Yisgav Shapira

Laryngotracheal Anastomosis: Primary and Revised Procedures

Objectives Acquired upper airway stenosis is usually associated with a complex of pathological conditions at the high tracheal and the subglottic levels. Reported reconstructive techniques include widening by incorporation of grafts, segmental resection, and anastomosis or combined procedures. The management of recurrent stenosis after reconstructive surgery is a major challenge and has rarely been discussed in the literature. The purposes of the present study are to compare the clinical course of primary versus revised reconstructive procedures and to analyze the effect of age, diabetes, chronic lung disease, grading of stenosis, extent of resection, and revised procedures on the operative rate of success.

Mastoidectomy reconstruction of the posterior wall and obliteration (MAPRO): Preliminary results

Abstract Conclusions: Our preliminary results indicate that mastoidectomy by reconstruction of the posterior wall and obliteration (MAPRO) avoided the disadvantages of a canal-wall-down mastoidectomy. MAPRO effectively prevented cholesteatoma recurrence, provided an excellent basis for hearing restoration, and was generally water-safe. Objective: To evaluate the authors’ experience with the MAPRO technique for eradication of cholesteatomas requiring canal-wall-down mastoidectomy. Methods: The medical files of all the patients who underwent MAPRO for cholesteatoma between 2008 and 2011 at the Sheba Medical Center were retrospectively reviewed. Results: This series included 49 patients (31 children and 18 adults). The index operation was the first procedure for 30 patients and repeat surgery for 19 patients. Eight patients underwent ossiculoplasty. The mean postoperative follow-up was 28 months. Water tolerance and absence of inflammation were achieved in 93.3% of the first-time group and in 73.7% of the repeat group. (Recurrent cholesteatoma was found on the postoperative non-echo planar base diffusion-weighted magnetic resonance imaging in six (12.2%) patients: three (10%) in the first-time group and three (15.8%) in the repeat group).

Foreign Body Reaction to Cochlear Implant

Two cases of foreign body reaction to a cochlear implant are described. A Nucleus-22 cochlear implant encased in silicone rubber was implanted in both. The first is a 66-year-old patient with idiopathic hearing loss. A year following the procedure, a fistulous tract developed over the implant with a typical histological foreign body reaction. The implant was removed and another Nucleus-22 device implanted on the contralateral side. No reaction to the new implant was noticed during a follow-up period of 7 years. The second case is a 6-year-old boy who developed a stubborn suppurative wound infection immediately following implantation. Upon removal of the implant, 2 months after implantation, granulation tissue was found to be encapsulating all parts of the device. Immediately following explantation, the scar and infection rapidly resolved. The tissue was histologically proven to be due to a foreign body reaction.

Cytoplasmic mislocalization of POU3F4 due to novel mutations leads to deafness in humans and mice.

POU3F4 is a POU domain transcription factor that is required for hearing. In the ear, POU3F4 is essential for mesenchymal remodeling of the bony labyrinth and is the causative gene for DFNX2 human nonsyndromic deafness. Ear abnormalities underlie this form of deafness, characterized previously in multiple spontaneous, radiation‐induced and transgenic mouse mutants. Here, we report three novel mutations in the POU3F4 gene that result in profound hearing loss in both humans and mice. A p.Gln79* mutation was identified in a child from an Israeli family, revealed by massively parallel sequencing (MPS). This strategy demonstrates the strength of MPS for diagnosis with only one affected individual. A second mutation, p.Ile285Argfs*43, was identified by Sanger sequencing. A p.Cys300* mutation was found in an ENU‐induced mutant mouse, schwindel (sdl), by positional cloning. The mutation leads to a predicted truncated protein, similar to the human mutations, providing a relevant mouse model. The p.Ile285Argfs*43 and p.Cys300* mutations lead to a shift of Pou3f4 nuclear localization to the cytoplasm, demonstrated in cellular localization studies and in the inner ears of the mutant mice. The discovery of these mutations facilitates a deeper comprehension of the molecular basis of inner ear defects due to mutations in the POU3F4 transcription factor.

Evidence for a right cochlear implant advantage in simultaneous bilateral cochlear implantation.

To compare speech perception performance with right versus left cochlear implants (CIs) in children with bilateral CIs implanted simultaneously.

The insertion trajectory in cochlear implantation - comparison between two approaches.

Abstract Conclusion. The suprameatal approach (SMA) for cochlear implantation is a safe procedure and is at least comparable to the classic mastoidectomy–posterior tympanotomy approach (MPTA) regarding the possibility of reducing electrode insertion trauma. Objectives. To compare the trajectory in the SMA with insertion through cochleostomy, to the MPTA with round window insertion. Methods: Nine temporal bones were implanted by both techniques, and the point of first contact of a precurved electrode was compared. Results: With the SMA, in all bones, the point of first contact was the inferior wall of the scala tympani and insertion was into the scala tympani. In the MPTA, in five of the bones, the point of first contact was the modiolus, the osseous spiral lamina or the basilar membrane.

Transcanal Endoscopic Ear Surgery for Middle Ear Cholesteatoma

OBJECTIVE To evaluate the clinical parameters, outcomes, and complications of transcanal endoscopic ear surgeries for middle ear cholesteatoma. STUDY DESIGN Retrospective study. SETTING Tertiary university-affiliated medical center. PATIENTS Adult patients (age >18) who underwent transcanal endoscopic ear surgeries for cholesteatoma, between March 2009 and March 2015. INTERVENTION Transcanal endoscopic surgery was indicated when the cholesteatoma did not extend posterior to the anterior limb of the lateral semicircular canal. Rigid endoscopes 4 and 2.7 mm in diameter, 0, 30, 45, and 70 degrees were used with angled picks, suction, and forceps.Preoperative assessment included high-resolution computed tomography of the temporal bones and/or non echo-planar diffusion-weighted magnetic resonance imaging and pure-tone audiometry. MAIN OUTCOME MEASURES Residual or recurrent disease was diagnosed by clinical examination and/or magnetic resonance imaging findings consistent with cholesteatoma. Intra- and postoperative complications, pre- and postoperative audiometric results were recorded. RESULTS Sixty operations (56 patients, mean age = 43.6) were included.Six operations (10%) were performed under local anesthesia. The most common sites of cholesteatoma involvement were: posterior epitympanum (n = 51, 91%), anterior epitympanum (n = 19, 33.9%), posterior mesotympanum (n = 13, 23.2%), and sinus tympani (n = 11, 19.6%). Intraoperative ossicular chain reconstruction was performed in 18 (30%) cases.Our overall residual and recurrence rates were 10% (n = 6) and 8.3% (n = 5), respectively, with mean duration of follow up of 35 months. The most common sites of residual disease were the mastoid cavity/antrum (n = 3, 50%), tympanic cavity, and posterior mesotympanum. Overall minor and major complication rates were 16.6 and 6%, respectively. CONCLUSIONS Transcanal endoscopic ear surgery was found to be an acceptable and safe technique for the exposure and eradication of middle ear and/or attic cholesteatoma.

Pain in cochlear implant recipients: An uncommon, yet serious, consequence of cochlear implantation

We describe pain around the receiver/stimulator [RS] presenting months to years after implantation.