Alternative Techniques in Cochlear Implantation.

OBJECTIVE: To review the alternative techniques in cochlear implantation and to compare the complications with different techniques. MATERIALS AND METHODS: Patients who had undergone cochlear implantation were reviewed. Those patients who were operated using alternative techniques were selected and evaluated for the cause of their hearing loss and for the type of alternative technique that was utilized. Complication types and rates in these patients were evaluated. RESULTS: In total, 38 patients were operated using alternative techniques following preoperative or intraoperative findings. The mean age of the patients was 8.3 (1-51) years. There were 20 male and 18 female patients. Thirteen patients were operated with a suprameatal approach and 18 with a transcanal approach. Resection of the bony part of the external ear canal and reconstruction (canal wall down technique) was performed in seven patients. Postoperative complications included wound infection, hematoma, chorda tympani injury, and tympanic membrane perforation. CONCLUSION: Cochlear implantation is an effective method in the rehabilitation of sensorineural hearing loss. Complications are rare but can sometimes cause hematoma, taste impairment, tympanic membrane perforation, or wound infections. The standard procedure is not always suitable for patients with temporal bone abnormalities. Surgeons performing cochlear implantation should be aware of these variations and should be able to perform alternative implant techniques in these cases.

Carbon dioxide laser endoscopic posterior cordotomy technique for bilateral abductor vocal cord paralysis: a 15-year experience.

IMPORTANCE: Treatment of bilateral vocal cord paralysis is a considerable challenge for otolaryngologists. Many surgical techniques have been developed for the management of this entity to eliminate the need for tracheotomy. OBJECTIVE: To evaluate the success of the unilateral carbon dioxide laser endoscopic posterior cordotomy technique for bilateral abductor vocal cord paralysis. DESIGN: A retrospective study. SETTING: A university department of otolaryngology-head and neck surgery. PARTICIPANTS: Sixty-six patients (58 women and 8 men) diagnosed as having bilateral abductor vocal cord paralysis. INTERVENTION: Endoscopic posterior cordotomy with the carbon dioxide laser. MAIN OUTCOME MEASURES: Decannulation and postoperative voice quality and exercise tolerance. RESULTS: The most common etiologic factor was recurrent laryngeal nerve paralysis after thyroidectomy, observed in 61 patients (92%); an unknown cause was observed in 5 (8%). Unilateral cordotomy sufficed in 58 patients (88%). We performed revision procedures for vocal cord granuloma in 4 patients (6%). Bilateral cordotomy was required for 4 patients (6%) with an insufficient airway. Postoperative tracheotomy was needed for only 4 patients owing to the edema in the operation site. These patients underwent decannulation within a mean period of 7 days. No patient had poor postoperative exercise tolerance. We found no statistically significant difference between the preoperative and postoperative voice quality using the 10-item Turkish version of the Voice Handicap Index. CONCLUSIONS AND RELEVANCE: Carbon dioxide laser endoscopic posterior cordotomy is a safe, minimally invasive, effective technique with a short operation time. A bilateral approach or a revision procedure is rarely required. Bilateral cordotomy should be reserved for patients with insufficient airway passage with unilateral cordotomy.

Surgical and medical management for complications in 475 consecutive pediatric cochlear implantations.

OBJECTIVE: The purpose of this study is to assess complications occurring after cochlear implantation (CI) in children and to discuss revision surgeries and medical interventions occurring during follow-up. STUDY DESIGN: Retrospective study of 475 consecutive pediatric cochlear implantations at a tertiary referral center. METHODS: The patients (n = 475) who received cochlear implants in our institution between March 2000 and March 2012 were followed up (range, 5 months-12 years). All complications were systematically reviewed, and their causes were analyzed for prevention and therapy. RESULTS: All children received unilateral CI. Mean age at implantation was 3 years 7 months (ranged from 10 months to 18 years). Forty-three patients (9%) experienced complications. Twenty-one patients (4.4%) had major complications, consisting of device failure (10 patients), flap necrosis (4 patients), meningitis (2 patients), electrode shifting (2 patients), hematoma (2 patients) and magnet migration (1 patient). Twenty-two (4.6%) had minor complications, consisting of acute otitis media (5 patients), skin lesion due to pressure reaction in contralateral ear during surgery (4 patients), flap swelling (3 patients), minor wound infection (3 patients), transient facial paralysis (2 patients), transient vertigo (2 patients), hematoma (1 patient), facial stimulation (1 patient), subcutaneous emphysema (1 patient). Complications led to reimplantation in 13 (30.2%) and other revision surgery in 7 (16.2%) of the 43 patients. One patient with meningitis cured with medical treatment and 22 patients with minor complications cured with either medical treatment or spontaneously. CONCLUSIONS: Cochlear implantation is a safe technique in experienced hands with a relatively low complication rate. Long term follow up is mandatory to minimize and control surgical complication.

Endonasal treatment of acute invasive fungal rhinosinusitis in immunocompromised pediatric hematology-oncology patients.

OBJECTIVES: Acute invasive fungal rhinosinusitis (AIFR) is an aggressive fungal infection in immunocompromised patients with high mortality rates. The aim of this study is to present our experiences on endonasal treatment in immunocompromised pediatric hematology-oncology patients with AIFR. METHODS: Thirteen pediatric hematology-oncology patients treated for AIFR between March 2006 and December 2011 were analyzed retrospectively. We reviewed the following data for all patients: age, gender, predisposing disease, initial symptoms, pathological diagnosis, microbiological results, laboratory findings, surgical procedure, number of operations and treatment outcomes. RESULTS: Nine of 13 patients with lesions confined to sinonasal cavity were operated with endoscopic approach. Open surgery was performed in four patients, three of them had palatal and buccal lesions and one had facial skin involvement. Endoscopic approach was also used for sinonasal lesions of these four patients. A total of 7 patients died: 4 patients with progression of the underlying disease, 2 patients with sepsis and 1 patient due to renal failure. Survival rate in surgically treated patients was found 46% (6/13 patients). CONCLUSIONS: Endonasal endoscopic approach is both feasible and efficient technique, also enables excellent local control with less morbidity compared to open surgery. This approach is suitable for patients who are diagnosed in the early stages of AIFR and also presents a less traumatic option for patients with poor health status. Open surgical procedure should be preferred in patients with disease extending out of the sinonasal cavity.