Endolymphatic sac tumors(ELSTs) are rare, papillary adenomatous tumors that arise from the endothelium of the endolymphatic sac. We demonstrate a difficult case of endolymphatic sac tumor and how it is managed via tra...Endolymphatic sac tumors(ELSTs) are rare, papillary adenomatous tumors that arise from the endothelium of the endolymphatic sac. We demonstrate a difficult case of endolymphatic sac tumor and how it is managed via transcanal endoscopic assisted technique, with discussion of feasibility of transcanal approach to lateral skull base tumor.展开更多
Objective: Multiple alternative approaches of cochlear implant surgery have been described, such as the suprameatal approach, transcanal approach, transmeatal approach and middle cranial fossa approach.Transmeatal(ope...Objective: Multiple alternative approaches of cochlear implant surgery have been described, such as the suprameatal approach, transcanal approach, transmeatal approach and middle cranial fossa approach.Transmeatal(open trnascanal) approach has not been adapted since first described in the clinical field.we aimed to assess the long-term complications of the transmeatal approach in a series of 131 patients at our center between 2004 and 2008.Methods: This study was a retrospective case series of all patients who underwent cochlear implants with the transmeatal(open transcanal) approach from May 2004 to December 2008 at King Faisal Specialist and Research Hospital(Riyadh, Saudi Arabia), which were conducted by the same surgeon.Results: Complications were observed often with various combinations-recurrent otitis externa, posterior tympanic membrane perforation, electrode extrusion, cholesteatoma, and chronic mastoiditis. The overall long-term complication rate was 16%(21/131). The gap between the implantation and the diagnosis of a complication ranged from <1 year to 11 years. Major complications were as follows:cholesteatoma in 5(3.8%) patients, extrusion of the electrode in 5(3.8%) patients, and tympanic membrane perforation or deep retractions in 5(3.8%) patients. Minor complications were as follows: recurrent mastoiditis with/without concomitant temporary facial nerve palsy in 4(3%) patients, recurrent otitis externa infections in 7(5%) patients, and weakness of the posterior canal wall in 1 patient.Conclusion: The transmeatal approach posed an high rate of complications on long-term follow-up such as cholestetoma formation, extrusion of electrode or perielectrode reaction formation to tympanic membrane and external auditory canal.展开更多
Objective: To investigate the feasibility of transcanal endoscopic myringoplasty in the hand of young beginner surgeons who had just completed the residency programme.Methods: In a three year period(August 2012 to Aug...Objective: To investigate the feasibility of transcanal endoscopic myringoplasty in the hand of young beginner surgeons who had just completed the residency programme.Methods: In a three year period(August 2012 to August 2015), 44 ears in 42 patients were operated upon by a beginner surgeon through the transcanal endoscopic approach in a subdistrict level hospital located in the north western ranges of the Himalayan region.Results: Of the 42 patient, 19 were male and 23 female. The mean age was 26.23 years(range: 15 e47 years). In 40 ears, complete perforation closure was achieved at six months(success rate: 90.9%). The mean air conduction PTA preoperatively was 40.84 dB HL and improved to 28.06 dB HL postoperatively(p <.001). The mean AB gap preoperatively was 22.40 dB, which improved to 9.1 dB postoperatively(p <.001).Conclusion: Endoscopic transcanal myringoplasty is safe and reliable even in young beginners' hands.Surgeons can consider endoscopic approach early in their careers without the fear of learning curve. The cost of endoscopic equipment is about one tenth as compared to open approach under a operating microscope, and an added advantage.展开更多
Introduction:Majority of petrous bone and lateral skull base pathologies are benign in nature.The complex anatomy usually warrants an extensive approach with associated morbidity.Case summary:Two cases of petrous bone...Introduction:Majority of petrous bone and lateral skull base pathologies are benign in nature.The complex anatomy usually warrants an extensive approach with associated morbidity.Case summary:Two cases of petrous bone cholesteatoma(1 congenital cholesteatoma with facial palsy and 1 acquired cholesteatoma)and a case of glomus tympanicum were treated with exclusive endoscopic transcanal approach.The cases of petrous cholesteatoma were addressed with trans-promontorial and infra-cochlear approaches.The mean operative time was approximately 140 min.No CSF otorrhoea was noticed in the post-operative period.The average period of hospital stay was 3.7 days.Conclusion:In the subset of cases with limited benign disease an endoscopic trans-canal approach is a better alternative to an external approach.It decreases operative time,blood loss,chance of meningitis,morbidity and hospital stay.The lack of depth perception is a major hurdle which can be come over by experience in endoscopic middle ear surgery.This approach can create direct access to cochlea/petrous apex/internal auditory canal(IAC)/Supra-geniculate ganglion region.展开更多
Glomus tumors are extremely rare tumors that arise from paraganglionic cells, which are derived from neural crest cells. These tumors are benign, slow-growing, locally invasive, and destructive. Glomus tumors are the ...Glomus tumors are extremely rare tumors that arise from paraganglionic cells, which are derived from neural crest cells. These tumors are benign, slow-growing, locally invasive, and destructive. Glomus tumors are the most common tumor of the middle ear cavity and the second most common tumor of the temporal bone. We present a case of a 49-year-old healthy female who, following diagnostic tools, received surgical intervention resulting in an excellent outcome. Our case report includes a comprehensive analysis of published cases in the literature.展开更多
Objective:To evaluate an endoscopic approach in the management of glomus tumor,and also to investigate and evaluate its appropriateness and feasibility.Methods:Glomus tumors,also known as paragangliomas,are benign pri...Objective:To evaluate an endoscopic approach in the management of glomus tumor,and also to investigate and evaluate its appropriateness and feasibility.Methods:Glomus tumors,also known as paragangliomas,are benign primary tumors of the middle ear.The advent of endoscopic ear surgery has provided new dimensions to the management of this highly vascular tumor.Retrospective analysis of six patients of glomus tympanicum,operated between July 2014 and June 2019,with modified Fisch classification Type A and B1,who were managed by a retroauricular transcanal endoscopic approach.Preoperative and postoperative analysis was done for these patients.Results:The chief complaint was pulsatile tinnitus,which disappeared in five cases and reduced in severity in one of them.Hearing was improved with reduction in air‐bone gap in all the cases.No major complications or recurrence were observed in any of the patients after 12 months of follow‐up.Conclusion:This endoscopic approach serves as a safe and reliable technique for tumor removal.It thus provides postoperative comfort for most of the patients.展开更多
Objective:To evaluate the necessity and effectiveness of a preplanned technique for drilling during transcanal endoscopic ear surgery.Methods:Study design:Retrospective case series study from June 2011 to June 2015.Se...Objective:To evaluate the necessity and effectiveness of a preplanned technique for drilling during transcanal endoscopic ear surgery.Methods:Study design:Retrospective case series study from June 2011 to June 2015.Setting:Private tertiary care hospital.Patients:Eighty-five ears of 78 patients,age ranging from 9 to 57 years underwent transcanal endoscopic drilling for various types of pathology in their middle and external ear.Interventions:Application of a preplanned technique for transcanal drilling in endoscopic ear surgery that involved short timed drilling with use of intermittent irrigation and suction.Every events of the procedure were done one after another with the single hand of the surgeon.An attachment providing protecting sheath around rotating burr was used during each time of drilling.Main outcomes measure:Efficacy of such drilling technique in single handed endoscopic ear surgery.Presence of any postoperative thermal injury of facial nerve and any lacerated injury of skin of external ear.Results:This preplanned technique was found suitable for transcanal endoscopic drilling with the single hand of the surgeon.Postoperative facial nerve palsy or laceration of skin of external ear was not noted in any patient.Conclusion:After using the present technique,transcanal endoscopic drilling could be done easily and safely with single hand of the surgeon.展开更多
Objective: The management of traumatic facial nerve paralysis(FNP) has remained a controversial issue with conflicting findings arguing between surgical decompression and conservative management.However, recent advanc...Objective: The management of traumatic facial nerve paralysis(FNP) has remained a controversial issue with conflicting findings arguing between surgical decompression and conservative management.However, recent advances in endoscopic surgery may consolidate the management plan for this condition.Methods: This prospective clinical study included patients with posttraumatic FNP at a tertiary referral center. Patients were categorized in two main groups: surgical and conservative. Indications for surgery included patients with immediate and complete FNP, no improvement in facial function on medical treatment, with electroneurography showing >90% degeneration or electromyography showing fibrillation potential. Patients who did not satisfy this criterion received the conservative approach. The transcanal endoscopic approach(TEA) or endoscopic assisted transmastoid approach was performed for facial nerve decompression in the surgical group.Outcome: The main outcome was facial function improvement, assessed using the House Brackmann grading scale(HBGS) 6 months after surgery, and hearing state assessed using the air bone gap(ABG).Results: The study included 38 patients, of whom 15 underwent had surgical decompression and 23underwent conservative therapy. A significant improvement in facial nerve function from a mean of4.66 ± 0.97 to 1.71 ± 0.69(P = 0.001) and ABG from a median of 30(10-40) to 20(10-25)(P = 0.002)was observed.Conclusion: Decision-making in cases of traumatic FNP is critical. The geniculate ganglion and tympanic segment were the most commonly affected areas in FNP cases. The TEA represents the most direct and least invasive approach for this area.展开更多
Objective:Endoscope has been used as diagnostic tool for recidivism and as an adjunct to microscopic technique in the management of cholesteatoma.At present transcanal endoscopic ear surgery(TEES)is being used as a mi...Objective:Endoscope has been used as diagnostic tool for recidivism and as an adjunct to microscopic technique in the management of cholesteatoma.At present transcanal endoscopic ear surgery(TEES)is being used as a minimally invasive alternative for microscopic approach.We aim to evaluate the feasibility,structural,functional and quality of life outcomes of endoscopic technique in middle ear cholesteatoma.Method:This prospective study was conducted at a tertiary care hospital from January 2017 to January 2018 including 32 adult patients who were treated by TEES for middle ear cholesteatoma.Feasibility of endoscopic technique was assessed by the conversion rates,visualization of middle ear structures and complications.Structural outcomes were evaluated in terms of graft uptake at the third month follow-up and presence of residual or recurrent disease.Functional outcomes were evaluated in terms of postoperative air-bone gap closure at third month follow-up.Patient outcomes in terms of post-operative pain,cosmetic score,day of return to daily activities and patient comfort scores were evaluated.The quality of life outcomes were evaluated using chronic ear survey(CES)and short form questionnaire12 version 2(SF-12V2)which are disease specific and general quality of life assessment tools respectively.Result:Out of 32 patients,endoscopic intact canal wall mastoidectomy was done for 28 and endoscopic canal wall down mastoidectomy in 4 patients.One(3.1%)patient had to be converted to microscopic technique.Median follow-up period was 32.8 months(9e46 months).There were no post-operative complications in any of our patients.The mean middle ear structural visibility index score was 8.4±1.4 with the use of zero-degree endoscope.Graft uptake rate at third month follow-up was 100%.Two(6.3%)patients had recurrent disease at 6 months follow-up and were treated by revision endoscopic surgery.The air conduction(51.3±20.2 dB vs.34.5±20.4 dB,p<0.001),and air-bone gap(33.5±11.1 dB vs.16.9±11.8 dB,p<0.001)has been significantly improved.The mean pain score at 0 hours,6 hours and 24 hours after surgery were 2.5/10,1.6/10 and 0.75/10 respectively.At the discharge,the mean patient comfort score was 9.3±0.6 out of 10.Mean cosmetic score was 9.3±0.5 at the third month follow-up.There was significant post-operative improvement in the sub-scale and total scores of CES and SF-12V2.Conclusion:Endoscopic approach to middle ear cholesteatoma is feasible and confers excellent structural,functional as well as patient related quality of life outcomes.展开更多
There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade.In this review paper,we discuss the current trends ...There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade.In this review paper,we discuss the current trends and applications of the endoscope in the field of otology and neurotology.Advantages of the endoscope include excellent ergonomics,compatibility with pediatric anatomy,and improved access to the middle ear through the external auditory canal.Transcanal endoscopic ear surgery has demonstrated comparable outcomes in the management of cholesteatoma,tympanic membrane perforations,and otosclerosis as compared to microscopic approaches,while utilizing less invasive surgical corridors and reducing the need for postauricular incisions.When a postauricular approach is required,the endoscopic-assisted transmastoid approach can avoid a canal wall down mastoidectomy in cases of cholesteatoma.The endoscope also has utility in treatment of superior canal dehiscence and various skull base lesions including glomus tumors,meningiomas,and vestibular schwannomas.Outside of the operating room,the endoscope can be used during examination of the outer and middle ear and for debridement of complex mastoid cavities.For these reasons,the endoscope is currently poised to transform the field of otology and neurotology.展开更多
文摘Endolymphatic sac tumors(ELSTs) are rare, papillary adenomatous tumors that arise from the endothelium of the endolymphatic sac. We demonstrate a difficult case of endolymphatic sac tumor and how it is managed via transcanal endoscopic assisted technique, with discussion of feasibility of transcanal approach to lateral skull base tumor.
文摘Objective: Multiple alternative approaches of cochlear implant surgery have been described, such as the suprameatal approach, transcanal approach, transmeatal approach and middle cranial fossa approach.Transmeatal(open trnascanal) approach has not been adapted since first described in the clinical field.we aimed to assess the long-term complications of the transmeatal approach in a series of 131 patients at our center between 2004 and 2008.Methods: This study was a retrospective case series of all patients who underwent cochlear implants with the transmeatal(open transcanal) approach from May 2004 to December 2008 at King Faisal Specialist and Research Hospital(Riyadh, Saudi Arabia), which were conducted by the same surgeon.Results: Complications were observed often with various combinations-recurrent otitis externa, posterior tympanic membrane perforation, electrode extrusion, cholesteatoma, and chronic mastoiditis. The overall long-term complication rate was 16%(21/131). The gap between the implantation and the diagnosis of a complication ranged from <1 year to 11 years. Major complications were as follows:cholesteatoma in 5(3.8%) patients, extrusion of the electrode in 5(3.8%) patients, and tympanic membrane perforation or deep retractions in 5(3.8%) patients. Minor complications were as follows: recurrent mastoiditis with/without concomitant temporary facial nerve palsy in 4(3%) patients, recurrent otitis externa infections in 7(5%) patients, and weakness of the posterior canal wall in 1 patient.Conclusion: The transmeatal approach posed an high rate of complications on long-term follow-up such as cholestetoma formation, extrusion of electrode or perielectrode reaction formation to tympanic membrane and external auditory canal.
文摘Objective: To investigate the feasibility of transcanal endoscopic myringoplasty in the hand of young beginner surgeons who had just completed the residency programme.Methods: In a three year period(August 2012 to August 2015), 44 ears in 42 patients were operated upon by a beginner surgeon through the transcanal endoscopic approach in a subdistrict level hospital located in the north western ranges of the Himalayan region.Results: Of the 42 patient, 19 were male and 23 female. The mean age was 26.23 years(range: 15 e47 years). In 40 ears, complete perforation closure was achieved at six months(success rate: 90.9%). The mean air conduction PTA preoperatively was 40.84 dB HL and improved to 28.06 dB HL postoperatively(p <.001). The mean AB gap preoperatively was 22.40 dB, which improved to 9.1 dB postoperatively(p <.001).Conclusion: Endoscopic transcanal myringoplasty is safe and reliable even in young beginners' hands.Surgeons can consider endoscopic approach early in their careers without the fear of learning curve. The cost of endoscopic equipment is about one tenth as compared to open approach under a operating microscope, and an added advantage.
文摘Introduction:Majority of petrous bone and lateral skull base pathologies are benign in nature.The complex anatomy usually warrants an extensive approach with associated morbidity.Case summary:Two cases of petrous bone cholesteatoma(1 congenital cholesteatoma with facial palsy and 1 acquired cholesteatoma)and a case of glomus tympanicum were treated with exclusive endoscopic transcanal approach.The cases of petrous cholesteatoma were addressed with trans-promontorial and infra-cochlear approaches.The mean operative time was approximately 140 min.No CSF otorrhoea was noticed in the post-operative period.The average period of hospital stay was 3.7 days.Conclusion:In the subset of cases with limited benign disease an endoscopic trans-canal approach is a better alternative to an external approach.It decreases operative time,blood loss,chance of meningitis,morbidity and hospital stay.The lack of depth perception is a major hurdle which can be come over by experience in endoscopic middle ear surgery.This approach can create direct access to cochlea/petrous apex/internal auditory canal(IAC)/Supra-geniculate ganglion region.
文摘Glomus tumors are extremely rare tumors that arise from paraganglionic cells, which are derived from neural crest cells. These tumors are benign, slow-growing, locally invasive, and destructive. Glomus tumors are the most common tumor of the middle ear cavity and the second most common tumor of the temporal bone. We present a case of a 49-year-old healthy female who, following diagnostic tools, received surgical intervention resulting in an excellent outcome. Our case report includes a comprehensive analysis of published cases in the literature.
文摘Objective:To evaluate an endoscopic approach in the management of glomus tumor,and also to investigate and evaluate its appropriateness and feasibility.Methods:Glomus tumors,also known as paragangliomas,are benign primary tumors of the middle ear.The advent of endoscopic ear surgery has provided new dimensions to the management of this highly vascular tumor.Retrospective analysis of six patients of glomus tympanicum,operated between July 2014 and June 2019,with modified Fisch classification Type A and B1,who were managed by a retroauricular transcanal endoscopic approach.Preoperative and postoperative analysis was done for these patients.Results:The chief complaint was pulsatile tinnitus,which disappeared in five cases and reduced in severity in one of them.Hearing was improved with reduction in air‐bone gap in all the cases.No major complications or recurrence were observed in any of the patients after 12 months of follow‐up.Conclusion:This endoscopic approach serves as a safe and reliable technique for tumor removal.It thus provides postoperative comfort for most of the patients.
文摘Objective:To evaluate the necessity and effectiveness of a preplanned technique for drilling during transcanal endoscopic ear surgery.Methods:Study design:Retrospective case series study from June 2011 to June 2015.Setting:Private tertiary care hospital.Patients:Eighty-five ears of 78 patients,age ranging from 9 to 57 years underwent transcanal endoscopic drilling for various types of pathology in their middle and external ear.Interventions:Application of a preplanned technique for transcanal drilling in endoscopic ear surgery that involved short timed drilling with use of intermittent irrigation and suction.Every events of the procedure were done one after another with the single hand of the surgeon.An attachment providing protecting sheath around rotating burr was used during each time of drilling.Main outcomes measure:Efficacy of such drilling technique in single handed endoscopic ear surgery.Presence of any postoperative thermal injury of facial nerve and any lacerated injury of skin of external ear.Results:This preplanned technique was found suitable for transcanal endoscopic drilling with the single hand of the surgeon.Postoperative facial nerve palsy or laceration of skin of external ear was not noted in any patient.Conclusion:After using the present technique,transcanal endoscopic drilling could be done easily and safely with single hand of the surgeon.
文摘Objective: The management of traumatic facial nerve paralysis(FNP) has remained a controversial issue with conflicting findings arguing between surgical decompression and conservative management.However, recent advances in endoscopic surgery may consolidate the management plan for this condition.Methods: This prospective clinical study included patients with posttraumatic FNP at a tertiary referral center. Patients were categorized in two main groups: surgical and conservative. Indications for surgery included patients with immediate and complete FNP, no improvement in facial function on medical treatment, with electroneurography showing >90% degeneration or electromyography showing fibrillation potential. Patients who did not satisfy this criterion received the conservative approach. The transcanal endoscopic approach(TEA) or endoscopic assisted transmastoid approach was performed for facial nerve decompression in the surgical group.Outcome: The main outcome was facial function improvement, assessed using the House Brackmann grading scale(HBGS) 6 months after surgery, and hearing state assessed using the air bone gap(ABG).Results: The study included 38 patients, of whom 15 underwent had surgical decompression and 23underwent conservative therapy. A significant improvement in facial nerve function from a mean of4.66 ± 0.97 to 1.71 ± 0.69(P = 0.001) and ABG from a median of 30(10-40) to 20(10-25)(P = 0.002)was observed.Conclusion: Decision-making in cases of traumatic FNP is critical. The geniculate ganglion and tympanic segment were the most commonly affected areas in FNP cases. The TEA represents the most direct and least invasive approach for this area.
文摘Objective:Endoscope has been used as diagnostic tool for recidivism and as an adjunct to microscopic technique in the management of cholesteatoma.At present transcanal endoscopic ear surgery(TEES)is being used as a minimally invasive alternative for microscopic approach.We aim to evaluate the feasibility,structural,functional and quality of life outcomes of endoscopic technique in middle ear cholesteatoma.Method:This prospective study was conducted at a tertiary care hospital from January 2017 to January 2018 including 32 adult patients who were treated by TEES for middle ear cholesteatoma.Feasibility of endoscopic technique was assessed by the conversion rates,visualization of middle ear structures and complications.Structural outcomes were evaluated in terms of graft uptake at the third month follow-up and presence of residual or recurrent disease.Functional outcomes were evaluated in terms of postoperative air-bone gap closure at third month follow-up.Patient outcomes in terms of post-operative pain,cosmetic score,day of return to daily activities and patient comfort scores were evaluated.The quality of life outcomes were evaluated using chronic ear survey(CES)and short form questionnaire12 version 2(SF-12V2)which are disease specific and general quality of life assessment tools respectively.Result:Out of 32 patients,endoscopic intact canal wall mastoidectomy was done for 28 and endoscopic canal wall down mastoidectomy in 4 patients.One(3.1%)patient had to be converted to microscopic technique.Median follow-up period was 32.8 months(9e46 months).There were no post-operative complications in any of our patients.The mean middle ear structural visibility index score was 8.4±1.4 with the use of zero-degree endoscope.Graft uptake rate at third month follow-up was 100%.Two(6.3%)patients had recurrent disease at 6 months follow-up and were treated by revision endoscopic surgery.The air conduction(51.3±20.2 dB vs.34.5±20.4 dB,p<0.001),and air-bone gap(33.5±11.1 dB vs.16.9±11.8 dB,p<0.001)has been significantly improved.The mean pain score at 0 hours,6 hours and 24 hours after surgery were 2.5/10,1.6/10 and 0.75/10 respectively.At the discharge,the mean patient comfort score was 9.3±0.6 out of 10.Mean cosmetic score was 9.3±0.5 at the third month follow-up.There was significant post-operative improvement in the sub-scale and total scores of CES and SF-12V2.Conclusion:Endoscopic approach to middle ear cholesteatoma is feasible and confers excellent structural,functional as well as patient related quality of life outcomes.
文摘There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade.In this review paper,we discuss the current trends and applications of the endoscope in the field of otology and neurotology.Advantages of the endoscope include excellent ergonomics,compatibility with pediatric anatomy,and improved access to the middle ear through the external auditory canal.Transcanal endoscopic ear surgery has demonstrated comparable outcomes in the management of cholesteatoma,tympanic membrane perforations,and otosclerosis as compared to microscopic approaches,while utilizing less invasive surgical corridors and reducing the need for postauricular incisions.When a postauricular approach is required,the endoscopic-assisted transmastoid approach can avoid a canal wall down mastoidectomy in cases of cholesteatoma.The endoscope also has utility in treatment of superior canal dehiscence and various skull base lesions including glomus tumors,meningiomas,and vestibular schwannomas.Outside of the operating room,the endoscope can be used during examination of the outer and middle ear and for debridement of complex mastoid cavities.For these reasons,the endoscope is currently poised to transform the field of otology and neurotology.
