Neil A. Giddings

Glomus tympanicum tumors: a clinical perspective.

Since Guild first discovered glomus bodies in the middle ear, the diagnostic evaluation and therapy of glomus tympanicum tumors have remained challenging. This study describes 73 cases diagnosed as glomus tympanicum tumors over the past 30 years. During this period, imaging techniques have markedly improved, and surgical approaches have evolved and been refined. These 73 cases were reviewed from a clinical perspective involving presentation, diagnostic evaluation, and therapeutic management.

Transcanal infracochlear approach to the petrous apex

Computerized tomography and magnetic resonance imaging have now made it possible to reliably differentiate cholesteatoma from cholesterol granuloma of the petrous apex. The treatment for cholesteatoma is complete surgical excision when possible, whereas cholesterol granuloma needs only adequate drainage for control. A new transcanal infracochlear approach for drainage of cholesterol granuloma involving the anterior petrous apex is described. Absolute measurements from 10 cadaveric temporal bones were obtained to determine the distances between the cochlea, jugular bulb, carotid artery, and facial nerve. In all specimens the petrous apex was entered without invading the cochlea, carotid, or jugular bulb. Advantages of this technique include a more direct route to the petrous apex, dependent drainage, and preservation of the normal hearing mechanism, including the tympanic membrane. Clincial indications for this technique include failure of other treatment approaches and a high jugular bulb obstructing an infralabyrinthine approach. Experience to date shows that patients experience little difficulty from the procedure.

Tympanosclerosis of the Stapes: Hearing Results for Various Surgical Treatments

When tympanosclerosis involves the tympanic membrane or the lateral ossicles, treatment is usually straightforward and uncomplicated. When the stapes is involved, therapy Is more controversial and may be more difficult. We report our results in 154 patients who underwent different surgical procedures for tympanosclerosis of the stapes. Followup was up to 10 years. Pure-tone average threshold was significantly improved (P < 0.05) in patients who underwent mobilization procedures or stapedectomy for definitive treatment. The air-bone gap was less than 20 dB at 6 months postoperative in 72% of patients and less than 30 dB in 90%. At 6 months, 2 years, and 5 years there were no statistically significant differences in hearing results between stapedectomy and mobilization patients, some of whom were followed for up to 10 years. No patient had a profound hearing loss after surgery. Surgical treatment for tympanosclerosis of the stapes is a safe procedure, with hearing results similar to those of surgery for other chronic ear diseases involving the ossicular chain.

Long-term follow-up of Stapedectomy in Children and Adolescents

Otosclerosis presenting in children and adolescents is uncommon. Typically, otosclerosis presents as a slowly progressive conductive hearing loss in the third to fourth decade. Many well-documented studies have demonstrated excellent long-term hearing results with stapedectomy. Although stapedectomy is highly effective, the rare complications may be devastating. Thirty-one patients, 21 years or younger, underwent 40 stapedectomies for otosclerosis at our institution. The average age at surgery was 16 years, with a range of 7 to 21 years. Postoperative results showed an average improvement in air-bone gap of 22 dB. Clinical and audiologic data were collected over a mean follow-up period of 25 years. There was no statistically significant difference in air-bone gap when comparing the immediate postoperative gap (measured 2 months after stapedectomy) with the last gap recorded (mean, 25 years after stapedectomy). Fifty percent of the ears operated on maintained an air-bone gap within 10 dB at the last follow-up, and an additional 40% maintained a 10- to 20-dB gap. There were no significant relationships between demographic or clinical factors and “success” (gap ≤ 10 dB) or long-term gap closure. Our data demonstrate that stapedectomy is an effective method for closing the air-bone gap in children and adolescents with otosclerosis, and long-term results parallel those of adults, showing maintenance of excellent gap closure. This review represents the largest population with the longest follow-up in children who underwent stapedectomy for the treatment of otosclerosis.

Long-Term Results of Stapedectomy in Children and Adolescents

require excision. Few reports exist of the use of FNA in children. Between January 1991 and November 1994, 64 FNAs were performed on children. Twenty-eight (44%) performed on 25 children were for head and neck masses. Based on the FNA findings, 12 patients underwent surgery. In 11 patients the final pathology was consistent with the FNA findings: granulomatous diseases (4), branchial cysts (2), and thyroid cyst, cystic hygroma, hemangioma, reactive lymphadenopathy, and Castlemans disease (one each). There was one false-negative and no false-positives. On the basis of the FNA, none of the remaining 13 patients required surgery. The pathology was cervical lymphadenopathy (9), abscess formation (2), and lymphangioma (1). One was nondiagnostic. The sensitivity and specificity were 100% and 92%, respectively. We conclude that FNA is an extremely useful tool in the management of neck masses in children.