Otitis

Myringostapediopexy after tympanomastoidectomy

August 31, 2007     Matthew Taljebini, MD; Eric P. Wilkinson, MD; Jose N. Fayad, MD
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A 53-year-old man presented with chronic otitis media in the right ear and a cholesteatoma in the right ear. Audiometric testing revealed a high-frequency sensorineural hearing loss in both ears and a mixed hearing loss in the right ear.

A comparison of outcomes following tympanostomy tube placement or conservative measures for management of otitis media with effusion

August 31, 2007     Svetlana Diacova, MD; Thomas J. McDonald, MD
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Abstract
We obtained the charts of 183 patients (197 ears) who had undergone surgery for chronic otitis media (COM), and we reviewed their otic histories to analyze the series of events that ultimately culminated in surgery. All ears had originally been treated for otitis media with effusion (OME); 125 ears had been treated with tympanostomy tube placement, and 72 ears had been treated with conservative measures. Our goal was to compare the influence that these two strategies had on the subsequent development of COM and its sequelae (i.e., retraction pockets, tympanic membrane perforations, and cholesteatomas) and thereby determine which strategy is preferable. We found that although retraction pockets developed in a significantly higher proportion of the tympanostomy-treated ears than the conservatively treated ears (58 vs. 35%; p < 0.01), a significantly greater percentage of retractions in the tympanostomy-treated ears were mild and situated in the anterior part of the tympanic membrane (52 vs. 32%; p < 0.05). Moreover, severe retractions were significantly more common in the conservatively treated ears (40 vs. 16%; p < 0.02); the incidence of complete retractions in the two groups of ears was similar (tympanostomy: 32%; conservative treatment: 28%). Cholesteatomas developed in a significantly lower percentage of tympanostomy-treated ears (67 vs. 81%; p < 0.05), and the incidence of large cholesteatomas that involved the tympanic and mastoid cavities was likewise significantly lower in these ears (44 vs. 69%; p < 0.05). There was no significant difference in the incidence of tympanic membrane perforations. Finally, even though all of these ears eventually required surgery for COM, the tympanostomy-treated ears required significantly fewer repeat surgeries (16 vs. 28%; p < 0.05) and significantly fewer radical modified tympanomastoidectomies (30 vs. 44%; p < 0.05). Therefore, we conclude that myringotomy with insertion of tympanostomy tubes to treat OME is superior to conservative treatment.

Unilateral hearing impairment in Oman: A community-based cross-sectional study

April 30, 2007     Mazin Al Khabori, FRCS (ENT); Rajiv Khandekar, Dip (Epi), MS (Ophth)
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Cerebrospinal fluid otorrhea presenting in complicated chronic suppurative otitis media

March 31, 2007     Vikram Bhat, MS, DNB, MNAMS (ORL-HNS); Dandinarasaiah Manjunath, MBBS
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Update on the medical and surgical treatment of chronic suppurative otitis media without cholesteatoma

September 30, 2006     Patrick J. Antonelli, MD, MS, FACS
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AOM and AOMT are different entities

September 30, 2006     Michael D. Poole, MD, PhD
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Are topical quinolones safe for middle ear use in children?

September 30, 2006     Joseph E. Dohar, MD, MS, FAAP, FACS
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Incorporating the endoscope into middle ear surgery

August 31, 2006     Shehzad Ghaffar, FCPS, FRCS; Mubasher Ikram, FCPS; Sadaf Zia, FCPS; Ahsan Raza, MSc
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Abstract
We conducted a study to evaluate the use of a pediatric rigid otoendoscope for determining the extent of middle ear disease and for assessing ossicular integrity and mobility during tympanoplasty. Our study population was made up of 132 patients who were undergoing surgery for the treatment of chronic suppurative otitis media; of this group, 41 patients underwent otoendoscopy and 91 underwent scutum lowering for purposes of visualization. In the otoendoscopy group, the ossicles were successfully visualized and their mobility assessed in 34 patients; the remaining 7 patients subsequently underwent scutum lowering. A 30° endoscope allowed for complete visualization of the middle ear in almost all of the 34 cases. The mean duration of surgery for the 34 patients in the otoendoscopy group was 62.85 minutes (±15.57), which was significantly shorter than the duration of surgery (71.23 ± 15.65 min) for the 98 patients who underwent scutum lowering (p < 0.005). A total of 50 patients required less than 60 minutes of surgical time-26 of 34 (76.5%) in the endoscopy group and 24 of 98 (24.5%) in the scutum-lowering group. Statistical analysis revealed that the possibility of completing a procedure in less than 60 minutes was 73.65% (±12.56%) when endoscopy was used and 58.62% (±12.60%) when scutum lowering was used-again, a statistically significant difference (p < 0.005). We conclude that incorporation of an angled otoendoscope into middle ear surgery is a worthwhile alternative to scutum lowering.
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