It is a surgical process that involves making a small incision in the tympanic membrane (eardrum) to ease buildup of pressure caused by excessive accumulation of fluids. The process may also be used to drain out pus. The surgery is usually conducted in both ears. It is used an optional curative process for swelling of the middle ear.

Myringotomy Etymology

The name of this operative procedure is derived from the fusion of the Latin term “myringa”, standing for “drum membrane”, and the Greek word “tome” which means “cutting”.

Myringotomy Names

The operative process is also known by other names like:

• Myringocentesis
• Tympanotomy
• Tympanostomy
• Paracentesis of the tympanic membrane

Myringotomy Cost

On an average, this operation costs around $2,800. In some cases, it may come as high as $5000. The price actually depends on where you live and where you are conducting it from.

Myringotomy Procedure

The actual operative procedure takes only about 10-15 minutes to be completed. However, the process requires some amount of preparation as well as after-care. Here are the steps to be followed before, during and after the surgery to help in successful completion of the operation.

Before the operation

Patients should not eat or drink anything at anytime between 6 and 24 hours before undergoing the surgery. This includes avoiding water completely. Physicians should be informed of any prior conditions or infections they might have had recently. Patients should inform doctors about any medications or herbs that they might have used recently or in the past. Since the procedure is generally conducted on children, their parents are asked to bring along stuffed animals or other toys that can make children feel more comfortable.

During the operation

During operation, patients are first administered with drugs that can make them relax. An anaesthesiologist is most likely to use general anesthesia for tranquilizing the patient. In some cases, however, local anesthesia may also be used. This involves application of a cream to the ear canal, which contains Prilocaine and Lidocaine. The cream is typically applied half-an-hour prior to the actual surgery. Rarely, medical acupuncture is used to manage painful symptoms. In such cases, acupuncture is usually started approximately 40 minutes before the operation and is continued until the surgery comes to an end.

After the operation

After the anesthesia is administered, surgeons thoroughly wash the ear and perform a small incision in the eardrum. The incision is made through the external ear canal with the aid of an operating microscope. The process does not leave any incisions or stitches that are outwardly visible. Once the incision has been made, accumulated fluids are suctioned out of the ear and an ear tube is put in the eardrum. In the majority of cases, drops are introduced into the ear. Cotton plugs are also inserted into the ear canal to control bleeding.

Myringotomy Video

This is a useful video that can allow you to get an idea of how the operation is actually performed.

Myringotomy in Adults

The operation is typically conducted in children aged between 1 and 2 years. In some cases, it is also found to be performed in 5 year old kids. In adults, the surgery can be carried out without the use of a general anesthetic. The patient needs to be very still even though they may experience some amount of pressure and discomfort.

Myringotomy Purpose

This surgical process is performed due to various reasons, such as:

• Providing relief from discomforting symptoms caused by the buildup of fluids in the eardrum
• Draining out fluid or taking a sample of it for laboratory examination to detect the presence of any known microorganisms
• Restoring hearing capabilities

The process can also be used to insert ear tubes. During surgery, ear tubes can be inserted into the incised area and left in place. Once the eardrum heals around the tubes, they get secured in place. Generally, these fall out within 6 months to one year without any external force. If that fails to happen, these may be removed by a doctor.

When left in place, the ear tubes prevent the closure of the incision by keeping open a channel between the middle and the outer ear. This lets air-drying of the fluid in the middle ear and prevents build-up of pressure in the middle ear. Once the fluid dries out, patients immediately find their hearing capability returning to normal. This also reduces the risk of recurrence.

Once ear tubes are inserted during Myringotomy, patients are often reported to hear and talk better. They are also found to sleep better and behave well without displaying any irritability.

In recent years, this operative process along with tube replacement has become a primary treatment for curing Otitis Media in children.

Myringotomy Complications

Like all surgeries, this operative procedure has its own risks. These include:

• Early protrusion of tube after surgery.
• Failure of the eardrum to recuperate after the falling out of the tube.
• If the incised area does not heal properly after surgery, a permanent hole can be formed in the eardrum. It can lead to partial loss of hearing and also raise the risk of infection.
• An improperly conducted operation may also make the ear tubes move inward and get stuck in the middle ear. In ideal conditions, the tubes should extend into the external ear and either fall out naturally or be removed by a doctor.
• An improper surgery may also lead to cutting or damaging of the external ear.
• Granular nodes may also develop at the site of surgery due to inflammation.
• If surgery is not conducted accurately, the eardrum can get perforated leading to permanent physical damage.
• A wrongly conducted operation may also cause buildup of cholesterol and skin cells in the middle ear. These can grow and damage the adjoining bone (Cholesteatoma)
• Following this operation, there can be a 13% risk of constant discharge from the ear (Otorrhea).
• In some people, general anesthesia or sedatives administered during the surgery can give rise to side effects.

The surgery does not guarantee permanent treatment. Approximately 30% children undergoing this operation as well as an insertion of ear tubes need to undergo the process in about 5 years.

Repeated surgeries of this type may result in structural changes in the eardrum, such as:

• Retraction or shrinkage
• Flaccidity or loss of tone
• Hardening of a region of the eardrum (Typmanosclerosis)

Repeated operations of these types may also increase the risk of hardening to 51%.

Bilateral Myringotomy

It is a surgical process conducted to place tubes within the ears. This helps stop recurring ear infections by allowing air to flow in and out of the middle ear of patients. However, it does not completely eliminate chances of ear infection. Tympanostomy tubes are typically made of Teflon or Silicon. Some are also made of stainless steel but used only infrequently. Their peculiar name comes from the fact that they are shaped like a Grommet or the English alphabet T.

Myringotomy and Grommets Insertion

This is a common operation that is conducted to allow free circulation of air in the middle section of the ear. The process includes insertion of grommets (also known as Tympanostomy tubes) into the eardrum. It helps relieve hear loss due to congestion caused by the presence of fluids in the middle ear. It also helps reduce pain occurring due to poor flow of air in the middle ear. Though a simple process, it can give rise to side effects like

• Soreness of ears after surgery
• Bloody discharge from the ears
• Development of scar tissues on the eardrum
• Drainage of pus after insertion of grommets (occasional)

Laser Myringotomy

Also referred to as OtoLAM or Laser Assisted Myringotomy, this laser-aided operation uses specialized Co2 laser equipment rather than a surgical instrument to make a hole in the eardrum. It is less invasive than incision by surgical equipments and can be conducted in an outpatient clinic or an office setting. It only requires use of a general anesthesia.

The process helps create an appropriate hole in the tympanic membrane which remains open for a number of weeks. According to clinical studies, around 60% cases resolve after the use of this process. It helps clear up underlying infection and also prevent repeated episodes of Otitis Media.

It was as early as in the 18th century when an incision in the ear drum was first promoted as a means to facilitate drainage of the ear cavity and cure deafness. With the aid of laser, Myringotomy has become even more advanced today and promises better chances of recovery. If properly carried out, the rate of healing is usually quite fast in any type of Myringotomy.

References:

http://www.yoursurgery.com/ProcedureDetails.cfm?BR=4&Proc=37

http://www.surgeryinformation.info/2011/08/myringotomy.html

http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/ent/myringot.html

http://www.eardoc.info/faq-2/myringotomy

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It is an important surgery used to prevent stroke by repairing constriction (Stenosis) in the common catroid artery. It is primarily used in individuals suffering from Cartoid Artery Disease.

The process is abbreviated as CEA.

Carotid Endarterectomy ICD 9 Code

The ICD 9 Code for Carotid Endarterectomy is 38.1.

Why is Carotid endarterectomy Performed?

It is mainly conducted to remove fat-filled plaque from the arteries located in the neck. Cartoid Artery Disease leads to the deposition of fatty plaque on the interior walls of the carotid arteries in the neck. The condition affects the vessels directed towards the head and the brain. The cells of the brain require a constant supply of oxygenated blood to survive and function. Blood is supplied to the brain by two large carotid arteries at an anterior position of the neck and two smaller vertebral arteries situated at a position posterior to the neck. Plaques are small, unusual patches that can be found inside the body. These are composed of calcium, fat, cholesterol and other materials found in the bloodstream. Over a period of time, these plaques harden and constrict the carotid arteries. When the carotid arteries get obstructed, the brain does not receive enough oxygen. This gives rise to a stroke. Carotid endarterectomy is carried out to remedy this condition. During this operation, surgeons make a cut (incision) in the neck and take out the accumulated plaques from a carotid artery. This helps restore normal flow of blood through the artery.

Carotid endarterectomy Procedure

This surgical process takes approximately a couple of hours to be performed. However, the time involved for making preparations and administering of anesthesia can increase the total duration involved for surgery. Prior to the surgery, vascular surgeon or physician may give certain instructions that patients need to follow, such as fasting. Before the operation is carried out, doctors may carry out a common test called Duplex Ultrasound to find out the extent of plaque accumulation in the arteries. This painless examination involves using sound waves to display the blood vessels and determine the speed of blood flow within them. The test can also help specify the location and extent of constriction in the carotid artery. Vascular surgeons may also use other tests, such as:

• Angiography (or arteriography)
• Computed tomographic angiogram (CTA)
• Computed tomography (CT) scan
• Magnetic resonance angiography (MRA)

The actual operation involves using anesthesia to put patients to sleep. Alternately, surgeons or anesthesiologists can choose to induce localized numbness in the neck region. This is done to keep patients awake so that they may communicate with the surgeon while the operation is being carried out. If patients stay awake, physicians can monitor more easily the reaction of the brain to reduced blood supply.

Whether the patient is conscious or unconscious, surgeons shave the skin of the neck region that is going to be the site of operation. Shaving the skin prior to an incision helps prevent outbreak of infections. This is followed by performing an incision on one side of the neck. This helps display the obstructed carotid artery. Next, the surgeon clamps the carotid artery temporarily to stop flow of blood through it. During operation, the brain gets blood supply from the carotid artery located on the other slope of the neck. Alternately, surgeons may also put in a shunt to move the blood in a roundabout way around the artery that is being fixed.

Once the carotid artery has been clamped, the surgeon directly makes an incision into the obstructed section. Next, the deposited plaque is peeled off by removing the inner lining of the affected arterial section that contains the plaque.

After the plaque has been removed, the surgeon sews the artery and takes off the clamps or the shunt. Bleeding, if any, is stopped. The neck incision is closed and the process is completed. As part of the surgical process, a patch is often used to broaden the artery. The material of the patch can be a vein of the patient, often taken from the leg, or various synthetic materials – whichever is deemed fit by the surgeon.

Carotid endarterectomy and Stroke Symptoms

In some cases, individuals with an obstruction in the carotid artery may suffer from symptoms related with a stroke, such as:

• Vision defects
• Slurred speech
• Mental confusion

Asymptomatic individuals with arterial blockage diagnosed during a physical test may display a bruit or an unusual sound related with defective flow of arterial blood. If a bruit is detected, further tests may be ordered to make greater evaluation of the condition of the carotid arteries of the affected individual.

Carotid endarterectomy Indications

It often becomes difficult for surgeons to decide who are eligible for a CEA operation. Surgery is indicated when patients are symptomatic and have more than 70% carotid artery stenosis. Surgery is also deemed appropriate in a asymptomatic or symptomatic patients with over 60% stenosis, especially if

• Ulcers are found on the plaque
• Patients show symptoms even when administered with aspirin
• The opposite carotid artery is obstructed
• CT or MRI scans of a minor stroke shows that no symptoms were produced
• The extent of Stenosis is higher, especially if progressive narrowing is demonstrated in serial studies
• The patient is comparatively young

Patients are considered fit for the process if they suffer from acute narrowing of the carotid arteries, particularly if they experience TIA (Transient Ischemic Attack) or have fairly good health otherwise. Patients, however, can be eligible but at a comparatively heightened risk of complications, if they have:

• Unstable angina (chest pains)
• Congestive heart failure
• A heart attack sometime in the past six months
• A major stroke without recovery
• Major cancer, with a life expectancy that is less than two years
• High blood pressure not properly controlled by medications or changes in lifestyle
• Symptoms of some progressive brain syndrome, such as Alzheimer’s disease

Carotid endarterectomy Contraindications

The process should not be performed if:

• Stenosis is lower than 50% in a symptomatic patient
• Stenosis is lower than 60% in an asymptomatic sufferer
• The sufferer is in poor health condition
• Studies show a recent large section of dead brain in the patient
• Death or surgical incidence of stroke is higher than 3%

Carotid endarterectomy Recovery Process

Following surgery, patients may need to spend 1 or 2 days in a special post-operative-care unit or an intensive care unit (ICU). During this time, patients are closely monitored by a physician to examine their progress. Doctors make sure that patients have normal blood pressure and brain functioning. Patients are also observed to check whether they have any bleeding from the neck region. In the early stages of recovery, they are usually administered with nutrients and fluids through a tiny, thin tube known as an intravenous (IV) catheter. Patients recuperating from surgery do not experience any major painful symptoms due to the small size of the neck incision.

At the time of discharge, physicians typically recommend patients to avoid driving and reduce physical activities for several weeks to come. They are advised to seek immediate medical assistance if they suffer from severe headaches or swelling in the neck or observe any change in brain function.

After surgery, patients may be given a medication for use at home. The drug reduces the possibility of blood clotting after operation. It may be used for a few weeks.

Patients are usually able to return to a normal, active lifestyle several weeks after the surgery.

Carotid endarterectomy Management

Around 6% patients suffer from a possibility of having a re-obstruction of the carotid artery. To avoid this condition, physicians recommend certain lifestyle changes for sufferers. These include:

• Exercising regularly
• Maintaining a proper body weight
• Avoiding foods rich in saturated fat and cholesterol
• Avoiding smoking
• Controlling high pressure and diabetes
• Follow-up visits to doctor at regular intervals

Left Carotid endarterectomy

This surgical process is performed when plaque or fat deposits are detected in the internal carotid artery. The process is conducted only the location of the obstruction has been clearly confirmed by an imaging test. The process is exactly similar to as any other type of Carotid endarterectomy. The difference is only in the way the process is implemented by a doctor.

The surgery is risky in nature and may cause death in some cases. Following the initial stages of recovery, patients may require subsequent scans to help doctors check how much successful the operation has been.

Right Carotid endarterectomy

The process is conducted to remove fat or plaque that is obstructing the right carotid artery. The surgery is performed immediately after an obstruction has been detected in the region. Right carotid endarterectomy surgery is a very important operative process that should never be delayed in any condition. It is quite similar to any other form of carotid endarterectomy as the preparation and incision point are similar. Patients should immediately report to doctors about any painful symptoms after the operation. Once the surgery is completed, patients should follow a proper diet.

Following surgery, patients generally recover in two or three days. During recovery, patients should again be scanned to determine the success of the process. If it is found to be successful, patients are discharged and gradually allowed to return to a normal, active lifestyle over time.

Bilateral Carotid endarterectomy

This surgical process involves both carotid arteries. It is highly effective in removing blockages of the cartoid arteries. However, it involves certain complications for patients who have to undergo the process. Vocal cord paralysis is one of the most dreaded complications of this process. The condition typically arises in patients of bilateral high grade stenois on whom the operation is carried out. Due to this surgeons opt for separating Carotid endarterectomy into stages and carrying each staged operation after 4 to 6 weeks.

Carotid endarterectomy Pictures

Here are some assistive Carotid endarterectomy photos. These Carotid endarterectomy images will let you get an idea about how the surgical process is carried out.

Picture 1 – Carotid Endarterectomy

Picture 2 – Carotid Endarterectomy Image

Carotid endarterectomy Video

Here is a useful video that will help you understand how this surgical process is performed in an ideal medical setting.

Carotid endarterectomy Risks

Quite a few risks are involved with this operative procedure, as is the case with most surgeries. The operation can involve acute complications. In extreme cases, stroke and death may also occur. Although CEA aims at reducing possibilities of a stroke, it actually results in one in certain cases. Stroke, however, is a rare complication and only occurs in 1-3% cases of people undergoing CEA.

Another abnormal complication is the recurrence of obstruction of the carotid artery. The condition is known as Restenosis and may arise later. The possibility of development of this condition is particularly higher in individuals who continue to smoke cigarettes. Generally, only about 2 to 3 percent patients have a possibility of developing a Restenosis that is acute enough to require another CEA surgery.

Temporary nerve injury is another rare but possible complication of this condition. It gives rise to various discomforting symptoms, such as:

• Hoarseness
• Swallowing difficulties
• Numbness in face or tongue

Short-term injuries of nerve generally resolve within a month and do not require any treatment. However, the possibility of a stroke can be much higher than any of these unusual complications if a significant carotid obstruction is not treated properly.

In some cases, patients also suffer from additional complications which include breathing difficulties and infection. Other complications include hemorrhage, hypoglossal nerve damage and Hyperperfusion Syndrome.

If you are suffering from Cartoid Artery Disease, consult your doctor to know whether CEA is the best treatment option for you.

References:

http://www.vascularweb.org/vascularhealth/Pages/carotid-endarterectomy.aspx

http://www.nhlbi.nih.gov/health/health-topics/topics/carend/

http://texheartsurgeons.com/CarotidEndarter.htm

http://www.strokecenter.org/patients/stroke-treatment/carotid-endarterectomy/

http://www.yoursurgery.com/ProcedureDetails.cfm?Proc=9

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Transsphenoidal Hypophysectomy Definition

It is a surgical method that is recommended for removal of pituitary tumors that arise from conditions like Hyperadrenocorticism (Cushing’s Syndrome) and Acromegaly.

Procedure

In case of Pituitary Adenoma, this surgery involves making an incision inside one of the noses. The tumor is removed through one of the nasal sinuses. A successful surgery quickly improves symptoms resulting from the tumor that presses on surrounding tissues. Operation also makes IGF-I and hormone growth levels normal.

During Transsphenoidal Hypophysectomy Adenoma surgery, the nose of the patient is jammed with sponge packing to soak in the drainage from the operative site. Small plastic materials known as stents are sewed to the septum of the nose. The stents and packing are taken away before sufferers leave hospital. The stitches in the lining of the gum dissolve on their own.

The surgery requires a lot of care as even a minor error can damage delicate tissues adjacent to the pituitary gland. The success of this operation depends on the experience and skill of the surgeon. Small adenomas recur in 80-85% cases and large adenomas may come back in 50-65% cases after surgery.

Some people need lifelong hormone replacement following surgical operation.

Endoscopic Transnasal Transsphenoidal Hypophysectomy

This surgical method leads to greater exposure of the vital structures that are located inside and outside the Stella. Greater exposure ensures a more accurate surgery that can keep these structures safe from any damage. It can avoid irreversible complications that may arise on account of damage to the structures during other surgical operations.

Complications

Usually, this surgery has an excellent prognosis. Little risk is involved with the process. However, the operation can lead to Postoperative Hypoadrenalism if carried out improperly. Careful monitoring is required to avoid complications from Hypoadrenalism.

In some cases, transient cases of antagonistic Antidiuretic Hormone Secretion (SIADH) may arise. This may be followed by a case of Diabetes Insipidus.

There is also a sensation of numbness in the teeth, upper lip or the gums. This usually goes away or disappears with time.

In severe cases, there may also be complications like

• High fever
• Stiff Neck
• Stomach upset
• Body rashes
• Pain, redness or inflammation in the foot or leg which is an indication of blood clots
• Acute chest pain
• Shortness of breath
• Excessive thirst and severe urination which is a sign of post-operative hormone problems

In acute cases, patients may cough up blood. This may be a sign of movement of blood clot into the lungs or some other acute health condition. During Intracranial Subfrontal Transsphenoidal Hypophysectomy anesthesia use can give rise to some severe problems. But in case of Tumoural Transsphenoidal Hypophysectomy anaesthesia use does not cause any problem.

Post Operative Care

Most patients take several weeks to recover completely after surgical operation. Patients easily get tired after Transsphenoidal Hypophysectomy surgery. Post-operative care involves taking as much rest as possible and avoiding strenuous activity. You should discuss with your doctor during follow-up appointment about how much you should increase your activity level.

However, prolonged bed rest is also bad for health. It can give rise to blood clots in the legs and lung problems. It is necessary that you go for short walks and take rest when you get tired. This will provide your body with some much needed exercise after surgical treatment.

Transsphenoidal Hypophysectomy approach is safe and gives rise to no complications if carried out properly. If you require this surgery, make sure that you get it done by an expert surgeon. This will ensure complete recovery without any harmful post-operative problems for you.

References:

http://www.rhodeislandhospital.org/rih/services/neuro/surgery/discharge/trans_hypo.htm

http://www.skullbaseinstitute.com/papers/transnasal-transsphenoidal-hypophysectomy.htm

http://www.felipedia.org/~felipedi/wiki/index.php/Transsphenoidal_hypophysectomy

http://www.wisegeek.com/what-is-a-hypophysectomy.htm

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