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Katar O, Kılıç S, Bajin MD, Sennaroğlu L. Long term results of glass ionomer ossiculoplasty. Eur Arch Otorhinolaryngol 2024; 281:171-179. [PMID: 37522908 DOI: 10.1007/s00405-023-08120-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To analyze and compare the early and late post-operative results of glass ionomer bone cement (GIBC) used in ossiculoplasty. METHODS The pre-operative, early post-operative (3 months) and late post-operative (> 2 years) audiometric findings, namely the pure-tone average (PTA), bone conduction threshold (BCT) and air-bone gap (ABG) of 40 patients who underwent GIBC ossiculoplasty for different etiologies were analyzed. Early and late results were compared. Also, the patients were grouped in terms of prognostic factors and applied ossiculoplasty techniques, and the results were compared between the groups. RESULTS There were statistically significant improvements in the pure-tone average and air-bone gap of the patients in the early post-operative period (PTA from 59.60 ± 15.95 to 40.37 ± 17.83 and ABG from 37.12 ± 11.18 to 19.78 ± 10.41, p < 0.001 for both). There were no statistically significant changes in any of the audiometric parameters in the late post-operative period (PTA from 40.37 ± 17.83 to 39.79 ± 17.91, ABG from 19.78 ± 10.41 to 19.32 ± 9.60, BCT from 17.99 ± 12.71 to 18.31 ± 13.99, p > 0.05 for all). Presence of tympanosclerosis was found to be the only prognostic factor to affect the outcome. CONCLUSION GIBC is a safe and reliable material for ossiculoplasty, which maintains its ability to conduct sound in the long-term follow-up.
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Affiliation(s)
- Oğuzhan Katar
- Department of Otolaryngology, Hacettepe University Faculty of Medicine, Sıhhiye, 06100, Ankara, Turkey.
| | - Samet Kılıç
- Department of Audiology, Hacettepe University Faculty of Health Sciences, Sıhhiye, 06100, Ankara, Turkey
| | - Münir Demir Bajin
- Department of Otolaryngology, Hacettepe University Faculty of Medicine, Sıhhiye, 06100, Ankara, Turkey
| | - Levent Sennaroğlu
- Department of Otolaryngology, Hacettepe University Faculty of Medicine, Sıhhiye, 06100, Ankara, Turkey
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Histopathological Effects of Bone Cement on Cartilage Tissue. J Craniofac Surg 2019; 30:936-939. [PMID: 30845082 DOI: 10.1097/scs.0000000000005202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Glass ionomer bone cement is frequently applied with cartilage grafts in otology, even as a single unit. OBJECTIVE This experimental study was performed to investigate the histopathological effects of bone cement on cartilage tissue. METHODS The study was conducted between January 2018 and April 2018 and used 12 New Zealand White rabbits. The right ears of the rabbits constituted the study group, while the left ears were the controls. Ketac Cem Radiopaque (3 M Germany) was used as glass ionomer cement. Tissue samples from the rabbits were subjected to histopathological analysis to compare acute and chronic inflammation, foreign body reaction, angiogenesis, collagenesis, fibrosis, necrosis, cartilage fracture, osseous metaplasia, and loss of chondrocyte nuclei between the groups. RESULTS The rates of cartilage fracture (P = 0.044), foreign body reaction (P < 0.001), acute inflammation (P = 0.009), chronic inflammation (P = 0.002), and angiogenesis (P = 0.003) were significantly higher in the study group compared with the controls. The study group showed some degree of necrosis; no necrosis was observed in the control group, but the difference was not statistically significant (P = 0.101). There were no significant differences in fibrosis, collagenesis, osseous metaplasia, or loss of chondrocyte nuclei between the groups. CONCLUSIONS This study showed that application of bone cement can cause acute and chronic inflammation, foreign body reactions, angiogenesis, and cartilage fractures. Further studies are needed to determine the long-term effects of bone cement on cartilage.
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Ilea A, Butnaru A, Sfrângeu SA, Hedeșiu M, Dudescu CM, Boșca BA, Trombitaș VE, Câmpian RS, Albu S. Temporal bone trauma effects on auditory anatomical structures in mastoid obliteration. Eur Arch Otorhinolaryngol 2018; 276:513-520. [PMID: 30506431 DOI: 10.1007/s00405-018-5227-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The risk of temporal bone fractures in head trauma is not negligible, as injuries also depend on the resistance and integrity of head structures. The capacity of mastoid cells to absorb part of the impact kinetic energy of the temporal bone is diminished after open cavity mastoidectomy, even if the surgical procedure is followed by mastoid obliteration. The aim of our study was to evaluate the severity of lesions in auditory anatomical structures after a lateral impact on cadaveric temporal bones in which open cavity mastoidectomy followed by mastoid obliteration was performed, compared to cadaveric temporal bones with preserved mastoids. METHODS The study was carried out on 20 cadaveric temporal bones, which were randomly assigned to two groups. In the study group, open cavity mastoidectomy followed by mastoid obliteration with heterologous materials was performed. All temporal bones were impacted laterally under the same conditions. Temporal bone fractures were evaluated by CT scan. RESULTS External auditory canal fractures were six times more seen in the study group. Tympanic bone fractures were present in 80% of the samples in the study group and 10% in the control group (p = .005). Middle ear fractures were found in 70% of the samples in the study group and 10% in the control group (p = .02). Otic capsule violating fractures of the temporal bone were present only in the study group. CONCLUSIONS Mastoid obliteration with heterologous materials after open cavity mastoidectomy increases the risk of fracture, with the involvement of auditory anatomical structures.
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Affiliation(s)
- Aranka Ilea
- Department of Oral Rehabilitation, Oral Health and Dental Office Management, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Str.Victor Babeș, No 15, Cluj-Napoca, Romania
| | - Anca Butnaru
- Department of Radiology, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Str. Clinicilor, No 1-3, Cluj-Napoca, Romania
| | - Silviu Andrei Sfrângeu
- Department of Radiology, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Str. Clinicilor, No 1-3, Cluj-Napoca, Romania
| | - Mihaela Hedeșiu
- Department of Dental Radiology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Str. Clinicilor, No 32, Cluj-Napoca, Romania
| | - Cristian Mircea Dudescu
- Department of Mechanical Engineering, Faculty of Mechanics, Technical University Cluj-Napoca, B-dul Muncii, No 103-105, Cluj-Napoca, Romania
| | - Bianca Adina Boșca
- Department of Histology, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Str. L. Pasteur, No. 4, 400349, Cluj-Napoca, Romania.
| | - Veronica Elena Trombitaș
- Department of Cervicofacial and ENT Surgery, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Str. Gheorghe Bilascu Nr. 16-20, Cluj-Napoca, Romania
| | - Radu Septimiu Câmpian
- Department of Oral Rehabilitation, Oral Health and Dental Office Management, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Str. Victor Babeș, No 15, Cluj-Napoca, Romania
| | - Silviu Albu
- Department of Cervicofacial and ENT Surgery, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Str. Gheorghe Bilascu Nr. 16-20, Cluj-Napoca, Romania
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Kökten N, Eğilmez OK, Kalcıoğlu MT, Baran M, Ekici AID. Evaluation of the Possible Neurotoxic Effect of the Bone Cement on the Facial Nerve: An Experimental Study. Clin Exp Otorhinolaryngol 2018; 11:174-180. [PMID: 29587474 PMCID: PMC6102333 DOI: 10.21053/ceo.2017.00864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/24/2017] [Accepted: 01/09/2018] [Indexed: 12/21/2022] Open
Abstract
Objectives To investigate neurotoxic effect of bone cement (BC) on facial nerve by using electrophysiological and histopathological methods. Methods This study included 20 male albino Wistar rats, divided into four equal groups. Group A was designed as the control group, while group B was sham group. In the group C, BC solution was dropped onto the facial nerve trunks of rats and washed with physiological saline after 5 seconds. In the group D, BC solution was dropped onto the facial nerve trunks of rats and after allowing 5 minutes to dry, wounds were closed. Pre- and postoperative (on 4th week) evoked electromyography (EMG) measurements were done. For histopathological assessments, the rats were euthanized and tissue samples of facial nerve and surrounding areas were collected. Results According to the wave amplitude levels of evoked EMG, postoperative amplitude levels of group D were significantly decreased, compared to preoperative amplitude levels (P=0.043). We found no statistically significant difference in inflammation among the groups. In none of the groups, foreign body reaction and granulation tissue were not detected in any of the groups. In addition, degeneration in axon, myelin, or perineural nets was not detected in any of the groups. Conclusion This study results suggest that BC has no direct toxicity on facial nerve, while it has indirect effects, by decreasing amplitude. Therefore, we conclude that direct contact of BC with nerve should be avoided, and the area should be cleaned by aspiration or washing with physiological saline in case of contact.
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Affiliation(s)
- Numan Kökten
- Department of Otorhinolaryngology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey
| | - Oğuz Kadir Eğilmez
- Department of Otorhinolaryngology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - M Tayyar Kalcıoğlu
- Department of Otorhinolaryngology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Baran
- Department of Physiology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey
| | - A Işın Doğan Ekici
- Department of Pathology, Yeditepe University, Faculty of Medicine, Istanbul, Turkey
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Demirci S, Tuzuner A, Callıoglu EE, Yumusak N, Arslan N, Baltacı B. Glass ionomer application for vocal fold augmentation: Histopathological analysis on rabbit vocal fold. Laryngoscope 2015; 126:E171-4. [PMID: 26394167 DOI: 10.1002/lary.25674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to investigate the use of glass ionomer cement (GIC) as an injection material for vocal fold augmentation and to evaluate the biocompatibility of the material. STUDY DESIGN Ten adult New Zealand rabbits were used. METHODS Under general anesthesia, 0.1-cc GIC was injected to one vocal fold and the augmentation of vocal fold was observed. No injection was applied to the opposite side, which was accepted as the control group. The animals were sacrificed after 3 months and the laryngeal specimens were histopathologically evaluated. RESULTS The injected and the noninjected control vocal folds were analyzed. The GIC particles were observed in histological sections on the injected side, and no foreign body giant cells, granulomatous inflammation, necrosis, or marked chronic inflammation were detected around the glass ionomer particles. Mild inflammatory reactions were noticed in only two specimens. The noninjected sides of vocal folds were completely normal. CONCLUSION The findings of this study suggest that GIC is biocompatible and may be further investigated as an alternative injection material for augmentation of the vocal fold. Further studies are required to examine the viscoelastic properties of GIC and the long-term effects in experimental studies. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Sule Demirci
- Department of Otorhinolaryngology-Head and Neck Surgery, Ankara, Turkey
| | - Arzu Tuzuner
- Department of Otorhinolaryngology-Head and Neck Surgery, Ankara, Turkey
| | - Elif Ersoy Callıoglu
- Department of Otorhinolaryngology-Head and Neck Surgery, Ministry of Health, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Nihat Yumusak
- Department of Pathology, Harran University Faculty of Veterinary Medicine, Ankara, Turkey
| | - Necmi Arslan
- Department of Otorhinolaryngology-Head and Neck Surgery, Ankara, Turkey
| | - Bülent Baltacı
- Department of Anesthesiology , Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
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Manubrio-stapedioplasty: new surgical technique for malleus and incus fixation due to tympanosclerosis. J Laryngol Otol 2015; 129:587-90. [PMID: 25883094 DOI: 10.1017/s0022215115000973] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This paper reports the authors' technique of manubrio-stapedioplasty using glass ionomer cement for malleus and incus fixation due to tympanosclerosis. METHODS A retrospective case review was conducted of five patients with conductive hearing loss (mean pre-operative air-bone gap of 42.75 dB) treated in a tertiary referral centre. The hearing results of a manubrio-stapedial bone cement ossiculoplasty technique, utilised on the five patients, were analysed. All cases were Wielinga and Kerr tympanosclerosis classification type 2 (attic fixation of the malleus-incus complex with a mobile stapes). The incus and head of the malleus were removed in all patients, and the manubrium was directly connected to the head of the mobile stapes using glass ionomer cement. Patients were evaluated in terms of pre- and post-operative audiometric results; hearing gain and post-operative air-bone gap were the main outcome measures. RESULTS Mean post-operative air-bone gap was 5.25 dB. Four patients had an air-bone gap of less than 10 dB; the remaining patient had an air-bone of 12.50 dB. CONCLUSION Manubrio-stapedioplasty is an effective method for ossicular reconstruction in cases of malleus and incus fixation due to tympanosclerosis.
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Glass ionomer cement in otological microsurgery: experience over 16 years. Eur Arch Otorhinolaryngol 2014; 272:2749-54. [DOI: 10.1007/s00405-014-3276-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
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Aydoğan F, Tüzüner A, Ünlü I, Demirci Ş, Aydin E, Yumuşak N, Taştan E, Keskin MN, Samim EE. The use of glass ionomer cement in the reconstructıon of the dorsal L-strut: an experımental study on rabbıts. Laryngoscope 2014; 124:E303-8. [PMID: 24500785 DOI: 10.1002/lary.24637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/24/2014] [Accepted: 01/31/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS This experimental study in a rabbit model aimed to investigate the use of glass ionomer cement as a tissue adhesive on the dorsal L-strut. STUDY DESIGN Sixteen adult male New Zealand White rabbits were used. The rabbits were equally divided into two groups as the control and the study groups. METHODS The nasal septum was exposed through a superior approach. A graft was harvested preserving an L-strut cartilage. In the control group, a vertical incision was performed on the dorsal part of the L-strut to divide it into two cut ends, and the graft was sutured to the cut ends with 5-0 polydioxanone suture. In the study group, the reconstruction of the dorsal L-strut was made by fixing the graft to the cut ends with glass ionomer cement as the tissue adhesive. At 2 months, the rabbits were sacrificed. The nasal septum was removed for histopathological examination. RESULTS No foreign body giant cells or acute inflammation were determined in the rabbits. The study group had less pronounced chronic inflammation. Comparison of the groups revealed that parameters regarding vascularization, cartilage proliferation, and new cartilage cells were statistically significant different between the two groups (P = .010, P = .010, P = .028, respectively). More vascularization, cartilage proliferation, and new cartilage cells were seen in the study group. CONCLUSIONS Glass ionomer cement was effective for the reconstruction of the dorsal L-strut without any foreign body reaction, cartilage necrosis, or marked inflammation in rabbits, and it may be a potentially beneficial alternative to suture fixation.
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Affiliation(s)
- Filiz Aydoğan
- Department of Otorhinolaryngology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
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Van der Gucht K, Van Rompaey V, Vanderveken O, Van de Heyning P, Claes J. Temporary removal of the posterior bony canal wall with reconstruction using microplate osteosynthesis in cholesteatoma surgery: a case series and description of the technique. Eur Arch Otorhinolaryngol 2013; 271:1497-503. [PMID: 23942812 DOI: 10.1007/s00405-013-2601-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 06/10/2013] [Indexed: 01/09/2023]
Abstract
We describe the surgical technique of temporary removal of the posterior auditory canal wall with reconstruction and report the outcome of using this technique as a treatment method for cholesteatoma in a case series. In 32 cases of cholesteatoma surgery a technique of temporary removal of the posterior bony wall was applied. During primary surgery the posterior auditory canal wall was removed using an oscillating saw. For the purpose of reconstruction, the canal wall was repositioned and fixed using two titanium microplates (n = 26). In case the canal wall could not be reconstructed with osteosynthesis, either glass-ionomeric cement (BioCem™) was used for fixation (n = 4) or fibrin glue (Tissucol™) (n = 2) to support the posterior wall. The outcome includes the healing process in the first postoperative month, the absence of residual or recurrent disease and the successful reconstruction of the posterior auditory canal wall as evaluated during second-look surgery. When microplates where used, we saw healing problems of the canal skin in about 4% of patients. Recurrent cholesteatoma was found in 4 cases (14%), residual cholesteatoma in 8 ears (25%). In the osteosynthesis group, successful reconstruction was achieved in 25 patients (96%). In 3 out of 4 patients of the glass-ionomeric cement group (75%) excessive granulation tissue developed with extensive bony lysis. Temporary removal of the posterior auditory canal wall offers potential for the control of cholesteatoma. Our first results suggest that osteosynthesis allows for a good anatomical and functional reconstruction.
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Affiliation(s)
- Karen Van der Gucht
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium,
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Park YH, Kim SG, Lee JW, Yoon YH. Obliteration of temporal dorsal bulla in guinea pigs using different types of calcium phosphate. Int J Pediatr Otorhinolaryngol 2011; 75:1176-80. [PMID: 21774997 DOI: 10.1016/j.ijporl.2011.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 06/14/2011] [Accepted: 06/18/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the applicability of different calcium phosphate types after mastoid obliteration procedure using the guinea pig as an animal model. MATERIALS AND METHODS Twenty six male guinea pigs were used for the experimental study. Four guinea pigs were used as a normal control group, with the remaining used for the experimental group. After bulla mucosa was removed, non-obliterated ears were used as control and granular (Polybone-G) or powder (Polybone-P) types of Polybone (tricalicium phosphate and polyphosphate) were applied into the dorsal bulla. The radiological and histologic findings were obtained from each animal at 8 and 20 weeks after obliteration. RESULTS On radiological examination, thickening of the bulla wall observed in all experimental groups compared with normal group. Increased homogenous bony densities continuous with the bulla wall were observed in the Polybone-G group compared to the other experimental groups, and some isolated bony densities were observed in the Polybone-P group. Histopathologic findings showed increased new bone formations and less inflammatory reactions in the Polybone-G group compared to the Polybone-P group. CONCLUSION This study demonstrates that granular type calcium phosphate can be used as effective material than powder type in mastoid obliteration.
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Affiliation(s)
- Yong Ho Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea; Research Insititute for Brain Sciences, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
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Ribeiro FDAQ. Foreign body in the Eustachian tube: case presentation and technique used for removal. Braz J Otorhinolaryngol 2008; 74:137-42. [PMID: 18392515 PMCID: PMC9450605 DOI: 10.1016/s1808-8694(15)30764-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Accepted: 03/22/2005] [Indexed: 11/29/2022] Open
Abstract
Foreign bodies of the external ear are very common; the same can not be said about foreign bodies of the middle ear, especially of the Eustachian tube. Case presentation Alcoholic and psychopathic patient presented a foreign body (barbecue wooden stick) purposefully introduced in his middle ear and Eustachian tube during an act of delinquency. The foreign body was stuck in the tube and could not be removed externally. It was surgically removed as described by the authors later on in the paper. Comments The patient recovered well, with no sequela on the facial nerve and without important vertigo.
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Bauer M, Pytel J, Vóna I, Gerlinger I. Combination of ionomer cement and bone graft for ossicular reconstruction. Eur Arch Otorhinolaryngol 2007; 264:1267-73. [PMID: 17562058 DOI: 10.1007/s00405-007-0367-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Accepted: 05/23/2007] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate the efficacy of the reconstruction of large ossicular chain defects with a combination of ionomer cement and an autogenous cortical bone graft. Different individual solutions are described if at least the handle of the malleus is present: restoration of a large defect of the long process of the incus, formation of the incus body and the long process, and replacement of the missing superstructure of the stapes with a short bone graft standing on the footplate. In a unique case, total reconstruction of the malleus handle was carried out. In further cases where the malleus and the incus were absent, the missing superstucture of the stapes was replaced by a bone graft fixed to the remnant of the anterior crus, supplemented with a cortical bone PORP. Between 1993 and 2005, 84 patients underwent middle ear operations with the use of ionomer cement. In 16 ears (9 males, 7 females), a combination of ionomer cement and autogenous cortical bone graft was used for ossicular reconstruction, with a documented follow-up of at least 6 months to 7 years. All operations were performed under general anesthesia. The components of the cement were mixed by hand and transferred to the bare bone surface with a curved needle. Complex structures were built up step by step. In seven cases, the tympanic membrane was simultaneously reconstructed. The postoperative air-bone gap was < 20 dB in 11/16, 68% of the cases. No columella rejection occurred. The reconstructed malleus handle is still intact, though the hearing has deteriorated. The audiological results are encouraging and a further prospective study is under design in order to analyze the efficacy of the combination of ionomer cement and an autogenous cortical bone graft for ossicular reconstruction. The simultaneous reconstruction of the superstructure of the stapes and the long process of the incus or the whole incus makes PORPs or TORPs superfluous, if at least the handle of the malleus is present.
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Affiliation(s)
- Miklós Bauer
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical School, University of Pécs, Munkácsy Mihály utca 2, 7621, Pécs, Hungary
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Abstract
Contemporary surgical techniques for treating various pathologies affecting the middle ear address not only eradication of the underlying disease process but also restoration of normal auditory function. Trauma, neoplasms, inflammatory processes, and cholesteatomas can erode and alter normal middle ear components and relationships vital for the transmission of auditory energy to the inner ear. Over the last five decades, various ossiculoplasty techniques and prostheses have been studied and reported in the literature. Unfortunately, the multitude of reconstructive techniques attests to the fact that none of the currently available methods are ideal.
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Affiliation(s)
- Luv Ram Javia
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania School of Medicine, 3400 Spruce Street, 5 Silverstein, Philadelphia, PA 19104, USA
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Bayazit YA, Ozer E, Kanlikama M, Durmaz T, Yilmaz M. Bone cement ossiculoplasty: incus to stapes versus malleus to stapes cement bridge. Otol Neurotol 2005; 26:364-7. [PMID: 15891635 DOI: 10.1097/01.mao.0000169781.92211.76] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In this study, our purpose was to evaluate results of our experience with bone cement repair of ossicular discontinuity between the incus and stapes and between the malleus and stapes. METHODS Medical records of patients who underwent surgery for chronic otitis media between March 2000 and December 2002 were evaluated retrospectively. Fifty-seven patients who underwent bone cement ossiculoplasty and had appropriate follow-up data were included in the study. Bone cement reconstruction of the ossicular chain was performed 1) from incus to stapes (I-S) in the absence of long arm or lenticular process of the incus and 2) from malleus to stapes (M-S) in the absence of the incus. The clinical data of the patients were evaluated by otoscopic examination and audiometry. RESULTS The graft take rate was 84.1%. I-S procedure was performed in 42 and M-S in 8 patients. Pre- and postoperative PTAs of all patients were compared, which showed a significant improvement in air PTA (p < 0.001) while bone PTA did not change (p > 0.05). In I-S and M-S groups, successful hearing restoration could be achieved in 78.6.1% and 87.5% of the patients, respectively. Hearing results of different aural pathologies (chronic otitis media and conductive hearing loss) and surgeries (tympanotomy and tympanoplasty with or without mastoidectomy) were not significantly different (p > 0.05). CONCLUSION Bone cement ossiculoplasty offers cost effective and significant improvement in conductive hearing loss.
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Affiliation(s)
- Yildirim A Bayazit
- Department of Otolaryngology, Faculty of Medicine, University of Gaziantep, Turkey
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Goebel JA, Jacob A. Use of Mimix hydroxyapatite bone cement for difficult ossicular reconstruction. Otolaryngol Head Neck Surg 2005; 132:727-34. [PMID: 15886626 DOI: 10.1016/j.otohns.2005.01.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the advantages of using Mimix hydroxyapatite (HA) bone cement in reconstructing a variety of ossicular chain abnormalities. STUDY DESIGN AND SETTING Case series at a tertiary medical center. RESULTS Twenty-five cases of HA reconstruction are included in this series (ages 23-74; mean, 47 years). The examples presented include (1) HA as the sole reconstructive material for incus erosion, (2) HA for securing a total or partial ossicular replacement prosthesis, (3) incus augmentation after crimping for revision stapedotomy with incus erosion, (4) HA in primary stapedotomy to fix the crimped prosthesis to an intact incus, and (5) other unique situations. Preoperative and postoperative audiograms were evaluated for 4-tone pure tone average (PTA), speech reception thresholds, word recognition scores, and air-bone gaps (AB gaps). Mean follow-up was 11 months (range 2 to 22 months). The mean PTA improved from 57 dB to 37 dB, whereas the mean AB gaps decreased from 33 dB to 16 dB. There were no cases of infection or extrusion. CONCLUSIONS Hydroxyapatite bone cement is an excellent adjunct or alternative to ossiculoplasty with preformed prostheses. Easily malleable, rapidly setting, and rapidly hardening, Mimix is particularly well suited for middle ear work. SIGNIFICANCE Definitive fixation with bone cements during difficult ossicular chain reconstruction may ensure a more enduring successful outcome.
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Affiliation(s)
- Joel A Goebel
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, 660 S. Euclid, Campus Box 8115, St. Louis, MO 63110, USA.
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Selesnick SH, Liu JC, Jen A, Newman J. The Incidence of Cerebrospinal Fluid Leak after Vestibular Schwannoma Surgery. Otol Neurotol 2004; 25:387-93. [PMID: 15129122 DOI: 10.1097/00129492-200405000-00030] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the incidence of cerebrospinal fluid leak after vestibular schwannoma removal reported in the literature. DATA SOURCES MEDLINE and PubMed literature search using the terms "acoustic neuroma" or "vestibular schwannoma," and "cerebrospinal fluid leak" or "cerebrospinal fluid fistula" covering the period from 1985 to the present in the English language literature. A review of bibliographies of these studies was also performed. STUDY SELECTION Criteria for inclusion in this meta-analysis consisted of the availability of extractable data from studies presenting a defined group of patients who had undergone primary vestibular schwannoma removal and for whom the presence and absence of cerebrospinal fluid leakage was reported. Studies reporting combined approaches were excluded. No duplications of patient populations were included. Twenty-five studies met the inclusion criteria. DATA EXTRACTION Quality of the studies was determined by the design of each study and the ability to combine the data with the results of other studies. All of the studies were biased by their retrospective, nonrandomized nature. DATA SYNTHESIS Significance (p < 0.05) was determined using the chi2 test. CONCLUSIONS Cerebrospinal fluid leak occurred in 10.6% of 2,273 retrosigmoid surgeries, 9.5% of 3,118 translabyrinthine surgeries, and 10.6% of 573 middle fossa surgeries. The type of cerebrospinal fluid leak was not associated with surgical approach. Meningitis was significantly associated with cerebrospinal fluid leak (p < 0.05). Age and tumor size were not associated with cerebrospinal fluid leak.
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Affiliation(s)
- Samuel H Selesnick
- Department of Otorhinolaryngology, Weill College of Medicine of Cornell University, New York, New York 10021, USA.
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Abstract
OBJECTIVE The objective of this study was to describe our results of ossicular reconstruction using bone cement. STUDY DESIGN We conducted a retrospective review of 264 patients with chronic suppurative otitis media operated on since 1999. SETTING Academic tertiary referral center. PATIENTS : Two hundred sixty-four patients with chronic suppurative otitis media underwent mastoidectomy with tympanoplasty. Eighty patients had incudostapedial disarticulation secondary to infection and or cholesteatoma and were reconstructed using an incus interposition graft (n = 31), a partial ossicular prosthesis (POP; n = 31), or more recently, bone source (n = 18). This study evaluates the results of the ossiculoplasties using bone source. INTERVENTION Ossicular discontinuity was repaired using bone cement. MAIN OUTCOME MEASURE Audiometric studies pre- and postintervention were compared. One to 3 years of follow up are provided. RESULTS Preoperative air-bone gaps ranged from 18 dB to 60 dB and averaged 33 dB. Postoperative air-bone gaps ranged from 1 to 24 dB and averaged 10 dB. No patients have experienced any increase in their persistent conductive hearing loss. The pre-/postoperative hearing loss comparisons showed statistically significant hearing improvement. There were no complications. CONCLUSION The use of POPs and incus interposition grafts is fraught with the possibility of migration and resultant recurrent conductive hearing loss. Using bone cement to reconstruct the ossicular chain restores the integrity of the ossicular chain in the most natural of ways. This reconstruction technique provides an excellent alternative to currently accepted methods and should be considered for incus-stapes disarticulation. There has been no dissolution of the bone source and the results have persisted thus far.
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Chen DA, Arriaga MA. Technical refinements and precautions during ionomeric cement reconstruction of incus erosion during revision stapedectomy. Laryngoscope 2003; 113:848-52. [PMID: 12792321 DOI: 10.1097/00005537-200305000-00014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The study describes the technical precautions and short-term hearing results of fast-setting ionomeric cement (SerenoCem) for managing incus erosion in revision stapedectomy. STUDY DESIGN Observational and retrospective chart review. METHODS Consecutive patients undergoing ionomeric cement incus reconstruction during revision stapedectomy had surgery on an ambulatory basis in a tertiary care referral center. Main outcome measures included technical details, precautions, and recommendations for handling this new material and 6-week hearing outcomes comparing preoperative and postoperative air-conduction and bone-conduction thresholds. RESULTS A small amount of ionomeric cement on the tip of otological picks applied to the incus remnant successfully reconstitutes the original length of the long process of the incus. In revision stapedectomy, a crimp-on prosthesis may be placed on the cement-lengthened incus. Six-week postoperative audiograms demonstrated significant closure of the air-bone gap in operated cases. Our experience in a failed case leads us to recommend that the setting time for the cement be increased to no less than 20 minutes as opposed to the manufacturer's recommendation of 10 minutes. Also, revision stapedectomy was more likely to be successful when the prosthesis was placed to the incus remnant and stabilized with cement, rather than placing the prosthesis on the cement itself. CONCLUSIONS Ionomeric cement permits direct reconstruction of a pathologically shortened incus in revision stapedectomy. Surgeons must be aware of precaution and limitations of this new material. Preliminary results indicate significant hearing improvement with this technique when appropriate precautions are taken.
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Affiliation(s)
- Douglas A Chen
- Pittsburgh Ear Associates-Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
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Ozer E, Bayazit YA, Kanlikama M, Mumbuc S, Ozen Z. Incudostapedial rebridging ossiculoplasty with bone cement. Otol Neurotol 2002; 23:643-6. [PMID: 12218612 DOI: 10.1097/00129492-200209000-00006] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study reports the authors' technique and hearing results with bone cement reconstruction of the incudostapedial chain. The technique is called incudostapedial rebridging ossiculoplasty. STUDY DESIGN A retrospective analysis of the hearing results of the incudostapedial rebridging ossiculoplasty was performed on 15 patients. BACKGROUND Recently, bone cements have been available commercially, and their use in otologic surgery is increasing. Polymaleinate glass ionomer cement is a commercially available bone cement that can be used to reconstruct a discontinuity between the incus and the stapes. SETTING Tertiary referral center. PATIENTS Disease-free or cleansed middle ear and mastoid and intact ossicular chain except for discontinuity between the long process of the incus and the head of the stapes. INTERVENTIONS Therapeutic. MAIN OUTCOMES MEASURES Functional results of incudostapedial rebridging ossiculoplasty. RESULTS Of 15 patients, 9 achieved a successful hearing result (an air-bone gap within 20 dB) with incudostapedial rebridging ossiculoplasty after 1 year. The mean preoperative and postoperative air-bone gaps were 32.9 and 14.3 dB, respectively. CONCLUSIONS Incudostapedial rebridging ossiculoplasty with bone cement is a cost-effective and safe procedure that yields good hearing results in selected patients.
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Affiliation(s)
- Enver Ozer
- Department of Otolaryngology, Faculty of Medicine, Gaziantep University, Turkey.
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