Otology

Transient auditory dysfunction: A description and study of prevalence

August 21, 2013     Laurence Maximilian Almond, MB ChB; Ketul Patel, MB ChB; and Darius Rejali, MB ChB
article

Abstract

Transient auditory dysfunction (TAD) is a previously undescribed symptom complex of unknown cause. It is characterized by short-lasting sensorineural hearing loss (unilateral or bilateral), it is associated with tinnitus, it resolves completely within minutes, and it is not accompanied by vestibular symptoms. We conducted a cross-sectional prospective study to define TAD, find its prevalence, and discuss its significance. Two hundred healthy subjects between the ages of 16 and 49 years were surveyed using a questionnaire. Of these subjects, 41 (20.5%) reported experiencing symptoms of TAD. The mean number of episodes was 5.9 times per month, the mean duration was 41 seconds, and 80% experienced concomitant tinnitus. We conclude that TAD is a common finding in a healthy population. This may have implications for the pathogenesis of sudden-onset sensorineural hearing loss. Further longitudinal studies and detailed audiologic evaluation of patients with TAD are required to ascertain the significance, etiology, and pathophysiology of this condition.

Subcutaneous emphysema and pneumolabyrinth plus pneumocephalus as complications of middle ear implant and cochlear implant surgery

July 21, 2013     Brian J. McKinnon, MD, MBA; Tamara Watts, MD, PhD
article

Abstract

We conducted a retrospective case review at a tertiary academic medical center for the complications of pneumolabyrinth with pneumocephalus and subcutaneous emphysema after surgery for middle ear and cochlear implants. Charts of 76 cochlear implant and 2 middle ear implant patients from January 2001 through June 2009 were reviewed. We identified 1 cochlear implant recipient with pneumolabyrinth and pneumocephalus, and 1 middle ear implant recipient with subcutaneous emphysema. Surgical exploration was performed for the pneumolabyrinth with pneumocephalus; the subcutaneous emphysema was managed conservatively. The patient with the cochlear implant, who had had a ventriculoperitoneal shunt placed, experienced pneumolabyrinth with pneumocephalus 6 years after uneventful surgery. Middle ear exploration revealed no residual fibrous tissue seal at the cochleostomy. The middle ear and cochleostomy were obliterated with muscle, fat, and fibrin glue. The ventriculoperitoneal shunt was deactivated, with clinical and radiographic resolution. On postoperative day 5, the patient who had undergone the middle ear implant reported crepitance over the mastoid and implant device site after repeated Valsalva maneuvers. Computed tomography showed air surrounding the internal processor. A mastoid pressure dressing was applied and the subcutaneous emphysema resolved. These 2 cases support the importance of recognizing the clinical presentation of pneumolabyrinth with associated pneumocephalus, as well as subcutaneous emphysema. Securing the internal processor, adequately sealing the cochleostomy, and providing preoperative counseling regarding Valsalva maneuvers and the potential risk of cochlear implantation in the presence of a ventriculoperitoneal shunt may prevent adverse sequelae.

Using a capsule flap for the reconstruction of a partial auricular defect

July 21, 2013     Barsil Keklik, MD; Memet Yazar, MD; Karaca Basaran, MD; Erdem Guven, MD; Samet Vasfi Kuvat, MD
article

Abstract

In this article we describe the capsular flap for covering the posterior surface of cartilaginous framework in ear reconstruction. This technique has not been previously described in the published literature.

Degraded tympanostomy tube in the middle ear

July 21, 2013     Nitin J. Patel, MD; Joshua Bedwell, MD; Nancy Bauman, MD; Brian K. Reilly, MD
article

Tympanostomy tubes can cause a foreign-body reaction that can lead to myringitis and the development of granulation tissue and polyps.

Large osteoma of the external auditory canal

July 21, 2013     Takashi Iizuka, MD; Takuo Haruyama, MD; Keiko Nagaya, MD
article

Cicatricial external auditory canal stenosis caused by ectodermal dysplasia: Rapp-Hodgkin syndrome

June 11, 2013     Amanda B. Sosulski, MD and James D. Hayes, MD
article

Abstract

We present a case of recurrent cicatricial stenosis of the external ear canals caused by ectodermal dysplasia, specifically Rapp-Hodgkin syndrome, in a 45-year-old woman. No form of medical or surgical management has produced durable patency of the patient's ear canals, and her hearing loss is being managed with hearing aids. Topical management of the recurring external otitis slows the process but has been unsuccessful in preventing restenosis of both external auditory canals.

Pressure ulcer of the pinna

June 11, 2013     Mainak Dutta, MS; Soumya Ghatak, MS; and Ramanuj Sinha, DLO, MS, DNB
article

Pressure ulcers over the pinna usually develop as a result of local compression from oxygen mask tubing.

Traumatic ossicle extrusion into the external auditory canal

June 11, 2013     Manish Gupta, MS(ENT); Sunder Singh, MS(ENT); and Monica Gupta, MD(Med)
article

Abstract

We report a rare case of incus dislocation into the external auditory canal following a head injury. The patient was a 35-year-old man who presented to the surgical emergency unit with a head injury that he had sustained during a traffic accident. An x-ray of the skull detected a longitudinal fracture of the right temporal bone. The ENT examination revealed the presence of a bony structure and a blood clot in the right external auditory canal. Computed tomography identified a disruption of the ossicular chain, with an incus-like bony shadow in the external canal. The wide opening of the fracture line and the impact of the accident were believed to have pushed the incus through the fracture and into the external canal. The patient was successfully treated with exploratory tympanotomy and ossiculoplasty.

Outcomes following ossicular chain reconstruction with composite prostheses: Hydroxyapatite-polyethylene vs. hydroxyapatite-titanium

June 11, 2013     Yoav Hahn, MD; and Dennis I. Bojrab, MD
article

Abstract

We conducted a retrospective study to compare the results of ossicular chain reconstruction (OCR) with two types of composite prosthesis: a hydroxyapatite-polyethylene (HAPEX) implant and a hydroxyapatite-titanium (HATi) prosthesis. We reviewed the records of 222 patients-104 males and 118 females, aged 8 to 79 years (mean: 39.7)-who had undergone OCR for ossicular chain dysfunction and who met our eligibility criteria. In addition to demographic data and the type of prosthesis, we compiled information on pre- and postoperative audiometric findings, the underlying diagnosis, the timing of surgery (primary, planned, or revision), the type of surgery (tympanoplasty alone, tympanoplasty with antrotomy, intact-canal-wall tympanomastoidectomy, or canal-wall-down tympanomastoidectomy), the extent of reconstruction (partial or total), the use of the malleus, the use of a tragal cartilage graft, and evidence of extrusion. Of the 222 patients, 46 had undergone insertion of either a partial (n = 36) or total (n = 10) ossicular replacement prosthesis (PORP and TORP, respectively) made with HAPEX, and 176 had received a PORP (n = 101) or TORP (n = 75) made with HATi. Postoperatively, the mean air-bone gap (ABG) was 14.0 dB in the HAPEX group and 14.7 dB in the HATi group, which was not a significant difference (p = 0.61). Postoperative success (ABG ≤20 dB) with PORP was obtained in 30 of the 36 patients in the HAPEX group (83.3%) and in 87 of the 101 patients in the HATi group (86.1%), while success with TORP was achieved in 7 of 10 HAPEX patients (70.0%) and 56 of 75 HATi patients (74.7%); there was no significant difference in either PORP or TORP success rates between the HAPEX and HATi groups (p = 0.32). A significantly better hearing result was obtained when the malleus was used in reconstruction (p = 0.035), but the use of tragal cartilage led to a significantly worse outcome (p = 0.026). Revision surgery was associated with a significantly worse postoperative result (p = 0.034). Prosthesis extrusion was observed in 9.0% of all cases. The two types of composite assessed in this study yielded similar results in terms of functional hearing and stability, but the HATi prosthesis had some significant advantages. For example, it was associated with more cases in which the ABG closed to less than 10 dB. In addition, because of its thinner stem and lower profile, it can be used in situations that are not possible with the HAPEX implant.

Evolution of acute otitis media

April 17, 2013     Joseph A. Ursick, MD; Jose N. Fayad, MD
article

Treatment for acute otitis media (AOM) ranges from watchful waiting to myringotomy with or without tube placement.

Endolymphatic sac tumor

April 17, 2013     Lester D.R. Thompson, MD
article

A study of persistent unilateral middle ear effusion caused by occult skull base lesions

April 17, 2013     John P. Leonetti, MD
article

Abstract

The goal of this article is to review a series of patients with persistent unilateral middle ear effusion (MEE) and to suggest a more contemporary diagnostic algorithm. The author conducted a retrospective chart review of adults with persistent unilateral MEE and normal findings on physical and nasopharyngoscopic examinations whose MEE was eventually found to be caused by a variety of occult skull base lesions. The study population was made up of 79 patients-52 women and 27 men, aged 21 to 83 (mean: 54.8) at presentation-who had been referred to an academic tertiary care medical center between July 1, 1988, and June 30, 2008. Follow-up ranged from 9 months to 19.5 years (mean: 8.7 yr). Of this group, 50 patients (63.3%) had a malignant tumor, 26 (32.9%) had a benign tumor, and 3 (3.8%) had an internal carotid artery aneurysm. Eustachian tube occlusion had been caused by diffuse invasion in 33 patients (41.8%), by intracranial pathology in 24 (30.4%), and by extracranial-infratemporal lesions in 22 (27.8%). Nasopharyngoscopy cannot identify a variety of rare skull base lesions that cause eustachian tube compression or tissue invasion that ultimately leads to MEE. Therefore, patients with unexplained persistent unilateral MEE should undergo coronal magnetic resonance imaging or computed tomography to look for any intra- or extracranial lesions before undergoing ventilation tube placement.

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