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(15) Cadaveric study of Mesotympanic Depth: Implications for Intratympanic Injection
Selected Abstracts ciliary dyskinesia appears to be fluctuant into adulthood. Therefore, otitis media with effusion in primary ciliary dyskinesia does not resolve by the age of nine years, regardless of treatment, as previously assumed. Ventilation tube insertion improves hearing in primary ciliary dyskinesia, but may lead to a higher rate of otorrhea when compared to the general population. Tympanic membrane changes were clinically insignificant. Our patient eventually underwent successful insertion of bilateral ventilation tubes, with a marked improvement in hearing and language with minimal otorrhea. CONCLUSION: The highest level of evidence found for the management of otitis media with effusion in children with primary ciliary dyskinesia was level IV. Currently, the evidence is inconclusive and conflicting. Whilst our Results are promising, clearly, higher quality research on a larger number of patients is required to definitively evaluate the management options for otitis media with effusion in these children. (14) Prospective Randomized Controlled Trial: Laser Versus Radiotherapy for T1 and T2 Laryngeal Cancers Professor William Coman* University of Queensland and Princess Alexandra Hospital, Queensland BACKGROUND: Radiotherapy has been the standard treatment for T1 and T2 laryngeal cancers for many years. The advent of laser surgery, as it was pioneered by Professor Wolfgang Steiner, seemed to have advantages over a prolonged and extensive course of radiotherapy. METHODS: The randomized control trial was carried out on patients with T1 and T2 laryngeal cancers who were allocated to either radiotherapy or to laser treatment. The rate of local recurrence, the survival rate, quality of life, swallowing function, speech, and the quality of voice measures were undertaken in each group. RESULTS: Results of this trial are presented to demonstrate that both treatments are equivocal. The difficulties of such a trial will be discussed and compared with other assessments of these modalities. CONCLUSION: The trial has demonstrated that treatment with either laser surgery or radiotherapy is equivocal. (15) Cadaveric study of Mesotympanic Depth: Implications for Intratympanic Injection Alex Saxby,* Robert Harris, William Gibson Royal Prince Alfred Hospital, New South Wales BACKGROUND: There are increasing indications for intratympanic injection of drugs for both therapeutic and diagnostic purposes. This cadaveric study looked at the depth of the middle ear cleft when measured transcanal, transtympanic membrane to determine an optimum site for intratympanic injection.
S47 METHODS: A cadaveric study of 12 human temporal bones. Mesotympanic depth was calculated at various positions of the tympanic membrane (TM) using stapedectomy measuring rods. 3.5 mm was considered the minimum depth to accommodate the bevel of an injecting needle. RESULTS: The median mesotympanic depth at all TM positions was very similar. However, the probability of a depth greater than 3.5 mm was greatest when the injection trajectory was in an anteroinferior direction toward the hypotympanum. The least favorable injection site was at the umbo. Generally, a greater depth was encountered towards the periphery of the TM. CONCLUSION: Intratympanic injection via an anteroinferior perforation with the needle directed toward the hypotympanum with the patient in a supine position will likely lead to a successful infusion of drug into the middle ear cleft due to the increased depth at this position. This site benefits from being safely away from middle ear structures, such as facial nerve and ossicles, and permits a larger volume of drug to be infiltrated before egress through the injection site or eustachian tube. (16) Herpes Zoster Oticus: Treatment and Outcomes Victoria Oey,* Glen R Croxson, Susan Coulson, Roger Adams Royal Prince Alfred Hospital, New South Wales Herpes zoster oticus (HZO) is the second most common cause of nontraumatic lower motor neurone facial nerve palsy. It is caused by reactivation of the varicella zoster virus. One hundred one patients with HZO were retrospectively analyzed. Symptoms of diplopia or swallowing difficulty were found to be related to poor facial recovery. The presence of oral vesicles was also found to be related to poor prognosis. Hearing loss and vertigo were not associated with a poor facial recovery. The sequence of symptom onset was not related to outcome. Older patients, and those with complete paralysis, did less well from a facial recovery viewpoint. All patients made some recovery, usually an average of 2.7 HB grades. A multicenter, randomized, placebo controlled trial with intention-to-treat methodology is required to assess the effectiveness of medical intervention. (17) Prophylactic Neck Dissection for Early Oral Tongue Squamous Cell Carcinoma Greater than 2 mm Depth Matthew J Lin,* Anthony J Guiney, Claire E Iseli, Malcolm R Buchanan, Tim A Iseli The Royal Melbourne Hospital, Victoria BACKGROUND: Regional recurrence is a significant problem following surgery for T1/T2 oral tongue squamous cell
S47 METHODS: A cadaveric study of 12 human temporal bones. Mesotympanic depth was calculated at various positions of the tympanic membrane (TM) using stapedectomy measuring rods. 3.5 mm was considered the minimum depth to accommodate the bevel of an injecting needle. RESULTS: The median mesotympanic depth at all TM positions was very similar. However, the probability of a depth greater than 3.5 mm was greatest when the injection trajectory was in an anteroinferior direction toward the hypotympanum. The least favorable injection site was at the umbo. Generally, a greater depth was encountered towards the periphery of the TM. CONCLUSION: Intratympanic injection via an anteroinferior perforation with the needle directed toward the hypotympanum with the patient in a supine position will likely lead to a successful infusion of drug into the middle ear cleft due to the increased depth at this position. This site benefits from being safely away from middle ear structures, such as facial nerve and ossicles, and permits a larger volume of drug to be infiltrated before egress through the injection site or eustachian tube. (16) Herpes Zoster Oticus: Treatment and Outcomes Victoria Oey,* Glen R Croxson, Susan Coulson, Roger Adams Royal Prince Alfred Hospital, New South Wales Herpes zoster oticus (HZO) is the second most common cause of nontraumatic lower motor neurone facial nerve palsy. It is caused by reactivation of the varicella zoster virus. One hundred one patients with HZO were retrospectively analyzed. Symptoms of diplopia or swallowing difficulty were found to be related to poor facial recovery. The presence of oral vesicles was also found to be related to poor prognosis. Hearing loss and vertigo were not associated with a poor facial recovery. The sequence of symptom onset was not related to outcome. Older patients, and those with complete paralysis, did less well from a facial recovery viewpoint. All patients made some recovery, usually an average of 2.7 HB grades. A multicenter, randomized, placebo controlled trial with intention-to-treat methodology is required to assess the effectiveness of medical intervention. (17) Prophylactic Neck Dissection for Early Oral Tongue Squamous Cell Carcinoma Greater than 2 mm Depth Matthew J Lin,* Anthony J Guiney, Claire E Iseli, Malcolm R Buchanan, Tim A Iseli The Royal Melbourne Hospital, Victoria BACKGROUND: Regional recurrence is a significant problem following surgery for T1/T2 oral tongue squamous cell