Operative Techniques in Otolaryngology - Head and Neck Surgery最新文献

Definitive diagnosis of conductive hearing loss requires a comprehensive audiological evaluation by a skilled audiologist. Threshold testing is performed with both air and bone conduction stimuli and frequently necessitates masking strategies. The fundamental aspects of bone conduction audiometry will be reviewed. Patients with bilateral conductive or mixed hearing loss need advanced strategies, such as the Rainville estimation method to acquire ear specific thresholds.¹ One hallmark of conductive hearing loss is preserved word recognition due to intact cochlear function. Immittance testing is another important component to comprehensive audiometry and can provide important information about the site of the conductive lesion. This article will review the fundamental aspects of the audiologic assessment of conductive hearing loss and touch on areas of recent research advances, including the assessment of high frequency conductive hearing loss using specialized bone conduction hardware.

This article provides an up-to-date accounting of various surgical options and reported trends in middle ear reconstruction for conductive hearing loss with a primary focus on hearing outcomes. In general, the results after bridging tympanoplasty type II are superior to the results after type III tympanoplasty. For type III tympanoplasty most case series report more favorable hearing outcomes for partial ossicular replacement prosthesis (PORP reconstruction) as compared to total ossicular replacement prosthesis (TORP reconstruction). Endoscopic ossicular chain reconstruction yields comparable hearing outcomes with improved early hearing outcome. Long-term outcome reporting of hearing outcomes after endoscopic ossiculoplasty are needed. Surgical reconstruction of the ossicular chain enables the ear surgeon to tailor the surgical treatment individually to the patient thanks to the wide range of surgical techniques and prosthesis designs available.

Otitis media with effusion (OME) is the most common cause of conductive hearing loss in children. Although middle ear effusions will often respond spontaneously, many children will develop chronic OME (COME) and require tympanostomy tube placement to achieve consistent middle ear health and to normalize hearing. While tympanostomy tube placement is a simple procedure, it is essential for any Otolaryngologist that manages children to have an in-depth knowledge of current evidence-based guidelines for the management of otitis media in children, given the incredibly high prevalence of the condition and the high frequency of tympanostomy tube placement relative to other otologic procedures. This article will review current guidelines for the management of otitis media in children, indications for tympanostomy tube placement, recommended management of risk factors for COME in children, intraoperative considerations, postoperative management guidelines, and avoidance/management of potential complications.

Despite the ease, efficacy, predictability, and widespread availability of osseointegrated bone conduction hearing devices, surgical repair of congenital aural atresia (CAA) remains a viable and rewarding operation for patients, parents, and surgeons. Careful selection of patients using appropriate audiometry, detailed radiographic interpretation, and assessment of family understanding and child cooperability are the first steps toward a successful outcome. Intimate knowledge of outer, middle, and inner ear anatomy—both in the normally and abnormally developed ear—coupled with meticulous technique at each stage of the operation can yield outstanding hearing results with a clean, skin-lined, dry, patent ear canal. This chapter reviews the preoperative evaluation and steps of the atresia repair operation, including postoperative management, and provides both predictive and published data on hearing outcomes.

The middle ear plays a critical role for the conversion of acoustic energy to mechanical vibrations that subsequently enter the cochlea. It is middle ear impedance matching through ossicular coupling that has enabled land-dwelling vertebrates to hear soft airborne sounds. Conductive hearing loss may result from damage to the delicate middle ear structures following infection, trauma or rapid pressure changes. An understanding of the mechanics of the middle ear significantly improves the oto-surgeon's ability to effectively diagnose conductive hearing loss, localize the responsible lesion and then effectively correct the conduction abnormality. This article reviews some of the basic knowledge of middle ear mechanics for sound transmission, highlights recent advances in developing new techniques to assist in diagnosis of middle ear disease, and finally sheds light on future research aimed at improving the diagnosis and management of middle ear pathology.

Conductive hearing loss is typically associated with pathology of the external auditory canal or middle ear. However, there are several disorders of the inner ear that can also lead to conductive hearing loss. Inner ear conductive hearing loss is believed to occur due to the presence of an abnormal third window within the inner ear that diverts acoustic energy away from the cochlea, thereby increasing air conduction thresholds. These third window lesions may arise from congenital anomalies in the cochlea or labyrinth or may be acquired in the setting of infections, cholesteatoma, trauma, or iatrogenic injuries. Herein, we explore the clinical presentation, diagnostic evaluation, and management of common third window syndromes, including superior semicircular canal dehiscence, perilymphatic fistula, enlarged vestibular aqueduct, and labyrinthine fistula

Successful ossiculoplasty aims to improve conductive hearing loss by restoring the mechanical transmission of energy from the tympanic membrane to the oval window. Ossiculoplasty is typically performed under general anesthesia with facial nerve monitoring as standard practice in our institution. Titanium implants have become the mainstay choice of prosthesis, due to its low density, high durability, and lower extrusion rate compared to other alloplastic implants. While microscopic techniques for ossiculoplasty have been the traditional approach, endoscopic ossiculoplasty has risen in popularity due to improved visualization of the middle ear.

Implantable bone conduction devices have been a beneficial addition to the armamentarium of surgical management of conductive hearing loss. They have demonstrated rapid improvement in technology and increased application over the years leading to several new devices. Thorough patient evaluation is necessary for proper device selection. Several factors are considered when choosing the appropriate implantable bone conduction device including age, aesthetic concerns, the severity of hearing loss, the need for frequent MRIs, and other surgical considerations including anatomic variations and past otologic procedure. Audiological outcomes are generally favorable. Patient evaluation, selection criteria, surgical decision-making, operative techniques, post-op care, and potential complications will be summarized.

Allograft tympanoplasty was once widely used across the world but is currently only performed by a limited number of surgeons in Belgium and Germany. Allograft tympanic membranes and ossicles are procured endoscopically nowadays and are processed in specific tissue banks subject to European Union regulations on human allograft tissue to ensure the receptor will receive quality-controlled tissue. The surgical procedure via retroauricular approach can teach us how we can manage difficult cases with total, subtotal and marginal perforations, but also cases of isolated pars tensa cholesteatoma.

Tympanic membrane (TM) perforation is a common medical condition often resulting from trauma or infection. TM perforation can lead to significant morbidity including pain, recurrent infections and conductive hearing loss. There are many methods of TM repair that have evolved to incorporate advancements in technology and reduce procedural burden. Three methods of repair that will be discussed include: transcanal endoscopic tympanoplasty, total drum replacement tympanoplasty, and in office TM repair. The size and location of the perforation, in addition to patient factors and physician preference influence the type of repair indicated. Closure rate of TM perforations and conductive hearing loss improvement have been shown to be similar across techniques. Steps to successfully master each technique including preoperative indications, specific surgical steps, and expected postoperative outcomes are discussed herein.