Myringoplasty - A Rewiev of 438 Cases.

The medical records of 438 patients who underwent myringoplasty followed up for a minimum of one year in the period of 1980 and 2015 were revised. Examination under otomicroscope was done of the ear to be operated. This was carried out with a speculum under the operating microscope to be reliably asses the tympanic membrane, site of perforation, to rule out any other pathology and assess the status of ossicular chain. All the patients submitted primary myringoplasty surgery were operated under postauricular, endaural and transcanal approach with overlay, underlay and inlay methods. In the study the patients were divided into three groups depending upon the technique utilized to repair the tympanic membrane. When we compared overlay technique group with underlay technique group, it was observed that overlay technique was no statistically significant difference between these three groups in term of age wise distribution, gender wise distribution, duration of disease and cause of disease, due to matching at the time of selection. In this study the outcome in terms of graft uptake rate was slight better in the overlay technique (94%) as compared to the underlay technique (86.2%), though the difference was statistically insignificant, P>0.05. Patients selection may have had a role in the high success rate in the present study as patients presenting with middle ear pathology were excluded. The complications rate in the present study was quite low, no case in inlay group, three cases of graft lateralization in underlay group, and 19 cases in overlay group. In this study, better results were achieved with overlay technique may probably be due to less surgical manipulation and faster healing process.

Endolymphatic Sac Surgery And Posterior Semicircular Canal Fenestration For Meniere's Disease.

Objective: To evaluate the efficiency and safety of the simultaneous endolymphatic sac drainage (ELSD) and posterior semicircular canal fenestration (PSCF) primary on the vestibular function as an new therapeutic strategy in the patients with medically refractory Meniere's disease (MD).Study Design: retrospective follow-up study.Setting: University Clinic of Otolaryngology.Methods: Twenty-six patients with MD with severe vertigo and disability who underwent ELSD and PSCF in the same time in the period of 1988 and 2007 were reviewed. The main outcome measures were frequency of vertigo, functional disability according the guidelines for diagnosis and evaluation of therapy in MD. The canal paresis was evaluated by caloric test. The degree of reduced vestibular response rates as an indicators of the vestibular function were compared before and after surgery.Results: The preoperative audition was already altered in all cases except in 8 patients who had no significant changes in hearing threshold. The mean value of vertigo attacks before operation was 8.6. After 3 years of surgery only one patient (3.8%) had one vertigo attack. Functional level was highly ameliorated except in two patients who presented functional level 2 or B in the late postoperative period. The mean caloric testing duration after 3 years postoperatively showed that the 50% of the patients approaching the normal results.Conclusion: Based on the results of simultaneous endolymphatic sac surgery and posterior canal fenestration, they are effective methods for treatment of the refractory Meniere's disease. Endolymphatic sac surgery enables drainage of endolymphatic fluid and the fenestration of the posterior semicircular canal enables the distension or dilatation of the membranous canal in the decompressed perilymphatic space across the perilymphatic leak at the level of the new fenestra, and, so, appearing of certain decrease of the endolymphatic pressure. Both techniques at the same time decrease the pressure in the case of the endolymphatic hydrops.

Simultaneous Presentation of Benign Paroxysmal Positional Vertigo and Meniere's Disease - Case Report.

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is one of the most common clinical entities, which develops spontaneously in most of the cases, but it can be secondary as a result of different conditions such as head injuries, viral neurolabyrinthitis, Meniere's disease and vertebrobasilar ischemia. The aim of presenting this case is to point out to the need of taking a precise clinical history and performing Dix-Hallpike manoeuvre in all patients who complain about vertigo regardless of the previously diagnosed primary disease of the inner ear. CASE PRESENTATION: A 63-year-old female patient presented with the classical triad of symptoms for Meniere's disease (fluctuating sensorineural hearing loss in the right ear, tinnitus and fullness in the same ear and rotary vertigo), two years later complained of brief episodes of vertigo linked to changes in head position relative to gravity. Dix-Hallpike manoeuvre showed a classical response in the head-hanging right position. Benign paroxysmal positional vertigo (BPPV) in the same ear was diagnosed in this patient. After treatment with Epley's canal repositioning manoeuvre for a few days, the symptoms of positional vertigo resolved. CONCLUSION: The authors recommend complete audiological and otoneurological evaluation in all patients with vertigo for timely recognition/diagnosis of any inner ear associated pathology.

The Pillars of the Nose-Crura Shortening for Over Projected Nose.

BACKGROUND: The over projected nose, commonly referred to as the "Pinocchio" nose is a significant challenge to the rhinoplasty surgeon. Firstly, we speak about a very large nose, and secondly, we speak about the correction of nasal cartilages (alar and triangular). Surgical correction of the over projected nose is the most difficult and least predictable component of rhinoplasty surgery. AIM: By performing rhinoseptoplasty we aimed to achieve an ideal landmarks position according to concepts of nasal projection as well as by making preoperative analyses to determine the ideal position for the nasal tip after having understood and defined the ideal position for the nasion. METHODS: We performed a retrospective study of patients who were admitted to ENT University Clinic, University Campus "St. Mother Theresa" Skopje, the Republic of Macedonia in the period 2011-2019. A total of 70 patients were enrolled in the study; 46 women (33%) and 24 men (33%). Operative technique rhinoseptoplasty was realised in 70 patients. All of the 70 (100%) patients underwent preoperative and postoperative evaluation during this period regularly to record the effects of various approaches on nasal projection, rotation, need for revision, and patient satisfaction. RESULTS: All patients used one or more of the preferred methods to treat over projection. Patients who had undergone 2 previous rhino/septoplasty procedures were excluded from the study, and hence, a total of 70 patients were evaluated. Full-transfixion incisions were made in all patients. From 2011 to 2019, in 72 cases, 1 or more of the preferred methods were used to treat over projection. CONCLUSION: The crural anatomy of the nasal tip relates to the size and shape of the lower lateral cartilages (LLC) and their relationship with the caudal septum and upper lateral cartilages (ULC). Modification of nasal tip rotation and projection should attempt to preserve or reconstruct major tip mechanisms.

Adenoid Vegetations - Reservoir of Bacteria for Chronic Otitis Media with Effusion and Chronic Rhinosinusitis.

INTRODUCTION: Otitis media and rhinosinusitis are commonly encountered illnesses in pediatric population. Literature reports have documented the association between the occurrence of these two conditions and even their almost identical microbiological findings. Until recently, the key factor in the association of these two conditions was considered to be the hypertrophic adenoid tissue, but within the past few years there have been evidences in the literature about the presence of bacterial biofilms on the adenoids suggesting biofilms to be also responsible for both conditions, chronic otitis media with effusion and chronic rhinosinusitis. AIM: The aim of this study was to make a microbiological analysis of the adenoid tissue specimens taken from patients with chronic otitis media with effusion and chronic or recurrent rhinosinusitis and to determine their potential for biofilms formation. METHODS: After the surgical intervention, adenoidectomy, microbiological evaluation and analysis of the adenoid tissue specimens taken from 20 patients were made. Having in mind the disease history, chronic otitis media with effusion was diagnosed in all 20 patients and chronic rhinosinusitis in 9 patients. RESULTS: The results obtained from the microbiological analyses showed many potentially pathogenic bacteria in the adenoids that were almost identical with the most common organisms incorporated in the etiopathogenesis of both conditions, in chronic otitis media with effusion and in chronic rhinosinusitis. In 7 (35%) patients Haemophylus influenzae was isolated, in 6 (30%) Streptococcus pneumoniae, in 4 (20%) Moraxella catаrrhalis, in 2 (10%) patients Staphylococcus aureus and in 1 (5%) patient Streptococcus pyogenes - group A was isolated. One bacterium was isolated from all adenoid vegetations, except in one case when two bacteria (Haemophylus influenzae and Staphylococcus aureus) were concurrently isolated. CONCLUSION: Our results have shown that the key role in adenoid vegetations in chronic otitis media with effusion and chronic rhinosinusitis is not only the mechanism of rhinopharyngeal obstruction, but also the presence of bacterial strains with a large potential for formation of biofilms adhered to their surface, especially in cases with symptoms of chronic otitis media with effusion and chronic rhinosinusitis that were resistant to antibiotic therapy.

Speech Perception Outcomes after Cochlear Implantation in Children with GJB2/DFNB1 associated Deafness.

BACKGROUND: Cochlear implants (CI) for the rehabilitation of patients with profound or total bilateral sensorineural hypoacusis represent the initial use of electrical fields to provide audibility in cases where the use of sound amplifiers does not provide satisfactory results. AIMS: To compare speech perception performance after cochlear implantation in children with connexin 26-associated deafness with that of a control group of children with deafness of unknown etiology. STUDY DESIGN: Retrospective comparative study. METHODS: During the period from 2006 to, cochlear implantation was performed on 26 children. Eighteen of these children had undergone genetic tests for mutation of the Gap Junction Protein Beta 2 (GJB2) gene. Bi-allelic GJB2 mutations were confirmed in 7 out of 18 examined children. In order to confirm whether genetic factors have influence on speech perception after cochlear implantation, we compared the post-implantation speech performance of seven children with mutations of the GBJ2 (connexin 26) gene with seven other children who had the wild type version of this particular gene. The latter were carefully matched according to the age at cochlear implantation. Speech perception performance was measured before cochlear implantation, and one and two years after implantation. All the patients were arranged in line with the appropriate speech perception category (SPC). Non-parametric tests, Friedman ANOVA and Mann-Whitney's U test were used for statistical analysis. RESULTS: Both groups showed similar improvements in speech perception scores after cochlear implantation. Statistical analysis did not confirm significant differences between the groups 12 and 24 months after cochlear implantation. CONCLUSION: The results obtained in this study showed an absence of apparent distinctions in the scores of speech perception between the two examined groups and therefore might have significant implications in selecting prognostic indicators of speech perception following cochlear implantation.