Acute otitis media (AOM) is a common disease in childhood. If predictors of outcome in AOM are known, it will be possible to individualize and select the appropriate therapy. We have employed the scoring system using severity of symptoms and severity of tympanic membrane changes and reported the usefulness in inferring the outcome of AOM. The aim of this study was to compare clinical significance of the scoring systems between that of Wakayama Medical University and that proposed by Japan AOM Guideline Committee. In this study, tow outcomes were assessed, i.e, persistence of symptoms at day 5 and persistence of tympanic membrane change at day 28. In both scoring systems, persistence of symptoms at day 5 was associated with younger age, higher symptom score on day 1 and colonization with S. pneumoniae. By using Wakayama Scoring System, persistence of tympanic membrane changes at day 28 was significantly associated with younger age, higher tympanic membrane score at day 1, nasopharyngeal colonization with S. pneumoniae, especially PRSP. On the other hand, the scoring system proposed by the committee showed that the significant persistence of tympanic membrane changes was associated with younger age and nasopharyngeal colonization of S. pneumoniae. The scoring system of the committee could not find any significance in tympanic membrane score at day 1 on the outcome of AOM. This study strongly suggested that decreased landmarks/cloudiness of drums is essential factor for the scoring system of AOM.
In Kansai Medical University Hospital, simple myringoplasty with fibrin glue using subcutaneous connective tissue grafts or conchal perichondrium with cartilage composite grafts was performed in 255 ears from January 1995 to December 2003, and 162 of these ears were observed for more than six months. The success rate was 80.4% in the subcutaneous connective tissue graft group and 76.4% in the conchal perichondrium with cartilage composite graft group. A few eardrums in the connective tissue graft group suffered perforation again within six months postoperatively. Compared with the rate of closure with subcutaneous connective tissue grafting, the rate with perichondrium with cartilage composite grafting group was higher at one year postoperatively. Twelve ears unsuccessfully ears treated with simple myringoplasty with fibrin glue using subcutaneous connective tissue grafts were operated on for eardrum perforations with conchal perichondrium with cartilage composite grafts. After the second operation, the overall closure rate was 91.7%. Our findings suggest that use of perichondrium with cartilage composite graft is advantageous for second operation or perforation of the eardrum.
We performed tympanoplasty with soft posterior meatal wall reconstruction on 41 ears from November 1999 to December 2004 at Kagawa University Medical Hospital. The mean follow up period was 39 months (from 18 to 66 months). No retraction of the posterior meatal wall was observed in 3 ears (7.3%), while attic retraction was seen in 10 ears (24.4%), and balloon-shaped retraction pocket into the mastoid cavity was found in 28 ears (68.3%). In most cases, the posterior meatal wall began to retract within 1 or 2 months. The retraction of the posterior meatal wall occured mainly within one year after surgery. In 29 ears, CT scan was performed after more than 1 year postoperatively. Aeration was seen in 6 ears (20.7%) in the attic and mastoid cavity, in 2 cases (6.9%) in the attic, and in 4 cases (13.8%) in the mastoid cavity only. ll of the Non-retraction cases showed good aeration both in the attic and mastoid cavity. In addition, aeration was seen in 7 ears (78%) of the attic retraction cases. On the other hand, the aeration was only seen in 2 ears (12%) of the cases showing a balloon-shaped retraction pocket into the mastoid cavity. The success rates for a recovery of hearing were 68.8% in tympanoplasty type Ill (3i 10/16, 3c 12/16) and 57.1% in type IV (4i 2/2, 4c 2/5). The mastoid cavity problems occurred in 14.6%(6/41). Recurrence of cholesteatoma was found in 4.8%(2/41). In conclusion, the above described surgical method was considered useful because it was easy to perform, and demonstrated good success rate regarding an improvement in postoperative hearing, a low rate of recurrence, and few mastoid cavity problems. However, narrow-neck retraction pocket formation did occur in a few cases and, as a result, long-term observations are thus needed for these patients.
We reported 3 cases of patients with congenital ossicular malformation and abnormal facial nerve pathway. In case 1, the facial nerve canal was absent and only the stapes head was observed below the facial nerve. The stapes was fixed and no surgical reconstruction was performed. In case 2, the facial nerve canal was absent and fibrous structure replacing the stapes was observed. The oval window was not existed and no surgical reconstruction was performed. In case 3, The long process of incus was connected to the stapes head with fibrous tissue. The facial nerve showed no bone defect and only the stapes head was observed below the facial nerve. Stapedial mobility was good and bone paste was used to connect the long process of the incus with the stapes head. After operation, hearing level improved and CT findings showed successful reconstruction of ossicular chain. Surgical techniques for ossicular reconstruction in patients with congenital ossicular malformation with abnormal facial nerve pathway were discussed.
Several surgeons have reported that radical extirpation of lesions in the temporal bone is very difficult. Extirpation can be particularly challenging when tumors involve the area surrounding the jugular bulb and tympanic sinus, which is anatomically very complex, specifically with regard to the relationship between the facial nerve and jugular bulb. The main causes of such problems associated with structural complexities are insufficient surgical view and difficulty securing hemostasis. We encountered 2 cases of benign intra-temporal lesions and operated using a intraoperative facial nerve anterior transposition. Such methods involve temporarily moving the appropriate part of the facial nerve anteriorly. The first case was a glomus hypotympanicum classified as Fisch class B, while the second was recurrent cholesteatoma that had extended into the internal auditory canal. We selected extended posterior tympanotomy for the glomus hypotympanicum and a trans-cochlear approach for the cholesteatoma. These cases were complicated by mild postoperative facial nerve palsy which, however, recovered completely and rather rapidly. Although a retro-facial approach is generally considered more suitable for preservation of facial nerve function due to no direct procedures in the nerve, we believe that a benefit of the intraoperative anterior transposition of the facial nerve is widening of the operational field and ease of manipulation. We therefore postulate that the intraoperative anterior transposition of the facial nerve in these operations can enable surgeons not only to perform the procedures safely but also to remove such tumors rather completely.