Fehler und Gefahren: Ohrchirurgie und Chirurgie der lateralen Schädelbasis

Abstract

Surgery of the ear and the lateral skull base is a fascinating, yet challenging field in otorhinolaryngology. A thorough knowledge of the associated complications and pitfalls is indispensable for the surgeon, not only to provide the best possible care to his patients, but also to further improve his surgical skills.Following a summary about general aspects in pre-, intra- and postoperative care of patients with disorders of the ear/lateral skull base, this article covers the most common pitfalls and complications in stapes surgery, cochlear implantation, surgery of vestibular schwannomas, and jugulotympanal paragangliomas. Based on these exemplary procedures, basic "do's and don'ts" of skull base surgery are explained, which the reader can easily transfer to other disorders. Special emphasis is laid on functional aspects, such as hearing, balance and facial nerve function. Furthermore, the topics of infection, bleeding, skull base defects, quality of life and indication for revision surgery are discussed.An open communication about complications and pitfalls in ear/lateral skull base surgery among surgeons is a prerequisite for the further advancement of this fascinating field in ENT surgery. This article is meant to be a contribution to this process.

Seltene Erkrankungen des vestibulären Labyrinths: von Zebras, Chamäleons und Wölfen im Schafspelz

“…Generally, pressure- or sound-induced vertigo and nystagmus can be triggered in all disorders of the middle and inner ear where the membranous labyrinth comes into direct contact with the stapes footplate 140 , e. g., inflammatory causes as mentioned in the first description of Hennebertʼs signs for patients with syphilis 157 , malformations of the middle ear, or post-operative / -traumatic scar formation between the stapes footplate and the vestibule 236 237 .…”

“…Particularly thorough pre-operative assessment of vestibular function is essential before surgery of the “second” side, e. g., in cases of skull base meningiomas, bilateral vestibular schwannomas, or in cochlear implant surgery 237 . When unilateral peripheral vestibular hypofunction after surgery of the first side was compensated well, it is often believed that this will also be the case after second-side surgery.…”

“…Generell kann ein druck- oder lärminduzierter Schwindel/Nystagmus bei allen Erkrankungen des Mittel- und Innenohres ausgelöst werden, bei denen es zu einem direkten Kontakt zwischen dem membranösen Labyrinth und der Stapesfussplatte kommt 140 . Hierzu zählen insbesondere entzündliche Ursachen, wie aus der Erstbeschreibung des Hennebert-Zeichens bei Patienten mit Syphilis hervorgeht 157 , Fehlbildungen des Mittelohres oder postoperative/-traumatische Vernarbungen zwischen Stapesfussplatte und Vestibulum 236 237 .…”

“…Eine besondere Bedeutung kommt der vestibulären Statusbestimmung bei der Operation der «zweiten Seite» zu, z. B. bei Schädelbasismeningeomen, bilateralen Vestibularisschwannomen oder auch Cochlea-Implantationen 237 . Wenn der Patient nach der Operation der ersten Seite einen peripher-vestibulären Funktionsverlust erlitten hat, welcher anschliessend gut zentral kompensiert wurde, herrscht oft die Meinung vor: «Wenn er beim ersten Mal gut kompensiert hat, wird er es beim zweiten Mal auch tun.».…”

Assessing physical functioning in otolaryngology: feasibility of the short physical performance battery

“…Balance problems can also result from common otologic surgeries such as cochlear implantation 11 and other procedures involving the ear and lateral skull base. 12 Furthermore, hearing loss, which affects approximately two-thirds of older adults in the United States, 13 is independently associated with poorer self-reported physical functioning 14, 15 and walking speed. 16 There is evidence that the relationship between hearing loss and physical functioning is mediated by more than concomitant vestibular disease, as hearing loss has been shown to be associated with falls independent of vestibular function.…”