Transcanal Excision of Exostoses: Large Series Comparing Bone Removal Methods

OBJECTIVE

External auditory exostosis (EAE) is a condition of progressive temporal bone growth into the external auditory canal most commonly from repeat cold water and wind exposure. Several tools have been utilized for EAE excision with varying implications for intra- and postoperative complications. However, comparisons of osteotome and microdrill are made difficult due to the few published cases and intervariability between surgeons. Furthermore, evidence is needed to analyze the safety of novel supplemental tools such as the piezoelectric bone-cutting device.

STUDY DESIGN

Retrospective chart review.

SETTING

Medical clinic and surgery center.

METHODS

A total of 413 subjects representing 472 ears met the inclusion criteria. Of which 159 ears were operated on using osteotome alone (OA), 271 using osteotome with a drill (OD), and 42 with osteotome with piezoelectric (OP). Charts were analyzed for the most reported intraoperative complications and postoperative symptoms and complications.

RESULTS

There were no significant differences in the rate of tympanic membrane perforations nor in total intraoperative complications between OA, OD, or OP. The OD group contained the only nonperforation intraoperative event. OA had the lowest or near lowest incidence of all symptoms analyzed. OA showed a significantly lower incidence of tinnitus when compared to OD and OP.

CONCLUSION

We found that OA performed the best, though not statistically significant in most measures, with regard to mitigating rates of complications postsurgery. Our findings suggest OA provides lower risk intraoperatively and postoperatively for patients undergoing transcanal exostosis excision.

Modified transcanal cochlear implantation in CHARGE syndrome: A case report

RATIONALE

Cochlear implantation (CI) in CHARGE syndrome is technically challenging because of the anatomical anomalies. This case aims to report a successful case of CI in CHARGE syndrome by using the modified transcanal approach with external auditory canal (EAC) obliteration.

PATIENT CONCERNS

The 3-year-old girl presented at the outpatient department with bilateral hearing loss and nasal obstruction since birth.

DIAGNOSIS

The patient had bilateral profound sensorineural hearing loss, patent ductus arteriosus, atresia of the choanae, middle and inner ear anomalies, and growth retardation, fulfilling the criteria for typical CHARGE syndrome. High resolution temporal bone computed tomography scan revealed a poorly developed mastoid cavity, cochlear dysplasia, hypoplastic semicircular canals, ossicular chain malformation, and sigmoid sinus engorgement. Magnetic resonance imaging revealed a narrow internal auditory canal and a hypoplastic cochlear nerve.

INTERVENTIONS

Modified transcanal approach with external auditory canal obliteration OUTCOMES:: CI was successfully done and there are no intraoperative or postoperative complications occurred after 1 year of follow up.

LESSONS

The modified transcanal approach is a reasonable and safer option for CI in CHARGE syndrome.

Improvement of otoendoscopic surgery for epitympanic cholesteatoma invading the mastoid

BACKGROUND

In recent years, the otoendoscopic surgery for epitympanic cholesteatoma has achieved great development, but it still has some disadvantages.

OBJECTIVE

This work aims to improve otoendoscopic surgery for epitympanic cholesteatoma invading the mastoid to retain the normal structure of the middle ear as much as possible.

METHODS

We classified the patients according to the lesion scope and applied different strategies of using the combination of otoendoscope and microscope. The surgery was improved and the recurrence and residual of middle ear cholesteatoma after operation were observed preliminarily.

RESULTS

Forty-six patients with middle ear cholesteatoma accepted surgical treatment, including 10 cases of independent otoendoscopic surgery, 29 cases of otoendoscope-microscope combined surgery, and seven cases of microscopic surgery assisted with an otoendoscope. All cases were treated with canal-up cholesteatoma surgery. The postoperative recurrent rate was 4/46.

CONCLUSION

We improved existing otoendoscopic surgery to reduce or avoid bony defects of the acoustic meatus, and then decreased the proportion of canal-down surgery.

Endoscopic cochlear implantation: Call for caution

OBJECTIVES/HYPOTHESIS

To assess whether transcanal endoscopic access to the basal turn of the cochlea for cochlear implantation is appropriate.

STUDY DESIGN

Case series study.

METHODS

We reviewed 100 consecutive computed tomographic studies of the sinuses and temporal bone in our institution. We excluded studies that demonstrated evidence of congenital anomalies, chronic ear disease, or inadequate visualization of the cochlea. On axial sections, the angles of the basal turn of the cochlea and of the ear canal in reference to the sagittal plane were recorded as a function of age.

RESULTS

Eighty-four studies were included and 16 were excluded. There was significant variability in the relationship between the ear canal and the basal turn of the cochlea in reference to the sagittal plane. A clear majority of images demonstrated the basal turn of the cochlea to align with a more posterior angle than that of the ear canal.

CONCLUSION

The trajectory provided by posterior tympanotomy aligns more favorably with the basal turn of the cochlea than transcanal access. Endoscopic technique, primarily an ear canal intervention, may not be useful in cochlear implant surgery.

LEVEL OF EVIDENCE

4. Laryngoscope, 126:689-692, 2016.

Endoscopic transcanal corridors to the lateral skull base: Initial experiences

OBJECTIVES/HYPOTHESIS

Surgical approaches to the lateral skull base, internal auditory canal (IAC), and petrous bone are widely known and have been extensively recorded. Despite the benign nature and limited dimensions of lesions located in this anatomical region, extirpative surgical approaches are often required to reach and remove the disease. The aim of present report was to describe our initial experiences with minimally invasive endoscopic approaches to the lateral skull base.

STUDY DESIGN

Retrospective review of patients' charts and video recordings from surgery.

METHODS

Twelve patients were included in the study. Three main corridors to the lateral skull base were identified: the transcanal suprageniculate corridor, the transcanal transpromontorial corridor, and the transcanal infracochlear corridor. Landmarks, tips, and pitfalls of the approaches have been reviewed and highlighted.

RESULTS

These corridors provide a direct approach to pathology involving the fundus, IAC, cochlea, petrous apex and geniculate ganglion region, without any external incision. The pathology was successfully removed in most cases with no important postoperative complications and reasonable facial nerve outcomes.

CONCLUSIONS

The transcanal endoscopic approaches to the lateral skull base proved to be successful for pathology removal involving the fundus, IAC, cochlea, petrous apex, and geniculate ganglion region. Future widespread application of this kind of approach in lateral skull base surgery will depend on the development of technology, and surgical and anatomical refinements.

LEVEL OF EVIDENCE

4.