1/7. Delayed facial paralysis after stapedotomy using KTP laser.OBJECTIVE: Delayed facial paralysis after stapes surgery is uncommon and has been reported after traditional, nonlaser techniques for stapedotomy. The purpose of this paper is to inform the reader of the potential risk of delayed facial nerve paralysis associated with the use of the potassium titanyl phosphate (KTP) laser for stapedotomy. Etiologic mechanisms are discussed. STUDY DESIGN: The study was a descriptive study-case report. SETTING: The study was conducted at a university-based otologic practice. patients: Two patients with otosclerosis and delayed onset facial palsy 5 to 7 days after uncomplicated stapedotomy using the KTP laser were included in the study. INTERVENTION: potassium titanyl phosphate laser stapedotomy was performed. patients received treatment of facial palsy with a tapering course of oral steroids. MAIN OUTCOME MEASURE: House-Brackmann facial nerve grade scores were used. RESULTS: Improvement of House-Brackmann facial nerve scores from Grade VI to Grade I-II in one patient, and improvement from Grade IV to Grade I-II in the other was seen. CONCLUSION: The probable etiology of delayed facial palsy is viral neuritis from reactivation of dormant virus within the facial nerve, initiated by thermal stress of the KTP laser. Presentation and resolution of the facial palsy is similar to other types of delayed facial palsy resulting from nonlaser techniques of stapes surgery and other types of middle ear and neurotologic surgeries previously reported.- - - - - - - - - - ranking = 1keywords = otologic (Clic here for more details about this article) |
2/7. Pure sensorineural hearing loss and otosclerosis. An imaging case report.Pure sensorineural hearing loss is not a rare finding in otological practice. Numerous aetiologies could be at the origin of such a deficit. However, otosclerosis is very rarely cited as a cause of pure sensorineural hearing loss. We present one such case of pure sensorineural hearing loss linked to otosclerosis in a 30-year old caucasian male and underline the high contribution of computed tomography to confirm such a diagnosis. Pure sensorineural hearing loss due to otosclerosis is a rare event and can be misdiagnosed. The clinical diagnosis of such a disease may be difficult. In these cases, CT-Scan is the exam of choice to confirm the diagnosis.- - - - - - - - - - ranking = 0.5keywords = otologic (Clic here for more details about this article) |
3/7. Lesions of the internal auditory canal and cerebellopontine angle in an only hearing ear: is surgery ever advisable?OBJECTIVE: To define the indications for surgery in lesions of the internal auditory canal (IAC) and cerebellopontine angle (CPA) in an only hearing ear. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. patients: Seven patients with lesions of the IAC and CPA who were deaf on the side opposite the lesion. Five patients had vestibular schwannoma (VS), and one each had meningioma and progressive osseous stenosis of the IAC, respectively. The opposite ear was deaf from three different causes: VS (neurofibromatosis type 2 [NF2]), sudden sensorineural hearing loss, idiopathic IAC stenosis. INTERVENTION(S): Middle fossa removal of VS in five, retrosigmoid resection of meningioma in one, and middle fossa IAC osseous decompression in one. MAIN OUTCOME MEASURE: Hearing as measured on pure-tone and speech audiometry. RESULTS: Preoperative hearing was class A in four patients, class B in two, and class C in one. Postoperative hearing was class A in three patients, class B in one, class C in two, and class D in one. CONCLUSIONS: Although the vast majority of neurotologic lesions in an only hearing ear are best managed nonoperatively, in highly selected cases surgical intervention is warranted. Surgical intervention should be considered when one or more of the following circumstances is present: (1) predicted natural history of the disease is relatively rapid loss of the remaining hearing, (2) substantial brainstem compression has evolved (e.g., large acoustic neuroma), and/or (3) operative intervention may result in improvement of hearing or carries relatively low risk of hearing loss (e.g., CPA meningioma).- - - - - - - - - - ranking = 0.5keywords = otologic (Clic here for more details about this article) |
4/7. Fenestration of the horizontal semicircular canal in congenital conductive deafness.Fenestration of the horizontal semicircular canal enables the otologic surgeon to restore hearing in those patients with congenital conductive deafness who are not candidates for stapedectomy, ossicular reconstruction, or tympanoplasty. Since the development of stapedectomy, much of the finesse technique of fenestration surgery has been lost, and many otologic surgeons today are unfamiliar with the fenestration operation. The surgical technique for creating a permanently patent fenestra in the horizontal semicircular canal is described. The causes of failure in fenestration surgery are reviewed. Thirty-three patients who have undergone fenestration for congenital conductive deafness over a 30-year period, and 100 patients who underwent fenestration for otosclerosis in 1950, are reviewed to demonstrate patient selection and the efficacy of this operation in establishing long-term hearing improvement.- - - - - - - - - - ranking = 1keywords = otologic (Clic here for more details about this article) |
5/7. Assessment by audiotympanometric testing: three case reports.Tympanometric measurements are versatile and accurate when more than one type of ear disease is present. Three cases are presented where information from tympanometry beyond that derived from otological and routine audiological testing yielded accurate diagnoses. A patient with a history of middle-ear disease presented with a sensori-neural loss. Measures of static conductance correctly identified the problem as stiffness of the ossicular chain. An infant with unilateral congenital atresia and questionable hearing in her normal-appearing ear was determined to have serous otitis media by tympanometry and reflex testing. The course of the disease was monitored and reversed. A 17-year-old female suffered a basal skull fracture with a sudden conductive hearing loss. Low conductance and high impedance correctly identified loss of mobility of the ossicular chain which was confirmed surgically. These three cases illustrate the advantages of tympanometry in making rapid, accurate, objective measurements involving complex diagnoses of middle-ear function.- - - - - - - - - - ranking = 0.5keywords = otologic (Clic here for more details about this article) |
6/7. Variant petrotympanic fissure as possible cause of an otologic complication during TMJ arthroscopy. A case report.In this reported case, a variant petrotympanic fissure--opening at the height of the orifice of the eustachian tube into the hypotympanon--was identified by high resolution computed tomography (CT) as the possible cause of a tympanic membrane perforation. Inner ear function was preserved by an otosclerotic stapes which prevented destruction of the labyrinth. The perforation was closed by a myringoplasty and was to be followed by a stapedectomy after six months to restore normal hearing. Surgeons performing temporomandibular joint arthroscopy should be aware that in a small percentage of patients a variant anatomy of the tympanic plate exists and, therefore, great care must be exercised in the manipulation of instruments near this structure. A preoperative high resolution CT with thin slices of the temporal bone might allow identification of these high risk patients.- - - - - - - - - - ranking = 2keywords = otologic (Clic here for more details about this article) |
7/7. Bilateral sudden sensorineural hearing loss following non-otologic surgery.hearing loss as a complication of non-otological surgery is rare. The majority of described cases have followed cardiac bypass surgery. To date there have been only 25 reported cases of non-otological surgery associated hearing loss (NOSAHL) which have not involved cardiopulmonary bypass. Only two cases of bilateral NOSAHL have been previously described, and neither resulted in permanent severe bilateral hearing deficit. We describe a case of permanent bilateral severe hearing loss following metatarsal pinning in a patient with pre-existing non-operated otosclerosis.- - - - - - - - - - ranking = 3keywords = otologic (Clic here for more details about this article) |