RETRACTION POCKETS AND PERFORATIONS BPOC, LONDON 2018 PROF IA BRUCE MD FRCS PAEDIATRIC OTOLARYNGOLOGIST, MANCHESTER, UK PERFORATIONS • Sequelae of acute or chronic ear infection, physical trauma, barotrauma or iatrogenic • Permanent perforation more likely with chronicity of ear disease & ETD • 5 types of Tympanoplasty described, dependent upon integrity and mobility of the ossicular chain • Choosing the technique for repair influenced more by perforation and patient factors than success for particular techniques MYRINGOPLASTY / TYPE 1 TYMPANOPLASTY • TM repair when middle ear normal- no ossicular surgery • Success in children varies widely (majority 50-95%), Mean on metanalysis 83.4% Hardman 2015 • Aims of myringoplasty: Limit infections and impact on QoL Prevent complications of recurrent ear infections Improve hearing Limit developmental consequences of hearing loss (HL) Avoid behind-the-ear (BTE) HA Avoid need for waterproofing / allow swimming FACTORS AFFECTING MYRINGOPLASTY SUCCESS • Patient factors ET function, health of contralateral ear -Hardman 2015, (age) • Perforation factors No unequivocal evidence that infection affects outcome - Tan 2016 Size of perforation - Hardman 2015 Site of perforation • Surgical factors Surgical technique Graft material
6
Embed
RETRACTION POCKETS AND PERFORATIONSmanchesterchildrensent.com/.../2018/03/...TWITTER.pdfRETRACTION POCKETS AND PERFORATIONS BPOC, LONDON 2018 PROF IA BRUCE MD FRCS PAEDIATRIC OTOLARYNGOLOGIST,
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
R E T R A C T I O N P O C K E T S A N D P E R F O R AT I O N S
B P O C , L O N D O N 2 0 1 8
P R O F I A B R U C E M D F R C S PA E D I AT R I C O T O L A R Y N G O L O G I S T, M A N C H E S T E R , U K
P E R F O R AT I O N S
• Sequelae of acute or chronic ear infection, physical trauma, barotrauma or iatrogenic
• Permanent perforation more likely with chronicity of ear disease & ETD
• 5 types of Tympanoplasty described, dependent upon integrity and mobility of the ossicular chain
• Choosing the technique for repair influenced more by perforation and patient factors than success for particular techniques
M Y R I N G O P L A S T Y / T Y P E 1 T Y M PA N O P L A S T Y
• TM repair when middle ear normal- no ossicular surgery
• Success in children varies widely (majority 50-95%), Mean on metanalysis 83.4% Hardman 2015
• Aims of myringoplasty:
Limit infections and impact on QoL
Prevent complications of recurrent ear infections
Improve hearing
Limit developmental consequences of hearing loss (HL)
Avoid behind-the-ear (BTE) HA
Avoid need for waterproofing / allow swimming
FA C T O R S A F F E C T I N G M Y R I N G O P L A S T Y S U C C E S S
• Patient factors
ET function, health of contralateral ear -Hardman 2015, (age)
• Perforation factors
No unequivocal evidence that infection affects outcome - Tan 2016
Size of perforation - Hardman 2015
Site of perforation
• Surgical factors
Surgical technique
Graft material
Adults & children Mean success 86.6% 5.8% higher failure rate in children Cartilage has superior closure rates (2.8% better than fascia) Success 6.1% better for perforations <50% No clear benefit from combined cortical mastoidectomy No superior graft placement technique (underlay etc.)
T I M I N G O F P E R F O R AT I O N R E PA I R
• How old? No current consensus, but trend towards younger ages Hartzell 2010
• How old? ETD commonest in 2-4 year olds…
…Consider in 4 + year olds if contralateral ear normal
Nasal Cavity RhinitisAssociation With Eustachian Tube Function Optimise Nasal Health
Ear- Infection/Inflammation/ Glue Ear
Granulations In Retraction- ? Cholesteatoma Indication Of Eustachian Tube Function
Ear- Extent Of Retraction
Grading System Or Narrative Description
Fixation To Middle Ear Structures Risks Iatrogenic Cholesteatoma If Attempt To Elevate And Resect Retraction Role Of Ventilation Tubes In Early Progressive Retractions
Erosion Of Ossicular Chain
Ear- Extent Of Tympanosclerosis
Extent Of TympanosclerosisInfluence On Technical Difficulty To Elevate Increases Size Of Perforation If Resect
Ear- CholesteatomaCholesteatoma In Retraction Pocket