ObjectivesUnderstanding the pattern of middle-ear cholesteatoma becomes pertinent with the rise of endoscopic surgery as surgeons decide on the optimal approach to visualise and extirpate disease. With modifications to the Telmesani attic–tympanum–mastoid staging system, this study aimed to evaluate the commonest patterns of middle-ear cholesteatoma and their implications for surgical approach.MethodsA retrospective study was conducted in a single tertiary institution in Singapore. All patients undergoing cholesteatoma surgery between January 2012 and June 2015 were included. Staging of cholesteatoma was based on clinical assessment corroborated by radiological findings.ResultsOut of the 55 ears included, 98.2 per cent had cholesteatoma involving the attic. The disease extended into the mastoid antrum and beyond in 43 cases (78.2 per cent). The facial recess and/or sinus tympanum was affected in 26 cases (47.3 per cent).ConclusionThe majority of cholesteatoma cases present with extensive attic disease and significant mastoid involvement. In these cases, endoscopes may be best suited to adjunctive rather than exclusive use in surgery.
Objectives: Tonsillectomies and adenotonsillectomies are among the most common procedures to be carried out in children throughout the world. Postoperative hemorrhages have previously been reported to be at a maximum expected rate of 13.9% with a mean of 4.5%. This study reports the postoperative hemostasis rate at the KK Women’s and Children Hospital, Singapore, a tertiary pediatric hospital. Methods: Retrospective study of tonsillectomy and adenotonsillectomy cases done on children up to 16 years of age from the end of January 2007 till early January 2013. The number of postoperative bleeds that required return to the operating room for hemostasis was recorded. Results: In total there were 2322 tonsillectomy cases. 1581 were adenotonsillectomies, and 741 were bilateral tonsillectomies only (without adenoidectomy). There were 33 cases that required return to the operating room for hemostasis, giving a postoperative hemostasis rate of 1.42%. There were no cases of bleeding from adenoidectomy. All 2322 cases were done with monopolar diathermy. Hemostasis intraoperatively was also done with monopolar diathermy. The operating surgeons ranged from first year residents to senior consultants. Conclusions: The postoperative hemostasis rate following tonsillectomy and adenotonsillectomy at KK Women’s and Children’s Hospital is 1.42%, comparable to the best rates quoted in the literature .
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