The 1.5-mm cochleostomies are associated with a decreased risk of perilymphatic fistula as compared to 1.0-mm cochleostomies at 30 cm H(2)O; this likely represents a phenomenon of packing adequacy.

Objective: Present a case of chondroblastoma of the temporal bone presenting as a facial nerve paralysis and explain the use of a 3-D acrylic model in surgical resection planning. Study Design: Case presentation. Methods: Benign chondroblastomas of the temporal bone are extremely rare. Approximately 1% of all chondroblastomas affect the skull base, with about 34 cases reported in the literature. Most patients are older (average age 43.8 years) and present with otologic symptoms such as tinnitus, hearing loss, otalgia, vertigo and ear fullness. Temporal bone chondroblastomas tend to be more aggressive requiring more extensive resection. We report the first case reported in the literature of chondroblastoma of the temporal bone presenting with facial nerve paralysis. A 3-D acrylic model of the temporal bone and skull base was used preoperatively to plan the surgical approach for resection and also reconstruction of the skull base defect. The tumor was subsequently completely excised via a Fisch Type B infratemporal fossa approach. Reconstruction was achieved using an iliac crest free flap. At one year postoperatively, the patient is free of disease with full facial nerve function. Results: Successful resection of chondroblastoma of the temporal bone and reconstruction with an iliac crest free flap with the aid of a 3-D acrylic model. Conclusions: Chondroblastomas of the temporal bone are extremely rare. Surgical resection and reconstruction can be challenging. 1) The use of 3-D models can be very beneficial when planning the surgical resection of temporal bone/skull base tumors. 2) Iliac crest free flap is a very suitable option to consider when planning post-resection reconstruction.

Objectives Our hypothesis was that the rates of persistent tympanic membrane (TM) perforation following pressure equalization (PE) tube removal were not higher with topical phenol application. 1) Determine perforation rates using topical phenol. 2) Compare perforation rates using infiltration of lidocaine with epinephrine vs. topical phenol application. Methods This was a retrospective review of all patients undergoing insertion of Silverstein tube and microwick placement for dexamethasone infusion. The procedure was completed in an outpatient setting using either infiltration of lidocaine with epinephrine (control) or topical phenol (experimental). Dexamethasone (10mg/ml) drops were administered 3 times a day for 6 weeks, at which time the tube and wick were removed. All subjects were followed for 6 months for evidence of perforation or surgical repair. Fisher's exact test was used for statistical analysis. Results A total of 79 patients were identified. 27 underwent lidocaine infiltration and 52 had topical phenol application. At 3 months, the perforation rate for the lidocaine group vs. the phenol group was 11% and 21%, respectively (p=0.21). 5 total perforations were surgically repaired (2 from the lidocaine group and 3 from the phenol group, p=0.27). At 6 months, there was complete resolution of perforations in the lidocaine group and only 4% of the phenol group persisted (p=0.43). Conclusions Topical phenol appears to be a safe method of local anesthesia for PE tube insertion without significant increased risk of persistent perforation. Phenol also offers a cost-effective, less painful, and less time-consuming option in an outpatient setting.

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