The "One Shot" Diode Laser Stapedotomy.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness and the safety of diode laser stapedotomy, through the functional results analysis. MATERIALS AND METHODS: A total of 179 primary cases of otosclerosis that had been operated on with a diode laser technique from 2004 to 2012 were retrospectively reviewed. Preoperative, 1 month postoperative, and late annual follow-up audiograms (up to 8 years) were obtained in all the cases. Mean preoperative and 1 month postoperative pure-tone average (500-1000-2000-4000 Hz) bone conduction thresholds (PTA-BCs), air conduction (AC) hearing outcomes for 8 kHz and mean postoperative air-bone gap (PTA-ABG) closure were analyzed. RESULTS: The mean preoperative (pre) PTA-BC was 24.22 dB (±8.7 SD) whereas the mean postoperative (post) PTA-BC was 21.11 dB (±9.1 SD). The mean preoperative 8 kHz AC was 56.41 dB (±22.86 SD) and the postoperative 8 kHz AC was 52.56 dB (±24.35 SD). A statistically significant improvement of the PTA-BC post and of the postoperative 8 kHz AC was observed. The 1 month ABG closure within 10 dB in 89.02% of the patients and within 20 dB in 97.69% of the patients was obtained with statistically significant stability over long-term follow-up. No major complications occurred in the series. CONCLUSIONS: The use of diode laser with high power and short time exposure as setup can be considered a safe, precise, and useful tool in stapes surgery.

Sporadic endolymphatic sac tumor: its clinical, radiological, and histological features, management, and follow-up.

BACKGROUND: Sporadic endolymphatic sac tumor (ELST) is rare. We described the clinical, radiological, and histological features, treatment, and follow-up of ELST. METHOD: This was a retrospective analysis of 7 cases of sporadic ELST that were managed between 1993 and 2010. RESULTS: Twenty-five to 75 years was the age range of the patients. Subjective hearing loss and tinnitus were the most common presenting features. Five patients had total deafness and 2 had severe sensorineural hearing loss. The most common radiological feature was temporal bone destruction with tumor extension to cerebellopontine angle and posterior cranial fossa. Cholesterol or hemosiderin cysts around the tumor could be a characteristic feature. Major skull base procedures were performed in all 7 cases, and complete tumor excision was achieved in 6 of them. One patient needed a second surgery after she was referred to us after an incomplete first surgery. Recurrences were detected in 2 patients during follow-up; 1 of them received irradiation without minimal change to the tumor size and the second refused any treatment for the recurrence. Both of them are alive with disease. CONCLUSION: Early detection and radical surgical excision at first attempt give best results. Radiotherapy could be considered only in unresectable recurrences.

Sporadic acoustic neuroma in pediatric patients.

OBJECTIVE: Sporadic acoustic neuroma, usually occur between the ages of 40 and 70 years, are very rare in children. We review the experiences of 10 cases of sporadic (non-NF2) acoustic neuromas in pediatric patients. METHOD: During last 26 years 2000 skull base procedures were performed in the Otorhinolaryngology Unit of the Ospedali Riuniti di Bergamo. Among these almost 900 cases were acoustic neuromas. Only 10 were at or under the age of 18 years. RESULTS: The age of the youngest patient in our series was 12 years. Deafness were the commonest presentation and were seen in eight patients. It varied between 10 and 65 dB sensorineural hearing loss. Among these eight cases, two patients have sudden onset of hearing loss. Two patients presented with dizziness. The duration of complaints were between 2 months and 5 years in these patients. The diameter of the tumors varied widely with minimum of 10 mm to maximum up to 60 mm. Five patients each underwent resection of the tumor by translabyrinthine and retrosigmoid approach, respectively. The minimum postoperative follow-up was 3 years and maximum was 22 years in our series. Postoperatively seven cases the facial nerve recovered to grade I, and one each to grade II and grade VI of House-Brackmann classification. All five cases who underwent retrosigmoid approach had moderate (40 dB) to total sensorineural hearing loss postoperatively. The youngest patient with largest tumor diameter of 60 mm developed transient hemiparesis in the immediate postoperative period and he recovered fully in due course. CONCLUSION: We found preservation of facial nerve function is more easier than hearing in this group of patients.