Haitham Odat

The role of preoperative CT scan in patients with chronic otitis media

Chronic otitis media may be due to chronic mucosal disease or cholesteatoma. Differentiating the two is usually achieved by clinical examination. The computed tomography (CT) scan is the standard imaging technique for the temporal bone, but its exact role in the preoperative assessment of patients with chronic otitis media is controversial. In this retrospective study we compared preoperative CT results with operative findings in 50 patients who had scan between January 2003 and December 2007. We analyzed the clinical presentation and checked if CT scan confirmed or excluded the presence of cholesteatoma and if this was affected by previous surgery. We concluded that CT scan could not be relied on to differentiate cholesteatoma from chronic mucosal disease. It should be used selectively in the preoperative preparation only if complications of the disease suspected.

Facial nerve management in jugular paraganglioma surgery: a literature review

OBJECTIVE This literature review analysed facial nerve management strategies in jugular paraganglioma surgery and discusses the tumour resection rate and the facial nerve outcome associated with each technique. METHODS A retrospective review of PubMed and Medline articles on the surgical treatments for jugular paraganglioma was performed. Tumour resection rates and post-operative facial nerve function after non-rerouting, short anterior rerouting and long anterior rerouting approaches were evaluated for each article. RESULTS A total of 15 studies involving a total of 688 patients were included. Post-operative facial nerve function was similar after non-rerouting and short anterior rerouting approaches (p = 0.169); however, both of these techniques had significantly better post-operative facial nerve outcomes compared with long anterior rerouting (p < 0.001 and p = 0.001, respectively). The total tumour removal rate was significantly higher for long anterior rerouting than with the non-rerouting approach (p = 0.016). There was no difference in total tumour removal rate between the long and short anterior rerouting approaches (p = 0.067) and between the short anterior rerouting and non-rerouting approaches (p = 0.867). CONCLUSION No strict guidelines for facial nerve management in jugular paraganglioma resection are available. Although long anterior rerouting provides the best tumour exposure along with a low morbidity rate, case-by-case selection of the surgical approach is recommended.

Effect of otitis media with effusion on cochlear implant surgery: technical difficulties, post-operative complications and outcome.

OBJECTIVE This study evaluated the complications and outcomes of cochlear implantation in patients who had otitis media with effusion at the time of surgery. METHODS A retrospective chart review study was performed of 87 consecutive paediatric patients (age range 22 months to 10 years, mean 4.8 years) who underwent successful cochlear implantation, with follow-up periods of 5-6 years. All patients had unilateral implants, with eight on the left side. All devices were activated two weeks after implantation. The effect of the middle-ear condition on the procedure, post-operative complications and outcome were evaluated. RESULTS Unilateral ears of 17 otitis media with effusion patients were implanted with some surgical difficulties but no long-term post-operative complications. CONCLUSION For children admitted for cochlear implantation who are subsequently found to have otitis media with effusion, surgeons should be aware of possible surgical difficulties. Greater intra-operative risks should be anticipated and more surgical time allowed for cochlear implantation in these patients.

Concha Bullosa and Ethmoid Structures Pneumatization: The Effect of Altitude and Other Variables

AbstractThe effect of altitude on the paranasal sinus pneumatization is not well understood. This study aims to evaluate the effect of altitude on the surface area and type of the concha bullosa (CB) as well as the number of aerated ethmoid structures, and to study the correlation between CB, age, gender, and Lund–Mackay score (LMS).Sixty-five randomly collected paranasal sinus computed tomography scans of adult patients with sinonasal symptoms who had CB were reviewed for the type and surface area of CB, ethmoid structures pnumatization including crista galli, nasal septum, superior turbinate, and uncinate process, as well as the LMS. The mean age of patients was 35 ± 9.64 years, with 29 females (41.7%) and 36 males (58.3%). The average LMS, altitude, and number of aerated ethmoid structures were 6 ± 4, 580 ± 325 m, and 4 ± 1.4, respectively.The average CB surface area in females was 163 mm2 compared to 109 mm2 in men; this difference was statistically significant. Furthermore, females had significantly higher prevalence of bulbous and extensive CB. There was no significant correlation between altitude and the presence of ethmoid structures pneumatization.We concluded that altitude is not an important factor in ethmoid structures aeration. Our results indicate that female patients have larger CB and number of pneumatized ethmoid structures than males. We found a significant correlation between the surface area of CB and the number of aerated ethmoid structures, which indicates possible common etiology.

Endoscopic monopolar cauterization of the sphenopalatine artery: a single surgeon's experience

BACKGROUND Epistaxis is one of the most common otolaryngology emergency conditions, and is usually treated conservatively by different types of nasal packs. A limited number of patients continue to bleed even with tightly fitted anterior and posterior packs in the nose. Such intractable epistaxis is managed by surgery or embolization. OBJECTIVES We reviewed the use and outcomes of endoscopic suction monopolar cauterization of the sphenopalatine artery. DESIGN Retrospective study. SETTING Tertiary academic center. PATIENTS AND METHODS Subjects who underwent consecutive monopolar sphenopalatine artery ligation for intractable epistaxis performed by a senior author from August 2010 to December 2014. MAIN OUTCOME MEASURE(S) Successful management of refractory epistaxis. RESULTS In 15 subjects (mean age 45 years; 10 men and 5 women) idiopathic epistaxis was the most common indication for surgery. Six patients had hypertension and three were on anticoagulation. One patient required bilateral cauterization and another had anterior ethmoid artery cauterization. The average operative time was 57 minutes. There was no major intra- or postoperative complications. Two patients underwent endoscopic sinus surgery to treat pathologies that were found during the procedure. All patients had healthy nasal and sinus mucosa during the follow-up period (average 17 months, range 1–70 months), and none suffered recurrent epistaxis. CONCLUSIONS Endoscopic monopolar cauterization of sphenopalatine artery is safe and effective for management of refractory epistaxis with minimal complications. It should be considered earlier in the algorithmic treatment of intractable epistaxis. LIMITATIONS Retrospective study, small number of patients, and no controls.

Facial Nerve Paralysis after Onyx Embolization of a Jugular Paraganglioma: A Case Report with a Long-Term Follow Up

Jugular paragangliomas are slow growing highly vascular tumors arising from jugular paraganglia. The gold standard of treatment is complete surgical resection. Pre-operative embolization of these highly vascular tumors is essential to reduce intra-operative bleeding, allow safe dissection, and decrease operative time and post-operative complications. Onyx (ethylene-vinyl alcohol copolymer) has been widely used as permanent occluding material for vascular tumors of skull base because of its unique physical properties. We present the case of a 33-year-old woman who had left-sided facial nerve paralysis after Onyx embolization of jugular paraganglioma. The tumor was resected on the next day of embolization. The patient was followed up for 30 months with serial imaging studies and facial nerve assessment. The facial verve function improved from House–Brackmann grade V to grade II at the last visit.