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  Contents > Previous page > Article detail print Order
o Issue N# 3 - 2010 o

OTOLOGY

Advantages of combined therapies in cosmetic medicine for the treatment of face aging: botulinum toxin, fillers and mesotherapy


Authors : Louvrier C, Montalban A, Lietin B, Gabrillargues J, Gilain L, Mom T. (Clermont-Ferrand)

Ref. : Rev Laryngol Otol Rhinol. 2010;131,3:193-197.

Article published in english
Downloadable PDF document english



Summary : Objective: To determine whether surgical pitfalls can be anticipated through a preoperative CT-Scan in case of middle ear implantation with a semi-implantable middle ear ossicular stimulator from Otologics® (SIMOS). A second outcome mea­su­re was to assess the auditory gain obtained in the series. Mate­rials and methods: A retrospective analysis of 19 consecu­tive surgical procedure for a SIMOS implantations was achie­ved. Preoperative Ct-Scans were analyzed and several measu­re­ments of the mastoid were taken out from axial trans­verse views, ie. the distance between the incus and the cortical mas­toid bone [d(i-c)], the distance between the sigmoid sinus and the incus [d(i-ss)], the distance between the sigmoid sinus and the cortical bone of the mastoid [d(c’-ss)]. On coronal images, the dura of the middle fossa was described as procident if it was lower than the head of malleus and/or body incus. Auditory gain was calculated on pure tone and speech audio­metry with bisyllabic words. Results: All cases were success­fully implan­ted. d(i-c) was on average at 33.1±2.6 mm in cases easy to implant. One case of contracted mastoid was difficult and led to the impaction of the sigmoid sinus. In this case the distance d(i-c) was shorter at 25 mm than the average minus 2 standard deviations of the others (27.9 mm). Also d(ss-c’) was lower at 7 mm than the average minus 2 standard deviations of the others (7.6 mm). Two other cases led to difficult surgical proce­du­res because of a low middle fossa dura. This too low middle fossa dura could be identified on preoperative coronal CT-scans in these two cases. Audiometric gains were remarka­ble, with an average of 39±16 dB. In case of severe senso­rineural hea­ring loss the average gain was higher at 46±9 dB. Two revision-pro­ce­dures were required, one for a device failure, the second because of skin alteration due to systemic inflammatory disease requiring corticosteroids. Mean follow-up was 50±22 months. Conclusion: The SIMOS is a powerful middle ear implant that can undoubtedly give a huge audiometric gain. The implan­tation procedure requires a precise microsurgical operation that can be hampered by anatomical conditions of the petrous bone. A thorough examination of preoperative CT-scan is highly recommended in order to obtain measurements of the mastoid in axial views, and the analysis of the position of the middle fossa dura in coronal views.

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