By Richard J. Wiet
Specializes in prevention and security in ear surgical procedure. It offers criteria of care via specialists, and the way to prevent problems and care for them in the event that they take place, for all universal ear surgical procedure tactics, and offers details re:indications and contraindications for surgery.
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Extra resources for Ear and temporal bone surgery: minimizing risks and complications
Communication with the anesthesia team is important in assuring a stable baseline before operative manipulation is undertaken and to make sure neuromuscular blockade (if it is employed) is not excessive. j Which Operative Procedures Should Be Monitored? The seventh and eighth nerves are the cranial nerves most frequently monitored. Common procedures in which the seventh nerve is monitored include acoustic neuroma removal, cholesteatoma removal, implantation of ossicular or cochlear prostheses, tympanomastoidectomy, parotid tumor removal, microvascular decompression of the seventh nerve, and posterior fossa or cerebellopontine angle tumor removal, as warranted.
Conductive losses may also result in an apparent absence of the reflex due to a lack of manifestation of the immittance change associated with the reflex. 14 Cochlear hearing losses may also manifest recruitment with the presence of a stapedial reflex at a lower stimulus than the expected level. Facial nerve lesions interrupt the efferent, motor innervation to the stapedius muscle, which results in the absence of the reflex. Operative procedures for otosclerosis, ossicular chain reconstruction, or chronic ear disease may also effectively disrupt the reflex by severing the stapedial tendon, effectively disconnecting the stapedius from the stapes.
Because repeated sampling is required to discern the evoked potential signal from background noise, the rate of sampling is important, and this rate needs to be twice the fastest component of the sampled signal (Nyquist frequency). Despite these difficulties small potentials like the brainstem auditory evoked response (BAER) can be successfully recorded intraoperatively by averaging the responses to many stimuli. j Efficacy of Intraoperative Monitoring of Cranial Nerves Various studies have shown the effectiveness of cranial nerve monitoring in reducing risk in otologic surgery.