Pediatric tympanoplasty: A paradigm shift?

INTRODUCTION AND OBJECTIVES: Pediatric tympanoplasty is still a matter of controversy. Many factors have been associated with the surgical outcome of tympanoplasty in children, including age, size and location of the perforation, surgical technique and Eustachian tube dysfunction. The optimal approach and timing of this surgery remains controversial. This study aims to evaluate the outcomes of pediatric tympanoplasty and analyze factors that may influence the success of this surgery. MATERIALS AND METHODS: A retrospective review was conducted which included children from 5 to 15 years old that underwent tympanoplasty with or without ossiculoplasty for chronic tympanic perforation in a tertiary care university hospital over a 6-year period. Patients were divided in two age groups (5 to ≤10 years old and >10 to 15 years old). Children with cholesteatoma or that underwent simultaneous mastoidectomy were excluded. RESULTS: 83 cases were included. Average age was 10.7±2.1 years and mean follow-up time was 9 months. Of the cases, 21.7% were revision surgeries. Successful closure of the tympanic membrane perforation was achieved in 76.9% of primary surgeries and 55.6% of revision surgeries. Most of the patients improved their conductive hearing-deficit. No statistical difference in graft failure was noted regarding age, presence of craniofacial dysmorphism and surgical approach. The use of simple graft (temporal muscle fascia or tragus perichondrium) was significantly superior in primary surgery (p<0.05). We also found a significant difference between the location of the perforation and revision surgery, with anterior perforations showing a higher risk (p<0.05). CONCLUSIONS: Pediatric tympanoplasty is effective in repairing chronic tympanic perforations. In our study, accepted predictors of surgical outcome such as age and surgical approach were not associated with graft failure.

Pediatric tympanoplasty: A paradigm shift?

Introduction and objectives: Pediatric tympanoplasty is still a matter of controversy. Many factors have been associated with the surgical outcome of tympanoplasty in children, including age, size and location of the perforation, surgical technique and Eustachian tube dysfunction. The optimal approach and timing of this surgery remains controversial.This study aims to evaluate the outcomes of pediatric tympanoplasty and analyze factors that may influence the success of this surgery.Materials and methodsA retrospective review was conducted which included children from 5 to 15 years old that underwent tympanoplasty with or without ossiculoplasty for chronic tympanic perforation in a tertiary care university hospital over a 6-year period. Patients were divided in two age groups (5 to ≤10 years old and >10 to 15 years old). Children with cholesteatoma or that underwent simultaneous mastoidectomy were excluded.Results83 cases were included. Average age was 10.7±2.1 years and mean follow-up time was 9 months. Of the cases, 21.7% were revision surgeries. Successful closure of the tympanic membrane perforation was achieved in 76.9% of primary surgeries and 55.6% of revision surgeries. Most of the patients improved their conductive hearing-deficit. No statistical difference in graft failure was noted regarding age, presence of craniofacial dysmorphism and surgical approach. The use of simple graft (temporal muscle fascia or tragus perichondrium) was significantly superior in primary surgery (p<0.05). We also found a significant difference between the location of the perforation and revision surgery, with anterior perforations showing a higher risk (p<0.05).ConclusionsPediatric tympanoplasty is effective in repairing chronic tympanic perforations. In our study, accepted predictors of surgical outcome such as age and surgical approach were not associated with graft failure. (AU)

Introducción y objetivos: La timpanoplastia pediátrica continúa siendo una cuestión controvertida. Se han asociado muchos factores al resultado quirúrgico de la timpanoplastia en niños, incluyendo la edad, el tamaño y la localización de la perforación, la técnica quirúrgica y la disfunción de la trompa de Eustaquio. El enfoque óptimo y la elección del momento de esta cirugía continúan siendo controvertidos. El objetivo de este estudio es evaluar los resultados de la timpanoplastia pediátrica y analizar los factores que pueden influir en el éxito de esta cirugía.Materiales y métodosSe realizó una revisión retrospectiva, que incluyó a niños de 5 a 15 años de edad sometidos a timpanoplastia con o sin osiculoplastia para perforación timpánica crónica en un hospital universitario terciario a lo largo de un periodo de 6 años. Se dividió a los pacientes en 2 grupos de edad (de 5 a ≤10 años, y >10 a 15 años). Se excluyó a los niños con colesteatoma o a los que se sometió simultáneamente a mastoidectomía.ResultadosSe incluyeron 83 casos. La edad media fue de 10,7±2,1 años, y el tiempo medio de seguimiento fue de 9 meses. El 21,7% de los casos fueron cirugías de revisión. El cierre exitoso de la perforación de la membrana timpánica se logró en el 76,9% de las cirugías primarias, y el 55,6% de las cirugías de revisión. La mayoría de los pacientes mejoró su pérdida auditiva conductiva. No se apreció diferencia estadística en cuanto a fracaso del injerto en términos de edad, presencia de dismorfismo craneofacial y abordaje quirúrgico. El uso de injerto simple (fascia de músculo temporal o pericondrio tragal) fue significativamente superior en la cirugía primaria (p<0,05). Encontramos también una diferencia significativa entre la localización de la perforación y la cirugía de revisión, presentando las perforaciones anteriores un riesgo más alto (p<0,05).(AU)

Pediatric tympanoplasty: A paradigm shift?

INTRODUCTION AND OBJECTIVES: Pediatric tympanoplasty is still a matter of controversy. Many factors have been associated with the surgical outcome of tympanoplasty in children, including age, size and location of the perforation, surgical technique and Eustachian tube dysfunction. The optimal approach and timing of this surgery remains controversial. This study aims to evaluate the outcomes of pediatric tympanoplasty and analyze factors that may influence the success of this surgery. MATERIALS AND METHODS: A retrospective review was conducted which included children from 5 to 15 years old that underwent tympanoplasty with or without ossiculoplasty for chronic tympanic perforation in a tertiary care university hospital over a 6-year period. Patients were divided in two age groups (5 to ≤10 years old and >10 to 15 years old). Children with cholesteatoma or that underwent simultaneous mastoidectomy were excluded. RESULTS: 83 cases were included. Average age was 10.7±2.1 years and mean follow-up time was 9 months. Of the cases, 21.7% were revision surgeries. Successful closure of the tympanic membrane perforation was achieved in 76.9% of primary surgeries and 55.6% of revision surgeries. Most of the patients improved their conductive hearing-deficit. No statistical difference in graft failure was noted regarding age, presence of craniofacial dysmorphism and surgical approach. The use of simple graft (temporal muscle fascia or tragus perichondrium) was significantly superior in primary surgery (p<0.05). We also found a significant difference between the location of the perforation and revision surgery, with anterior perforations showing a higher risk (p<0.05). CONCLUSIONS: Pediatric tympanoplasty is effective in repairing chronic tympanic perforations. In our study, accepted predictors of surgical outcome such as age and surgical approach were not associated with graft failure.

Palatine Tonsils Primary Presentation of Blastoid Variant of Mantle Cell Lymphoma: Case Report.

Head and neck lymphomas can present with a wide range of symptoms. Timely and accurate diagnosis is often challenging. The blastoid variant of mantle cell lymphoma (MCL) accounts for less than one-third of all MCL cases. Isolated primary presentation on the palatine tonsils is rare, and prognosis and outcome are seemingly unfavorable. An 81-year-old man presented with persistent odynophagia, dysphagia, and obstructive hypertrophic palatine tonsils with purulent exudate. The signs and symptoms were non-responsive to antibiotic therapy, and the tonsils were biopsied. The cellular morphology, immunophenotype, and genotype supported a diagnosis of the blastoid variant of MCL. After staging, the patient underwent chemotherapy with Rituximab-Bendamustine (R-Benda). The patient is in clinical remission more than two years after therapy. We report an exceedingly rare case of blastoid MCL that is prone to be misdiagnosed as tonsillitis. We review the literature and discuss treatment options of this uncommon malignancy.

Early Management of Acute Unilateral Vocal Fold Paralysis: Update of the Literature.

BACKGROUND: Unilateral vocal fold paralysis (UVFP) often leads to significant morbidity that may include dysphonia, swallowing problems and aspiration. The best timing for medialization procedures is still controversial. Published data suggest that early intracordal injection positively affects long-term outcomes. OBJECTIVES: To critically review current literature in order to determine if early treatment of acute UVFP influences clinical outcomes of the patients. TYPE OF REVIEW: Nonsystematic literature review. METHODS: A literature review was performed, using the Pubmed database. All relevant articles published in English addressing the effect of early treatment in acute unilateral focal fold paralysis were analyzed. Twenty-six articles were included due to their scientific interest. RESULTS: Published literature suggests that early intracordal injection in patients with UVFP reduces pulmonary infections, hospital length of stay and improves voice parameters. Also, patients who receive early intracordal injection seem to be less likely to undergo subsequent medialization thyroplasty. CONCLUSIONS: Early intracordal injection should be offered to patients with newly diagnosed UVFP since it promotes a satisfactory position of the vocal fold and seems to improve clinical outcomes. More investigation, with long-term follow up data and treatment randomization, is necessary to develop clinical consensus for these patients.