Chronic otitis media and cholesteatoma

 

Chronic otitis media results from a perforation in the eardrum and an active bacterial infection within the middle ear space that has lasted for several weeks or more. There may be enough pus present that it drains to the outside of the ear (otorrhea). Hearing impairment often accompanies this disease. Cholesteatoma involves a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Although cholesteatomas are not classified as either tumors or cancers, they can still cause significant problems because of their erosive and expansive properties. They may result in the destruction of bones in the middle ear, which requires surgery. They may, as well, spread through the base of the skull into the brain. Tympanoplasty is the surgical operation performed for the reconstruction of the eardrum and/or the small bones of the middle ear after removal of granulation and/or cholesteatoma. Common graft sites include the temporalis fascia. We perform more than 20 operations in patients with chronic otitis media and cholesteatoma each year. Canal wall down tympanoplasty with reconstruction of soft posterior meatal wall is usually our method for treating cholesteatoma.

Ear tube insertion for recurrent acute otitis media and otitis media with effusion

The insertion of an ear tube reduces the occurrence of middle ear infections and allows the drainage of excess fluids. The most common indication for insertion of an ear tube remains recurrent acute otitis media (AOM) in children and persistent otitis media with effusion (OME) with conductive hearing loss. We insert ear tubes into more than 50 children each year under general anesthesia.

Facial nerve paralysis

Facial nerve paralysis is one of the diseases that commonly lead to the loss of facial expression. We treat more than 70 patients with facial nerve paralysis, including 80% with Bell’s palsy and 20% with Ramsay-Hunt syndrome each year. Patients with severe facial nerve paralysis are hospitalized and treated with intravenous prednisolone tapering from 120mg, low-molecular dextran, vitamin B12, ATP and glycerin. Speech-language-hearing therapists (ST) perform rehabilitation of facial muscles in these patients. We assess the possibility of the mitigation of facial nerve paralysis by electroneurography (ENoG). Patients with severe facial nerve paralysis who do not improve with steroidal therapy and ENoG < 10% are considered for facial nerve decompression. We inject botulinum toxin (Botox®) to the ocular and zygomatic muscle to improve pathologically associated movement.

Sudden sensorineural hearing loss

Sudden sensorineural hearing loss (SSHL), commonly known as sudden deafness, occurs as an unexplained, rapid loss of hearing –usually in one ear– either suddenly or over several days. We treat more than 80 patients with this disease each year. Patients with severe hearing loss are hospitalized and treated with intravenous prednisolone tapering from 120mg, low-molecular dextran, Vitamin B12, ATP and glycerin. Hyperbaric oxygen (HBO) therapy is also used for our patients.