Otolaryngology Ear Surgery

We describe 4 pediatric patients (age 6-11 years) who underwent transcanal endoscopic ear surgery (TEES) with the assistance of a flexible fiber CO2 laser over a period of 6 months. Three of these individuals suffered from densely adherent cholesteatoma, where the laser permitted one-handed dissection while preserving endoscopic visualization by limiting bleeding. In the fourth patient, TEES ossiculoplasty was performed for a congenital stapes bar, with subsequent hearing improvement. Advantages and disadvantages of the flexible fiber CO2 laser in the setting of TEES are discussed. Use of the flexible fiber CO2 laser was found to expand the TEES toolkit.

Acute otitis media (AOM) is a multifactorial disease with a significant socioeconomic impact. The pathogenesis of AOM is attributed to a variety of well-established internal and extrinsic factors. Recent evidence strongly points to bacterial biofilm formation as an important contributor to this disease entity. The nasopharynx is a likely reservoir for infection with subsequent seeding of pathogens to the middle ear via planktonic shedding. Various modalities have been used to directly detect biofilm formation in the middle ear mucosa of children with AOM. Further insights into this disease may lead to new strategies for prevention and treatment.

Background: Transcanal endoscopic ear surgery has many advantages over conventional microscopic ear surgery and is used as adjunct to microscope or is used independently. Precise large visual field and angular vision has edge over the clumsy, expensive, peeping tubular vision of microscopes. Moreover, it is a better teaching methodology for the undergraduates and postgraduates. Our study comprised of twenty-five patients who had safe ear and underwent transcanal endoscopic ear surgery (TEES). Methods: This prospective study was carried out between October 2014 to December 2015 at Hayaat hospital, Allahabad, Uttar Pradesh, India and Hind Institute of Medical Sciences, Safedabad, Barabanki. Twenty-five patients of age group more than fifteen years were selected. All the patients selected had dry and safe type of chronic suppurative otitis media (CSOM). Results: Of the twenty five people ten were females and fifteen males in the ratio of 2:3. All the patients selected had dry ear and safe type of chronic suppurative otitis media (CSOM). All had conductive hearing loss of variable decibels but not greater than fifty-five decibels. Conclusions: Further research is needed in the field of operative TEES. We all need to discuss and more research work is needed to prove its genuinity and practicality.

Aim: To study the role of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) for assessment of severity in Laryngopharyngeal Reflux (LPR) and to assess the improvement of symptoms following treatment with Proton Pump Inhibitors (PPI) using RSI. Design: Prospective single blinded observational study. Methods: Patients with symptoms of LPR with RSI and RFS scores more than 7 were included in the study and were treated with PPI for 8 weeks and followed up with RSI. Results: A total of 107 patients were included over a period of 7 months.There is a positive correlation between RSI and RFS taken before starting treatment (P = 0.016). The mean of RSI score as well as all the 9 individual symptoms showed statistically significant decrease after therapy. Conclusion: RSI & RFS scores of 7& above can be considered as clinical indicators of LPR and RSI alone can be used to assess its treatment.

Cases of foreign body ingestion are common among children. But impaction of ingested foreign body in nasopharynx is extremely rare. We present a male patient 4 months old with ingestion of foreign body (marble) impacted in the nasopharynx. The patient came after suspicion of his mother that he ingested marble ball but the patient had no symptoms, the patient diagnosed by X-ray head, neck and chest, the was removed immediately under general anaesthesia using finger and magill forceps.

OBJECTIVES:

Biofilms have been implicated in the development of several chronic infections. We sought to demonstrate middle ear pathogens in adenoid biofilms using scanning electron microscopy (SEM) and fluorescent in situ hybridization (FISH) with confocal laser scanning microscopy (CLSM).
METHODS:

Comparative micro-anatomic investigation of adenoid mucosa using SEM and FISH with confocal scanning laser microscopic (CLSM) imaging from patients with recurrent acute otitis media (RAOM).
RESULTS:

All otitis-prone children demonstrated biofilm surface area presence greater than 85% by SEM. FISH accompanied by CLSM imaging also demonstrated patchy biofilms All biofilms contained middle ear pathogens and were frequent in polymicrobial distributions: 4 of 6, 4 of 6 and 3 of 6 samples contained Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis, respectively.
CONCLUSIONS:

Dense adenoid biofilms may act as a reservoir for reinfection of the tubotympanum. Aspiration of planktonic middle ear pathogens existing in resistant adenoid biofilms during a viral upper respiratory tract infection may be an important event in the development of RAOM.

Sturge-Weber syndrome (SWS), also known as encephalotrigeminal angiomatosis, was reported by Schirmer, Sturge and Weber in succession in mid-19th century. And it is a neurocutaneous disease classically presenting with a facial port-wine stain in the ophthalmic distribution of the trigeminal nerve, glaucoma and vascular eye abnormalities, and an ipsilateral occipital leptomeningeal angioma. It is possible to observe nose and sinus involvement in SWS [1]. And there already have been some cases about SWS accompanying with chronic rhinosinusitis [2], but to our knowledge, there are still no cases describing SWS combining with ipsilateral chronic rhinosinusitis and unusual nasal polyps. Here, we report a case of SWS which incorporated with ipsilateral chronic rhinosinusitis and nasal polyps-more precisely hemangioma-liked nasal polyps. A half year ago, a 40-year-old Chinese man known to have SWS visited our department complaining of progressive nasal obstruction, recurrent purulent nasal discharge and anosmia many years. He had been treated with no success using antibiotics, topical nasal decongestants and steroid nasal sprays. He had a history of left-sided epilepsy (but he had been seizure-free for many years without any antiepileptic therapy), headache, right buphthalmos and glaucoma which led his right eye to blindness, and progressive left hemiparesis. Fortunately, he was not severe mental disabled, and could look after himself and communicate with others basically. There was no family history of epilepsy, mental retardation or a neurocutaneous syndrome.

Congenital cholesteatoma of the petrous bone, though originating in childhood, has often a delayed diagnosis due to its poor symptoms and can grow achieving great extension. When asymptomatic or pauci-symptomatic, the diagnosis is incidental and purely radiological. Leaving the lesion untreated implies an inexorable progression leading to extensive erosion of the petrous bone and cranial nerves involvement. First choice treatment is radical surgical excision. An aggressive treatment is recommended, a combination of approaches to the petrous bone and skull base may be used to obtain complete removal. Surgical morbidity is a balance between the choice of the approach and the goal of radical excision. Prevention of relapse is essential not to expose the patient to further morbidity some years later. Long term follow-up is essential.

Background: Children with cerebral palsy (CP) suffer from multiple problems and potential disabilities. These range from musculoskeletal problems, mental retardation, epilepsy, ophthalmologic and hearing impairment among others. Consequences of hearing loss include problems with speech and language development. Early detection in this difficult-to-test population may prevent these consequences of hearing loss. An otoacoustic emission assessment is useful in this regard. This study assessed transient-evoked otoacoustic emissions (TEOAEs) in children with CP. Materials and Methods: The study population were children with CP who presented at the paediatric neurology clinic during the study period. An equal number of control population matched for age and sex were also recruited using simple random sampling. An interviewer-administered questionnaire was used to obtain relevant clinical information. All participants selected underwent a detailed ear, nose and throat examination and TEOAE testing. Results: There were 330 participants in this study, categorised into CP cases (165) and non-CP controls (165). The age range of the participants was 1–12 years, with a mean age of 4.44 ± 2.92 among CP patients and 4.47 ± 2.90 among the controls. The male-to-female ratio was 2:1. TEOAEs were 'failed' in 83.6% of the CP patients and in 28.5% of the controls. This study found a statistically significant difference in 'failed' TEOAE result between the CP patients and the controls (P = 0.0001). Conclusion: This study found a high prevalence of 'failed' TEOAEs in children with CP in Kano.

PURPOSE: There are no formal radiologic criteria to stratify patients for transcanal (TEES) or transmastoid endoscopic ear surgery for resection of cholesteatoma. We aim to determine 1) whether standard preoperative computed tomography (CT) findings are associated with the need for conversion to a transmastoid approach and 2) the amount of time added for conversion from TEES to transmastoid techniques.
MATERIALS AND METHODS: Retrospective chart review of consecutive pediatric and adult cases of TEES for primary cholesteatoma from 2013 through 2015 (n = 52). TEES cases were defined as endoscope-only procedures that did not require a transmastoid approach (n = 33). Conversion cases were defined as procedures that began as TEES however, required conversion to a transmastoid approach due to the inability to complete cholesteatoma removal (n = 19). Preoperative CT findings and total operating room (OR) times of TEES and conversion cases were compared.
RESULTS: Preoperative CT scan characteristics that were associated with conversion included tegmen erosion (p = 0.026), malleus erosion (p < 0.001), incus erosion (p = 0.009), mastoid opacification (p = 0.009), soft tissue opacification extending into the aditus ad antrum (p = 0.009) and into antrum (p = 0.006). Total OR time for TEES cases was significantly shorter than conversion cases (median 143 min versus 217 min, p < 0.001). CONCLUSIONS: Preoperative CT findings, notably extension of soft tissue in the aditus ad antrum, antrum and mastoid, are associated with need for conversion to transmastoid technique to achieve removal of cholesteatoma. Endoscope-only cases were significantly faster than cases that required conversion to a transmastoid approach.