Juan José Navarro

Cirugía del implante osteointegrado: estudio prospectivo empleando incisión lineal sin reducción de tejido subcutáneo

INTRODUCTION AND OBJECTIVES The classic surgical procedure for percutaneous bone-anchored hearing devices involves removal of a large area of subcutaneous tissue down to the periosteum. This leads to alopecia and raises the risk of devascularization of the overlying skin with the potential for infection and scarring. The objective of this study was to determine the results of implant placement using a single, linear incision with no underlying soft tissue reduction. MATERIAL AND METHOD A prospective study was conducted in our hospital over a period of 14 months in all consecutive surgeries performed using this technique in adults. Patients were reviewed regularly (week 1, week 3, weeks 4-6 and months 3, 6 and 12) to assess wound healing including evaluation with the Holgers scale. RESULTS Corresponding to 34 patients, 34 cases were consecutively enrolled in this study. We found that 15% of the patients had minor skin reactions during the first visit (Holgers grade 1 or 2); this number raised to 20% in week 3, but at week 4 only 1 patient had a reaction score of 1 (which was solved by week 6). None of the cases required revision surgery and all skin reactions were treated topically. CONCLUSIONS Our results suggest that the tissue preservation technique is a simple and effective insertion technique with a favourable healing process and cosmesis.

Island cartilage myringoplasty. Anatomical and functional results in 122 cases

Abstract Introduction and objectives In certain situations (“high risk perforations”) such as large perforations, revision cases, middle ear pathology, eustachian tube dysfunction and atelectatic ears, the failure rate for myringoplasty is high. Some authors have suggested that the materials most frequently used for myringoplasty (fascia and perichondrium) may play a role in this failure rate. Cartilage myringoplasty, however, achieves good results in these “high risk” cases. The purpose of this study was to analyse our results and describe the technique. Methods A retrospective study of all consecutive patient charts for cartilage myringoplasties performed in a 5-year period (2002–2007) was carried out. Results During the study period, cartilage was used in 99 patients (122 cases). More than 66% of the cases were large perforations and 26% of the cases were revision cases. Successful closure was achieved in 92% of the cases and the functional results showed improvement in the air-bone gap average with statistical significance for type I tympanoplasty. Discussion The reconstruction of tympanic membrane perforations with cartilage is recommended in certain cases (“high risk” perforations). The results described here show that the anatomical and functional results are good and we consider the technique easy to learn. Conclusions We consider cartilage myringoplasty to be a technique that can be used in “high risk” perforations where a technique using fascia or perichondrium may have a higher risk of failure.

Utilidad de la petrosectomía subtotal en el tratamiento de la otitis media crónica

INTRODUCTION AND OBJECTIVES Subtotal petrosectomy is the complete exenteration of all air cell tracts of the temporal bone. The isthmus of the Eustachian tube is obliterated and the external auditory canal is closed. The aim of this study was to describe the use of this technique in the management of certain cases of chronic otitis media. MATERIAL AND METHODS We conducted a retrospective revision of the patients treated in our Institution with this technique for chronic otitis media in a 5-year period (2008-2012). All charts were reviewed and data from the otomicroscopy, audiometry, radiology, surgical findings, postoperative complications and follow-up (including diffusion magnetic resonance imaging, MRI) of a minimum of 24 months were collected. RESULTS In this period petrosectomy was performed on 28 patients for chronic otitis media. We treated 13 cases as primary cases, while 15 cases were secondary (patients that had already undergone another procedure in that ear). Fifteen cases had no serviceable hearing. Only 1 case had an immediate postoperative complication (infection); during the posterior follow-up, 2 cases had to be reoperated for diffusion restriction in the mastoid area revealed in the MRI 2 years after surgery. CONCLUSIONS A subtotal petrosectomy is rarely performed for the treatment of chronic otitis media. However, it is a technique that we have to keep in mind for the treatment of certain cases where there is recurrence and deep hearing loss, as well as in cases with good cochlear reserve if the disease coexists with other complications.

Abordaje por fosa media para el cierre de fístulas de líquido cefalorraquídeo espontáneas a oído medio

INTRODUCTION Spontaneous cerebrospinal fluid (CSF) leaks to the middle ear due to tegmen tympani defects can result in hearing loss or hypoacusis and predispose to meningitis as well as other neurological complications. Surgical repair of the defect can be performed through a middle cranial fossa (MCF) approach or a transmastoid approach. MATERIAL AND METHODS We conducted a retrospective study of the patients in our Department due to a spontaneous CSF leak to the middle ear treated using a MCF approach during a 6-year period (2009-2014). RESULTS Thirteen patients with spontaneous CSF leak to the middle ear were treated with this approach. The primary and first symptom in all of them was conductive hearing loss. In all cases, the defect or defects were closed in a multilayer manner using muscle, temporalis fascia and cortical bone. Minimum follow-up in this series was 14 months, with successful closure in all but one patient (who required reintervention). We found no intra- or postoperative complications due to the craniotomy, and the audiometry improved and normalised in all cases except for the failed case. CONCLUSIONS The MCF approach with a multilayer closure of the defect is an effective technique for repairing spontaneous CSF leaks to the middle ear and for restoring hearing in these patients.

Evaluación del cambio en el umbral de la vía ósea en pacientes operados de estapedectomía

INTRODUCTION AND OBJECTIVES Bone conduction threshold depression is not always a result of inner ear and cochlear nerve pathology. In fact, middle ear pathologies may be responsible for such threshold depression, as occurs in otosclerosis. The aims of this study were to evaluate the improvement of bone conduction threshold in patients with otosclerosis that underwent stapedectomy and to study the postoperative audiological results. MATERIAL AND METHODS This was a retrospective study on 95 patients (116 ears) diagnosed with otosclerosis having conductive or mixed hearing loss that received surgery (stapedectomy and complete removal of the footplate) consecutively. Audiometry was performed on all patients pre- and postoperatively (one month and one year after surgery). Bone and air conduction thresholds were measured at 4 frequencies (500, 1000, 2000 and 4000Hz). RESULTS The air-bone gap was closed, with a residual air-bone gap below 10dB in 92.2% of the patients and below 5dB in 79.3% of the cases. The air conduction threshold improved an average of 25dB. The patients that had an affected bone conduction threshold preoperatively improved bone conduction postoperatively at the frequencies of 1000 and 2000Hz (6 and 12dB, respectively). Consequently, the Carhart notch disappeared on the audiogram. These results were maintained at one year of follow up. CONCLUSIONS We found a significant improvement in the bone conduction threshold at the frequencies of 1000 and 2000Hz and a disappearance of the Carhart notch in the audiogram after stapedectomy and total footplate removal in patients diagnosed with otosclerosis having mixed hearing loss.