Table of Contents
Surgical Anatomy A. Rauchfuss 1
Preoperative Evaluation J. Lautermann H. Sudhoff H. Hildmann 10
Audiology 11
Imaging 11
Patient Information 11
Signed Consent 12
Medical Treatment 13
Nerve Monitoring and Computer-Assisted Surgery 13
When Not To Do Surgery H. Hildmann H. Sudhoff 14
Postoperative Treatment H. Sudhoff H. Hildmann 15
Local Anaesthesia H. Sudhoff H. Hildmann 17
General Anaesthesia 18
Approaches to the Middle Ear A. Gurr H. Sudhoff H. Hildmann 19
Transcanal Approach 19
Endaural Approach 19
Retroauricular Approach 20
Tympanomeatal Flap 22
Harvesting and Processing of Soft Tissues H. Sudhoff H. Hildmann 24
Harvesting Cartilage 26
Preparation of Cartilage 28
Harvesting Perichondrium 29
External Ear Canal Surgery H. Hildmann H.Sudhoff 30
Postoperative Changes 30
Postoperative Stenosis 30
Other Postoperative Changes 32
Trauma 33
Fractures Into the Medial Cranial Fossa 34
Post-traumatic Atresia 34
Inflammation and Sequelae 34
Postinflammatory Stenosis 34
Necrosis of the Floor or the External Auditory Canal 35
Postinflammatory Meatal Fibrosis 35
Malignant External Otitis 35
Idiopathic Changes 36
Exostosis 36
Tympanic Membrane Closure H. Sudhoff H. Hildmann 38
Transmeatal Approach 38
Central Perforations 38
Endaural Incision 39
Harvesting of the Graft 39
Preparation of the Skin Flap 40
Cartilage 42
Cartilage Palisade Tympanoplasty M. Bernal-Sprekelsen 44
Surgical Technique 44
Evaluation 45
Results 45
Conclusions 46
Ossicular Chain Reconstruction H. Sudhoff H. Hildmann 49
Materials for Ossicular Chain Reconstruction M. Yung 55
Antrotomy and Mastoidectomy H. Sudhoff H. Hildmann 62
Definition 62
Indications 62
Cholesteatoma Surgery H. Sudhoff H. Hildmann 67
Introduction 67
General Principles for Surgery 69
Surgical Steps 70
Mastoid Cavity H. Sudhoff H. Hildmann 73
Indications 73
Definition of Open and Closed Techniques 73
Open Cavity 75
Surgical Steps 76
Reduction of Volume 80
Meatoplasty 81
Closed Techniques 81
Intact Canal Wall Technique 81
Surgical Steps 82
Obliteration 88
Reconstruction 91
Fistulas of the Semicircular Canals 92
Packing 93
Specific Infections H. Sudhoff H. Hildmann 94
Complications J. Lautermann H. Sudhoff 95
Labyrinthitis and Facial Palsy 95
Extradural Complications 96
Intracranial Complications 97
Tympanosclerosis H. Sudhoff 98
The Atelectatic Ear H. Hildmann 99
Revision Surgery H. Hildmann H. Sudhoff 100
Early Revisions 100
Late Revisions 100
Special Problems 101
Facial Nerve Surgery O. Guntinas-Lichius H. Sudhoff H. Hildmann 103
Indications 103
Facial Nerve Palsy After Temporal Bone Fracture and Other Traumas 105
Approaches for Facial Nerve Exploration and Decompression 106
Techniques of Facial Nerve Reconstruction 107
Iatrogenic Lesions During Ear Surgery 110
Postoperative Complete Palsy After Ear Surgery in Patients with Normal Preoperative Facial Nerve Function 110
Facial Nerve Palsy in Patients with Chronic Inflammatory Disease 110
Postoperative Adjuvant Treatment 111
Stapes Surgery H. Sudhoff H. Hildmann 112
Floating Footplate 116
Abnormal Course of the Facial Nerve 118
Malleovestibulopexy 118
Laser Stapedotomy S. Jovanovic 120
Introduction 120
Laser Equipment 120
CO[subscript 2] Laser 120
Micromanipulator 121
Scanner System 121
Safe and Effective Energy Parameters for CO[subscript 2] Laser Stapedotomy 121
Surgical Technique of CO[subscript 2] Laser Stapedotomy 123
Special Cases 126
Obliterative Otosclerosis 126
Overhanging Facial Nerve 126
Overhanging Promontory 127
Inaccessible Footplate 127
Floating Footplate 127
Problems in Revision Procedures 128
Surgical Technique of CO[subscript 2] Laser Revision Stapedotomy 128
Conclusions 129
Stapes Revision Surgery S. Dazert H. Hildmann 131
Early Revisions 131
Late Revisions 132
Displacement of the Prosthesis 132
Complete Destruction of the Incus 132
Reclosure of the Oval Window 132
Fixation of Incus or Malleus 133
Schuknecht's Prosthesis 133
Perilymphatic Fistula 133
Vertigo 133
Middle Ear Trauma H. Hildmann H. Sudhoff 134
Traumatic Tympanic Membrane Perforation 134
Ossicular Chain Trauma 134
Perilymph Fistula 135
Rupture of the Round Window 135
Traumatic Stenosis or Atresia 135
Fractures of the Temporal Bone 135
Endolymphatic Sac Surgery H. Sudhoff H. Hildmann 137
Surgical Procedure 138
Anatomical Position of the Endolymphatic Sac 138
Malformation Surgery H. Hildmann 140
Surgery of Middle Ear Malformations 140
Minor Malformations 140
Small Tympanic Membrane 141
Chain Reconstruction 141
Major Malformations 142
Timing of Diagnosis 142
Surgical Steps and Landmarks 144
Cochlear Implantation S. Dazert H. Sudhoff H. Hildmann 146
Surgical Approach 146
Raising of the Flaps 146
Preparation of the Implant Bed for the Receiver 148
Mastoid Work 148
Posterior Tympanotomy 148
Cochleostomy 150
Placement of the Receiver and Electrode Insertion 150
Closure 152
Mastoiditis 152
Revision Surgery After Cochlear Implantation J. Muller H. Sudhoff H. Hildmann 153
Revision Surgery Can Become Necessary for Several Reasons 153
Medical Reasons 153
Electronic Failures 153
Trauma 153
Electrode Failures 153
Soft Failures 154
Labyrinthectomy H. Hildmann 156
Definition 156
Indications 156
Surgical Procedure 156
Vestibular Neurectomy - Translabyrinthine Approach H. Hildmann 158
Indications 158
Contraindications 158
Surgical Steps 158
Vestibular Neurectomy - Transtemporal Approach H. Hildmann 162
Indications 162
Contraindications 162
Complications 162
Anatomy 162
Surgical Procedure 162
Retrosigmoidal Approach M. Scholz 167
Introduction 167
Surgical Procedure 167
Positioning 167
Skin Incision 170
Preparation of Subcutaneous Tissue and Nuchal Muscles 170
Trephination 171
Fine Work with the Drill 172
Withdrawal of Cerebrospinal Fluid 172
Opening of the Dura 172
Intracranial Part 172
Closing Procedure 174
Otological Instruments J. Lautermann H. Sudhoff H. Hildmann 175
Special Instruments 175
Operating Room Arrangement 175
Suggested Reading 181
References 182
Subject Index 189
This comprehensive, richly illustrated textbook provides a systematic approach to frequent otological operations. Procedures in surgery of the ear canal, acute and chronic middle ear diseases, otosclerosis, cochlear implantation and vertigo are visualized step by step to acquaint the beginner with proven surgical repertoires. Each operative procedure is also shown on the accompanying DVD. Even the experienced surgeon will find valuable hints and suggestions to facilitate routine middle ear operations.
