Techniques of the tympanomastoidectomy with reconstruction of the posterior bone wall of the external auditory canal

A combined tympanoplasty method, the mobile-bridge tympanoplasty, has been applied at the Clinic for Ear, Nose and Throat Diseases in Novi Sad since 1998. Mobile-bridge tympanoplasty is performed at our Clinic by applying Feldmann’s procedure utilizing a microsurgical oscillating saw. It is a combination of closed and open techniques for surgical treatment of middle ear diseases. In addition to this technique, a method for reconstruction of the posterior bone wall of the external auditory canal was introduced. This procedure is applied in cases of damage or impairment of the bony ear canal wall using mastoid cortical temporal bone graft or modeled cartilage of the concha. Maintenance of general anatomical relations in the middle ear enables good ventilation of pneumatic spaces of the middle ear and Eustachian tube permeability, thus providing good conditions for ossicular chain reconstruction. The incidence of recurrent cholesteatoma in combined mobile-bridge tympanoplasty and tympanoplasty with reconstruction of the posterior bone wall was 6% in total. The incidence values for the recurrent cholesteatoma in closed tympanoplasty and in cases of open techniques were 10%. Mobile-bridge tympanoplasty and reconstruction of the posterior bone wall of external auditory canal are methods of choice in surgical treatment of middle ear cholesteatoma that progressed to the attic space, sinus tympani and facial recess

Congenital cholesteatoma of mastoid origin: A multicenter case series

Background/Aim. The mastoid is the rarest site for the onset of congenital cholesteatoma (CC). The symptoms are atypical and minimal. The aim of this multicenter retrospective descriptive study was to define this extremely rare condition and its clinical presentation, diagnosis and management. Methods. We analyzed data files for a 15- year period in 4 tertiary otology centers and discovered 6 patients with the diagnosis of CC of the mastoid. Results. The clinical presentation of CC varied from incidental findings in patient to patient with otogenic meningitis. The most common findings during surgical procedures were mastoid cortex erosion, sigmoid plate dehiscence, dural exposure and external canal wall destruction. Conclusion. CC of mastoid origin tends to occur in adult patients probably because of minimal symptoms and the delayed diagnosis. It can exist for years in a nonaggressive state and develop to giant sizes. In children it is almost incidentally diagnosed. Early imaging is necessary in order to prevent serious complication

Endoscopic repair of cerebrospinal fluid rhinorrhea

Abstract Introduction: Nasal liquorrhea indicates a cerebrospinal fluid fistula, an open communication between the intracranial cerebrospinal fluid and the nasal cavity. It can be traumatic and spontaneous. Objective: The aim of this study was to assess the outcome of endoscopic repair of cerebrospinal fluid fistula using fluorescein. Methods: This retrospective study included 30 patients of both sexes, with a mean age of 48.7 years, treated in the period from 2007 to 2015. All patients underwent lumbar administration of 5% sodium fluorescein solution preoperatively. Fistula was closed using three-layer graft and fibrin glue. Results: Cerebrospinal fluid fistulas were commonly located in the ethmoid (37%) and sphenoid sinus (33%). Most patients presented with traumatic cerebrospinal fluid fistulas (2/3 of patients). The reported success rate for the first repair attempt was 97%. Complications occurred in three patients: one patient presented with acute hydrocephalus, one with reversible encephalopathy syndrome on the fifth postoperative day with bilateral loss of vision, and one patient was diagnosed with hydrocephalus two years after the repair of cerebrospinal fluid fistula. Conclusion: Endoscopic diagnosis and repair of cerebrospinal fluid fistulas using fluorescein intrathecally has high success rate and low complication rate

Video head impulse test in children after cochlear implantation

Background/Aim. Cochlear implantation (CI) is a therapeutic modality that provides a sense of sound to children and adults with profound sensorineural hearing loss or deafness. The aim of this work was to evaluate the lateral semicircular canal function using a high frequency video head impulse test in children after CI. Methods. A prospective descriptive study included 28 children (6–17 years old) with profound sensorineural hearing loss and unilateral CI. The control group included 20 healthy children with normal hearing. The measurement of vestibular function of the lateral semicircular canal was performed using video head impulse test. After cochlear implantation, the children underwent the vestibular testing. Values vestibulo-ocular reflex of lateral semicircular canal were measured using the video head impulse test in the children with cochlear implant and the control group. The values of vestibulo-ocular reflex were compared between the group. Also, in the children with CI values of vestibulo-ocular reflex were compared between the non-implanted ear and the ear with the embedded CI. Results. All 28 children with sensorineural hearing loss underwent the placement of CI through cochleostomy at the average age of 4.8 ± 2.92 years. Children with the cochlear implant had a significantly lower vestibulo-ocular reflex gain of the lateral semicircular canal measured by a high frequency video head impulse test compared to the control group of children with normal hearing (T test: t = 3.714; p = 0.001). However in these children there was no statistically significant difference of vestibulo-ocular reflex gain in the lateral semicircular canal measured in ears with embedded CI and non-implanted ears (T test: t = 0.419; p = 0.677). Conclusion. The values of vestibulo-ocular reflex gain in the lateral semicircular canal evaluated by the video head impulse test are significantly lower in the children with a profound sensorineural hearing loss compared to the children with normal hearing. The CI did not appear to have a negative impact on the lateral semicircular canal