Abordaje por fosa media, aplicaciones en lesiones del hueso temporal / Middle fossa approach: Applications in temporal bone lesions

El abordaje por fosa media es una técnica quirúrgica de gran utilidad en la cirugía de base de cráneo lateral. Si bien es cierto, que por sus restringidas indicaciones así como por su complejidad técnica ha tenido una implantación limitada. Presentamos nuestra experiencia en 10 pacientes en los cuales por gran complejidad del proceso, la situación o la extensión de la lesión, el abordaje por fosa media fue el tratamiento de elección. A pesar de la gran complejidad de los casos no hubo ningún caso de mortalidad asociada a la cirugía. De la morbilidad registrada destacar un hematoma epidural y un hematoma córtico-subcortical. La función auditiva se preservó en 5 pacientes de los 7 pacientes que presentan audición en el momento de la cirugía. En 8 pacientes se logró una función facial House/Brackmann I-II y en los 2 restantes no hubo empeoramiento de la misma función. En 9 de los 10 pacientes se realizó una cirugía resolutiva de la patología. El abordaje por fosa media es una técnica quirúrgica segura y fiable. Nos proporciona un gran control y exposición de los diferentes procesos patológicos de la base de cráneo. Consideramos de gran importancia su conocimiento, pues en determinados pacientes puede ser la única alternativa viable y resolutiva, de ahí la importancia de difundir este abordaje en nuestra especialidad (AU)

The middle fossa approach is a surgical technique that is very useful for lateral skull base surgery. However, it is true that it has limited surgical indications and implementation due to its technical complexity. We present our experience in 10 patients in whom the middle fossa approach was the treatment of choice because of the extent of the injury and complexity of the lesion or process. Despite the complexity of the cases, there was no mortality associated with surgery. Postoperative complications were found in 2 patients who presented an epidural hematoma and a cortico-subcortical hematoma. Hearing function was preserved in 5 patients out of the 7 who had adequate hearing at the time of surgery. House/Brackmann I-II facial nerve function was achieved in 8 patients; the remaining 2 had no deterioration of the nerve function. In 9 out of 10 patients, the surgery achieved complete solution of the lesion. The middle fossa approach is a safe and reliable surgical technique. It gives us great control and exposure of different skull base processes. We consider its knowledge of great importance, because it may be the only viable surgical alternative in some specific patients. That is the reason why it is important to learn this approach and know about it in our specialty (AU)

Middle fossa approach: Applications in temporal bone lesions. / Abordaje por fosa media, aplicaciones en lesiones del hueso temporal.

The middle fossa approach is a surgical technique that is very useful for lateral skull base surgery. However, it is true that it has limited surgical indications and implementation due to its technical complexity. We present our experience in 10 patients in whom the middle fossa approach was the treatment of choice because of the extent of the injury and complexity of the lesion or process. Despite the complexity of the cases, there was no mortality associated with surgery. Postoperative complications were found in 2 patients who presented an epidural hematoma and a cortico-subcortical hematoma. Hearing function was preserved in 5 patients out of the 7 who had adequate hearing at the time of surgery. House/Brackmann I-II facial nerve function was achieved in 8 patients; the remaining 2 had no deterioration of the nerve function. In 9 out of 10 patients, the surgery achieved complete solution of the lesion. The middle fossa approach is a safe and reliable surgical technique. It gives us great control and exposure of different skull base processes. We consider its knowledge of great importance, because it may be the only viable surgical alternative in some specific patients. That is the reason why it is important to learn this approach and know about it in our specialty.

Acúfeno e implante coclear. Experiencia preliminar / Tinnitus and cochlear implantation. Preliminary experience

Objetivo: Valorar el efecto del implante coclear en pacientes con «acúfeno incapacitante». Materiales: Realizamos una evaluación del efecto de la implantación coclear sobre la evolución del acúfeno incapacitante. Se han evaluado 3 adultos afectos de hipoacusia postlingual implantados en nuestro hospital, con acúfenos preimplantación. Los pacientes fueron evaluados de acuerdo con los efectos del acúfeno en las emociones de los pacientes y las actividades de la vida cotidiana. Resultados: De los tres, uno declaró la supresión del acúfeno, otros dos atenuación tras la cirugía, en diversos grados, no encontrando ningún paciente con peores resultados tras la implantación. Conclusiones: El efecto beneficioso de la implantación coclear sobre el acúfeno, reportado en nuestros pacientes, puede ser debido al enmascaramiento acústico, a través de la estimulación eléctrica del nervio acústico, y todo ello por la reorganización cerebral de las vías del sistema nervioso central (SNC) y las áreas de asociación cerebral tras la implantación coclear (AU)

Objective: To assess the effect of cochlear implantation in patients with disabling tinnitus. Materials: We conducted an evaluation of the effect of cochlear implantation on the development of disabling tinnitus. Three adults with pre-implantation tinnitus, implanted in our hospital, were evaluated for postlingual hearing loss. Patients were evaluated according to the effects of tinnitus on their emotions and activities of daily living. Results: One patient reported that the tinnitus disappeared and two reported different degrees of attenuation. We did not find any patients with worse outcomes after implantation. Conclusions: The beneficial effect of cochlear implantation on tinnitus reported in our patients may be due to acoustic masking, through electrical stimulation of the acoustic nerve, all from brain reorganisation of central nervous system (CNS) pathways and cerebral association areas after cochlear implantation (AU)

Hemorragia intralaberíntica / Intralabyrinthine haemorrhage

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[Tinnitus and cochlear implantation. Preliminary experience]. / Acúfeno e implante coclear. Experiencia preliminar.

OBJECTIVE: To assess the effect of cochlear implantation in patients with disabling tinnitus. MATERIALS: We conducted an evaluation of the effect of cochlear implantation on the development of disabling tinnitus. Three adults with pre-implantation tinnitus, implanted in our hospital, were evaluated for postlingual hearing loss. Patients were evaluated according to the effects of tinnitus on their emotions and activities of daily living. RESULTS: One patient reported that the tinnitus disappeared and two reported different degrees of attenuation. We did not find any patients with worse outcomes after implantation. CONCLUSIONS: The beneficial effect of cochlear implantation on tinnitus reported in our patients may be due to acoustic masking, through electrical stimulation of the acoustic nerve, all from brain reorganisation of central nervous system (CNS) pathways and cerebral association areas after cochlear implantation.

[Myringoplasty: auditory follow-up and study of prognostic factors]. / Miringoplastia: seguimiento auditivo y estudio de factores pronósticos.

OBJECTIVE: To perform a five-year study of hearing evolution in patients undergoing myringoplasty to determine whether eardrum repair correlates with improved hearing. We also studied factors that might predispose to failure and their usefulness as prognostic factors. MATERIAL AND METHOD: In a serial case study, we reviewed all myringoplasties performed at our centre during 2000, 2001, and 2002. We reviewed 83 case histories and studied the closure of the perforation, auditory function pre-operatively, postoperatively and after 5 years, as well as different associated factors. RESULTS: The perforation was closed in 75.9 % of cases. The mean gain of auditory function was 1.5 dB at five years, without statistical significance. The hearing evolution presented a post-surgical improvement and a subsequent deterioration, both statistically significant. We found a statistically significant relationship between the size of the perforation and the condition of the contralateral ear. CONCLUSIONS: Perforation closure in our series (75.9 %) is similar to that reported in the literature. We found contralateral ear pathology and the perforation extension to be associated with poor prognosis after myringoplasty.

Miringoplastia: seguimiento auditivo y estudio de factores pronósticos / Myringoplasty: auditory follow-up and study of prognostic factors

Objetivo: Realizar un estudio a 5 años de la audición de los pacientes sometidos a miringoplastia a fin de probar si la restitución timpánica tiene correlación con la mejora auditiva. Se investigan también posibles factores predisponentes al fracaso y averiguar si podemos describirlos como factores pronósticos. Material y método: Se realiza estudio tipo serie de casos y una revisión de las miringoplastias realizadas en nuestro centro en los años 2000, 2001 y 2002. Se revisaron 83 historias y se estudió el cierre de la perforación, la función auditiva prequirúrgica, posquirúrgica y a 5 años, así como diferentes factores relacionados. Resultados: Se obtiene un cierre de la perforación en el 75,9 % de los casos. En cuanto a la función auditiva, obtenemos una ganancia sin significación estadística de 1,5 dB a los 5 años. La evolución auditiva presenta una mejora posquirúrgica y un empeoramiento posterior, ambos estadísticamente significativos. Se ha obtenido una relación estadística en el tamaño de la perforación y el estado del oído contralateral. Conclusiones: Se presenta un resultado de cierre de la perforación acorde con la mayoría de las series. El estado patológico del oído contralateral y la extensión de la perforación son factores de mal pronóstico de la miringoplastia (AU)

Objective: To perform a five-year study of hearing evolution in patients undergoing myringoplasty to determine whether eardrum repair correlates with improved hearing. We also studied factors that might predispose to failure and their usefulness as prognostic factors. Material and method: In a serial case study, we reviewed all myringoplasties performed at our centre during 2000, 2001, and 2002. We reviewed 83 case histories and studied the closure of the perforation, auditory function pre-operatively, postoperatively and after 5 years, as well as different associated factors. Results: The perforation was closed in 75.9 % of cases. The mean gain of auditory function was 1.5 dB at five years, without statistical significance. The hearing evolution presented a post-surgical improvement and a subsequent deterioration, both statistically significant. We found a statistically significant relationship between the size of the perforation and the condition of the contralateral ear. Conclusions: Perforation closure in our series (75.9 %) is similar to that reported in the literature. We found contralateral ear pathology and the perforation extension to be associated with poor prognosis after myringoplasty (AU)

[Stapedotomy outcomes in the treatment of otosclerosis: our experience]. / Resultados de la estapedotomía en el tratamiento de la otosclerosis: nuestra experiencia.

OBJECTIVE: The main objective of our study is to identify whether there is measurable audiometric deterioration in patients undergoing stapedotomy with a follow-up of more than eight years. MATERIAL AND METHOD: We conducted a retrospective clinical study in which we reviewed a total of 150 case histories of patients with stapedotomy at our department between 1993 and 1997, with a successful initial audiological assessment using tone audiometry in the first three months after surgery and later audiometrical follow-up. RESULTS: We obtained a significant mean post-operative hearing impairment of 1.02 dB per year, with a pre-operative mean PTA of 51.45 dB, going on to early post-operative mean PTA of 26.71 dB, and later post-operative mean PTA of 35.42 dB, with all these changes turning out to be statistically significant. CONCLUSIONS: The auditory level obtained after surgery worsens as the years go by, but always without exceeding the hearing loss prior to surgery.

Resultados de la estapedotomía en el tratamiento de la otosclerosis: nuestra experiencia / Stapedotomy outcomes in the treatment of otosclerosis: our experience

Objetivo: Nos propusimos valorar el deterioro audiométrico de los pacientes intervenidos de estapedotomía, con un seguimiento mayor de 8 años. Material y método: Realizamos un estudio clínico retrospectivo en el que revisamos un total de 150 historias de pacientes intervenidos de estapedotomía entre los años 1993 y 1997 en nuestro servicio, con buen resultado audiológico inicial valorado mediante audiometría tonal en los primeros 3 meses tras la cirugía y con seguimiento audiométrico posterior. Resultados: Obtuvimos una media de deterioro auditivo postoperatorio significativa (1,02 dB por año), con una media auditiva preoperatoria de 51,45 dB, que pasa a una media de 26,71 dB en el postoperatorio temprano, y una media de 35,42 dB en el postoperatorio tardío; todos estos cambios son estadísticamente significativos. Conclusiones: El nivel auditivo obtenido tras la cirugía empeora con el paso de los años; pero siempre sin sobrepasar la pérdida auditiva previa a la cirugía (AU)

Objective: The main objective of our study is to identify whether there is measurable audiometric deterioration in patients undergoing stapedotomy with a follow-up of more than eight years. Material and method: We conducted a retrospective clinical study in which we reviewed a total of 150 case histories of patients with stapedotomy at our department between 1993 and 1997, with a successful initial audiological assessment using tone audiometry in the first three months after surgery and later audiometrical follow-up. Results: We obtained a significant mean post-operative hearing impairment of 1.02 dB per year, with a pre-operativemean PTA of 51.45 dB, going on to early post-operativemean PTA of 26.71 dB, and later post-operative mean PTA of 35.42 dB, with all these changes turning out to be statistically significant. Conclusions: The auditory level obtained after surgery worsens as the years go by, but always without exceeding the hearing loss prior to surgery (AU)

[Abnormal internal carotid artery in the middle ear and severe otorrhagia after myringotomy]. / Arteria carótida aberrante. A propósito de un caso.

We present a clinical-surgical case of a 72-year-old woman referred from another Hospital due to presentation of otorrhagia following myringotomy. We later determined by means of imaging studies that it was a case of an aberrant internal carotid artery. All masses in the middle ear, especially pulsing masses, must be studied by imaging methods such as computerized tomography and, preferably, magnetic resonance angiography.

Arteria carótida aberrante. A propósito de un caso / Abnormal internal carotid artery in the middle ear and severe otorrhagia after myringotomy

Los autores presentan un caso clínico-quirúrgico de una mujer de 72 años de edad, remitida desde otro centro hospitalario por una otorragia grave tras una miringotomía. Mediante estudios de imagen se determinó que se trataba de un caso de arteria carótida aberrante de oído derecho. Toda masa en oído medio, especialmente las que son pulsátiles, deben ser estudiadas mediante pruebas de imagen como tomografía computarizada y, preferentemente, angiografía por resonancia magnética

We present a clinical-surgical case of a 72-year-old woman referred from another Hospital due to presentation of otorrhagia following myringotomy. We later determined by means of imaging studies that it was a case of an aberrant internal carotid artery. All masses in the middle ear, especially pulsing masses, must be studied by imaging methods such as computerized tomography and, preferably, magnetic resonance angiography