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Hanna, B. M., I. Kivekäs, Y. - H. Wu, L. J. Guo, H. Lin, J. Guidi, and D. Poe, "Minimally invasive functional approach for cholesteatoma surgery.", The Laryngoscope, vol. 124, issue 10, pp. 2386-92, 2014 Oct. Abstract

OBJECTIVES/HYPOTHESIS: Report the efficacy of a functional minimally invasive approach for cholesteatoma surgery.

STUDY DESIGN: Retrospective review of surgical cases performed between 1996 and 2008.

METHODS: One hundred sixty-nine patient charts were reviewed in which ears with primary cholesteatomas that extended beyond the mesotympanum were operated on with a plan for canal wall up (CWU) mastoidectomy. The surgical approach consisted of progressive exposure from transcanal to postauricular tympanoplasty to CWU mastoidectomy, as needed, to identify and lyse the fibrous attachments that bind the capsule to the surrounding mucosa. Endoscopic guidance was employed as appropriate to minimize exposure needs. Any planned second-stage operations were attempted with a transcanal approach if appropriate and with endoscopic assistance.

RESULTS: One hundred eighty-four ears of 169 patients were included. The median age was 32 years (range, 1-79 years). The mean follow-up was 3.2 years (range, 1-11 years). Eighty-three (45%) were planned for a second-look operation, and three (2%) required unplanned second operations. The overall recurrence rate was 24/184 (13%), and the unexpected residual rate was 5/184 (3%). The residual rate with endoscopy (5/119, 4%,) or without endoscopy (1/65, 2%), were not significantly different. Hearing results in 156 ears improved significantly, from a preoperative pure-tone average (PTA) of 41 dB to a postoperative PTA average of 29 dB (P < .0001).

CONCLUSIONS: A functional minimally invasive approach to cholesteatoma surgery provided equivalent residual rates but higher recurrence rates compared to published canal wall down mastoidectomy. Endoscopic techniques were helpful in providing adequate views while minimizing exposure.

Acar, O. Gül, I. Kivekäs, B. M. Hanna, L. Huang, Q. Gopen, and D. S. Poe, "Comparison of stapedotomy minus prosthesis, circumferential stapes mobilization, and small fenestra stapedotomy for stapes fixation.", Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, vol. 35, issue 4, pp. e123-9, 2014 Apr. Abstract

OBJECTIVE: To compare the outcomes of 3 surgical techniques for primary stapes fixation: stapedotomy minus prosthesis (STAMP), circumferential stapes mobilization (CSM), and small fenestra stapedotomy (SFS).

STUDY DESIGN: Retrospective review of 277 primary cases operated for stapes fixation from 1997 to 2007.

SETTING: Tertiary academic center.

PATIENTS: Consecutive adult and pediatric cases operated for conductive hearing loss because of stapes fixation.

INTERVENTIONS: STAMP was performed for otosclerosis limited to the anterior footplate, CSM was conducted for congenital stapes fixation, SFS was performed for more extensive otosclerosis or anatomic contraindications to STAMP/CSM.

MAIN OUTCOME MEASURES: Pure-tone audiometry was performed preoperatively and postoperatively (3-6 wk) and the most recent long-term results (≥ 12 mo).

RESULTS: Ninety-nine ears in 90 patients had audiologic follow-up data over 12 months. Sixty-seven ears (68%) underwent SFS, 16 (16%) STAMP, and 16 (16%) CSM. There was significant improvement in average air conduction (AC) thresholds and air-bone gap (ABG) for all techniques. Mean ABG for SFS closed from 29 to 7.1 dB (SD, 6.0), for STAMP from 29 to 3.8 dB (SD, 5.8 dB), and for CSM from 34 to 20 dB (SD, 8.2 dB). AC results were better in the STAMP than in the SFS group, especially in high frequencies. Bone conduction improvements were seen in all groups, highest in STAMP (4.3 dB) and CSM (3.8 dB) groups, but the differences between groups were not statistically significant.

CONCLUSION: Satisfactory hearing results were achieved with all the techniques, and STAMP showed better hearing outcomes, especially in high frequencies. CSM is a good option for children and patients in whom it is desirable to avoid a footplate fenestration or prosthesis. CSM and STAMP had significantly higher rates of revision for refixation than SFS.

Hanna, B. M. N., and S. J. Kilty, "Middle turbinate suture technique: a cost-saving and effective method for middle meatal preservation after endoscopic sinus surgery.", Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, vol. 41, issue 6, pp. 407-12, 2012 Dec. Abstract

BACKGROUND: Lateralization of the middle turbinate following endoscopic sinus surgery (ESS) can lead to increased patient morbidity. Numerous techniques have been proposed to avoid this complication, including middle turbinectomy, stents, controlled synechiae formation, and metal clips.

OBJECTIVES: To determine if a suture technique is an effective middle turbinate stabilization procedure and to determine the cost savings of this technique compared to commercially available middle meatal stents.

MATERIAL AND METHODS: Retrospective review of 60 cases, all performed by the senior author using a middle turbinate suture technique, and the 3-month postoperative results. The efficacy of the technique was determined, as well as its cost compared to other materials for middle meatal preservation.

RESULTS: A total of 110 turbinates were treated with the suture technique in 60 patients. The success rate was 98.2% (108 of 110). Commercial stent use cost ranged from 8 to 83 times the price of the suture depending on the stent.

CONCLUSION: The middle turbinate suture technique is effective in preventing turbinate lateralization and has a significantly lower cost than commercially available middle meatal spacer materials.

Poe, D. S., and B. M. N. Hanna, "Balloon dilation of the cartilaginous portion of the eustachian tube: initial safety and feasibility analysis in a cadaver model", American Journal of Otolaryngology, vol. 32, no. 2, pp. 115 - 123, 2011. AbstractWebsite

Background Balloon catheter dilation of diseased sinus ostia has recently demonstrated efficacy and safety in the treatment of chronic sinus disease with 2 years of follow-up. Similar to sinus surgery, initial studies of partial resection of inflamed mucosa from within the cartilaginous eustachian tube (ET) have demonstrated efficacy and safety in the treatment of medically refractory otitis media with effusion. Therefore, balloon dilation of the cartilaginous \{ET\} was investigated as a possible treatment modality for otitis media. Methods A protocol for sinus balloon catheter dilation was evaluated in each of the cartilaginous \{ETs\} in 8 fresh human cadaver heads. Computed tomographic scans and detailed endoscopic inspections with video or photographic documentation were performed pre- and posttreatment, and gross anatomical dissections were done to analyze the effects of treatment and to look for evidence of undesired injury. Results Catheters successfully dilated all cartilaginous \{ETs\} without any significant injuries. There were no bony or cartilaginous fractures, and 3 specimens showed minor mucosal tears in the anterolateral or inferior walls. Volumetric measurements of the cartilaginous \{ET\} lumens showed a change from an average of 0.16 to 0.49 cm3 (SD, 0.12), representing an average increase of 357% (range, 20–965%). Conclusions Balloon catheter dilation of the nasopharyngeal orifice of the \{ET\} was shown to be feasible and without evidence of untoward injury. A significant increase in volume of the cartilaginous \{ET\} was achieved. A clinical study is now indicated to determine whether balloon dilation will demonstrate lasting benefits and safety in the treatment of otitis media.

Poe, D. S., and B. M. N. Hanna, "Eustachian Tube Dysfunction", UpToDate , 2009.
Hanna, B. M. N., Cutaneous Vacular Anomalies of the Head and Neck, , Cairo, Cairo University, 2006.