Endolymphatic sac decompression

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.

Surgical management of keratosis obturans

Keratosis obturans is a condition of the external auditory canal (EAC) characterised by formation and accumulation of desquamated keratin resulting in varying symptoms. Clinically presents as otalgia, conductive hearing loss and recurrent infection. Typically seen in younger age group and can occur bilaterally. Extension to adjacent structures can occur and result in further complications. The proposed theory is that there is a defect in epithelial in migration resulting in widening / osteitis of  external canal bone.

Condition was first described by Toynbee in 1850, and named by Wreden in 1874. Pipergerdes in 1980 distinguished keratosis obturans as separate disease from external auditory canal cholesteatoma. Ever since various treatment regime has been recommended but none of them have been curative. Michael M Paparella was first to propose surgical treatment in 1966 and he then modified the surgical technique in 1981.

Because the defect is in epithelial migration, canaloplasty with or without graft, without obliterating the bony canal defect will not restore epithelial migration. Hence, M. M Paparella’s surgical technique was NOT popularized.

Mr Basavaraj proposes novel technique which not only clears the diseased bone but obliterates the bony defect, and grafts the ear canal to bring it back to normal shape and size to encourage normal epithelial migration.

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