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Tympanoplasty—Undersurface Graft Technique: Postauricular Approach

Please access Videos to view the corresponding videos for this chapter. Since the fundamental principles of tympanoplasty were introduced by Wullstein and Zollner, there has been great diversity in the accepted surgical techniques used for repair of the tympanic membrane. The multitude of graft materials employed is a testimony to the difficulty of middle ear reconstruction. With advanced microsurgical techniques, the state of the art has…

Endoscopic Tympanoplasty

Rationale for Endoscopic Approach This chapter will review the preoperative work-up, indications, surgical technique, and postoperative care of tympanoplasty using an endoscopic approach for the repair of a tympanic membrane perforations. When compared to the traditional microscopic approaches for middle ear surgery, advocates of total endoscopic ear surgery (TEES) cite its distinct advantages of improved visualization and access to middle ear structures, no postauricular incision or…

Tympanoplasty—Undersurface Graft Technique: Transcanal Approach

Please access Videos to view the corresponding videos for this chapter. Many otologic surgeons prefer placing connective tissue grafts medial to the tympanic membrane remnant. This graft placement can be accomplished through either a transcanal or postauricular approach. This chapter describes in detail the transcanal technique and discusses our rationale for favoring it. Rationale and Requirements In our experience, the transcanal approach and medial graft placement…

Cartilage Tympanoplasty

Please access Videos to view the corresponding videos for this chapter. The use of cartilage in middle ear surgery is not a new concept. From the original description by Salen of using septal cartilage for myringoplasty, interest and techniques have developed. Unfortunately, the initial published audiological outcomes did not differentiate type I cartilage tympanoplasty from cartilage ossiculoplasty, and the poor results of the latter were associated…

Tympanoplasty: Outer Surface Grafting Technique

Please access Videos to view the corresponding videos for this chapter. The aims of tympanoplasty are the elimination of disease and restoration of function. Restoration of function requires a tympanic membrane; an air-containing, mucosa-lined middle ear (so that the membrane vibrates); and a secure connection between the tympanic membrane and the inner ear fluids. This chapter presents one of the three major techniques of tympanic membrane…

Office Management of Tympanic Membrane Perforation and the Draining Ear

Introduction Otorrhea occurs most often from chronic otitis media secondary to a tympanic membrane perforation or indwelling pressure equalization tubes; however, less common conditions such as granular myringitis, cholesteatoma, cerebrospinal fluid (CSF) fistula, and neoplasms should be considered. Otorrhea can be managed in the office in the majority of cases, but there are instances where formal surgical management is necessary. This chapter will focus on in-office…

Diagnosis and Management of the Patulous Eustachian Tube

Please access Videos to view the corresponding videos for this chapter. A patulous or abnormally patent (“stuck open”) eustachian tube (ET) causes an amplified perception of one’s own voice and breathing (termed autophony of voice and breathing) that can range from minimal to extremely disturbing. Although the condition is not known to cause pathology in the ear, the symptoms can motivate a patient to seek medical…

Surgery of Ventilation and Mucosal Disease

Bilateral myringotomy with ventilation tube placement is the most common surgical procedure performed in the United States, where an estimated 1.05 million tympanostomy tube procedures are performed, annually. In addition, otitis media is the most common diagnosis of patients who make office visits to physicians in the United States; the annual visit rate for children younger than 2 years of age increased by a statistically significant…

Congenital Malformation of the External Auditory Canal and Middle Ear

Acknowledgment The authors thank Antonio De la Cruz, MD, and Karen Teufert, MD, authors of this chapter in the previous edition. Please access Videos to view the corresponding videos for this chapter. Preoperative assessment with comprehensive audiometry and high-resolution computed tomography (CT) have improved the safety and surgical outcomes of atresia surgery. Nevertheless, consistent, stable long-term outcomes, including improved hearing and a clean, dry, well-epithelialized canal,…

Malignancies of the Temporal Bone: Limited and Radical Temporal Bone Resection

Please access Videos to view the corresponding videos for this chapter. Introduction Although carcinoma of the temporal bone is uncommon and aggressive, the best outcome depends on careful evaluation and planning that result in a complete resection with pathologically clear surgical margins. The most common lesion is primary squamous cell carcinoma of the external auditory canal (EAC). Tumors involve the temporal bone through primary growth, direct…

Canalplasty for Exostoses of the External Auditory Canal and Miscellaneous Auditory Canal Problems

Please access Videos to view the corresponding videos for this chapter. Although clinical disease caused by exostoses of the external auditory canal (EAC) is infrequent, it occurs often enough that a method of surgical management should be in the armamentarium of the otologic surgeon. Because it is not a high-incidence problem or one that is life-threatening, many otolaryngologists use various independent approaches, which frequently result in…

Otologic Instrumentation

Acknowledgment We would like to acknowledge and thank previous contributors, including Jose N. Fayad. Sophisticated micro-otosurgical techniques mandate that the otologic surgeon and surgical team have an in-depth understanding of the operating room (OR) layout and surgical instrumentation. This chapter describes in detail the different surgical procedures and the necessary OR setup and instruments. Appendix 1.1 provides a comprehensive list of the necessary instruments and equipment.…

Pediatric vestibular dysfunction following head injury: Diagnosis and management

Introduction The causes of vestibular symptoms after traumatic brain injury and concussion in children and adolescents are generally similar to those that impact adults. However, there are many unique considerations in the evaluation and management of children and adolescents with posttraumatic vestibular dysfunction relative to adults, which warrant special consideration. Posttraumatic dizziness and imbalance in the pediatric population are most commonly attributed to central causes at…

Management of pediatric otologic trauma

Overview There are a variety of injuries to the ear that can be seen in the pediatric population. These vary from minor lacerations of the external ear to more severe cases of traumatic injury such as temporal bone fractures. Children with ear injuries may present in the outpatient setting, such as a pediatrician or otolaryngologist's office, or in the emergency department, depending on the nature of…

Vestibular rehabilitation following head injury

H.R. is a 53-year-old male who fell on ice, resulting in traumatic brain injury (TBI) characterized by a subdural hematoma. He returned to work within 2 months, as a computer programmer, working 6–8 h per day. He was referred to outpatient physical therapy, with a chief complaint of cervical pain. During the examination of the cervical spine, the patient moved from a sitting to supine position…

Adult vestibular dysfunction following head injury: diagnosis and management

Introduction A patient's sense of “balance” is a complex, dynamic phenomenon that integrates information from the visual, peripheral vestibular, and somatosensory systems. The vestibular system is comprised of both peripheral sensory organs and central structures within the brainstem, cerebellum, and cerebrum. Chiefly, the peripheral portion consists of the semicircular canal system and otolith organs of the ear. These peripheral components of the vestibular system continuously collect…

Medical and surgical management of otic barotrauma

Overview Otic barotrauma (OBT) is traumatic injury of the middle ear and tympanic membrane resulting from a high-pressure differential existing between the middle ear and external environment. In common daily activities (e.g., driving to different elevations, air travel), individuals may experience slight changes in pressure of the middle ear, which results in mild, self-limiting otologic symptoms (e.g., slight aural discomfort). However, it is possible for these…

Management of cerebrospinal fluid leak following lateral skull base trauma

Introduction Leakage of cerebrospinal fluid (CSF) can occur when a defect of the skull base and dura results in an abnormal communication between the subarachnoid space and nasal or middle ear cavities. , This pathologic entity was first reported by St Clair Thompson in 1899 and can occur in the nose (CSF rhinorrhea) or the ear (CSF otorrhea). CSF leaks are further classified into traumatic and…

Facial nerve injury following temporal bone fracture: diagnosis and management

Background Temporal bone trauma accounts for 5% of all facial palsy cases , and 3% of all bilateral facial palsy. Only 7% of temporal bone fractures result in facial palsy and 25% of those result in complete facial paralysis. Historically, temporal bone fractures have been classified as either longitudinal or transverse, a classification scheme that refers to the direction of the fracture with respect to the…

Vascular injury following lateral skull base trauma: diagnosis and management

Introduction Head trauma has been cited as the most frequent clinical presentation in the emergency department. According to a 2013 survey by American College of Surgeons, nearly 800 trauma admissions were reported across different healthcare facilities in the United States. Additionally, skull base injuries were seen in one-third of the patients. The reported incidence is even greater in the developing countries or regions of limited healthcare…