There is general agreement that the delivery of topical nasal medication by sprays is suboptimal. This study examines the distribution of spray to the anterior end of the middle turbinate as a guide to the distribution to the middle meatus by means of an endoscopic photographic comparison using dyed aqueous nasal spray. The technique was found to be reproducible. The effect of vigorously inhaling whilst spraying was studied by means of a randomized crossover trial and was found to have no significant effect. This technique could be used in conjunction with other means of assessing intranasal distribution when assessing improved topical nasal drug delivery systems.
The ossified cochlea poses both concerns and challenges to any implant team. One of the surgical aims is to implant as many of an implant system's electrodes into the cochlea as close to the modiolus as possible, thus facilitating stimulation of the surviving cell bodies in the spiral ganglion. Within the field of otorhinolaryngology various surgical navigation systems have been introduced to facilitate surgical orientation during endoscopic sinus and skull-base surgery. The principle behind such systems is that specialized software uses high-resolution computerized tomography and magnetic resonance imaging scans to create a 3D image of the patient's anatomy. This 'virtual patient model' is then 'registered' with the patient's anatomical landmarks. Surgical instruments registered into, or linked with, the system can then be tracked within the 3D model. This is the first time this system has been described for surgery of the inner ear, and we describe how the technique allows more precise control of the bur tip while drilling tunnels that approximate with the apical and distal parts of the basal coil of the ossified cochlea.
The ossified cochlea poses both concerns and challenges to any implant team. One of the surgical aims is to implant as many of an implant system's electrodes into the cochlea as close to the modiolus as possible, thus facilitating stimulation of the surviving cell bodies in the spiral ganglion. Within the field of otorhinolaryngology various surgical navigation systems have been introduced to facilitate surgical orientation during endoscopic sinus and skull-base surgery. The principle behind such systems is that specialized software uses high-resolution computerized tomography and magnetic resonance imaging scans to create a 3D image of the patient's anatomy. This 'virtual patient model' is then 'registered' with the patient's anatomical landmarks. Surgical instruments registered into, or linked with, the system can then be tracked within the 3D model. This is the first time this system has been described for surgery of the inner ear, and we describe how the technique allows more precise control of the bur tip while drilling tunnels that approximate with the apical and distal parts of the basal coil of the ossified cochlea.
The patientIn 1997, Mr O, at the age of 50 years, developed pneumococcal meningitis. As a result he suffered a profound hearing loss but, apart from initial vertiginous problems, no other sequelae. He was promptly referred and assessed but did not want an implant. Two years later he returned having changed his mind. Computerized tomography (CT) imaging at this stage showed total ossification
Cochlear implantation is a surgical procedure with progressively widening indications in the management of profound deafness. In the majority of cases the operation involves the formation of a posterior tympanotomy for electrode insertion. This process carries documented risks to the mastoid portion of the facial nerve. Here we summarize the variations found in the mastoid portion of the facial nerve, discuss the surgical methods that optimize nerve safety and present the Yorkshire Cochlear Implant Unit's series.
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