Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft / Timpanoplastia endoscópica com enxerto de cartilagem tragal de espessura parcial ou total

Abstract Introduction: Cartilage is the grafting material of choice for certain disorders of the middle ear. The indications for its routine use remain controversial due to the possible detrimental effect on post-operative hearing. Objective: The present study was carried out to report a personal experience with "tragal cartilage shield" tympanoplasty to compare the results, in terms of graft uptake and hearing improvement, of endoscopic cartilage shield technique using either partial thickness or full thickness tragal cartilage for type 1 tympanoplasty and to highlight the tips for single-handed endoscopic ear surgery. Methods: Fifty patients with safe chronic suppurative otitis media, assisted at out-patient department from February 2014 to September 2015 were selected. They were randomly allocated into two groups, 25 patients were included in group A where a full thickness tragal cartilage was used and 25 patients included in group B where a partial thickness tragal cartilage was used. Audiometry was performed 2 months after the surgery in all cases and the patients were followed for one year. Results: Out of the total of 50 patients 39 (78%) had a successful graft take up, amongst these 22 belonged to group A and 17 belonged to the group B. The hearing improvement was similar in both groups. Conclusion: This study reveals that endoscopic tragal cartilage shield tympanoplasty is a reliable technique; with a high degree of graft take and good hearing results, irrespective of the thickness. Furthermore, the tragal cartilage is easily accessible, adaptable, resistant to resorption and single-handed endoscopic ear surgery is minimally invasive, sutureless and provides a panoramic view of the middle ear.

Resumo Introdução: A cartilagem é o material de enxerto de escolha no tratamento cirúrgico de certas condições clínicas da orelha média. Devido ao possível efeito prejudicial na audição pós-operatória, as indicações para seu uso rotineiro ainda são controversas. Objetivo: Relatar a experiência dos autores com a timpanoplastia tipo 1 endoscópica usando cartilagem tragal e comparar os resultados entre a cartilagem tragal com espessura parcial e espessura total, em termos de integração do enxerto e melhoria da audição. O estudo também buscou apresentar sugestões para cirurgia endoscópica de orelha média com uma única mão (single-handed endoscopic ear surgery). Método: Foram selecionados 50 pacientes com otite média crônica supurativa, atendidos neste ambulatório entre fevereiro de 2014 e setembro de 2015, alocados aleatoriamente em dois grupos: 25 pacientes foram incluídos no grupo A, no qual uma cartilagem tragal de espessura total foi usada e outros 25 pacientes foram incluídos no grupo B, no qual foi usada uma cartilagem tragal de espessura parcial. Em todos os casos, uma audiometria foi feita dois meses após a cirurgia; os pacientes foram acompanhados por um ano. Resultados: Dos 50 pacientes, o enxerto foi bem-sucedido em 39 (78%), entre os quais 22 pertenciam ao grupo A e 17 pertenciam ao grupo B. A melhoria da audição em ambos os grupos foi muito semelhante. Conclusão: O estudo indicou que a timpanoplastia endoscópica com cartilagem tragal é uma técnica confiável, com alto grau de integração do enxerto e bons resultados de audição, independentemente da espessura usada. Além disso, a cartilagem tragal é facilmente acessível, adaptável e resistente à reabsorção; a cirurgia endoscópica é minimamente invasiva, sem sutura e proporciona uma visão panorâmica da orelha média.

Butterfly tragal cartilage for repair of focal canal wall defects / Cartílago tragal en mariposa para reparar los defectos focales de la pared del conducto auditivo externo

BACKGROUND: Meato-mastoid fistula is a connection between the external auditory canal and the mastoid cavity. It may be iatrogenic or pathological. The repair of these focal canal wall defects is necessary to prevent retraction pockets or sequential cholesteatoma and attain relief from otorrhoea. AIM/OBJECTIVE: To study the effectiveness of an innovative technique for repair of meato-mastoid fistula (less than or equal to 10 mm in size) in the bony external auditory canal. MATERIAL AND METHODS: We performed a retrospective review of 5 surgeries performed in our hospital between January 2017 and December 2017 for the repair of posterior bony canal wall defects. Active ear disease was ruled out before the repair. We used full-thickness butterfly tragal cartilage graft for the repair of these fistulae. All our surgeries were endoscopic and sutureless. RESULTS: The butterfly tragal cartilage graft was in situ at the repair site and viable on examination at 2 years follow-up, in all our cases. CONCLUSION AND SIGNIFICANCE: Small posterior canal wall defects can be successfully repaired using this technique. The method is minimally invasive and cosmetic, with good patient compliance. The curling property of the cartilage graft is exploited effectively in this method of repair

INTRODUCCIÓN: La fístula meato-mastoidea es una conexión entre el canal auditivo externo y la cavidad mastoidea. Puede ser iatrogénica o patológica. La reparación de estos defectos focales de la pared del canal es necesaria para evitar las bolsas de retracción o el colesteatoma secuencial, y aliviar la otorrea. OBJETIVO: Estudiar la eficacia de una técnica innovadora para reparación de fístula meato-mastoidea (inferior o igual a 10 mm de tamaño) en el hueso del canal auditivo externo. MATERIAL Y MÉTODOS: se realizó una revisión retrospectiva de 5 cirugías en nuestro hospital de atención terciaria entre enero y diciembre de 2017 para la reparación de defectos de la pared ósea del canal posterior. Se descartó la enfermedad activa del oído antes de la reparación. Utilizamos injerto de cartílago tragal en mariposa de espesor completo para la reparación de estas fístulas. Todas las cirugías fueron endoscópicas y sin sutura. RESULTADOS: El injerto de cartílago tragal en mariposa se realizó in situ en el sitio de reparación, siendo viable durante el examen de seguimiento a los 6 meses, en todos nuestros casos. CONCLUSIÓN: Los defectos de la pared del canal posterior pequeños pueden repararse exitosamente con esta técnica. El método es mínimamente invasivo y cosmético, con buena aceptación del paciente. La propiedad ondulada del injerto de cartílago se aprovecha eficazmente en este método de reparación

Butterfly tragal cartilage for repair of focal canal wall defects.

BACKGROUND: Meato-mastoid fistula is a connection between the external auditory canal and the mastoid cavity. It may be iatrogenic or pathological. The repair of these focal canal wall defects is necessary to prevent retraction pockets or sequential cholesteatoma and attain relief from otorrhoea. AIM/OBJECTIVE: To study the effectiveness of an innovative technique for repair of meato-mastoid fistula (less than or equal to 10mm in size) in the bony external auditory canal. MATERIAL AND METHODS: We performed a retrospective review of 5 surgeries performed in our hospital between January 2017 and December 2017 for the repair of posterior bony canal wall defects. Active ear disease was ruled out before the repair. We used full-thickness butterfly tragal cartilage graft for the repair of these fistulae. All our surgeries were endoscopic and sutureless. RESULTS: The butterfly tragal cartilage graft was in situ at the repair site and viable on examination at 2 years follow-up, in all our cases. CONCLUSION AND SIGNIFICANCE: Small posterior canal wall defects can be successfully repaired using this technique. The method is minimally invasive and cosmetic, with good patient compliance. The curling property of the cartilage graft is exploited effectively in this method of repair.

Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft.

INTRODUCTION: Cartilage is the grafting material of choice for certain disorders of the middle ear. The indications for its routine use remain controversial due to the possible detrimental effect on post-operative hearing. OBJECTIVE: The present study was carried out to report a personal experience with "tragal cartilage shield" tympanoplasty to compare the results, in terms of graft uptake and hearing improvement, of endoscopic cartilage shield technique using either partial thickness or full thickness tragal cartilage for type 1 tympanoplasty and to highlight the tips for single-handed endoscopic ear surgery. METHODS: Fifty patients with safe chronic suppurative otitis media, assisted at out-patient department from February 2014 to September 2015 were selected. They were randomly allocated into two groups, 25 patients were included in group A where a full thickness tragal cartilage was used and 25 patients included in group B where a partial thickness tragal cartilage was used. Audiometry was performed 2 months after the surgery in all cases and the patients were followed for one year. RESULTS: Out of the total of 50 patients 39 (78%) had a successful graft take up, amongst these 22 belonged to group A and 17 belonged to the group B. The hearing improvement was similar in both groups. CONCLUSION: This study reveals that endoscopic tragal cartilage shield tympanoplasty is a reliable technique; with a high degree of graft take and good hearing results, irrespective of the thickness. Furthermore, the tragal cartilage is easily accessible, adaptable, resistant to resorption and single-handed endoscopic ear surgery is minimally invasive, sutureless and provides a panoramic view of the middle ear.

Impacted Incus Foreign Body in the Eustachian Tube.

INTRODUCTION: Foreign bodies in the external auditory canal are fairly common, and tend to be seeds, toys, or insects. However, foreign bodies in the middle ear are rarer and are generally accidental or iatrogenic. Although there are numerous reports regarding fascinating foreign bodies in the ear, the same cannot be said about foreign bodies in the Eustachian tube (ET). CASE REPORT: A 20-year-old male patient presented with right-sided active squamosal chronic otitis media (COM) persisting for 10 years. An incidental finding of a hyperintense foreign body (FB) located near the isthmus of the right ET was reported on high-resolution computed tomography (HRCT) of the temporal bones. The FB was bony (eroded incus), which was impacted near the isthmus of the ET and was extremely difficult to remove. A natural FB such as an eroded ossicle in the ET which aggravated the adhesive otitis and caused active squamosal COM has not been reported in the literature. CONCLUSION: We have reported this case not only for its rarity but also to make readers aware of such incidental findings which can be found only by imaging, and to suggest how they can be tackled with current equipment and technology.

Pediatric Meningoencephaloceles Endoscopic Endonasal Repair: Our Experience.

BACKGROUND: Pediatric patients presenting with a nasal mass is uncommon and a high index of suspicion for it to be a meningoencephalocele is essential. Majority of these are congenital and require early intervention owing to the risk of meningitis. Surgery in these cases is very challenging because of the risk of anesthesia and limited space. OBJECTIVE: This study aimed to describe our technique and experience in managing pediatric meningoencephaloceles. METHODS: A retrospective study of 19 pediatric patients (age ranging from 40-day-old infants to 11.5-year-old children) was conducted at our tertiary care center from January 2012 to February 2017. Patients presenting with an intranasal meningoencephalocele were treated by endoscopic approach, using otological microinstruments. After detailed imaging and clinical evaluation, a tailored repair, using fat/fascia/cartilage, a multilayer closure, was carried out in all cases. RESULTS: All patients had a successful repair and recovery, except for one death following an episode of convulsion. There was a minor circumferential narrowing of the nasal vestibule and synechia formation in 2 of our cases. CONCLUSION: Transnasal endoscopic repair of meningoencephalocele is minimally invasive. It avoids permanent anosmia and is cosmetic. A combination of miniaturized instruments and a 4-mm 0° nasal endoscope gives excellent visual field and an adequate working space. Owing to the larger defects in congenital meningoencephaloceles, a multilayer repair provides excellent outcomes.

A Misdiagnosed Laryngeal Web: Treated with an Innovative Self-Made Keel.

Laryngeal web is a rare congenital anomaly. Late presentation at the age of 10 years as in our case, with misleading diagnosis of asthma in a Cohen's type III glottic web is even rarer. In cases of congenital laryngeal web the aim is to provide a patent airway and to achieve a good voice quality. Regardless of the technique used; the primary concern is recurrence. Traditionally, the treatment of choice for laryngeal web was laryngofissure with placement of a keel however; endoscopic laser excision of the web with keel placement is now the preferred technique for thin anterior glottic webs. This endoscopic technique not only requires a Lichtenberger needle carrier but also the ready-made keel, which many of the government set-ups in our country cannot provide. For an alternative to this problem, we have described an innovative, minimally invasive technique for placement of a self-made silicone keel without any sophisticated instruments.

Isolated Langerhans Histiocytosis in Thyroid: Thyroidectomy or Chemotherapy?

Langerhans cell histiocytosis (LCH) is a rare disorder of mononuclear phagocytic system whose clinical presentation varies from the localised involvement of a single bone to a widely disseminated disease. Langerhans cell histiocytosis rarely involves the thyroid gland and isolated involvement of thyroid is even rarer. We report a case of an eight-year-old male child diagnosed with Langerhans cell histiocytosis limited to thyroid gland with review of literature. Should thyroidectomy be done or proceed with chemotherapy? Our case report raises this question with a note on the role of 18 fluoro deoxy glucose positron emission tomography-computed tomography in the management of the same.