Case 42 - typanomastoidectomy Flashcards

1
Q

why is typanomastoidectomy performed?

A
  • eustachian tube malfunctions, vacuum created in middle ear
  • vacuum assoc with chronic upper resp infections
  • cholesteatoma - abnormal growth of primarily skin cells
    • grows behind a perf tympanic membrane (perf due to recurrent infections)
    • cholesteatoma assoc with progressive hearing loss, facial nerve damage
  • Typanomastoidectomy - remove cholesteatoma and infected bone of middle ear
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2
Q

any preop considerations assoc with tympanomastoidectomy?

A
  • pts usually manfiest middle ear diseaes: nystagmus, vertigo, n/v
  • PONV is important issue to address in these pts
    • combo therapy is effective
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3
Q

What are the intraop requirements for tympanomastoidectomy?

A

1) surgical anatomy is small, need mangnifying scope
* cruicial to minimize introp bleeding to allow surgical view under scope
2) injury to facial nerve

  • facial nerve electromyography may be used
  • avoid NMBDs

3) patient position 90 to 180 degree away from anesthesiologist

  • long extension circuits
  • neck not hyperextended
  • eye and ear free of pressure
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4
Q

Is nitrous oxide contraindicated during tympanomastoidectomy?

A

Best to avoid nitrous oxide for two reasons:

1) expansion of middle ear air space

  • nitrous oxide is more soluble in blood than nitrogen. nitrous oxide will enter middle ear space quicker than nitrogen can diffuse into blood –> expansion of air space.
  • typanic membrane graft can be dislodged

2) PONV

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5
Q
A
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