Objectives of Ossiculoplasty скачать в хорошем качестве

Objectives of Ossiculoplasty

ORG India Otology Nuggets – 13 Good morning everyone. Today I am going to talk to you about some of the basic principles of creating an optimal condition for an Ideal ossiculplasty. Now a day, I find that most of the ENT surgeons are doing basic Otologic work such as myringoplasty and tympanoplasty. And results being reported are also very good. However, results of hearing improvement and ossiculoplasty are disappointing. This is mainly because of the several mis-conception about ossiculoplasty, which I would like to clear with this series of presentations. To begin with, I would like to clarify, I have no conflict of Interest. I have not received any financial support or kick from any prosthesis or implant company and I am not peddling any specific company prosthesis here. This is actually the last slide in my presentation “Creating optimal conditions for an ideal ossiculoplasty”, however I would like to start with the last slide here. Let us Begin with the End in Mind, that means let us begin each day, task, or project with a clear vision of our desired direction and destination, and then continue by flexing oour proactive muscles to make things happen. Let us make Personal Mission Statement to achieve the same. First step or statement is having a clear goal in our mind. That is, an objective of the ossiculoplasty is reducing the conductive hearing loss to less that 20 dB. Goals gives us direction. Goals give us know how. And Goals give us an impetus to take up the task. Second step is, never promise a patient hearing improvement if patient has a mixed hearing loss with Cochlear reserve or sensori-neural component is more than 30 dB. Patients are not going to appreciate the hearing improvement, if there is a closure of AB Gap. Patient may still require sound amplification device such as a hearing aid. Counsel the patient properly and inform about possibilities and future course of action. Always promise less and deliver more. Third step, always do single stage ossiculoplasty. Many studies say that second stage ossiculoplasty is better. However, in developing countries like ours, patients cannot afford a second surgery. Rarely they comeback for second surgery. They may even perceive that the first surgery may be a failure and blame you for that. Moreever, if what you have done doesnot work, you can always do a revision second stage ossiculplasty. Fourth and important step, when patient has a significant conductive hearing loss, i.e., more than 20 dB of Airbone gap, or in cases conductive hearing loss likely to increase, always the post the cases as Ossiculoplasty cses. Always begin with end in the mind. When you start with singular objective, you are likely to do a better job. I would like quote a famous American Otologist of an Egyptian Origin, Prof. Hamed Sajjadi, MD, FACS. , Quoted in Otolaryngologic Clinics of North America, Vol 32. No. 3. Published on June 1999. “Every intra-op surgical decision needs to be custom-made to the individual patient’s needs and the surgeon’s capabilities and facilities. Surgeon’s must avoid fitting their patients to their surgical techniques. On the contrary, we must adjust our surgical choices to fit each patients situation needs.” “Multiple choices may have to be considered before each patient is offered a particular type of surgery, and surgeons need to be prepared to change their techniques accordingly and competently.” See the big picture! Ossiculoplasty is not just about fixing some damn prosthesis or ossicular replacement material over remnant ossicles. It is creating or replacing the homeostasis of the middle ear or re-creating normal middle ear transformer mechanism. Understand the normal physiology of the middle ear function and recreate the same. For that you need to go back to basic. Go back to basics. On the way to successful ossiculoplasties, you are likely to have failure. Don’t worry. Remember this quote by one of the great statesman and a Prime Minister of England and a man who stood against the mighty Hitler, Sir. Winston Churchill. “Success consists of going from failure to failure without losing enthusiasm.” Have a great day. Keep encouraging us with your feedback, questions, hi fives, likes, pokes and pass-it-ons’. Please visit our Facebook page at the following link for more such nuggets and please like our page if you have not done so.   / orgofindia   With Best Regards, Dr. Prahlada N.B Chitraudrga