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OBJECTIVES: Medialization thyroplasty (MT) using various implants has been employed as a corrective procedure for unilateral vocal fold paralysis (UVFP). A newly developed APrevent® vocal implant system (VOIS) offers an innovative solution with a finely adjustable design. This study aimed to investigate the long-term functional voice outcomes and benefits of postoperative adjustments in patients receiving MT using the VOIS-implant. METHODS: This is a prospective case series study at single tertiary medical center. Fourteen adult patients diagnosed with UVFP received MT with the VOIS implant and were followed up for more than 1 year. Implant adjustment procedure by injecting 0.9% physiological saline solution was performed both during and after the surgery to optimize glottal closure and voice quality. Objective voice outcomes and acoustic parameters were assessed preoperatively and postoperatively at various timepoints. RESULTS: Thirteen patients (93%) received intraoperative balloon adjustment, ranging from 0.05to 0.12 ml. Four patients underwent adjustments postoperatively and exhibited a positive trend towards immediately improving acoustic voice quality. Our long-term results demonstrated a notable improvement after the surgery in voice quality, with significant decreases in VHI-30 and improvements in perceptual parameters of GRBAS scale, acoustic measures such as jitter and signal-to-noise ratio (p < 0.001) and cepstral peak prominence smoothed in sustained vowel and short sentences. The voice outcomes remained stable more than 1 year follow-up. CONCLUSIONS: Overall, MT with VOIS implantation provides a favorable long-term outcomes and stability in voice quality for patients with UVFP and also an effective tool for postoperative adjustment without major revision surgeries.
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Laringoplastia , Parálisis de los Pliegues Vocales , Voz , Adulto , Humanos , Laringoplastia/métodos , Pliegues Vocales/cirugía , Parálisis de los Pliegues Vocales/cirugía , Calidad de la Voz , Resultado del TratamientoRESUMEN
PURPOSE: This study aimed to compare the outcomes of endoscopic tympanoplasty with post-conchal perichondrium (PCP) and microscopic tympanoplasty with temporalis fascia in repairing large-sized eardrum perforations. METHODS: We performed a retrospective chart review of 43 patients who underwent type 1 tympanoplasty for simple large-sized perforations. The patients were divided into two groups: Group I (endoscopic ear surgery with a PCP graft, 22 patients) and Group II (microscopic ear surgery with temporalis fascia, 21 patients). Graft success rate, demographic data, pre- and postoperative pure-tone average and word-recognition score, closure of the air - bone gap, and postoperative pain scale scores were compared between the two groups. RESULTS: The graft success rates in groups I and II were 86.3% and 85.7%, respectively. The mean operation time in Group I (79.8 ± 16.5 min) was significantly shorter than that in Group II (99.9 ± 26.7 min) (p = 0.006). Both groups showed significant improvements in the pure-tone average and word-recognition scores. Average closure of the air - bone gap (ABG) in groups I and II was 20.7 ± 6.9 dB and 17.6 ± 8.4 dB, respectively. The reduction in ABG in Group I had a significantly higher magnitude than in Group II at 1000 and 2000 Hz, respectively (p = 0.028 and p = 0.017). The two groups showed no significant difference in postoperative pain scores. CONCLUSION: Endoscopic tympanoplasty with PCP showed a reliable, fascia-preserved, and excellent outcome in repairing large-sized perforations.
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Perforación de la Membrana Timpánica , Humanos , Perforación de la Membrana Timpánica/cirugía , Timpanoplastia , Estudios Retrospectivos , Resultado del Tratamiento , Dolor PostoperatorioRESUMEN
OBJECTIVE: The objective of this study was to evaluate the clinical outcomes of conventional two-dimensional (2D) endoscope with a novel computer-based three-dimensional (3D) imaging system for otologic surgical procedures. METHODS: A conventional 2D monocular endoscope with a novel computer-based 3D imaging system was applied to 18 otologic surgical procedures, including chronic otitis media (COM), cholesteatoma, otosclerosis, external canal osteoma and cochlear implant. Operation duration and complications of COM and attic cholesteatoma were recorded to compare 2D and 3D endoscopic ear surgery. Questionnaires were completed by 35 observers participating in the procedures and were used to evaluate clinical and potential side effects. RESULTS: The surgical procedures were performed smoothly for all patients. No patient required switching to conventional 2D endoscopic surgery. No significant differences were apparent in operation duration using the 3D imaging system for chronic otitis media and attic cholesteatoma compared with conventional 2D endoscopic ear surgery. Thirty-five observers completed the questionnaires. Most of them agreed that this 3D imaging system enabled them to perceive stereoscopic vision (94%), provide superior depth perception (85%). Furthermore, 97.1% reported no visual fatigue or discomfort when observing the 3D images. CONCLUSION: Our study demonstrated that the computer-based 3D imaging system enables the application of 3D vision technology to otologic surgery. The system has no obvious side effects, such as visual fatigue or time delay. It not only facilitates performing the related surgical procedures but also helps in teaching and learning endoscopic ear surgeries.
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Colesteatoma del Oído Medio/cirugía , Endoscopía/instrumentación , Imagenología Tridimensional/instrumentación , Otitis Media/cirugía , Procedimientos Quirúrgicos Otológicos/instrumentación , Adolescente , Adulto , Anciano , Preescolar , Percepción de Profundidad , Oído Medio/cirugía , Endoscopios , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Cirugía Asistida por ComputadorRESUMEN
Hearing impairment is a global issue, affecting billions of people; however, there is a gap between the population affected by hearing loss and those able to access hearing healthcare. Tele-audiology, the application of telemedicine in audiology, serves as a new form of technology which aims to provide synchronous or asynchronous hearing healthcare. In this article, we reviewed some recent studies of tele-audiology-related topics to have a glimpse of the current development, associated challenges, and future advancement. Through the utilization of tele-audiology, patients can conveniently access hearing healthcare, and thus save travel costs and time. Recent studies indicate that remote hearing screening and intervention are non-inferior to the performance of traditional clinical pathways. However, despite its potential benefits, the implementation of tele-audiology faces numerous challenges, and audiologists have varying attitudes on this technology. Overcoming obstacles such as high infrastructure costs, limited reimbursement, and the lack of quality standards calls for concerted efforts to develop effective strategies. Ethical concerns, reimbursement, and patient privacy are all crucial aspects requiring in-depth discussion. Enhancing the education and training of students and healthcare workers, along with providing relevant resources, will contribute to a more efficient, systematic hearing healthcare. Future research will aim to develop integrated models with evidence-based protocols and incorporating AI to enhance the affordability and accessibility of hearing healthcare.
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BACKGROUND: Attic cholesteatomas can be exenterated by transcanal endoscopic ear surgery (TEES). In the limited operative field of exclusive transcanal endoscopic atticotomy, surgeons use either a piezosurgery scalpel or a drilling system to remove the posterior lateral bony wall of the epitympanum. We aimed to investigate the feasibility of using piezosurgery or microdrill for endoscopic atticotomy during exenteration of attic cholesteatomas. METHODS: This study is a retrospective chart review of patients diagnosed with attic cholesteatoma, who were treated by exclusive TEES. The superior and posterior external auditory canal bones were excised using a piezosurgery scalpel or microdrill. Preoperative and postoperative hearing thresholds were measured by pure-tone audiometry. RESULTS: The postoperative follow-up duration varied from 6 to 37 months. There were no significant differences in age, sex, laterality of the affected ear, and preoperative bone conduction thresholds between the piezosurgery scalpel and microdrill groups. The operative duration was longer in the piezosurgery group than in the microdrill group (135.6 ± 19.5 minutes vs 117.3 ± 29.1 minutes, p = 0.042). Seven of 30 (23.3%) patients in the microdrill group, but none in the piezosurgery group, had a friction injury from the drilling. Postoperative testing at higher frequencies of 2000, 3000, and 4000 Hz showed no deterioration in the bone conduction threshold in the piezosurgery group. CONCLUSION: Endoscopic atticotomy performed using a piezosurgery scalpel is potentially safer but slower than using a microdrill for exenteration of attic cholesteatomas.
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Colesteatoma del Oído Medio , Procedimientos Quirúrgicos Otológicos , Humanos , Colesteatoma del Oído Medio/cirugía , Estudios Retrospectivos , Piezocirugía , Oído Medio/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVE: Our objective was to perform a systematic review and meta-analysis comparing the clinical outcomes after endoscopic and microscopic type I tympanoplasty. STUDY DESIGN: Randomized controlled trials, two-arm prospective studies, and retrospective studies were included. SETTING: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until March 1, 2022 using the combinations of search terms: "endoscopic," "microscopic," and "tympanoplasty." METHODS: Two independent reviewers utilized the abovementioned search strategy to identify eligible studies. If any uncertainty existed regarding eligibility, a third reviewer was consulted. Primary outcome measures were graft success rate, air-bone gap (ABG) improvement, and operative time. Secondary outcomes were the rate of need for canalplasty, the proportion of self-rated excellent cosmetic results, and pain visual analog scale (VAS). RESULTS: Forty-three studies enrolled a total of 3712 patients who were undergoing type I tympanoplasty and were finally included. The pooled result showed endoscopic approach was significantly associated with shorter operative time (difference in means: -20.021, 95% confidence interval [CI]: -31.431 to -8.611), less need for canalplasty (odds ratio [OR]: 0.065, 95% CI: 0.026-0.164), more self-rated excellent cosmetic results (OR: 87.323, 95% CI: 26.750-285.063), and lower pain VAS (difference in means: -2.513, 95% CI: -4.737 to -0.228). No significant differences in graft success rate or ABG were observed between the two procedures. CONCLUSION: Endoscopic type I tympanoplasty provides a similar graft success rate, improvement in ABG, and reperforation rate to microscopic tympanoplasty with a shorter operative time, better self-rated cosmetic results, and less pain. Unless contraindicated, the endoscopic approach should be the procedure of choice in type I tympanoplasty.
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Endoscopía , Timpanoplastia , Timpanoplastia/métodos , Humanos , Endoscopía/métodos , Microcirugia/métodos , Resultado del Tratamiento , Tempo OperativoRESUMEN
OBJECTIVES: To investigate the role of normal weight central obesity (NWCO) in the prognosis of sudden sensorineural hearing loss (SSNHL). METHODS: We retrospectively investigated 807 cases of SSNHL from January of 2008 to August of 2019 from the Department of Otorhinolaryngology at Kaohsiung Medical University Hospital in southern Taiwan. We analyzed the association between overweight and obesity, NWCO, and the prognosis of SSNHL. The demographic and clinical characteristics, audiometry results, and outcomes were also reviewed. RESULTS: The nonobese (body mass index [BMI] < 24 kg/m2) and overweight and obese groups (BMI ≥ 24 kg/m2) comprised 343 (42.50%) and 464 (57.50%) patients, respectively. The favorable prognosis rates in the nonobese and the overweight and obese groups were 45.48% and 45.91%, respectively, without a significant difference (P = .9048). Multivariate logistic regression revealed that BMI (adjusted odds ratio [aOR] = 1.00, 95% CI = 0.948-1.062, P = .9165) was not significantly associated with SSNHL recovery. The normal weight noncentral obesity (NWNCO) and NWCO groups comprised 266 (77.55%) and 77 (22.45%) patients, respectively, and had favorable prognosis rates of 48.50% and 35.06%, respectively. The difference between the groups was significant (P = .0371). Multivariate logistic regression analysis revealed that NWCO (aOR = 2.51, 95% CI = 1.292-5.019, P = .0075) was significantly associated with SSNHL recovery. CONCLUSIONS: NWCO may significantly affect the prognosis of SSNHL.
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Pérdida Auditiva Sensorineural , Pérdida Auditiva Súbita , Humanos , Obesidad Abdominal/complicaciones , Obesidad Abdominal/epidemiología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Sobrepeso , Obesidad/complicaciones , Obesidad/epidemiología , Pérdida Auditiva Súbita/diagnóstico , Pérdida Auditiva Súbita/etiología , Pérdida Auditiva Sensorineural/diagnóstico , Pérdida Auditiva Sensorineural/epidemiología , Pérdida Auditiva Sensorineural/etiologíaAsunto(s)
Cartílago Auricular/trasplante , Audición/fisiología , Cirugía Endoscópica por Orificios Naturales/métodos , Perforación de la Membrana Timpánica/cirugía , Timpanoplastia/métodos , Adolescente , Adulto , Anciano , Niño , Conducto Auditivo Externo , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Perforación de la Membrana Timpánica/fisiopatología , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVE: Ultrasound has emerged as a promising modality for detecting middle ear effusion (MEE) in pediatric patients. Among different ultrasound techniques, ultrasound mastoid measurement was proposed to allow noninvasive detection of MEE by estimating the Nakagami parameters of backscattered signals to describe the echo amplitude distribution. This study further developed the multiregional-weighted Nakagami parameter (MNP) of the mastoid as a new ultrasound signature for assessing effusion severity and fluid properties in pediatric patients with MEE. METHODS: A total of 197 pediatric patients (n = 133 for the training group; n = 64 for the testing group) underwent multiregional backscattering measurements of the mastoid for estimating MNP values. MEE, the severity of effusion (mild to moderate vs. severe), and the fluid properties (serous and mucous) were confirmed through otoscopy, tympanometry, and grommet surgery and were compared with the ultrasound findings. The diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUROC). RESULTS: The training dataset revealed significant differences in MNPs between the control and MEE groups, between mild to moderate and severe MEE, and between serous and mucous effusion were observed (p < 0.05). As with the conventional Nakagami parameter, the MNP could be used to detect MEE (AUROC: 0.87; sensitivity: 90.16%; specificity: 75.35%). The MNP could further identify effusion severity (AUROC: 0.88; sensitivity: 73.33%; specificity: 86.87%) and revealed the possibility of characterizing fluid properties (AUROC: 0.68; sensitivity: 62.50%; specificity: 70.00%). The testing results demonstrated that the MNP method enabled MEE detection (AUROC = 0.88, accuracy = 88.28%, sensitivity = 92.59%, specificity = 84.21%), was effective in assessing MEE severity (AUROC = 0.83, accuracy = 77.78%, sensitivity = 66.67%, specificity = 83.33%), and showed potential for characterizing fluid properties of effusion (AUROC = 0.70, accuracy = 72.22%, sensitivity = 62.50%, specificity = 80.00%). CONCLUSIONS: Transmastoid ultrasound combined with the MNP not only leverages the strengths of the conventional Nakagami parameter for MEE diagnosis but also provides a means to assess MEE severity and effusion properties in pediatric patients, thereby offering a comprehensive approach to noninvasive MEE evaluation.
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Otitis Media con Derrame , Humanos , Niño , Otitis Media con Derrame/diagnóstico por imagen , Otitis Media con Derrame/cirugía , Pruebas de Impedancia Acústica , Apófisis Mastoides/diagnóstico por imagen , Curva ROC , UltrasonografíaRESUMEN
BACKGROUND/PURPOSE: Globus pharyngeus and dysphagia are common complaints of patients referred to ear, nose, and throat (ENT) clinics. We aimed to establish an efficient method to rule out the presence of malignancy in patients with globus pharyngeus and dysphagia. METHODS: The use of flexible transnasal esophagoscopy (TNE) was evaluated in 30 patients with globus pharyngeus and 6 patients with dysphagia. The patients were immediately informed of the findings on TNE examination, and then treatments were planned. All patients were treated with lansoprazole for 2 weeks and provided education on lifestyle changes at the initial examination and at the 3-month follow-up. RESULTS: The patients reported an improvement in symptoms of globus pharyngeus after treatment (p<0.001). Follow-up TNE confirmed improvement with less dysphagia, erythema, and vocal cord edema evident (all p<0.001). CONCLUSION: The use of TNE and patient education are efficient management strategies for patients with symptoms of globus pharyngeus and dysphagia.
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Esofagoscopía , Educación del Paciente como Asunto , Enfermedades Faríngeas/terapia , 2-Piridinilmetilsulfinilbencimidazoles/uso terapéutico , Adulto , Anciano , Trastornos de Deglución/terapia , Femenino , Humanos , Lansoprazol , Estilo de Vida , Masculino , Persona de Mediana Edad , Inhibidores de la Bomba de Protones/uso terapéuticoRESUMEN
OBJECTIVE: We aimed to identify the sound pressure distribution along the external auditory canal after radical mastoidectomy with meatoplasty by combining real ear measurements and measurements obtained using a finite-element model. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care university hospital. PATIENTS: We evaluated 16 patients who had undergone radical mastoidectomy with meatoplasty in one ear and had intact nonoperated contralateral ears, which served as the control group. INTERVENTION DIAGNOSTIC: Real ear measurements testing at specific frequencies were performed postoperatively. MAIN OUTCOME MEASURE: Sound pressure gains were measured at five different depths along the external auditory canal, and a validated finite-element model was used to simulate the sound pressure distributions along the external auditory canals of the operated and nonoperated ears. RESULTS: The average peak resonant frequency near the tympanic membrane in operated ears was significantly lesser than that in nonoperated ears (2434.4 ± 616.4 versus 2935.9 ± 602.2 Hz; Wilcoxon signed-rank test, p < 0.05). The average peak resonant amplitude near the tympanic membrane showed no significant intergroup difference (paired-sample t test, p > 0.05). The peak resonant frequencies at different depths of the external auditory canal varied in the nonoperated ears (Kruskal-Wallis rank-sum test, 2880.9 ± 581.7 Hz, p = 0.02) but did not differ significantly in the operated ears (Kruskal-Wallis rank-sum test, 2464.4 ± 670.3 Hz, p = 0.75). In the finite-element model, the peak resonant frequencies along the depth of the external auditory canal varied in the normal ear and were homogeneous in the operated ear. CONCLUSION: Radical mastoidectomy with meatoplasty altered the sound distribution in the external auditory canal. Our finite-element model successfully simulated the postoperative sound distribution in the external auditory canal and will facilitate development of wearable equipment for these patients.
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Apófisis Mastoides , Mastoidectomía , Oído , Conducto Auditivo Externo/cirugía , Humanos , Apófisis Mastoides/cirugía , SonidoRESUMEN
Medical history taking, otoscopy, tympanometry, and audiometry are clinical methods to diagnose middle ear effusion (MEE); however, these procedures are experience-dependent and result in misdiagnosis under unfavorable conditions of the external auditory canal in non-cooperative young children. This study aimed to explore the use of transmastoid ultrasound combined with the Nakagami parameter analysis to detect MEE in children aged 3−5 years and to compare the proposed method with clinical evaluation methods. A total of forty subjects were enrolled; for each subject, a single-element ultrasound transducer of 2.25 MHz was used to measure backscattered signals returned from the mastoid for estimating the Nakagami parameter, which is a measure of the echo amplitude distribution. Tympanogram and hearing loss were also measured for comparisons. The results showed that the Nakagami parameter in the patients with MEE was significantly larger than that of the normal group (p < 0.05). The area under the receiver operating characteristic curve (AUROC) for using the Nakagami parameter to detect MEE was 0.90, and the sensitivity, specificity, and accuracy were 82.5%, 97.5%, and 79.6%, respectively. The Nakagami parameter for tympanogram types B/C was higher than that for tympanogram type A (p < 0.05); it was also higher in the subjects with hearing loss (p < 0.05). Quantitative transmastoid ultrasound based on the Nakagami parameter analysis has the potential to detect MEE and evaluate hearing loss.
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BACKGROUND: Endoscopic transcanal transtympanic myringoplasty (ETTM) is a relatively easier technique than endoscopic transcanal tympanoplasty (ETT) for repairing tympanic membrane perforations. No studies have compared the outcomes of these two procedures with tragal perichondrium after 1-year. Furthermore, there is no evidence-based stratification according to variations in perforation size in endoscopic ear surgery. Therefore, we compared the 1-year outcomes of ETTM and ETT stratified according to perforation size. METHODS: Patients who underwent ETT and ETTM to repair eardrum perforations with a tragal perichondrium graft were identified. Pure-tone audiometric tests and otoscopic examination were performed to assess hearing outcomes and perforation sizes both preoperatively and at least 1 year postoperatively. RESULTS: In total, 158 patients (159 ears) were included. ETT was performed on 83 ears, and ETTM was performed on 76 ears. The ETTM procedure time was 10-minutes shorter than that for ETT ( p < 0.001). Perforation size was significantly correlated with graft take-rate. For large perforations, the ETT success rate was significantly higher than that of ETTM (91.7% vs. 78.9%). Success rates for small-medium perforations were comparable for both methods ( p > 0.05). However, for medium perforations, the graft take-rate of ETT reached a plateau after 6 months, while that of ETTM gradually declined during the 12-month follow-up. Both groups had a comparable mean postoperative air-bone gap gain ( p = 0.666). CONCLUSION: ETTM is suitable for repairing small perforations, whereas ETT is preferred for large perforations. Both methods, and particularly ETTM, should be employed cautiously for medium perforations.
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Miringoplastia , Perforación de la Membrana Timpánica , Endoscopía/métodos , Estudios de Seguimiento , Humanos , Miringoplastia/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Perforación de la Membrana Timpánica/cirugía , Timpanoplastia/métodosRESUMEN
OBJECTIVES/HYPOTHESIS: Evaluation of the clinical outcomes after 6 months of treatment with a novel adjustable implant, the APrevent® Vocal-Implant-System (VOIS), in conjunction with medialization thyroplasty (MT) in patients with unilateral vocal fold paralysis. STUDY DESIGN: Prospective case series study at single tertiary referral center. METHODS: Preoperative and 1 week, 7 weeks, and 6 months postoperative glottal efficiency (maximum phonation time [MPT]), voice quality (including GRBAS-scores and acoustic parameters) and self-perceived voice-related handicap (voice handicap index [VHI-30]) were measured and analyzed, whereas type of vocal fold closure was evaluated and determined by flexible videolaryngoscopy based on Södersten and Lindestad classification (Wilcoxon signed-rank test). RESULTS: Thirteen patients underwent MT with VOIS under local anesthesia. Six months after surgery, the VHI-30 and MPT had improved from a preoperative mean of 75.0 ± 22.9 and 2.7 ± 2.1 s to a postoperative mean of 20.6 ± 19.7 and 6.3 ± 4.0 s, respectively. The mean GRBAS score improved from preoperative scores of Gpreop = 2.7, Rpreop = 2.6, Bpreop = 2.6, Apreop = 2.2, and Spreop = 2.0 to Gpostop = 0.3, Rpostop = 0.3, Bpostop = 0.2, Apostop = 0.2, and Spostop = 0.3 at 6 months postoperatively. Improved glottal closure was achieved in all patients (n = 13). Five patients received postoperative adjustment for the optimization of voice quality and glottal closure. No intra- or postoperative complications were observed. Significant improvements in acoustic parameters, including percentage jitter, percentage shimmer, and signal-to-noise ratio, were also observed after MT. All results were statistically significant (P < .05, Cohen's d > .8). CONCLUSIONS: APrevent® VOIS-Implantation is a safe procedure with good voice outcomes. Postoperative adjustments can be performed smoothly to optimize voice quality and glottal closure. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:1622-1629, 2022.
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Laringoplastia , Parálisis de los Pliegues Vocales , Glotis , Humanos , Resultado del Tratamiento , Parálisis de los Pliegues Vocales/cirugía , Pliegues Vocales/cirugía , Calidad de la VozRESUMEN
BACKGROUND: External auditory canal (EAC) osteomas are rare, slow-growing benign neoplasms. Microscopic surgical excision had been reported for symptomatic osteomas. However, there was no study published on the feasibility of transcanal endoscopic ear surgery (TEES) for EAC osteoma. In this study, we propose two methods of TEES for symptomatic EAC osteomas and report the surgical outcomes of our patients. METHODS: Fifteen patients diagnosed with symptomatic EAC osteoma who underwent TEES were recruited at two otolaryngology referral centers. The extent of osteoma and degree of EAC stenosis was calculated based on high-resolution computed tomography (HRCT) imaging. We divided all the patients into two groups, solitary pedunculated osteoma or broad-based osteomas. The postoperative outcomes and complications were recorded for at least 6 months of outpatient follow-up. RESULTS: In this study, twelve patients with solitary osteoma underwent the first method, a direct transcanal removal procedure. In this approach, only a small bare bony area remained postoperatively, and it healed completely within 1 month. Three patients with broad based osteoma underwent the second method, a transcanal approach involving a skin flap. The degree of stenosis in all patients ranged from 29% to 90%. All of them could be treated completely through a transcanal endoscopic approach. No intraoperative or postoperative complications were noted during follow-up, and no canal stenosis and no recurrences were noted during at least 6 months of follow-up. CONCLUSIONS: This endoscopic transcanal approach to EAC osteomas demonstrated good results for lesion removal without recurrence or intraoperative complications.
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Conducto Auditivo Externo , Osteoma , Conducto Auditivo Externo/cirugía , Endoscopía , Humanos , Recurrencia Local de Neoplasia , Osteoma/cirugía , Tomografía Computarizada por Rayos XRESUMEN
A 2D monocular endoscope has been used in transcanal transpromontory vestibular schwannoma surgery instead of craniotomy. However, the absence of depth perception is the limitation of this approach. With the loss of depth perception, the surgeon will be not able to perform delicate and particularly complicated surgery. A binocular endoscope has been developed to provide stereoscopic vision with better depth perception for complicated anatomic structures and has been applied in some endoscopic surgeries. However, the diameter of the endoscope is a limitation in the performance of transcanal otologic surgeries. A small diameter endoscope facilitates easier surgery in a restricted space. A computer-based 3D imaging system can obtain 3D images in real-time using a small monocular endoscope. In this study, to evaluate the feasibility of a computer-based 3D imaging system for endoscopic lateral skull base surgery, we applied this 3D imaging system in a transcanal transpromontorial approach in two patients with vestibular schwannomas. The surgical procedure was completed without complication in these two cases. There was no mortality, perioperative complications, nor notable postoperative complications. Using this computer-based 3D imaging system, a better depth perception and stereoscopic vision was observed compared to a conventional 2D endoscope. The improvement in depth perception offers superior management of the complicated surgical anatomy.
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Neuroma Acústico , Computadores , Endoscopios , Endoscopía , Humanos , Imagenología Tridimensional , Neuroma Acústico/diagnóstico por imagen , Neuroma Acústico/cirugíaRESUMEN
PURPOSE: Obstructive sleep apnea (OSA) is characterized by recurring hypoxic-apneic events during sleep, and labyrinthine vascular compromise is a pathophysiologic hallmark of idiopathic sudden sensorineural hearing loss (ISSNHL). Some reports have discussed the relationship between OSA and hearing impairment; however, few have examined hearing prognosis in OSA and patients without OSA with ISSNHL. We aimed to investigate clinical manifestations of ISSNHL in patients with OSA, including severity of hearing loss and response to treatment. PATIENTS AND METHODS: A case-control study was conducted by extracting data from the sleep center and cochlea center databases of the Chang Gung Memorial Hospital. A retrospective chart review was performed to include confirmed adult OSA patients diagnosed with unilateral ISSNHL. Age and sex-matched patients without OSA with ISSNHL were enrolled as controls. Pure-tone average (PTA) thresholds were measured at specific frequencies. Changes in PTA before and after standard treatment with oral prednisolone (1mg/kg/day for 5 days, then tapered) and between participants with OSA and without OSA were compared. Standard treatment was given to all ISSNHL patients. RESULTS: Twenty-eight out of 8500 (0.33%) OSA patients experienced subsequent ISSNHL in 9 years. Patients with OSA (n=28) had poorer high-frequency perception in the unaffected ear than the patients without OSA (n=120), although the difference was not significant. Hearing in the affected ear among patients with OSA was comparable to that patients without OSA at individual frequencies and average, suggesting no difference in hearing loss in the affected ear between the two groups. In terms of high-frequencies (4000 and 8000 Hz) perception, patients with OSA had significantly poorer responses to steroid treatment than patients without OSA. CONCLUSION: ISSNHL may be one of the auditory complications associated with OSA. Patients with OSA had poorer prednisolone related hearing improvement in high frequencies than patients without OSA. Despite study limitations, OSA-related hypoxia and snoring noise is hazardous to hearing and standard treatments with CPAP is suggested in OSA patients for both holistic and auditory health.
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OBJECTIVE: Delayed facial palsy is a complication of otologic surgery. Tympanoplasty is commonly employed in chronic otitis media. We compared the incidence and characteristics of delayed facial palsy and hearing restoration between endoscopic and microscopic tympanoplasty for the treatment of simple chronic otitis media. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary medical center. SUBJECTS AND METHODS: We retrospectively analyzed 468 patients who underwent type I tympanoplasty from January 2009 to April 2017. Patients were divided into transcanal endoscopic ear surgery and microscopic ear surgery groups. Their epidemiological profiles were reviewed and the outcomes of tympanoplasty were analyzed. Blood sample tests for herpes simplex virus and varicella-zoster virus immunoglobulin M and immunoglobulin G were arranged in patients with delayed facial palsy. RESULTS: Transcanal endoscopic ear surgery exhibited similar benefits to microscopic ear surgery in graft-taking rate and hearing restoration but had a shorter operation time (P < .01). Eight patients (1.71%) developed delayed facial palsy, but no statistically significant difference was observed between the 2 surgical approaches. All patients tested negative for varicella-zoster virus and herpes simplex virus immunoglobulin M and positive for immunoglobulin G of the same viruses; however, the titer did not exhibit a 4-fold increase, implying that patients did not have active viral infections. CONCLUSION: Transcanal endoscopic ear surgery is an ideal alternative for simple tympanoplasty. The incidence of delayed facial palsy was not significantly different between the 2 approaches. Because of the favorable prognosis and the absence of direct serological evidence supporting viral reactivation, treatment with antivirals may not be required.