Publications

July 30, 2016
Abstract CONCLUSION: Evaluation of the protympanic segment of the eustachian tube is feasible during chronic ear surgery. Balloon dilatation of that segment yields a bigger aperture. OBJECTIVE: To evaluate the feasibility of visualization and balloon dilatation of the protympanic segment of the eustachian tube during chronic ear surgery. METHODS: This study was carried out on a consecutive case series. All patients undergoing surgical treatment for cholesteatoma or tympanic membrane perforation over a 6-month period of time at a tertiary hospital were evaluated intraoperatively for the ability to visualize the protympanic segment of the eustachian tube, perform balloon dilatation, and then perform visual inspection of the effect of dilatation. RESULTS: A total of 21 chronic ear procedures were performed; visualization of the protympanic segment was feasible in 12 ears, obstruction was identified in 7 ears, and dilatation was undertaken. Immediate assessment showed increased aperture of the tube in all patients when […]
July 30, 2016
Abstract OBJECTIVES/HYPOTHESIS: Assess the feasibility of using the Valsalva maneuver to visualize the cartilaginous eustachian tube lumen with computed tomography (CT) in subjects with no ear disease. STUDY DESIGN: Prospective case series study. METHODS: Thirty-eight consecutive patients undergoing CT of the sinuses for nose-related complaints with normal radiographic findings consented for a CT of the temporal bone while performing the Valsalva maneuver. Multiplanar reconstruction was performed along the axis of the tube. Images were assessed for visualization of the whole length of lumen of the tube, or partial visualization with ratio of visualized to nonvisualized segments. RESULTS: The Valsalva maneuver allowed visualization of the whole length of the tube in 27/76 (35%) ears examined. It consistently visualized the distal one-third of the cartilaginous tube in 71/76 (94%) ears. Paradoxical collapse of the eustachian tube was present in three ears along with evidence of poor Valsalva technique. CONCLUSIONS: Valsalva CT consistently […]
July 30, 2016
Abstract OBJECTIVES/HYPOTHESIS: To assess whether transcanal endoscopic access to the basal turn of the cochlea for cochlear implantation is appropriate. STUDY DESIGN: Case series study. METHODS: We reviewed 100 consecutive computed tomographic studies of the sinuses and temporal bone in our institution. We excluded studies that demonstrated evidence of congenital anomalies, chronic ear disease, or inadequate visualization of the cochlea. On axial sections, the angles of the basal turn of the cochlea and of the ear canal in reference to the sagittal plane were recorded as a function of age. RESULTS: Eighty-four studies were included and 16 were excluded. There was significant variability in the relationship between the ear canal and the basal turn of the cochlea in reference to the sagittal plane. A clear majority of images demonstrated the basal turn of the cochlea to align with a more posterior angle than that of the ear canal. CONCLUSION: The […]
July 29, 2016
OBJECTIVE: Assess the patency of the proximal and distal segments of the Eustachian tube in patients undergoing surgery for chronic ear disease. STUDY DESIGN: Case study with control group. METHODS: All consecutive patients presenting for surgery for chronic ear disease in our practice over 14 months underwent preoperative Valsalva computed tomography (CT), and an attempt was made intraoperatively using angled rigid scopes to evaluate obstruction of the protympanic segment of the Eustachian tube. Endoscopic examination of the same segment in 19 cadaver ears served as a control group. RESULTS: Preoperative Valsalva CT showed patency of the distal one-third of the Eustachian tube in 51 of 53 ears. Intraoperative endoscopy allowed visualization of the protympanic opening of the Eustachian tube in 31 of 53 ears; 21 of 31 ears showed obstruction of the protympanic opening of the Eustachian tube. CONCLUSION: A clear obstruction was more likely to be present in the […]
July 10, 2016
We reviewed the reported experience with actinomycosis otomastoiditis in the international literature, along with a recent case from our experience. All recently reported cases presented with persistent drainage and partial response to multiple courses of antibiotics. Diagnosis was uniformly made postoperatively, and the outcome was excellent following a prolonged course of antibiotic treatment. (Arch Otolaryngol Head Neck Surg. 1993;119:561-562)
July 10, 2016
This study aimed to describe and evaluate endoscopic technique for treatment of acquired cholesteatoma. This study was a case series. The study was performed in a private otolaryngology practice. Thirty-eight adult patients with acquired cholesteatoma and no previous ear surgery composed the patient population. Thirty-six patients underwent transcanal endoscopic tympanotomy and extended atticotomy with removal of the cholesteatoma sac; the attic defect was reconstructed in 25 patients and was packed open in 11 patients. Two patients underwent traditional postauricular procedures. The main outcome measure was disease-free ears as evident on: 1) clinical examination at 1 year follow-up for 30 patients and at 2 years for 13 patients; and 2) surgical exploration in 6 patients at 2 years. There were no significant complications associated with the 36 endoscopic procedures: 29 of 30 patients were disease free at 1 year, 10 of 13 were disease free on clinical examination at 2 years, […]
July 10, 2016
One hundred sixty-five middle ear procedures were performed with an endoscope, a camera, and a video monitor instead of the microscope. The endoscope offers the following advantages: 1) it visualizes the whole tympanic membrane and the ear canal without having to manipulate the patient’s head or the microscope, 2) it extends the operative field in transcanal procedures into structures usually hidden from the microscope (anterior tympanic perforation, posterior retraction pocket, facial recess, and hypotympanum), and 3) it visualizes structures from multiple angles as opposed to the microscope’s single axis along the ear canal. Disadvantages of the endoscope include the one-handed surgical technique, a loss of depth perception, limited magnification, and the need for training. The endoscope holds the greatest promise in tympanoplasty and cholesteatoma surgery and should increase the utilization of transcanal over postauricular procedures.
July 10, 2016
This report evaluates long-term results of transcanal endoscopic management and surveillance of cholesteatoma. Sixty-nine ears with acquired cholesteatoma underwent endoscopic transcanal tympanotomy and atticotomy to access and completely remove the sac. Reconstruction with a composite tragal graft was performed in 38 ears, and the cavities were packed open in 31 ears. Office-based endoscopic surveillance and follow-up were performed. Forty-three ears were operated on with the patient under local anesthesia, and 58 were done on an outpatient basis. Three cases were converted into postauricular tympanomastoidectomy. There were no iatrogenic facial nerve injuries. Bone thresholds were stable, except in 1 patient with perilymphatic fistula. Mean follow-up was 41 months, and 19 ears underwent 5 years of follow-up. Six ears required revision surgery, and 9 required office-based minor procedures. An endoscopic technique allows transcanal, minimally invasive management and surveillance of cholesteatoma with long-term results that compare well to those of postauricular methods.
July 10, 2016
Microscopic postauricular tympanomastoidectomy provides a limited exposure to the attic, especially anteriorly. In contrast, the endoscope offers wide transcanal access to the attic, allowing for complete removal of limited attic disease, possibly without interrupting the ossicular chain. This report evaluates 8 years of experience with transcanal endoscopic management of limited attic cholesteatoma. Case series. Seventy-three ears with limited attic cholesteatoma underwent endoscopic transcanal tympanotomy and extended atticotomy to access and completely remove the sac. Disease was dissected off the tegmen, the medial and lateral attic walls, and the ossicles. Appropriate ossicular reconstruction was performed. The defect was reconstructed with a composite tragal graft. A transcanal endoscopic approach was adequate for removal of disease in all cases. There were no iatrogenic facial nerve injuries. Bone thresholds were stable. Disease was dissected off the head of the malleus and the body of incus with preservation of both in 24 ears. Mean follow-up […]
July 10, 2016
This paper attempts to review changes in the lives of hearing-impaired patients within the developing world, brought about by globalisation and development. The paper also explores limitations to improved care and addresses the collective moral responsibility of developed nations. Analysis of literature.Results:Within developing nations, large populations have emerged with a similar pattern of problems, access to information and aspirations as those living in developed nations. However, marked differences in income have persisted. These trends have resulted in a relative increase in the proportion of the hearing-impaired population in need of cochlear implantation, while at the same time restricting their access to such treatment. The emergence of global markets and media and a shared sense of destiny amongst the people of this planet should translate into a concerted, worldwide effort to assist the deaf in developing countries. Much more can be done within existing resources and frameworks to improve the quality […]
July 10, 2016
In this paper a new method that enables semi-automatic feature extraction and visualization of inner ear structures, including the cochlea, is presented. The system offers an interactive, computer-based assessment tool for pre-operative evaluation and surgical planning of maximally invasive procedures, such as for cochlear implantation. The user is able to segment the cochlea and surrounding landmarks with minimal input to generate a three-dimensional display of the region for interactive analysis of patient morphology. Spiral CT scans of the temporal bone are input to the image processing and visualization pipeline which is implemented in ITK and VTK respectively. A connected threshold region growing algorithm is then applied for semi-automatic extraction of structures of interest. Results of this process are verified using a supervised approach. Following segmentation, surface-and volume-based visualizations are displayed, with image scans superimposed for landmark evaluation. The software is currently in use as a supplementary tool for planning access […]
July 10, 2016
The advantages and limitations of the microscope have defined postauricular access as the surgical intervention of choice The advantages and limitations of the microscope have defined postauricular access as the surgical intervention of choice for the treatment of diseases of the middle ear. The wide-angle view provided by the endoscope enables transcanal access to for the treatment of diseases of the middle ear. The wide-angle view provided by the endoscope enables transcanal access to the tympanic cavity, and its otherwise difficult-to-reach extensions: The attic, sinus tympani, facial recess, and hypotympanum. the tympanic cavity, and its otherwise difficult-to-reach extensions: The attic, sinus tympani, facial recess, and hypotympanum. These areas are the primary sites of disease and surgical failure to cure. The endoscope also allows an all encompassing view These areas are the primary sites of disease and surgical failure to cure. The endoscope also allows an all encompassing view of the […]
July 10, 2016
Until recently, tympanic facial nerve surgery had been performed using microscopic approaches, but in recent years, exclusive endoscopic approaches to the middle ear have increasingly been used, particularly in cholesteatoma surgery. The aim of this report was to illustrate the surgical anatomy of the facial nerve during an exclusive endoscopic transcanal approach. Retrospective video review of cadaveric dissections and operations on living patients in a tertiary university referral center. Between November 2008 and July 2010, a total of 12 endoscopic cadaveric dissections were performed by an exclusive endoscopic transcanal approach. All dissections were recorded and stored in a database. In July 2010, video recordings from those dissections were reviewed, and the anatomic variations and accessibility of the tympanic facial nerve were studied and noted. Two further video recordings from living patients affected by middle ear chronic disease were also included in our study. In all 14 subjects, the transcanal endoscopic […]
July 10, 2016
The authors present a manual of transcanal ear dissection, a completely clinically focused discussion of the goals, steps, and outcomes of endoscopic dissection of the middle ear. From operating station setup through instrumentation and tasks, the reader is presented with detailed technique steps interspersed with observe notes that provide anatomic and technique pearls, such as “by removing the skin of the canal and the epithelial layer of the tympanic membrane (TM), you have largely eliminated the bleeding elements of the external ear and TM”.
June 20, 2016
Abstract The endoscope allows for better inspection for cholesteatoma in cases with chronic otitis media, better access to selective epitympanic poor ventilation and secondary selective chronic otitis media, better visualization of anterior poor ventilation of the mesotympanum (reestablishing adequate ventilation to the mesotympanum), better visualization and reconstruction of anterior tympanic membrane perforations, allows use of Sheehy’s lateral graft tympanoplasty through a transcanal approach, and increases the odds of preoperative detection of ossicular chain disruption associated with perforations.
June 20, 2016
Abstract Program Description: Endoscopic ear surgery (EES) is a current hot topic in our specialty, but it is not entirely correct to introduce EES as “new.” Although not new, it is clear that during the last few years, endoscopes have proven to be safe and effective instruments to manage ear diseases in a minimally invasive way, preserving important anatomical structures, allowing functional approaches to well-known conditions. Moreover, endoscopes have provided a better view and understanding of traditional middle ear anatomy and physiology, allowing new landmarks, novel concepts of tissue preservation, ventilation routes, and management of other conditions within the middle ear and beyond.
June 20, 2016
Abstract In contrast to other means of studying the epitymapnum, the endoscope allows unparallel access without disruption of anatomy. The aim of this study is to delineate the anatomy of the epitympanum through transcanal endoscopy. Systematic dissection of anatomic specimens. We performed systematic endoscopic dissection of 20 ears in 10 fresh frozen anatomical specimens. A detailed flow sheet was filled up documenting the status of the lateral attic folds, the tensor fold, the cog and the tensor folds, the supratubal recess, and the patency of the anterior and posterior isthmus. None of the ears showed indication of previous chronic otitis media. The lateral incudomallear fold was intact in all but one ear. The lateral mallear fold was intact in all specimens. The tensor fold was complete in 16 ears and partial in four. Two of these ears belonged to the same specimen. The epitympanic diaphragm was complete in 15 out […]
June 20, 2016
Abstract A detailed and comprehensive discussion of transcanal endoscopic management of cholesteatoma is presented. After a presentation of the anatomy of the area, the rationale, advantages and limitations, technique, and long-term results of each technique are presented. A case presentation follows each technique. Techniques presented are: endoscopic transcanal management of limited cholesteatoma, endoscopic open cavity management of cholesteatoma, and expanded transcanal access to middle ear and petrous apex.
June 9, 2016
Silver Book | Endoscopic Cholesteatoma Management by Joao Nogueira  
June 8, 2016
  Endoscopic ear surgery manual. Silver Book. Anatomy and Dissection Manual