Skull base osteomyelitis is a serious disease with a high risk of complications including neuroinfection. Typically, the inflammation of the skull base results from infection from neighboring tissues. In case of malignant otitis externa, inflammation disseminates from the external auditory canal. In this study, we present our experience with seven patients diagnosed with skull base osteomyelitis that began with otitis externa and have been treated in our department for the last 10 years. Department Patient Database was searched for the diagnosis skull base osteomyelitis. The search covered the last 10 years. The search revealed seven patients who met the above-described criteria. Medical records of those patients were carefully analyzed including age, gender, symptoms and signs, diagnostics details, treatment, performed procedures, number of hospitalization days, comorbid diseases, and complications including any cranial nerve palsy. Detailed analysis of medical records of patients included in this study showed that skull base osteomyelitis presents a challenge for diagnosis and treatment. Treatment strategy requires prolonged aggressive intravenous antibiotic therapy, and in some cases combined with surgical intervention. Cranial nerve paresis indicates progression of the disease and is associated with longer hospital stay. Similar relationship is observed in patients with skull base osteomyelitis that required surgery. Diabetes in patient’s medical history may complicate the healing process. Diabetes, neural involvement, and surgery may overlap each other resulting in longer hospital stay. Cranial nerve paresis may not resolve completely and some neural deficits become persistent.
IntroductionEndoscopic-assisted microsurgery of the middle ear enables the field of view of the surgeon to be expanded during the removal of inflammatory tissue from the tympanic cavity and during myringo- and ossiculoplasty. Canal wall up tympanoplasty with posterior tympanotomy is a gold standard in surgical treatment of chronic otitis media. Most applications of endoscopy in middle ear surgery concern exclusively the endoscopic transcanal approach.AimTo determine the usefulness of endoscopic visualization during the standard surgical approach through the posterior tympanotomy.Material and methodsThe study compared the visualization of the elements of the middle ear through the posterior tympanotomy by endoscopes with 30° and 45° optics and a microscope. Posterior tympanotomy was performed in eleven temporal bones. Visualization of the tympanic recesses was assessed on a subjective scale. A microscope and 30° and 45° endoscopes were used for inspection of the hypotympanum, sinus tympani, Eustachian tube, Prussak's space and footplate. Friedman ANOVA test and Dunn's multiple comparisons test were used for statistical analysis of the data.ResultsVisualization of particular recesses by endoscopes, both 30° and 45°, was excellent, while the microscopic view was statistically significantly worse, especially for sinus tympani, Prussak's space and footplate. There were no significant differences in visibility of the middle ear spaces between the two types of endoscopic optics.ConclusionsAdditional application of the endoscopes during middle ear surgery provides valuable information due to excellent visualization of key recesses usually hidden from the microscope.
Endoscopy is used in the middle ear surgery for above twenty years when decrease of cholesteatoma recurrence due to employing endoscope was revealed in comparison to standard microscopic only visualisation. Endoscopy may be the only way of visualisation in transcanal myringoplasty for the retraction pocket, stapedoplasty and transcanal ossiculoplasty. In canal wall up or second look tympanoplasty with mastoidectomy and posterior tympanotomy endoscopy may serve as an additional point of view supported the classical microscopical technique. In result of many manners in surgical treatment of chronic otitis media, there are very concept for endoscopy application. In the ENT Department at Medical University of Warsaw were performed 53 procedures by aid of endoscopy in period from September 2009 to December 2010. In this study there were 18 canal wall up tympanoplasties, 12 second look tympanoplasties and 8 canal wall down tympanoplasties. According to authors' experience endoscopy is the most useful in: There were three cases of cholesteatoma recurrence in the study found only due to endoscope support. In authors' opinion, the endoscopy is the useful tool in surgical treatment of chronic otitis media. Application of endoscopy during the middle ear surgery results in decrease in frequency of cholestatoma recurrence and increase in the effectiveness of the ossiculoplasty.
IntroductionThe anterior epitympanum recess (AER) is a common place of the development of the cholesteatoma, which is why removal of the matrix from this area plays a key role in the surgical treatment of chronic otitis media.AimTo evaluate the intraoperative visibility of AER in endoscopic optics in comparison to microscopic optics and to determine the prevalence of cholesteatoma in various types of construction of the AER. Study design: retrospective analysis of intraoperative search.Material and methodsThe study included 55 patients treated in the Department of Otolaryngology, Medical University of Warsaw within the years 2009–2011, who underwent endoscopy-assisted canal wall up tympanoplasty with posterior tympanotomy. The type of construction of the AER – cellular or dome-shaped – was determined.ResultsCellular type of recess was found intraoperatively in 32% of ears and dome-shaped in 68% of the study group. The population with chronic otitis media does not differ significantly compared to the general population in terms of the construction of the anterior epitympanum recess (p = 0.668108; χ2 = 0.1838235, df = 1). Among the ears with cholesteatoma a cellular AER was found in 48.3% of cases and a dome-shaped AER was found in 51.7%.ConclusionsThe cellular type of AER was significantly more frequent in ears with cholesteatoma (p < 0.01, χ2 = 29.86492, df = 1). Level of evidence: 1b.
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