scholarly journals CANAL WALL RECONSTRUCTION SURGERY IN RETRACTION PATHOLOGYEXPERIENCE AT AL NAHDHA HOSPITAL*, OMAN

2020 ◽  
Vol VOLUME 8 (ONE) ◽  
pp. 17-23
Author(s):  
M Kashoob
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Long Term Results ◽  
Surgical Removal ◽  
Canal Wall ◽  
Surgical Methods ◽  
Middle Ear Cholesteatoma ◽  
Defect Repair

Abstract Objectives: Tympanic membrane retraction pathology is a frequently encountered middle ear problem that can be a self cleansing pocket, a deep sac with hidden cholesteatoma or a potential reservoir for its future formation. In selected cases, a defect in attic and posterior superior canal wall can result after surgical removal of the diseased epithelium and/or cholesteatoma. If this occurs, reconstruction is usually attempted. Avoiding an open cavity in such conditions is currently the preferred approach. We sought to study the cartilage reconstruction outcomes of the attic and/or posterior superior canal wall defects for selected cases of retraction pathology without a need for an open mastoid cavity. We investigated the short and long term results with regards to the resorption with time, displacement or recurrence of cholesteatoma. Methods: This is a retrospective study conducted at Al Nahda Hospital in Oman between 2008 and 2014. A total 301 patients who underwent inside-out atticotomy with attic defect repair or cortical mastoidectomy with atticotomy and attic defect repair were included in the study. Staging and classication criteria for middle ear cholesteatoma proposed by the Japan Otological Society (JOS) were applied based on surgical and follow-up notes in cases with recurrent cholesteatoma. The status of the reconstructed part of the outer attic wall with respect to survival and stability of cartilage was assessed carefully at less than six months (short term) and at more than two year periods (long term) after surgery. Results: Out of 301 patients who underwent mastoid surgeries between 2008 and 2014, 72 patients met the inclusion criteria. Results of both surgical methods were then assessed. It was noted that the longer the duration after postoperative period (> 2 years), the more chance to have a recurrence of disease, displacement/ resorption of the reconstructed part or retraction/perforation of tympanic membrane (p < 0.026). Moreover, the reconstruction part of the attic and posterior superior canal wall may be resorbed with time in some cases as shown in this study (9.4%). However, the rate is low and worth considering in all the cases of attic or selected atticoantral cholesteatomas. Conclusion: Resorption and displacement of the reconstructed part of the attic and/or posterior superior canal wall was observed during the follow–up period of this study. This may have contributed to the retraction pocket reformation followed by the recurrence of cholesteatoma. It was noted to be more obvious during long duration of follow-up. Hence, we recommend a longer follow-up of at least 2 years post operatively even if the ndings are showing good results during initial visits. Although the recurrence rate of disease with the used surgical methods in this study was 16.9%, in order to compare the results of this surgical method with either canal wall up or canal wall down, future surgical methods will require a randomized trial. Key words: Cholesteatoma, mastoidectomy, reconstruction, cartilage, canal wall, atticotomy

Combined Heermann and Tos (CHAT) technique in cholesteatoma surgery: surgical technique and preliminary results

2005 ◽  
Vol 119 (6) ◽  
pp. 429-435 ◽  
Author(s):  
Cem Uzun ◽  
Recep Yagiz ◽  
Abdullah Tas ◽  
Mustafa K Adali ◽  
Muhsin Koten ◽  
...  
Keyword(s):  
Middle Ear ◽  
Long Term Results ◽  
Type I ◽  
Canal Wall ◽  
Auricular Cartilage ◽  
Cortical Mastoidectomy ◽  
Thin Bridge ◽  
Stage 1

The combined Heermann and Tos (CHAT) technique is the combination of Heermann’s ’cartilage palisade tympanoplasty’ and Tos’s ’modified combined approach tympanoplasty = modified intact canal wall mastoidectomy’. The first author (Cem Uzun) performed the CHAT technique as a one-stage operation in 15 ears of 15 patients with cholesteatoma. Two patients (one with a follow up of less than six months and one who did not show up at the final re-evaluation) were excluded from the study. Median age in the remaining 13 patients was 37 years (range: 14–57 years). Cholesteatoma type was attic, sinus (Tos tensa type 1) and tensa retraction (Tos tensa type 2) in six, five and two ears, respectively. Cholesteatoma stage was Saleh and Mills stage 1, 2, 3, 4 and 5 in one, three, four, four and one ear, respectively. The eustachian tube was not involved with cholesteatoma in any ear. After drilling of the superoposterior bony annulus, transcanal atticotomy with preservation of thin bridge and cortical mastoidectomy with intact canal wall, the cholesteatoma was removed, and the eardrum and atticotomy were reconstructed with palisades of auricular cartilage. Type I tympanoplasty was performed in two ears, type II in nine ears and type III (stapes absent) in two ears, with either autologous incus (eight cases), cortical bone (two) or auricular cartilage (one). No complication occurred before, during or after surgery. Oto-microscopy and audiometry were done before and at a median of 13 months after surgery (mean 14 months, range 7–30 months). There was no sign of residual or recurrent cholesteatoma in any patient during the follow-up period. At the final examination, all ears were dry and had an intact eardrum except one with a small, central hole, which had been seen since the early post-operative period. Clean and stable attic retraction with a wide access was observed in two ears. Post-operative hearing at the final evaluation was better (change > 10 dB) than the pre-operative one in nine ears and did not change in the remaining four. Pre- and post-operative mean hearing values were, pure-tone average 47 and 35 dB (p = 0.01) and air-bone gap 30 and 20 dB (p = 0.02), respectively. With the CHAT technique, cholesteatoma can be completely and safely removed from the middle ear, and a durable and resistant reconstruction of the middle ear with reasonable hearing can be achieved. However, a further study should analyse long-term results of a larger patient group.

scholarly journals Vibrant Soundbridge Implantable Hearing Device: Critical Review and Single-Surgeon Short- and Long-Term Results

2010 ◽  
Vol 89 (9) ◽  
pp. E9-E14 ◽  
Author(s):  
Charles M. Luetje ◽  
Sandra A. Brown ◽  
Robert D. Cullen
Keyword(s):  
Middle Ear ◽  
Final Analysis ◽  
Senior Author ◽  
Long Term Results ◽  
Direct Drive ◽  
Vibrant Soundbridge ◽  
Short And Long Term ◽  
Hearing Device

We conducted a retrospective descriptive study of a series of 31 consecutively presenting patients who had been implanted with the Vibrant Soundbridge middle ear hearing device. All implantations had been performed by the senior author. Three of these patients had undergone bilateral implantation, and 4 others had undergone subsequent explantation and reimplantation in response to known or suspected device failure, giving us a total of 34 ears and 38 implants. Our goal was to ascertain short- and long-term outcomes as measured by conventional audiometry (pure-tone average at 1 to 6 kHz) and long-term benefit as defined by the use or nonuse of the device. We found that at the initial activation session 2 months postoperatively, the average hearing thresholds were within 3 dB of the preoperative thresholds in all 34 ears and all 38 implants. The mean short-term gain at activation in the 38 implants was 28.1 dB. Nineteen patients (20 ears) were available for long-term evaluation, with the length of follow-up ranging from less than 1 year to 11 years (mean: 7.3). Of these 20 ears, 9 demonstrated further gain (mean: 10.8 dB) despite any natural hearing deterioration; of the remaining 11 ears, gain was unchanged in 2, diminished in 7 (mean: −3.6 dB), and gain data were unavailable in 2. In the final analysis, there were 20 user ears and 10 nonuser ears; 4 ears were lost to all follow-up. We conclude that direct-drive hearing with the Vibrant Soundbridge middle ear hearing device is beneficial and provides sustained audiometric gain. Factors that have a significant impact on patient use or nonuse include difficulty in obtaining audiologic support and the direct and indirect costs of the device. Without audiologic or financial support, some patients may choose to become nonusers and to either switch to conventional hearing aid amplification or become apathetic about hearing improvement.

scholarly journals Colitis ulcerosa minimálisan invazív sebészi kezelése – hosszú távú eredmények

2015 ◽  
Vol 156 (39) ◽  
pp. 1585-1592 ◽  
Author(s):  
János Tajti jr. ◽  
Zsolt Simonka ◽  
Attila Paszt ◽  
Szabolcs Ábrahám ◽  
Klaudia Farkas ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Perioperative Period ◽  
Bowel Function ◽  
Long Term Results ◽  
Minimally Invasive Surgical ◽  
Function Recovery ◽  
Surgical Methods

Introduction: For the surgical treatment of ulcerative colitis, laparoscopy is used more widely, but less data are available on long-term results in Hungary. Aim: The aim of the authors was to compare the mean 47.8-month follow-up results of patients treated with conventional and minimally invasive surgical methods. Method: Between January 1, 2005 and December 31, 2014, 56 patients were treated with surgery (20 emergencies, and 36 elective cases). Laparoscopy was used in 33 and conventional method in 23 cases. Results: There was no difference between the two groups in hospital and intensive care unit stay, bowel function recovery, need for transfusion, and complications during the perioperative period. Regarding long-term complications, the occurrence of intestinal obstruction, septic condition and other complications were significantly fewer in the laparoscopy group. The quality of life improved in both groups after the surgery. Conclusions: Laparoscopy can be used safely; it provides good quality of life and better cosmetic results, and the long-term rate of complications is lower as compared to open surgery. Orv. Hetil., 2015, 156(39), 1585–1592.

scholarly journals Pilonidal sinus- limberg versus karidakis flap our experience at SIMS, Shivamogga

2017 ◽  
Vol 4 (11) ◽  
pp. 3641
Author(s):  
Madhusudhan A. ◽  
Madhan D. P. Swamy ◽  
Mohhamad Arif
Keyword(s):  
Pilonidal Sinus ◽  
Long Term Results ◽  
Pilonidal Sinus Disease ◽  
Surgical Removal ◽  
Limberg Flap ◽  
Sinus Disease ◽  
Number Of Patients ◽  
Successful Recovery ◽  
Surgical Methods

Background: The etiology and pathogenesis of sacro-coccygeal pilonidal sinus are not clear. The pathogenesis of the disease is hypothesized to be related to the accumulation of weak and lifeless hair in the intergluteal region, which over time gives rise to foreign body reaction, causing abscess and sinus formation. A deep natal cleft with one of favourable factors enhance sacro-coccygeal pilonidal sinus, e.g., sweating, maceration, bacterial contamination and penetration of hairs. Obesity, trauma, local irritation and a sedentary lifestyle are usually associated with PS. Although pilonidal sinus can be treated using various conservative and surgical methods, recurrence rate remains high. Complete surgical removal of the pilonidal sinus or sinuses and appropriate reconstruction can lead to successful recovery. However, collection of the lifeless hair depends on the anatomy of the intergluteal area, and accompanying risk factors can lead to subsequent recurrence.Methods: The objective of this study is to compare the immediate post-operative and long-term results of Limberg flap and Karydakis flap, which are being widely used now to treat pilonidal sinus disease. It was a retrospective observational study where the patients (total number of patients-30) who underwent both the procedures were compared, Limberg flap (LF; n = 13) and Karydakis flap (KF; n = 17).Results: Present study found out that short and long-term results of the LF and KF procedures are similar. In present study we also noted that all patients with pilonidal sinus disease were men, and most of them had jobs which involved sitting for long durations. Poor hygiene and hirsutism however was not noted in most of the patients, and was not objectively assessed.Conclusions: Both the techniques can be used safely and effectively in sacro coccygeal pilonidal sinus disease.

Bilateral Occurrence of Congenital Middle Ear Cholesteatoma

2002 ◽  
Vol 127 (5) ◽  
pp. 480-482 ◽  
Author(s):  
Mohamed A. El-Bitar ◽  
Sukgi S. Choi
Keyword(s):  
Middle Ear ◽  
Early Stage ◽  
Congenital Cholesteatoma ◽  
Pediatric Age Group ◽  
Middle Ear Cholesteatoma ◽  
Long Term Follow Up ◽  
Group A ◽  
High Index Of Suspicion

Congenital cholesteatoma of the middle ear is a relatively rare entity that is becoming more frequently encountered in the pediatric age group. A high index of suspicion is needed to recognize this entity at an early stage. More challenging is the bilateral occurrence of the lesion that, although still rare, should always be remembered when examining children with congenital cholesteatoma, not only on the initial visit but also on subsequent follow–up. We report the eleventh case of bilateral congenital middle ear cholesteatoma and stress the importance of long–term follow–up in these cases.

scholarly journals Long-term follow-up of patients with popliteal artery entrapment syndrome treated by endoluminal revascularization

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 189-195 ◽  
Author(s):  
Meier ◽  
Schneider ◽  
Amann-Vesti
Keyword(s):  
Popliteal Artery ◽  
Long Term Results ◽  
Surgical Removal ◽  
Popliteal Aneurysm ◽  
Entrapment Syndrome ◽  
Endovascular Revascularization ◽  
Popliteal Artery Entrapment Syndrome ◽  
Popliteal Artery Entrapment

The popliteal artery entrapment syndrome (PAES), a rare cause for leg ischemia, is usually treated by surgical removal of the compressing structure and either venous bypass or interposition graft. However, endovascular revascularization followed by surgery to release the artery has been reported as a feasible alternative. So far long-term results of this approach are not known. We report the follow-up of three patients with PAES and thrombotic occlusion of the popliteal and calf arteries treated by local lysis, percutaneous thrombembolectomy and angioplasty followed by musculotendinous dissection. One patient had an uneventful follow-up of 11 years while the second patient developed a popliteal aneurysm four months after the index procedure. In the third patient, angioplasty of a stenosis of the popliteal artery was performed after two years. However, occlusion of the artery occurred two years later due to a small popliteal aneurysm. Endovascular revascularization followed by surgical release of the artery may be a viable alternative in the treatment of PAES especially in cases with distal embolization. However, careful follow-up by duplex ultrasound is mandatory because of the high risk of reocclusion or development of a popliteal aneurysm.

Long-term status of middle-ear aeration post canal wall down mastoidectomy

2019 ◽  
Vol 133 (8) ◽  
pp. 662-667 ◽  
Author(s):  
T Ezulia ◽  
B S Goh ◽  
L Saim
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Mastoid Cavity ◽  
Canal Wall ◽  
Retraction Pocket ◽  
The Status ◽  
Tube Dysfunction ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy

AbstractBackgroundRetraction pocket theory is the most acceptable theory for cholesteatoma formation. Canal wall down mastoidectomy is widely performed for cholesteatoma removal. Post-operatively, each patient with canal wall down mastoidectomy has an exteriorised mastoid cavity, exteriorised attic, neo-tympanic membrane and shallow neo-middle ear.ObjectiveThis study aimed to clinically assess the status of the neo-tympanic membrane and the exteriorised attic following canal wall down mastoidectomy.MethodsAll post canal wall down mastoidectomy patients were recruited and otoendoscopy was performed to assess the neo-tympanic membrane. A clinical classification of the overall status of middle-ear aeration following canal wall down mastoidectomy was formulated.ResultsTwenty-five ears were included in the study. Ninety-two per cent of cases showed some degree of neo-tympanic membrane retraction, ranging from mild to very severe.ConclusionAfter more than six months following canal wall down mastoidectomy, the degree of retracted neo-tympanic membranes and exteriorised attics was significant. Eustachian tube dysfunction leading to negative middle-ear aeration was present even after the canal wall down procedure. However, there was no development of cholesteatoma, despite persistent retraction.

Revision myringoplasty

1997 ◽  
Vol 111 (6) ◽  
pp. 517-520 ◽  
Author(s):  
Gilead Berger ◽  
Dov Ophir ◽  
Eliezer Berco ◽  
Jacob Sadé
Keyword(s):  
Retrospective Study ◽  
Success Rate ◽  
Tympanic Membrane ◽  
Otitis Media ◽  
Acute Otitis Media ◽  
Long Term Results ◽  
Short And Long Term ◽  
Graft Necrosis

AbstractThis retrospective study was undertaken to review the short- and long-term results of 70 revision and 16 re-revision myringoplasty operations. Of the former, 43 cases (61.4 per cent) had initial success, six weeks following surgery. The leading causes of immediate failure (27 cases) were associated with a complete no- take of thegraft, infection with graft necrosis and poor anterior adaptation of the graft in decreasing order. Six out of the 43 patients developed late re-perforations during the follow-up period, thus reducing the success rate of revision myringoplasty to 52.8 per cent. Late re-perforations were attributed to insidious atrophy of the tympanic membrane or episodes of acute otitis media. Sixteen patients underwent re-revision myringoplasty and their success rate was 62.5 per cent. The overall success rate of revision and re-revision myringoplasty was 54.7 per cent. It has been concluded that results of revision myringoplastywere independent of patients' age, location and size of perforation and the seniority of the surgeon.

Staging in Cholesteatoma Surgery

1993 ◽  
Vol 72 (3) ◽  
pp. 197-200 ◽  
Author(s):  
Christian Deguine
Keyword(s):  
Middle Ear ◽  
Disease Process ◽  
Optimal Conditions ◽  
Second Stage ◽  
Closed Technique ◽  
Middle Ear Cholesteatoma ◽  
Long Term Follow Up ◽  
Cholesteatoma Surgery

The closed technique is the treatment of choice for middle ear cholesteatoma in the opinion of the author. Several interventions may be required. At the onset, the purpose of the systematic second stage procedure was to verify the absence of any residual cholesteatoma. Experience has shown that the interest of this second intervention lies equally in the opportunity to observe the evolution of the otitis disease process, and the tubal status and in the possibility of restoring transmission under optimal conditions, thanks in particular to the utilization of thick silastic sheeting. This technique necessitates, however, a long-term follow-up. On occasion, a third intervention may be required. Despite the iterative nature of this surgery, it should be considered as a form of a logical progression offering the best chances of a successful anatomic and functional outcome for the patient.

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