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Cochlear implantation is mostly performed under general anaesthesia. This study aimed to evaluate cochlear implantation performed under local anaesthesia and sedation.
Twenty patients had a cochlear implant fitted under combined local anaesthesia (local anaesthesia group) and 41 patients had one fitted under general anaesthesia (general anaesthesia group) for bilateral profound hearing loss, from 2011 to 2014. Surgical duration, period of post-operative hospitalisation and early post-operative symptoms were compared. In the local anaesthesia group, operative symptoms reported during the surgery and by questionnaire were analysed.
Mean surgical duration was significantly shorter in the local anaesthesia group: 87 versus 122 minutes (p < 0.001). No significant difference was observed between the local anaesthesia and general anaesthesia groups regarding mean post-operative hospitalisation and early post-operative symptoms. Under local anaesthesia, patients had no particular symptoms in 60 per cent of cases. The remaining patients in this group experienced vertigo (10 per cent), pain (20 per cent) and pain-related movement (10 per cent) during the intervention. These symptoms can be controlled with symptomatic treatment.
Combined local anaesthesia for cochlear implantation is a good alternative to general anaesthesia for co-operating patients.
Inexperienced otologists require training on the temporal bone drilling process, prior to any surgical activity. The shortage of cadaveric temporal bones exerts pressure to create realistic physical prototypes. This paper describes the evaluation by otology experts of a specially developed temporal bone resin model.
Computed tomography images were transformed into digital files, and anatomically identical right temporal bone models were created using stereolithography. These hand-painted resin prototypes were sent to 25 otologists, accompanied by a 20-item questionnaire.
Satisfaction rate was 92 per cent. The overall prototype score was 48.87 out of 60. Average scores were: 12.63 out of 15 for anatomy-morphology, 6.98 out of 9 for quality of drilling, 16.74 out of 21 for identification of anatomical elements and 7.41 out of 9 for stages of drilling. Limitations of the model included an excessively vivid facial nerve colour and difficulty in identifying the posterior semicircular canal. Disadvantages related to the thickness of the resin and its residues were identified.
The prototype appears to provide an attractive solution to the shortage of cadaveric temporal bones. However, interest in the model for drilling technique training for inexperienced otologists has not yet been assessed.
Foreign bodies in the transnasal ethmoido-sphenoidal sinus are uncommon. We present a case of unilateral rhinorrhoea caused by a foreign body which had been lodged in the ethmoido-sphenoidal sinus for 38 years.
A 40-year-old woman presented with unilateral rhinorrhoea. Computed tomography showed a foreign body located in the right ethmoido-sphenoidal sinus, with a defect of the lamina papyracea and the ethmoid roof. The endonasal approach did not permit extraction of the foreign body. A combined approach allowed the extraction of a pen cap, and the defect of the ethmoid roof was rebuilt.
Despite its limitations, the endonasal approach remains the treatment of first choice for osteo-meningeal defects, because of its minimal invasiveness and high success rate. However, in the presented case a combined approach was needed.
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