Contributor: Gresham T. Richter, MD (Arkansas Children’s Hospital)
Pressure equalization tube placement is one of the most common procedures in the pediatric population. This video demonstrates the surgeon’s view of the right ear through the operative microscope.
Indications: recurrent otitis media with effusion, chronic otitis media with effusion (>3 months duration), speech/language delay secondary to otitis. Instruments: operative microscope, ear speculum, ear curette, myringotomy knife, suction tube, pressure equalization tube
Procedure Steps:
1. Speculum inserted into external auditory canal
2. Cerumen removed with the curette (not shown in video)
3. Myringotomy performed on anterior-inferior quadrant of tympanic membrane
4. Fluid aspirated with suction tube
5. Pressure equalization tube (PET) inserted and secured
6. Antibiotic otic drops applied
7. Cotton dressing applied
Recommended Resource: Lambert E, Roy S. Otitis media and ear tubes. Pediatric Clinics of North America. 2013;60(4):809-26. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23905821
The authors have no conflicts of interest or financial disclosures.
DOI: http://dx.doi.org/10.17797/fzlqossgrh
A five year old with conductive hearing loss due to traumatic ossicular discontinuity presents for surgical management. Ossicular discontinuity with a fibrous union of the incudostapedial joint is identified. Transcanal Endoscopic middle ear exploration with incus interposition is performed.
DOI: http://dx.doi.org/10.17797/t0il7famg9
Editor Recruited By: Sanjay Parikh, MD, FACS
Otosclerosis causes conductive hearing loss with absent acoustic reflexes. Stapedotomy is a successful surgery that is demonstrated in this video.
Editor Recruited By: Ravi Samy, MD, FACS
DOI: http://dx.doi.org/10.17797/6c3g45u2tw
Emphasis on soft tissue removal
DOI: http://dx.doi.org/10.17797/1hfipu5fg1
Author Recruited by: Ravi N. Samy, MD, FACS
Contributors: Jacob B. Hunter, Reid C. Thompson and David S. Haynes
Superior semicircular canal dehiscence (SCD) is a condition in which the bone overlying the superior semicircular canal is absent. The clinical presentation of SCD is highly variable and may include both auditory and vestibular manifestations. The more common symptoms include autophony, sound or pressure induced vertigo, hypersensitivity to sound, and low frequency conductive hearing loss. Repair can be accomplished via either transmastoid or middle fossa approaches, with numerous materials used to either plug or resurface the canal. Herein, we describe our resurfacing technique using a loose areolar tissue-bone pâté-loose areolar tissue sandwich through a middle fossa approach.
DOI#: http://dx.doi.org/10.17797/kcwvab3b7r
Stage 1 Microtia Repair using rib cartilage and modifications to the Nagata method of auricular formation.
DOI#: http://dx.doi.org/10.17797/cquv22l7p3
Contributors: Shira Koss
6 year old boy suffering from bullying at school as a result of bilateral cryptotia, a very unusual congenital ear anomaly in which the superior helix is buried under temporal skin.
DOI#: http://dx.doi.org/10.17797/le4g6c5rk5
This is the second stage of Microtia Reconstruction, the first stage was depicted in a prior video. The ear is elevated and lateralized to take its 3-dimensional form, and this is accomplished with use of an anteriorly based mastoid fascial flap as well as costal cartilage graft and full thickness skin graft.
Editor Recruited By: Michael Golinko, MD
Contributors: Amelia Cussans and Mr Shreeshyla Basavaraj
Music: Fifth Avenue Stroll
Ménière’s disease is an inner ear disorder, characterised by intermittent attacks of vertigo, fluctuating hearing loss, tinnitus and sense of pressure in the ear. The pathophysiology is not fully understood; however, it is believed to be associated with abnormal fluid regulation of the endolymph. Whilst medical therapy is sufficient in most cases, some patients require surgical intervention. Endolymphatic sac decompression is one of the surgical methods that can be employed in the treatment of patients with medically intractable Ménière’s disease. It aims to reduce vertigo by relieving endolymphatic pressure in the cochlea and vestibular system. This video demonstrates Mr Sreeshyla Basavaraj’s surgical technique.
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.
