Leakage of TEF in prosthetic voice restoration usually responds well to conservative measures. If these measures fail, and in all cases of TPF, surgical intervention is necessary for transtracheostomal or transcervical closure with multilayer sutures of the esophagus and trachea. Persisting TEF/TPF after unsuccessful surgical attempts at revision surgery remain challenging. Our experiences show that tracheostoma transposition for dissociation of the cranial end of the trachea and the hypopharynx and esophagus is essential for effective closure. In rare cases of TPF combined with pharyngoesophageal stricture formation, a resection and immediate reconstruction of the stenotic pharyngoesophageal segment with a tube-shaped fasciocutaneous radial forearm flap must be considered.

We report two siblings with palatal tremor (PT) and ear clicks who can voluntarily elicit or suppress both PT and ear clicks by just "thinking" about starting or stopping the sounds. The patients were also able to voluntarily modulate the frequency of their ear clicks and PT. They did not have any signs of cerebellar, brain stem, or other neurologic disease. These familial palatal movements may represent a variant of palatal tremor but can not satisfactorily be classified as either symptomatic or essential PT.

No abstract

The objectives of this study were to determine whether autologous bone chips are suitable materials for canal wall reconstruction after cholesteatoma removal and to evaluate the effectiveness of a separate attic bone graft for the prevention or recurrent cholesteatomas using prospective study of two consecutive patient series (29/31 unselected patients with an average follow-up of 36.3 +/- 11.1/21.5 +/- 6.3 months) and retrograde resection of the posterior-superior canal wall followed by reconstruction of the canal defect using one or more temporal squama bone chips. In the second series, lateral attic wall reconstruction and pars flaccida reinforcement was established by a notched bony attic strut attached onto the neck and short process of the malleus for structural support. In the first series, the rate of recurrent cholesteatomas (17.3%), in particular of attic retraction pockets (31%), was significantly high. The average postoperative air-bone gap was 6.4 +/- 6.3 dB in type-I tympanoplasty (TP), 8.7 +/- 3.4 dB in type-III TP with intact stapes suprastructure, and 16.4 +/- 9.3 dB in type-III TP with TORP, respectively. In the second series, recurrent cholesteatoma and retraction pocket rate could be decreased to 9.7 and 6.5%, respectively. The postoperative air-bone gap was 7.5 +/- 5.1 dB HL in type-I tympanoplasty (TP), 11.6 +/- 4.9 dB HL in type-III (PORP) TP, and 17.9 +/- 12.2 dB HL in type-III (TORP) TP. Connecting the attic strut to the malleus neck did not affect the malleus mobility and hearing outcome. Osteoplastic atticoantrotomy with autologous bone chip reconstruction enables a tailor-made anatomical and physiological reconstitution of the auditory ear canal, thus enhancing the acoustic properties. Precise reconstruction of the lateral attic wall and reinforcement of the superior part of the tympanic membrane seems to be important for the prevention of retraction pockets and subsequent recurrent cholesteatoma development.

We report a patient with a 30-year history of progressive, involuntary movements of the left ear and clicking sounds in both ears for 2 years. The patient had rhythmic contractions of the tensor veli palatini muscle and could relieve palatal movements and ear clicks, but not ear movements, by pressing a pillow against the left ear or by finger pressure on the tragus or the retroauricular region. We discuss the significance of these sensory tricks and the nosology of the long-standing ear movements within a classification of essential and symptomatic palatal tremor. Current diagnostic criteria for both types of palatal tremor may not cover some atypical cases such as ours.