Otology Flashcards
What are the five primary causes of conductive hearing loss after stapedectomy?
- Failure to recognize obliterative otosclerosis of the round window
- Displacement of the prosthesis after head trauma or large changes in middle ear pressure
- Necrosis of the long process of the incus
- Migration of the prosthesis in the oval window
- Adhesions
When is stapedectomy contraindicated?
- In young children until it has been demonstrated that they are not prone to otitis media
- In the presence of active middle or external ear disease
- Active URI
- tympanic membrane perforation
- Meniere’s disease.
What psychological problems are contraindications to cochlear implantation?
- Organic brain dysfunction
- mental retardation
- psychosis
- unrealistic expectations.
What is the incidence of malleus ankylosis during primary surgery for otosclerosis?
1-2%.
What are the expected residual hearing levels after PORP and TORP?
15 dB conductive hearing loss PORP; 25 dB conductive hearing loss TORP.
What is the incidence of ossification after pneumococcal meningitis?
20-30%.
What percent of patients will have improved tinnitus and hearing after endolymphatic sac surgery?
50% experience improvement in tinnitus and 30-40% experience improvement in hearing.
What percent of patients will have new bone growth covering the round window niche and membrane during cochlear implantation?
50%.
What is the incidence of malleus ankylosis during revision surgery for otosclerosis?
5-14%.
What percent of patients have improvement of vertigo after endolymphatic sac surgery?
70% experience complete relief, 20% experience decreased vertigo.
Why is stapedectomy dangerous in patients with Meniere’s disease?
A dilated saccule may sit immediately beneath the footplate and be injured upon entry into the vestibule.
How do the surgical findings differ during removal of a congenital cholesteatoma from removal of a cholesteatoma associated with chronic suppurative otitis media?
Absence of inflammatory changes/adhesions and easier removal with potential for complete preservation of the middle ear mucosa.
What are the indications for using plastic sheeting in middle ear surgery?
Absence of mucosa on the promontory, in most of the middle ear, or in the middle ear cleft (except in the eustachian tube).
What are the indications for simple mastoidectomy?
Acute coalescent mastoiditis with complications or acute mastoiditis that does not resolve after appropriate antibiotic therapy and myringotomy.
How should an extruded prosthesis be managed?
Allow spontaneous extrusion; TM may heal and make a spontaneous connection.
What are the complications of lateral tympanoplasty?
Anterior blunting, lateralization, epithelial pearls, and canal stenosis.
What are the indications for performing a lateral tympanoplasty?
Anterior or large perforations, revision tympanoplasty, or if the anterior canal wall is in the way.
Where is the endolymphatic sac?
Anterior to Trautmann’s triangle within the dura, medial and inferior to the posterior sec.
Which way is the sigmoid sinus retracted in the retrosigmoid approach to vestibular nerve section?
Anteriorly.
What is the management of injury to the sigmoid sinus during mastoidectomy?
Apply gentle pressure, place a Surgicel or Gelfoam patch, and continue with surgery.
What are the two most important landmarks in the middle fossa approach to the internal auditory canal?
Arcuate eminence and hiatus for the greater superficial petrosal nerve.
What are the options for surgical management of the chronically draining mastoid cavity?
Autologous cultured epithelial graft (from buccal mucosa), large meatoplasty, revision mastoidectomy, reconstruction of canal wall with an aerated cavity, mastoid cavity obliteration, and mastoid/middle ear obliteration.
Which of these is superior in complete elimination of vertigo?
Both are equally effective.
Which laser can be used on the tympanic membrane to treat atelectasis?
Carbon dioxide laser.