Otosclerosis can lead to progressive conductive hearing loss, significantly affecting quality of life. For patients who choose surgery, the tympanic membrane is elevated, and the middle ear space is explored. If the surgeon confirms that the stapes is fixed in the oval window, either a stapedotomy or stapedectomy can be performed.
In the stapedotomy, the surgeon removes the stapes superstructure, creates a fenestration in the footplate, and places a prosthesis from the incus through the fenestration into the vestibule. In this instance, the patient was able to regain nearly all of the hearing that had been lost as a result of stapes fixation.
Endolymphatic sac (ELS) decompression can be performed for patients with Meniere’s disease who have failed conservative treatment such as dietary changes and medical therapy. The full pathophysiological mechanisms that result in Meniere’s disease are not entirely understood. The variation in techniques for performing ELS decompression support this; there is no concrete data to justify one approach over another. Regardless, in the correct patient, ELS decompression can significantly alleviate the patient’s symptoms. To do so, a mastoidectomy is performed to expose the bony labyrinth as well as the bone overlying the sigmoid sinus. Decompression of the sac can be accomplished by removing overlying bone, incising the dura, or stenting the dura open.
Superior semicircular canal dehiscence (SSCD) is associated with conductive hearing loss, autophony, and pressure/sound induced vertigo. Patients who are symptomatic may elect to undergo surgical intervention.
Here, Dr. Kaylie demonstrates the transmastoid approach to repairing SSCD. This approach affords the opportunity for an outpatient procedure to expose and plug the canal around the defect.
Charles R. Woodard, MD¹; Alexandra L. Elder, BS²; Helen A. Moses, MD¹; C. Scott Brown, MD¹ ¹Duke University Medical Center ²Thomas Jefferson University
Botox injection is one of the most common cosmetic procedures performed. Botox temporarily paralyzes targeted skeletal muscles of the face, reducing the patient’s ability to produce unwanted dynamic wrinkles. Commonly treated areas of the face include the procerus and corrugator supercilii muscles to treat glabellar frown lines, the frontalis muscle to treat horizontal rhytids of the forehead, and the orbicularis oculi muscle to treat “crow’s feet” wrinkles along the lateral aspect of the orbit.
A thorough facial analysis is necessary to develop a treatment plan for each problem area, particularly by engaging the patient to determine what his or her goals for treatment are. Providers must take care when injecting into the face to avoid complications of overtreatment, such as brow ptosis from over-injecting the forehead or elevated brow from over-injecting the periorbital muscles.
Eustachian tube dysfunction can often cause otitis media, tympanic membrane perforation, or conductive hearing loss. In this video article, myringoplasty was performed using a CO2 laser that provided reorganization of collagen fibers and improved compliance of the tympanic membrane. Given the ongoing eustachian tube dysfunction, a pressure equalization tube was placed to prevent recurrent retraction and atelectasis of the eardrum.
In this video, Dr. Scott Brown performs an endoscopic stapedectomy for the treatment of conductive hearing loss. He explains his technique and the advantages afforded by adoption of the endoscope in ear surgery.
Bone conduction implants can improve hearing in patients with conductive or mixed hearing loss as well as in cases of single-sided deafness (SSD). The patient in this case previously underwent resection of a vestibular schwannoma via a middle fossa craniotomy that ultimately resulted in SSD. Here, Dr. Kaylie at Duke University Medical Center demonstrates the step-by-step surgical technique for the Bonebridge implant to allow sound transmission from the patient’s deaf ear to the contralateral cochlea via bone conduction.
With improvement in both preoperative parathyroid tumor identification and the use of intraoperative parathyroid hormone assay, minimally invasive parathyroidectomy (MIP) is now performed more frequently in patients with primary hyperparathyroidism (pHPT). Still, many institutions are not familiar with performing MIP under regional or local anesthesia. Here, Dr. Tobias Carling presents an MIP performed under local cervical block anesthesia on a patient with pHPT and parathryoid adenoma.
1Duke University Medical Center 2College of Osteopathic Medicine, Touro University California
In this case, a patient with a symptomatic Zenker’s diverticulum is treated with an endoscopic staple-assisted diverticulotomy. The clinical presentation, diagnostic criteria, surgical procedure, and postoperative care are highlighted.
In this case, Dr. Tobias Carling and Dr. Courtney Gibson at Smilow Cancer Hospital at Yale New Haven perform a TOETVA on a 45-year-old patient who presented with a growing thyroid nodule that was shown to be a Hurthle cell neoplasm on fine-needle aspiration.
Numerous minimally-invasive approaches to thyroidectomy have been developed over the years to minimize the neck surgical scar, many of which are performed using endoscopic or robotic assistance. However, a more diminutive anterior cervical scar still remains a problem for some patients, as well as more extensive dissections for remote access operations. Therefore, natural orifice surgery was adopted at select institutions in an effort to perform a truly scarless thyroidectomy. Trans-oral endoscopic thyroidectomy has been the latest approach developed, known as the natural orifice transluminal endoscopic thyroidectomy, which is categorized as a natural orifice transluminal endoscopic surgery (NOTES) procedure. There are several ways to perform the natural orifice transluminal endoscopic thyroidectomy. Here, the authors present the TOETVA under general anesthesia.