Vivek Raut

Chorda tympani injury: Operative findings and postoperative symptoms

Objectives This study aims to assess whether operative findings of chorda tympani nerve (CTN) trauma correlate with postoperative symptoms. Study Design and Setting A prospective study was conducted over 2 years on 140 middle ear operations analyzing taste disturbances. The operations were subdivided into myringo-plasty/tympanoplasty (56 cases), mastoidectomy (64 cases), and tympanotomy (20 cases). Results Twenty-one (15%) patients reported taste disturbance. Altered taste was most reported (n = 15, 71%) with loss of taste reported by 29% (n = 6). Symptoms were most observed in the tympanotomy group (45%). Stretching of the CTN was associated with more symptoms than nerve transection. Recovery was complete in 76% (n = 16) of the symptomatic cases by 12 months. Conclusion Patients who undergo middle ear surgery should be thoroughly counseled with respect to CTN injury and symptoms regardless of the type of damage to the nerve. Significance This study highlights the high incidence of postoperative alterations in taste after middle ear surgery, especially in non-diseased ears, and that CTN transection results in fewer symptoms than CTN stretching.

Kurz titanium prosthesis ossiculoplasty—Follow-up statistical analysis of factors affecting one year hearing results

OBJECTIVE Analysis of the one year results of Kurz titanium ossicular prosthesis and the factors affecting the outcome from this prosthesis. The hearing results of titanium partial ossicular replacement prosthesis (PORP) and total ossicular replacement prosthesis (TORP) were compared. METHODS This is prospective study of 97 Kurz prosthesis ossiculoplasties, performed by the same senior author (VVR) between 2004 and 2006. All patients undergoing ossiculoplasty using Kurz prosthesis between 2004 and 2006 were included. All patients had minimum follow-up period of one year. There were 97 patients in total. 65 patients had PORPs and 32 had TORPs. The mean preoperative and postoperative air-bone gaps for the frequencies (500, 1000, 2000, and 3000Hz) were calculated. The improvement of the mean air-bone gap (ABG) and air conduction over the same frequencies were measured. A postoperative ABG less than or equal to 20dB was considered a successful result. Statistical analysis was used to identify the factors which affect the postoperative results. RESULTS The mean preoperative ABG was 27.89dB (SD=11.71). The mean postoperative ABG for the entire series was 11.39dB (SD=10.47). The mean improvement in ABG was 16.50dB (SD=14.00). 81.4% (79 patients) had postoperative ABG< or =20dB. 56.7% (55 patients) of the patients had postoperative ABG< or =10dB. The mean postoperative ABG for all PORP patients was 10.6dB (SD=9.7). The mean postoperative ABG of TORP was higher in this study (14.84dB, SD=12.86) but it was not statistically significant (p=0.10, 2-tailed t-test, 95% CI -9.35 to 0.924). There was no significant effect of age, presence or absence of cholesteatoma or retraction pocket, type of mastoid surgery and thickness of the cartilage graft used on the results. The effect of the preoperative ossicular condition on the postoperative hearing results was also analysed. CONCLUSION Titanium ossicular reconstruction gives stable short-term results. There was no statistically significant difference between the total and partial replacement prostheses. The preoperative status of the stapes superstructure did influence the mean postoperative ABG.

Long-term results of endoscopic stapling diverticulotomy for pharyngeal pouches.

OBJECTIVE: The aim of the present study was to evaluate the long-term success of endoscopic stapling as a primary procedure for the treatment of pharyngeal pouches. METHODS: This study is a retrospective case review of 25 patients with pharyngeal pouches treated by endoscopic stapling (23 stapled, 2 abandoned) over a 4-year period (1994 to 1998) at a University teaching hospital in the United Kingdom. Outcomemeasures used were relief of symptoms over a long-term follow-up of 2 to 5 years. RESULTS: Of the 25 patients analyzed, 12 patients (48%) have remained asymptomatic after their initial stapling. Eight patients (32%) were relieved of their symptoms after revision stapling. The overall long-term success rate for endoscopic stapling was 80% (20 of 25 patients) CONCLUSION: Reduced morbidity and few complications in the elderly make endoscopic stapling a favored primary technique of treating pharyngeal pouches. Open surgery is recommended only in healthy patients with very large pouches.

Titanium versus autograft ossiculoplasty.

Abstract Conclusion: In this comparative series, hearing results were superior with titanium compared with autograft ossiculoplasty in the absence of a stapes superstructure. However, in the presence of a stapes superstructure, titanium ossiculoplasties gave superior results to autografts only when comparing an air–bone gap of < 10 dB. Objective: To compare the hearing outcomes of autograft versus titanium ossiculoplasty at 1 year. Methods: Two consecutive groups of patients with chronic suppurative otitis media with and without cholesteatoma suitable for ossiculoplasty, either primarily or as a staged procedure, were recruited for the study. A total of 52 consecutive patients who underwent an autograft ossiculoplasty were compared with 51 consecutive patients who underwent a titanium ossiculoplasty. Hearing results were statistically compared at 1 year between the two groups using the four frequency average (FFA) of 0.5/1/2/4 kHz and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) four frequency average of 0.5/1/2/3 kHz. The results were analysed statistically. Results: A statistically significant number of titanium TORP ossiculoplasties achieved an air–bone gap closure to within < 20 dB compared with the autograft equivalent group (p = 0.039 FFA; p = 0.016 AAO-HNS). The number of titanium PORP ossiculoplasties achieving an air–bone gap closure to within < 10 dB compared with the autograft equivalent group was also statistically significant (p = 0.006 FFA; p = 0.002 AAO-HNS).

Kurz titanium prostheses in paediatric ossiculoplasty—Short term results

OBJECTIVE The objective of this study is to assess the efficacy of ossiculoplasty procedures in the paediatric population when the Kurz titanium ossicular prosthesis is used. PATIENTS AND METHODS Data was collected prospectively upon 14 ossiculoplasty cases using Kurz titanium prostheses. Audiological parameters using four frequency average (FFA(0.5, 1, 2 and 4kHz)) were assessed pre- and post-operatively. RESULTS In the case of patients reconstructed using partial ossicular reconstruction prostheses, 7/9 (78%) achieved an air bone gap (<20dB) using FFA criteria. Parameters at 12-month follow-up suggested 4/5 (80%) patients reconstructed using total ossicular reconstruction prostheses achieved an air bone gap (<20dB) using FFA. CONCLUSION The question of age and presence of co-existing cholesteatoma or tympanic membrane perforation does not appear to mitigate against performing ossicular reconstruction in this age group. Consequently, the results of this study suggest that the use of Kurz titanium prostheses is a feasible option to augment hearing in paediatric cases involving chronic otitis media. This is a significant finding especially in view of the added psychological burden of hearing difficulties carried by the paediatric population.

Reply to Drs Landis and Hummel

Although taste disorders after otologic surgery have been recognized for a long time, their exact frequency of occurrence was unknown. Drs Michael and Raut tried to close this gap with their prospective study. However, this investigation suffers from the shortcoming of not having provided sensorial measures of taste function. Such measures would have allowed for a conclusion whether the complaints also reflect detectable changes in taste function and not just the subjects’ response bias. It would also have allowed the authors to evaluate the rate of unnoticed injuries to the gustatory system after surgery. In addition, this very extensive report does not provide any analyses apart from descriptive statistics. To remedy this, we performed Fisher exact tests comparing the occurrence of taste alteration after surgery for chronic inflammatory ear diseases (mastoidectomy and tympano/myringoplasty) with those after procedures undertaken for noninflammatory diseases (tympanotomy, stapedectomy, and ossiculoplasty). In fact, taste disorders occurred significantly more often (P 0.002) after surgical procedures undertaken for nonchronic inflammatory middle ear diseases, which partly contradicts the authors’ assumption that the incidence of postoperative taste complaints is higher in the tympanotomy group compared with the mastoidectomy group. Thus, the chorda tympani seems to be more vulnerable in cases of chronic inflammatory middle ear diseases. This is probably because of the fact that chorda tympani function and structure is already altered preoperatively. In conclusion, it remains a matter of medicolegal debate to which extent and in which patients preoperative taste testing should be performed on a routine basis. Basile N. Landis, MD Thomas Hummel, MD Department of Otolaryngology Smell and Taste Clinic Geneva, Switzerland E-mail, Basile.Landis@hcuge.ch

11:40 AM: Chorda Tympani Injury Operative Findings and Post-Op Symptoms

otologic dysfunction and their presentation. 2. Be able to discuss otologic surgical options, success rates, and hearing recovery rates in patients that have sustained ear and/or temporal bone trauma. METHODS: A retrospective study was conducted of 179 patients who underwent otologic surgery over a 29-year period at a tertiary care center for sequelae of otologic trauma. Preoperative, postoperative, and most recent audiograms were obtained and correlated with extent of injury. Complications are discussed. A Student’s T-test was used to determine statistical improvement in hearing after surgery. RESULTS: Patients were stratified into major (67%) and minor (33%) trauma cohorts. Temporal bone fracture without CSF leak was the most common major trauma (17.7%). Traumatic tympanic membrane (TM) perforation was the most common minor insult (39.7%); 233 cases were performed on the study population, with 24 patients (13%) requiring multiple operations. Ossicular chain reconstruction (OCR) prostheses were placed in 32.2%. Bone conduction thresholds were significantly worse (p 0.031) in the major trauma cohort. Hearing was significantly improved in patients with major trauma and OCR (p 0.004), but not in the minor trauma group. Closure of air-bone gap to within 20db occurred in 42% of all patients and 33% of major trauma patients. CONCLUSIONS: Major trauma patients have worse hearing due to the mechanism and extent of injury, but hearing can be significantly improved with surgical intervention. Hearing improvement is less than what is seen historically in patients with chronic ear disease, particularly in major trauma patients with OCR.

10:14 AM: COM Autograft Ossicular Reconstruction: Medium-Term Results

night (p 0.002). Sore throat pain at week 1 (6.6 2.1) was significantly reduced by week 2 (2.1 1.7; P 0.001) and completely resolved by week 3 in all but 2 patients (with VAS 2). Mild swelling persisted in 3 patients at week 4. CONCLUSIONS: A soft palate reduction procedure using RF-based methods frequently requires 2 treatment sessions to treat socially unacceptable snoring. These patients responded well to one treatment session using the device under study in a simple standard approach.