Comparison of incus interpositioning technique versus glass ionomer cement application in type 2 tympanoplasty.

Objective of this study is to compare glass ionomer cement application and incus interpositioning techniques in patients who have chronic otitis media, conductive hearing loss with intact tympanic membrane and who undergo hearing reconstruction of staged surgery using a retrospective chart review in the setting of Ministry of Health Ankara Training and Research Hospital ENT Clinic, Turkey. We retrospectively evaluated patients who underwent otological surgery and hearing reconstruction with auto graft incus during 2005-2008 or glass ionomer cement during 2008-2010. Patients who had cholesteatoma, stapes fixation and tympanosclerosis were excluded. Postoperative mean follow-up time of 107 patients was 9.8 months (6-38 months, 83.2 % of them was ≤ 9 months). Postoperative pure tone hearing thresholds, graft status, gain scores and air bone gaps were recorded. Intact graft, dry ear on the operated side and ABG scores less than 20 dB were accepted as surgical success. Preoperative ABG score was 30.6 ± 7.93 dB in glass ionomer (group I) and 33.6 ± 11.99 dB in incus interpositioning (group II). Postoperative ABG scores were 13.6 ± 10.40 and 22.6 ± 12.39 dB, respectively, in group I and II. Success of closure in ABG scores was obtained in both groups (p < 0.001). Gain scores in group I were better (p = 0.035). Graft success (p = 0.020) correlated with gain score. Results showed that the glass ionomer cement application is a good, cost-effective technique, easy to perform and yields better hearing scores and lower complication rates compared to incus interpositioning technique.

First-choice treatment in mild to moderate obstructive sleep apnea: single-stage, multilevel, temperature-controlled radiofrequency tissue volume reduction or nasal continuous positive airway pressure.

OBJECTIVE: To compare the efficacy of single-stage, multilevel, temperature-controlled radiofrequency tissue volume reduction (TCRFTVR) for the soft palate and base of the tongue with that of nasal continuous positive airway pressure (CPAP) in primary treatment of mild to moderate obstructive sleep apnea. DESIGN: A prospective nonrandomized clinical study. SETTING: Tertiary care referral center. PATIENTS: Data from 47 patients with mild to moderate obstructive sleep apnea treated between January 1, 2003, and October 31, 2006, were reviewed. INTERVENTIONS: Twenty-six patients underwent TCRFTVR and 21 underwent nasal CPAP as a primary treatment modality. MAIN OUTCOME MEASURES: Baseline and 12-month posttreatment measurements using the Epworth Sleepiness Scale and polysomnography were compared. RESULTS: The baseline characteristics of the groups were not significantly different. Both methods showed meaningful results for the Epworth Sleepiness Scale and polysomnography variables 12 months after treatment compared with baseline measurements. The results were not significantly different in the posttreatment intergroup comparisons. Treatment success rates were 52.4% for nasal CPAP and 53.8% for TCRFTVR (P = .92). CONCLUSION: Similar comparison results with nasal CPAP in objective and subjective variables make single-stage, multilevel TCRFTVR a good alternative in primary treatment of mild to moderate obstructive sleep apnea.

The effect of stapes mobility on hearing outcome and which procedure to choose in fixed stapes in children tympanosclerosis.

OBJECTIVES: Our objective was to evaluate the features of tympanosclerosis in children and to determine the effect of stapes mobility and the type of one-stage operation on hearing outcomes. MATERIALS AND METHODS: Fifty-one children who were performed different types of single-stage otologic surgery for tympanosclerosis between January 1997 and December 2006 were retrospectively chart reviewed. The children were divided into two groups according to the mobility of ossicular chain, especially the stapes. Stapes fixed group was also evaluated in detail according to the type of surgery that was performed. Patients who had previous ventilation tube insertion, tympanic membrane parasynthesis or any other otologic surgery were excluded from the study. Improvement of the hearing by at least 10 dB and air-bone gap less than 20 dB were accepted as success criteria after 24 months of follow-up period. RESULTS: The air conduction levels, and the air-bone gap values of both groups were improved significantly after the single-stage operations. Pure tone averages pre- and postoperatively for stapes mobile group were 45.55+/-15.96 and 34.50+/-16.64 dB (p=0.002); and in stapes fixed group these were respectively 43.97+/-13.45 and 33.16+/-12.14 dB (p<0.001). When pre- and postoperative air-bone gap levels were evaluated it was seen that in both groups they were improved more than 10 dB, from 34.10+/-11.37 to 23.05+/-12.32 dB (p=0.002) in stapes mobile group and from 35.29+/-11.65 to 24.48+/-12.50 dB (p<0.001) in stapes fixed group. In stapes fixed group air-bone gap was less than 20 dB in 11 of 23 (47.8%) patients who had mobilization and 3 of 8 (37.5%) patients who had small fenestra stapedotomy operations. Although it was not statistically significant, gain was more than 10 dB only in 2 of 8 (25.0%) patients in the stapedotomy group but 14 of 23 (60.9%) patients in mobilization group (p=0.698 for ABG and p=0.220 for gain). The change in the bone conduction levels were improved 0.75 dB in group 1 and got worse 0.52 dB in group 2 and this was not statistically significant (p=0.239). CONCLUSIONS: In this study about children, the status of stapes and the place of tympanosclerotic mass had no significant negative effect on hearing improvement. You can perform mobilization in one-stage if you are experienced and have to prefer second-stage surgery if stapes is fixed and stapedectomy is needed.

Comparison of radiofrequency tissue volume reduction and submucosal resection with microdebrider in inferior turbinate hypertrophy.

OBJECTIVES: To compare the efficacy of submucosal temperature-controlled radiofrequency tissue volume reduction (TCRFTVR) and resection with microdebrider (SMRM) in chronic inferior turbinate hypertrophy. STUDY DESIGN: Prospective, randomized, and single-blinded clinical trial. METHODS: The study group consisted of 30 symptomatic patients who underwent simultaneous TCRFTVR and SMRM for consecutive sides. Visual analogue scale (VAS) and acoustic rhinometry (ARM) were made preoperatively and at 12th week and 6th month postoperatively; saccharine transport time (STT) and ciliary beat frequency (CBF) were performed at 12th week and 6th month postoperatively. The rate of the need for the revision operation was determined between 6 and 12 months period postoperatively. RESULTS: Significant improvement was achieved in VAS scores and ARM measurements after both procedures, whereas both parameters did not differ significantly between two procedures postoperatively. STT and CBF showed no significant post-treatment variation in comparison of the intergroup measurements. The rates of the need for revision operation were not significantly different. CONCLUSION: Identical results in objective and subjective parameters were observed for both techniques.

Bilateral congenital choanal atresia in a 7-day-old patient: transnasal endoscopic repair with stent.

Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral cases because this is a life-threatening situation in newborns. This paper is a case report of a 7-day-old full term girl infant presenting the history of attacks of cyanosis and having difficulty in suckling and respiration. On examination, alternating cyanosis and normal colour was observed in the patient. The application of nelaton cannulas bilaterally revealed the diagnosis of bilateral CCA. Transnasal endoscopic repair with stents was performed. Symptomatic resolution persists 6 months postoperatively.

Success is a matter of experience: type 1 tympanoplasty : influencing factors on type 1 tympanoplasty.

Our objective was to identify the factors that could influence the success rate of type 1 tympanoplasty in a tertiary care centre where both residents and senior surgeons perform this operation. Six hundred and seven patients who had been performed type 1 tympanoplasty as a primary otologic surgery between January 1997 and December 2004 were retrospectively chart reviewed. The patients had intact and mobile ossicular chain peroperatively. Patients with any other macroscopic otologic pathology like cholesteatoma, granulation in the middle ear and osteitis in mastoid cells were excluded from the study. Dry ear, intact and mobile tympanic membrane, improvement of the hearing by at least 10 dB and air-bone gap less than 25 dB were accepted as success criteria after 12 months of follow-up period. Chi-square test was used for statistical comparison of the different influencing factors. The male gender, younger age, smaller-sized perforations and experience of the surgeon were stated as good prognostic factors due to statistical evaluation. Afterwards the data of the study group was reanalysed in order to decide the cases for the residents. Finally, it was observed that seniors had better results in cases with perforations greater than 50%, dry ears and patients older than 16 years. In training and research clinics where both residents and senior surgeons perform type 1 tympanoplasty, the rate of success can be enhanced if patients with perforations greater than 50%, dry ears and patients older than 16 years are operated by the senior surgeons. The reason for this is that these groups have the overall worse results and should by argument be done by senior surgeons.

Surgical treatment of cholesteatoma in children.

OBJECTIVES: To present our experience in the surgical treatment of cholesteatoma in children. STUDY DESIGN: Retrospective clinical trial. PATIENTS AND METHOD: Charts of 114 patients who met the inclusion criteria of the study were examined. Surgical results were compared with respect to applied surgical methods. Cholesteatoma recidivism (CR) and hearing improvement were the main parameters which were examined. RESULTS: The mean age was 13 years and mean follow-up period was 3.7 years. A total of 200 operations performed on 114 children: 114 children operated at the first stage, 84 children underwent a second surgery, and 2 a third surgery. At initial operation; canal wall-up (CWU) tympanomastoidectomy was the choice of surgical procedure in 35 (31%) patients, and canal wall-down (CWD) tympanomastoidectomy was preferred for the other 79 (69%) patients. At final analysis; 26 of 114 (23%) patients had CWU procedure, 67 patients (59%) had CWD procedure and 21 patients (18%) had radical mastoidectomy. (CR) rate was 26 and 16%, respectively for CWU and CWD procedures for initial surgeries (P = 0.248). Hearing improvement was achieved in 36% of CWU procedures and 38% of CWD procedures (P = 0.957). Hearing deterioration was observed in 36% of CWU procedures and 47% of CWD procedures (P = 0.328). CONCLUSION: There was no significant difference between CWU and CWD procedures with respect to CR, hearing improvement, and hearing deterioration. Therefore, choose of surgical procedure should be individualized for each patient. In our opinion; open techniques must be employed in the presence of extensive disease, whereas the closed technique is reserved for those with a more localized problem.