The results of this study suggested that intermittent treatment with topical 9-mg sodium hyaluronate plays a role in minimizing symptoms and could prevent exacerbations of CRS.
Background:
The present article aims to introduce the endolymphatic duct and sac decompression technique (DASD) and to give a spotlight on its benefits in Ménière’s disease (MD) treatment.
Methods:
Eighty-two patients with intractable MD which met the inclusion criteria were recruited and underwent DASD. This technique allows a meningeal decompression of the duct and the sac from the posterior cranial fossa to the labyrinthine block. The authors considered as main outcomes, the change of the dizziness handicap inventory (DHI) results, with the evaluations of the three sub-scales (Functional scale, Physical scale, and Emotional scale); ear fullness and tinnitus change on the perceptions of the patient; and hearing stage with four-Pure Tone Average (500 hz-1000 hz-2000 hz-4000 hz). The differences between the preoperative and the postoperative score were evaluated. A comparison with the literature was conducted.
Results:
After a 14-month follow-up, patients that underwent DASD reported a remarkable improvement of the symptoms in all three functional scales, confirmed by the total DHI. The difference between preoperative and postoperative scores is statistically significant. The data describe an ear fullness and tinnitus improvement. The multi-frequency tonal average before and after the surgery does not suggest a worsening of the value for any of 82 patients.
Conclusion:
The modification of sac surgery includes the endolymphatic duct in the decompression area allowing inner ear functional improvement, vertigo control, ear fullness improvement with minimal risk of facial nerve paralysis, and hearing loss. DASD is an improved old surgical technique.
Complications of middle ear cholesteatoma are well described in the literature and are classified into two major categories: intratemporal and intracranial. They are due either to infection or to local extension of the disease and consequent invasion of surrounding tissues. We describe an unusual case of an extratemporal complication in a young woman who was treated at our service. Ten years previously she had undergone canal-wall-down tympanoplasty that did not achieve complete control of the disease. At this admission, the patient was found to have peculiar extension of the recurrent cholesteatoma into the temporozygomatic area. She underwent tympanoplasty of the canal wall using a targeted surgical technique. We resected the recurrent cholesteatoma en bloc without damaging the facial nerve despite extension of the mass to the ear and face. Follow-up was performed each year for 7 years without evidence of recurrence. Cholesteatomas are highly osteolytic, and extension of any residual cholesteatoma is unpredictable. Cholesteatoma of the middle ear requires a careful surgical approach to avoid complications, maintaining awareness of its possible extension into surrounding structures.
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