear Implantation ◽  
Randomised Controlled Trials ◽  
Case Series ◽  
Middle Ear Surgery ◽  
Controlled Trials ◽  
Retrospective Case ◽  
Ear Surgery ◽  
Randomised Controlled

AbstractObjective:A systematic review was performed to evaluate the role and effectiveness of head bandages after routine elective middle-ear surgery.Methods:Studies that compared the effectiveness of head bandage use after elective middle-ear surgery (e.g. myringoplasty, mastoidectomy and cochlear implantation) were identified using the following databases: Ovid Medline and Embase, the Ebsco collections, the Cochrane Library, PubMed, and Google Scholar. An initial search identified 71 articles. All titles and abstracts were reviewed. Thirteen relevant articles were inspected in more detail; of these, only five met the inclusion criteria. These included three randomised, controlled trials, one retrospective case series and one literature review.Results:The three randomised, controlled trials (level of evidence 1b) showed no statistically significant differences in post-operative outcomes (in terms of complications) associated with head bandage use in middle-ear surgery. This finding was supported by the retrospective case series involving patients undergoing cochlear implantation.Conclusion:Current available evidence shows no advantage of head bandage use after middle-ear surgery. Head bandages may not be required after routine, uncomplicated middle-ear surgery.

scholarly journals 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

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.

Microsurgical anatomy of the superior petrosal venous complex: new classifications and implications for subtemporal transtentorial and retrosigmoid suprameatal approaches

2007 ◽  
Vol 106 (6) ◽  
pp. 1041-1050 ◽  
Author(s):  
Necmettin Tanriover ◽  
Hiroshi Abe ◽  
Albert L. Rhoton ◽  
Masatou Kawashima ◽  
Galip Z. Sanus ◽  
...  
Keyword(s):  
Petrous Apex ◽  
Type I ◽  
Microsurgical Anatomy ◽  
Type Ii ◽  
Drainage Pattern ◽  
Type Iii ◽  
Working Space ◽  
Surgical Exposure ◽  
Transtentorial Approach ◽  
The Ideal

Object The purpose of this study was to define the patterns of drainage of the superior petrosal venous complex (SPVC) along the petrous ridge in relation to the Meckel cave and internal acoustic meatus (IAM) and to delineate its effect on the surgical exposures obtained in subtemporal transtentorial and retrosigmoid suprameatal approaches. Methods The patterns of drainage of the SPVC along the petrous ridge were characterized according to their relation to the Meckel cave and the IAM based on an examination of 30 hemispheres. Subtemporal transtentorial and retro-sigmoid suprameatal approaches were performed in three additional cadavers to demonstrate the effect of the drainage pattern on the surgical exposures. Conclusions The SPVC emptied into the superior petrosal sinus (SPS) within a distance of 1 cm from the midpoint of the Meckel cave. The patterns of drainage of the SPVC were classified into three groups. Type I emptied into the SPS above and lateral to the boundaries of the IAM. The most common type, Type II, emptied between the lateral limit of the trigeminal nerve at the Meckel cave and the medial limit of the facial nerve at the IAM, within an area of approximately 13 mm. Type III emptied into the SPS above or medial to the Meckel cave. The ideal SPVC for a subtemporal transtentorial approach (with or without anterior extradural petrosectomy) seems to be a Type I. In SPVC Type III and those Type II cases in which the SPVC is located near the Meckel cave, the amount of working space is significantly limited in a subtemporal transtentorial approach. In contrast, the ideal type of SPVC for a retrosigmoid suprameatal approach would be a Type III, and the SPVC must be divided in the majority of Type I and II cases for a satisfactory surgical exposure along the Meckel cave and middle fossa dura. The proposed modified classification system and its effect on the surgical exposure may aid in planning the approach directed along the petrous apex and may reduce the probability of venous complications.

scholarly journals Choledochal Cyst in Adults: Etiopathogenesis, Presentation, Management, and Outcome—Case Series and Review

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Norman Oneil Machado ◽  
Pradeep J. Chopra ◽  
Adil Al-Zadjali ◽  
Shahzad Younas
Keyword(s):  
Abdominal Pain ◽  
Choledochal Cyst ◽  
Past History ◽  
Abdominal Mass ◽  
Case Series ◽  
Biliary Tree ◽  
Type I ◽  
Type Ii ◽  
Complete Excision ◽  
Type Iii

Background. Choledochal cyst, a rare congenital cystic dilatation of biliary tree, is uncommon in adults. Their presentations differ from children and surgical management has evolved.Methods. A retrospective review of the records of all the patients above 15 years, who underwent therapeutic intervention in our hospital, was carried out.Results. Ten cases of choledochal cyst were found; 8 female, with mean age 31 years. These included 8 cases of Todani type I and one case each of type II and type III. The predominant symptoms were abdominal pain and jaundice. Abdominal mass and past history of cholangitis and pancreatitis were seen in 2 patients. Investigations included ultrasound in 8 patients, CT in 7, ERCP in 3, and MRCP in 5. Surgical intervention included complete excision of the cyst with hepaticojejunostomy and cholecystectomy (type I), excision of the diverticulum (type II), and ERCP sphincterotomy (type III). Malignancy was not seen in any patients. The long-term postoperative complications included cholangitis in two patients.Conclusion. Choledochal cyst is rare in adults. The typical triad of abdominal pain, jaundice, and mass is uncommon in adults. The surgical strategy aims for single stage complete excision of the cyst with hepaticojejunostomy.

scholarly journals Evaluation of graft taking and hearing threshold after tympanoplasty

2020 ◽  
Vol 12 (1) ◽  
pp. 37-44
Author(s):  
Ehab Taha Yaseen ◽  
Ali Mohamed Abdul Qader ◽  
Adnan Qahtan Khalaf ◽  
Ali Zeno Thanoon
Keyword(s):  
Hearing Loss ◽  
Middle Ear ◽  
Hearing Threshold ◽  
Type I ◽  
Type Ii ◽  
Radical Mastoidectomy ◽  
Suppurative Otitis Media ◽  
Type Iii ◽  
Cortical Mastoidectomy ◽  
Modified Radical Mastoidectomy

Background: Tympanoplasty is one of the surgical procedures mainly aimed to restoring the hearing loss and eradication of chronic middle ear diseases. Aim: To evaluate the hearing threshold preoperatively and postoperatively in patients who were subjected to tympanoplasty procedures. Patients and methods: This prospective study included 27 patients attended ENT department of AL-Yarmouk Teaching Hospital ,from February -2017 to October- 2018 , The age of patients between (10-60 years) of both gender . they presented with hearing loss as a result of chronic suppurative otitis media. After full assessment and proper preparation , They underwent Tympanoplasty procedure through post auricular incision using underlay temporalis fascia graft , The type of Tympanoplasty procedure was planned according to the status of the middle ear and ossicular chain .To eradicate disease from both the mastoid and middle ear cavity procedure and could be combined with mastoidectomy, Patients were evaluated preoperatively and followed up for 6 months postoperatively, pure Tone Audiogram was done to asses the change in hearing. Results: The study included 27 patients, (74.06%) of them were the age group between (21–40) years , the least number of patients were younger than 21 years and older than 51 years , 16 females (59.3%) and 11 males (40.7%) , Patients were classified according to tympanoplasty procedures into five groups : (Group1):10 patients (37.03%) underwent only Type I tympanoplasty. (Group2): 11 patients (40.7%) Type I with Cortical Mastoidectomy. (Group3): 2 patients (7.4%) Type II with Cortical Mastoidectomy. (Group4): 3 patients (11.1%) Type III with Cortical Mastoidectomy (Group5): one patient (3.7%) Type III with Modified Radical Mastoidectomy. They had a mean Air-Bone gap improvements were (9.66 dB), (17.4 dB), (13.2 dB), (9.60 dB) and (5.54 dB) respectively. The overall graft success rate was (92.5%). Conclusion: Significant improvement was noted in the subjective symptom of hearing loss following the tympanoplasty procedures. The mean Air-Bone gap closure was greatest for type I with cortical mastoidectomy; followed by type II with Cortical Mastoidectomy, type I alone and then type III with Cortical Mastoidectomy. Modified radical mastoidectomy was associated with the least hearing improvement as otherwise.

A new adhesive bone conduction hearing system as a treatment option for transient hearing loss after middle ear surgery

2019 ◽  
Vol 277 (3) ◽  
pp. 751-759 ◽  
Author(s):  
Roxanne Weiss ◽  
Andreas Loth ◽  
Martin Leinung ◽  
Sven Balster ◽  
Daniel Hirth ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Treatment Option ◽  
Middle Ear ◽  
Bone Conduction ◽  
Middle Ear Surgery ◽  
Ear Surgery ◽  
Bone Conduction Hearing ◽  
Hearing System

DICER1 Hotspot Mutations in Pleuropulmonary Blastoma: A Case Series From a Tertiary Center

2019 ◽  
Vol 23 (3) ◽  
pp. 204-209 ◽  
Author(s):  
O Hurdogan ◽  
I Yilmaz ◽  
SB Bay ◽  
S Vural ◽  
D Tugcu ◽  
...  
Keyword(s):  
Survival Rate ◽  
Case Series ◽  
Pleuropulmonary Blastoma ◽  
Type I ◽  
Missense Mutations ◽  
Type Ii ◽  
Turkish Children ◽  
Type Iii ◽  
Tertiary Center ◽  
Hotspot Mutations

Pleuropulmonary blastoma (PPB) is a potentially aggressive, rare childhood neoplasia. We investigated histopathological features, survival, and DICER1 hotspot mutations among PPB patients. Archive records at our institution were reviewed, covering a 20-year period. Thirteen children (6 males and 7 females) with a mean age of 30.5 (range 6–83) months were included. The tumor subtypes were type I in 6 (46%), type II in 4 (31%), and type III in 3 (23%). Only tumors with type II and type III histology showed anaplasia (4/7, 57%). Median follow-up was 28 (range 9–216) months. Three-year overall survival rate was 83.3% and 3-year progression-free survival rate was 25%. Progression was seen in 60% (3/5) of type I and 66.7% (4/6) of type II and type III cases. Two patients died of disseminated disease at 9 and 44 months. Hotspot missense mutations on DICER1 gene were detected in all 11 patients with available tumor tissue. We found an additional novel germline loss-of-function mutation (c.5436dupT; p.E1813*) in 1 case. To the best of our knowledge, this is the first study to investigate hotspot missense mutations on DICER1 gene among the largest series of Turkish children with PPB.

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