[Significance of computed tomography evaluation before revision stapes surgery]

Surgery of the ear and the lateral skull base: pitfalls and complications

Surgery of the ear and the lateral skull base is a fascinating, yet challenging field in otorhinolaryngology. A thorough knowledge of the associated complications and pitfalls is indispensable for the surgeon, not only to provide the best possible care to his patients, but also to further improve his surgical skills. Following a summary about general aspects in pre-, intra-and postoperative care of patients with disorders of the ear/lateral skull base, this article covers the most common pitfalls and complications in stapes surgery, cochlear implantation and surgery of vestibular schwannomas and jugulotympanal paragangliomas. Based on these exemplary procedures, basic "dos and don'ts" of skull base surgery are explained, which the reader can easily transfer to other disorders. Special emphasis is laid on functional aspects, such as hearing, balance and facial nerve function. Furthermore, the topics of infection, bleeding, skull base defects, quality of life and indication for revision surgery are discussed. An open communication about complications and pitfalls in ear/lateral skull base surgery among surgeons is a prerequisite for the further advancement of this fascinating field in ENT surgery. This article is meant to be a contribution to this process.

Radiological control of the floating mass transducer attached to the round window

The surgical rehabilitation of mixed hearing losses can be performed by coupling the floating mass transducer of the Vibrant Soundbridge to the round window. The quality of coupling the floating mass transducer to the round window is crucial for the audiological outcome. It was the aim of this study to further observe the different patterns of floating mass transducer position at the round window. We compared twenty patients with mixed hearing loss implanted with a floating mass transducer attached to the round window and 24 surgeries between 5/2007 and 6/2010. An evaluation of the chronological observation of the flat panel angiography-controlled position of the floating mass transducer at the round window with relation to the surgical report and the audiological outcome was done. We observed no changes in the mean pre- and postbone conduction thresholds. The floating mass transducer position was variable and could be radiologically classified and correlated with the audiologically outcome. A learning curve was observed from the earlier to later implantations. Postoperative, radiological evaluation of the location and angle of the floating mass transducer by means of flat panel tomography allowed us to classify the floating mass transducer position at the round window into 4 groups.

[Temporal bone surgery. Surgical sequelae and complications]

The saying "no surgery, no surgical complications" is certainly true for all specialties. Three categories of undesired events may occur following surgery: surgical sequelae, failure to cure and complications. A critical self-analysis of surgical complications often reveals that these arise in vexing fashion according to Murphy's law, i.e. "what can go wrong, will go wrong". Incomplete preoperative evaluation, insufficient exposure of the surgical field, failure to identify surgical landmarks and misjudgment of the patient's preoperative complaints may culminate in an undesired surgical outcome. Modern preoperative radiology, the possibilities of actual or even virtual temporal bone drilling in the laboratory and the surgeon's level of experience all ensure the relative rarity of relevant surgical complications in otology.

Depth of stapes prosthesis in the vestibule: baseline values and correlation with stapedectomy outcome

CONCLUSION

Deeper protrusion of the prosthesis into the vestibule does not correlate with worse postoperative hearing outcome.

OBJECTIVES

To establish baseline values for the depth of the stapes prosthesis in the vestibule after stapedectomy and to investigate a possible correlation between the relative prosthesis depth (actual depth expressed as a percentage of the vestibule depth) and the hearing results.

METHODS

This was a prospective case study. Sixteen patients underwent stapedectomy and were examined by high-resolution CT of the temporal bone during the first week after surgery. They then underwent audiometric follow-up at specified intervals during the first postoperative year. The actual depth of the prosthesis in the vestibule, its relative depth, and correlations between the relative depth and postoperative hearing results (at 1 week, 1 month, and 1 year) or postoperative complications (prolonged vertigo and sensorineural hearing loss) were measured.

RESULTS

The actual depth of the prosthesis in the vestibule (mean +/- SD) was 2.39 +/- 0.42 mm (range 1.83-3.39 mm). The depth of the prosthesis relative to the depth of the vestibule was 52 +/- 9.74% (range 41.3-74.2%). In general, deeper protrusion of the prosthesis into the vestibule did not correlate with a worse hearing outcome. On the contrary, the correlation between prosthesis depth and better hearing results was positive at several frequencies.