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Magical solution to ear surgery

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'Magical solution' to ear surgery

St. Justine claims breakthrough; Surgeon's procedure takes 20 minutes and can be done on outpatient basis

January 17, 2012

Dr. Issam Saliba with Benjamin Côté, 10. Côté underwent Saliba's new technique for repairing perforated eardrums that spares kids pain and saves about $1,500 in hospital costs.

Photograph by: ALLEN MCINNIS THE GAZETTE, The Gazette

In what Ste. Justine Hospital is claiming to be a world first, one of its surgeons has pioneered a new technique to repair a perforated eardrum that spares kids general anesthesia and hospitalization.

The 20-minute procedure can be done under local anesthesia and has been shown to achieve the same results as conventional surgery. What's more, the operation saves about $1,500 in hospital costs compared to the standard technique.

"Why should we have to hospitalize a child for something that can be done on an outpatient basis?" asked Dr. Issam Saliba, who invented the technique at Ste. Justine about six years ago.

"This new technique doesn't carry the risks associated with general anesthesia, and the child can go to school the next day. Parents also don't have to take extra time off work. What we're doing here is similar to an appointment at the dentist's office."

A traditional myringoplasty (reconstruction of the torn eardrum) involves grafting muscle tissue from behind or above the ear into the hole in the ear canal. Surgeons also can graft a piece of cartilage - the tragus - which sticks out away from the inner ear.

The operation takes about 90 minutes. Children usually have to stay home from school for at least 10 days following the operation.

Saliba's technique, by comparison, uses fatty tissue grafted from a five-millimetre incision at the back of the neck. Peering through a microscope and using a scalpel, forceps and a probe, Saliba inserts the fatty tissue into the eardrum.

He then places a small membrane composed of a healing solution, called hyaluronic acid, onto the fatty tissue. Hyaluronic acid had already been shown to promote tissue regeneration in the middle ear.

The innovation in Saliba's approach was to combine tissue grafting with the hyaluronic acid. (Hence, the name for the technique: hyaluronic acid fat graft myringoplasty.) "That's the magical solution," Saliba said, alluding to the unique properties of the acid. "It promotes the migration of healthy tympanic cells" across the grafted fatty tissue in the ear canal. A five-year study demonstrated that Saliba's technique successfully repaired perforated eardrums in 92.7 per cent of adults who underwent the procedure. For children, the success rate was 85.6 per cent. Those results are comparable with the traditional technique.

Hearing-tests results were equally similar and positive, Saliba said.

One of Saliba's patients who underwent the surgery last February returned to Ste. Justine on Monday for a checkup. Ever since he can remember, 10-year-old Benjamin Côté has always suffered from ear infections.

One particularly bad infection left Benjamin's left eardrum perforated, causing dramatic hearing loss.

"Today, Benjamin's hearing is normal," Saliba said. "His eardrum has healed perfectly."

"I'm so happy," Benjamin said during a break in the news conference. "I feel free. Now I don't have to worry when I go swimming. I can dunk my head under water."

Benjamin's father, Christian Côté, explained that water trickling into his son's ears would often cause infections. As a result, Côté often had to stand next to his son in the shower to shield his ears. He said he no longer has to accompany his son in the shower stall.

Ear, nose and throat specialists at Maisonneuve-Rosemont and Verdun hospitals are already performing the new technique on adults. A couple of specialists in Vancouver are also keen on the technique, and Saliba has been invited to a number of medical conferences to teach it to fellow specialists.

Saliba said the new technique has the potential to dramatically shorten waiting times for the elective procedure. Still, the average waiting time at Ste. Justine for Saliba's procedure is already a year and a half.


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