Endoscopic Transcanal Transpromontorial Removal of an Intracochlear Schwannoma and Traditional Cochlear Implantation

Vestibular schwannomas (acoustic neuromas) develop due to mutations in Schwann cells that cause uncontrolled cell division. As a result, a tumor forms. As these tumors grow, they can compress the cochlear nerve causing unilateral hearing loss and tinnitus. Vestibular schwannomas may cause imbalance and occasionally vertigo. Intralabyrinthine schwannomas account for about 10% of vestibular schwannomas in centers that specialize in temporal bone imaging. Intracochlear schwannomas are the most common type of intralabyrinthine schwannomas. In this video, we describe an endoscopic transcanal transpromontorial approach to intracochlear schwannoma removal.

This surgery was performed by James Prueter, DO, of Southwest Ohio ENT Specialists in Dayton, OH.

Video editing was performed by Austin Miller, OMS-II, Ohio University Heritage College of Osteopathic Medicine.

Draping Technique for Major Ear Surgery during Pandemic!!!

Covid -19 Pandemic has changed the way we provide our healthcare services to our patients. ENT / Otolaryngology is one of the high risk speciality for contracting Covid infection. We as  professionals has to take maximum precautions not only to protect our patients but also all our healthcare staff working with us in to minimise the risk of contracting the virus ((Krajewska).

Unfortunately our patients do need appropriate necessary treatment for their otological problems during this pandemic. Drilling mastoid bone will generate significant aerosol during the procedure, putting everyone in the operating theatre at risk (Prof P Rae). Though every patient who undergoes any surgical procedure should have Covid test, self isolate and free from Covid symptoms. There is risk of contracting Covid infection from asymptomatic patient or staff. We should try and take every step to minimise the risk of  contracting Covid infection either from Covid positive / negative Or symptomatic / asymptomatic patient or staff.

There are few techniques been tried by our colleagues around the world to minimise aerosol during major ear surgery.  We tried to use of the technique proposed by our colleagues in UK ( W. Hellier), as it was too cumbersome during the procedure, we propose the modified technique to drape the surgical site during major ear surgery to reduce the aerosol.

Lateral Graft Tympanoplasty

Title: Lateral Graft Tympanoplasty

Description: A lateral graft tympanoplasty is performed to demonstrate the utility of this technically challenging approach. The technical pearls that contribute to the high success rate of this graft are highlighted.

Learning Points: The lateral graft tympanoplasty was popularized by Sheehy in the 1960s. Although technically more demanding than underlay graft techniques, the lateral graft is an essential method for Otologists to have in their armamentarium. The lateral graft is especially useful in cases of total perforation or anterior marginal perforation as well as revision tympanoplasty. Potential disadvantages of this technique include graft lateralization and anterior blunting as well as keratin pearl formation. When performed by an experienced surgeon, the results of lateral grafting are excellent. The technical considerations that promote successful lateral grafting are highlighted in this video.

Endoscopic Stapedotomy (2:55)

Stapedotomy is used to treat conductive hearing loss caused by a fixed stapes footplate. The procedure is traditionally performed via a surgical microscope. In recent years an endoscopic approach has been increasingly utilized due to several advantages that it offers over the microscopic approach, chiefly the excellent visualization of middle ear structures provided by the endoscope. In this video we describe our technique for stapedotomy via an endoscopic approach.

 

This surgery was performed by James Prueter, DO, of Southwest Ohio ENT Specialists in Dayton, OH.

 

Video editing was performed by Wesley Greene, MS-4 Wright State University Boonshoft School of Medicine with assistance from Britney Scott, DO, PGY-3 Kettering Health Network Otolaryngology Surgery.

Endoscopic Tympanoplasty with Tragal Cartilage Graft in a Pediatric Patient (3:54)

Tympanoplasty is used to repair persistent perforations of the tympanic membrane. The procedure has traditionally been performed via a surgical microscope. In recent years an endoscopic approach has been increasingly used due to several advantages that it offers over the microscopic approach, chiefly the excellent visualization of middle ear structures provided by the endoscope. In this video we describe our technique for endoscopic tympanoplasty using a tragal cartilage graft in a pediatric patient.

 

This surgery was performed by James Prueter, DO, of Southwest Ohio ENT Specialists in Dayton, OH.

 

Video editing was performed by Wesley Greene, MS-4 Wright State University Boonshoft School of Medicine with assistance from Britney Scott, DO, PGY-3 Kettering Health Network Otolaryngology Surgery.

Endoscopic Repair of a Jugular Diverticulum

We present a case of a patient with a jugular diverticulum causing persistent pulsatile tinnitus which was successfully treated with a CO2 laser endoscopic procedure. To our knowledge this is the first instance of a dehiscent jugular diverticulum being successfully treated in this manner. We believe this procedure is advantageous when compared to other treatment modalities because it is 1) minimally invasive 2) there is decreased pain and recovery time compared to other surgical approaches and 3) the risk of serious post-op infection such as meningitis is theoretically much lower when compared to posterior auricular approaches that must expose the dura of the brain to reach the jugular diverticulum.

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