Atresia repair before microtia reconstruction: comparison of early with standard surgical timing.

OBJECTIVE: To compare short-term results of atresia repair when performed before versus after microtia reconstruction. STUDY DESIGN: Retrospective case review. SETTING: Tertiary otologic referral center. PATIENTS: Congenital aural atresia with or without microtia: 70 cases over 24 months. INTERVENTION: Atresia repair before Medpor microtia reconstruction (ARM) versus atresia repair after microtia reconstruction with autogenous rib (ARR) versus atresia reconstruction without microtia (AR). MAIN OUTCOME MEASURES: Surgical outcomes, short-term postoperative audiometric results (at least 4 months after surgery but within the first postoperative year), complications. RESULTS: Data from the 3 groups are as follows: ARM, 31 patients with median age 4.2 years (range, 2.5-9.3 yr); ARR, 28 patients with median age 12 years (range, 6.9-61); and AR, 11 patients with median age 5.9 years (range, 5.5-59 yr). Preoperative computed tomographic grading using the Jahrsdoerfer scale demonstrated an average score of 7.4 (range, 6-9) for the ARM group, 7.7 (range, 6-9) for the ARR group, and 8.5 (range, 8-9) for the AR group. For patients scoring 8 to 10 on the Jahrsdoerfer scale, postoperative pure-tone average 2 for each group were as follows: ARM, 28 dB hearing loss (HL); ARR, 32 dB HL; and AR, 29 dB HL. For patients scoring 7 or less, postoperative pure-tone average 2 were as follows: ARM, 42 dB HL; and ARR, 41 dB HL (AR, no patients). Surgical complications of infection and facial nerve injury were not seen in any group. Meatal stenosis was higher in the ARR group. One patient in the ARM group suffered a high-frequency sensorineural HL. No patient receiving Medpor microtia reconstruction suffered a complication due to the presence of the ear canal before microtia reconstruction. CONCLUSION: Early results of ARM compare favorably with results achieved with atresia repair after microtia reconstruction with autogenous rib cartilage and with atresia repair without microtia repair. Hearing outcome and complications in this study are also comparable with previously reported expert results. Because restoration of binaural hearing has been shown to be advantageous for auditory development and function, timing of atresia repair can be considered before microtia reconstruction on an individual case basis, provided preoperative computed tomographic evaluation shows an adequate chance of surgical success.

Catecholamine-secreting paragangliomas: recent progress in diagnosis and perioperative management.

Catecholamine-secreting paragangliomas (CSPs) present challenges for the managing team of surgeons and anesthesiologists. Without proper preoperative management and planning, the patient is at high risk for complications and significant morbidity. A review of the literature looking at all aspects of the care of patients with CSP was performed to provide a consensus on the comprehensive care of these difficult patients. A case study is also provided to illustrate the management algorithm. Specific recommendations are made with regards to preoperative workup, including serum and urine testing, tumor localization, angiography, and embolization. Preoperative and intraoperative management techniques by the surgical and anesthesiology teams are discussed, including pharmaceutical interventions and fluid management. Aspects of postoperative care are also discussed. Management of patients with CSP requires significant attention to detail by a multidisciplinary team of surgeons and anesthesiologists. By following the recommendations included within this article, the morbidity associated with removal of these tumors can be significantly reduced or eliminated.

Effect of intracapsular tonsillectomy on quality of life for children with obstructive sleep-disordered breathing.

OBJECTIVE: To assess the change in disease-specific quality of life (QOL) in pediatric patients with obstructive sleep-disordered breathing (OSDB) secondary to adenotonsillar hypertrophy after powered intracapsular tonsillectomy and adenoidectomy. DESIGN: Prospective outcomes study. SETTING: Hospital-based pediatric otolaryngology practice. PATIENTS: Fifty children with a mean age of 4.5 years who had a clinical diagnosis of OSDB. INTERVENTIONS: A caregiver of qualifying patients completed a validated QOL survey of pediatric obstructive sleep apnea, the OSA-18 (Obstructive Sleep Apnea-18), preoperatively and 3 months and 1 year postoperatively. MAIN OUTCOME MEASURE: The OSA-18 mean change scores. RESULTS: The mean (SD) total OSA-18 change score at the 3-month follow-up visit was 2.3 (1.2) and at the 1 year follow-up visit was 2.2 (1.3). The total and individual domain change scores were significantly improved at both postoperative intervals (P<.001 for all). There were no significant changes in the total or domain change scores between the intervals. The total change score was not significantly associated with either tonsil size or tonsil position. CONCLUSION: The OSDB-related QOL is significantly improved after powered intracapsular tonsillectomy and adenoidectomy, and this improvement remains stable even after 1 year.