Laser-assisted tympanomastoidectomy for active mucosal chronic otitis media.

Laser-assisted tympanomastoidectomy for active mucosal chronic otitis media. OBJECTIVES: Achieving disease control in the context of active granulating mucosal chronic otitis media (COM) is typically challenging. Adjuvant laser use in cholesteatomatous COM surgery enhances disease clearance, yet its role in mucosal COM remains unexplored. The purpose of this study is to present the outcomes and our experience of the latter, and to attempt to define the role of this approach in managing mucosal COM. METHODS: Patients that underwent primary laser-assisted tympanomastoidectomy (2007-2012) for active granulating mucosal COM with at least six months follow-up were studied. Disease control was defined by successful tympanic membrane repair and resolution of otorrhoea. Time-to-event analysis using the Kaplan-Meier method was used to gain a temporal estimate of disease control. RESULTS: Seventy ears (66 patients) were included with mean follow-up of 22 months (6-50 months). Disease control was achieved in 94.3% of cases at latest follow-up, while one- and two-year temporal estimates of control were 97.1% and 91.8% respectively. A mean post-operative four-frequency air-bone gap of 20 dB was achieved in 52 cases (74.3%). Surgical complications included transient vertigo (n = 2), wound infection (n = 2), and temporary facial nerve palsy (n = 1). CONCLUSIONS: We present disease control rates favourable to other published series of active mucosal COM, supporting the use of the laser as an efficacious adjunct to tympanomastoid surgery in this context. This initial report should foster further appraisal of this approach in larger prospective studies.

Prevention of blood staining of endoscope tip during Functional Endoscopic Sinus Surgery: sleeve technique.

Optimisation of the endoscopic view during FESS may require correction of a deviated septum. The resulting incision leads to bleeding which could obscure the view of the endoscope. Repeated cleaning of the endoscope intraoperatively is time consuming and traumatisation of the lining of the nasal mucosa may lead to formation of adhesions post operatively. We discuss the use a segment of suction tubing that can act as a conduit or sleeve for the passage of the endoscope into the nasal cavity. This protects the endoscope tip from the bleeding area.

Steri-strips as an aid to intra-operative monitoring of the eye during endoscopic sinus surgery.

Although uncommon, ocular complications of endoscopic sinus surgery have the potential to cause considerable morbidity. Direct intra-operative monitoring of the eye may alert the surgeon to potential complications at an early stage. We describe the use of Steri-strips during endoscopic sinus surgery as an aid to monitoring for ocular complications during surgery. This is a cheap, simple and effective method of intra-operative monitoring.

Randomized-controlled study comparing post-operative pain between coblation palatoplasty and laser palatoplasty.

OBJECTIVES: This study aimed to evaluate differences in post-operative pain comparing KTP laser-assisted uvulopalatoplasty without tonsillectomy (LAUP) with a new described surgical method: coblation uvulopalatoplasty with tonsillectomy (CP). We also evaluate the impact of each surgical technique in reduction of snoring loudness. MATERIAL AND METHODS: Single blind randomized-controlled trial. From a population of 41 consecutive patients on the waiting list for uvulopalatoplasty for simple snoring, the study group was reduced to 17 CP and 13 LAUP. Post-operative pain and reduction of snoring loudness were recorded using visual analogue scales (VAS) during the first 15 post-operative days. Post-operative snoring loudness was documented for 1-year period. RESULTS: Both groups had similar post-operative pain during the first seven post-operative days. A statistically significant reduction in post-operative pain was observed in the CP group after day 8, and maintained until the end of the study. Reduction of snoring loudness was significant in both groups, but no differences were observed between them. DISCUSSION: Coblation uvulopalatoplasty compared with LAUP demonstrates a reduction in post-operative pain, significant after the first post-operative week. The collateral thermal injury caused by laser is responsible for the slow-healing rate and maintained post-operative pain. Coblation dissociates tissue at lower temperatures with minimal collateral thermal injury and consequently faster and less painful recovery. Both surgical procedures have significant and similar reduction in snoring loudness. CONCLUSIONS: Both methods are adequate treatment options for snoring. The less painful recovery in CP promotes this surgical technique as our preferred choice for palate surgery.

An easier way of inserting the Shah permavent grommet.

Ventilation tube insertion plays an important role in the management of otitis media with effusion. In selected cases, repeated grommet insertion due to persistent eustachian tube dysfunction necessitates the need for longer-term ventilation. Insertion of such tubes can however occasionally be more difficult than insertion of standard grommets. One such long-term ventilation tube is the Shah permavent grommet. This paper describes a simple modification of the technique that is less time-consuming and less traumatic.

Disaster avoided: otalgia warns of potential electrode extrusion.

Cochlear implantation is usually a safe procedure but, as in most surgical interventions, it can carry some risk of complications. These can be divided into major and minor that, in turn, in turn can present early or late. This case report highlights a potential late, major complication of cochlear implantation namely extrusion, which was averted by prompt intervention. The patient presented with a three months' history of otalgia some six years after successful implantation. The posterior half of the tympanic membrane was found to be retracted on the electrode, which appeared to be on the point of extruding through the drum. A tragal cartilage myringoplasty was performed to separate the electrode from the medial surface of the tympanic membrane. There was immediate and lasting relief of the otalgia, the electrode was well protected and performance with the device was unchanged. The authors recommend reinforcing an atrophic tympanic membrane at the time of the cochlear implantation by a cartilage graft to avoid this potentially serious complication. The case also highlights the need for regular otoscopy for all implanted patients.

New method for raising the mucoperichondrial flap in septal surgery: microscope-assisted hydrodissection technique.

An essential step in septal surgery is the correct identification of the subperichondrial plane. Access to this plane can be improved by hydrodissection under enhanced vision. Hydrodissection consists of pressure insufflation of fluid into an anatomical space with a consequent increase in the hydrostatic pressure that separates the tissue planes. In septal surgery, the subperichondrial plane is hydrodissected by infiltration of 2 ml of xylocaine with adrenaline. This creates a bloodless and wide surgical field that facilitates surgery. With the use of a surgical microscope equipped with a teaching arm, it is possible to teach nasal anatomy and septal surgery to trainees.