Can MRI replace a second look operation in cholesteatoma surgery?

The purpose of this paper is to investigate whether a magnetic resonance imaging (MRI) examination of the petrous bones could replace the conventional second look surgical procedure when a canal wall up tympanoplasty procedure has been performed during the first look surgery. Eighteen patients were examined with MRI prior to a second look surgical procedure. MRI was performed on a 1.5 T superconducting system. T2 weighted images before contrast and T1 weighted images after contrast (gadopentate dimeglumine) were obtained. Imaging results were compared with surgical findings. The poor radiosurgical correlation (50% and 61% after re-evaluation) suggests that, at the present time, MRI is not a valid alternative to a second look surgical intervention in the case of cholesteatoma treated by canal wall up tympanoplasty. In our study, MRI was not capable of differentiating small pearls of residual cholesteatoma from surrounding scar tissue.

Predicting vocal outcome by means of a vocal endurance test: a 5-year follow-up study in female teachers.

OBJECTIVES: Investigate whether vocal problems in future professional activities can be predicted by early laryngeal and phoniatric evaluation and whether a vocal endurance test can contribute to this evaluation. STUDY DESIGN: Five-year follow-up study of 30 female education majors, initially documented with a standard voice assessment and a vocal endurance test. Measurements before and after vocal endurance testing were compared and related to the vocal outcome 5 years after the initial testing. METHODS: Voice assessment included perceptual evaluation, airflow measurements, Fo and SPL measurements, voice range profile and laryngeal (stroboscopic) examination. The Standard Tolerance Test, as recommended by the Union of European Phoniatricians, was followed. This data set was completed with a questionnaire concerning the subjects' vocal behavior. This questionnaire was repeated 5 years later. RESULTS: No significant differences were found for ENT scores (laryngostroboscopy) (P = .018). Logistic regression was used to determine a relationship between initial observations and the final outcome. CONCLUSIONS: The role of an endurance test as used in this study is negligible for the prediction of vocal outcome. A combination of laryngeal examination, maximum phonation time, and perceptual evaluation, assessed prior to the endurance test, reveals a prediction of the vocal outcome with a specificity of 90% and a sensitivity of 70%.

Blindness due to electrocoagulation following functional endoscopic sinus surgery.

A case is presented with irreversible blindness in one eye and restriction of the infratemporal visual field in the other eye, due to electrocoagulation performed for delayed bleeding after functional endoscopic sinus surgery (FESS). Although blindness due to rhinosurgery is a well-known, but rare complication, a review of the recent literature did not reveal a similar incident. The use of electrocoagulation especially under conditions of poor visualization, that may be the case in post-operative bleeding following (endoscopic) sinus surgery, is strongly discouraged.

[Blindness due to electrocoagulation following functional endoscopic sinus surgery]. / Blindheid ten gevolge van electrocoagulatie na FESS.

A case is presented with irreversible blindness in one eye and restriction of the infratemporal visual field in the other eye, due to electrocoagulation performed for delayed bleeding after functional endoscopic sinus surgery (FESS). Although blindness due to rhinosurgery is a well-known, but rare complication, a review of the recent literature did not reveal a similar incident. The use of electrocoagulation especially under bad visualization circumstances, which may be the case in postoperative bleeding following endoscopic sinus surgery, is strongly discouraged.

Management of labyrinthine fistulas in cholesteatoma.

Surgical management of labyrinthine fistulas caused by cholesteatoma remains controversial. In 213 patients with middle ear surgery for cholesteatoma, 18 patients (18 ears-8.5%) presented a labyrinthine fistula. These cases are reviewed in the present paper. Symptoms, audiometry, pre-operative imaging, surgical procedure and results are discussed. In all cases total removal of the pathology was pursued with preservation of cochlear function. A two-stage closed technique was used. During the first stage reconstruction with tympano-ossicular allografts, according to the technique of J. Marquet, was performed. A second look followed one year later. Three ears were deaf pre-operatively. Improvement of bone conduction was observed in more than 50% and hearing preservation in all other cases but one. In one ear total deafness occurred from extensive intralabyrinthine invasion by cholesteatoma, demanding a labyrinthectomy. The hearing was preserved in four cases in which an amputation of a large part of the membranous labyrinth could be observed. Since neither pre-operative clinical examination nor imaging can be relied on to reveal a fistula, the surgeon needs to be prepared for unexpected fistulas.

Psychoacoustical tuning curves. Normative data for clinical use.

This normative study presents a clinically applicable method with which to obtain Psychoacoustical Tuning Curves: data are obtained with clinical audiometers, and measurements are performed on normal-hearing non-trained volunteers. A simultaneous masking method with test frequency of 4,000 Hz was used, withmasking being incremented in 5 dB or 1 dB steps. One group of subjects was tested three times with 5 dB incrementing steps to evaluate the method's reproducibility. A second group of subjects was measured twice with 1 dB incrementing steps, to compare the reproducibility of the 1-dB step measurements, and the difference between the 1-dB step and 5-dB step measurements. All the data were evaluated as normative values. The method presented proves to have a good reproducibility. Although testing with 1-dB incrementing steps provides more accurate measurements and curves with steeper slopes, the 5-dB incrementing step method is more practicable. Interest variability evaluation indicates that differences between two measurements performed on the same person exceeding 120 Hz (2 SD) bandwidth can be interpreted as significant.

Blindness following paranasal sinus surgery: a report of two cases.

Two cases of blindness following paranasal sinus surgery are presented. The first patient, a 38-year old man, developed a delayed massive haemorrhage, after bilateral sphenoethmoidectomy. This hemorrhage could be stopped by electric cauterisation under endoscopical control. During this reintervention the patient developed total blindness of his right eye, and a restriction of the inferotemporal left visual field. The second patient, a 10-year old girl, developed, after bilateral spheno-ethmoidectomy for isolated sphenoiditis, total blindness of the left eye and paralysis of the ipsilateral extraocular muscles. According to the literature, blindness secondary to paranasal surgery is mainly due to retrobulbar hemorrhage. In the first case blindness was due to a direct cauterisation of the optic nerve, after perforation of the lamina papyracea. In the second case, blindness was probably due to a hemorrhage in the orbital apex.