We have replaced radical or partial mastoidectomy with tympanoplasty under the operative microscopy in order to reconstruct ear function step by step. From 1995 to 1998 with 210 cases, we have used 4 operating methods: 1. Radical or partial mastoidectomy, regarding to COM with cholesteatoma (34 cases). 2. Modified radical mastoidectomy with canal wall down technique (22 cases). 3. One-stage tympanoplasty with Cana Wall up technique (120 cases). 4. One-stage tympanoplasty with posterior tympanotomy (34 cases).
Otitis Media ; therapeutics ; surgery

Humans ; Otitis Media ; classification ; pathology ; surgery

Body Fluids ; Child ; Humans ; Middle Ear Ventilation ; Otitis Media ; Otitis Media with Effusion/surgery*

Child ; Humans ; Middle Ear Ventilation ; Otitis Media ; Otitis Media with Effusion ; surgery ; Recurrence

Humans ; Mastoiditis ; diagnosis ; surgery ; Otitis Media ; diagnosis ; surgery

Intracranial abscess is a serious, life-threatening condition with a dire prognosis. Although the advent of the antibiotic era has drastically reduced the incidence of the disease, predisposing factors such as untreated ear infections, poor personal hygiene, significant trauma with violation of the sterile cranial environment as well as existing co-morbidities such as an immunocompromised state make intracranial abscess a horrifying reality. Ear infections, in particular, are notorious for being the origin of roughly 50% of cerebellar abscesses.1 Chronic suppurative otitis media (CSOM) is one of the leading causes of brain abscess. Shaw and Russell2 reviewed 47 cases of cerebellar abscess and showed that 93% were caused by CSOM; the most common mechanism of entry into the brain parenchyma being direct extension. Chronic infection in the middle ear space could erode through the tegmen tympani and into the temporal lobe or through the tegmen mastoidei into the cerebellum. Neurological symptoms may be delayed as the abscess ‘grows’ in areas around the cerebellum that are regarded as ‘silent’, until vital areas such as those responsible for coordination and balance are violated. We describe a case of cerebellar abscess secondary to CSOM and discuss the possibility of performing ear surgery with simultaneous drainage of a contiguous abscess through a transmastoid approach in cases of chronic suppurative otitis media with intracranial complications.
Human ; Male ; Young Adult ; EAR DISEASES ; OTITIS ; Otitis Media, Suppurative ; OTITIS MEDIA-COMPLICATIONS, suppuration, SURGERY ; CHRONIC EAR DISEASE ; pain ; Headache

Humans ; Otitis Media ; classification ; surgery ; Practice Guidelines as Topic

OBJECTIVE: To investigate the influence of drying the ear canal by cleaning the focus of infection in the posterior tympanum in middle ear operations. METHOD: Retrospectively analyze 168 cases of middle ear operations, which were divided into two groups by whether the posterior tympanum was open or not in the operation process. Then comparing the drying ear rate. RESULT: The drying ear rate (DEC) were 81.7% (67/82) and 91.9% (79/86) in the posterior tympanum unopened and opened group, respectively. In the posterior tympanum unopened group, the DEC rate were 78.9% (30/38) and 84.1% (37/44) in 38 cases of chronic otitis media and mastoiditis with cholesteatoma and in 44 cases of chronic otitis media and mastoiditis with granulation tissue, respectively. In the posterior tympanum opened group, the DEC rate were 88.2% (37/42) and 94.7% (42/44) in 42 cases of chronic otitis media and mastoiditis with cholesteatoma and in 44 cases of chronic otitis media and mastoiditis with granulation tissue, respectively. In the posterior tympanum unopened group, the DEC rate were 81.7% (36/44) and 84.6% (34/38) in 44 cases of radical mastoidectomy and in 38 cases of tympanoplasty; compared with the posterior tympanum opened group, the DEC rate were 91.3% (42/46) and 92.5% (37/40) correspondingly. CONCLUSION In the middle ear operation, open the posterior tympanum in convention can not only have profits to clear the insidious focus of infection, but also have profits to skeletonized to lower facial ridge to the utmost limits and make the drainage of the ear canal easy and smooth. At last, the rate of DEC was raised.
Cholesteatoma, Middle Ear ; surgery ; Ear, Middle ; surgery ; Humans ; Otitis Media ; surgery ; Otitis Media, Suppurative ; surgery ; Retrospective Studies ; Treatment Outcome ; Tympanoplasty ; methods

OBJECTIVETo investigate the clinical significance of intact canal wall mastoidectomy combined with facial recess opening in the treatment of secretory otitis media of children.

METHODSThe clinical data of 17 children (19 ears) with recurrent secretory otitis media yet failed tube insertion more than 3 times, and treated with intact canal wall mastoidectomy combined with facial recess opening, in the Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of SUN Yat-sen University, were reviewed. And because of the eustachian tube dysfunction, 7 ears simultaneously accepted tube insertion, which were removed after 1 to 3 months.

RESULTSPathological examination of the lesions in middle ear and mastoid of the 19 ears, revealed cholesterol granuloma in 9 ears and inflammatory granulation in 10 ears. All 19 ears recovered with normal tympanic membranes. There were 16 ears with type A tympanogram and 3 ears with type C tympanogram (negative pressure less than 150 mm H₂O). The air-bone gaps were less than 15 dB in 3 months after surgery. There was no recurrence in all cases after 2 - 3 years follow-up.

CONCLUSIONSIn case of recurrent otitis media in children, especially when tube insertion is ineffective, intact canal wall mastoidectomy combined with facial recess opening can be adopted to clear the lesions thoroughly, and to establish long-time and effective ventilation of eustachian tube, tympanic cavity, tympanic antrum, and mastoid.

Adolescent ; Child ; Face ; surgery ; Female ; Humans ; Male ; Mastoid ; surgery ; Otitis Media with Effusion ; surgery ; Retrospective Studies

Posterior tympanotomy is a procedure performed to access the posterior mesotympanum through a mastoid exposure while preserving the posterior external auditory canal wall. It is dangereous to drill the the site of procedure, as it is surrounded by incuidal fossa superiorly, facial nerve posteriomedially, and chorda tympani nerve anterolaterally, and forms a very narrow pathway. There is always a risk of surgical trauma involving important surgical structures, especially facial nerve and chorda tympani nerve. The development of image-guided surgery (IGS) has significantly improved the performance of many surgical procedures by aiding the identification of surgical landmarks, improving surgical outcomes, rendering the procedure safer and more efficient, especially for beginner otologic surgery, in revision operations, in cases of massive bleeding and tumor of complex anatomy. To see how IGS could help otologic surgeons to identify fine, important structures during posterior tympanotomy, we report a case of posterior tympanotomy in chronic otitis media, which was done using the image-guided surgical technique.
Chorda Tympani Nerve ; Ear Canal ; Facial Nerve ; General Surgery ; Hemorrhage ; Mastoid ; Otitis Media* ; Otitis* ; Surgery, Computer-Assisted ; Wounds and Injuries