Cochlear implantation in patients with chronic otitis: indications for subtotal petrosectomy and obliteration of the middle ear

Normally, active chronic suppurative otitis media is regarded as a contraindication for cochlear implantation. In case of a radical cavity after surgical treatment for cholesteatoma, the electrode covered by the epithelial lining of the mastoid will likely become exposed or extruded. Under these circumstances we suggest the subtotal petrosectomy, obliteration of the middle ear cleft with abdominal fat, and the blindsac closure of the external ear canal before cochlear implantation.Fourteen patients with chronic otitis media were successfully implanted with an intracochlear multichannel cochlear implant. After an average follow-up of 28 months a temporary facial palsy in one patient and an insufficient closure of a retroauricular fistula over the mastoid cavity in two cases were observed as postoperative complications. One patient with a tumefactive inflammatory pseudotumor developed a massive inflammation in the implanted ear 2 months after surgery which could not be controlled by conservative treatment. The implant had to be removed and after administration of cyclophosphamide she could be successfully reimplanted 7 months later.Implantation of a foreign body in a potentially infected space which communicates with the endocranium means a surgical challenge which can be managed by obliteration of the middle ear. In case of massive inflammation we prefer a two-stage procedure.

Fibroinflammatory pseudotumor of the temporal bone

Chronic inflammatory tumor-like lesions of the temporal bone represent a difficult clinical task for the skull base surgeon. Their osteolytic aggressiveness endangers vital structures and may not be controlled by surgery alone. We present the course of four cases of fibroinflammatory pseudotumor of the temporal bone which were treated by a combined approach of skull base surgery and chemotherapy. Three patients were deafened by the disease and underwent several operafive measures. One patient was lost, most likely due to an arrosive bleeding of the internal carotid artery. The chronic and recurrent process could only be stopped by petrosectomy, followed by antiproliferative chemotherapy. Two patients were subsequently provided with a cochlear implant. The differential diagnosis, diagnostic, and operative options of this rare but severe disease are discussed.

Minocycline-induced hyperpigmentation: treatment with the Q-switched Nd:YAG laser

BACKGROUND AND OBJECTIVE

Cutaneous hyperpigmentations are well-documented, but nevertheless rare side-effects of high-dose or long-term minocycline therapy. The pigmental changes, may last for years, even though therapy has been abrogated. To date, no safe and effective therapy has been described to target this cosmetically disturbing sequela.

STUDY DESIGN/MATERIALS AND METHODS

A 57-year-old female patient with extensive pigmental changes of the face due to long-term minocycline therapy was treated in eight consecutive sessions with the Q-switched Nd:YAG-laser (1,064-nm wavelength, 5- to 7-nsec impulse length).

RESULTS

A 90% resolution of the pigmentation could be achieved after five treatments. After the last session the lesions were completely gone; no hypopigmentation scars, or other side-effects were observed.

CONCLUSION

Treatment with the Q-switched Nd:YAG laser seems to be an effective, safe, and easily applicable strategy for the therapy of minocycline-induced hyperpigmentations.

Treatment of a nonresponding port-wine stain with a new pulsed light source (PhotoDerm VL)

BACKGROUND AND OBJECTIVE

The pulsed dye laser is effective and safe in the treatment of port-wine stains. It is the laser of choice for port-wine stains and initial superficial hemangiomas in children. For the treatment of darker port-wine stains in adults that have not responded to pulsed dye laser treatment, excellent results can be achieved using the PhotoDerm VL, a new technology based upon the emission of wide band, noncoherent intense pulsed light.

STUDY DESIGN/PATIENT AND METHODS

Our report presents a patient with a facial port-wine stain that hardly responded to previous pulsed dye laser therapy. After the first ineffective treatment trial, the patient refused further dye laser applications. An intense pulsed light source (Photoderm VL) was applied instead.

RESULTS

The lesion responded well after the first treatment session and was completely resolved after four treatments with the PhotoDerm VL.

CONCLUSIONS

The new intense pulsed light source Photoderm VL seems to be a promising treatment alternative for the therapy of otherwise nonresponding port-wine stains due to its special technical features.

Treatment of sebaceous gland hyperplasia with the pulsed dye laser

BACKGROUND AND OBJECTIVE

Sebaceous gland hyperplasia may be treated by cryotherapy, cauterization, topical chemicals, or excision. The major disadvantage of these therapeutic strategies is a considerable risk of postoperative scarring or dyspigmentation. The pulsed dye laser may be an effective and safe alternative treatment option.

STUDY DESIGN AND METHODS

Our report presents two patients with sebaceous gland hyperplasia who were treated with the pulsed dye-laser (585 nm, 6.5-8 J/cm2, 300-450/microsecond).

RESULTS

After 2-3 treatment sessions, the lesions were completely gone. To data, no side effects have been observed.

CONCLUSIONS

Based upon our experiences, we recommend the pulsed dye laser as a safe, fast, and minimal straining treatment alternative for hyperplasia of sebaceous glands.

Expression pattern of the plasminogen activator-plasmin system in human cholesteatoma

The plasminogen activator-plasmin system plays a pivotal role in the delicately regulated process of extracellular matrix remodeling. Recent studies have shown that an imbalance of proteolytic enzymes over specific inhibitors in this system may lead to an aggressive, expanding, and infiltrating cellular phenotype. As cholesteatoma resembles a tumor in many ways, we investigated the pattern of expression for members of the plasminogen activator-plasmin system in 12 human cholesteatomas, using immunohistochemistry. As controls, 3 tympanic membranes and 4 ear canal skin specimens were used. In contrast to the tympanic membranes, all cholesteatoma specimens showed a strong expression of plasminogen at the basal epithelial cell layers. In ear canal skin, only the basal surface of the most basal epithelia stained discretely positive. The urokinase-type plasminogen activator (uPA) could be detected in the basal stratum of the cholesteatoma matrix and in the surrounding granulation tissue, while tissue-type plasminogen activator (tPA) was not detectable at all. Plasminogen activator inhibitor-1 (PAI-1) was expressed in both the granulation tissue and the granular cell layer of the matrix, but not in the basal epithelial cells; PAI-2 showed a pericellular expression pattern in the subbasal and granular cell layers. Neither uPA, tPA, nor the PAIs could be detected in tympanic membrane controls; ear canal skin showed the same staining pattern as cholesteatoma only for PAI-2. Our data demonstrate that there is a clear imbalance in favor of proteolytic activity in the basal epithelial layers of the cholesteatoma matrix, which might at least partly account for the aggressive behavior of this tumorlike lesion. Further, the pattern of expression resembles the pattern described for several epithelial malignancies.

Q-switched ruby laser treatment of tattoos and benign pigmented skin lesions: a critical review

The Q-switched ruby laser (694 nm, 25-40 nsec) is an effective and safe therapeutic device for the treatment of tattoos and well-defined, benign, pigmented epidermal and dermal lesions. Because of its selective mode of action, dermal pigments of natural and artificial origin are destroyed photothermically and removed without scar. This method is exceptionally suited for the elimination of lay and professional tattoos, traumatic tattoos, and permanent makeup. Other frequent indications include benign pigmented lesions such as lentigines, freckles, café-au-lait spots, seborrheic keratosis, and Becker nevi. As a dermal pigmented lesion, the nevus of Ota is perfectly treatable. However, chloasma can no longer be considered an indication for ruby laser treatment due to unsatisfactory results. Melanocytic nevi and congenital nevi should be treated only in clinical studies. The effectiveness of the long-term epilation of dark hair with this laser device has to be verified in future investigations. Particularly attractive is the nonproblematic and straightforward removal of pigmented lesions in precarious anatomic regions like the lips, eyelids, and genitals (e.g., benign melanosis of the lips or of the penis, seborrheic keratosis of the lid angle).

Treatment of essential telangiectasias with an intense pulsed light source (PhotoDerm VL)

BACKGROUND

The flashlamp-pumped pulsed dye laser (585 and 577 nm) has proven to be a very effective and safe treatment option in the therapy of essential telangiectasias (ETE). Nevertheless, the postoperative intracutaneous hematomata, which most patients see as cosmetically disfiguring, always has been a matter of concern.

OBJECTIVE

To test the efficacy and safety of a new, large spot size, intense pulsed light source, the PhotoDerm VL, which omits noncoherent light adjustable within the 515-1200-nm range, in the treatment of ETE.

METHODS

Fourteen patients were treated with the PhotoDerm VL. They suffered from ETE of the face, postoperative teleangiectasis of the nose, ETE of both legs, and poikiloderma of Civatte.

RESULTS

All treated lesions could be abrogated with excellent results by this new device. There were no unpleasant side effects of the treatment. Additionally, due to the large spot size (2.8 cm2), a larger area could be treated within one session. No anesthesia was required.

CONCLUSION

The PhotoDerm VL is an innovative, highly effective, and comparably safe therapeutic alternative to the laser in the treatment of ETE. The rate of cosmetically relevant side effects is considerably smaller, the patient compliance is excellent, and the method can be applied easily in an outpatient setting.

Effective treatment of hypertrichosis with pulsed light: a report of two cases

Hypertrichosis is an often stigmatizing cosmetic problem not only for women but also for male-to-female transsexual patients. The hitherto described therapeutic measures include chemical epilation, razoring, camouflage, electrolysis and thermolysis, and waxing. All of these measures are transient, more or less painful, and may lead to severe side effects (e.g., inflammatory responses and scarring). We report the successful treatment of the perioral and mandibular area of two transsexual patients (male to female), who we treated with a recently introduced intense, pulsed light source--the PhotoDerm VL. Two days after the nearly painless treatment, hair could be epilated easily with forceps. Biopsies of the treated area show an atrophy of the follicles, which can be contributed either to direct thermal injury or to an indirect photothermolytical effect. Six months after the last treatment, there is no local recurrence and no side effects.

[Facial wrinkles--ultrapulsed CO2 laser: alternative or supplement to surgical face lift?]

BACKGROUND

For many years, the treatment of facial wrinkles has been performed exclusively by dermabrasion, chemical peeling, or surgical face lifting. However, the recently introduced carbon dioxide lasers which emit ultrashort coherent light beams enable the cosmetic surgeon to ablate superficial epidemic layers with absent or very limited side effects. The purpose of this paper is to compare laser skin resurfacing with classical face lifting and discuss the potentials and limitations of each method.

METHODS AND PATIENTS

Three patients suffering from facial wrinkles on photoaged skin were treated with the ultrapulsed CO2 laser (UltraPulse 5000 C; wavelength 10,600 nm, pulse duration 0.6 to 0.9 ms, maximum pulse energy 500 mJ). This laser guarantees vaporization of very thin superficial skin layers without scarring and with minimizing lateral thermal injury due to extreme short pulse duration. A special handpiece (CPG) permits an exact approach and a bloodless ablation of relatively large areas of facial skin. The fourth patient underwent a surgical face lift due to the depth of wrinkles.

RESULTS

Excellent cosmetic results were achieved in all three patients with superficial wrinkles who were treated by laser skin resurfacing. When treating deeper wrinkles, e.g., glabella or nasolabial fold, the surgical face lift is the preferred method.

CONCLUSION

Ultrapulsed CO2 laser treatment expands the therapeutic options for superficial facial wrinkles, especially for perioral, periorbital, forehead, and cheeks wrinkles. It proves to be a safe and effective method with very limited if any side effects. Nevertheless, deeper wrinkles are still a domain of the classical face lift. The combination of both methods may improve the overall outcome in the future.

Treatment of xanthelasma palpebrarum with the pulsed dye laser

BACKGROUND OF OBJECTIVE: Treatment of xanthelasma palpebrarum may prove difficult due to its delicate location at the periorbita and its sometimes extensive dimension. During recent years, carbon dioxide and argon lasers have been used with good results. However, local anesthesia is always required, and there is a concrete risk of scarring and pigmentation changes after the treatment.

STUDY DESIGN/PATIENTS AND METHODS

In this case report, we describe for the first time the treatment of xanthelasmas with the pulsed dye laser.

RESULTS

This technique can be carried out without anesthesia and shows excellent cosmetic results.

CONCLUSION

We see the pulsed dye laser as a good alternative to the hitherto used other two laser types in the treatment of xanthelasma palpebrarum.