Cerebrospinal Fluid Gusher in Cochlear Implantation and Its Association with Inner-Ear Malformations.

BACKGROUND: It is aimed to investigate the incidence of cerebrospinal fluid gusher in cochlear implantation and the association between cerebrospinal fluid gusher and inner-ear malformations in adult and pediatric patients. METHODS: A retrospective case review of 1025 primary cochlear implantation procedures was performed. Patients with inner-ear malformation or cerebrospinal fluid gusher during primary cochlear implantation were included and divided into 2 groups according to age: pediatric and adult groups. RESULTS: The incidence of inner-ear malformation was 4.19% (17/405) and 7.6% (47/620) in the adult and pediatric groups, respectively. There was a significant difference in the incidence of inner-ear malformation in the pediatric group. The incidence of cerebrospinal fluid gusher was 0.9% (4/405) and 4.1% (26/620) in the adult and pediatric groups, respectively. There was a significant difference in the incidence of gusher between the adult and pediatric groups. CONCLUSION: The incidence of a cerebrospinal fluid gusher is higher in the pediatric group, compared to adults due to a higher rate of inner-ear malformation. Inner-ear malformation poses a risk factor for cerebrospinal fluid gusher.

Otitis media prone children with cystic fibrosis: A new normal.

OBJECTIVES: To determine if children with cystic fibrosis (CF) who are otitis media prone and treated with tympanostomy tube placement (TTP) follow the natural course of non-CF children regarding the incidence of tympanostomy tube otorrhea (TTO) (21-34%). METHODS: All CF patients seen at a large tertiary pediatric hospital were retrospectively reviewed from 2010 to 2019. A total of 483 patients were identified and seventeen met the inclusion criteria and were included in the analysis. Data collected included demographics, CF diagnosis history including date of diagnosis and genotype, TTP notes, and otorrhea found in otolaryngology clinic and pediatrician clinic notes for up to 18 months post-TTP. RESULTS: CF was diagnosed at a median age of 13 days (0 days to 6 years). In terms of surgical frequency, 14/17 (82.4%) patients had one TTP, 2/17 (11.8%) had two TTPs, and 1/17 (5.9%) had five TTPs. The median (range) age at first TTP was 2 years (3 months to 13 years). After the first TTP, TTO occurred in 5 (29.4%) patients at 3 months, 6 (35.3%) at 6 and 9 months, and 7 (41.2%) at 12 and 18 months at median (range) = 1 (0-5) otolaryngology appointments and median (range) = 0 (0-8) pediatrician appointments. CONCLUSION: To our knowledge this is the first study to report that CF children are more likely to be severely affected with recurrent acute otitis media (RAOM), to require TTP, and to exhibit a natural history of TTO commensurate with the non-CF population.

Cerebrospinal fluid gusher in cochlear implant and its associated factors.

Introduction: Cochlear implants (CI) is considered a safe procedure with overall complication rate of 12.5% amongst adult and pediatric population. Cerebrospinal fluid (CSF) gusher is regarded as a common CI intraoperative complication.Objective: In this study, we determined the association between probable associated factors and occurrence of intraoperative CSF gusher.Method: In a retrospective survey, 394 patients with severe to profound sensorineural hearing loss who underwent primary cochlear implantation surgery were evaluated. Patients with incomplete electronic or manual file and those with revision, explantation or reimplantation surgery were excluded.Result: three hundred and ninety-four CI patients with a mean age of 8.74 ± 12.21 years were reviewed 49.62% of them were female. CSF gusher developed in 22 patients (5.58%). Patients with CSF gusher had more structural abnormalities in their CT scans' report. Common cavity malformation and Mondini dysplasia were the most common abnormal reports amongst those with intra-operative CSF gusher.Conclusion: In conclusion, cochlea structural abnormalities affect the incidence of CSF gusher in CI recipients. Common cavity malformation and Mondini dysplasia were associated with an increased incidence of CSF gusher. We insist on more precise pre-operative imaging of those with abnormal cochlea structures to provide the needed management.

Cerebrospinal fluid leak during stapes surgery: Gushing leaks and oozing leaks, two different phenomena.

Cerebrospinal fluid (CSF) leak is an uncommon event that can occur during stapes surgery. Such leaks can be classified as gushing leaks (stapes gushers) and oozing leaks. A stapes gusher is a massive flow of CSF through the perforated footplate that fills the middle ear suddenly, while an oozing leak is a slower and less profuse flow. We conducted a retrospective, observational, multicenter study of 38 patients-23 men and 15 women, aged 23 to 71 years (mean: 47)-who had experienced a CSF leak during stapes surgery. Patients were divided into various groups according to the type of surgical procedure performed and the type of postoperative complications they experienced. Audiometric and clinical evaluations were carried out pre- and postoperatively. Correlations among surgical variations (total or partial stapedectomy, placement of a prosthesis), hearing outcomes, and the incidence of postoperative complications (postoperative CSF leak and vertigo) were studied. Our statistical analysis revealed that gushing leaks and oozing leaks result in different degrees of hearing impairment and different rates of complications. We recommend that an individual approach be used to manage these complications.

Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas.

OBJECTIVE: To assess the advantages and limitations of the endoscopic endonasal approach to anterior skull base meningiomas, a minimally invasive approach that avoids extensive bone drilling, brain retraction, and manipulation of nerves and critical vessels, versus open transcranial surgery. METHODS: A MEDLINE (2000-2010) search was performed to identify series for either olfactory groove meningiomas or tuberculum sellae (TS) or planum sphenoidale meningiomas. Statistical analyses of categorical variables such as extent of resection, morbidity, and visual outcome were performed using χ(2) and Fisher exact tests. RESULTS: The literature review included 60 studies, involving 1426 patients. Open surgery achieved a higher rate of gross total resection (GTR) for both olfactory groove (P < 0.001) and TS and planum (P < 0.001) meningiomas. Postoperative cerebrospinal fluid (CSF) leak occurred more frequently in the endoscopic cohort (P < 0.001). Other postoperative complications occurred more frequently in the open cohort, although this difference was not statistically significant. There were no significant differences in postoperative visual outcome between the groups. CONCLUSIONS: Based on the current literature, open transcranial approaches for olfactory groove and TS and planum sphenoidale meningiomas still result in higher rates of total resection with lower postoperative CSF leak rates. The endoscopic endonasal approach may be safe and effective for certain skull base meningiomas; careful patient selection and multilayer closure techniques are essential.

Complications and clinical analysis of 416 consecutive cochlear implantations.

OBJECTIVES: Cochlear implantation is a safe technique with a relatively low complication rate. However, certain complications may require specific attention to treat. The purpose of this study was to investigate complications of cochlear implantation for prevention and therapy. STUDY DESIGN: Retrospective case series at a tertiary referral center in China. METHODS: The patients (n=416) who received cochlear implants in our department between 2000 and 2010 were followed up (range, 3 months to 10 years). The complications were identified as "minor" or "major". All complications were systematically reviewed, and their causes were analyzed for prevention and therapy. RESULTS: There were a total of 29 complications (7%). The minor were 23 cases (5.5%), including postoperative subcutaneous hematoma in 13 cases, acute otitis media in 2 cases, postoperative wound infection in 2 cases, delayed facial paralysis in 1 case, clonic facial spasm in 1 case, and severe vertigo in 4 cases. The major were 6 cases (1.5%), including cerebrospinal fluid leakage in 2 cases, implant-related infection and extrusion in 1 case, tympanic membrane perforation induced electrode exposed in 1 case, implantation failure due to cochlear ossification in 1 case, and magnet displacement in 1 case. CONCLUSIONS: Although cochlear implantation is popular, it is essential to decrease the incidence of complications.

Association between cerebrospinal fluid leak and meningitis after skull base surgery.

BACKGROUND: Meningitis and cerebrospinal fluid (CSF) leak are serious complications of skull base surgery, but whether postoperative CSF leak increases the risk of meningitis is unknown. OBJECTIVE: To evaluate any association between meningitis and CSF leak after open or endoscopic skull base resection. STUDY DESIGN AND SETTING: A retrospective case series with chart review in a tertiary care university-affiliated medical center. METHODS: A total of 156 patients underwent intradural tumor resection in our institution between 1994 and 2009, 135 (86%) via the subcranial approach and 21 (14%) through the expanded endonasal approach. All occurrences of meningitis, brain abscess, and CSF leak had been recorded and were available for analysis. RESULTS: Nine patients (5.7%) had postoperative meningitis, and 3 patients had postoperative CSF leak (1.9%). The risk of meningitis in patients without CSF leak was 4.5% (7/153) compared to 66% (2/3) in those with CSF leak. A statistical analysis revealed a significant association between CSF leak and meningitis, with a relative risk of 14.6 (95% confidence interval, 4.95-42; P = .008). CONCLUSION: Postoperative CSF leak significantly increases the risk of meningitis. Most cases of meningitis after skull base operation are probably associated with lumbar drainage infection or from an obscure leak.

Management and outcome of pediatric skull base fractures.

OBJECTIVE: The management of skull base fractures in the pediatric age group continues to be a major challenge even for experienced multidisciplinary teams. This retrospective study was undertaken at a tertiary care academic hospital to evaluate the management and outcome of pediatric skull base fractures. METHODS: Retrospective analysis covering a period of 13.5 years (from 1996 to 2009) and 63 patients (mean age 10.7 years; range 1-18 years) was performed. RESULTS: A road traffic accident was the most frequent etiological factor (38%). The most common skull base fracture type was temporal bone fracture (64%). Longitudinal temporal fractures were observed in 45% and transversal in 23% of these patients; in 10 cases (25%) the fracture was comminuted or mixed type. A fracture involving the spheno-ethmoidal complex was the second most common type of basilar skull fracture (41%) followed by fracture through the orbital bone (35%). Forty-three percent of the patients had a concomitant intracranial injury. Early neurological deficits were diagnosed in 21 patients (33%) and 10 patients (16%) had permanent neurological deficits. One patient died after 1 week of intensive care treatment. Fifty-four patients (86%) were discharged home and 8 patients (13%) were discharged for further rehabilitation. Glasgow Coma Scale score of 8 or lower correlated with moderate to poor outcome. CONCLUSIONS: We conclude that skull base fracture is a rare injury in childhood. Mortality is uncommon, but this trauma is commonly associated with intracranial injury. Early neurological deficits are caused by traumatic brain injury and were observed in one-third of the patients. However, only less than one-sixth suffered from permanent neurological or neuropsychiatric disorders.

New considerations in the cause of spontaneous cerebrospinal fluid otorrhea.

OBJECTIVE: To examine the demographic and radiographic features of patients with spontaneous cerebrospinal fluid otorrhea and to determine whether they display similar characteristics to patients with idiopathic intracranial hypertension. STUDY DESIGN: Retrospective case review. SETTING: Academic, tertiary referral center. PATIENTS: All individuals presenting with spontaneous cerebrospinal fluid otorrhea, diagnosed between 2000 and 2009, undergoing primary surgical repair. INTERVENTIONS: All patients underwent surgical repair via a transmastoid, middle fossa, or combined transmastoid-middle fossa approach. MAIN OUTCOME MEASURES: Patient demographics such as age, race, sex, height, weight, and body mass index, the presence of a radiographically empty or partially empty sella, and preoperative radiographic and intraoperative surgical findings of the temporal bone. RESULTS: Twenty-three patients underwent primary surgical repair for spontaneous cerebrospinal fluid otorrhea. Fifteen patients underwent preoperative magnetic resonance imaging of the head with 12 (80%) demonstrating the presence of an empty or partially empty sella. Mean body mass index of those patients with an empty or partially empty sella was 38.0 kg/m2 compared with 28.5 kg/m2 for those without an empty sella. CONCLUSION: Patients with spontaneous cerebrospinal fluid otorrhea are often middle-aged and obese, with females being affected nearly twice as often as males. Empty or partially empty sella was observed in 80% of patients with spontaneous cerebrospinal fluid otorrhea as demonstrated by preoperative magnetic resonance imaging. Patients with spontaneous cerebrospinal fluid otorrhea who display these demographic and radiographic features should be further evaluated for the presence of idiopathic intracranial hypertension.

Complications in retrosigmoid cranial nerve surgery.

CONCLUSIONS: Although microvascular decompression (MVD), facial nerve splitting (FNS) and neurectomy procedures were safe treatments for hemifacial spasm (HFS), trigeminal neuralgia (TN) and glossopharyngeal neuralgia (GPN) in retrosigmoid cranial nerve surgery, fatal and severe complications may occur. It is essential to pay great attention to the entire procedure to avoid these complications. OBJECTIVE: To report the complications of cranial nerve surgery via the retrosigmoid approach. PATIENTS AND METHODS: We reviewed 516 cases of cranial nerve surgery via the retrosigmoid approach for HFS, TN and GPN. There were 208 cases of HFS, of which 117 cases underwent FNS alone and 91 cases underwent combined MVD and FNS. There were 273 cases of TN treated by MVD and selective neurectomy. There were 35 cases of GPN treated by neurectomy. RESULTS: Of the cases with complications, two (0.4%) died. Hearing impairment ranging from mild to severe occurred in 31 (6.0%) patients; 4 of these (0.8%) presented total hearing loss. Postoperative cerebrospinal fluid leakage occurred in 29 (5.6%) cases.

[CSF fistulae following surgery for cerebellopontine angle tumours and their relationship with the body mass index]. / Fístulas de LCR tras la cirugía de tumores del ángulo pontocerebeloso y su relación con el índice de masa corporal.

INTRODUCTION: The most frequent complication after vestibular schwannoma surgery is cerebrospinal fluid (CSF) fistula. MATERIAL AND METHODS: Retrospective study of 170 patients who had vestibular schwannoma (163) or other tumours in the cerebello pontine angle (CPA) (7). Resection was carried out using different approaches: retrosigmoid (66%), translabyrinthine (24%), middle cranial fossa (5%) and others (5%). We studied the day of onset, location and treatment of the CSF leaks, and the influence of demographic, radiological and clinical variables, including Body Mass Index. RESULTS: 27 patients developed a CSF fistula (15.9%): 15 were incisional (8.8%), 8 patients developed CSF rhinorrhea (4.7%), 1 CSF otorrhea (0.6%) and 3 a combination of the above (1.8%). We controlled 11 CSF fistulae with bed rest and compressive dressings (6.5%), 7 required lumbar drainage (4.1%), 2 lumbar drainage and wound closure with local anaesthesia (1.2%) and 7 patients required returning to the operating room under general anaesthesia (4.1%). There was not a significant relationship between the apparition of CSF and tumour size, type of approach, age or body mass index (BMI). CONCLUSIONS: Despite the great development and new surgical techniques, CSF fistulae are still a frequent complication after VS surgery. There might be other aetiological factors such as intracranial pressure. There was no significant relationship between CSF fistula and BMI. Adequate management and early conservative measures led to reduced reintervention rates of less than 5% in all patients.

Gold laser adenoidectomy: long-term safety and efficacy results.

OBJECTIVES: To report the long-term results of Gold laser adenoidectomy with pressure equalization tube (PET) placement by measuring the incidence of otorrhea and middle ear effusion after tube extrusion. STUDY DESIGN: A prospective study of 50 patients, ages 8-48 months, that underwent Gold laser adenoidectomy with PE tube placement in a pediatric outpatient setting. METHODS: We previously reported the initial results at 4 months post-op of 50 patients treated for adenoid hypertrophy and chronic otitis media with effusion (COME). All patients were then evaluated at 8, 12, and 16 months post-operatively. The incidence of otorrhea, extrusion of the PE tubes, and middle ear status was recorded. RESULTS: The incidence of otorrhea was 3/50 (6%) at 8 months, 0 (0%) at 12 months, and 2 (4%) at 16 months. At 16 months, the PE tubes had extruded in 29 (58%) and 28/29 (97%) of these had clear middle ears. Forty-nine patients (98%) overall had clear middle ears at the last exam. One patient required a second set of tubes. CONCLUSION: The long-term results of Gold laser adenoidectomy with PE tube placement for adenoid hypertrophy and COME compare favorably with the initial report of the technique, as well as with other techniques as reported in other studies.

Prevalence and appearance of the posterior wall defects of the temporal bone caused by presumed arachnoid granulations and their clinical significance: CT findings.

BACKGROUND AND PURPOSE: Arachnoid granulations (AGs) of the posterior wall of the temporal bone are a rare cause of spontaneous CSF leakage. The purpose of this study was to investigate the prevalence and appearance of presumed AGs, evidenced by the posterior wall defects of the temporal bone with lobulated or scalloped margins on CT scans. MATERIALS AND METHODS: We retrospectively reviewed CT scans of the temporal bone obtained in 1255 patients (573 men and 682 women; mean age, 42 years). We evaluated the prevalence, multiplicity, size, and location of presumed AGs in the posterior wall of the temporal bone. Preservation of the posterior wall of the mastoid air cells was also investigated and correlated with clinical features. RESULTS: Thirty patients (2.4%), including 13 men and 17 women, aged 27-88 years (mean, 55 years), showed a total of 40 presumed AGs on CT scans. Their prevalence tended to increase with age. They were most commonly located at the lateral third of the temporal bone at a level of or above the common crus. Although 15 lesions in 11 patients also caused focal loss of the posterior wall of the mastoid air cells, symptomatic CSF leakage was found in only 2 patients, in both of whom the adjacent mastoid air cells were also opacified on CT scans. CONCLUSION: Although rare, radiologists need to be familiar with the posterior wall defects of the temporal bone caused by presumed AGs on CT scans, because they might cause CSF leakage.

Early onset otitis media: risk factors and effects on the outcome of chronic suppurative otitis media.

The onset of early otitis media (EOM), in the first few months of life has been reported to predict later chronic otitis media (CSOM), although the prevalence rates are increasing little is known about specific risk factors. In this survey we examined the hypothesis that higher risk factors is associated with the development of OM within 1 year compared to later onset and early onset otitis media (OM) has potential for negative outcome of CSOM. This is a survey of the age at onset of otorrhoea and associated risk factors in children with CSOM, in five sites spread in two sub-urban cities in two states in Nigeria. Questionnaires were administered on the informants followed by examination of the children. EOM was seen in 136/189 (70%) with CSOM, the age range was 1-150 months, mean of 59.25 (SD = 44.55). Of the 85 CSOM subjects with hearing loss, EOM accounted for 49 (57.7%) while 36 (42.4%) was later onset, On multivariate analysis (OR = 0.276, CI = 0.133-0.572, P = 0.001) revealing EOM was significant in the development of hearing loss however there was no correlation with the frequency of attack of otorrhoea (OR = 1.025, CI = 0.88-1.19, P = 0.75). Low socioeconomic status seen in 110/136 EOM (P = 0.000), allergy (P = 0.030) and number of people >10 in household (OR = 4.13, CI = 1.81-9.39, P = 0.001) constituted the significant risk for EOM compared to later onset. Bottlefeeding, adenoiditis/adenoid hypertrophy, indoor cooking and upper respiratory infection were not found to have statistical significance in early onset OM compared to later onset OM. This study found correlation between EOM and hearing loss and identified allergy, low social status and chronic exposure to overcrowding through increased number of children in the household significant risk factors for future research focus. This may help in controlling the prevalence of hearing loss accompanying CSOM.

Relationship between obesity, obstructive sleep apnea, and spontaneous cerebrospinal fluid otorrhea.

OBJECTIVES/HYPOTHESIS: To investigate the relationship between obesity, obstructive sleep apnea (OSA), and spontaneous cerebrospinal fluid (CSF) otorrhea. STUDY DESIGN: Retrospective review of patients presenting with the diagnosis of CSF otorrhea during a 15-year period to a tertiary care medical center. METHODS: Patient records were reviewed and the following data were extracted: age, sex, height, weight, past medical/surgical history, laterality of otorrhea, findings at operation, and method of repair. Otorrhea was considered spontaneous in the absence of trauma, otologic surgery, infection, and neoplasm. RESULTS: Of the 29 adult patients identified, 14 patients presented with CSF otorrhea that was spontaneous in nature. The average body mass index among these patients was 35.2 +/- 8, which was higher than the average in the nonspontaneous group, 28.5 +/- 5 (P = .01). Diagnoses of OSA were also more common in the spontaneous group (n = 4) compared with the nonspontaneous group (n = 0). One case of bilateral spontaneous CSF leaks was recorded. The majority of patients were repaired with hydroxyapatite cement through a transmastoid approach. There were no recurrences. CONCLUSIONS: In this series, patients with spontaneous CSF otorrhea were more likely to be severely and morbidly obese than were patients with nonspontaneous otorrhea. OSA was also more common in these patients. The findings from this study support an association between obesity and spontaneous CSF leaks. Patients presenting with spontaneous CSF otorrhea should therefore be screened for OSA and signs of increased intracranial pressure.

Surgical approaches and complications in the removal of vestibular schwannomas.

Vestibular schwannomas are benign tumors that usually originate from the balance portion of cranial nerve VIII. The treatment options currently available for vestibular schwannomas include observation with serial imaging, stereotactic radiation, and microsurgical removal. Although the ultimate goal in treatment of vestibular schwannomas is preservation of life, the best option for each patient depends on symptoms, tumor size, tumor location, and the patient's general health and age. Surgical exposure of the cerebellopontine angle for removal of vestibular schwannomas can be performed safely via a translabyrinthine, retrosigmoid, and middle fossa approach. Each approach has its advantages and disadvantages. The goal of surgery is complete eradication of tumor with preservation of hearing and facial nerve function when possible.

Tympanic membrane perforation among adults in West Africa.

CONTEXT: The knowledge of variations of the tympanic membrane (TM) perforations with the climatic changes in the West African subregion would help clinicians in its prevention and management. OBJECTIVE: To analyze the pattern of clinical presentations and associated features of TM perforation in adults in West Africa. DESIGN: A prospective study. SETTING: Tertiary referral centre, University hospital. PATIENTS OR OTHER PARTICIPANTS: Thirty-five (35) consecutive adults with TM perforations during a 1-year period had clinical evaluation of each TM using head mirror, video otoscopy, and micro-otoscopy. MAIN OUTCOME MEASURES: Clinical presentations and associated features of TM perforations. RESULTS: Thirty-five patients, 20 (57%) men and 15 (43%) women, with 42 perforated TMs were examined. Twenty-eight (80%) patients had unilateral perforations. Infection was responsible for 90.5% of cases, and trauma was responsible for the rest. Locations of perforations were central (29; 69.1%), anteroinferior (4; 9.5%), posteroinferior (4; 9.5%), anterosuperior (3; 7.1%), and posterosuperior (2; 4.8%). The sizes of the perforations ranged from 1.2 to 83.2%. Large sizes of 25% and more were found to occur in humid and wet seasons, and also, clinical presentations of otorrhea (65.6%), otalgia (51.5%), tinnitus (37.1%), and ear itching (34.4%) seemed to worsen. CONCLUSION: Most TM perforations result from infection and are preventable via appropriate health education. Posterosuperior perforation is rare, and this is probably one of the factors making choleasteatoma uncommon in West Africa. Approximately 83.3% of TM perforations measure more than 25% in size and appear during the wet humid season of the year. These findings are important for both local and foreign otolaryngologists who may be practicing in this subregion of the world.

Tacrolimus: a new option in therapy-resistant chronic external otitis.

OBJECTIVE: To evaluate the efficacy of the novel topical immune modulator tacrolimus in chronic uninfectious otherwise therapy-resistant external otitis (EO). STUDY DESIGN: Prospective clinical study. PATIENTS AND METHODS: There were 53 patients aged 5 to 83 years. An ear wick containing 0.1% tacrolimus ointment (Protopic) was inserted into the external auditory canal every 2nd to 3rd day. Altogether, the wick was changed three times. The pre-, intra- and posttherapeutic state of the clinical parameters otalgia, edema, otorrhea, erythema, pruritus, and desquamation was rated by means of a 6-point score system. Treatment efficiency was evaluated on the basis of follow-up investigations at 3-month intervals, a standardized findings sheet, and photograph documentation. RESULTS: The short-term results showed a clear improvement in 85% of the patients and significant reductions of the severity levels for all clinical parameters investigated (P < .001). Concerning the long-term results, a one-time treatment cycle led to complete healing in 46% of the patients throughout a follow-up of 10 to 22 months. Of the patients, 54% had recurrent EO events with significantly extended mean symptom-free intervals. Reapplied tacrolimus treatment patterns attenuated the relapsing course of disease and significantly reduced the number of EO episodes. Within the observation period, no relevant side effects were observed, except for a local feeling of heat, occasional skin burning, and itching. CONCLUSIONS: The topical application of 0.1% tacrolimus ointment in the outer ear canal appears to be an effective and well-tolerated new option in corticosteroid-free treatment of chronic therapy-resistant EO.

Congenital cholesteatoma: risk factors for residual disease and retraction pockets--a report on 117 cases.

OBJECTIVES: To define predictors of residuals and retraction pockets (RP) in children operated on for congenital cholesteatoma (CC). DESIGN AND SETTING: Retrospective review (1996-2005), academic center. PATIENTS: One hundred seventeen patients treated for CC corresponding to modified Derlacki's criteria were included (median age, 6.5 yr). No case of RP at time of diagnosis, with a mean follow-up of 2.5 years after last surgery. MAIN OUTCOME MEASURES: Clinical and surgical data influencing outcome. Multivariate analysis. RESULTS: Two groups were defined after CC removal: group I (12 cases), no second look required and no case of subsequent re-intervention; group II (105 cases), planned second look always performed (mean delay, 12.1 mo), no difference of sex ratio (M/F = 2). Group I patients were younger than in group II (3.3 vs. 5.9 yr, P < .001). All of them had a normal contralateral eardrum and a disclosure of CC by routine examination (vs. 19% in group II, P < .001). In group I, the mass occupied one or two anterior quadrants (41.6% and 58.4%, respectively) versus more than two quadrants in 46.6% in group II. Residuals and RP rates were 41% and 15%, respectively (only in group II). Predictors for residuals were atticotomy (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.3-6.7) and destruction of stapes (OR 4.3, 95% CI 1.7-10.5). Predictors for RP were eustachian tube extension (OR 6.8, 95% CI 1.7-26.8) and nonreconstructed atticotomy (OR 5.9, 95% CI 1.1-30.9). CONCLUSIONS: Young children with small CC had no recurrences. Residuals were more frequent in case of atticotomy and stapes destruction. RP occurred especially in cases of eustachian tube extension and if cartilage tympanoplasty was not performed. Tympanic and canal wall reinforcement should be considered in extensive CC.

Ciprofloxacin/dexamethasone drops decrease the incidence of physician and patient outcomes of otorrhea after tube placement.

OBJECTIVE: To evaluate ciprofloxacin 0.3%/dexamethasone 0.1% (CIPRODEX, Alcon, Ft. Worth, TX) for the prevention of early post-operative otorrhea following TT placement. METHODS: This was a single-center, randomized, evaluator-blinded, parallel-group study. Two hundred children undergoing bilateral TT placement were categorized as having unilateral ("wet/dry"), bilateral ("wet/wet"), or no ("dry/dry") effusion at the time of surgery. All patients received Ciprodex or no treatment for 5 days post-operatively and returned at 2 weeks. RESULTS: Physician-observed otorrhea was reported in 5 (4.95%) patients receiving Ciprodex and 39 (39.39%) patients receiving no treatment (p<0.0001). Treatment decreased otorrhea in all groups, while the greatest benefit was observed in patients with bilateral effusion (93% reduction). Ciprodex treatment also decreased the rate of clinically diagnosed otitis media (OM) and effusion following TT placement (p< or =0.0006). CONCLUSION: Ciprodex reduced early post-operative otorrhea, clinically diagnosed OM and effusion following TT insertion. The greatest reduction in otorrhea was observed in patients with bilateral effusion at the time of surgery.