Subtotal petrosectomy and cerebrospinal fluid leakage in unilateral anacusis

Objective This study presents a group of patients experiencing recurrent cerebrospinal fluid (CSF) leakage associated with ipsilateral anacusis who underwent subtotal petrosectomies with the goal of stopping the CSF leak and preventing meningitis. Materials and Methods Eight patients with CSF leakage were enrolled: three patients with giant vestibular schwannomas had CSF leakage after gamma knife failure and subsequent removal via a retrosigmoid approach; two patients had malformations at the level of the inner ear with consequent translabyrinthine fistulas; two had posttraumatic CSF leakages; and one had a CSF leakage coexisting with an encephalocele. Two patients developed meningitis that resolved with antibiotic therapy. Each patient had preoperative anacusis and vestibular nerve areflexia on the affected side. Results The patients with congenital or posttraumatic CSF leaks had undergone at least one unsuccessful endaural approach to treat the fistula. All eight patients were treated successfully with a subtotal petrosectomy. The symptoms disappeared within 2 months postoperatively. No meningitis, signs of fistula, or other symptoms occurred during the follow-up. Conclusion A subtotal petrosectomy should be the first choice of treatment in patients with recurrent CSF leakage whenever there is associated unilateral anacusis

Meatal Segment of facial nerve and cavernous hemangioma

Cavernous malformations of the internal auditory canal (IAC) are a rare clinical entity. We report a rare case of cavernous hemangioma involving the internal auditory canal and the meatal segment of the facial nerve without any evident lesion to the cerebello-pontine angle and geniculate ganglion. In English language literature several studies have described cavernous malformations of the IAC, but only a few authors have described a facial nerve origin for this type of lesion. Removal of the entire lesion was achieved via the surgical resection of the facial nerve and facial nerve continuity was restored using a great auricular nerve graft. Optimal postoperative facial function recovery was reported

Petrous bone cholesteatoma: clinical longitudinal study.

Abstract The object of this retrospective study was to describe a series of patients with petrous bone cholesteatomas, paying particular attention to classification, diagnosis, surgical strategy, results, complications and recurrences. Furthermore, the study was designed to evaluate the impact of imaging techniques on an early diagnosis. Topographically, the petrous bone cholesteatomas of the present series were grouped using Sanna’s classification and different surgical approaches were used. High resolution CT and/or MRI were used to follow-up the patients. The case notes of 52 patients with petrous bone cholesteatomas who were referred to our hospital for surgery between 1987 and 2003 were reviewed postoperatively. There were 45 primary cases and 7 recurrences. The facial nerve had been inWltrated and compressed by the cholesteatoma in 18 patients. Fourteen were managed with cable grafts using sural nerve or great auricular nerves. About 26 patients with preoperative grade Ivconfirmed their normal facial function in 23 cases. In the other ten patients, the preoperative facial paralysis was due to compression by the cholesteatoma and its removal provided partial recovery of facial function in four patients. Our study compared two observation periods (1987–1996 and 1997–2003) when the diffusion and the availability of imaging techniques in our national health system had considerably increased. Two important factors emerged: firstly, the number of less extensive surgical approaches was higher in the more recent observation period, proving that cholesteatomas smaller in size had been diagnosed. Secondly, preoperative facial paralysis was less frequent in the same period—falling to 25% of cases of total facial paralysis from the 45.8% of the earlier period practically half as much. The partial paralyses instead increased slightly, demonstrating that otologists have become more sensitive to and pay more attention to this symptom

A 1-year follow-up study with C-VEMPs, O-VEMPs and video head impulse testing in vestibular neuritis

The aim of this paper was to evaluate prospectively, in a group of patients affected by VN, a diagnostic protocol employing C-VEMPs, O-VEMPs and vHIT together. The diagnosis of vestibular neurolabyrinthitis was based on the clinical history, absence of associated auditory or neurological symptoms, and a neuro-otological examination with an evaluation of lateral semicircular canal function using the Fitzgerald-Hallpike caloric vestibular test and ice test. Our series revealed an incidence of 55 % of superior and inferior vestibular neurolabyrinthitis, 40 % of superior vestibular neurolabyrinthitis and 5 % of inferior vestibular neurolabyrinthitis. These data, however, comprised different degrees of vestibular involvement considering the evaluation of each single vestibular end-organ with potential different prognosis. Four patients had only deficits of the horizontal and superior semicircular canals or their ampullary nerves. The implementation of C-VEMPs, O-VEMPs and vHIT in a vestibular diagnostic protocol has made possible to observe patients with ampullary VN, unidentifiable with other types of vestibular exams. The effect of age seems to have some impact on the recovery. When recovery firstly involves the utricular and saccular nerves and subsequently the ampullary nerves, it may be reasonable to expect a more favorable and successful outcome

Giant petrous bone cholesteatoma: combined microscopic surgery and an adjuvant endoscopic approach

Petrous bone cholesteatomas (PBCs) are epidermoid cysts, which have developed in the petrous portion of the temporal bone and may be congenital or acquired. Cholesteatomas arising in this region have a tendency to invade bone and functional structures and the middle and posterior fossae reaching an extensive size. Traditionally, surgery of a giant PBC contemplates lateral transtemporal or middle fossa microscopic surgery; however, in recent years, endoscopic surgical techniques (primary or complementary endoscopic approach) are starting to receive a greater consensus for middle ear and mastoid surgeries. We report the rare case of an 83-year-old Caucasian male affected by a giant cholesteatoma that eroded the labyrinth and the posterior fossa dura and extended to the infralabyrinthine region, going beyond the theca and reaching the first cervical vertebra. The giant cholesteatoma was managed through a combined approach (microscopic and, subsequently, complementary endoscopic approach). In this case report, we illustrate some advantages of this surgical choice

Results and complications of facial reanimation following cerebellopontine angle surgery

The present study was undertaken to evaluate the results of a group of patients following treatment for cerebellopontine angle lesions who developed postoperative facial palsy and underwent facial nerve repair in order to reanimate the muscles of facial expression. A retrospective study was performed on 23 patients treated between 1988 and 1997 at the 2nd and 4th ENT chairs of University "La Sapienza" of Pome for facial palsy following cerebellopontine angle surgery. Tumors included acoustic neuromas (n = 3). Seventeen patients underwent hypoglossal-facial anastomoses [10 with end-to-end anastomoses, 4 with May's interposition "jump-nerve" grafts and 3 with partial (30%) use of the hypoglossal nerve plus a facial cross-over]. The remaining patients were operated on using a cable graft with the sural nerve (n = 2) and the great auricular nerve (n = 4). Postoperative facial function was determined by the House-Brackmann 6-scale classification The hypoglossal-facial anastomoses resulted in long-term grade III or IV findings. Cable grafts improved facial function from grade VI to grade III. None of the patients operated on with the modified VII-XII anastomosis developed swallowing disturbances. The ten patients having traditional hypoglossal-facial anastomoses showed different degrees of tongue disability and retention of residue in the oral cavity. Surgical recovery of postoperative facial palsy can be obtained with various techniques according to the availability of the proximal facial nerve stump at the brain stem. Since a traditional hypoglossal-facial anastomosis procedure can be a source of a separate disability for the patient: techniques are preferred that leave the hypoglossal nerve mostly intact and uncompromised

Mucoepidermoid carcinoma of the external auditory canal: case report.

This study reports a case of mucoepidermoid carcinoma (MEC) of the external auditory canal, which to date has only been described once in literature. Because the lesion is extremely rare, it is particularly difficult to classify it into stages following normal diagnostic parameters. This obviously limits the possibilities of treatment that consequently are either empirical or based on those of squamous cell carcinoma. The problems in the diagnosis and the possible methods of treatment of mucoepidermoid carcinoma are discusse

Reconstruction of old radical cavities and long-term results

Various techniques and materials have been proposed to deal with the problems that concern radical cavities, such as recurrence of the inflammatory process, the need for regular medication, and social inconvenience (eg, inability to practice water sports, working in an adverse enviroment). This article provides a detailed report of the results of revalidation of old radical cavities using hydroxyapatite granules as a filling. The material was incorporated with fibrin adhesive to fill the mastoid cavity and was covered with a sheet of bone pate sealant. Twenty-eight patients with chronic discharging old radical cavities were selected for this study (mean follow-up 11.4 years; range 10-14 years). At the 6-month follow-up, grafting was successful in 25 patients, whereas the functional outcomes showed an air-bone gap below 30 dB in 18 patients. No postoperative sensorineural hearing loss was observed. The long-term follow-up demonstrated a slight worsening of the initial findings; four other patients had reperforation of the tympanic membrane, and hearing deteriorated in five patients to above 30 dB air-bone gap. These results could be a consequence of an alteration in the function of the eustachian tube and of the severity of the preoperative pathologic processes

Taste and olfaction in middle ear surgery

OBJECTIVE: The aim of this study was to assess pre- and postoperative taste ability in patients undergoing middle ear surgery for otosclerosis or chronic otitis media. Olfactory function was also evaluated to rule out taste deficits due to concomitant nasal pathology. METHODS: All patients underwent ear, nose, and throat examination, otomicroscopy, nasal endoscopy, anterior rhinomanometry, taste testing, and olfactory testing. Patients were evaluated at 1 to 5 days preoperatively (T0), and at 1 (T1), 6 (T6), and 12 (T12) months postoperatively. RESULTS: Both groups of patients experienced worsening of the mean taste threshold postoperatively. This phenomenon was more serious in poststapedotomy patients. Follow-up showed progressive improvement in both groups. All values of olfactory testing were within the normal range for otosclerosis patients. Patients with chronic otitis media showed variable postoperative findings. CONCLUSION: Chorda tympani function can be negatively affected by middle ear surgery. Deficits may be more marked in stapedotomy patients than in those undergoing tympanoplasty. Postoperative recovery of taste is satisfactory, although with different timelines for the 2 types of patholog