Emilia Karchier

Comparison of visualization of the middle ear by microscope and endoscopes of 30° and 45° through posterior tympanotomy

Introduction Endoscopic-assisted microsurgery of the middle ear enables the field of view of the surgeon to be expanded during the removal of inflammatory tissue from the tympanic cavity and during myringo- and ossiculoplasty. Canal wall up tympanoplasty with posterior tympanotomy is a gold standard in surgical treatment of chronic otitis media. Most applications of endoscopy in middle ear surgery concern exclusively the endoscopic transcanal approach. Aim To determine the usefulness of endoscopic visualization during the standard surgical approach through the posterior tympanotomy. Material and methods The study compared the visualization of the elements of the middle ear through the posterior tympanotomy by endoscopes with 30° and 45° optics and a microscope. Posterior tympanotomy was performed in eleven temporal bones. Visualization of the tympanic recesses was assessed on a subjective scale. A microscope and 30° and 45° endoscopes were used for inspection of the hypotympanum, sinus tympani, Eustachian tube, Prussaks space and footplate. Friedman ANOVA test and Dunns multiple comparisons test were used for statistical analysis of the data. Results Visualization of particular recesses by endoscopes, both 30° and 45°, was excellent, while the microscopic view was statistically significantly worse, especially for sinus tympani, Prussaks space and footplate. There were no significant differences in visibility of the middle ear spaces between the two types of endoscopic optics. Conclusions Additional application of the endoscopes during middle ear surgery provides valuable information due to excellent visualization of key recesses usually hidden from the microscope.

Intraoperative endoscopy of the anterior epitympanum recess through the posterior tympanotomy

Introduction The anterior epitympanum recess (AER) is a common place of the development of the cholesteatoma, which is why removal of the matrix from this area plays a key role in the surgical treatment of chronic otitis media. Aim To evaluate the intraoperative visibility of AER in endoscopic optics in comparison to microscopic optics and to determine the prevalence of cholesteatoma in various types of construction of the AER. Study design: retrospective analysis of intraoperative search. Material and methods The study included 55 patients treated in the Department of Otolaryngology, Medical University of Warsaw within the years 2009–2011, who underwent endoscopy-assisted canal wall up tympanoplasty with posterior tympanotomy. The type of construction of the AER – cellular or dome-shaped – was determined. Results Cellular type of recess was found intraoperatively in 32% of ears and dome-shaped in 68% of the study group. The population with chronic otitis media does not differ significantly compared to the general population in terms of the construction of the anterior epitympanum recess (p = 0.668108; χ2 = 0.1838235, df = 1). Among the ears with cholesteatoma a cellular AER was found in 48.3% of cases and a dome-shaped AER was found in 51.7%. Conclusions The cellular type of AER was significantly more frequent in ears with cholesteatoma (p < 0.01, χ2 = 29.86492, df = 1). Level of evidence: 1b.

Usunięcie guza nerwu przedsionkowego z jednoczesną implantacją ślimakową w obustronnej głuchocie – opis przypadku

Summary This is a case report of cochlear implantation after vestibular schwannoma removal. 75-years-old woman was admitted to Depatrment of Otolaryngology at Medical University of Warsaw with bilateral profound hearing loss which has lasted for 20 years. Since two years, patient complains of deterioration of hearing in the right ear. MRI scan showed vestibular schwannoma 8x3 mm inside the right internal auditory canal. After schwannoma removal using TL approach on the right side, cochlear implantation was performed simultaneously on the same side. Postoperative results showed that cochlear implantation after vestibular schwannoma removal could be an effective method of hearing restoration providing social effective communication.

Zastosowanie endoskopii w chirurgii ucha środkowego

Summary Endoscopy has been used in middle ear surgery for 20 years. Ear endoscopy assists usually the standard microscopical procedure, but more often constitutes an independent visualisation method. Many authors claim that endoscopy-assisted middle ear surgery may result in decrease in the index of cholesteatoma recurrence. With the aid of endoscopy may be performed many types of procedures, such as: stapes surgery, ossiculoplasty and second-look tympanoplasty. Exploration of the Eustachian tube and visualisation of the tympanic cavity from two endoscopes inserted transtympanaly and through the Eustachian tube are performed in scientific study, but may be developed as minimal invasive access in the future. Modern technology is able to obtain the three-dimensional endoscopical visualisation resulting in accurate estimation of deep and facilitation the spatial manipulations. Such solution are used in surgical robots. Endoscopical-assisted middle ear surgery may lead to improvement the results of treatment for chronic otitis media and constitutes the minimal invasive access to the tympanic cavity.

Raki ucha w materiale Kliniki Otolaryngologii Warszawskiego Uniwersytetu Medycznego w latach 2004–2008

Summary Ear carcinoma constitutes 0.5% of all cancers of the head and neck hardly, however with poor prognosis. In the study we use University of Pittsburgh Staging System. This study is retrospective analysis of the surgical treatment outcomes of the patients with external and middle ear carcinomas in the ENT Department at the Medical University of Warsaw in years from 2004 to 2008. Histopatologicallly, there were:18 squamous cell carcinoma, 17 basal cell carcinoma, 2 neuroendocrine carcinoma, basal cell adenocarcinoma and 1 metatypical carcinoma. Tumors were localised: ear concha in 19 patients, external auditory canal in 6 patients, middle ear in 3 patients, temporal bone and skull base in 9 patients. Among 19 tumors of the auricle, basal cell carcinoma occured the most often (12 patients – 63%), following squamous cell carcinoma (6 patients – 31%), in one case (6%) metatypical carcinoma was confirmed. There were 18 tumors of external auditory canal and tumors with temporal bone involvement in stage T1–T4. In this group 8 subtotal temporal bone resection were performed, however in 5 cases tumor was not totally excised. Additional radiotherapy was performed in 5 patients, 5 died of the disease, three had recurrence in the period of the study and 8 had confirmed metastasis into the breast, lung, cervical and mediastinal lymph nodes. Generally, in this group of patients, 6 died (33%) of the disease in the period from one month to 2 years after surgery. In 6 tumors with no evidence of bone involvement resection limited to the tumor was performed. In 2 tumors of external auditory canal the resection was totally and the patients have no recurrence (100%). Squamous cell carcinoma has poor prognosis, but early diagnosis gives the chance for long-term survival.

Całkowicie wszczepialny implant ucha środkowego – wskazania, technika chirurgiczna i wyniki pierwszej operacji

AIM The aim of this study is to present indications, surgical technique and first results of fully implantable middle ear implant (Otologics Carina), first time in Polish clinical practice. MATERIAL AND METHODS 24-years-old patient with bilateral moderate sensorineural hearing loss. The surgery with fully implantable middle ear implant was performed on November 11th, 2008 (implant device Otologics Carina). Two months after the surgery the patient was admitted to hospital for the first fitting. Audiological tests were performed before the surgery and after on every fitting visit (4 fitting visits so far). RESULTS Postoperative bone and air conduction thresholds confirmed no cochlear damage due to the surgery. Free field pure tone and speech audiometry proved better results in aided conditions compared to unaided. Further fitting sessions are planned in 6-8 weeks intervals in order to improve hearing thresholds along with anti-feedback adjustments. CONCLUSIONS Our results confirm that fully implantable middle ear implant is a viable treatment for adult patients with moderate sensorineural hearing loss. In selected cases it may become an alternative to conventional hearing aids.Summary Aim The aim of this study is to present indications, surgical technique and first results of fully implantable middle ear implant (Otologics Carina), first time in Polish clinical practice. Material and methods 24-years-old patient with bilateral moderate sensorineural hearing loss. The surgery with fully implantable middle ear implant was performed on November 11th, 2008 (implant device Otologics Carina). Two months after the surgery the patient was admitted to hospital for the first fitting. Audiological tests were performed before the surgery and after on every fitting visit (4 fitting visits so far). Results Postoperative bone and air conduction thresholds confirmed no cochlear damage due to the surgery. Free field pure tone and speech audiometry proved better results in aided conditions compared to unaided. Further fitting sessions are planned in 6–8 weeks intervals in order to improve hearing thresholds along with anti-feedback adjustments. Conclusions Our results confirm that fully implantable middle ear implant is a viable treatment for adult patients with moderate sensorineural hearing loss. In selected cases it may become an alternative to conventional hearing aids.