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Laser Eustachian Tuboplasty: Case Report
P242
Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
CONCLUSIONS: Three techniques were found to be feasible for tympanic membrane perforations smaller than 3 mm. However, paper patch and fat myringoplasty appeared to be more suitable for perforations smaller than 2 mm, whereas perichondrium myringoplasty was favorable for perforations larger than 2 mm.
P089 Residual Cholesteatoma: Problems Revealed by Video Analysis Shin-Ichi Haginomori, MD (presenter); Atsuko Takamaki, MD; Hiroshi Takenaka, MD OBJECTIVES: 1. Evaluate the incidence and regions of residual cholesteatoma observed in planned second-stage operations. 2. Reveal inappropriate manipulations performed in first-stage operations leading to residual cholesteatomas by retrospective video analysis. METHODS: Enrolled were 85 ears from 85 patients who underwent planned staged tympanoplasty for extensive cholesteatoma at Osaka Medical College from 2001 through 2006. For cases in which residual cholesteatomas were found at the second stage, videos taken in the first-stage operations were analyzed retrospectively. RESULTS: Eighteen ears had residual cholesteatomas, and the overall incidence was 21%. In terms of regions, 6 cholesteatomas were observed in the epitympanum, 3 in the sinus tympani, 3 in the antrum, 2 on the stapes, 2 in the tympanic membrane, 1 on the tympanic portion of the facial canal, and 1 in the skin of the external auditory canal. With regard to inappropriate manipulations, removal of the matrix under indirect surgical view due to incomplete opening of the attic or insufficient drilldown to the facial canal was considered to be a chief cause of residua. Residua of the matrix in the bony defects of the middle cranial fossa or facial canal and keratinizing epithelial rolling obtained in the event of tympanic membrane reconstruction also were main causes of residual cholesteatomas. CONCLUSIONS: Retrospective video analysis, which is extremely useful to reveal technical problems in first-stage operations leading to residual cholesteatomas, reveals what manipulations we have to do carefully to decrease residua. The incidence and regions of residual cholesteatomas were similar to those in previous reports.
P090 Debrider/Laser Eustachian Tuboplasty: Case Report Carlos Yanez, MD, FICS (presenter); Nallely Mora, MD OBJECTIVES: This is a case report of a successful endoscopic endonasal combined microdebrider and CO2 laser-assisted tuboplasty case experience. This paper reports the feasibility, safety and efficacy of this endoluminaleustachian tube operation for the
treatment of eustachian tube dysfunction secondary to surgical trauma during an adenoidectomy procedure. METHODS: Setting: The patient was a four-year-old boy suffering from recurrent otitis media with severe otorrhea as a consequence of a lesion of the posterior wall and cartilage of the eustachian tube after a microdebrider adenoidectomy performed at another hospital. Eustachian tube mobility was severely compromised. The eustachian tuboplasty was carried out in two steps: (1) scar tissue and adenoid remnants occluding the eustachian tube were removed transnasally using the microdebrider; (2) the second step was done transnasally using CO2 laser six months postoperatively after the first step. RESULTS: A wider eustachian tube opening and lumen were achieved, the mobility of the tensor veli palatine muscle was improved, otorrhea disappeared. The patient had a two-year follow-up with absence of middle ear effusion. There were no intraoperative complications. CONCLUSIONS: Surgical trauma to the eustachian tube may be one of the most dreaded complications during adenoidectomies. Microdebrider and/or laser eustachian tuboplasty may be useful as a secondary procedure for the surgical correction of this complication. This procedure is safe and efficacious in expert hands.
P091 Selective Therapeutic Strategy for Perilymphatic Fistula Ken Hayashi, MD, PhD (presenter) OBJECTIVES: Confirm the efficacy of the selective therapy for perilymphatic fistula (PLF) classified by air bubble presence or absence in cochlea investigated using the limited conebeam X-ray CT (3D Accuitomo). METHODS: The inner ear structure in 20 patients with suspected PLF was observed using 3D Accuitomo. And then, for patients with air bubble in the cochlea, a new surgical technique was performed: a hole was created in the central portion of the footplate, physiological saline was circulated inside the cochlea, and the oval window was closed by gel form. The presenters also performed a repair of labyrinthine window fistulas for patients without air bubbles in the cochlea. Each patient was assessed for comparison of their pre- and postoperative hearing levels. RESULTS: It was possible to identify air bubbles in the cochlea of 11 patients with PLF. Therefore, through a new surgical technique, the presenters were able to clear air bubbles from the cochlea; the 9 patients withour air bubbles underwent repair of the labyrinthine window fistula. In consequence, hearing levels were significantly improved in 85% (17/20) of cases. CONCLUSIONS: The selective therapy based on presence or absence of air bubbles in the cochlea was effective for PLF. In addition, there is evidence that air bubbles in the cochlea of patients with PLF lead to hearing loss. In conclusion, it is sug-
Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
CONCLUSIONS: Three techniques were found to be feasible for tympanic membrane perforations smaller than 3 mm. However, paper patch and fat myringoplasty appeared to be more suitable for perforations smaller than 2 mm, whereas perichondrium myringoplasty was favorable for perforations larger than 2 mm.
P089 Residual Cholesteatoma: Problems Revealed by Video Analysis Shin-Ichi Haginomori, MD (presenter); Atsuko Takamaki, MD; Hiroshi Takenaka, MD OBJECTIVES: 1. Evaluate the incidence and regions of residual cholesteatoma observed in planned second-stage operations. 2. Reveal inappropriate manipulations performed in first-stage operations leading to residual cholesteatomas by retrospective video analysis. METHODS: Enrolled were 85 ears from 85 patients who underwent planned staged tympanoplasty for extensive cholesteatoma at Osaka Medical College from 2001 through 2006. For cases in which residual cholesteatomas were found at the second stage, videos taken in the first-stage operations were analyzed retrospectively. RESULTS: Eighteen ears had residual cholesteatomas, and the overall incidence was 21%. In terms of regions, 6 cholesteatomas were observed in the epitympanum, 3 in the sinus tympani, 3 in the antrum, 2 on the stapes, 2 in the tympanic membrane, 1 on the tympanic portion of the facial canal, and 1 in the skin of the external auditory canal. With regard to inappropriate manipulations, removal of the matrix under indirect surgical view due to incomplete opening of the attic or insufficient drilldown to the facial canal was considered to be a chief cause of residua. Residua of the matrix in the bony defects of the middle cranial fossa or facial canal and keratinizing epithelial rolling obtained in the event of tympanic membrane reconstruction also were main causes of residual cholesteatomas. CONCLUSIONS: Retrospective video analysis, which is extremely useful to reveal technical problems in first-stage operations leading to residual cholesteatomas, reveals what manipulations we have to do carefully to decrease residua. The incidence and regions of residual cholesteatomas were similar to those in previous reports.
P090 Debrider/Laser Eustachian Tuboplasty: Case Report Carlos Yanez, MD, FICS (presenter); Nallely Mora, MD OBJECTIVES: This is a case report of a successful endoscopic endonasal combined microdebrider and CO2 laser-assisted tuboplasty case experience. This paper reports the feasibility, safety and efficacy of this endoluminaleustachian tube operation for the
treatment of eustachian tube dysfunction secondary to surgical trauma during an adenoidectomy procedure. METHODS: Setting: The patient was a four-year-old boy suffering from recurrent otitis media with severe otorrhea as a consequence of a lesion of the posterior wall and cartilage of the eustachian tube after a microdebrider adenoidectomy performed at another hospital. Eustachian tube mobility was severely compromised. The eustachian tuboplasty was carried out in two steps: (1) scar tissue and adenoid remnants occluding the eustachian tube were removed transnasally using the microdebrider; (2) the second step was done transnasally using CO2 laser six months postoperatively after the first step. RESULTS: A wider eustachian tube opening and lumen were achieved, the mobility of the tensor veli palatine muscle was improved, otorrhea disappeared. The patient had a two-year follow-up with absence of middle ear effusion. There were no intraoperative complications. CONCLUSIONS: Surgical trauma to the eustachian tube may be one of the most dreaded complications during adenoidectomies. Microdebrider and/or laser eustachian tuboplasty may be useful as a secondary procedure for the surgical correction of this complication. This procedure is safe and efficacious in expert hands.
P091 Selective Therapeutic Strategy for Perilymphatic Fistula Ken Hayashi, MD, PhD (presenter) OBJECTIVES: Confirm the efficacy of the selective therapy for perilymphatic fistula (PLF) classified by air bubble presence or absence in cochlea investigated using the limited conebeam X-ray CT (3D Accuitomo). METHODS: The inner ear structure in 20 patients with suspected PLF was observed using 3D Accuitomo. And then, for patients with air bubble in the cochlea, a new surgical technique was performed: a hole was created in the central portion of the footplate, physiological saline was circulated inside the cochlea, and the oval window was closed by gel form. The presenters also performed a repair of labyrinthine window fistulas for patients without air bubbles in the cochlea. Each patient was assessed for comparison of their pre- and postoperative hearing levels. RESULTS: It was possible to identify air bubbles in the cochlea of 11 patients with PLF. Therefore, through a new surgical technique, the presenters were able to clear air bubbles from the cochlea; the 9 patients withour air bubbles underwent repair of the labyrinthine window fistula. In consequence, hearing levels were significantly improved in 85% (17/20) of cases. CONCLUSIONS: The selective therapy based on presence or absence of air bubbles in the cochlea was effective for PLF. In addition, there is evidence that air bubbles in the cochlea of patients with PLF lead to hearing loss. In conclusion, it is sug-