Introduction. Literature review search did not show enough information to answer the question concerning the need to remove hair in the external auditory canal as a part of preoperative preparation of the surgical field in middle ear surgery with endaural and transcanal approaches.Aim of the study. To substantiate the removal of hair from the external auditory canal during transcanal and endaural otosurgery.Materials and methods. A prospective randomized study included 2 groups. In the first group, tympanoplasty and stapedoplasty were performed via endaural approach with and without hair removal in the external auditory canal. The effect on the intraoperative overview and postoperative wound healing was assessed. Shunting of the tympanic cavity in the second group, with transcanal approach, have been performed under the control of a microscope and endoscope. The evaluation was done via a questionnaire, it was given to the doctor before and after hair removal separately. Postoperative inflammatory reaction was also assessed.Results. Postoperative wound healing of the external auditory canal in the first group were considered comparable between the main and the control group, and had no complications. In the second group, inflammation was absent in all patients. Hair removal significantly improve the visibility in endaural and transcanal approach.Conclusions. Hair removal from the external auditory canal increases the visibility of the surgical field and facilitates the work of an otosurgeon. It is especially recommended as a preoperative preparation, especially for transcanal surgical interventions on the middle ear under endoscope control.
Introduction. Preoperative, in particular, antiseptic, preparation of the external auditory canal (EAC) is an important issue for the otosurgeon to take in mind, especially with endaural approach.The aim of the study is to assess the skin microbiota of the EAC and the effectiveness of antiseptic treatment before endaural intervention.Materials and methods. A prospective study including 19 patients who underwent ear surgery by endaural approach: 10 stapedoplasty; 9 tympanoplasty. Ear swabs culture were taken from all the patients preoperatively and after removing the tamponade. Of the 10 patients with otosclerosis, 5 underwent skin preparation with 10% povidone iodine and a swab culture.Results. According to the microbiological examination results, Staphulacoccus Auricularis prevailed in the first smear - 52.6%. In 5 patients with otosclerosis, in comparison to the 1st swab: one case with absence of microorganisms growth, in the other 4 -decrease in the degree of contamination by half. In the 3rd swab, there was no growth in these patients and in the rest, who didn't undergo antiseptic preparation. Patients, without antiseptic preparation of the ear canal, after tympanoplasty (9 patients) in the second smear, had an increase of contamination (from 105 to 106 CFU/ml).Conclusions. Analysis of the microbiome before and after the operation revealed the growth of predominantly (94.7%) opportunistic microorganisms. Preoperative antiseptic preparation reduces the degree of contamination of the skin, which, in our opinion, prevents complications and improves the healing process.
Otitis media with effusion is difficult to diagnose, since the course of the disease is mostly asymptomatic, while the initial stage of the disease is very similar to Eustachiitis or the pre-perforative stage of acute otitis media. At this stage, dysfunction of the auditory tube and negative pressure in the tympanic cavity creates the conditions for the production of transudate, which clinically, in addition to hearing loss, is accompanied by soreness, a feeling of congestion, pressure, fluid transfusion in the ear. When conducting local medical procedures, they are primarily guided by the condition of the mucous membrane of the eustachian tube, nasopharynx and nasal cavity, but changes in the eardrum are no less important. Thus, the use of topical analgesics with an anti-inflammatory effect becomes no less relevant in the treatment.A literature review was carried out with an analysis of scientific research data on the use of a topical combination drug that has a local anesthetic and anti-inflammatory effect in the treatment of diseases of the external and middle ear.Analysis of the literature showed that the use of lidocaine-phenazone-containing drops promotes rapid regression of the inflammation in the external auditory canal and the tympanic membrane, as well as relieving of pain. It can be used both in children (including newborns) and in adults who are suffering from otitis media but with intact tympanic membrane, including otitis media with effusion.Combined topical drugs containing lidocaine-phenazone demonstrate efficacy and safety in the treatment of catarrhal and otitis media with effusion in all age groups.
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