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Abstract(Please copy/paste the abstract send to the congress) : |
1-A new approach to detect recurrent cholesteatoma among cochlear implant patients; A rare albeit challenging complication
Masoud Motasaddi Zarandy1, Farzad Firouzi2
1Professor, ENT Research Center, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
2Resident of ENT, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background: Pediatric cochlear implant (CI) is the most successful sensory neural prosthe¬sis to restore hearing sensation, however, it is associated with complications such as cholesteatoma formation. Detecting recurrent cholesteatoma is a challenging issue particularly in patients with cochlear implant. Different modalities of MRI and conventional CT scans have their own limitations. The present study proposes a new modality to facilitate early detection of recurrent cholesteatoma.
Case presentation: A known case of CI boy was scheduled for surgery with the suspicious pathology of middle ear during which cholesteatoma was removed from middle ear, mastoid cavity and around the prosthesis. Then, the cavity was filled with patient’s adipose tissue with the concept of facilitating early detection of recurrence since adipose tissue has a unique appearance in CT scan imaging.
Conclusion: Detecting recurrent cholesteatoma is still a challenging issue among ear surgeons. With respect to the relatively incom¬patibility of CI with MRI due to the in¬terference between the magnetic field and the metallic package of the implantable unit, we believed that filling the cavity with adipose tissue could facilitate early detection of recurrent cholesteatoma with HRCT scan and provide this modality of imaging as a more reliable tool.
2-Management of Glomus Tumors in a Single Referral Center
Dr. Masoud Motasaddi Zarandy
professor of Otology,Neurotology, Tehran University of Medical Sciences,Tehran,Iran
Abstract:
Glomus tumor is the most common primary tumor of the middle ear. A typical glomus tumor presents with pulsatile tinnitus and unilateral hearing loss. This study provides a clinical perspective of glomus tumor.
Methods:
A prospective study was performed on 26 patients (10 glomus tympanicum and 16 glomus jugulare) from January 2009 to January 2011 in Amir Alam hospital (tertiary referral center). All patients underwent neurological examination, audiometry and radiological survey before and after surgery. A questionnaire was completed by patients to evaluate the postoperative quality of life. The Fisch classification was used in this study.
Results:
The mean age was 45.4 years. Hearing loss was the most common symptom and pulsatile tinnitus the most common symptom lead to seek medical care. 10 glomus tympanicum underwent surgery via transcanal or transmastoid approach and 16 glomus jugulare underwent preop embolization and surgery via infratemporal approach. One patient underwent adjuvant radiotherapy due to incomplete resection. In small tumors, we removed tumor without rerouting of facial nerve. In large tumor (class C, D and sometimes B), our approach was anterior rerouting of the nerve. When the nerve was involved, we transected the involved part and grafted it with greater auricular nerve. Vertigo and tinnitus significantly decreased postoperatively. Air-bone gap increased in jugulare patients and reduced slightly in tympanicum. 42.3% of patients had preoperative lower cranial nerve deficits and 38.5% found new deficits after surgery. Eight patients with glomus jugulare found facial nerve paralysis postoperatively that all resolved to grade I-II House-Brackmann in follow up. We found one recurrence. The most common cause of depressive mood and anxiety after surgery was facial nerve dysfunction.
we also discuss the results of additional 30 patients who treated by radiotherapy for some reasons and some important points during the surgery to get better results.
Conclusions:
Surgical removal is an acceptable approach to reach total tumor removal. Although immediate postoperative morbidities (esp. facial nerve palsy) in infratemporal approach were considerable, follow up showed improvement of nerve dysfunctions. High percentage of preoperative cranial deficits (42.3%) suggests majority of deficits were related to the late diagnosis of tumor, not treatment modality or surgical approach. This fact highlights importance of attention to the red flags of this disease by physicians.
3-New advances in hearing restoration:different indications of VSB, Round window vibroplasty and ...
Dr. Masoud Motasaddi Zarandy
professor of Otology,Neurotology, Tehran University of Medical Sciences,Tehran,Iran
Hearing restoration treatments improve quality of life however, high initial costs of fitting &
maintenance may have restricted their use. recently, improvements in the following research axis bring a bright hope for impaired and deaf people.
1-Improvements in hearing aid technology like development of directional microphone, alteration in signal processing strategy and digital hearing aids.
2-these days ,in many otologic centers, implantable hearing aids with their abilities are acceptable surgical methods to restore hearing in many situations with conductive ,sensorineural and mixed hearing loss.
Also improvements in cochlear implant technology, biological restoration of hearing and experimental use if neurotrophic factors for regenerating spiral ganglion neurons highlight new advancements for hearing.
In this presentation while we discuss the different indications of vibrant sound bridge, we try to explain some tips during surgery with some video clips. finally we will focus on advantages and disadvantages of different kinds of implantable hearing aids. |