Otalgia surgery: Difference between revisions

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<u>'''[[Cholesteatoma]]'''</u>: Surgery is the definitive form of treatment. Two kinds of procedures exist for treatment of Cholesteatoma. They are
<u>'''[[Cholesteatoma]]'''</u>: Surgery is the definitive form of treatment. Two kinds of procedures exist for treatment of Cholesteatoma. They are


*Canal-wall-down operations - for those who had several recurrences and is willing to avoid future episodes. Have the advantage of permanently ridding the patient of Cholesteatoma
*Canal-wall-down operations - for those who has had several recurrences and is willing to avoid future episodes. Have the advantage of permanently ridding the patient of Cholesteatoma


*Canal-wall-up procedures - for those who are unwilling or unable to return for a second-look procedure. Have the advantage of maintaining normal appearance. But have the disadvantage of high probability of recurrences.
*Canal-wall-up procedures - for those who are unwilling or unable to return for a second-look procedure. Have the advantage of maintaining normal appearance. But have the disadvantage of high probability of recurrences.

Revision as of 16:34, 17 July 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Overview

Surgery forms the main stay of treatment for major ear pathologies like Otitis media (OM), Otitis externa, Cholesteatoma, Mastoiditis etc., and some non-ear pathologies like TMJ disorder, Retropharyngeal abscess etc.

Surgical treatment for Primary Otalgia

Otitis media: Surgical options for Otitis media include :

Indications for Tympanocentesis include:

  • Severe Otalgia, seriously ill, or appearing toxic.
  • Unsatisfactory response to antimicrobial therapy.
  • Onset of AOM in a patient receiving antimicrobial therapy.
  • Potential suppurative complication.
  • OM in a newborn, sick neonate, or patient who is immunologically deficient.

Indications for Myringotomy and Tympanostomy tube insertion:

Intratemporal and intracranial complications of Otitis media requires surgical consultation. Patients with Cleft palate[1], Down syndrome, or other craniofacial abnormalities, may require early surgical intervention to prevent Otitis Media.[2]

Otitis externa: Surgery is now reserved for local debridement, removal of bony sequestrum, or abscess drainage.

Cholesteatoma: Surgery is the definitive form of treatment. Two kinds of procedures exist for treatment of Cholesteatoma. They are

  • Canal-wall-down operations - for those who has had several recurrences and is willing to avoid future episodes. Have the advantage of permanently ridding the patient of Cholesteatoma
  • Canal-wall-up procedures - for those who are unwilling or unable to return for a second-look procedure. Have the advantage of maintaining normal appearance. But have the disadvantage of high probability of recurrences.

Mastoiditis: Surgical procedures may be performed (while continuing the medication) if the condition does not quickly improve with antibiotics. The most common procedure is a myringotomy, a small incision in thetympanic membrane (eardrum), or the insertion of a tympanostomy tube into the eardrum. These serve to drain the pus from the middle ear, helping to treat the infection. The tube is extruded spontaneously after a few weeks to months, and the incision heals naturally. If there are complications, or the mastoiditis does not respond to the above treatments, it may be necessary to perform a mastoidectomy in which a portion of the bone is removed and the infection drained.

Surgical treatment for Referred Otalgia

  • Retropharyngeal abscess: Treatment depends upon the size of the abscess as visualized on CT scan or Ultrsonography of neck. If the abscess is of small size, needle aspiration can be done to completely evacuate the pus. For extensive abscesses which spread deep into the fascial planes of neck, open surgery proves to be the best option to prevent further spread and ensure complete removal of the abscess.

References

  1. Klockars T, Rautio J (2012). "Early placement of ventilation tubes in cleft lip and palate patients: Does palatal closure affect tube occlusion and short-term outcome?". Int J Pediatr Otorhinolaryngol. doi:10.1016/j.ijporl.2012.06.028. PMID 22796197. Unknown parameter |month= ignored (help)
  2. Hartzell LD, Dornhoffer JL (2010). "Timing of tympanoplasty in children with chronic otitis media with effusion". Curr Opin Otolaryngol Head Neck Surg. 18 (6): 550–3. doi:10.1097/MOO.0b013e32833febc4. PMID 21045692. Unknown parameter |month= ignored (help)



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