Resection of left tympanic paraganglioma using blue photoangiolytic laser

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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#41; Otoscopy image 3 months after placement of a TTD in the left ear&#46; B&#41; Audiometry of the patient&#44; with transmissive gap in the pantonal left ear&#46; C&#41; MRI image of axial section showing Fisch&#39;s type A2 paraganglioma in the left ear &#40;blue arrow&#41;&#46; D&#41; MRI image of coronal section&#44; Fisch&#8217;s type A2 paraganglioma &#40;red arrow&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical case</span><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 46-year-old woman who attended ENT surgeries due to a left ear tamponade of several months&#8217; evolution&#46; Her general practitioner diagnosed her with serous otitis media and prescribed treatment with nasal corticosteroids but without any improvement&#46; At the ENT outpatient visit&#44; seromucosal otitis was first diagnosed with audiometry&#44; acoumetry&#44; tympanogram and congruent otoscopy&#44; due to the clinical symptoms of persistent ear tamponade&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Audiometry showed transmissive hearing loss in the left ear with a tonal threshold of 35&#8239;dB and a pantonal gap of 15&#8239;dB&#46; The tympanogram showed a type B curve in the left ear and the acoumetry was consistent with transmissive hearing loss&#46; Otoscopy suggested an amber&#44; domed eardrum&#46; With all these findings&#44; a transtympanic drain &#40;TTD&#41; was inserted under local anaesthesia&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">After 3 postoperative months&#44; at follow-up surgery visits&#44; an erythematous pulsatile mass was observed in the anterior tympanic area&#44; with a TTD inserted in the lower area&#44; sparing the lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A CT scan of the petrous bone with contrast was run&#44; showing a tumour of 7&#8239;&#215;&#8239;8&#8239;&#215;&#8239;4&#8239;mm in the left middle ear&#44; in the mesotympanum&#58; suspected tympanic paraganglioma&#46; This tumour was related to the cochlear promontory and involved the handle of the malleus and the incudostapedial joint&#46; The study was supplemented with an MRI that confirmed the diagnosis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">After the analysis of the CT scan and MRI images&#44; it was concluded that the paraganglioma corresponded to Fisch&#8217;s A2&#44; since it occupied the middle ear exclusively&#44; however the tumour margins were not observed in otoscopy&#44; extending anteriorly&#44; reaching the Eustachian tube&#44; towards the mesotympanum&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Surgery was scheduled for excision of the tympanic paraganglioma with blue photoangiolytic laser&#44; and interdepartmental consultation was requested with the Endocrinology unit to expand the hormonal and genetic study on their part&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Surgery</span><p id="par0035" class="elsevierStylePara elsevierViewall">Under general anaesthesia and nasotracheal intubation&#44; a retroauricular approach was performed&#44; lifting the tympanomeatal flap under prior infiltration of local anaesthesia&#46; The middle ear was accessed&#44; exploring the cavity and revealing the angiomatous lesion described&#46; The paraganglioma was closely related to the cochlear promontory and the handle of the malleus&#44; involving the incudomalleolar joint&#46; Excision began with dissection with spatula and cottonwool soaked in adrenaline&#46; Once the lesion had been located and individualised&#44; it was excised using a 300&#8239;nm blue laser fibre&#46; During the procedure&#44; the manubrium of the malleus was amputated to facilitate the excision of the lesion&#44; respecting the incudomalleolar joint&#44; which was released and individualised from the paraganglioma &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#8211;F&#41;&#46; A complete resection of the pathology was obtained&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The laser parameters used were as follows&#58; 80&#8239;ms pulse&#44; a pause of 300&#8239;ms and 2&#8239;W power&#46; The surgical time was 42&#8239;min and blood loss was minimal&#46; The procedure was completed without any relevant complications&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">During follow-up&#44; the patient evolved favourably&#44; improving the transmissive component of the hearing loss and presenting a normal otoscopy&#46; After 12 months of follow-up&#44; there were no complications or recurrences of the lesion&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Photoangiolytic lasers&#44; such as the blue laser&#44; have emerged in recent years&#44; improving the therapeutic practice of otolaryngology surgeons&#46; The angiolytic characteristics of the blue laser and its particular absorption by tissues result in a reduction of mucosal lesions&#46; Thanks to this fact&#44; it can be used to perform tissue resections&#44; greatly limiting the affected neighbouring tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Among other features&#44; a very beneficial property of photoangiolytic lasers is their ability to coagulate superficial and subepithelial blood vessels with minimal damage to the epithelium between the laser and the lesion&#44; thus reducing the absorption of energy from surrounding tissue&#46; Photoangiolytic lasers applied using very small gauge fibres &#40;300 or 400&#8239;&#956;m&#41; enable very selective application of laser pulses&#46; Until the advent of the blue laser&#44; we were forced to choose between cutting lasers &#40;prototypically a CO2 laser&#41; or a photoangiolytic laser &#40;PDL&#44; KTP&#41;&#44; however in the case of the blue laser&#44; this combines these two characteristics&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">These characteristics have generalised the use of photoangiolytic lasers in the treatment of vascular and mucosal lesions&#44; with more experience in the field of laryngology&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> The blue laser has been proven to be a safe and effective alternative in the treatment of laryngeal lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Their easy portability&#44; the small size of the laser fibres and their properties have facilitated their use&#44; even in outpatient surgeries&#44; enabling lesion resection procedures to be performed under local anaesthesia&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a> Other vascular and mucosal lesions at the nasal and ear level may be suitable for treatment with blue photoangiolytic laser&#44; although these procedures are much less documented in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;10</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Our clinical case details a resection of a Fisch&#8217;s type A2 tympanic paraganglioma by blue laser in theatre&#44; demonstrating the usefulness&#44; safety and efficacy of this laser in the treatment of vascular ear lesions&#46; To date&#44; we have found only one recent bibliographical reference that describes the excision of a tympanic paraganglioma by blue laser&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The Spanish group has concluded that the blue laser is safe and effective in the minimally invasive treatment of paragangliomas in the early stages&#46; In our study we have proposed Fisch&#39;s type A1 and A2 paragangliomas as the most suitable lesions to be resected by blue laser&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Noel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> present a case series with 5 patients who underwent surgery for tympanic paraganglioma by endoscopic approach and the use of KTP laser&#46; The authors emphasize the advantages of the endoscopic approach to visualise and completely resect the lesion&#44; as well as the advantages of the KTP laser when performing glomus excision with less intraoperative bleeding&#46; Molony et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> describe a clinical case in which they present a 39-year-old woman who underwent surgery for a type A2 tympanic paraganglioma that occupied the mesotympanum and hypotympanum&#46; The use of the KTP laser to coagulate this vascular lesion enabled safe removal of the tumour and avoided the need for an extended facial recess or hypotympanotomy surgery&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Alkhelder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> summarise that Fisch&#39;s type A tympanic glomus is the most recommended for laser treatment&#44; in line with our experience&#46; In addition&#44; they emphasize the importance of adequate knowledge of ear anatomy and sufficient experience in the use of lasers to guarantee a good post-surgical result&#46; Durvarsula et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> present 9 cases of tympanic paragangliomas treated with KTP and Diode lasers and can conclude&#44; after 3&#46;18 months of mean post-surgical follow-up&#44; that both lasers are effective and safe in the management of these lesions&#46; The morbidity observed with this laser technique is lower&#44; although this emphasizes the need for more literature to support this statement&#44; as well as comparisons between different lasers&#46; The NdYAG laser can also be useful when resecting tympanic paragangliomas using low levels of power to avoid energy transmission at the level of the cochlea&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Photoangiolytic lasers have been shown to be useful in the treatment of vascular and mucosal lesions due to their combined cutting and coagulation properties&#46; In the field of otology&#44; more studies are needed to support these lasers&#44; in order to guarantee their efficacy and safety&#44; thus generalising their use&#46; In our clinical case&#44; the blue photoangiolytic laser turned out to be a useful tool in the treatment of type A tympanic paragangliomas&#44; presenting no intra- or postoperative complications&#44; facilitating the resection of the lesion by reducing bleeding&#44; as well as reducing surgery time&#46; More studies are needed to confirm these claims and compare the different laser techniques that exist&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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                        "volumen" => "275"
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            1 => array:3 [
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transoral flexible laser surgery of the larynx with blue laser"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Gonz&#225;lez-Herranz"
                            1 => "M&#46; Mart&#237;nez-Ruiz-Coello"
                            2 => "E&#46; Hern&#225;ndez-Garc&#237;a"
                            3 => "E&#46; Miranda"
                            4 => "C&#46; Garc&#237;a-Garc&#237;a"
                            5 => "O&#46; Arenas"
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                  ]
                  "host" => array:1 [
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                        "tituloSerie" => "J Clin Med&#46;"
                        "fecha" => "2023"
                        "volumen" => "12"
                        "paginaInicial" => "5250"
                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
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                            2 => "J&#46; Valencia"
                            3 => "L&#46; Arango"
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                    0 => array:2 [
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                        "tituloSerie" => "Eur Arch Otorhinolaryngol&#46;"
                        "fecha" => "2023"
                        "volumen" => "280"
                        "paginaInicial" => "765"
                        "paginaFinal" => "774"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36138227"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
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            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Office-based blue laser therapy of vocal fold polyps&#58; a cohort of 18 patients&#58; blue laser therapy of vocal fold polyps"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;L&#46; Hamdan"
                            1 => "J&#46; Hosri"
                            2 => "P&#46;A&#46;R&#46; Feghali"
                            3 => "C&#46; Abi Zeid Daou"
                            4 => "A&#46; Ghanem"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lary.30602"
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                        "tituloSerie" => "Laryngoscope&#46;"
                        "fecha" => "2023"
                        "volumen" => "133"
                        "paginaInicial" => "2712"
                        "paginaFinal" => "2718"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36752582"
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              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "KTP-laser-assisted endoscopic management of glomus tympanicum tumors&#58; a case series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;E&#46; Noel"
                            1 => "H&#46; Sajjadi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/014556131809701209"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ear Nose Throat J&#46;"
                        "fecha" => "2018"
                        "volumen" => "97"
                        "paginaInicial" => "399"
                        "paginaFinal" => "402"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30540890"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "KTP laser assisted excision of glomus tympanicum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46;C&#46; Molony"
                            1 => "M&#46; Salto-Tellez"
                            2 => "W&#46;E&#46; Grant"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/s0022215100142173"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Laryngol Otol&#46;"
                        "fecha" => "1998"
                        "volumen" => "112"
                        "paginaInicial" => "956"
                        "paginaFinal" => "958"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10211220"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effective surgical management of glomus tympanicum tumor using diode laser&#58; a case report study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Alkheder"
                            1 => "A&#46; Ghareeb"
                            2 => "M&#46;S&#46; Almasalmeh"
                            3 => "A&#46; Yousfan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijscr.2023.108356"
                      "Revista" => array:3 [
                        "tituloSerie" => "Int J Surg Case Rep&#46;"
                        "fecha" => "2023"
                        "volumen" => "107"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Laser excision of glomus tympanicum tumours&#58; long-term results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46;S&#46; Durvasula"
                            1 => "R&#46; De"
                            2 => "D&#46;M&#46; Baguley"
                            3 => "D&#46;A&#46; Moffat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00405-004-0822-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Arch Otorhinolaryngol&#46;"
                        "fecha" => "2005"
                        "volumen" => "262"
                        "paginaInicial" => "325"
                        "paginaFinal" => "327"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15316822"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "NdYAG laser treatment of a glomus tympanicum tumour"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;J&#46; Robinson"
                            1 => "H&#46;R&#46; Grant"
                            2 => "S&#46;G&#46; Brown"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S0022215100122728"
                      "Revista" => array:5 [
                        "tituloSerie" => "Laryngol Otol&#46;"
                        "fecha" => "1993"
                        "volumen" => "107"
                        "paginaInicial" => "236"
                        "paginaFinal" => "237"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
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              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blue laser for the exclusive endoscopic transcanal approach to middle ear paraganglioma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Quer-Castells"
                            1 => "M&#46; Sandoval"
                            2 => "F&#46; Larrosa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00405-024-08470-x"
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                        "tituloSerie" => "Eur Arch Otorhinolaryngol&#46;"
                        "fecha" => "2024"
                        "volumen" => "281"
                        "paginaInicial" => "2041"
                        "paginaFinal" => "2045"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/38334782"
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                      ]
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                ]
              ]
            ]
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