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Assessment and management of retraction pockets

100%
Alper C. M., Olszewska E.
Polish Journal of Otolaryngology
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2017
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vol. 71
|
issue 1
1-21
EN
This manuscript intends to review types, pathogenesis, associated risk factors, and potential methods of prevention and treatment of the retraction pockets in adults and children. The importance of retraction pockets (RP) lies in loss of original histological and anatomical structure which is associated with development of ossicular chain erosion, cholesteatoma formation and potentially life threatening complications of cholesteatoma. The trans-mucosal exchange each gas in the middle ear (ME) is towards equalizing its partial pressures with the partial pressure in the environment. MEs that have abnormalities in the volume and ventilation pathways in the epitympanic may be more susceptible to retraction pockets. Sustained pressure differences and/or inflammation leads to destruction of collagen fibers in the lamina propria. Inflammatory mediators and cytokines lead to release of collagenases result in viscoelastic properties of the lamina propria. The process of changes in the tympanic membrane structure may evolve to the cholesteatoma formation. There are many different staging systems that clinicians prioritize in their decision making in the management of RP. The authors discuss the management possibilities in different clinical situations: RP without and with ongoing or intermittent evidence of Eustachian Tube Dysfunction (ETD), presence of adenoid hypertrophy or re-growth of adenoids, presence or absence of effusion, invisible depth of RP without effusion. invisible depth of RP with effusion, ongoing RP after VT insertion, and finally suspicion of cholesteatoma in a deep RP with ME effusion. A decision algorithm regarding the management of TM retraction and retraction pockets is provided.
2
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Glomus tympanicum – clinical characteristics and surgical management

100%
Łukawska-Popieluch I., Bartoszewicz R., Morawski K., Niemczyk K.
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EN
Objective: The aim was to determine the clinical characteristics and analysis of surgical treatment of patients with glomus tympanicum hospitalized in the Department of Otorhinolaryngology. Material and methods: Between 2000 and 2015, 27 patients were hospitalized. Age ranged 28-79 years old. The study analyzed data from the clinical examination and the type of surgical technique. Results: The most common symptoms were tinnitus and hearing loss. Resection of the tumor was performed by anterior tympanotomy in 3 (11,1 %), CWU mastoidectomy in 21 (77,8 %), CWD mastoidectomy in 1 (3,7 %), lateral petrosectomy in 2 (7,4 %) patients. Conclusion: Glomus tympanicum have a quite characteristic clinical picture with dominant symptoms of tinnitus, hearing loss and reddening of the tympanic membrane in otoscopic examination. This type of tumors require surgical treatment. Surgical access depends on the size of the tumor in the tympanic cavity. Most of these tumors can be removed using antromastoidectomy, with posterior tympanotomy and hypotympanotomy.
3
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Assessment and management of retraction pockets

100%
Alper C. M., Olszewska E.
Otolaryngologia Polska
|
2017
|
vol. 71(1)
1-21
EN
This manuscript intends to review types, pathogenesis, associated risk factors, and potential methods of prevention and treatment of the retraction pockets in adults and children. The importance of retraction pockets (RP) lies in loss of original histological and anatomical structure which is associated with development of ossicular chain erosion, cho¬lesteatoma formation and potentially life threatening complications of cholesteatoma. The trans-mucosal exchange each gas in the middle ear (ME) is towards equalizing its partial pressures with the partial pressure in the environ¬ment. MEs that have abnormalities in the volume and ventilation pathways in the epitympanic may be more suscep¬tible to retraction pockets. Sustained pressure differences and/or inflammation leads to destruction of collagen fibers in the lamina propria. Inflammatory mediators and cytokines lead to release of collagenases result in viscoelastic properties of the lamina propria. The process of changes in the tympanic membrane structure may evolve to the cho¬lesteatoma formation. There are many different staging systems that clinicians prioritize in their decision making in the management of RP. The authors discuss the management possibilities in different clinical situations: RP without and with ongoing or intermittent evidence of Eustachian Tube Dysfunction (ETD), presence of adenoid hypertrophy or re-growth of adenoids, presence or absence of effusion, invisible depth of RP without effusion. invisible depth of RP with effusion, ongoing RP after VT insertion, and finally suspicion of cholesteatoma in a deep RP with ME effusion. A decision algorithm regarding the management of TM retraction and retraction pockets is provided.
4
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Congenital cholesteatomas

88%
Narożny W., Kuczkowski J., Stankiewicz C.
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2015
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vol. 4(2)
78-83
EN
Congenital cholesteatoma is a rare ear disorder. The most common presentation is a pearly and white mass, visible with an intact tympanic membrane in individuals with no previous history of ear discharge, ear surgery or perforation of tympanic membrane. Based on a careful overview of literature, authors of this article present: the most probable theories of the cause of development of congenital cholesteatoma, diagnostic criteria of congenital cholesteatoma, its most common clinical symptoms, preoperative studies, methods of surgical treatments and goals of postoperative proceedings. Furthermore, authors present a comparison of histological, molecular and clinical features of congenital and acquired cholesteatomas.
5
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Drainage or paracentesis

75%
Zielnik-Jurkiewicz B.
Polski Przegląd Otorynolaryngologiczny
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2017
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vol. 6(2)
1-7
EN
Tympanostomy tube insertion and tympanic membrane incision are two the most frequently performed surgical procedures in otolaryngology, especially in children. The tympanic membrane incision - paracentesis, or myringotomy – is an incision of the tympanic membrane for diagnostic purposes or to allow drainage of pathological secretion from the tympanic cavity. Tympanostomy tube insertion involves incision made in the tympanic membrane and insertion of a ventilation tube (various types and for various periods of time) to improve hearing and aeration of the tympanic cavity. Procedures are performed through the ear canal (transcanal approach), under local or general anesthesia. Complications may occur in some cases of paracentesis and tympanostomy tube insertion.
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