Variation among pre-surgical CT assessments of chronic otitis media

OBJECTIVE

To investigate the reliability of preoperative computed tomography (CT) in patients with chronic otitis media (COM) as assessed by otologist-ENT surgeons, compared with surgical findings and respective radiological assessments, and to identify areas of the middle ear that are difficult to evaluate reliably with preoperative CT.

MATERIALS AND METHODS

Fifty patients with COM underwent preoperative temporal bone CT reported by a qualified radiologist. Each operating surgeon completed a standardized questionnaire regarding the status of 10 middle-ear structures after the operation. Two otologists blindly reviewed the scans. AC1-statistics between the radiology/otology report and the intra-operative findings were calculated.

RESULTS

In the attic, malleus-incus complex, tympanic cavity, and round window niche, the otologists' assessments of CT scans corresponded better to intra-operative findings than did the respective radiology report. In the lateral semicircular canal and sigmoid sinus, the otologists' assessments also outperformed those of the radiologists in cases of erosion. Radiological assessments outperformed those of otologists in only one of 10 studied areas: confirmation of an unexposed dura in the tegmen area. The scutum and oval window represent difficult areas for which to obtain a reliable preoperative CT scan report.

CONCLUSION

Otologists' assessments regarding the pre-surgical status of the temporal bone in COM appear more reliable than those of radiologists. This finding has serious implications in current clinical practice, and should be considered when designing strategies for Radiology Head & Neck training. The inherent limitations of CT may necessitate modifications to imaging and operating strategies.

Surgical correction of pinna malformations

BACKGROUND

Auricle reconstruction is a surgical procedure described in the medical literature as early as 600 BC. The aim of the present paper is to review these attempts and their results.

METHODS

Literature search and medical history books were used as scientific sources.

RESULTS

More than 40 different cartilagenous, osseous or other alloplastic frame materials (autogenous tibial bone, iliac bone, mastoid bone, maternal auricular cartilage, autogenous nasoseptal cartilage, allogenous meniscus, autogenous meniscus and many more) have been used since 1891. From approximately 40 reconstruction procedures that had been proposed, only eight were still in use in the 1980s. The reason for abandoning the majority of these surgical techniques was the unacceptable aesthetic result. However, at the end of the 20th Century two new techniques were introduced. These techniques were designed by Satoru Nagata and Burt Brent. Both techniques provide cosmetic and functional results that are acceptable both to the patient and to the surgeon.

CONCLUSIONS

Although the outcome of surgical auricle reconstruction was in general disappointing through the centuries, at the end of the 20th Century new surgical methods were established and at the present time auricle reconstruction can be attempted with acceptable results.

Topical antibiotic ear drops: are they safe?

A discharging ear is a very common condition for the general practitioner and the ENT surgeon. Oral and intravenous antibiotics have potential complications, are costly, and exhibit increasing resistance. This study explores the advantages and disadvantages of all common otic preparations and compares effectiveness, safety, cost and complication rates. In chronic otitis media (chronic discharging ears), topical antibiotics seem to be the treatment of choice by comparison with oral or intravenous antibiotics. Cultures and antibiograms do not correspond directly to clinical efficacy, as laboratory determination of resistance does not take into account the high concentration of antibiotics in local preparations. It is safer to use quinolone drops as a first-line treatment, but it is still possible to use short courses of other drops if quinolones are either unavailable or contraindicated (e.g. allergy), or when bacteria are resistant to them. However, in such a situation, a round window membrane involved in an established inflammatory process and therefore less permeable to the passage of topical preparations is the preferred setting, as ototoxicity is a potential complication, especially in the case of gentamicin, in which case patients should be warned accordingly.