Introduction Decompression of the orbit may be considered for the treatment of space-occupying lesions causing compromise of function as a result of expansion of the orbital contents or a decrease in the rigid orbital confines. The volume of the orbit averages about 30 mL, and it is only anteriorly that it is not bound by bone. By far, the most common indication for decompression is Graves…
Introduction 1. Visual compromise due to injury or compression of the optic nerve can be debilitating and lead to significant impairment in a patient’s quality of life. 2. Transcranial and transfacial access for optic nerve decompression have been the classical approaches for surgical intervention, although endoscopic/transnasal approaches are playing a more common role in the management of pathology affecting the optic canal. a. Improvements in endoscopic…
Introduction External dacryocystorhinostomy (DCR) was first described by Toti in the early 20th century. The technique is applicable to patients complaining of tearing and demonstrating obstruction of the lacrimal outflow system. The procedure consists of creating a fistula for egress of tears directly from the lacrimal sac into the nose and bypassing the nasolacrimal duct ( Fig. 149.1 ). Description of endonasal DCR took place even…
Introduction Acoustic neuroma, also known as vestibular schwannoma, is a benign neoplasm arising from the vestibular portion of the cochleovestibular nerve. This tumor can cause a variety of sequelae, most common among which are hearing loss, tinnitus, and dizziness The tumor can grow to a large size and cause additional symptoms related to brain-stem compression, hydrocephalus, and effects on other cranial nerves (CNs). Extremely large tumors…
Introduction Superior semicircular canal dehiscence (SCD) syndrome was first described by Minor et al. in 1998; it consists of anatomic dehiscence of the superior semicircular canal accompanied by symptoms including dizziness, autophony, and hearing loss. The prototypical dizziness symptoms associated with SCD syndrome include sound- and/or pressure-induced vertigo. Autophony indicates the hearing of internal body sounds, such as hearing the heartbeat or hearing the eyes move. Hearing…
Introduction Surgery for vertigo is typically a treatment of last resort, whether due to a peripheral or central etiology. The vast majority of patients may be managed conservatively with medical treatment and/or vestibular rehabilitation therapy. Critical to the management of patients with vertigo is the correct diagnosis of the underlying pathology. The small percentage of patients who fail maximal medical management may benefit from surgery. It…
Introduction Major head injuries can cause a variety of craniofacial fractures. Temporal bone trauma may occur as a result of blunt or nonpenetrating injury or a penetrating injury, such as gunshot wounds. The temporal bone contains several important structures, including the facial nerve, cochleovestibular nerve, labyrinth, ossicles, tympanic membrane, and internal carotid artery, that may be injured as a result of temporal bone trauma. If the…
Introduction Cerebrospinal fluid (CSF) leak of the temporal bone results from having a connection between the air-containing spaces of the temporal bone and the intracranial subarachnoid space. The connection is by way of defect(s) in the tegmen mastoideum or tegmen tympani with or without the presence of a concurrent encephalocele ( Fig. 144.1 ) or meningoencephalocele. CSF collects in the middle ear and mastoid, and the…
Introduction Benign lesions of the temporal bone present treatment challenges due to their central location among critical neurovascular structures. These lesions may remain undetected for years due to their insidious growth pattern and are often diagnosed incidentally by radiologic imaging. Larger lesions can encroach upon adjacent neurovascular structures, presenting with hearing loss, tinnitus, vertigo, cranial neuropathies, or headaches. Accurate diagnosis of petrous apex lesions is made…
Video 142.1 , Video 142.2 , Video 142.3 Paraganglioma or glomus tumor is a tumor of the neuroendocrine system derived from neural crest cells and chemoreceptor cells. Although most tumors are sporadic, familial glomus tumors may occur in 20% of patients with glomus tumors. Some of the tumors are multicentric and bilateral at the time of presentation, which typically occur at an earlier age in successive…
Introduction Resection of the temporal bone may be indicated as a component of management for advanced cancers of the parotid gland, peri-auricular skin, and neck, as well as primary lesions of the external auditory canal (EAC), middle ear, and mastoid. The anatomy of the temporal bone is complex with implications for the spread of cancer from one anatomical region through pathways that expand the need for…
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Introduction Disorders of the facial nerve most commonly develop because of a variety of infectious and inflammatory processes. Involvement of the facial nerve can occur anywhere along its course ranging from the posterior fossa, temporal bone, to parotid gland either by primary or secondary involvement of the facial nerve. Tumors of the facial nerve represent a much less common etiology in patients presenting with facial nerve…
Introduction The facial nerve is afflicted by paralysis more frequently than any other nerve in the body, most commonly in its peripheral segment as it courses through the temporal bone. The functional and cosmetic implications of facial paralysis carry the potential to significantly impact a patient’s life, with resulting psychologic damage. There are many sources of otologic facial paralysis ( Table 138.1 ), and managing facial…
Introduction A cochlear implant is an implanted medical device that restores the ability to perceive sound. The two patient populations that have benefited most from cochlear implants are children with congenital or early-onset profound hearing loss and postlingual adults who no longer benefit from amplification. Key Operative Learning Points The middle ear is accessed via mastoidectomy through a facial recess approach between the facial and chorda…
Introduction This chapter is devoted to a review of active middle ear implants that are currently approved by the US food and drug administration (FDA) and are available locally as a surgical rehabilitation option for select hearing impaired individuals. These include the Esteem Implant (Envoy Medical Corporation, Minnesota), the Vibrant Soundbridge Implant System (MED-EL Corporation, Innsbruck, Austria), and the Maxum System (Ototronix, Texas). In the United…
Introduction Bone-anchored devices conduct sound through bone vibration, bypassing the external and middle ear conductive apparatus Useful in patients with conductive or mixed hearing loss who cannot benefit from conventional amplification and are not candidates for surgical correction of their hearing loss Also useful in patients with single-sided deafness, as the sound coming to the deafened side can be transmitted by bone vibration to the intact…
Video 134.1 , Video 134.2 , Video 134.3 , Video 134.4 , Video 134.5 , Video 134.6 , Video 134.7 , Video 134.8 , Video 134.9 , Video 134.10 , Video 134.11 , Video 134.12 , Video 134.13 The early indications for mastoid surgery involved drainage procedures for acute, life-threatening infections. In current practice, acute coalescent mastoiditis is infrequent and most mastoidectomies are done for chronic…
Introduction Definition Otosclerosis is a disease of the otic capsule characterized by both resorption and bony deposition with associated neovascularization. This abnormal bony growth of the otic capsule will eventually result in fixation of the ossicles, frequently at the stapes footplate or the incudostapedial joint. The disease was first identified by Valsalva in 1704 and later termed otosclerosis by Politzer in 1894. Histologically the sclerotic foci…
Introduction Conductive Hearing Loss Conductive hearing loss results from restriction of sound wave energy in displacing the basilar membrane of the organ of Corti. Conductive hearing loss not of middle ear or tympanic membrane origin can result from obstruction in the external auditory canal and possibly from fluid distention within the inner ear, such as that seen in early Meniere’s disease. Inner ear conductive hearing loss…