Air space reduction tympanomastoidectomy improves outcomes over tympanoplasty in repairing tympanic membrane perforations in the presence of unfavorable risk factors.
Retrospective review of 67 subjects' 87 operations.
Interventions were tympanoplasty versus air space reduction tympanomastoidectomy. Risk factors were contracted mastoid air cells, previous failed operations, descent from the indigenous peoples of the Americas, and middle/ear mastoid volumes l
Although it has long been known that surgery on the middle ear may be carried out under local anaesthesia (LA), the majority of ear operations in Denmark are carried out under general anaesthesia (GA). A prospective review is presented of 103 ear operations of which 71 were undertaken under local anaesthesia and 32 under general anaesthesia. Local anaesthesia has considerable advantages as compared with general anaesthesia, particularly that the anaesthetic capacity is released and can be employed for other purposes. Employment of local anaesthesia does not present any disadvantages for the surgeon and the procedure appears to be acceptable for the majority of patients. In order not to bring the procedure into disrepute, patients should be assessed meticulously preoperatively by an experienced surgeon so that operation under local anaesthesia is not performed in unsuitable patients.
A new autofibrin glue compound (AFGC) is suggested. The experiment has demonstrated that the inclusion of antibiotics and lysozyme does not influence its adhesive qualities or sterilization with gamma radiation. It has been revealed that the dose to sterilise the compound was 75 Gy. AFGC was used during tympanoplasties in 55 patients for fixation of ossiculoplasties, fascia autotransplant and skin of the external auditory meatus. Morphological and functional results of tympanoplasties turned out to be better than those of the control group in which the glue was not used.
Chlorhexidine is a common antiseptic used to prevent surgical infection. However, its exposure to the middle ear may lead to deafness. The mechanisms of the ototoxicity of chlorhexidine are reviewed. The importance of recognizing its toxicity cannot be overstated in preventing injury to patients undergoing ear surgery.
A systematic literature search was performed looking at data from human and animal studies. Search engines included MEDLINE, EMBASE, The Cochrane Library, CENTRAL, CINAHL, and Web of Science to November 1, 2010, for relevant studies published in all languages. Two independent reviewers (P.L. and D.D.P.) screened the references from published articles for additional relevant studies. Medical Subject Headings and key words including intervention (chlorhexidine, antiseptic), exposure (myringoplasty, intratympanic), and adverse effects (sensorineural hearing loss, ototoxicity, vestibular toxicity) were used.
Twelve studies were identified, two of which were non-English and were excluded. Only 2 articles on human subjects and 12 articles on animal models concerning chlorhexidine ototoxicity were identified.
Chlorhexidine in both human studies and animal models demonstrates ototoxicity if it reaches the inner ear. The toxicity of chlorhexidine appears to be related to its concentration and probable contact time with the round window membrane intraoperatively. It is conceivable that the incidence of chlorhexidine toxicity may be higher than stated if unrecognized or has resulted in subsequent medicolegal actions. From the evidence available, safer preparation solutions are available without clinical risks for ototoxicity should surgeons continue with this practice.
To conduct a survey of the antiseptic preparations used for ear surgeries among otolaryngologists in Canada.
An electronic survey was sent to active members of the Canadian Society of Otolaryngology-Head and Neck Surgery via e-mail. Questions included the use of antiseptic, choice of preparation solution, duration of preparation, use of a barrier method, and compliance with hospital protocol changes.
The e-mail was received by 253 otolaryngologists, and 85 completed the survey. Four of 85 respondents did not perform tympanoplasty surgery and were not included in the analysis. Of those who performed tympanoplasty (n ?=? 81), 78 of the 81 respondents (96%) used an antiseptic preparation solution at surgery, whereas 3 respondents (4%) did not. Sixty-six of the 77 respondents (86%) used aqueous povidone-iodine, 4 (5%) used a chlorhexidine-based preparation, 3 (4%) used an alcohol-based solution, 3 (4%) used others, and 1 answered "I don't know." Thirty-eight of 75 (29%) respondents used a barrier method, 23 (31%) answered "always," 18 (24%) answered "sometimes," and 5 (7%) answered "I don't know." When asked if they would comply with a hypothetical hospital policy to use chlorhexidine in ear surgery, 15 of 79 (19%) respondents agreed, whereas 64 (81%) disagreed. Among the aqueous povidone-iodine users (n ?=? 66), 7 (11%) agreed to change to chlorhexidine.
There is a wide variation in practice in the use of surgical preparation solution among otolaryngologists performing ear surgery. Surgeons must be vigilant to avoid ototoxicity. A national society consensus on appropriate preparation solutions for ear surgery would minimize patients' risk and minimize future medicolegal actions.
The high incidence of chronic ear disease among the three ethnic groups, Eskimo, Algonkian Indians, and Caucasians living under the same environmental conditions is studied. The role of socio-economic factors in the incidence and sequelae of ear disease in this population was similar to other studies among the native peoples of Alaska, Canada, and Greenland. The variation in the disease pattern in the different ethnic groups was shown to be related to the aeration of the middle ear cleft. The air cell system of the mastoid is determined by x-rays and/or surgical exploration, but the patency of the Eustachian tube and its size is determined by impedance audiometry and use of ureteric catheters. The clinical and surgical findings of the behavior of chronic ear disease in the different ethnic groups is correlated to tissue culture experiments. The role of lowered oxygen tension in the formation and behavior of cholesteatoma is illustrated well among the Caucasians with poor aeration of the middle ear cleft who show a high incidence of cholesteatoma, unlike the Eskimos with good aeration who show a complete absence of cholesteatoma.
From: Fortuine, Robert et al. 1993. The Health of the Inuit of North America: A Bibliography from the Earliest Times through 1990. University of Alaska Anchorage. Citation number 2445.
Chronic otitis media and hearing loss is a major health problem today in the Canadian Eskimo. The subject is reviewed and the findings of projects and a survey that have been carried out recently are discussed. A modality of treatment is proposed which is based upon the findings of the projects, the survey and other information that is available at the present time.
From: Fortuine, Robert et al. 1993. The Health of the Inuit of North America: A Bibliography from the Earliest Times through 1990. University of Alaska Anchorage. Citation number 2392.