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Non-otitis conductive hearing loss in children
Wednesday, September 20, 1995 8:00 to 9:30 A.M. Room D 1 O t o l o g y / N e u r o t o l o g y a n d Pediatric O t o l a r y n g o l o g y Session C L O U G H SHELTON, M D , a n d STEPHEN G. HARNER, M D ( m o d e r a t o r s ) , Salt L a k e C i t y , Utah, and Rochester, Minn.
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8:00 A.M.
Non-Otitis Conductive Hearing Lossin Children WILLIAM H. SLATTERY,III, MD (presenter), and TATLAM, MS, Los Angeles, Calif. Both congenital abnormalities and juvenile otosclerosis can produce a conductive hearing loss in children. However, surgery for correction of the conductive loss is not recommended in all cases. This study examined the characteristics of cases in which surgery was recommended in comparison with cases in which patients did not undergo surgery. Between 1980 and 1994, 173 children presented to our otologic clinic with a normal tympanic membrane, a conductive hearing loss, and no significant history of otitis. The 82 male patients and 91 female patients ranged in age at diagnosis from less than one year to I8 years, with a mean age at diagnosis of 10.1 years. One hundred fourteen (66%) of the children underwent surgery, whereas the other 59 did not undergo surgery. The surgical group more commonly had bilateral disease than the nonsurgical group (p <0.0001), was older at age of diagnosis (p <0.001), had a larger preoperative air-bone gap (p <0.05), and had a greater degree of sensorineural hearing toss (p <0.0001). The groups did not differ in gender, presence of a syndrome or of a facial anomaly, or family history. Results of surgical intervention will be discussed in light of patient characteristics. The preoperative evaluation, including audiometric testing, radiologic evaluation, and prior hearing aid use will be discussed, and a decision-making strategy will be presented. 8:08 A.M.
Is Surgical Excision of Facial Nerve Schwannomas Always Indicated? SIMON I. ANGELI,MD (presenter), and DERALDE. BRACKMANN,MD, Los Angeles, Calif. Despite the sophistication of current diagnostic tests, intracranial facial nerve schwannomas are often misdiagnosed as acoustic neuromas. In patients with normal facial function preoperatively, finding a facial neuroma during surgery for a presumed acoustic neuroma poses a dilemma to the
neurotologic surgeon. Unlike acoustic neuroma removal, excision of a facial neuroma almost always results in some degree of permanent facial dysfunction even when primary nerve anastomosis or grafting is accomplished. Because these neoplasms are invariably slow-growing, sacrifice of facial motor function in all cases may be unwarranted or unacceptable to some patients. An alternative to surgical excision is wide bony decompression of the facial tumor. We review our experience with wide decompression or exploration for intratemporal facial neuromas in five patients. They ranged in age from 11 to 75 years, and have been followed up for as long as 16 years in one case. Tumor size ranged from 0.3 to 1.3 cm. All four cases with preoperative normal facial function (grade I) have maintained normal function. The fifth case had an improvement from a preoperative grade V to postoperative grade II. Recommendations about the indications, timing, and techniques involved will be presented. This conservative management philosophy can provide long-term preservation of function of the seventh and eighth cranial nerves. 8:]6 A.M.
Hearing Lossas a Complication of Stapes Surgery RONALD AMEDEE,MD, FACS(presenter), GUDRUN FUERST, MD, WOLF J. MANN, MD, FACS,and HAROLDG. TABB,MD, FACS, New Orleans, La., and Mainz, Germany Over a 10-year period (1984 to 1994), 1229 stapes operalions for otosclerosis were performed at our respective institutions by experienced surgeons well trained in the various techniques. Procedures included 691 stapedectomies, 234 small-fenestrae stapedotomies, and 304 revision operations. These primary and revision cases resulted in 23 ears with anacusis noted in the immediate postoperative period. The purpose of this presentation is to critically evaluate those procedures with profound hearing loss and to attempt to determine possible reasons for this occurrence. We hope this data will allow surgeons to identify preoperatively or intraoperatively patients at risk of developing this complication and therefore decrease the overall morbidity of this exacting procedure.
P153
r
r
O ta.t tt~
8:00 A.M.
Non-Otitis Conductive Hearing Lossin Children WILLIAM H. SLATTERY,III, MD (presenter), and TATLAM, MS, Los Angeles, Calif. Both congenital abnormalities and juvenile otosclerosis can produce a conductive hearing loss in children. However, surgery for correction of the conductive loss is not recommended in all cases. This study examined the characteristics of cases in which surgery was recommended in comparison with cases in which patients did not undergo surgery. Between 1980 and 1994, 173 children presented to our otologic clinic with a normal tympanic membrane, a conductive hearing loss, and no significant history of otitis. The 82 male patients and 91 female patients ranged in age at diagnosis from less than one year to I8 years, with a mean age at diagnosis of 10.1 years. One hundred fourteen (66%) of the children underwent surgery, whereas the other 59 did not undergo surgery. The surgical group more commonly had bilateral disease than the nonsurgical group (p <0.0001), was older at age of diagnosis (p <0.001), had a larger preoperative air-bone gap (p <0.05), and had a greater degree of sensorineural hearing toss (p <0.0001). The groups did not differ in gender, presence of a syndrome or of a facial anomaly, or family history. Results of surgical intervention will be discussed in light of patient characteristics. The preoperative evaluation, including audiometric testing, radiologic evaluation, and prior hearing aid use will be discussed, and a decision-making strategy will be presented. 8:08 A.M.
Is Surgical Excision of Facial Nerve Schwannomas Always Indicated? SIMON I. ANGELI,MD (presenter), and DERALDE. BRACKMANN,MD, Los Angeles, Calif. Despite the sophistication of current diagnostic tests, intracranial facial nerve schwannomas are often misdiagnosed as acoustic neuromas. In patients with normal facial function preoperatively, finding a facial neuroma during surgery for a presumed acoustic neuroma poses a dilemma to the
neurotologic surgeon. Unlike acoustic neuroma removal, excision of a facial neuroma almost always results in some degree of permanent facial dysfunction even when primary nerve anastomosis or grafting is accomplished. Because these neoplasms are invariably slow-growing, sacrifice of facial motor function in all cases may be unwarranted or unacceptable to some patients. An alternative to surgical excision is wide bony decompression of the facial tumor. We review our experience with wide decompression or exploration for intratemporal facial neuromas in five patients. They ranged in age from 11 to 75 years, and have been followed up for as long as 16 years in one case. Tumor size ranged from 0.3 to 1.3 cm. All four cases with preoperative normal facial function (grade I) have maintained normal function. The fifth case had an improvement from a preoperative grade V to postoperative grade II. Recommendations about the indications, timing, and techniques involved will be presented. This conservative management philosophy can provide long-term preservation of function of the seventh and eighth cranial nerves. 8:]6 A.M.
Hearing Lossas a Complication of Stapes Surgery RONALD AMEDEE,MD, FACS(presenter), GUDRUN FUERST, MD, WOLF J. MANN, MD, FACS,and HAROLDG. TABB,MD, FACS, New Orleans, La., and Mainz, Germany Over a 10-year period (1984 to 1994), 1229 stapes operalions for otosclerosis were performed at our respective institutions by experienced surgeons well trained in the various techniques. Procedures included 691 stapedectomies, 234 small-fenestrae stapedotomies, and 304 revision operations. These primary and revision cases resulted in 23 ears with anacusis noted in the immediate postoperative period. The purpose of this presentation is to critically evaluate those procedures with profound hearing loss and to attempt to determine possible reasons for this occurrence. We hope this data will allow surgeons to identify preoperatively or intraoperatively patients at risk of developing this complication and therefore decrease the overall morbidity of this exacting procedure.
P153
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r