Preservation of conductive hearing in approaches to tumors of the jugular foramen.
OBJECTIVE
Surgical approaches to the jugular foramen, most often used for the resection of glomus jugulare tumors, may include removal of the external auditory canal wall and overclosure of the meatus, resulting in maximal conductive hearing loss. Modifications have been described that maintain hearing by preserving the canal wall at the price of decreased exposure and are, therefore, suitable only for small and favorably located tumors. Our technique for removal and then reconstruction of the canal wall with hydroxyapatite cement allows for complete anterior translocation of the facial nerve as far proximal as the geniculate ganglion, giving uncompromising exposure of even the most extensive tumors, with the potential for preservation of normal hearing. The purpose of this study was to describe and report our experience with this technique.


METHODS
: Retrospective review.


METHODS
Private otology practice.


METHODS
Between 2000 and 2005, seven patients between the ages of 34 and 77 years were identified who underwent procedures using this technique.


METHODS
Surgical management of jugular foramen tumors.


METHODS
Successful anatomical reconstruction of the external auditory canal and middle ear. Preoperative and postoperative audiograms are compared, and facial nerve function is reported. Complications are discussed.


RESULTS
All seven patients had successful reconstruction of the external auditory canal. Complications were minor and did not require additional surgical intervention. Postoperative pure-tone average differed from the preoperative average by a mean of 7.5 dB. Facial nerve function ranged from House-Brackmann Grades I to III when checked at least 7 months after surgery.


CONCLUSIONS
This study reveals that this technique of external auditory canal reconstruction using hydroxyapatite cement allows complete anterior translocation of the facial nerve, while safely and reliably preserving the potential for normal hearing, without any compromise in exposure of the jugular foramen in the setting of an infratemporal fossa approach.
Gold
Steven R
SR
Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, North Carolina 28226, USA. sgold@carolina.rr.com
Kamerer
Donald B
DB
D050153:Abdominal Fat / Q000637:transplantation; D000328:Adult; D000368:Aged; D001844:Bone Conduction; D004424:Ear Canal / Q000601:surgery; D004429:Ear Ossicles / Q000601:surgery; D005154:Facial Nerve / Q000601:surgery; D005260:Female; D005557:Formaldehyde; D005781:Gelatin Sponge, Absorbable; D005925:Glomus Jugulare Tumor / Q000601:surgery*; D006314:Hearing Loss, Conductive / Q000517:prevention & control*; D006801:Humans; D006882:Hydroxyapatites; D008279:Magnetic Resonance Imaging; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D011142:Polyvinyl Alcohol; D011183:Postoperative Complications / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
D006882:Hydroxyapatites; C475044:hydroxyapatite cement; D005557:Formaldehyde; C027490:polyvinyl alcohol formaldehyde foam; D011142:Polyvinyl Alcohol