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Scarring from hyaluronic acid film in middle ear surgery
P90
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
CONCLUSIONS: Self motion direction-detection perceptual thresholds to roll-tilt at 0.1 Hz are reduced in patients with MAV compared to age-matched controls indicating that abnormal otolith function or canal-otolith interaction may be responsible for vestibular symptoms in MAV. Self motion direction-detection perceptual threshold testing is a potential diagnostic test for MAV.
Risk factors for incudal necrosis in chronic otitis media Rupa Vedantam, MS, DLO (presenter); Jareen Ebenezer OBJECTIVES: Determine the predictive value of preoperative clinical, audiological and radiological factors in diagnosing incudal necrosis in patients with tubotympanic chronic suppurative otitis media. METHODS: Prospective cohort study between August 2007August 2008 on chronic suppurative otitis media in a tertiary care referral centre. Patients underwent otoscopy, pure tone audiometry and cortical mastoidectomy with/ without ossiculoplasty. Presence of incudal necrosis noted intraoperatively. Presence, duration and blood staining of discharge, site, size and adherence of edges of perforation, incudostapedial joint exposure, middle ear and mastoid granulations, hearing levels and air-bone gap, malleus abnormalities, mastoid pneumatisation and aditus block noted. Univariate, bivariate and multivariate logistic regression analysis for all risk factors performed. RESULTS: Incus necrosis was present in 24 (16.7%) patients. On bivariate analysis, findings of active ear discharge (p⫽0.01), exposure of incudostapedial joint (p⫽0.04), edematous middle ear mucous membrane (p⫽0.05), foreshortening of the handle of malleus (p⫽0.04), moderately severe hearing loss (56-70dB HL) (p⫽0.00) and air- bone gap of ⬎ 40dB (p⫽0.001) were found to be significantly associated with incus necrosis. Mastoid pneumatisation, middle ear granulations and site of the perforation were not found to be significant. On multivariate analysis, an actively discharging ear (p⫽ 0.04), foreshortening of the handle of malleus (p⫽0.05) and moderately severe hearing loss (56-70dB HL) (p⫽0.03) were found to be highly significant risk factors. CONCLUSIONS: Identification of reliable predictors of incus necrosis preoperatively in patients with tubotympanic chronic suppurative otitis media enables the surgeon to plan concomitant ossiculoplasty and advise the patient regarding hearing outcomes.
Scarring from hyaluronic acid film in middle ear surgery Adrian James, FRCS (presenter); Glenn Taylor; Ines Sherifi
OBJECTIVES: 1) Assess the effect of a hyaluronic acid derivative [HA] on mucosal scarring after middle ear surgery. 2) Determine whether it promotes healing without adhesion of mucosal surfaces as has been proposed. We report our experience with an HA lamina (EpiFilm) by specifically focusing on the histological properties of middle ear tissues after its application at surgery for cholesteatoma resection. METHODS: This is a retrospective observational study of five patients who underwent staged canal wall up tympanomastoidectomy for cholesteatoma removal in a tertiary/quaternary pediatric hospital in 2007–2008. HA lamina was placed in the mesotympanum and epitympanum at the first stage of surgery. Scar tissue in these areas was biopsied at the second stage for histological analysis. RESULTS: The mean age at the first surgical stage was 12.3 ⫹/- 2.0 years. The mean interval time between the first and second surgeries was one year. Histopathology from all initial surgeries confirmed the diagnosis of cholesteatoma. Histopathology from the second surgeries uniformly revealed a dense cicatrix-like fibroconnective tissue containing a lymphohistiocytic infiltrate consistent with a giant cell foreign body reaction. This result was not seen in middle ear scar tissue without HA. CONCLUSIONS: We have found that placement of an HA lamina in the middle ear appeared to contribute to formation of a dense fibrotic scar and did not prevent mucosal adhesion. This reaction has the potential to interfere with middle ear compliance and tympano-mastoid ventilation. Sigmoid sinus reconstruction for the treatment of pulsatile tinnitus Elina Kari, MD (presenter); Douglas E Mattox, MD; Patricia Hudgins, MD OBJECTIVES: 1) To better understand an anatomic variant associated with pulsatile tinnitus. 2) Learn a novel surgical reconstructive method in the correction of sigmoid sinus diverticulum. METHODS: Retrospective chart review of patients evaluated for pulsatile tinnitus and found to have sigmoid sinus diverticula. Patients were followed between 2001–2009 at an academic, tertiary care referral center. Assessment included physical examination including effect of supravenous neck compression on the tinnitus, audiogram and computed-tomography angiography (CTA). Intervention included mastoidectomy with sigmoid sinus diverticulum repair and reconstruction. Outcome measurements included assessment of patients tinnitus and complications. RESULTS: Of the seven patients treated surgically, five were female, two were male. Mean and median ages were 49 and 47, respectively. All patients demonstrated unilateral findings. Six of seven patients underwent sigmoid sinus diverticulum repair and reconstruction. At the time of one-year follow-up,
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
CONCLUSIONS: Self motion direction-detection perceptual thresholds to roll-tilt at 0.1 Hz are reduced in patients with MAV compared to age-matched controls indicating that abnormal otolith function or canal-otolith interaction may be responsible for vestibular symptoms in MAV. Self motion direction-detection perceptual threshold testing is a potential diagnostic test for MAV.
Risk factors for incudal necrosis in chronic otitis media Rupa Vedantam, MS, DLO (presenter); Jareen Ebenezer OBJECTIVES: Determine the predictive value of preoperative clinical, audiological and radiological factors in diagnosing incudal necrosis in patients with tubotympanic chronic suppurative otitis media. METHODS: Prospective cohort study between August 2007August 2008 on chronic suppurative otitis media in a tertiary care referral centre. Patients underwent otoscopy, pure tone audiometry and cortical mastoidectomy with/ without ossiculoplasty. Presence of incudal necrosis noted intraoperatively. Presence, duration and blood staining of discharge, site, size and adherence of edges of perforation, incudostapedial joint exposure, middle ear and mastoid granulations, hearing levels and air-bone gap, malleus abnormalities, mastoid pneumatisation and aditus block noted. Univariate, bivariate and multivariate logistic regression analysis for all risk factors performed. RESULTS: Incus necrosis was present in 24 (16.7%) patients. On bivariate analysis, findings of active ear discharge (p⫽0.01), exposure of incudostapedial joint (p⫽0.04), edematous middle ear mucous membrane (p⫽0.05), foreshortening of the handle of malleus (p⫽0.04), moderately severe hearing loss (56-70dB HL) (p⫽0.00) and air- bone gap of ⬎ 40dB (p⫽0.001) were found to be significantly associated with incus necrosis. Mastoid pneumatisation, middle ear granulations and site of the perforation were not found to be significant. On multivariate analysis, an actively discharging ear (p⫽ 0.04), foreshortening of the handle of malleus (p⫽0.05) and moderately severe hearing loss (56-70dB HL) (p⫽0.03) were found to be highly significant risk factors. CONCLUSIONS: Identification of reliable predictors of incus necrosis preoperatively in patients with tubotympanic chronic suppurative otitis media enables the surgeon to plan concomitant ossiculoplasty and advise the patient regarding hearing outcomes.
Scarring from hyaluronic acid film in middle ear surgery Adrian James, FRCS (presenter); Glenn Taylor; Ines Sherifi
OBJECTIVES: 1) Assess the effect of a hyaluronic acid derivative [HA] on mucosal scarring after middle ear surgery. 2) Determine whether it promotes healing without adhesion of mucosal surfaces as has been proposed. We report our experience with an HA lamina (EpiFilm) by specifically focusing on the histological properties of middle ear tissues after its application at surgery for cholesteatoma resection. METHODS: This is a retrospective observational study of five patients who underwent staged canal wall up tympanomastoidectomy for cholesteatoma removal in a tertiary/quaternary pediatric hospital in 2007–2008. HA lamina was placed in the mesotympanum and epitympanum at the first stage of surgery. Scar tissue in these areas was biopsied at the second stage for histological analysis. RESULTS: The mean age at the first surgical stage was 12.3 ⫹/- 2.0 years. The mean interval time between the first and second surgeries was one year. Histopathology from all initial surgeries confirmed the diagnosis of cholesteatoma. Histopathology from the second surgeries uniformly revealed a dense cicatrix-like fibroconnective tissue containing a lymphohistiocytic infiltrate consistent with a giant cell foreign body reaction. This result was not seen in middle ear scar tissue without HA. CONCLUSIONS: We have found that placement of an HA lamina in the middle ear appeared to contribute to formation of a dense fibrotic scar and did not prevent mucosal adhesion. This reaction has the potential to interfere with middle ear compliance and tympano-mastoid ventilation. Sigmoid sinus reconstruction for the treatment of pulsatile tinnitus Elina Kari, MD (presenter); Douglas E Mattox, MD; Patricia Hudgins, MD OBJECTIVES: 1) To better understand an anatomic variant associated with pulsatile tinnitus. 2) Learn a novel surgical reconstructive method in the correction of sigmoid sinus diverticulum. METHODS: Retrospective chart review of patients evaluated for pulsatile tinnitus and found to have sigmoid sinus diverticula. Patients were followed between 2001–2009 at an academic, tertiary care referral center. Assessment included physical examination including effect of supravenous neck compression on the tinnitus, audiogram and computed-tomography angiography (CTA). Intervention included mastoidectomy with sigmoid sinus diverticulum repair and reconstruction. Outcome measurements included assessment of patients tinnitus and complications. RESULTS: Of the seven patients treated surgically, five were female, two were male. Mean and median ages were 49 and 47, respectively. All patients demonstrated unilateral findings. Six of seven patients underwent sigmoid sinus diverticulum repair and reconstruction. At the time of one-year follow-up,