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OBJECTIVE: To test the hypothesis that conductive hearing loss (CHL) is associated with dementia, and that middle ear reconstruction (MER) associates with improved outcomes for these measures in a multinational electronic health records database. STUDY DESIGN: Retrospective cohort study with propensity-score matching (PSM). SETTING: TriNetX is a research database representing about 110 million patients from the United States, Taiwan, Brazil, and India. PATIENTS: Subjects older than 50 years with no HL and any CHL (ICD-10: H90.0-2). Subjects of any age with and without any MER (CPT: 1010174). MAIN OUTCOME MEASURES: Odds ratios (ORs) and hazard ratios with 95% confidence intervals (95% CIs) for incident dementia (ICD-10: F01, F03, G30). RESULTS: Of 103,609 patients older than 50 years experiencing any CHL, 2.74% developed dementia compared with 1.22% of 38,216,019 patients with no HL (OR, 95% CI: 2.29, 2.20-2.37). Of patients experiencing CHL, there were 39,850 who received MER. The average age was 31.3 years, with 51% female patients. A total of 343,876 control patients with CHL were identified; 39,900 patients remained in each cohort after 1:1 PSM for HL- and dementia-related risk factors. Matched risk for developing dementia among MER recipients was 0.33% compared with 0.58% in controls (OR: 0.58, 0.46-0.72). CONCLUSIONS: CHL increases the odds for dementia, and MER improves the odds for incident dementia. This study represents the first population study on the topic of CHL, MER, and dementia.
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Bases de Datos Factuales , Demencia , Pérdida Auditiva Conductiva , Humanos , Femenino , Masculino , Persona de Mediana Edad , Demencia/epidemiología , Demencia/complicaciones , Pérdida Auditiva Conductiva/cirugía , Pérdida Auditiva Conductiva/epidemiología , Pérdida Auditiva Conductiva/etiología , Anciano , Estudios Retrospectivos , Oído Medio/cirugía , Estados Unidos/epidemiología , Taiwán/epidemiología , Procedimientos de Cirugía Plástica/métodos , Brasil/epidemiología , India/epidemiología , Anciano de 80 o más Años , Procedimientos Quirúrgicos Otológicos/métodosRESUMEN
OBJECTIVES: This study proposes a new surgical alternative for the most common deformity in the ears, the so-called "protruding/prominent ears", which is a condition that affects 5% of the Caucasian population (Goulart et al. in Rev Bras Cir Plast 26:602-607, 2011). This technique comes with the benefits of reduced surgical time, shallow learning curve, and a low revision rate. METHODS: We studied a total of 213 patients with an indication for otoplasty from January 2020 to January 2021. Women made up 65% of the study population, while men made up 35%, with an average age of 21 years, the youngest being 7 years of age. The technique presented here corrects all the deformities that cause protruding ears and can be performed together with other ear surgeries, such as surgical treatment of macrotia and lobuloplasty. All surgeries were performed in an outpatient setting under local anesthesia and sedation. RESULTS: All surgeries followed a performance-optimized protocol, with an average total surgical time of 45 min for a bilateral approach. Revision surgery was needed in 2% of cases, with the most frequent complaint being asymmetry in the upper third of the ears. The complication rate was approximately 7.5%, with 1 case of hematoma, 1 case of mild infection, 2 cases of altered ear sensitivity, 3 cases of keloid scar formation, 6 cases of asymmetry in the upper third of the ears, and 3 cases of irregularities or spikes in the antihelix cartilage. Patient satisfaction was measured using the McDowell/Wright Objectives and Outcome Index (McDowell in Plast Reconstr Surg 41:17-27). CONCLUSION: The proposed performance technique is a viable alternative to optimize the surgical time of otoplasty in an outpatient setting. This technique can be performed together with other corrective ear surgeries, has a shallow learning curve, and has a low revision rate. LEVEL IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.
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Pabellón Auricular/cirugía , Procedimientos Quirúrgicos Otológicos , Procedimientos de Cirugía Plástica , Adolescente , Adulto , Niño , Pabellón Auricular/anomalías , Femenino , Humanos , Masculino , Procedimientos Quirúrgicos Otológicos/efectos adversos , Procedimientos Quirúrgicos Otológicos/educación , Procedimientos Quirúrgicos Otológicos/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/educación , Procedimientos de Cirugía Plástica/métodos , Reoperación/estadística & datos numéricos , Técnicas de Sutura , Factores de Tiempo , Adulto JovenRESUMEN
INTRODUCTION: The bone-anchored hearing system has become the most viable treatment option for subjects with conductive or mixed hearing loss, who are unable to benefit from conventional hearing aids or middle ear surgery. OBJECTIVE: To compare the surgical and audiological outcomes between the minimally-invasive Ponto surgery and a linear incision with soft tissue preservation techniques in bone-anchored hearing system recipients. METHODS: A retrospective study was carried out from January 2017 to June 2018. Forty-two adult patients eligible for unilateral bone-anchored hearing system surgery with the Ponto system were included in the study. The implant and abutment lengths used varied from 3 to 4mm and from 6 to 14mm, according to the bone and skin thickness of the participants, respectively. RESULTS: Twenty-two surgeries were performed using the minimally invasive Ponto surgery technique (52.4%) and 20 (47.6%) using the linear incision. The mean age of the subjects implanted with minimally invasive Ponto surgery and linear incision techniques were 42.0 and 33.3 years old, respectively. Ten male (45,5%) and 14 (70%) female patients were implanted using minimally invasive Ponto surgery and the linear incision techniques, respectively. There were no differences between pure tone audiometric thresholds and monosyllabic word recognition scores of the subjects, when comparing both surgical techniques. The minimally invasive Ponto surgery technique significantly reduced the surgical time compared to the linear incision technique. There were no differences between both surgical techniques for skin-related complications; (Holgers 3 and 4) which occurred in 18.8% for MIPS and in 25% for linear incision. Subjects included in the minimally invasive Ponto surgery technique group showed a superior cosmetic outcome, with no surgical scar or additional sutures. CONCLUSION: The surgical and audiological outcomes were satisfactory and were not correlated to the surgical technique selected in all subjects. When compared to the linear incision, the minimally invasive Ponto surgery technique showed reduced surgical time and superior esthetic outcomes in the postoperative follow-up.
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Audífonos , Pérdida Auditiva , Procedimientos Quirúrgicos Otológicos , Adulto , Conducción Ósea , Femenino , Pérdida Auditiva/cirugía , Humanos , Masculino , Procedimientos Quirúrgicos Otológicos/métodos , Estudios Retrospectivos , Anclas para SuturaRESUMEN
Abstract Introduction Local anesthesia with sedation has been employed for an increasingly number of otolaryngology procedures, and might be associated with lower surgical morbidity and costs. Facial nerve monitoring is often advisable in otology to minimize the risks of injuries to this cranial nerve, but the principles, techniques and parameters involved have only been studied for procedures under general anesthesia. Objective To report the preliminary outcomes of intraoperative facial nerve moni- toring during otologic procedures under sedation and local anesthesia. Methods A total of five procedures and their respective intraoperative electrophysi- ological main findings were described. Facial neuromonitoring was performed using the same device by an electrophysiologist. The monitor sensitivity was set at 100 mV, and a stimulating probe was used whenever needed. Results Progressively decreasing low-amplitude baseline values were usually obtained as the level of anesthesia increased, with isolated oscillations possibly related to some degree of voluntary muscular activity. These oscillations could be easily distinguished from those of the surgical manipulation or electrical stimulation of the nerve, which tended to be of much greater amplitude and shorter latency, occurring during specific surgical steps. Conclusion With a surgical team with proper procedural knowledge and broad expertise regarding the technique, intraoperative facial nerve monitoring under local anesthesia with sedation seemed both feasible and reliable. Thus, the need for intraoperative neuromonitoring should not be an obstacle for otologic procedures under less aggressive anesthetic management.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Procedimientos Quirúrgicos Otológicos/métodos , Monitoreo Intraoperatorio/métodos , Nervio Facial/fisiología , Anestesia Local , Resultado del Tratamiento , Estimulación Eléctrica , ElectromiografíaRESUMEN
Introduction: The anatomy of the temporal bone is complex due to the large number of structures and functions grouped in this small bone space, which do not exist in any other region in the human body. With the difficulty of obtaining anatomical parts and the increasing number of ear, nose and throat (ENT) doctors, there was a need to create alternatives as real as possible for training otologic surgeons. Objective: Developing a technique to produce temporal bone models that allow them to maintain the external and internal anatomical features faithful to the natural bone. Methods: For this study, we used a computed tomography (CT) scan of the temporal bones of a 30-year-old male patient, with no structural morphological changes or any other pathology detected in the examination, which was later sent to a 3D printer in order to produce a temporal bone biomodel. Results: After dissection, the lead author evaluated the plasticity of the part and its similarity in drilling a natural bone as grade "4" on a scale of 0 to 5, in which 5 is the closest to the natural bone and 0 the farthest from the natural bone. All structures proposed in the method were found with the proposed color. Conclusion: It is concluded that it is feasible to use biomodels in surgical training of specialist doctors. After dissection of the bone biomodel, it was possible to find the anatomical structures proposed, and to reproduce the surgical approaches most used in surgical practice and training implants (AU)
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Humanos , Masculino , Adulto , Hueso Temporal/cirugía , Simulación por Computador , Impresión Tridimensional , Modelos Anatómicos , Procedimientos Quirúrgicos Otológicos/métodos , Hueso Temporal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Educación Médica , Entrenamiento SimuladoRESUMEN
BACKGROUND: Candidates for otoplasty have variable anatomy that may result in an aesthetically suboptimal appearance. The authors describe an algorithm to obtain ideal aesthetic position of the ear using a standardized suturing only technique. METHODS: A retrospective review was conducted at a major children's hospital. Pre- and postoperative distances from the mastoid to the posterior lateral helical rim were measured at 3 consistent points (upper helix, mid helix, and lobule). Cosmetic outcomes were determined by visual analog cosmetic score (VACS), assigned by 3 independent reviewers. RESULTS: A total of 26 patients underwent otoplasty for prominent ear (average age 8.2 years). Duration of follow-up was an average of 32 weeks postoperatively. Pre- and postoperative VACSs were determined for all patients: overall-appearance, 25.8 versus 71.3; overall-ear appearance, 25.7 versus 70.0; shape, 24.4 versus 72.6; and projection, 23.7 versus 73.9 (Pâ<â0.05 for all). There was no inter-rater difference between scores. There was greater symmetry between ears postoperatively (Pâ<â0.05). Measurements were significantly improved pre- versus postoperatively: upper-helix 2.04 versus 1.20âcm, mid-helix 2.22 versus 1.18âcm, and lobule 1.85 versus 1.49âcm (Pâ<â0.05.) Postoperative measurements are in accordance with established norms for ideal ear position (1.0-1.2âcm upper third of the ear). Two patients recurred, and 1 experienced a spitting suture (11.5%). CONCLUSION: Aesthetic ideal was established on the operating table based on the appearance of the ear. Postoperative measurements fell within aesthetic ideal for a normal ear, suggesting that the use of intraoperative measurements are not needed to obtain an aesthetically acceptable outcome.
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Oído Externo/cirugía , Procedimientos Quirúrgicos Otológicos/métodos , Procedimientos de Cirugía Plástica/métodos , Técnicas de Sutura/instrumentación , Suturas , Adolescente , Niño , Preescolar , Oído Externo/anomalías , Femenino , Humanos , Masculino , Apófisis Mastoides/cirugía , Periodo Posoperatorio , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Numerous suture techniques and covering flaps have been described to minimize complications related to sutures in otoplasty. The split postauricular fascial flap is one of such techniques, and it has been used to pad otoplasty suture. The aim of this study was to evaluate complications related to nonabsorbable cartilage sutures in otoplasty, using a variation of the split postauricular fascial flap. In this retrospective case series, we analyzed otoplasty patients in whom simplified split postauricular fascial flap was utilized. A postauricular skin ellipse was de-epithelialized (preserving dermis) and a longitudinally split in half. Flaps were dissected, and they were positioned on the cartilage to promote additional soft tissue coverage to the sutures. The lateral flap covered conchoscaphal sutures while the medial flap covered the conchomastoid sutures. Both the flaps were not sutured to cartilage. Early and late postoperative complications were evaluated. A total of 142 patients were included. Twenty-four (16.9%) patients developed late complications: 13 (9.1%) patients had palpable and visible sutures, nine (6.3%) had suture extrusion and two (1.4%) had hypertrophic scars. In this case series, the simplified split postauricular flap did not prevent or reduce late complications related to suture extrusion in otoplasty. It is possible that suturing the entire length of the flaps may play a role in our results. So, anchoring the flap and possibly tightening it a little may be an important technical step to prevent extrusion of sutures whenever the postauricular flap is used.
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Pabellón Auricular/cirugía , Procedimientos Quirúrgicos Otológicos/métodos , Complicaciones Posoperatorias/prevención & control , Colgajos Quirúrgicos , Técnicas de Sutura , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Procedimientos Quirúrgicos Otológicos/efectos adversos , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Protruding ears represent the main abnormality of the external ear, which has required numerous anatomic and surgical studies. Most studies give attention to the absence of the antihelix as the anatomic defect responsible for the clinical deformity of the lateral aspect of the ear that leads to its anteversion. The reason for this study is the controversial origin of the fold of the antihelix within the auricle framework, a field of interest for aesthetic otoplasty. The current study examined the medial surface of the cartilaginous ear frame from cadaver specimens with right morphology to investigate the starting point of the fold of the antihelix. This allowed for verification of a natural plica at the anatomic base of this antihelical fold, which to date has not had its topography described morphologically. It is acknowledged that relevant literature makes no reference to this innominate natural plica at the origin of the antihelix, whose anatomic and surgical importance is related in this report. This study aimed to show that the existence of a natural plica at the base of the antihelix in ear framing represents a landmark between normal and protruding ear morphology. METHODS: For 8 years, 118 ears were carefully investigated within rigid ethical principles based on a thorough review of the pertinent literature. The study investigated 16 selected cadaver specimens and 102 protruding ears dissected by the senior author including 49 bilateral cases (26 males and 23 females) and 4 unilateral cases (2 males and 2 females). Bifacial anthropometric measurements by calipers were used for documentation. RESULTS: A natural plica at the base of the antihelix was found in all cadaver ears selected with right morphology, whereas it was totally absent in every surgically treated protruding ear irrespective of color, gender, age, or ethnic origin. Ambilateral measures of the antihelix eminence certify the study object in normal specimens as well as its lack in abnormal ones. CONCLUSION: Technical and topographic knowledge that a natural plica exists at the anatomic base of the antihelix is a valuable key point in recognizing the normal external ear. In addition, the making of a natural plica is the first and most effective factor in the reconstruction of the antihelical fold and its absolute absence results in the pathologic condition for protruding ears. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A3 online Instructions to Authors. http://www.springer.com/00266 .
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Pabellón Auricular/anatomía & histología , Pabellón Auricular/cirugía , Procedimientos Quirúrgicos Otológicos/métodos , Procedimientos de Cirugía Plástica/métodos , Adolescente , Adulto , Cadáver , Cefalometría , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
ABSTRACT INTRODUCTION: Transcanal myringoplasty has the advantages of demanding lower operative time and minimal external incisions. It can be performed using the microscopic or endoscopic approach. In the last decade, the use of endoscopes in ear surgery has increased significantly. This technique may allow "around the corner" visualization of small recesses, through narrow spaces, without the aid of canalplasty in unfavorable ear canals. OBJECTIVE: To describe a case series of transcanal endoscopic myringoplasty performed in a university service. The characteristics, advantages, and disadvantages of this technique are also discussed. METHODS: A case series study, based on the chart review of patients submitted to transcanal endoscopic myringoplasty in the period from January of 2012 to October of 2014. RESULTS: Data from 22 patients were analyzed. Tympanic perforation closure three months after surgery was observed in 86.4% of all patients. There was statistically significant improvement in pure tone average thresholds after surgery (p < 0.001). CONCLUSION: Transcanal endoscopic myringoplasty is a feasible, safe, and effective procedure; it can be an alternative to microscopic surgery.
Resumo Introdução: A miringoplastia realizada por via transcanal possui como vantagens a maior rapidez do procedimento e menor incisão externa, podendo ser realizada com auxílio de microscópio ou endoscópio. Na última década tem sido observado um aumento do uso de endoscópios na cirurgia otológica. Essa técnica pode permitir melhor visibilização de espaços encobertos e estreitos, sem necessidade canaloplastia em meatos desfavoráveis. Objetivo: Descrever uma série de casos de miringoplastia endoscópica transcanal, em um serviço universitário, discutindo suas particularidades, vantagens e desvantagens. Método: Estudo de série de casos, baseado na revisão de prontuários dos pacientes submetidos a miringoplastia com uso exclusivo de endoscópio rígido, no período de Janeiro de 2012 a Outubro de 2014. Resultados: Foram analisados os dados de 22 pacientes. Na otoscopia pós-operatória, foi observado fechamento da perfuração timpânica em 86,4% dos pacientes, após 3 meses da intervenção. Para a amostra estudada, foi observada melhora funcional estatisticamente significante da média dos limiares tonais (PTA) após a cirurgia (p < 0,001). Conclusão: A miringoplastia endoscópica transcanal é um procedimento seguro, factível e efetivo, podendo ser realizado como alternativa à cirurgia microscópica.
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Humanos , Masculino , Femenino , Niño , Adulto , Procedimientos Quirúrgicos Otológicos/métodos , Perforación de la Membrana Timpánica/cirugía , Conducto Auditivo Externo/cirugía , Endoscopía/métodos , Miringoplastia/métodos , Estudios Transversales , Estudios de Cohortes , Resultado del Tratamiento , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Hospitales Universitarios , Microcirugia/métodosRESUMEN
INTRODUCTION: Transcanal myringoplasty has the advantages of demanding lower operative time and minimal external incisions. It can be performed using the microscopic or endoscopic approach. In the last decade, the use of endoscopes in ear surgery has increased significantly. This technique may allow "around the corner" visualization of small recesses, through narrow spaces, without the aid of canalplasty in unfavorable ear canals. OBJECTIVE: To describe a case series of transcanal endoscopic myringoplasty performed in a university service. The characteristics, advantages, and disadvantages of this technique are also discussed. METHODS: A case series study, based on the chart review of patients submitted to transcanal endoscopic myringoplasty in the period from January of 2012 to October of 2014. RESULTS: Data from 22 patients were analyzed. Tympanic perforation closure three months after surgery was observed in 86.4% of all patients. There was statistically significant improvement in pure tone average thresholds after surgery (p<0.001). CONCLUSION: Transcanal endoscopic myringoplasty is a feasible, safe, and effective procedure; it can be an alternative to microscopic surgery.
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Conducto Auditivo Externo/cirugía , Endoscopía/métodos , Miringoplastia/métodos , Procedimientos Quirúrgicos Otológicos/métodos , Perforación de la Membrana Timpánica/cirugía , Adulto , Niño , Estudios de Cohortes , Estudios Transversales , Femenino , Hospitales Universitarios , Humanos , Masculino , Microcirugia/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: Evaluate the feasibility of an adequate exposure with anatomical preservation of labyrinth structures through retrosigmoid transmeatal approach (RSA) in surgeries for resection of acoustic neuromas/vestibular schwannomas (VS). METHOD: Thirty patients underwent surgical resection and were preoperatively evaluated with fine slice high definition CT scans and 3D-MRI volumetric reconstructions. Extension of internal auditory canal (IAC) opening during surgery was measured using 3 mm right-angle calibrated hook and neuronavigation parameters. Postoperatively, the extension of IAC opening and integrity of the labyrinth were confirmed through preoperatively images procedures. RESULTS: The preoperative length of IACs varied between 7.8 and 12.0 mm (mean 9.3 mm, SD 0.98, 95%CI 8.9 to 9.6, and median 9.0 mm). Postoperative images demonstrated adequate opening of the IAC and semicircular channels integrity. CONCLUSION: A complete drilling of the posterior wall of IAC through the RSA is feasible and allows direct visualization of the IAC-fundus without damaging the semicircular canals.
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Oído Interno/cirugía , Neuroma Acústico/cirugía , Tratamientos Conservadores del Órgano/métodos , Canales Semicirculares/anatomía & histología , Estudios de Factibilidad , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Microcirugia/métodos , Persona de Mediana Edad , Neuroma Acústico/patología , Neuronavegación/métodos , Procedimientos Quirúrgicos Otológicos/métodos , Periodo Posoperatorio , Estudios Prospectivos , Reproducibilidad de los Resultados , Canales Semicirculares/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Carga TumoralRESUMEN
Objective Evaluate the feasibility of an adequate exposure with anatomical preservation of labyrinth structures through retrosigmoid transmeatal approach (RSA) in surgeries for resection of acoustic neuromas/vestibular schwannomas (VS). Method Thirty patients underwent surgical resection and were preoperatively evaluated with fine slice high definition CT scans and 3D-MRI volumetric reconstructions. Extension of internal auditory canal (IAC) opening during surgery was measured using 3 mm right-angle calibrated hook and neuronavigation parameters. Postoperatively, the extension of IAC opening and integrity of the labyrinth were confirmed through preoperatively images procedures. Results The preoperative length of IACs varied between 7.8 and 12.0 mm (mean 9.3 mm, SD 0.98, 95%CI 8.9 to 9.6, and median 9.0 mm). Postoperative images demonstrated adequate opening of the IAC and semicircular channels integrity. Conclusion A complete drilling of the posterior wall of IAC through the RSA is feasible and allows direct visualization of the IAC-fundus without damaging the semicircular canals. .
Objetivo Avaliar a possibilidade de exposição adequada preservando anatomia das estruturas labirínticas pelo acesso retrosigmóide-transmeatal (RSA) nas ressecções de schwannomas do vestibular (VS). Método Trinta pacientes foram submetidos à ressecção cirúrgica e avaliados no pré-operatório com tomografias de alta definição e reconstruções de ressonância magnética 3D. A extensão da abertura do conduto auditivo interno (CAI) foi medida e confirmada com parâmetros de neuronavegação. No pós-operatório, a extensão da abertura e a integridade do labirinto foram confirmadas por imagens de tomografia computadorizada. Resultados A extensão do CAI no pré-operatório apresentou variação de 7,8-12 mm (média 9,3 mm, DP 0,98, IC95% de 8,9-9,6 e mediana 9 mm). Imagens pós-operatórias demonstraram abertura adequada do IAC e integridade dos canais semicirculares. Conclusão A abertura completa da parede posterior do CAI pelo RSA é possível e permite a visualização direta do fundo do conduto sem prejudicar os canais semicirculares. .
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Femenino , Humanos , Masculino , Persona de Mediana Edad , Oído Interno/cirugía , Neuroma Acústico/cirugía , Tratamientos Conservadores del Órgano/métodos , Canales Semicirculares/anatomía & histología , Estudios de Factibilidad , Imagen por Resonancia Magnética/métodos , Microcirugia/métodos , Neuroma Acústico/patología , Neuronavegación/métodos , Procedimientos Quirúrgicos Otológicos/métodos , Periodo Posoperatorio , Estudios Prospectivos , Reproducibilidad de los Resultados , Canales Semicirculares/cirugía , Resultado del Tratamiento , Carga Tumoral , Tomografía Computarizada por Rayos X/métodosRESUMEN
INTRODUÇÃO: Orelha proeminente, popularmente conhecida como orelha em abano, é uma afecção muito frequente em nosso meio. Constitui a deformidade mais comum da cabeça e pescoço, prevalecendo em aproximadamente 5% da população em geral. O trabalho tem como objetivo demonstrar que, com a junção de técnicas cirúrgicas simples, é possível corrigir as deformidades e obter um ótimo índice de satisfação dos pacientes. MÉTODO: Um total de 60 pacientes de ambos os sexos, entre 11 e 40 anos foram submetidos à otoplastia bilateral entre fevereiro de 2009 e dezembro de 2010. RESULTADOS: Em todos os casos se realizou otoplastia bilateral. Não houve casos de hematomas, infecção de sítio cirúrgico ou cicatriz hipertrófica. Cicatrizes visíveis ou granulomas de corpo estranho na face posterior da orelha foram constatados em 5 casos (8,3%). Houve 1 caso de condrite. O índice de deformidade residual com 1 ano de pós-operatório ocorreu em 3 casos, sendo todos bilaterais. Recidiva total foi presenciada em 1 caso (1,7%). Após um ano da cirurgia, 56 pacientes (93,3%) consideraram o resultado como bom e estavam satisfeitos, 3 pacientes sofreram reintervenção por deformidade residual e em 1 caso ocorreu a recidiva total, em que o mesmo não desejou correção. CONCLUSÃO: O presente estudo vem demonstrar que a associação das técnicas de Mustardè com a de Furnas traz alto grau de satisfação, baixo índice de complicações, podendo ser realizada com tranquilidade em nível ambulatorial e com baixo custo.
INTRODUCTION: Prominent ears, popularly known as bat ears, are the most common deformity of the head and neck, occurring in approximately 5% of the general population. This study aims to demonstrate that, with the use of simple surgical techniques, it is possible to correct the deformity and achieve optimal patient satisfaction. METHOD: A total of 60 patients of both sexes, aged between 11 and 40 years, underwent bilateral otoplasty between February 2009 and December 2010. RESULTS: In all cases, bilateral otoplasty was performed. There were no cases of hematomas, surgical site infection, or hypertrophic scars. In 5 cases (8.3%) visible scars or foreign body granulomas were found in the posterior surface of the ear. Chondritis occurred in one patient. Bilateral residual deformity occurred in 3 cases at 1 year post-surgery. Total recurrence was observed in 1 case (1.7%). After one year of surgery, 56 patients (93.3%) considered the result as good and were satisfied, 3 patients underwent reintervention for residual deformity, and total recurrence occurred in 1 case, which the patient did not wish to correct. CONCLUSION: The present study demonstrates that concurrent use of the Mustardé and Furnas otoplasty techniques results in a high degree of satisfaction and a low rate of complications. The procedure can easily be performed at the outpatient level and at a low cost.
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Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Historia del Siglo XXI , Recurrencia , Procedimientos Quirúrgicos Otológicos , Estudio Comparativo , Estudio de Evaluación , Oído , Deformidades Adquiridas del Oído , Procedimientos Quirúrgicos Otológicos/métodos , Oído/cirugía , Deformidades Adquiridas del Oído/cirugíaRESUMEN
OBJECTIVES: To report the results of cochlear implantation via the middle fossa approach in 4 patients, discuss the complications, and present a detailed description of the programming specifications in these cases. STUDY DESIGN: Retrospective case review. SETTING: Tertiary-care referral center with a well-established cochlear implant program. PATIENTS: Four patients with bilateral canal wall down mastoid cavities who underwent the middle fossa approach for cochlear implantation. INTERVENTIONS: Cochlear implantation and subsequent rehabilitation. A middle fossa approach with cochleostomy was successfully performed on the most superficial part of the apical turn in 4 patients. A Nucleus 24 cochlear implant system was used in 3 patients and a MED-EL Sonata Medium device in 1 patient. The single electrode array was inserted through a cochleostomy from the cochlear apex and occupied the apical, middle, and basal turns. Telemetry and intraoperative impedance recordings were performed at the end of surgery. A CT scan of the temporal bones was performed to document electrode insertion for all of the patients. MAIN OUTCOME MEASURES: Complications, hearing thresholds, and speech perception outcomes were evaluated. RESULTS: Neural response telemetry showed present responses in all but 1 patient, who demonstrated facial nerve stimulation during the test. Open-set speech perception varied from 30% to 100%, despite the frequency allocation order of the MAP. CONCLUSION: Cochlear implantation via the middle cranial fossa is a safe approach, although it is a challenging procedure, even for experienced surgeons.
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Implantación Coclear/métodos , Fosa Craneal Media/cirugía , Pérdida Auditiva/terapia , Procedimientos Quirúrgicos Otológicos/métodos , Adulto , Umbral Auditivo/fisiología , Quimioradioterapia/efectos adversos , Colesteatoma del Oído Medio/complicaciones , Colesteatoma del Oído Medio/cirugía , Implantación Coclear/efectos adversos , Fosa Craneal Media/anatomía & histología , Enfermedades del Oído/terapia , Nervio Facial/fisiología , Femenino , Pérdida Auditiva Bilateral/cirugía , Humanos , Masculino , Apófisis Mastoides/cirugía , Persona de Mediana Edad , Monitoreo Fisiológico , Neoplasias Nasofaríngeas/complicaciones , Neoplasias Nasofaríngeas/terapia , Procedimientos Quirúrgicos Otológicos/efectos adversos , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Percepción del Habla , Telemetría , Hueso Temporal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: This report describes the authors' personal experience with an otoplasty technique used to correct several deformities of the auricular cartilage in prominent ears using a single surgical procedure. METHODS: This technique allows for correction of all alterations in prominent ears by acting on four basic sites of the auricular cartilage using incisions, microincisions, and microresections that shape the curvature of the auricular cartilage. This, combined with elliptical resection of the retroauricular skin, provides prompt reshaping of the ear, conferring a natural appearance. This technique was used for 897 patients ages 5 to 65 years for a period of 16 years (1994-2010). Of these patients, 304 had undergone previous otoplasty. The postoperative follow-up period for these patients was 1 to 14 years. RESULTS: This technique allowed for correction of prominent ears to achieve a natural appearance. It achieved complete satisfaction for 890 patients and a low rate of complications. Three cases of postoperative infection occurred, which were effectively controlled with antimicrobial treatment, and four cases of immediate postoperative hematoma occurred, which had no consequences because early drainage was used. There were no cases of keloids, hypertrophic scarring, or necrosis. CONCLUSIONS: This versatile and complete technique allows for correction of all deformities that constitute prominent ears. It is associated with a low rate of complications and relapses by preventing strain of the cartilage. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Asunto(s)
Oído Externo/anomalías , Oído Externo/cirugía , Estética , Procedimientos Quirúrgicos Otológicos/métodos , Procedimientos de Cirugía Plástica/métodos , Técnicas de Sutura , Adolescente , Adulto , Anciano , Anestésicos Locales/administración & dosificación , Niño , Disección/métodos , Pabellón Auricular/anomalías , Pabellón Auricular/cirugía , Cartílago Auricular/anomalías , Cartílago Auricular/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Complicaciones Posoperatorias/prevención & control , Reoperación , Adulto JovenRESUMEN
UNLABELLED: Since the 1970s, few studies have been conducted to elucidate the use of caloric tests on middle ear disorders, despite the many controversies that this test may produce in anatomical structures that are so distinct. In cases of mastoidectomy, such studies are even rarer. OBJECTIVE: This study aims to analyze the findings from air caloric stimulation done in individuals submitted to unilateral radical mastoidectomy without complaints of dizziness. MATERIALS AND METHOD: Thirty-six individuals without vestibular complaints were enrolled in this prospective study. Air caloric stimulation was offered to all subjects. Twenty-one individuals had undergone unilateral open mastoidectomy and 15 did not present any middle or outer ear abnormalities. RESULTS: 80.95% of the individuals presented asymmetrical responses in the cold caloric test, with greater response on the side of the open mastectomy. In 72.73% of the subjects the same effect was observed in the hot caloric test. The four stimulation modes revealed asymmetries in both hot and cold tests in 81.82% of the cases. Paradoxical stimulation was observed in 47.61% of hot caloric tests. CONCLUSION: Nystagmic responses on the side of the open mastoidectomy were greater than on the healthy side. Paradoxical stimulation in caloric tests was a frequent finding. No hypofunctioning responses were found.
Asunto(s)
Pruebas Calóricas/métodos , Oído Medio/fisiopatología , Apófisis Mastoides/cirugía , Adulto , Estudios de Casos y Controles , Electronistagmografía , Femenino , Humanos , Masculino , Procedimientos Quirúrgicos Otológicos/métodos , Estudios ProspectivosRESUMEN
Poucos trabalhos desde a década de 70 foram realizados a fim de elucidar a prova calórica em alterações da orelha média, apesar de inúmeras controvérsias que este exame pode trazer em estruturas anatômicas tão distintas. Na mastoidectomia radical, estes estudos são mais escassos. OBJETIVO: Este estudo teve como objetivo analisar os achados da estimulação calórica a ar em indivíduos com mastoidectomia radical unilateral sem queixas de tontura. MATERIAL E MÉTODO: Estudo prospectivo, realização da estimulação calórica a ar em 36 indivíduos sem queixas vestibulares, sendo 21 com cirurgia de mastoidectomia aberta unilateral e 15 sem nenhuma alteração na orelha média ou externa. RESULTADOS: 80,95% dos indivíduos apresentaram respostas assimétricas na prova calórica frias, sendo as respostas maiores do lado da mastoidectomia aberta. Em 72,73%, o mesmo efeito ocorreu com a prova calórica quente. Na análise das quatro estimulações, encontrou-se assimetria das provas quente e frias em 81,82% dos casos. Em 47,61%, foi encontrada estimulação paradoxal da prova calórica quente. CONCLUSÃO:As respostas nistágmicas do lado da mastoidectomia aberta foram maiores se comparadas com o lado saudável. A estimulação paradoxal da prova calórica quente foi um achado frequente. Não foram encontradas respostas hipofuncionantes.
Since the 1970s, few studies have been conducted to elucidate the use of caloric tests on middle ear disorders, despite the many controversies that this test may produce in anatomical structures that are so distinct. In cases of mastoidectomy, such studies are even rarer. OBJECTIVE: This study aims to analyze the findings from air caloric stimulation done in individuals submitted to unilateral radical mastoidectomy without complaints of dizziness. MATERIALS AND METHOD: Thirty-six individuals without vestibular complaints were enrolled in this prospective study. Air caloric stimulation was offered to all subjects. Twenty-one individuals had undergone unilateral open mastoidectomy and 15 did not present any middle or outer ear abnormalities. RESULTS: 80.95% of the individuals presented asymmetrical responses in the cold caloric test, with greater response on the side of the open mastectomy. In 72.73% of the subjects the same effect was observed in the hot caloric test. The four stimulation modes revealed asymmetries in both hot and cold tests in 81.82% of the cases. Paradoxical stimulation was observed in 47.61% of hot caloric tests. CONCLUSION: Nystagmic responses on the side of the open mastoidectomy were greater than on the healthy side. Paradoxical stimulation in caloric tests was a frequent finding. No hypofunctioning responses were found.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Pruebas Calóricas/métodos , Oído Medio/fisiopatología , Apófisis Mastoides/cirugía , Estudios de Casos y Controles , Electronistagmografía , Procedimientos Quirúrgicos Otológicos/métodos , Estudios ProspectivosRESUMEN
OBJECTIVE: To assess the laser-assisted curvature inversion technique for the treatment of patients with patulous Eustachian tube (PET). STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary care medical center. SUBJECTS AND METHODS: Eleven patients with Eustachian tube dysfunction underwent laser-assisted curvature inversion technique (CIT) of the medial and lateral lamina of the Eustachian tube. A KTP laser is used to cross-hatch the medial and lateral lamina of the tube to modify the curvature and to alter the spring of the posterior cushion. A change in the direction of the cartilaginous structure curvature is created to promote full closure of the patulous gap without interfering with the tube's muscular activity. None of the patients had any concurrent disease or additional surgical procedure. RESULTS: There were no surgical complications. Following CIT, subjective symptoms of autophony on nasal breathing improved in 9 of 11 patients (81.8%), while voice autophony improved in 8 patients (72.7%); posterior cushion curvature became inverted and less wide, and the valve was seen more closed postoperatively on simple endoscopy and slow-motion video-endoscopic analysis. On otoscopy, abnormal tympanic membrane excursions disappeared in 10 of 11 patients (90.9%). Mean immittance changes in tympanometric measurements for the forced respiration conditions improved postoperatively at least 0.05 mmhos in 9 of 11 patients (81.1%; P = .015). The follow-up period was 24 months. CONCLUSION: CIT appears to be a promising and relatively feasible technique for the treatment of PET.
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Enfermedades del Oído/cirugía , Trompa Auditiva/fisiopatología , Trompa Auditiva/cirugía , Terapia por Láser/métodos , Procedimientos Quirúrgicos Otológicos/métodos , Pruebas de Impedancia Acústica/métodos , Adulto , Estudios de Cohortes , Enfermedades del Oído/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Medición de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
Parotid fistulae are a very infrequent complication after ear reconstruction in microtia when the local conditions are favorable. We report 2 cases of salival fistulae after microtic ear reconstruction. Timing of the diagnosis is important to decide the treatment. We recommend conservative management by restricted citric diet in early postoperative salival fistulae and Botox injections in the case that it persists.
Asunto(s)
Toxinas Botulínicas/uso terapéutico , Oído Externo/anomalías , Oído Externo/cirugía , Asimetría Facial/cirugía , Procedimientos Quirúrgicos Otológicos/métodos , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/tratamiento farmacológico , Fístula de las Glándulas Salivales/tratamiento farmacológico , Niño , Femenino , Humanos , Ultrasonografía IntervencionalRESUMEN
OBJECTIVES: To determine the incidence of severe atelectatic otitis media and acquired cholesteatoma (AC) in children treated for congenital cholesteatoma (CC). METHODS: Retrospective chart review of 15 children who underwent primary surgery for CC over a 15 year period by a single surgeon. RESULTS: The mean postoperative follow up was 3.1 years. Significant tympanic retraction occurred in 6 children, included a retraction pocket that required T-tube insertion (3), and AC requiring tympanomastoid surgery (3). There was no complication related to retraction pocket in 9 children however 2 developed residual disease. In comparing the two groups, those with and without subsequent significant tympanic retraction, both groups had similar gender, age, extent of CC (median Potsic grade of 2), bone erosion, and surgical technique. Differences were noted in air-bone gap at presentation (PTA 32.4 and 17.25), otitis media with effusion in the contralateral ear (3/6 and 1/9), smaller mastoid volume ratio compared with the contralateral ear (0.74 and 1.21), and longer average timing for second surgery (14.8 months and 8 months). CONCLUSIONS: Acquired middle ear disease, including cholesteatoma, can follow surgical removal of CC, and long term follow up of all patients is required. Factors at initial evaluation indicative of risk of AC include a significant air-bone gap, otitis media with effusion in the contralateral ear and a smaller mastoid cavity ratio. The use of composite grafts at the time of CC surgery should be considered. Additionally, our findings suggest that the mastoid volume plays a causative role in the development of AC.