Otology

Modified radical mastoidectomy and its complications-12 years' experience

May 7, 2014     Sardar U. Khan, DLO, FCPS, FRCS(Ire); Rajesh K. Tewary, MS, FRCS(Ed); Timothy J. O'Sullivan, FRCS(Canada)
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Abstract

To find the incidence of complications of modified radical mastoidectomy and to evaluate different parameters that play a role in their causation, we conducted a retrospective study spanning a period of 12 years. Included were 210 patients who underwent primary modified radical mastoidectomies performed by one senior surgeon; of these patients, 163 fulfilled the inclusion criteria. The charts were evaluated for patients' age and sex, laterality, intraoperative pathology, and complications. The complications were grouped into nine categories for analysis of their etiology. The results in this study were compared with those from other published reports. Complications were documented in 46 of 163 (28.2%) operated ears; 21 (45.7%) of them were noted in children <15 years of age, and 25 (54.3%) were found in adults. Sex and laterality were of no significance. The most common complication recorded was residual/recurrent cholesteatoma (20 [12.3%]), followed by meatal stenosis (11 [6.7%]). A moist cavity with discharging ear was noted in only 4 (2.5%) patients. No facial nerve palsies or dead ears were observed. Eleven (6.7%) patients had more than one complication. The parameters evaluated were size of the meatus, tympanic membrane appearance, status of the mastoid cavity, height of the facial ridge, and extent of the disease process. Complications can be caused by a number of factors, such as congenital anomalies, disease process, and the surgeon's skill. Each complication must be thoroughly evaluated for immediate management and to learn how to avoid it in the future.

Prevalence and correlates of dizziness in the Ibadan Study of Ageing

May 7, 2014     Akeem O. Lasisi, MBChB, FWACS, FMCORL; Oye Gureje, MBBS, PhD, DSc
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Abstract

Dizziness is common among older people, but little is known about its prevalence and risk factors in the sub-Saharan population. We conducted a cross-sectional study to determine the prevalence of dizziness and its sociodemographic, lifestyle, and clinical correlates in 1,299 subjects-551 men (42.4%) and 748 women (57.6%), aged 65 years and older (mean: 77.3 ± 6.3)-who lived in the Yoruba-speaking areas of Nigeria. Among this group, 318 persons reported dizziness, which represents a prevalence of 24.5%. Univariate analysis of sociodemographic and lifestyle variables revealed that low economic status (p = 0.05) and smoking (p = 0.01) were significantly correlated with dizziness; however, on logistic regression analysis, only smoking (p = 0.01) was found to be significant. Neither sex (p = 0.07), age (p = 0.71), area of residence (p = 0.34), education level (p = 0.74), nor alcohol consumption (p = 0.44) had a significant correlation with dizziness. On multivariate modeling, significant clinical correlates in patients with dizziness included self-reports of a history of suppurative otitis media (p = 0.01), head injury (p = 0.03), and recurrent rhinosinusitis (p = 0.01); no significant correlation was seen between dizziness and hypertension, transient ischemic attack, and diabetes. Finally, balance testing conducted in a subset of 1,006 subjects revealed poor balance in 93 of 250 persons with dizziness (37.2%) and in 189 of 756 subjects without dizziness (25.0%) (p = 0.01). Logistic regression analysis of sex and age revealed that the probability of poor balance was 1.5 times greater among those persons with dizziness. We conclude that the high incidence of dizziness among community-dwelling elderly and its significant correlations with remediable medical conditions suggest the need for policy formulation for the care of the elderly in Nigeria.

Necrotizing fasciitis of the ear: An unusual case

March 18, 2014     Jessica L. Gullung, MD; Jacob E. Smith, MD; April D. Hendryx, DO; Krishna G. Patel, MD, PhD
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Abstract

We describe a rare case of necrotizing fasciitis of the ear in an otherwise generally healthy 39-year-old man. The ear is rarely involved in this often-fatal disease. The diagnosis was suspected on the basis of clinical examination and confirmed by computed tomography and pathology of a biopsy specimen, which revealed subcutaneous gas formation and dermal infiltration of inflammatory cells, respectively. The patient was promptly treated with surgical debridement, intravenous antibiotics, and hyperbaric oxygen. He recovered well and subsequently underwent otoplastic reconstruction with very satisfactory results. By documenting this case, we aim to heighten awareness of necrotizing fasciitis of the head and neck in an effort to improve survival rates.

Bilateral external auditory canal cholesteatomas

March 18, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Robert W. Jyung, MD
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External auditory canal cholesteatomas may be classified as idiopathic or secondarily acquired, most commonly occurring in postoperative or post-traumatic settings.

Implants in otology

March 18, 2014     Barry E. Hirsch, MD
article

Progress in technology facilitates progress in patient care.

Nonmicroscopic reconstruction of subtotally amputated/torn auricles: Report of 3 cases

February 12, 2014     Shuaib K. Aremu, FWACS
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Abstract

Otolaryngologists are increasingly expected to perform a variety of minor surgical procedures in both elective and emergency situations. Surgical repair of the subtotally amputated/torn auricle, hitherto the realm of plastic surgeons, is a procedure that can be performed both at the clinic and in the emergency room, thereby sparing patients the inconvenience and cost of referral to another subspecialist. Presented in this article are 3 cases of traumatic tearing/amputation of the external ear: 1 caused by a motorbike accident, 1 caused by a human bite, and 1 by a machete. All three ears were successfully reconstructed nonmicrovascularly.

Unilateral sensorineural hearing loss and facial nerve paralysis associated with low-voltage electrical shock

February 12, 2014     Mahmut Ozkiris;, MD
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Abstract

Electrical injuries can occur as a result of contact with low- or high-voltage electricity. Low-voltage injuries are more common, as they usually occur in the home, but reports in the literature are few. After exposure to electric current, almost every organ system in the body is affected. The severity of an injury depends on many factors, including the type of current, the duration of exposure, and the resistance of the tissue involved. Reported cases of hearing loss and facial nerve paralysis associated with low-voltage electrical shock are rare, and minimal information is available about this circumstance. In this article, the author describes a case of low-voltage electrical shock in a 20-year-old man. To the best of the author's knowledge, this is the first report in the literature of a resolution of unilateral sensorineural hearing loss and facial nerve paralysis caused by a low-voltage electrical shock.

Recurrent auricular perichondritis in a child as the initial manifestation of insulin-dependent diabetes mellitus: A case report

February 12, 2014     Andria M. Caruso, MD; Macario Camacho Jr., MD; and Scott Brietzke, MD
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Abstract

An 8-year-old boy presented to our otolaryngology clinic three times in a 3-month period for treatment of acute auricular perichondritis. At each visit he was treated with an antibiotic, and he responded quickly in each case, with a complete resolution of his infection. The results of standard autoimmune laboratory tests were negative. Three months after his initial presentation, the patient developed the classic signs and symptoms of diabetes mellitus, including polydipsia, polyuria, and weight loss. He was diagnosed with and treated for type 1 (insulin-dependent) diabetes, and his recurrent infections ceased. There has been no recurrence over a 4-year follow-up period. This case report serves to illustrate the fact that recurrent infections may be the first sign of diabetes. Since diabetes and perichondritis are known to be associated, we recommend that for patients who present with recurrent episodes of perichondritis, a basic metabolic panel and measurement of the glycosylated hemoglobin level be added to standard autoimmune laboratory testing to possibly identify undiagnosed diabetes.

Eosinophilic otitis media

February 12, 2014     Alejandro Vazquez, MD; Danielle M. Blake, BA; and Robert W. Jyung, MD
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Eosinophilic otitis media is refractory to conventional therapy for otitis media and may lead to severe hearing impairment if not recognized promptly.

Delayed recovery of speech discrimination after fractionated stereotactic radiotherapy for vestibular schwannoma in neurofibromatosis 2

February 12, 2014     Michael Hoa, MD; Eric P. Wilkinson, MD; and William H. Slattery III, MD
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Abstract

Hearing loss commonly occurs after radiation therapy for an acoustic neuroma, and it is highly unusual for hearing to return after a prolonged period of time. We report the case of a 12-year-old boy with neurofibromatosis 2 who underwent fractionated stereotactic radiotherapy for the treatment of a left-sided vestibular schwannoma. Following treatment, he demonstrated an elevation of pure-tone audiometric thresholds and a sudden decrease in speech discrimination score (SDS) to 0%. However, 20 months postoperatively, his SDS suddenly and spontaneously rose to 92%, although there was no improvement in his speech reception threshold. We discuss the possible reasons for the unusual outcome in this patient.

A case of direct intracranial extension of tuberculous otitis media

February 12, 2014     Dong-Kee Kim, MD; Shi-Nae Park, MD, PhD; Kyung-Ho Park, MD, PhD; and Sang Won Yeo, MD, PhD
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Abstract

We describe a very rare case of tuberculous otitis media (TOM) with direct intracranial extension. The patient was a 55-year-old man who presented to our ENT clinic for evaluation of severe headaches and right-sided otorrhea. A biopsy of granulation tissue obtained from the right external auditory canal demonstrated chronic inflammation that was suggestive of mycobacterial infection. Magnetic resonance imaging of the brain indicated intracranial extension of TOM through a destroyed tegmen mastoideum. After 2 months of antituberculous medication, the headaches and otorrhea were controlled, and the swelling in the external ear canal subsided greatly. Rarely does TOM spread intracranially. In most such cases, intracranial extension of tuberculosis occurs as the result of hematogenous or lymphogenous spread. In rare cases, direct spread through destroyed bone can occur, as it did in our patient.

Basaloid squamous cell carcinoma of the pinna: Report of a rare case

January 21, 2014     Anil Jain, MS; Ashish Katarkar, MS; Pankaj Shah, MS; Jignasa Bhalodia, MD; Sanyogita Jain, MD; Sapna Katarkar, DA
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Abstract

Basaloid squamous cell carcinoma (BSCC) is rare. We report a case of BSCC in a 60-year-old woman who presented with a bleeding vascular growth on the left pinna. To the best of our knowledge, no case of BSCC of the pinna has been previously reported in the literature. We present this case to alert physicians that this highly aggressive variant of squamous cell carcinoma can appear on the pinna and therefore it should be considered in the differential diagnosis of lesions in this area.

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