Search

• The cause of unilateral serous otitis media should be investigated at five levels of the temporal tone. • The most common level for Eustachian tube obstruction is by edema in the nasopharynx. • Neoplastic causes for serous otitis media may be in the nasopharynx, infratemporal fossa or the petrous apex. • A nonobstructive cause of serous otitis media is spontaneous cerebrospinal fluid leak. • Pediatric preformed pathways for cerebrospinal fluid are: - Enlarged fallopian canal - Tympanomeningeal (Hyrtl's) fissure - Mondini dysplasia • Adult preformed dural defects are caused by AGs. [ABSTRACT FROM AUTHOR]

• Implantation of a multiple-channel electrode prosthesis has proven to be a successful approach to the profoundly deafened patient, acquired or congenital. • The results in the post lingual deafened patient are superior to those in the patients with congenital forms of profound hearing loss. • Insertion of the prosthesis close to spiral ganglion cells in Rosenthal's canal (scala tympani is the desired location). • The intracochlear prosthesis may be introduced via a transmastoid approach through the facial recess or a transcanal approach through the posterior epitympanic space. [ABSTRACT FROM AUTHOR]

• The most common benign tumors in the TB are the vestibular schwannoma (acoustic neuroma) and the paraganglioma (glomus tumor). • Other benign tumors of the internal auditory canal include meningioma, epidermoid, lipoma, and arachnoid cyst. Additional benign tumors in the middle ear include adenoma, carcinoid, chondroma, and schwannoma. • Treatment of vestibular schwannoma may be nonsurgical (irradiation) or surgical. In the medically stable young patient, surgery is preferred, while irradiation is effective in the elderly or medically compromised patient. • Surgical approach to vestibular schwannoma may utilize either the posterior or middle cranial fossa. Posterior fossa approach may be transmastoid translabyrinthine (no hearing) or suboccipital (hearing preservation). The middle fossa approach is employed for tumors limited to the internal auditory canal, where hearing is to be preserved. • Glomus tumors may be limited to the middle ear space (glomus tympanicum) or arise in the jugular bulb and extend to the middle ear, mastoid, neck and other perilabyrinthine compartments (glomus jugulare). • Glomus tympanicum tumors are best removed through an endaural surgical approach. • Glomus jugulare tumors require an extended lateral skull base approach including the neck and wide TB exenteration. Preoperative endovascular embolization is not effective in reducing blood loss. • Partial (lateral) TB resection is an effective surgical procedure for carcinoma limited to the external auditory canal. • Pseudoepithelial hyperplasia may simulate squamous cell carcinoma of the ear canal clinically and histopathologically. [ABSTRACT FROM AUTHOR]

• The cause of most recurrent vestibulopathies is viral. The syndromes known as vestibular neuronitis, Ménière's disease, and benign paroxysmal positional vertigo account for the majority of these presentations. Others that do not fulfill the criteria for these three account for the remainder. • These recurrent vestibulopathies are viral neuropathies caused by neurotropic viruses (e.g., Herpesviridae family). • Initial treatment of these vestibulopathies is the use of antiviral agents orally or by intratympanic administration. • Ablation therapy is used when the antiviral approach fails to control vertigo. • Selective vestibular ablation of one ear may be accomplished by intratympanic gentamycin or selective vestibular nerve transaction. • Selective bilateral vestibular ablation is best achieved by parenteral administration of streptomycin sulfate. • Nonselective ablation of vestibular function is achieved by labyrinthectomy. • Refractory benign paroxysmal positional vertigo (posterior canal) is relieved by singular neurectomy. [ABSTRACT FROM AUTHOR]

• Functional components of the facial nerve include: - General efferents to facial muscles - Secretomotor preganglionic efferents to the submandibular, lacrimal, and nasal glands - Special sensory to taste receptors in the tongue and palate/nasal pharynx - Somatic sensory to the skin of external auditory canal and concha • The motor axons to regional facial muscle groups are mixed, not compartmentalized, through the temporal course of the facial nerve. • The sensory ganglia of the facial nerve are the geniculate and meatal ganglia. • Surgery is usually indicated for facial nerve paralysis secondary to chronic otitis media, transverse TB fracture, neoplasia, ear surgery, and pseudotumor. • Surgery is usually not indicated in idiopathic facial paralysis (Bell's palsy) and longitudinal TB fracture. [ABSTRACT FROM AUTHOR]

• Two categories of spontaneous cerebral spinal fluid otorhhea: (1) pediatric: ages 1-5 years, (2) adult: over 50 years of age • Pediatric preformed pathways are: - Enlarged fallopian canal - Patent tympanomeningeal (Hyrtl's) fissure - Mondini dysplasia with communication to internal auditory canal • The adult form is caused by enlarging arachnoid granulations through the middle fossa or posterior fossa surfaces of the temporal bone. • CT (1-mm cuts) of the temporal bone in both axial and coronal planes is best to demonstrate the bony defect and associated soft tissue mass. • Surgical repair (middle fossa approach for tegmen defects; mastoidectomy for posterior fossa defects) with soft tissue repair is recommended. [ABSTRACT FROM AUTHOR]

• Obstructive lesions of the external auditory canal require surgical management when conductive hearing loss, retained epithelial debris, and recurrent canal infection is present. • Surgical method requires adequate enlargement of the bony and cartilaginous segments with re-epithelialization employing skin flaps or split thickness skin grafts. [ABSTRACT FROM AUTHOR]

• Cholesteatoma may be acquired or congenital. • Acquired cholesteatoma is the result of retraction pocket extension, invasion through a perforation, or trapped epithelium from a temporal bone fracture. • Congenital cholesteatoma represents the isolation of squamous epithelial elements in the temporal bone during development. These are located in the middle ear, petrous apex, or mastoid compartment. • As a rule, the cholesteatoma epithelial lining should be surgically removed although instances exist where marsupialization may prevent enlargement. [ABSTRACT FROM AUTHOR]