Audit of middle-ear surgery outcomes in a tertiary referral Australian teaching hospital
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This study aimed to audit middle-ear surgical procedures, provide a record of Australian experiences and allow comparisons with other published audits.A retrospective continuous series audit was conducted on 274 patients who underwent tympanoplasty, mastoidectomy and stapedotomy surgery at Westmead Hospital, Sydney. All consecutive surgical procedures, performed by multiple operators at various stages of training but under the care of a single surgeon, were included.Graft uptake was 86.9 per cent in tympanoplasty. Well healed cavities were seen in 72 per cent of mastoidectomies. Although 42 per cent of the patients had one or more co-morbidities, this did not influence the outcome. Hearing improvement was dramatic in stapedotomy and minimally changed in mastoidectomy. Post-operative complications were minimal.All forms of middle-ear surgery were effective in achieving their surgical goals. Aural discharge and inflammatory diseases were well controlled with tympanoplasty and mastoid surgery.Keywords:
Mastoidectomy
Tertiary care
Tertiary referral hospital
Tertiary referral centre
Otology
This study aimed to audit middle-ear surgical procedures, provide a record of Australian experiences and allow comparisons with other published audits.A retrospective continuous series audit was conducted on 274 patients who underwent tympanoplasty, mastoidectomy and stapedotomy surgery at Westmead Hospital, Sydney. All consecutive surgical procedures, performed by multiple operators at various stages of training but under the care of a single surgeon, were included.Graft uptake was 86.9 per cent in tympanoplasty. Well healed cavities were seen in 72 per cent of mastoidectomies. Although 42 per cent of the patients had one or more co-morbidities, this did not influence the outcome. Hearing improvement was dramatic in stapedotomy and minimally changed in mastoidectomy. Post-operative complications were minimal.All forms of middle-ear surgery were effective in achieving their surgical goals. Aural discharge and inflammatory diseases were well controlled with tympanoplasty and mastoid surgery.
Mastoidectomy
Tertiary care
Tertiary referral hospital
Tertiary referral centre
Otology
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Survey of Anesthesiology: August 2011 - Volume 55 - Issue 4 - p 180 doi: 10.1097/01.SA.0000398708.07668.90
Tertiary referral hospital
Tertiary care
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Tertiary referral centre
Patient referral
Tertiary referral hospital
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Objective To evaluate the usefulness of cartilage plates as tympanic membranes combined with total middle ear reconstructive surgery for radicalized ears. Study Design Retrospective study between 1994 and 1999. Setting Tertiary care referral medical center. Patients Seven patients had seven ears with severe chronic otorrhea after radical mastoidectomy. All patients had severe to profound sensorineural hearing loss and expected a trouble-free ear rather than improved hearing after surgery. Patients were followed up for 4 years postoperatively. Methods After the middle ear space was cleaned, the tympanic membrane was reconstructed using a plate prepared from the tragal cartilage. The major part of the posterior wall was reconstructed using a conchal cartilage plate. Cortical bone segments were inserted to support the cartilage plate. Results Preoperatively, cultures of ear discharge were positive for various bacteria. Recovery with dry eardrums was noted in six patients, and one patient showed minimal erosion. No postoperative complications were encountered, but the hearing threshold did not improve postoperatively. Conclusions Total middle ear reconstructive surgery is suitable for patients with chronic otorrhea complicating radical mastoidectomy. The use of cartilage plates seems to be clinically appropriate, particularly for patients with severe infection who expect a trouble-free ear rather than hearing gain after surgery.
Mastoidectomy
Otology
Reconstructive Surgery
Otologic Surgical Procedures
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Myringoplasty
Endoscope
Otology
Animal model
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Otology
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Tertiary referral centre
Tertiary care
Tertiary referral hospital
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Objective To evaluate the effect of otoendoscopy on middle ear cholesteatoma surgery. Methods From 2003 to 2005 otoendoscope-assisted mastoidectomy and tympanoplasty was performed for 43 patients suffered from middle ear cholesteatoma, all cases received a regular follow-up for at least 2 years. Results Forty cases achieved a dry ear successfully 1.5 months to 3 months after operation. Two cases developed retraction pockets caused by middle ear adhesion found by revision endoscopic operation 1 year after the first operation. Another case recurred half a year later and obtained a dry ear after a revision operation during which cholesterol granuloma was found in the posterior tympanum. Hearing was improved by 10 - 20 dB in 21 cases, by 21 - 30 dB in 15 cases, by more than 30 dB in 4 cases, and only 3 cases improved by 10 dB or less. Conclusion Otoendoscopy can assist the surgeon in performing microscopic ear surgery and increase the success rate.
Mastoidectomy
Tympanum (architecture)
Otology
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Middle ear surgery is usually performed using a surgical microscope. Initially, in otorhinolaryngology practice, endoscopes were used for paranasal sinus surgeries. It was only later that they were applied in the area of otology. In otologic surgeries, endoscopes were first used to visualize the middle ear, before being used to assist with visualization of instruments during cholesteatoma surgeries, although they are still not used alone in various otologic surgeries. As in other surgical fields, there is also a trend towards minimally invasive intervention in the field of otorhinolaryngology. Smaller incisions performed under the guidance of endoscopes are preferred over conventional large incisions. Using this approach, improved outcomes can be achieved and postoperative morbidities can be reduced. In addition, the outcomes of grafts performed using the endoscopic approach are similar to that achieved by the microscopic approach. Therefore, endoscopic ear surgery implementations are becoming increasingly popular.
Otology
Endoscopic sinus surgery
Mastoidectomy
Sinus (botany)
Operating microscope
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To survey graduating residents or recent graduates of otolaryngology residency programs to evaluate their Otology/Neurotology (ON) experience in residency and discern if they had received adequate training in time to decide whether to pursue a fellowship in Otology or Neurotology.Internet-based survey.A survey was distributed to all US otolaryngology residency programs to distribute to 5th year residents and recent graduates in last 4 years. The survey assessed satisfaction in ON experience, presence of ON fellows, adequacy of experience to decide on ON fellowship, post-graduate year (PGY) year at which residents observed, performed, and proficiently performed five procedures (tympanoplasty, mastoidectomy, ossiculoplasty, stapedectomy, and cochlear implant), and plan for performing these surgeries in practice.89/106 (84%) of respondents felt they had adequate training in Otology in time to decide whether or not to pursue a fellowship and were found to observe and perform surgeries significantly earlier in training by PGY including: mastoidectomy (observed PGY 1.9 versus PGY 2.3, performed PGY 2.9 versus PGY 3.5), ossiculoplasty (observed 2.1 versus 3.0, performed 3.6 versus 4.3), stapedectomy (observed 2.3 versus 3.0, performed 3.9 versus 4.5), and cochlear implant (observed 2.1 versus 2.8, performed 3.4 versus 4.1) all p < 0.05. There were 19/106 (17.9%) respondents who came from programs with fellowships and 78.9% thought fellows were beneficial to their ON experience.Early exposure to ON surgeries may aid in residents' decision to pursue a fellowship in ON. The presence of fellows appears to facilitate residents' ON experience.
Otology
Neurotology
Stapedectomy
Mastoidectomy
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