Fisch technique in prevention of external pore stenosis and atresia after surgery for congenital aural atresia
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OBJECTIVE To investigate and evaluate the Fisch technique in prevention of atresia or stenosis of external auditory canal after surgery for congenital aural atresia. METHOD Seventy-three cases (74 ears) of congenital aural atresia with middle ear deformity during Jan 2000 to June 2006 were studied. All the patients were received trans mastoid antrum canal plasty and tympanoplasty, and Fisch technique was used for canalplasty. There were 59 ears (79.72%) followed-up for six months to 5 years. RESULT Two ears among 59 ears were re-stenosis (3.38%), which happened inside the new external canals. But no cases had atresia just at the new external pores. The long-term hearing results of 49 ears (83.05%) were stable, and the other ears (10 ears, 16.95%) had hearing loss (> or =15 dB) due to thickening of new tympanic membrane. CONCLUSION Fisch technique can prevent atresia or stenosis of external auditory canal after surgery for congenital aural atresia. And regular follow-up and antiinflammatory management are necessary after surgery.Keywords:
Microtia
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To define high resolution computed tomography findings in the external, middle and inner ear of patients with congenital aural atresia and to emphasize the importance of these findings in the preoperative evaluation.Twenty one patients with congenital aural atresia (14 male, 7 female) aged between 1-30 years were evaluated with high resolution computed tomography of the temporal bone. A Toshiba TCT-600 scanner was used in 11 cases, and a Xvision/GX scanner was used in 10 cases. Sections 1 mm thick were obtained in axial and coronal projections using high bone detail algorithms. Sagittal reformations were also made when necessary.Forty-two ears in 21 patients with congenital aural atresia were studied. These included 8 patients with high bilateral and 13 with unilateral congenital aural atresia in which 8 patients had right sided and 5 patients had left sided atresia. Stenosis of the external auditory canal was found in 11 ears, complete atresia was found in 13 ears, incomplete atresia was found in 1 ear. There was varied ossicular deformity in 18 ears. Anomalies of the stapes and oval window were found in 6 ears. An anteriorly located mastoid segment of the facial nerve canal was identified in 11 ears. An inferiorly located tympanic segment of the facial nerve canal was identified in 2 ears, and 3 ears had an abnormal posterior orientation of the mandibular condyles. Only 2 patients had associated inner ear deformity.High resolution computed tomography is an effective method for the evaluation of the anomalies of the external, middle and inner ear in patients with congenital aural atresia and for planning the surgical treatment.
High-resolution computed tomography
Oval window
Aplasia
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To investigate the treatments and complications of the congenital aural atresia.Form 1996 to 2002, 446 ears with congenital aural atresia underwent operations in the Otolaryngology Department of the Tongren Hospital. During the follow up from 6 months to 5 years, 47 ears occurred postoperative complications, which can be divided into five groups: external acoustic pore stenosis, external auditory canal stenosis, hearing loss, facial nerve palsysis. The hearing results of these 43 ears showed 12 ears had a decrease of 10 dB, 19 ears of 20 dB, 12 ears of 30-40 dB.The causes of complications mainly were insufficient opening of bony external canal, secondary infection and lateral healing of the transplanted tympanic membrane, and the surgeon did not master the anatomic characters of the abnormal facial nerve. Forty-three ears received operation again, including 24 ears with external acoustic pore stenosis, 9 ears with external auditory canal stenosis, 8 ears with hearing loss and 1 ear with facial nerve palsysis. Hearing improvement was found in 43 ears (100%) in which 10 ears (23.3%) with improvement of 10-20 dB, 21 ears (48.8%) of 20-30 dB, 12 ears (27.9%) of 30-40 dB. The one ear with facial nerve palsysis recovered 2 months after operation.External auditory canal stenosis and lateral healing of the transplanted tympanic membrane are the primary causes of postoperative hearing loss. Do not injure the facial nerve for hearing improvement in cases of facial nerve abnormalities.
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Objective:To investigate the clinical characteristics and treatment of congenital malformation of external and middle ear.Methods:The data of 13 patients with congenital malformation of external and middle ear were analysed retrospectively.Primary restoration for congenital malformation of external and middle ear was performed in 13 patients.The direct entrance surgical approach was employed in 7 cases,and the tympanic antrum surgical approach in 6 cases.Results:During the follow up of 1 to 5 years,the hearing of 6 cases improved by 20 dB.The shape of tympanic membrane and of aural canal was ideal in 6 cases.Four cases developed postoperative atresia of the aural canal.Conclusions:Prevention of postoperative atresia of the aural canal is crucial in the treatment of congenital malformation of external and middle ear.
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Congenital aural atresia is characterized by aplasia of the external auditory canal (EAC), often associated with abnormalities of the auricula (microtia), the middle ear, and, occasionally, the inner ear structures. The aim of this study is to evaluate the surgical challenges, complications and long term results of congenital aural atresia(CAA) surgery. Records of 103 patients who underwent surgery because of congenital aural atresia were reviewed between 1992 and 2012 in a tertiary referral center. Audiological and surgical events were observed. Surgical technique, incision type, graft material and long term results were noted. Postoperative visit records and audiograms were investigated. Many types of ossicular chain abnormalities such as absence of an ossicle, deformity of an ossicle or ossicular block were observed. Facial canal dehiscence or abnormal location of the facial nerve was seen in 33.9% of patients. Closure of the air-bone gap (ABG) to 30 dB or less at short-term follow-up occurred in 63.1% of patients. Major complications were as follows: restenosis of the external ear canal, hearing loss, facial paralysis, iatrogenic cholesteatoma and perforation of the graft. The air-bone gap cannot be totally closed in all aural atresias, and there is also the chance of sensorineural type hearing loss. Success of the surgery depends on accompanying abnormalities like unexpected route or dehiscence of facial nerve, status of the ossicular chain and middle ear cleft and surgical techniques. Long term results of congenital aural atresia surgery are encouraging and promising.
Facial canal
Aplasia
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Meatus
Otology
Grading (engineering)
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Microtia
Pinna
Etiology
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Objective To study management of traumatic stenosis and atresia of the external auditory canal.Methods Nineteen cases of traumatic stenosis or atresia of the external auditory canal treated between July 1991 and December 2007 were retrospectively analyzed.All 19 cases were treated with external auditory canal plastic surgery and followed for 1 to 12 years.Results Adequate ear canal sizes were maintained in 15 cases with normal hearing at their last follow ups.Recurrent stenosis occurred in 4 cases,of which 1 was treated with iodoform gauze packing,,2 with silastic tubes,and 1 with revision surgery.Conclusion External auditory canal plastic surgery is effective in treating traumatic stenosis and atresia,preferably in the early stage.
Silastic
Meatal stenosis
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Objective To investigate the clinical characters of congentital aural atresia and the surgical treatment of the disease. Methods In this series, 64 ears with congentital aural atresia operated on in our hospital during the period from January 1999 to December 2003 were restrospectively analysed. Results Forty-one of these ears were surgically corrected by anterior approach, the remaining 23 were corrected by transmastoid approach. Of all cases, the tympanic cavity was encountered without difficulty in 61 ears except for 3 ears. Ossicular chain anomalies occurred in all these 61 ears, and varying degrees of abnormal facial nerve were found in 40 ears ( 65.57% ). Postoperative follow-up ranged from 1 to 5 years. The hearing improvement was observed in 49 ears( 80.33% ), of which 32 ears had hearing improvement greater than 30 dB and the air-bone conduction gap was within 15 dB( 52.46% ). The external auditory stenosis occurred in 6 of these ears during the priod from postoperative 3 months to 2 years, of which 4 ears obtained goood results after the second operation. Lateralization of the tympanic membrane presented in 2 ears and infections of the cavity in other 2 ears. Facial paralysis occurred postoperatively in 3 ears, which recovered 2 to 6 months later. Conclusions The surgical procedures had no regular pattern, depending upon what one sees during the operation. The sclerotic and diploetic atretic bone could be indications for superoanterior surgical approach, whereas it would be wiser for the mixed and pneumatic mastoid to be corrected by transmastoid approach.
Bone conduction
Tympanic cavity
Facial paralysis
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To investigate the clinical characters and treatments of congenital aural atresia.From 1986 to 1996, 44 patients (50 ears) with congenital aural atresias were operated in the ENT Department of the PLA General Hospital. Postoperative audiological follow-up ranged from 6 months to 9 years.Ossicular chain anomalies were presented in all cases. This consisted most frequently of fusion (54%) or deficiency (36%) of the malleus and the incus with or without fusion to the tympanic wall. Facial nerve abnormalities were seen in 16 ears (32%). After the operation, hearing improvement was found in 33 ears (66%), in which 13 ears (26%) had hearing improvement (pure tone threshold) up to 40 dB. The postoperative complications were external auditory canal stenosis, lateralization of the tympanic membrane and recurrent infections of the cavity and canal skin, with incidences of 34%, 18% and 14%, respectively.Maintenance of width of the aural canal and prevention of lateral healing of the transplantated tympanic membrane were crucial in the treatment of congenital aural atresia.
Malleus
Incus
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