We studied 137 ears with chronic otitis media (COM) underwent tympanoplasty at Osaka Rosai Hospital from April 2005 to March 2010. The patients' mean age was 56.2 years, with a range of 7-79 years. Classification of the perforation size showed grade I (25% perforation of TM) in 7 ears (5.1%), grade II (50% perforation of TM) in 31 ears (22.6%), grade III (75% perforation of TM) in 55 ears (40.1%) and grade IV (total perforation of TM) in 44 ears (32.1%).
The overall postoperative closure rate of the perforation was 97.1% and the hearing improvement rate was 82.5%. There was no significant difference among grade I-IV groups in both closure rate and hearing improvement rate.

View full abstract

We encountered a case of a temporal cyst in a patient with chronic otitis media. The patient was a 65-year-old woman. Her chief complaint was otorrhea and impaired hearing in the right ear. She had been suffering from otitis media of the right ear since childhood. She had visited a medical practitioner in her neighborhood, complaining of increased otorrhea. At this time, a mass was detected in the right auditory canal. She was referred to our hospital for further examination of the mass. The tympanic membrane was not visible because of the mass in the external auditory canal. Pure-tone audiometry showed that she was deaf in the affected ear. A computed tomography scan showed a low-density area extending to the posterior cranial fossa and external auditory canal, obscuring the temporal bone. The mass was punctured, and a dark brown fluid was suctioned out. Cytological examination of this fluid showed the presence of red blood cells, histiocytes, and lymphocytes. Therefore, we suspected the mass to be a cyst of the temporal bone and performed an operation. During the surgery, we found a cyst in the mastoid process, accompanied by a cholesterin granuloma. The tympanic membrane was severely perforated, and an inflammatory granuloma was found extending from the mastoid process to the tympanic isthmus, thus completely obstructing the ventilation route. The cyst was thought to have developed because of the obstruction of the aditus ad antrum. We resected the malleus and incus and then attempted to correct the obstruction.
We did not reconstruct the ossicular chain because the patient was already deaf in the concerned ear. Pathological examination showed the presence of cholesterin in the cyst wall.

View full abstract

We studied 23 patients (23 ears) with congenital cholesteatoma who underwent surgery at our department from January 1998 to December 2008, focusing on the localization and type of cholesteatoma, surgical procedures and results. We used a staging system which was developed by Potsic PW et al. at 2002. The ratio of the posterior quadrant and open type cholesteatoma increased, with progression of stages. Second look operation was done in 60% of stage III and 75% of stage IV cases, thereafter residual cholesteatoma was found in 20% of stage III and 75% of stage IV cases. In addition, we have reviewed the surgical procedures of anterior quadrant cases, and proposed a current surgical procedure.

View full abstract

Cholesteatoma localized in the tympanic membrane is rare especially in pediatric patients although cholesteatoma usually extends from the middle ear to inner ear with epithelial debris accumulation.
Two pediatric patients presented with cholesteatoma in the tympanic membrane, and the pathogenesis and the treatment were discussed.
The first case, a 2-year-old boy, with a white pearl-like lesion growing in the pars flaccida of the left tympanic membrane was referred to us. The lesion was incised and encapsulated epithelial debris was removed. The lesion was diagnosed as congenital cholesteatoma in the tympanic membrane because of no history of previous ear infection.
The second case, a 3-year-old girl with two white pearl-like lesions growing in the pars tensa of the right tympanic membrane originating after closure of traumatic tympanic membrane perforation, was referred to us. The lesions were removed together with the tympanic membrane due to the cholesteatoma invasion. The acquired cholesteatoma in the tympanic membrane was diagnosed because of the prior trauma.
Surgical intervention will be applied even to the pediatric cases with cholesteatoma in the tympanic membrane was indicated. The surgical approach should be selected according to the pathogenesis.

View full abstract

Middle ear cholesteatoma shows often a gradually expanding growth destroying the temporal bone or ossicles, but is sometimes accompanied by abnormal calcification or ossification called tympanosclerosis. Here we studied the clinical characteristics of cholesteatoma with sclerotic regions. In our hospital 168 patients with cholesteatoma underwent tympanoplasty for the first time from March 2006 to March 2010. Among them, 33 showed sclerotic regions. We compared the patients with sclerotic regions and those without them, and the patients of chronic otitis media with tympanosclerosis. Sclerotic regions were found in any type of cholesteatoma and often existed next to the cholesteatoma matrix. Our findings suggest some close relationship between cholesteatoma and tympanosclerosis. In addition, some unique mechanism may be responsible for sclerotic change in cholesteatoma.

View full abstract

Objective: To compare the usefulness and safety of a skeeter drill with those of a KTP laser in stapedotomy.
Materials and Methods: Primary stapedotomy was performed in 24 ears between April 2004 and December 2009 at the Kobe City Medical Center General Hospital. A skeeter drill was used to cut the stapes crura in 12 ears and a KTP laser was used in the other 12 ears, while all stapes footplates were fenestrated with a skeeter drill. We compared the skeeter drill technique and the KTP laser technique on the basis of the following 3 points; (1) immediate symptoms indicating inner ear dysfunction such as vertigo and tinnitus, (2) postoperative changes in bone-conduction hearing, and (3) air-conduction hearing at 1 year after surgery.
Results: No statistically significant differences in the 3 points were observed for the 2 techniques.
Conclusion: A skeeter drill, just like a KTP laser, may be safely used to cut the stapes crura during stapedotomy.

View full abstract

Most of patients with patulous eustachian tube (PET) are diagnosed by the clinical history, symptoms and eardrum findings during respiration. In addition, the results of eustachian tube function tests are useful to diagnose PET. However, we often experienced the clinical findings showing clearly PET but the results of eustachian tube function tests showed negative. Thus we analyzed eustachian tube function tests including tubo-tympano-aerodynamic graphy (TTAG) and sonotubometry of the patients with PET diagnosed by the clinical history, symptoms and eardrum findings during respiration. Then, we also compared the results of tubal function tests using TTAG and sonotubometry in the patients with unilateral or bilateral PET, or PET with or without eardrum movement during respiration. The positive rate of TTAG and sonotubometry of the patients with PET was 53.1% and 84.4%, respectively. Thus the positive rate of sonotubometry of the patients with PET was significantly higher than TTAG. The positive rate of sonotubometry in the patients with unilateral PET or PET without eardrum movement during respiration was significantly higher than TTAG. Moreover, the tubal opening was obtained significantly more easily by sonotubometry than TTAG and the rate of tubal opening in response to Valsalva maneuver of the patients with unilateral PET was significantly lower than bilateral PET.
These results suggested that sonotubometry was more useful as a screening test for the diagnosis of the patients with unilateral PET or PET without eardrum movement during respiration, including the patients with PET who were not responding to Valsalva maneuver than TTAG, and that sonotubometry could be complementary to TTAG for the diagnosis of those patients with PET.

View full abstract

We studied the efficacy of intratympanic steroid treatment on idiopathic sudden sensorineural hearing loss (ISSNHL) in comparison with hyperbaric oxygen therapy (HBO). Two hundred and forty consecutive patients with ISSNHL (initial hearing level ≥ 40 dB, time from onset to the start of treatment ≤ 30 days) were enrolled. In addition to systemic steroid administration to all patients, 174 underwent HBO (HBO group) and 66 received the intratympanic dexamethasone injection (IT group). Hearing outcomes were evaluated by 6 indices; the cure rate, marked-recovery rate, and recovery rate according to the criteria of the Ad Hoc Committee of the Japanese Ministry of Health, Labor and Welfare, and the hearing improvement rate, hearing level after treatment, and hearing gain. The overall recovery rate was significantly higher in the IT group than in the HBO group (81.8% vs. 68.4%, p = 0.039), which was confirmed by multiple logistic regression analysis (odds ratio = 2.184; 95% confidence interval, 1.015-4.701; p = 0.046). The recovery rate in the patients without vertigo and that in the patients treated within 7 days from onset were also higher in the IT group than in the HBO group (87.8% vs. 72.4%, p = 0.043; 87.0% vs. 72.7%, p = 0.036). These results indicate that the intratympanic steroid treatment is more effective than HBO on ISSNHL.

View full abstract

The complete loss of hearing is a frequent result of neurofibromatosis type 2 patients (NF2). To overcome this handicap, auditory brainstem implantation (ABI) has become one option. However, the reported hearing outcomes vary significantly. Recently, several individual case reports have appeared in the literature describing good hearing outcomes using cochlear implantation (CI) in NF2 patients with profound deafness. Then, we compared the hearing outcomes in 9 deaf patients with NF2, in those two of them fitted with CI and seven fitted with ABI.
Among the seven patients fitted with ABI, only two patients achieved speech recognition (respectively, 7% and 31% in the CI-2004 school child sentences test). Thirty one percent is the best score of the seven patients fitted with ABI. In the group of 2 patients fitted with CI, one reached exellent speech recognition, scoring 88% in the CI-2004 adult on daily conversation sentences test. Another patient achieved speech recognition 33% in the CI-2004 school child sentences test.
If the cochlear nerve can be preserved anatomically and promontory stimulation test can be positive, and if the degree of a tumor compression symptom can be allowed, CI should be preceded to ABI.

View full abstract

The middle cranial fossa approach (MCF) was introduced by William House in 1961 to expose and manage the temporal bone including CP angle lesions via middle cranial base without destroying the inner ear. Surgical approach of MCF is generally employed for patients with small acoustic neuroma having good hearing, petrous cholesteatoma, cholesterol cyst, superior semicircular canal deficiency syndrome, facial nerve tumor, severe facial nerve paralysis caused by Bell's palsy, Ramsay Hunt syndrome or temporal bone trauma. With development of images such as MRI, small lesions in the temporal bone are detectable easily before losing useful inner ear function. We otologists should do our best to preserve useful inner ear function. For that intraoperative monitoring and navigation systems may be powerful tools for surgeons.

View full abstract

Jugular foramen neuroma (JFN) is often misdiagnosed as vestibular schwannoma (VS) because the chief complaint and symptoms of JFN are quite similar to those of VS. If JFN is operated on under the wrong diagnosis, functional preservation is not achieved. On the contrary, if JFN is properly operated, hearing preservation and restoration after surgery is possible in many cases. In this paper, the results of the management of JFN and the mechanism of restoration after tumor removal is discussed.
Nine cases have been diagnosed and operated on by the author and collegues for JFN through far lateral approach. Hearing acuity before and after the surgery was examined by pure tone and speech audiometry, auditory brainstem responses (ABR) and distortion product otoacoustic emissions (DP-OAE), and analysed in relation to the operative findings.
On the operation, the seventh and eighth nerves were clearly dissected from the tumor, thanks to arachnoid membrane in between. Hearing level was restored to almost normal range and speech discrimination score was restored to 95-100% in 8 out of 9 cases. In ABR, only wave I was detected before the surgery but waves I to V were well recognized after the surgery in some cases. The DP-OAE was detected before and after the surgery.
In conclusion, hearing can be well restored by the meticulous dissection during the surgical procedure of JFN provided the preoperative diagnosis is correct.

View full abstract

We introduce here our experience of skull base surgery for temporal bone malignancies and their prognoses. The relationships of their preoperative image study and pathological findings are also estimated prognoses. Twenty-one cases with temporal bone malignancies (carcinoma of the external auditory canal: 20, carcinoma of the middle ear: 1) who underwent radical removal of the tumor were enrolled for this study. These cases were composed of T2: 9, T3: 2 and T4: 10 by the T classification by Kishimoto. According to imaging studies by CT and MRI, 13 lateral petrosectomy and 8 subtotal temporal bone resection were performed. Surgical specimens were histologically diagnosed with negative margins, therefore, these cases had undergone radical surgery. However, 3 of 21 cases showed recurrences and other 18 cases are alive without tumor recurrence. Five year survival rate was 81.1 % by Kaplan-Meier method (6-78 months, median 28 months). These recurrences were mainly observed in the distant area from the surgical site, for example, neck lymph nodes or parapharyngeal spaces. Therefore, a more detailed preoperative image evaluation is put up for future problems.

View full abstract