The tympanic membrane and nasopharyngeal orifice of the Eustachian tube of 40 former leprosy patients were reported. There were 16 cases of secretory otitis media, 20 ears, in 40 patients. 13 cases in these 16 cases have deformity of the nasal cavity, especially a large perforation or defect of the nasal septum, and remarkable atrophy of the nasal conchae. They have a large nasal cavity. In 9 cases, the nasopharyngeal orifice of the Eustachian tube might be deformed due to leprosy. The patients of patent tube are observed in 16 cases, also they are aged. They have little deformity of their nasal cavity and the nasopharyngeal orifice of the Eustachian tube, but their mucous membrane and submucous tissue of the nasopharyngeal orifice of the Eustachian tube is remarkably atrophic.
Sixty three cases of radically mastoidectomized ear with persistent ear discharge and hearing impairment were treated with three types of reconstruction methods of canalplasty, single cortical bone grafting (38 cases), mastoid obliteration with bone chips (10 cases) and T-shape assembled cortical bone grafting (10 cases). Clinical results in our department were summarized from 1987 to 1997. Ear discharge was arrested in 87%. Hearing impairment was improved in 60%. No apparent difference of clinical results was found among three reconstruction methods. However, long-term observation revealed an apparent difference in three methods. 56% cases developed re-retraction following single cortical bone grafting. On the other hand, only 30% cases of re-retraction of posterior wall were found following mastoid obliteration with bone chips and T-shape assembled cortical bone grafting. Our results indicated that mastoid obliteration with bone chips and T-shape assembled cortical bone grafting were better to prevent re-retraction of posterior wall of the external ear canal than single cortical bone grafting.
Eleven patients who underwent total middle ear reconstruction for infection of the radically mastoidectomized ears and six patients who underwent tympanoplasty at university of Tokyo hospitals between January 1997 and March 1999, were studied. They were given cefozopran (CZOP) 2g intravenously at 30 minutes before operation, and the drug concentrations in mucosa of the middle ear and in subcutaneous tissue of the mastoid antrum were measured 60 minutes after the intravenous administration. Thereafter, CZOP was given for 7-8 days at 2g×twice/day, and its clinical effect was studied. In the patients who underwent total middle ear reconstruction, the concentrations in mucosa of the middle ear and in subcutaneous tissue of the mastoid antrum were 27.8μg/g and 29.8μg/g respectively. In the patients who underwent tympanoplasty, the concentrations were 33.2μg/g and 13.9μg/g respectively. Thus, in comparison with MIC80, of CZOP against various bacteria except MRSA, this drug is considered to have maintained concentrations that exhibited sufficient antibacterial activity. After administration of CZOP, all strains of Gram-positive coccus disappeared, and Pseudomonas aeruginosa disappeared or its bacterial count decreased. After administration, although fungi etc. developed newly in seven patients, no problems in postoperative treatment happened. In respect to effectiveness rate and usefulness rate, both were 90.9%(10/11) in patients with total middle ear reconstruction. In patients with tympanoplasty, the rates were both 100%(6/6). After tympanoplasty, exceptionally fever, urinary protein and neutropenia developed in one patient. However, the symptoms disappeared with administration of an antipyretic drug or discontinuation of CZOP.
Two-staged intact canal wall tympanoplasty is a common operation for treatment of middle ear cholesteatoma. MRI provides better tissue differentiation of the middle ear and/or mastoid, which are often occupied with soft tissue density after the first operation. If MRI is able to detect the presence of a recurrent or residual cholesteatoma with sufficient sensitivity and specificity, it may lead to a decrease in number of second look operation. The purpose of this study is to compare the MRI findings to the surgical findings of the second look operations by calculating the correlation rates between them. Thirty ears, which underwent intact canal wall tympanoplasty for cholesteatoma at the first operation, were examined by MRI prior to the second look. Otoscopic findings of the tympanic membrane were unremarkable in all cases. The true positive rate was 11/30 (37%) and the true negative rate was 10/30 (33%), leading to a radiosurgical correlation of 70%, whereas the false positive rate was 6/30 (20%) and the false negative rate was 3/30 (10%). This indicates that 30% of the MRI findings were incorrect. Therefore, at the present, MRI does not appear as replacement to second look surgery in cases of intact canal wall tympanoplasty.
Vestibular schwannoma is the most common tumor presenting in the cerebello-pontine (CP) angle. While, we often find the other kinds of small CP angle tumors, such as meningioma, lipoma, hemangioma, because of the development of diagnostic tool such as MRI. We underwent tumor removal for 527 cerebello-pontine angle tumors including 20 meningiomas, 10 facial neurinoma 10 epidermoids, 6 trigeminal schwannomas, 3 lipomas, 2 astorocytomas, 2 chordomas, 2 hypoglossal schwannoma, one choroid plexus papilloma, one hemangioma, one arachnoid cyst from 1975 to 1998. Preoperative differential diagnosis based on MRI usually helps surgeons to formulate an appropriate treatment protocol. While, we sometimes fail in diagnosis with MRI, especially in small tumors. In this paper, we showed the two CP angle tumor cases which we failed in preoperative diagnosis in MRI. We also discussed about the diagnostic problems in MRI for these CP angle tumors. We also realized that we have to cosider the difference in the principals between conventional MRI technique and our MRI technique (SPGR).
A white pearl-like mass on the facial nerve was recognized at the second operation of the planned staged tympanoplasty for attic type cholesteatoma. The mass that resembled a residual cholesteatoma was not recognized at the initial operation. The mass was arising from the dehiscent facial nerve canal, and it was supposed as a herniation or traumatic neuroma of the facial nerve from the clinical view pint. Careless extraction of the mass should be avoided to prevent the surgical hazard to the facial nerve.
A 55-year-old man developed otalgia, otorrhea, fever, vomiting and unconsciousness. Subdural abscess secondary to cholesteatoma was diagnosed. He was successfully treated by removal of subdural abscess with craniotomy, radical mastoidectomy and intravenous antibiotics. CT scan was very useful to make diagnosis of otogenic intracranial complication. The three-dimensional reconstruction image from the temporal bone helical volume CT suggested that infection had passed through bone defect of the middle cranial fossa from the mastoid antrum and had spread to intracranial space directly.