Techniques of the Tympanomastoidectomy with Reconstruction of the Posterior Bone Wall of the External Auditory Canal.

A combined tympanoplasty method, the mobile-bridge tympanoplasty, has been applied at the Clinic for Ear, Nose and Throat Diseases in Novi Sad since 1998. Mobile-bridge tympanoplasty is performed at our Clinic by applying Feldmann's procedure utilizing a microsurgical oscillating saw. It is a combination of closed and open techniques for surgical treatment of middle ear diseases. In addition to this technique, a method for reconstruction of the posterior bone wall of the external auditory canal was introduced. This procedure is applied in cases of damage or impairment of the bony ear canal wall using mastoid cortical temporal bone graft or modeled cartilage of the concha. Maintenance of general anatomical relations in the middle ear enables good ventilation of pneumatic spaces of the middle ear and Eustachian tube permeability, thus providing good conditions for ossicular chain reconstruction. The incidence of recurrent cholesteatoma in combined mobile-bridge tympanoplasty and tympanoplasty with reconstruction of the posterior bone wall was 6% in total. The incidence values for the recurrent cholesteatoma in closed tympanoplasty and in cases of open techniques were 10%. Mobile-bridge tympanoplasty and reconstruction of the posterior bone wall of external auditory canal are methods of choice in surgical treatment of middle ear cholesteatoma that progressed to the attic space, sinus tympani and facial recess.

Complications in Cochlear Implantation at the Clinical Center of Vojvodina.

INTRODUCTION: The first modern cochlear implantation in Serbia was performed on November 26, 2002 at the Center for Cochlear Implantation of the Clinic for Ear, Nose and Throat Diseases, Clinical Center of Vojvodina. OBJECTIVE: The aim of the paper is the analysis of intraoperative and postoperative complications. Major complications include those resulting in the necessity for revision surgery, explantation, reimplantation, severe disease or even lethal outcomes. Minor complications resolve spontaneously or can be managed by conservative therapy and do not require any prolonged hospitalization of the patient. METHODS: In the 2002-2013 period, 99 patients underwent surgical procedures and 100 cochlear implants were placed. Both intraoperative and postoperative complications were analyzed in the investigated patient population. RESULTS: The analysis encompassed 99 patients, the youngest and the oldest ones being one year old and 61 years old, respectively. The complications were noticed in 11 patients, i.e. in 10.5% of 105 surgical procedures. The majority of procedures (89.5%) were not accompanied by any post-surgical complications. Unsuccessful implantation in a single-step procedure (4.04%) and transient facial nerve paralysis can be considered most frequent among our patients, whereas cochlear ossification (1.01%) and transient ataxia (2.02%) occurred rarely. Stimulation of the facial nerve (1.01%), intraoperative perilymph liquid gusher (1.01%), device failure and late infections (1.01%) were recorded extremely rarely. CONCLUSION: Complications such as electrode extrusion, skin necrosis over the implant or meningitis, which is considered the most severe postoperative complication, have not been recorded at our Center since the very beginning. Absence of postoperative meningitis in patients treated at the Center can be attributed to timely pneumococcal vaccination of children.

Congenital cholesteatoma of mastoid origin--a multicenter case series.

BACKGROUND/AIM: The mastoid is the rarest site for the onset of congenital cholesteatoma (CC). The symptoms are atypical and minimal. The aim of this multicenter retrospective descriptive study was to define this extremely rare condition and its clinical presentation, diagnosis and management. METHODS: We analyzed data files for a 15-year period in 4 tertiary otology centers and discovered 6 patients with the diagnosis of CC of the mastoid. RESULTS: The clinical presentation of CC varied from incidental findings in patient to patient with otogenic meningitis. The most common findings during surgical procedures were mastoid cortex erosion, sigmoid plate dehiscence, dural exposure and external canal wall destruction. CONCLUSION: CC of mastoid origin tends to occur in adult patients probably because of minimal symptoms and the delayed diagnosis. It can exist for years in a nonaggressive state and develop to giant sizes. In children it is almost incidentally diagnosed. Early imaging is necessary in order to prevent serious complication.

Functional hearing results in patients with otosclerosis before and after stapedotomy.

Surgical treatment of otosclerosis with stapedotomy leads to the improvement of subjective and objective problems in patients with otosclerosis. A prospective study included patients who had been treated surgically at the Department for Ear, Nose and Throat in Novi Sad in the period from September 2006 to September 2007. On the basis of the appropriate diagnostic procedures, 33 patients were diagnosed with otosclerosis. Functional hearing was assessed before and after surgery by means of pure tone audiometry. The comparison of functional results before and after surgery revealed no changes in pure tone average of bone conduction threshold (average hearing threshold for hearing range), whereas pure tone average of air conduction and pure tone average of the gap showed statistically significant improvement. The results of this study demonstrated the applicability of stapedotomy as a method for successful management of otosclerosis. This way of examination offers a new perspective on patients' health, which should be defined as a physical, psychosocial and social well-being, and not only the absence of a disease itself.

[Otitis media in children--a parallelism between the state-of-the-art knowledge and the context of real clinical practice].

INTRODUCTION: Inflammation of the middle ear is the most common illness among children. It is commonly recurrent by its nature, causing transient or long-term hearing reduction. From the clinical aspect, the problem of recrudescence and chronicity of childhood otitis media is enormous. There are controversies and nonuniformities in defining the cause, conservative and surgical treatment, prevention, mostly due to morphofunctional specificities and dynamic developmental features of the tubotympanomastoid complex. Some open questions are as follows: is recurrent otitis media in childhood really recurrent, or we are dealing with clinical manifestations of exacerbation of the chronic process (chronic from the very beginning), which are the factors predisposing and/or reflecting inflammatory processes in the middle ear, which are the potentials of real clinical practice, which are the modalities of prevention of inflammatory processes in the middle ear in children, is there a parallelism between the real clinical, therapeutic practice and current knowledge of the etiopathogenesis of otitis media in children? DISCUSSION: This study reviews current knowledge and identifies potential etiopathogenetic factors in the development of inflammatory processes of the tubotympanomastoid complex. Special attention was given to external predisposing factors, as well as internal factors which include genetic, immunobiochemical, factors of increased adherence of pathogens and Eustachian tube dysfunction. The study also deals with the potentials of diagnostic morphofunctional procedures, as well as modalities of the real clinical practice. CONCLUSION: An open question remains with regard to the parallelism between real clinical therapeutic potentials and state-of-the-art knowledge, as well as the role of preventive procedures in the field of inflammatory processes of the tubotympanic complex in children.

[Techniques end results of surgical treatment cholesteatoma of middle ear].

INTRODUCTION: Basic surgical techniques in the treatment of middle ear cholesteatoma include the intact-canal-wall and canal-wall-down tympanoplasty and combined method, i.e. the "mobile-bridge" tympanoplasty. The techniques including reconstruction of the posterior bone wall of the external auditory canal are combination of formerly mentioned methods. These tympanoplasty procedures involve a partial or complete removal of the posterior bone wall of the meatus. Subsequently, after the elimination of pathological process, the reconstruction of the middle ear is performed. MATERIAL AND METHODS: 200 patients with middle ear cholesteatoma, who had undergone various microsurgical procedures, were monitored and evaluated in the period 1998-2006. The aim of this study was to present the main principles of tympanoplasty and outcomes of middle ear cholesteatoma surgery through a comparative analysis of the applied tympanoplasty techniques. The closed ICW and open CWD tympanoplasty were compared with the combined mobile-bridge technique with the reconstruction of the posterior bone wall of the external auditory canal. RESULTS: The incidence values for the recurrent cholesteatoma in closed tympanoplasty and in cases of open techniques with radical trepanation of the temporal bone were 6% and 10%, respectively. In cases of combined mobile-bridge tympanoplasty with the reconstruction of the posterior bone wall of the auditory canal the incidence of residual cholesteatoma was 2%. The postoperative rejection of the replanted bone was observed in 2% of. the patients. CONCLUSION: The selection of the appropriate surgical procedure is determined by the type and extent of pathological process, anatomic features of the pneumatic space of the middle ear, available microsurgical equipment and otosurgical skills of the surgeon.