We observed a significant discrepancy between ioABR and follow-up hearing thresholds. If ioABR indicates a hearing loss, audiologic testing should be performed at least several weeks later to confirm the results.
OBJECTIVE: 1) Define the role of preoperative investigations for an accurate diagnosis of site/extension of the skull base defect (SBD). 2) Identify different solutions in performing duraplasty, choosing among available techniques/materials. 3) Evaluate the efficacy and safety of the endoscopic endonasal approach in pediatric age. METHOD: From 2000 to 2010, 26 patients (14 males, 12 females, mean age 8.9 years) affected by SBD referred to our Institute. The diagnostic work-up provided endoscopic examination and neuroimaging with CT and MR. Intraoperative intrathecal fluorescein test was performed during surgery to display the defects site/s and ensure a watertight duraplasty. Follow-up was carried out with periodic endoscopic and MR evaluation. RESULTS: Pediatric SBDs represent 9.6% of our experience in cerebrospinal fluid leaks treatment. 14 patients were affected by spontaneous defects, 12 by traumatic defects (2 iatrogenic, 10 accidental). 21 patients were treated with a pure endoscopic technique, 5 patients underwent a combined, endoscopic endonasal and craniotomic surgical approach. Duraplasty was performed with single/double layer (11) or multilayer (15) technique, depending on the site. The most employed materials were autologous. No intra-and postoperative complications were observed. Mean follow up was 5.5 years. CONCLUSION: SBDs are rare conditions, which require surgical treatment in order to avoid serious complications. Our experience highlights that an accurate preoperative assessment of the defect is mandatory to guarantee the proper selection of the surgical technique. The use of dedicated instruments grants a minimally invasive surgical approach, which decreases the risk of functional/aesthetic strings. Larger and longer studies are needed.
Objectives Understand the utility of intraoperative ABR testing after myringotomy and tube placement. Methods We performed a retrospective chart review of 27 patients (mean age 23 months) who underwent intraoperative ABR (ioABR) after myringotomy and tube placement at Primary Childrens Medical Center from 2004 to 2007. Paired t-tests were perfomed to analyze the difference in threshold levels from the ioABR to follow up behavioral audiometry at 1kHz and 4kHz frequencies, accounting for the presence or absence of fluid at the time of surgery. Results 15 patients (29 ears) showed a mean improvement of 10 dB at the 1 kHz frequency (p=0.007), and 16 patients (31 ears) improved by 5 dB at 4kHz (p=0.83). An improvement of at least 15 dB was seen in 45% of patients (13/29 ears) at 1 kHz and in 26% (8/31 ears) at 4 kHz; 5 patients improved by as much as 35–50 dB. Of the patients whose thresholds improved by at least 15 dB, 77% at 1 kHz and 83% at 4 kHz showed evidence of fluid at the time of the ioABR Conclusions Patients who undergo ioABR testing show a significant improvement of dB level on follow-up behavioral audiometry. Many patients whose hearing threshold improved by at least 15 dB had fluid at the time of myringotomy. Therefore, the presence of middle ear pathology may lead to an overestimation of ioABR thresholds. Consequently, ioABR results should be interpreted with caution in isolation, and subsequent audiometric testing should always be performed to validate prior results.
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