- Email: [email protected]
A New Role of Staged Tympanoplasty for Cholesteatoma
P52
Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
technologies is not as simple, as new joining surgeons profit from experienced colleagues. The complication rate clearly seems to depend on experience; however, patient adjusted survival rates do not. Vox-Implants Injection after Partial Laryngectomy Angelo Ghidini (presenter); Giuseppe Bergamini; Matteo Alicandri-Ciufelli; Gabriele Molteni, MD; Francesco Mattioli; Livio Presutti, MD; Daniele Marchioni OBJECTIVE: To illustrate a surgical technique for swallowing rehabilitation of patients after partial laryngectomy and to evaluate quality of life after treatment. METHODS: A longitudinal prospective study. 11 patients with persistent swallowing impairment after partial laryngectomy were included in the study. Swallowing disorders were diagnosed with videofluoroscopy and FEES (fiberoptic endoscopic evaluation of swallowing), and were quantified by 2 scales (a dysphagia score and a modified Penetration-Aspiration scale). A self-evaluation questionnaire about quality of life after polydimethylsiloxane (PDMS) injection was submitted to each patient (EORTC-QLQ 30). After identification of site of inhalation of bolus, PDMS was injected into the neoglottis to fill the neoglottic gap in order to obtain a better continence of the neolarynx. Aerodynamics and acoustic analysis were assessed before and after treatment. RESULTS: Average follow-up was 25 months (range 5-39). All patients showed an improvement both in the dysphagia score and in the modified Penetration-Aspiration scale. Average improvement was 2.6 points in the dysphagia score (p⫽0.0042) and 2.1 in the modified Penetration-Aspiration scale (p⫽0.0043). MPT showed an average improvement of 5 sec (p⫽0,037). The quality of life assessment showed a subjective improvement in each patient. CONCLUSIONS: PDMS injection can be a useful technique in surgical rehabilitation of swallowing in patients who underwent partial laryngectomy. FEES is a very important tool in identifying anatomical alterations that can cause incorrect passage of bolus in the airways during deglutition. Filling these regions with PDMS can avoid passage of food into the airways, thus improving deglutition and voice and by consequence, patients’ quality of life.
Otology/Neurotology A New Role of Staged Tympanoplasty for Cholesteatoma Yasuyuki Hinohira, MD, PhD (presenter); Naoaki Yanagihara, MD; Naohito Hato, MD OBJECTIVE: 1) Investigate a correlation between pathological findings at the 2nd stage operation and long-term outcomes
in a staged canal wall-up tympanoplasty (SCUT) for middle ear cholesteatoma. 2) Advocate a new role of the staged manner based on the study. METHODS: SCUT was performed on 90 ears with cholesteatoma involving both the ossicles and the mastoid cavity. The 1st stage operation included scutum plasty and mastoid cortex plasty with bone pate following removal of cholesteatoma and ossicles involved. The 2nd stage operation records were reviewed regarding the pathological findings associated with retraction pocket (RP) and residual cholesteatoma (RC) formation. The scutum defect was revised with auricular cartilage, and the mastoid cortex plasty was again performed after removal of RC. Postoperative follow-up with endoscopic observation and CT was performed for all patients. RESULTS: At the 2nd stage, RP was seen in 15 ears (16.7%) which all showed partial or total absorption of the scutum reconstructed. Aeration grade of the mastoid cavity reconstructed did not correlate with RP or RC formation. RC was found in 28 ears (31.1%) regardless of RP formation. The long-term follow up study revealed that the statistically higher incidence of RP re-formation (26.7%) and RC (3.2%) was seen in ears which had been identified at the 2nd stage, respectively. CONCLUSIONS: The present study showed that the longterm outcomes after SCUT were correlated with RP and RC formation at the 2nd stage. This indicates the 2nd stage operation has a role of the long-term prognosis in addition to exploration of RC. Chorda Tympani in Chronic Inflammatory Middle Ear Disease Arun Goyal (presenter); P P Singh, MD; Gautam Dash, MD OBJECTIVE: To study the effect of chronic inflammatory middle ear disease on gustatory function of chorda tympani nerve. METHODS: A prospective study was performed in 2007 on 85 patients of unilateral chronic inflammatory middle ear disease of both cholesteatomatous and noncholesteatomatous type. Gustatory assessment on both sides of the tongue was performed using dry taste strips. Taste strips were made of filter paper soaked in four different taste solutions of four different concentrations each and dried. The taste score is the number of correctly identified taste strips. Results were analyzed using Analysis of Variance (ANOVA) and t-test. RESULTS: Comparison of mean taste scores on the side of diseased ear with normal ear was done. On the diseased side, the mean taste score was 9.16 and on the normal side, the mean taste score was 13.24. The difference between the two was found to be statistically significant (p⬍0.0001). The results were also analyzed for various other parameters like type, duration, and location of disease. Site of cholesteatoma was found to have a significant effect on the taste score of the
Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
technologies is not as simple, as new joining surgeons profit from experienced colleagues. The complication rate clearly seems to depend on experience; however, patient adjusted survival rates do not. Vox-Implants Injection after Partial Laryngectomy Angelo Ghidini (presenter); Giuseppe Bergamini; Matteo Alicandri-Ciufelli; Gabriele Molteni, MD; Francesco Mattioli; Livio Presutti, MD; Daniele Marchioni OBJECTIVE: To illustrate a surgical technique for swallowing rehabilitation of patients after partial laryngectomy and to evaluate quality of life after treatment. METHODS: A longitudinal prospective study. 11 patients with persistent swallowing impairment after partial laryngectomy were included in the study. Swallowing disorders were diagnosed with videofluoroscopy and FEES (fiberoptic endoscopic evaluation of swallowing), and were quantified by 2 scales (a dysphagia score and a modified Penetration-Aspiration scale). A self-evaluation questionnaire about quality of life after polydimethylsiloxane (PDMS) injection was submitted to each patient (EORTC-QLQ 30). After identification of site of inhalation of bolus, PDMS was injected into the neoglottis to fill the neoglottic gap in order to obtain a better continence of the neolarynx. Aerodynamics and acoustic analysis were assessed before and after treatment. RESULTS: Average follow-up was 25 months (range 5-39). All patients showed an improvement both in the dysphagia score and in the modified Penetration-Aspiration scale. Average improvement was 2.6 points in the dysphagia score (p⫽0.0042) and 2.1 in the modified Penetration-Aspiration scale (p⫽0.0043). MPT showed an average improvement of 5 sec (p⫽0,037). The quality of life assessment showed a subjective improvement in each patient. CONCLUSIONS: PDMS injection can be a useful technique in surgical rehabilitation of swallowing in patients who underwent partial laryngectomy. FEES is a very important tool in identifying anatomical alterations that can cause incorrect passage of bolus in the airways during deglutition. Filling these regions with PDMS can avoid passage of food into the airways, thus improving deglutition and voice and by consequence, patients’ quality of life.
Otology/Neurotology A New Role of Staged Tympanoplasty for Cholesteatoma Yasuyuki Hinohira, MD, PhD (presenter); Naoaki Yanagihara, MD; Naohito Hato, MD OBJECTIVE: 1) Investigate a correlation between pathological findings at the 2nd stage operation and long-term outcomes
in a staged canal wall-up tympanoplasty (SCUT) for middle ear cholesteatoma. 2) Advocate a new role of the staged manner based on the study. METHODS: SCUT was performed on 90 ears with cholesteatoma involving both the ossicles and the mastoid cavity. The 1st stage operation included scutum plasty and mastoid cortex plasty with bone pate following removal of cholesteatoma and ossicles involved. The 2nd stage operation records were reviewed regarding the pathological findings associated with retraction pocket (RP) and residual cholesteatoma (RC) formation. The scutum defect was revised with auricular cartilage, and the mastoid cortex plasty was again performed after removal of RC. Postoperative follow-up with endoscopic observation and CT was performed for all patients. RESULTS: At the 2nd stage, RP was seen in 15 ears (16.7%) which all showed partial or total absorption of the scutum reconstructed. Aeration grade of the mastoid cavity reconstructed did not correlate with RP or RC formation. RC was found in 28 ears (31.1%) regardless of RP formation. The long-term follow up study revealed that the statistically higher incidence of RP re-formation (26.7%) and RC (3.2%) was seen in ears which had been identified at the 2nd stage, respectively. CONCLUSIONS: The present study showed that the longterm outcomes after SCUT were correlated with RP and RC formation at the 2nd stage. This indicates the 2nd stage operation has a role of the long-term prognosis in addition to exploration of RC. Chorda Tympani in Chronic Inflammatory Middle Ear Disease Arun Goyal (presenter); P P Singh, MD; Gautam Dash, MD OBJECTIVE: To study the effect of chronic inflammatory middle ear disease on gustatory function of chorda tympani nerve. METHODS: A prospective study was performed in 2007 on 85 patients of unilateral chronic inflammatory middle ear disease of both cholesteatomatous and noncholesteatomatous type. Gustatory assessment on both sides of the tongue was performed using dry taste strips. Taste strips were made of filter paper soaked in four different taste solutions of four different concentrations each and dried. The taste score is the number of correctly identified taste strips. Results were analyzed using Analysis of Variance (ANOVA) and t-test. RESULTS: Comparison of mean taste scores on the side of diseased ear with normal ear was done. On the diseased side, the mean taste score was 9.16 and on the normal side, the mean taste score was 13.24. The difference between the two was found to be statistically significant (p⬍0.0001). The results were also analyzed for various other parameters like type, duration, and location of disease. Site of cholesteatoma was found to have a significant effect on the taste score of the