RESUMO
Sigmoid sinus diverticula are relatively rare but typically cause pulsatile tinnitus (PT) in the involved ear. Occasionally, symptoms produced by blood flowing through the diverticulum are severe enough to necessitate recontouring the sigmoid sinus. Recently, a 59-year-old female was evaluated after years of worsening unilateral PT. CT angiography identified a 5 mm sigmoid sinus diverticulum near the sinodural angle. Given the severity of symptoms, the patient's diverticulum was surgically decompressed and recontoured using hydroxyapatite bone cement.
RESUMO
OBJECTIVES: To demonstrate the feasibility and efficacy for next-day loading of a percutaneous bone-anchored hearing device. STUDY DESIGN: Multicenter prospective cohort study. SETTING: Tertiary neurotologic referral centers. SUBJECT AND METHODS: In this multicenter prospective study, a 4.5-mm laser-etched bone-anchored hearing device was implanted in adult subjects who had conductive/mixed hearing loss or single-sided deafness. One day following implantation, the surgical site was assessed for soft tissue reaction per the Holgers Scale, and implant stability was evaluated by manual palpation and resonance frequency analysis. On the same day, subjects were fitted with the processor. Follow-up evaluations were at 1 week, 4 weeks, 3 months, 6 months, and 12 months. The Glasgow Benefit Inventory and Abbreviated Profile of Hearing Aid Benefit questionnaires were completed postoperatively. RESULTS: Fourteen devices were implanted in 12 subjects. Two subjects underwent bilateral implantation. Implant stability was rated as firm at every interval for all ears, and the Implant Stability Quotient values at 3 months were stable or increased as compared with day 1 measurements. Skin irritation was limited to Holgers grade 0 and 1, with the majority having no skin irritation. The mean Glasgow Benefit Inventory global score was +43.8, and the mean Abbreviated Profile of Hearing Aid Benefit global benefit score was 60.2%. All 14 implants have remained firmly anchored. CONCLUSIONS: Next-day loading of this 4.5-mm-diameter percutaneous bone-anchored hearing device appears to be a feasible alternative to the original 3-month delayed loading. Although this is a preliminary study, the results support continued investigation of a next-day loading strategy.
Assuntos
Auxiliares de Audição , Perda Auditiva Condutiva/cirurgia , Âncoras de Sutura , Adulto , Estudos de Coortes , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osseointegração , Fatores de Tempo , Suporte de Carga , CicatrizaçãoAssuntos
Dexametasona/administração & dosagem , Perda Auditiva Neurossensorial/terapia , Injeção Intratimpânica/métodos , Glucocorticoides/administração & dosagem , Pesquisas sobre Atenção à Saúde , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Otolaringologia/métodos , Resultado do Tratamento , Estados UnidosRESUMO
The current advancements in otosclerosis therapy cannot be fully appreciated without studying the history, rediscovery, and modification of a once-forgotten procedure. The evolution of stapes surgery can be best summarized into 4 noteworthy eras: the preantibiotic era (which was forgotten and then rediscovered), the fenestration era (mainstreamed by Julius Lempert), the mobilization era (led by Samuel Rosen), and the modern stapedectomy era (revived and revolutionized by John Shea). Each era is unique with its own challenges and ingenious techniques to overcome what used to be among the leading causes of deafness.
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Fenestração do Labirinto/história , Otosclerose/história , Cirurgia do Estribo/história , Europa (Continente) , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Estados UnidosRESUMO
Controversies have been associated with the etiology, diagnosis, evaluation, and management of otosclerosis since Valsalva first described stapes fixation as a cause of hearing loss. Although the exact mechanism of the bone remodeling associated with otosclerosis remains uncertain, stapedotomy has been accepted as the surgical treatment of most patients with stapedial otosclerosis. There remains a disparity of opinion, however, regarding the role of preoperative imaging, surgical technique, implant selection, and medical therapy for cochlear otosclerosis. In addition, opinions vary regarding the optimal postoperative care of patients undergoing stapedotomy and a patient's ability to participate in activities that may result in barotrauma.
Assuntos
Difosfonatos/uso terapêutico , Perda Auditiva Condutiva/fisiopatologia , Prótese Ossicular , Otosclerose/diagnóstico por imagem , Otosclerose/terapia , Audiometria de Tons Puros , Barotrauma , Perda Auditiva Condutiva/terapia , Humanos , Terapia a Laser , Estribo/fisiologia , Cirurgia do Estribo/métodos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVES/HYPOTHESIS: To assess balloon dilation of the Eustachian tube with Eustachian tube balloon catheter in conjunction with medical management as treatment for Eustachian tube dilatory dysfunction. STUDY DESIGN: In this prospective, multicenter, randomized, controlled trial, we assigned, in a 2:1 ratio, patients age 22 years and older with Eustachian tube dilatory dysfunction refractory to medical therapy to undergo balloon dilation of the Eustachian tube with balloon catheter in conjunction with medical management or medical management alone. METHODS: The primary endpoint was normalization of tympanogram at 6 weeks. Additional endpoints were normalization of Eustachian Tube Dysfunction Questionaire-7 symptom scores, positive Valsalva maneuver, mucosal inflammation, and safety. RESULTS: Primary efficacy results demonstrated superiority of balloon dilation of the Eustachian tube with balloon catheter + medical management compared to medical management alone. Tympanogram normalization at 6-week follow-up was observed in 51.8% (72/139) of investigational patients versus 13.9% (10/72) of controls (P < .0001). Tympanogram normalization in the treatment group was 62.2% after 24 weeks. Normalization of Eustachian Tube Dysfunction Questionaire-7 Symptom scores at 6-week follow-up was observed in 56.2% (77/137) of investigational patients versus 8.5% (6/71) controls (P < .001). The investigational group also demonstrated substantial improvement in both mucosal inflammation and Valsalva maneuver at 6-week follow-up compared to controls. No device- or procedure-related serious adverse events were reported for those who underwent balloon dilation of the Eustachian tube. CONCLUSIONS: This study demonstrated superiority of balloon dilation of the Eustachian tube with balloon catheter + medical management compared to medical management alone to treat Eustachian tube dilatory dysfunction in adults. LEVEL OF EVIDENCE: 1b. Laryngoscope, 128:1200-1206, 2018.
Assuntos
Dilatação/métodos , Otopatias/terapia , Tuba Auditiva/fisiopatologia , Adulto , Feminino , Testes Auditivos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento , Estados UnidosRESUMO
OBJECTIVES/HYPOTHESIS: To review hearing results and complications for the NiTiBOND next generation shape memory prosthesis and compare them with results for the current shape memory prosthesis (SMart). STUDY DESIGN: Retrospective, multicenter chart review. METHODS: Primary laser stapedotomy was performed using either a NiTiBOND or a SMart prosthesis. Ninety-two ears in 79 patients were included in the study (67.4% female), 52 with the NiTiBOND prosthesis and 40 with the SMart prosthesis. Data collected included demographic variables, pre- and postoperative pure-tone air and bone conduction thresholds, speech discrimination scores, complications, and the need for revision surgery. Pure-tone average (PTA) and PTA air-bone gap (ABG) pre- and postoperative were computed. Success was defined as a postoperative ABG of ≤10 dB. RESULTS: There were no significant differences between groups in hearing results, including improvement in ABG, change in speech discrimination, change in air or bone PTA, or change in high-frequency bone PTA. Short-term (mean = 4.4 and 4.9 weeks, respectively) success rates for the NiTiBOND and SMart prostheses were 84.6% and 70.0%, respectively, with this difference closing at the most recent test (83.7% and 80.0%, respectively). No revision surgery took place in either group, and there were no differences in complications such as dizziness, tinnitus, or taste disturbance, though the NiTiBOND group tended to have a lower rate of transient or permanent vertigo. CONCLUSIONS: Compared with the SMart prosthesis, the NiTiBOND prosthesis is a safe prosthesis that achieves at least comparable hearing results and may offer some surgical advantages. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:915-920, 2017.
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Prótese Ossicular/tendências , Otosclerose/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Desenho de Prótese , Cirurgia do Estribo/métodos , Adulto , Idoso , Audiometria de Tons Puros/métodos , Limiar Auditivo/fisiologia , Condução Óssea/fisiologia , Estudos de Coortes , Feminino , Seguimentos , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Otosclerose/diagnóstico , Implantação de Prótese/métodos , Estudos Retrospectivos , Medição de Risco , Percepção da Fala/fisiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
For the past three decades, surgery of glomus jugulare tumors (GJTs) has been characterized by extensive combined head and neck, neuro-otologic, and neurosurgical approaches. In recent years, the authors have modified the operative technique to a less invasive approach for preservation of cranial nerves while achieving satisfactory tumor resection. We evaluated and compared the clinical outcomes of our current less invasive approach with our previous more extensive procedures. The clinical records of 39 cases of GJT surgically treated between 1992 and 2011 were retrospectively reviewed. The less invasive transjugular approach with Fallopian bridge technique (LI-TJ) was used for the most recent five cases. The combined transmastoid-transjugular and high cervical (TM-HC) approach was performed in 30 cases, while four cases were treated with a transmastoid-transsigmoid approach with facial nerve translocation. Operative technique, extent of tumor resection, operating time, hospital stay, and morbidity were examined through the operative records, and a comparison was made between the LI-TJ cases and the more invasive cases. No facial nerve palsy was seen in the LI-TJ group while the TM-HC group demonstrated six cases (17.6%) of facial palsy (House-Brackmann facial nerve function grading scale grade II and III). The complication rate was 0 % in the LI-TJ group and 16.7% in the more invasive group. The mean operative time and hospital stay were shorter in the LI-TJ group (6.4 h and 4.3 days, respectively) compared with the more invasive group (10.7 h and 8.0 days, respectively). The LI-TJ approach with Fallopian bridge technique provided adequate tumor resection with cranial preservation and definitive advantage over the more extensive approach.
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Traumatismos do Nervo Facial/prevenção & controle , Nervo Facial/anatomia & histologia , Tumor do Glomo Jugular/cirurgia , Transtornos da Audição/prevenção & controle , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Perda Sanguínea Cirúrgica , Vazamento de Líquido Cefalorraquidiano , Rinorreia de Líquido Cefalorraquidiano/epidemiologia , Rinorreia de Líquido Cefalorraquidiano/etiologia , Vértebras Cervicais/cirurgia , Nervos Cranianos/fisiologia , Nervo Facial/patologia , Traumatismos do Nervo Facial/epidemiologia , Traumatismos do Nervo Facial/etiologia , Feminino , Transtornos da Audição/epidemiologia , Transtornos da Audição/etiologia , Humanos , Tempo de Internação , Masculino , Processo Mastoide/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Decúbito Dorsal , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Despite advanced microsurgical techniques, more refined instrumentation, and expert team management, there is still a significant incidence of complications in vestibular schwannoma surgery. OBJECTIVE: To analyze complications from the microsurgical treatment of vestibular schwannoma by an expert surgical team and to propose strategies for minimizing such complications. METHODS: Surgical outcomes and complications were evaluated in a consecutive series of 410 unilateral vestibular schwannomas treated from 2000 to 2009. Clinical status and complications were assessed postoperatively (within 7 days) and at the time of follow-up (range, 1-116 months; mean, 32.7 months). RESULTS: Follow-up data were available for 357 of the 410 patients (87.1%). Microsurgical tumor resection was performed through a retrosigmoid approach in 70.7% of cases. Thirty-three patients (8%) had intrameatal tumors and 204 (49.8%) had tumors that were <20 mm. Gross total resection was performed in 306 patients (74.6%). Hearing preservation surgery was attempted in 170 patients with tumors <20 mm, and good hearing was preserved in 74.1%. The main neurological complication was facial palsy (House-Brackmann grade III-VI), observed in 14% of patients (56 cases) postoperatively; however, 59% of them improved during the follow-up period. Other neurological complications were disequilibrium in 6.3%, facial numbness in 2.2%, and lower cranial nerve deficit in 0.5%. Nonneurological complications included cerebrospinal fluid leaks in 7.6%, wound infection in 2.2%, and meningitis in 1.7%. CONCLUSION: Many of these complications are avoidable through further refinement of operative technique, and strategies for avoiding complications are proposed.
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Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: For hearing preservation in acoustic neuroma (AN) surgery, the middle fossa (MF) or retrosigmoid (RS) approach can be used. Recent literature advocates the use of the MF approach, especially for small ANs. OBJECTIVE: To present our critical analysis of operative results comparing these 2 approaches. METHODS: We reviewed 504 consecutive AN resections performed between November 1998 and September 2007 and identified 43 MF and 82 RS approaches for tumors smaller than 1.5 cm during hearing preservation surgery. Individual cases were examined postoperatively with respect to hearing ability, facial nerve activity, operative time, blood loss, and symptoms resulting from retraction of the cerebellar or temporal lobes. RESULTS: Good hearing function (American Academy of Otolaryngology-Head and Neck Surgery class B or better) was preserved in 76.7% of patients undergoing surgery via the MF approach and in 73.2% of the RS group (P = .9024). Temporary facial nerve weakness was more frequent in the MF group (P = .0249). However, late (8-12 months) follow-up examinations showed good recovery in both groups. The mean operative time was 7.45 hours for the MF group and 5.2 hours for the RS group (P = .0318). The mean blood loss was 280.5 mL for the MF group and 80.8 mL for the RS group (P < .0001). Temporary symptoms of temporal lobe edema (drowsiness or speech disturbance) were noted in 6 MF cases. No cerebellar dysfunction was noted in the RS group. CONCLUSIONS: Although hearing and facial nerve function assessed at approximately 1 year was similar with these 2 approaches, the RS approach provided several advantages over the MF approach for ANs smaller than 1.5 cm.
Assuntos
Fossa Craniana Média/cirurgia , Fossa Craniana Posterior/cirurgia , Craniotomia/métodos , Perda Auditiva/prevenção & controle , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Audiometria/métodos , Fossa Craniana Média/anatomia & histologia , Fossa Craniana Posterior/anatomia & histologia , Craniotomia/normas , Feminino , Perda Auditiva/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/patologia , Procedimentos Neurocirúrgicos/normas , Complicações Pós-Operatórias/epidemiologiaRESUMO
OBJECTIVE: Evaluate the effectiveness of remote programming for cochlear implants. STUDY DESIGN: Retrospective review of the cochlear implant performance for patients who had undergone mapping and programming of their cochlear implant via remote connection through the Internet. METHODS: Postoperative Hearing in Noise Test and Consonant/Nucleus/Consonant word scores for 7 patients who had undergone remote mapping and programming of their cochlear implant were compared with the mean scores of 7 patients who had been programmed by the same audiologist over a 12-month period. Times required for remote and direct programming were also compared. The quality of the Internet connection was assessed using standardized measures. Remote programming was performed via a virtual private network with a separate software program used for video and audio linkage. RESULTS: All 7 patients were programmed successfully via remote connectivity. No untoward patient experiences were encountered. No statistically significant differences could be found in comparing postoperative Hearing in Noise Test and Consonant/Nucleus/Consonant word scores for patients who had undergone remote programming versus a similar group of patients who had their cochlear implant programmed directly. Remote programming did not require a significantly longer programming time for the audiologist with these 7 patients. CONCLUSION: Remote programming of a cochlear implant can be performed safely without any deterioration in the quality of the programming. This ability to remotely program cochlear implant patients gives the potential to extend cochlear implantation to underserved areas in the United States and elsewhere.
Assuntos
Implantes Cocleares , Telecomunicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Audiometria de Tons Puros , Implante Coclear , Feminino , Audição/fisiologia , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Ruído , Estudos Retrospectivos , Software , Percepção da Fala/fisiologia , Adulto JovemRESUMO
OBJECT: Hearing preservation remains a challenging problem in vestibular schwannoma (VS) surgery. The ability to preserve hearing in patients with large tumors is subject to particular difficulty. In this study, the authors focus on hearing preservation in patients harboring large VSs. METHODS: A total of 344 consecutive patients underwent surgical removal of VSs over the past 9 years. Of these 344 cases, 195 VSs were > 20 mm in maximum cisternal diameter. Of the 195 cases, hearing preservation surgery was attempted for 54 patients who had a Class A, B, C, or D preoperative hearing level; that is, a pure tone average
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Perda Auditiva/prevenção & controle , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Nervo Coclear/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/classificação , Neuroma Acústico/patologia , Procedimentos Neurocirúrgicos/efeitos adversos , Estudos Retrospectivos , Aderências Teciduais/patologia , Resultado do TratamentoRESUMO
OBJECTIVE: To discuss the surgical technique and evaluate the effectiveness of external auditory canal (EAC) closure in patients with refractory chronically draining ears. STUDY DESIGN AND SETTING: A retrospective case review of seven patients who underwent EAC closure for chronically draining ears at a private tertiary otologic referral center between 2001 and 2004. Three patients underwent concomitant placement of a BAHA implant, and one patient underwent cochlear implantation during a second-stage procedure. RESULTS: All seven patients had successful closure of the external auditory canal with elimination of chronic drainage. The follow-up interval ranged from 10 to 35 months. There were no cases of iatrogenic cholesteatoma formation or breakdown of the ear canal closure. CONCLUSION AND SIGNIFICANCE: In patients with refractory chronically draining ears, EAC closure, alone or in conjunction with a bone-anchored implant, may be a treatment option. A BAHA implant can be placed during the initial procedure or staged.
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Meato Acústico Externo/cirurgia , Otite Média com Derrame/cirurgia , Adolescente , Adulto , Idoso , Doença Crônica , Implante Coclear , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otológicos/métodos , Estudos Retrospectivos , TimpanoplastiaRESUMO
OBJECTIVES: Two studies were designed to investigate a hyaluronan (HA) gel for middle ear (ME) wound healing. METHODS: We used a guinea pig model of ME wound healing. In a long-term study, we performed a comparison of hearing and ME inflammation in 3 groups. Group 1 (n = 8) underwent bilateral wounding of ME mucosa and unilateral packing of the ME with HA gel (Sepragel). Group 2 (n = 6) was the same as group 1 except that the packing was absorbable bovine collagen sponges (Gelfoam). Group 3, the control group (n = 14), had operated, unpacked ears. In a short-term study, we investigated ME retention of HA gel at 1 and 2 weeks (n = 16). RESULTS: At 1 week, all ears showed decreased distortion product otoacoustic emissions (DPOAEs) and auditory brain stem responses (ABRs) secondary to ME packing and postsurgical inflammation. The controls recovered preoperative DPOAEs and ABRs by week 2. Group 1 had decreased low-frequency DPOAEs at weeks 2 and 6, but their high-frequency DPOAEs and ABRs recovered to preoperative values by week 6. Group 2 had hearing losses that persisted throughout the study. Group 1 showed normal ME and inner ear histologic characteristics. Group 2 showed inflammatory cells within the ME and cochleas. Group 1 showed less packing retention than did group 2 at week 6 (p = .016). Eighty-five percent of the HA packing remained at 1 week, and 73% at 2 weeks. CONCLUSIONS: Hyaluronan gel was a relatively safe and effective ME packing material in our animal model.
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Adjuvantes Imunológicos/administração & dosagem , Orelha Média/lesões , Ácido Hialurônico/administração & dosagem , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/tratamento farmacológico , Animais , Limiar Auditivo/fisiologia , Reagentes de Ligações Cruzadas , Modelos Animais de Doenças , Seguimentos , Géis , Cobaias , Injeções , Fatores de Tempo , Resultado do Tratamento , Ferimentos e Lesões/patologia , Ferimentos e Lesões/fisiopatologiaRESUMO
OBJECTIVES: The educational objectives were to discuss a new technique to manage acquired cholesteatomas and to compare this with standard approaches used for cholesteatoma removal. The study objective was to determine the feasibility of using a new approach, the reversible canal wall down approach, in conjunction with bone cement to remove acquired cholesteatomas and, potentially, preserve the ossicular chain. STUDY DESIGN: Retrospective review of five patients who underwent resection of their acquired cholesteatomas using a technique that maximizes exposure, yet preserves the posterior canal wall and, potentially, the ossicular chain. METHODS: In the setting of a tertiary otological referral center, five consecutive patients with acquired cholesteatomas underwent reversible canal wall down surgery. Four patients were male (ages, 41, 53, 26, and 10 y), and one patient was a woman [age, 51 y]). A reversible canal wall down mastoidectomy approach was used in the patients. Main outcome measures were intraoperative findings with respect to cholesteatoma removal and postoperative clinical examination, including postoperative audiograms. RESULTS: Five patients had dry ears postoperatively. One patient initially had granulation tissue forming on the posterior ear canal. This eventually resolved. The patients who had a postoperative audiogram after cholesteatoma resection with ossicular chain preservation noted an improvement or stabilization in their hearing. CONCLUSIONS: Using the reversible canal wall down approach in conjunction with bone cement, one is able to obtain excellent exposure of the cholesteatoma and, potentially, preserve the ossicular chain. This approach may be particularly useful in revision cholesteatoma surgery or in cases of acquired cholesteatoma in which the surgeon may be able to preserve the ossicular chain.
Assuntos
Colesteatoma da Orelha Média/cirurgia , Meato Acústico Externo/cirurgia , Processo Mastoide/cirurgia , Adulto , Audiometria de Tons Puros , Criança , Ossículos da Orelha/cirurgia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/etiologiaRESUMO
OBJECTIVE: Limitations in biocompatibility and hearing improvement with ossicular chain reconstruction prostheses are addressed with new, lightweight titanium prostheses designed to maximize visualization of the capitulum and footplate regions. The effectiveness of these new prostheses is being tested in a prospective multicenter study. STUDY DESIGN: Prospective case series. SETTING: Multicenter (8 sites), primarily tertiary private practice or academic otologic clinics. PATIENTS: A convenience sample of 31 patients undergoing ossiculoplasty, with 16 partial ossicular chain reconstructions using the Bell prosthesis and 15 total reconstructions using the Aerial prosthesis. INTERVENTION: Ossiculoplasty using new Kurz titanium prostheses. Cartilage was interposed between the tympanic membrane and the prosthesis. MAIN OUTCOME MEASURES: Air-bone gap for pure tone average and 3,000 and 4,000 Hz, assessed preoperatively and 3 months, 6 months, and 12 months postoperatively; percent of patients obtaining an air-bone gap of =20 dB; high-frequency average (1,000, 2,000, and 4,000 Hz) to evaluate sensorineural hearing loss; and extrusion rate. RESULTS: A postoperative air-bone gap of =20 dB was obtained in 81% of Bell prosthesis patients and 67% of Aerial prosthesis patients at 3 months. The results were stable to improved for later time intervals. High-frequency gaps were similar to the pure tone average gap. To date, there have been no instances of extrusion, and all the surgeons found the prostheses easy to use and thought that the design characteristics facilitated accurate placement. CONCLUSIONS: Initial evaluation of the Kurz titanium prostheses produced low extrusion rates (none to date) with excellent hearing results, including good high-frequency conduction. Good visualization and accurate placement were easy to achieve. Further studies are needed to confirm long-term efficacy.
Assuntos
Prótese Ossicular , Titânio , Audiometria de Tons Puros , Limiar Auditivo/fisiologia , Condução Óssea/fisiologia , Cartilagem/transplante , Seguimentos , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Discriminação da Altura Tonal/fisiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Desenho de Prótese , Ajuste de PróteseRESUMO
SUMMARY: Three cases of intracanalicular meningioma mimicking vestibular schwannoma are presented. In each case, a contrast-enhancing mass filling the internal auditory canal was identified on MR images and was originally diagnosed as a vestibular schwannoma. Although it is difficult to differentiate definitively between these lesions preoperatively, imaging findings inconsistent with a diagnosis of vestibular schwannoma can be identified. Preoperative identification of intracanalicular meningiomas permits alterations in surgical planning that allow for the more complete resection of these rare tumors.
Assuntos
Neoplasias da Orelha/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Neuroma Acústico/diagnóstico , Adulto , Idoso , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
OBJECT: To evaluate the possible prognostic factors for hearing preservation, the authors retrospectively reviewed the results of 30 consecutive acoustic neuroma operations in which hearing preservation was attempted, in a total series of 63 acoustic neuromas. METHODS: Intracanalicular tumors or those that extended less than 3 mm outside the porus acusticus (10 cases) were resected via the middle fossa approach. The retrosigmoid approach was used for tumors exceeding the limits for the middle fossa approach (20 cases). Overall, hearing was preserved (pure tone average < or = 50 dB and speech discrimination score > or = 50%) in 21 patients (70%). There were 11 patients with severe adhesion between the cochlear nerve and tumor capsule, and 19 without. Hearing was preserved postoperatively in only two (18.2%) of 11 patients with severe adhesion, whereas all 19 without severe adhesion had hearing preservation. CONCLUSIONS: The presence or absence of severe adhesion in the interface between the cochlear nerve and the tumor might be the most significant prognostic factor for hearing preservation postsurgery.