General, Urological and Gynaecological Surgery
Elizabeth Combeer in The Final FRCA Short Answer Questions, 2019
This question is virtually identical to one from 2006, and then recurs in 2016. I am slightly unclear as to why the College underlined the word laparoscopy when they clearly wanted you to discuss issues related to the position of the patient. Generally, though, if they mention the type of operation a patient is having, it is for a reason. Cancer surgery? Minimal opportunity for delaying for optimisation, consider impact of radio- and chemotherapy. Pelvic or lower abdominal laparoscopic surgery? Often Trendelenberg position, with its attendant issues. Ear surgery? Consider nausea and vomiting. Day case surgery? Think about optimising analgesia and antiemesis in order to get the patient out within 24 hours. However, note that the College was approving of those who had used a ‘good systematic approach’.
Otoendoscopy
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
In otology, the operating microscope revolutionized ear surgery by improving the accuracy and safety of operative procedures. Indeed, the use of the microscope with microinstruments led to otology being one of the first fields of minimally invasive surgery. The advantages of the operating microscope are obvious: it delivers a stable image in the familiar head-on view with the ability to vary magnification while freeing both of the surgeon’s hands to operate. However, its straight-line view is also the microscope’s main limitation as it is unable to navigate around anatomical corners to provide a wide and variable direction of view, unlike the endoscope. Modern advances in endoscope design have provided a new tool for the examination of anatomical structures in the middle ear and more challenging applications extend to neuro-otological operations such as the removal of acoustic neuromas. A spectrum of approaches currently exists between totally microscopic ear surgery and totally endoscopic ear surgery, with an increasing number of otologists using the endoscope to some extent during an otologic procedure. This chapter deliberately concentrates on the otoendoscope, often to the exclusion of the microscope, as traditional or conventional methods are covered elsewhere. The authors vary in their views from mixed usage to a totally endoscopic approach but all believe that the otoendoscope is an essential piece of equipment for the best practice of otology. Each individual must decide his or her own position with respect to the degree of usage of the otoendoscope.
Emergency treatment of sudden hearing loss
S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague in ENT Head & Neck Emergencies, 2018
Ten key areas to cover in the history are: The onset. The shorter the history of hearing loss, the better the prognosis.The baseline hearing level. SSNHL can be new or an incremental loss, and fluctuating hearing levels may point to Ménière’s disease.Unilateral or bilateral. A bilateral SHL could suggest ototoxicity or autoimmune disease.The degree of hearing loss. A poorer prognosis is associated with an increasingly severe hearing loss.Associated symptoms such as tinnitus, vertigo and aural fullness could represent a diagnosis of endolymphatic hydrops.Vertigo is present in 30–40% of cases of SSNHL. It is a poor prognostic indicator.Any history of trauma, diving, flying and intense noise exposure is relevant.Past medical history. Any previous or concurrent viral infections. Systemic disease associated with sudden hearing loss should be explored, as SSNHL can rarely be the first presentation of a systemic disease.Any previous ear surgery should be noted.Ototoxicity should be excluded with a careful drug history.
Acquired stenosis of the external auditory canal – long-term results and patient satisfaction
Published in Acta Oto-Laryngologica, 2018
David Schwarz, Jan Christoffer Luers, Karl Bernd Huttenbrink, Konrad Johannes Stuermer
The treatment of acquired stenosis/atresia of EAC is challenging and often characterized by failures and recurrences. Therefore, this surgery and its postoperative management are considered one of the most difficult tasks in the field of functional ear surgery. The biggest challenge is keeping the surgically extended auditory canal open postoperatively. In chronic recurrent otorrhea and hearing loss, surgery is usually the only useful option. However, the long-term success of the treatment depends in particular on a careful and meticulous aftercare. If surgery and follow-up are not treated by the same clinician, as is often the case, the close cooperation between the surgeon and the private ENT specialist is of essential importance for the success of the therapy. Over the past 30 years there have been several publications on the treatment of acquired stenosis/atresia of the EAC [1,13,14]. Disadvantages of these investigations are often a small number of patients, a short follow-up period or heterogeneity of the surgical or aftercare technique. Moreover, the risk and prevention of postoperative blunting of the anterior tympanomeatal angle has not been analyzed in detail to date.
Round window and promontory movements during bone conduction with different middle ear conditions in Thiel embalmed specimens
Published in Acta Oto-Laryngologica, 2019
Christof Stieger, Martin Kompis, Marco Caversaccio, Jérémie Guignard, Andreas Arnold
Using psychoacoustic measurements, Arnold et al. showed that the BC thresholds change directly after the removal of a fixed stapes footplate for four audiometric frequencies [12]. As stated before, clinically a decreased BC threshold represents an inner ear (perceptive) hearing loss and is generally thought to result from damaged cochlear structures. Sensorineural hearing loss in otosclerosis has been attributed to hydrolases set free from bursting lysosomes in histiocytes and TNF-alpha released from otosclerotic microfoci into the perilymph during the course of the disease [13–15]. Actual sensorineural hearing loss cannot be improved by ear surgery. However, in patients with a fixed ossicle chain, successful surgery not only improves middle ear transmission, but also the BC hearing threshold, i.e. inner ear function [12].
Comparison of type I tympanoplasty with acellular dermal allograft and cartilage perichondrium
Published in Acta Oto-Laryngologica, 2019
Zifei Yang, Xianmin Wu, Xiaoyun Chen, Yideng Huang, Lian Fang, Xiaofei Li, Yue Zhang, Minghui Jia
All patients were subjected to transcanal endoscopic ear surgery under general anesthesia. The AlloDerm was cut to a suitable size that is slightly larger than the perforation. After marginal trimming, the basement membrane of the AlloDerm is placed outwardly and under the tympanic membrane margin above the handle of malleus. After the procedure, we covered the graft with gelatin sponge particles and stuffed the external auditory canal with iodine spun yarn. The cartilage perichondrium obtained from the tragus cartilage was used for perichondrium tympanoplasty with the same surgical conditions. Antibiotics were used for 1 week as a preventive treatment. An audiogram and otoscopy were performed at 6 months after surgery to assess the hearing outcomes and graft healing in patients.
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