Cases reported "Ear Diseases"

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1/46. Salivary gland choristoma of the middle ear: case treated with KTP laser.

    Salivary gland choristoma of the middle ear is rare. It consists of non-malignant, non-growing, normal salivary gland tissue in the middle ear. It is a developmental abnormality that occurs around the proximal part of the second branchial arch before the fourth month of intrauterine life. The authors found the 25th recorded case in our centre and another 24 reported cases from a review of the literature between 1961 and 1999. Intratympanic salivary gland choristoma frequently occurs during the first and second decades of life and with a female preponderance (56 per cent). Nearly all the patients (96 per cent) in our review presented with a hearing loss, that had begun since birth, in infancy, or during childhood. tinnitus (28 per cent), and serous otitis media (24 per cent) were also commonly present. One case complained of otorrhoea. Intratympanic and extratympanic anomalies were found in 96.2 per cent and 34.6 per cent of cases respectively. Of these anomalies, ossicular chain (88.5 per cent), facial nerve (65.4 per cent), middle-ear muscles (30.8 per cent) and labyrinthine windows (23 per cent) were the four most common sites. Therefore, salivary gland choristoma may represent a manifestation of a congenital ear anomaly. diagnosis of salivary gland choristoma is generally not documented pre-operatively, but is based on surgical biopsy and histopathological investigations. Treatment of this rare lesion depends on the size, location and extent of the mass, degree of anatomical abnormality and expertise of the surgeon. In difficult cases where the mass is attached to the dehiscent or inferiorly placed facial nerve, only biopsy is recommended. However, complete surgical removal is advocated for a mass that is easy to remove. KTP laser use via a 200 micron fibre-optic light carrier can facilitate removal especially in cases with ossicular chain involvement.
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2/46. Complications of venous insufficiency after neurotologic-skull base surgery.

    OBJECTIVE: To characterize the incidence and complications resulting from venous insufficiency after neurotologic-skull base surgery. STUDY DESIGN: Retrospective case review of >3,500 cases. SETTING: Tertiary referral center, inpatient surgery. patients: Six patients: four with complications related to chronic venous insufficiency and two with complications related to acute venous insufficiency. INTERVENTION(S): Medical (steroids, acetazolamide, hyperventilation, mannitol) and surgical (lumboperitoneal shunt, optic nerve decompression, embolectomy) interventions were undertaken. MAIN OUTCOME MEASURE(S): Chronic venous insufficiency: nonobstructive hydrocephalus manifested by headache, disequilibrium, and papilledema with resultant visual loss. Acute venous insufficiency: acute nonobstructive hydrocephalus resulting in mental status abnormalities in the postoperative period. CONCLUSIONS: (1) incidence of 1.5 per 1,000 cases. (2) Acute and chronic forms with different pathogenesis. (3) Acute form presents postoperatively with change in consciousness and herniation, and may proceed to death. (4) Chronic form presents months or years postoperatively with headache, disequilibrium, and visual changes from papilledema. (5) Occurs almost solely in patients with preoperative abnormalities of the venous collecting system. (6) Causes mental status changes postoperatively.
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3/46. choristoma of the middle ear: a component of a new syndrome?

    CASE REPORT: Salivary choristoma of the middle ear is a rare entity. The authors report the 26th known case, which is unique in several respects: the patient had abnormalities of the first and second branchial arches, as well as the otic capsule and facial nerve in ways not yet reported. Our patient presented with bilateral preauricular pits, conchal bands, an ipsilateral facial palsy, and bilateral Mondini-type deformities. A review of the literature revealed salivary choristomas of the middle ear to be frequently associated with branchial arch abnormalities, most commonly the second, as well as abnormalities of the facial nerve. review OF THE literature: All 25 cases were reviewed and the results reported with respect to clinical presentation, associated abnormalities, operative findings, and hearing results. It has been proposed that choristoma of the middle ear may represent a component of a syndrome along with unilateral hearing loss, abnormalities of the incus and/or stapes, and anomalies of the facial nerve. CONCLUSION: Eighty-six percent of the reported patients with choristoma have three or four of the four criteria listed to designate middle ear salivary choristoma as part of a syndrome. In the remaining four patients, all of the structures were not assessed.
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4/46. Promontory dehiscence: a case report.

    Dehiscence of the bony promontory without preoperative fistula formation occurred in a patient with a history of chronic otitis media and perforation of the tympanic membrane without cholesteatoma.
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5/46. False-positive magnetic resonance image in the diagnosis of small acoustic neuroma.

    A patient presented with sudden hearing loss on her first visit to our department. gadolinium-DTPA-enhanced magnetic resonance imaging (MRI) of the posterior cranial fossa portrayed an intracanalicular tumour image (2-3 mm), and the pure tone average (PTA) and speech discrimination score (SDS) values were 65 dB and 60 per cent, respectively. Surgical intervention to remove the suspected tumour was scheduled by the translabyrinthine approach. Intracanalicular observations by the retrolabyrinthine approach revealed limited oedema on the inferior vestibular nerve with vascular dilation. The tumour image disappeared two years after the operation. Surgical findings and the post-operative course advocate that gadolinium-DTPA-enriched MRI image of an intracanalicular lesion such as arachnoiditis might produce a false-positive result.
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6/46. rupture of the round window membrane.

    A perilymph leak into the middle ear through a ruptured round window membrane results in the symptoms of hearing loss, tinnitus and vertigo, either singly or in combination. The case histories of thirteen patients with such a fistula are described, these patients having in common a predisposing incident which had led to a rise of C.S.F. pressure. Symptomatology and the results of investigation are analysed and operative technique and results discussed. While it appears that vertigo uniformly responds very satisfactorily to operative treatment the improvement in hearing loss and tinnitus is more difficult to predict.
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ranking = 2
keywords = operative
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7/46. Reparative granuloma seen in cases of gold piston implantation after stapes surgery for otosclerosis.

    OBJECTIVE: to determine the occurrence of the unusual side effect of a reparative granuloma after the implantation of a pure gold piston in cases of otosclerosis. STUDY DESIGN: a retrospective case review study of 475 stapes operations with a pure gold piston. SETTING: Department of Otorhinolaryngology of the University of Amsterdam, The netherlands and the HNO clinic in Luenen (Brambauer) in germany. patients: four hundred and seventy five patients (328 women, 147 men, average age: 45.2 years), who clinically and per-operatively had otosclerosis, underwent a stapedotomy using a pure gold piston prosthesis. Therapeutic intervention: in cases of suspicion of a reparative granulomas or those cases that did not have improvement of the hearing after the stapedotomy, a re-operation by transcanal approach was performed. RESULTS: in seven cases a reparative granuloma was diagnosed by this revision surgery. The postoperative incidence of these granulomas following stapedotomy using the pure gold piston turned out to be 1.5%. CONCLUSION: reparative granulomas can occur after stapedotomy with a pure gold stapes piston although the incidence is low. The role of grafting material to seal the oval window niche and the treatment of these reparative granulomas following stapes surgery are discussed.
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ranking = 2
keywords = operative
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8/46. The natural history of congenital cholesteatoma.

    OBJECTIVES: To describe the natural history of congenital cholesteatoma (CC) and to determine whether such a description provides clues about the origins and end points of these lesions. DESIGN: A retrospective qualitative analysis of intraoperative illustrations of 34 consecutive patients with 35 CCs (1 bilateral). SETTING: Two tertiary care children's hospitals. patients: Thirty-four children with CC, mean age, 5.6 years (range, 2-13 years). RESULTS: Congenital cholesteatoma originates generally, but not universally, in the anterior superior quadrant. The progression of growth is toward the posterior superior quadrant and attic and then into the mastoid. Contact with the ossicular chain generally results in loss of ossicular continuity and in conductive hearing loss. CONCLUSIONS: Congenital cholesteatoma appears to have a predictable trajectory of growth, starting as a small pearl in the middle ear, eventually growing to involve the ossicles and mastoid, and causing varying degrees of destruction and functional impairment. The clinical picture of a young child with otorrhea, conductive hearing loss, tympanic membrane perforation in a nontraditional location, and a mastoid filled with cholesteatoma may represent the end point in the natural history of CC, despite the fact that this type of lesion is outside the accepted definition of CC.
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9/46. Deoxyribonucleic acid fingerprinting in an outbreak of staphylococcus aureus intracranial infection after neurotologic surgery.

    BACKGROUND: meningitis is the most common life-threatening infection occurring as an early postoperative complication of neurotologic surgery. From January to March 2001, staphylococcus aureus intracranial infection developed in three patients; two cases were consecutive. methods: All staff members involved in surgery on any of the three patients had nasal swabs for S. aureus. The three patient isolates and all S. aureus isolates from staff members were typed by pulsed-field gel electrophoresis. Operating room procedures were reviewed. RESULTS: All three patient isolates were identical by pulsed-field gel electrophoresis. Six staff members (40%) were found to be S. aureus carriers. The isolate from one staff members was identical to the patient isolates. A procedure audit of the operating room revealed several breaks in recommended practice. The staff carrier was immediately removed from patient care duties, given decolonization therapy, and treated for chronic rhinosinusitis. Practice changes in the operating room were implemented. CONCLUSIONS: S. aureus remains a common cause of surgical site infections. S. aureus carriage is common, and carriers with intercurrent respiratory infections have increased shedding and are a higher risk to patients. Proper use of barrier devices and consistent hand hygiene reduce bacterial contamination of the wound. Current operating room technology involves technical personnel not traditionally trained in operating room procedures. Epidemiologic investigation may be delayed if operating room records are incomplete with respect to these personnel. molecular typing of bacterial isolates can identify common source outbreaks and effectively focus investigations.
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10/46. Neuroepithelial cysts of the middle ear.

    Neuroepithelial cysts are lesions of the central nervous system that have previously been reported in cerebral parenchyma, in the spinal cord, and within the ventricles in association with the choroid plexus. We describe 2 cases of neuroepithelial cysts of the middle ear. One was diagnosed after surgery for a retraction pocket and chronic otitis media complicated by an intraoperative cerebrospinal fluid (CSF) leak. The other produced bilateral spontaneous CSF otorrhea and mimicked the presentation of arachnoid granulations. Both cases were verified with immunohistochemical stains. Neuroepithelial cysts, although rare, should be considered in the differential diagnosis of spontaneous CSF otorrhea or an epitympanic mass.
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