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Schimanski E, Lenarz T, Busch S, Arndt S, Offergeld C, Arnoldner C, Riss D, Hornung J, Taha L, Zwittag PM, Rubicz N, Beutner D, Bevis N, Loader B, Windisch F, Sprinzl G, Magele A, Wolfram W, Niederwanger L, Plichta Ł, Skarżyński PH. Safety and performance of the new med-el total ossicular replacement prostheses. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08784-w. [PMID: 39001922 DOI: 10.1007/s00405-024-08784-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/07/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE This multicentric, retrospective study provides safety and performance data of the MED-EL total ossicular replacement prostheses (TORP). METHODS Patients underwent tympanoplasty with mXACT Total Prosthesis Center, mXACT Total Prosthesis Offcenter or mXACT PRO Total Prosthesis. The clinical data were retrospectively analyzed. Follow-up examination included access to the medical record (for adverse events) of the patients, ear microscopy and pure-tone audiometry to determine the post-operative pure tone average of the frequencies 0.5, 1, 2 and 3 kHz (PTA4). The post-operative PTA4 air bone gap (ABG) was used to evaluate the audiological outcome. A post-operative minimum and maximum follow-up period was not defined. RESULTS 103 patients were implanted with a TORP. 102 (88 adults, 14 children; 37 CHL, 64 MHL, 1 not specified) patients were analyzed for safety and 92 (79 adults, 13 children) patients for performance of the prostheses. ADVERSE EVENTS RESULTS (N = 102): In 1 patient (child, mXACT Total Prosthesis Offcenter) a prosthesis dislocation was reported, which lead to a revision surgery. No prosthesis extrusion or migration was reported. AUDIOLOGICAL RESULTS (N = 92): 49 (53.3%) of the 92 patients had a PTA4 ABG of ≤ 20 dB and therefore a successful rehabilitation. The mean post-operative PTA4 ABG of all 92 patients was 21.0 ± 9.7 dB. The first endpoint, improvement in post-operative PTA4 ABG of ≤ 20 dB by ≥ 25% of the patients was achieved. The individual Δ BC PTA4 (post-operative minus pre-operative BC PTA4) thresholds were stable (within ± 5 dB HL) in 91 (98.9%) patients. 1 patient had a BC PTA4 deterioration of 11.3 dB HL. CONCLUSION The MED-EL TORPs are safe and effective for middle ear reconstruction. Trial registration number NCT05565339, September 09, 2022, retrospectively registered.
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Affiliation(s)
- Esther Schimanski
- ENT Practice, Zentrum fuer Mittelohrchirurgie (Centre for Middle Ear Surgery), 44536, Luenen, Germany.
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, 30625, Hannover, Germany
| | - Susan Busch
- Department of Otolaryngology, Hannover Medical School, 30625, Hannover, Germany
| | - Susan Arndt
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Medical Center-University Of Freiburg, University of Freiburg, 79106, Freiburg, Germany
| | - Christian Offergeld
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Medical Center-University Of Freiburg, University of Freiburg, 79106, Freiburg, Germany
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Medical University of Vienna, 1090, Vienna, Austria
| | - Dominik Riss
- Department of Otorhinolaryngology, Medical University of Vienna, 1090, Vienna, Austria
| | - Joachim Hornung
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Lava Taha
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Paul Martin Zwittag
- Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, 4020, Linz, Austria
- Medical Faculity, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040, Linz, Austria
| | - Nina Rubicz
- Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, 4020, Linz, Austria
- Medical Faculity, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040, Linz, Austria
| | - Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Nicholas Bevis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Benjamin Loader
- Department of Otorhinolaryngology, Head and Neck Surgery, 1030 Wiener Gesundheitsverbund, Klinik Landstraße, 1030, Vienna, Austria
| | - Franz Windisch
- Department of Otorhinolaryngology, Head and Neck Surgery, 1030 Wiener Gesundheitsverbund, Klinik Landstraße, 1030, Vienna, Austria
| | - Georg Sprinzl
- University Clinic St. Poelten, Department of Otorhinolaryngology, Head & Neck Surgery, 3100, St. Pölten, Austria
| | - Astrid Magele
- University Clinic St. Poelten, Department of Otorhinolaryngology, Head & Neck Surgery, 3100, St. Pölten, Austria
| | - Wendelin Wolfram
- Department of Otorhinolaryngology-Klinikum Wels-Grieskirchen, 4600, Wels, Austria
| | - Lisa Niederwanger
- Department of Otorhinolaryngology-Klinikum Wels-Grieskirchen, 4600, Wels, Austria
| | - Łukasz Plichta
- Center of Hearing and Speech MEDINCUS, Clinical Trials Department, Kajetany, Poland
- World Hearing Center of the Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Piotr H Skarżyński
- Center of Hearing and Speech MEDINCUS, Clinical Trials Department, Kajetany, Poland
- Institute of Sensory Organs, Kajetany, Poland
- World Hearing Center of the Institute of Physiology and Pathology of Hearing, Kajetany, Poland
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, 10 Mochnackiego Street, 02-042, Warsaw, Poland
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Pollastri F, Locatello LG, Bruno C, Maggiore G, Gallo O, Pecci R, Giannoni B. Otoendoscopy in the era of narrow-band imaging: a pictorial review. Eur Arch Otorhinolaryngol 2023; 280:1683-1693. [PMID: 36129549 PMCID: PMC9988719 DOI: 10.1007/s00405-022-07656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Otoendoscopy represents the initial non-invasive diagnostic cornerstone for external and middle ear disorders. Recently, new techniques of enhanced imaging such as narrow-band imaging (NBI) have been introduced but their role as a potential aid in otological practice remains unproven. In this pictorial review, we want to present the potential application of this endoscopic method, highlight its limitations, and give some hints regarding its future implementation. METHODS Representative cases of external and/or middle ear pathologies were selected to illustrate the role of NBI in this regard. RESULTS NBI may represent a useful aid in the otological work-up, in the differential diagnosis of ear tumor-like masses, and, possibly, in the prognosis of tympanic perforations. For other ear disorders, instead, this technique does not seem to add anything to the standard clinical practice. CONCLUSIONS NBI might prove useful in the assessment of selected external and middle ear disorders but its role must be prospectively validated.
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Affiliation(s)
- Federica Pollastri
- Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy. .,Department of Neuroscience, Psychology, Drug's Area and Child's Health, University of Florence, Florence, Italy.
| | | | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | | | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Rudi Pecci
- Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Beatrice Giannoni
- Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.,Department of Neuroscience, Psychology, Drug's Area and Child's Health, University of Florence, Florence, Italy
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Hidaka H, Ito M, Ikeda R, Kamide Y, Kuroki H, Nakano A, Yoshida H, Takahashi H, Iino Y, Harabuchi Y, Kobayashi H. Clinical practice guidelines for the diagnosis and management of otitis media with effusion (OME) in children in Japan - 2022 update. Auris Nasus Larynx 2022:S0385-8146(22)00232-2. [PMID: 36577619 DOI: 10.1016/j.anl.2022.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022]
Abstract
This is an update of the 2015 Guidelines developed by the Japan Otological Society and Oto-Rhino-Laryngeal Society of Japan defining otitis media with effusion (OME) in children (younger than 12 years old) and describing the disease rate, diagnosis, and method of examination. Recommended therapies that received consensus from the guideline committee were updated in consideration of current therapies used in Japan and based on available evidence. METHOD Regarding the treatment of OME in children, we developed Clinical Questions (CQs) and retrieved documents on each theme, including the definition, disease state, method of diagnosis, and medical treatment. In the previous guidelines, no retrieval expression was used to designate a period of time for literature retrieval. Conversely, a literature search of publications from March 2014 to May 2019 has been added to the JOS 2015 Guidelines. For publication of the CQs, we developed and assigned strengths to recommendations based on the collected evidence. RESULTS OME in children was classified into one group lacking the risk of developing chronic or intractable disease and another group at higher risk (e.g., children with Down syndrome, cleft palate), and recommendations for clinical management, including follow-up, is provided. Information regarding management of children with unilateral OME and intractable cases complicated by adhesive otitis media is also provided. CONCLUSION In clinical management of OME in children, the Japanese Clinical Practice Guidelines recommends management not only of complications of OME itself, such as effusion in the middle ear and pathologic changes in the tympanic membrane, but also pathologic changes in surrounding organs associated with infectious or inflammatory diseases.
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Affiliation(s)
- Hiroshi Hidaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191, Japan.
| | - Makoto Ito
- Department of Pediatric Otolaryngology, Jichi Children's Medical Center Tochigi, Jichi Medical University, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology-Head & Neck Surgery, Iwate Medical University, Japan
| | | | | | - Atsuko Nakano
- Division of Otorhinolaryngology, Chiba Children's Hospital, Japan
| | - Haruo Yoshida
- Department of Otolaryngology Head and Neck Surgery, Nagasaki University School of Medicine, Japan
| | - Haruo Takahashi
- Department of Otolaryngology Head and Neck Surgery, Nagasaki University School of Medicine, Japan
| | - Yukiko Iino
- Department of Otolaryngology, Tokyo-Kita Medical Center, Japan
| | - Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Japan
| | - Hitome Kobayashi
- Department of Otorhinolaryngology, Showa University School of Medicine, Japan
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abdel aziz AAR, Youssef AM, Mostafa MM, talaat M, Abdelzaher KM, Sadeq AA. Cartilage tympanoplasty in the treatment of adhesive otitis media with and without Eustachian tube balloon dilatation. J Otol 2022; 17:226-231. [PMID: 36249921 PMCID: PMC9547107 DOI: 10.1016/j.joto.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/01/2022] [Accepted: 08/16/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose To compare cartilage tympanoplasty (CT) combined with eustachian tube balloon dilatation (ETBD) and cartilage tympanoplasty alone as a surgical treatment modality for adhesive otitis media (AdOM) in terms of graft healing, audiological outcomes, and impact on life style, using Chronic Otitis Media Outcome Test 15 (COMOT-15). Methods 50 patients with AdOM were randomly classified into 2 groups: 25 patients for cartilage tympanoplasty only (CT group) and 25 patients for cartilage tympanoplasty combined with eustachian tube balloon dilatation (CT + ETBD group). Clinical outcomes in both groups were compared at 3 and 6 months of follow up. Results There was no significant difference in graft healing between the two groups. Postoperative COMOT-15 scores significantly decreased in both groups with a significant difference between the groups with regard to the decrease in COMOT-15 scores at 3 and 6 months of follow-up (P < 0.05). Hearing improvement was achieved, as the mean preoperative ABG was 26.5 ± 5.4 and 27.1 ± 4.6 dB, and the mean postoperative ABG at 6 months was 19.4 ± 4.4 and 14.6 ± 3.9 dB in the CT and the CT + ETBD groups, respectively. The difference in the magnitude of ABG reduction in the two groups was significant at 3 and 6 months of postoperative follow-up (P < 0.05) in favour of the CT + ETBD group. Conclusion ETBD can increase the success rate of cartilage tympanoplasty in patients with AdOM by enhancing the audiological outcome and quality of life.
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Radiological dimensions of the Eustachian tube in patients with adhesive otitis media. J Laryngol Otol 2022; 137:520-523. [PMID: 35811420 DOI: 10.1017/s0022215122001645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study aimed to analyse the computed tomography parameters for effective ventilation in patients with adhesive otitis media. METHODS Twenty-six patients with unilateral adhesive otitis media were included in the study. The patients' temporal bone computed tomography images were retrospectively reviewed. Eustachian tube length and diameter were measured. Mastoid pneumatisation and middle-ear size were evaluated by measuring petroclival and Eustachian tube-tympanic cavity ventilation angles. RESULTS The average Eustachian tube length was 38.4 mm and 38.9 mm in adhesive otitis media and healthy ears, respectively. The Eustachian tube diameter of the adhesive otitis media ears (1.47 mm) was significantly narrower than that of the healthy ears (1.83 mm). There were no significant differences in the angles between adhesive otitis media and healthy ears. CONCLUSION A narrow Eustachian tube diameter was associated with developing adhesive otitis media. Measuring Eustachian tube diameter is simple and can be routinely performed when examining temporal bone computed tomography images for Eustachian tube function evaluation.
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Li M, Mu Y, Cai H, Wu H, Ding Y. Application of New Materials in Auditory Disease Treatment. Front Cell Neurosci 2022; 15:831591. [PMID: 35173583 PMCID: PMC8841849 DOI: 10.3389/fncel.2021.831591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
Auditory diseases are disabling public health problems that afflict a significant number of people worldwide, and they remain largely incurable until now. Driven by continuous innovation in the fields of chemistry, physics, and materials science, novel materials that can be applied to hearing diseases are constantly emerging. In contrast to conventional materials, new materials are easily accessible, inexpensive, non-invasive, with better acoustic therapy effects and weaker immune rejection after implantation. When new materials are used to treat auditory diseases, the wound healing, infection prevention, disease recurrence, hair cell regeneration, functional recovery, and other aspects have been significantly improved. Despite these advances, clinical success has been limited, largely due to issues regarding a lack of effectiveness and safety. With ever-developing scientific research, more novel materials will be facilitated into clinical use in the future.
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Cavalcanti TC, Lew HM, Lee K, Lee SY, Park MK, Hwang JY. Intelligent smartphone-based multimode imaging otoscope for the mobile diagnosis of otitis media. BIOMEDICAL OPTICS EXPRESS 2021; 12:7765-7779. [PMID: 35003865 PMCID: PMC8713661 DOI: 10.1364/boe.441590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
Otitis media (OM) is one of the most common ear diseases in children and a common reason for outpatient visits to medical doctors in primary care practices. Adhesive OM (AdOM) is recognized as a sequela of OM with effusion (OME) and often requires surgical intervention. OME and AdOM exhibit similar symptoms, and it is difficult to distinguish between them using a conventional otoscope in a primary care unit. The accuracy of the diagnosis is highly dependent on the experience of the examiner. The development of an advanced otoscope with less variation in diagnostic accuracy by the examiner is crucial for a more accurate diagnosis. Thus, we developed an intelligent smartphone-based multimode imaging otoscope for better diagnosis of OM, even in mobile environments. The system offers spectral and autofluorescence imaging of the tympanic membrane using a smartphone attached to the developed multimode imaging module. Moreover, it is capable of intelligent analysis for distinguishing between normal, OME, and AdOM ears using a machine learning algorithm. Using the developed system, we examined the ears of 69 patients to assess their performance for distinguishing between normal, OME, and AdOM ears. In the classification of ear diseases, the multimode system based on machine learning analysis performed better in terms of accuracy and F1 scores than single RGB image analysis, RGB/fluorescence image analysis, and the analysis of spectral image cubes only, respectively. These results demonstrate that the intelligent multimode diagnostic capability of an otoscope would be beneficial for better diagnosis and management of OM.
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Affiliation(s)
- Thiago C Cavalcanti
- Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea
| | - Hah Min Lew
- Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea
| | - Kyungsu Lee
- Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea
| | - Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- co-first authors
| | - Jae Youn Hwang
- Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea
- co-first authors
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Lewis A, Vanaelst B, Hua H, Yoon Choi B, Jaramillo R, Kong K, Ray J, Thakar A, Järbrink K, Hol MKS. Success rates in restoring hearing loss in patients with chronic otitis media: A systematic review. Laryngoscope Investig Otolaryngol 2021; 6:522-530. [PMID: 34195374 PMCID: PMC8223463 DOI: 10.1002/lio2.576] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/01/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of tympanoplasty in treating chronic otitis media-related hearing loss, published literature was systematically reviewed to determine the clinical success rate of tympanoplasty at restoring hearing in chronic otitis media patients at a minimum follow-up period of 12-months. DATA SOURCES PubMed, Embase and the Cochrane Library. METHODS Two independent reviewers performed literature searches. Publications reporting long-term (≥12-month) hearing outcomes and complications data on adult and pediatric patients with chronic otitis media were included and assessed for risk of bias and strength of evidence. To assess how tympanoplasty influences long-term hearing outcomes, data on pure tone audiometry (air-bone gap) and complications were extracted and synthesized. RESULTS Thirty-nine studies met the inclusion criteria. Data from 3162 patients indicated that 14.0% of patients encountered postoperative complications. In adult patients, mean weighted air-bone gap data show closure from 26.5 dB hearing level (HL) (preoperatively) to 16.1 dB HL (postoperatively). In studies that presented combined adult and pediatric data, the mean preoperative air-bone gap of 26.7 dB HL was closed to 15.4 dB HL. In 1370 patients with synthesizable data, 70.7% of patients had a postoperative air-bone gap ˂ 20 dB HL at long-term follow-up. Finally, subgroup analysis identified that mean improvement in ABG closure for patients with and without cholesteatoma was 10.0 dB HL and 12.4 dB HL, respectively. CONCLUSION In patients with chronic otitis media, tympanoplasty successfully closed the air-bone gap to within 20 dB HL in 7/10 cases and had an overall complication rate of 14.0%. LEVEL OF EVIDENCE 2a.
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Affiliation(s)
- Aaran Lewis
- Cochlear Bone Anchored Solutions ABMölnlyckeSweden
| | | | - Håkan Hua
- Cochlear Bone Anchored Solutions ABMölnlyckeSweden
| | - Byung Yoon Choi
- Bundang HospitalSeoul National UniversitySeongnamSouth Korea
| | | | | | - Jaydip Ray
- ENT DepartmentSheffield Teaching HospitalsSheffieldUK
| | - Alok Thakar
- All India Institute of Medical SciencesNew DelhiIndia
| | | | - Myrthe K. S. Hol
- Department of Otorhinolaryngology, Donders Center for NeurosciencesRadboud University Medical CenterNijmegenNetherlands
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center GroningenUniversity of GroningenGroningenNetherlands
- Research School of Behavioral and Cognitive Neurosciences, Graduate School of Medical SciencesUniversity of GroningenGroningenNetherlands
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Lou Z. Endoscopic full-thickness cartilage-perichondrium double graft myringoplasty in adhesive perforation: retrospective case series. Acta Otolaryngol 2021; 141:14-18. [PMID: 32921208 DOI: 10.1080/00016489.2020.1814406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The adhesive perforation could be the sequela of adhesive otitis media, that partial tympanic membrane remnant is bound completely to the medial wall of the middle ear by fibrous adhesions. However, few studies have reported on the repairing of adhesive perforation. OBJECTIVES To evaluate the long-term outcome of endoscopic full-thickness cartilage-perichondrium double graft myringoplasty for adhesive perforation. MATERIALS AND METHODS In total, 26 patients with unilateral adhesive perforation associated with chronic otitis media who underwent full-thickness cartilage-perichondrium double graft myringoplasty were included. Outcomes were evaluated in terms of the hearing gain and graft success rate at 12 and 24 months. RESULTS The graft success rate was 96.15% (25/26) at 12 months and 88.46% (23/26) at 24 months. The neovascularization and epithelium covering the lateral surface of the cartilage graft were seen at preoperative 4 weeks, the superficial cartilage graft got complete epithelialization within 4-6 months. CT revealed the well-pneumatized middle ear and mastoid cells at postoperative 24th months in all the patients, no middle ear cholesteatoma formation and keratin pearls were found during the period of follow up. CONCLUSIONS Endoscopic full-thickness cartilage-perichondrium double graft myringoplasty without the tympanomeatal flap elevation is a feasible method for repairing adhesive perforations, with a higher graft success rate and satisfactory hearing results.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, affiliated Yiwu Hospital of Wenzhou Medical University (Yiwu Central Hospital), Yiwu City, Zhejiang Province, China
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Kaffenberger TM, Belsky MA, Oberlies NR, Kumar A, Donohue JP, Yang TS, Shaffer AD, Chi DH. Long-term Impact of Middle Ear Effusion in Pediatric Tympanostomy Tubes. Laryngoscope 2020; 131:E993-E997. [PMID: 32621539 DOI: 10.1002/lary.28860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/12/2020] [Accepted: 05/20/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Bilateral myringotomy and tympanostomy tube placement (BMT) is the most common pediatric surgery in the United States. Intraoperative middle ear effusion (MEE) is a risk factor for future BMTs in children with recurrent acute otitis media (RAOM). However, the impact of the type of MEE is unknown. Here, we assess otologic outcomes based on intraoperative MEE type and indication for surgery. STUDY DESIGN Case series chart review. METHODS After institutional review board approval, we performed a review of children undergoing BMTs between 2008 and 2009. Included patients had their first BMT, preoperative visit, and an operative report. Patients with cleft palate or Down syndrome were excluded. Indications for surgery included RAOM and chronic otitis media with effusion (COME). Other variables evaluated were future BMT, acquired cholesteatoma, and otorrhea. Logistic regression was used for statistical analysis. RESULTS Out of 1,045 patients reviewed, 680 were included and underwent their first BMT. There were 619 patients who had RAOM. Serous effusions were present in 22.2%, mucoid in 31.3%, purulent in 12.9%, undocumented or bloody in 2.3% of patients, and 31.2% of patients had dry middle ears. Moreover, 22.7% of patients underwent future BMTs. In RAOM patients, serous effusions decreased odds of perforation (odds ratio [OR]: 0.195, 95% confidence interval [CI]: 0.0438-0.867, P = .032), and purulent effusions increased the odds of in-office otorrhea suctioning (OR: 2.13, 95% CI: 1.20-3.77, P = .010) compared to dry. Mucoid effusions had no significant effect on outcomes in COME or RAOM patients. CONCLUSIONS Intraoperative MEEs were noted in 68.7% of cases; purulent effusions increase the odds of in-office suctioning in RAOM patients. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E993-E997, 2021.
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Affiliation(s)
- Thomas M Kaffenberger
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Michael A Belsky
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Nicholas R Oberlies
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Aarti Kumar
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Joseph P Donohue
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Tiffany S Yang
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Amber D Shaffer
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - David H Chi
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.,University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
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Lagos A, Villarroel P, García-Huidobro F, Delgado V, Huidobro B, Caro J, Martín JS. Tympanoplasty: factors associated with anatomical and audiometric results. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Tympanoplasty: factors associated with anatomical and audiometric results. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:219-224. [PMID: 32156440 DOI: 10.1016/j.otorri.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/06/2019] [Accepted: 07/24/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Tympanoplasty is a frequent surgery in otolaryngology. Its main indication is tympanic perforation, followed by adhesive otopathy. Its main and (or) anatomic objective is to restore the tympanic membrane's integrity, preventing infections, and its secondary or audiometric objective is to preserve or improve hearing. MATERIAL AND METHOD Retrospective study of all patients submitted to tympanoplasty at our hospital. Biodemographic, ear pathology and surgery characteristics were registered, and anatomic and audiometric success rates were analyzed. RESULTS A total of 182 patients were included, most female (57.1%), with average age of 36.1 years. The main surgical indication was tympanic perforation (89.0%), followed by adhesive otopathy (7.1%). Most tympanoplasties were primary surgeries (84.1%), type I (62.6%), performed by endoaural approach (83.5%) using medial or Austin technique (90.1%). Compound cartilage-perichondrium grafts were most frequently used (87.9%). The anatomic success rate was 84.6%, and the audiometric success rate was 66.8%. Patients who underwent myringoplasty (without raising of tympanomeatal flap) presented a better audiometric result (p=.003). No factors associated with better anatomical results were identified. CONCLUSIONS Our anatomic and audiometric results are comparable to those previously published. Further prospective studies are required to define factors associated with improved anatomic and audiometric results.
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Volgger V, Lindeskog G, Krause E, Schrötzlmair F. Identification of risk factors for residual cholesteatoma in children and adults: a retrospective study on 110 cases of revision surgery. Braz J Otorhinolaryngol 2019; 86:201-208. [PMID: 31523024 PMCID: PMC9422382 DOI: 10.1016/j.bjorl.2018.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 09/20/2018] [Accepted: 11/10/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction Residual disease after cholesteatoma removal is still a challenge for the otorhinolaryngologist. Scheduled “second-look” surgery and, more recently, radiological screenings are used to identify residual cholesteatoma as early as possible. However, these procedures are cost-intensive and are accompanied by discomfort and risks for the patient. Objective To identify anamnestic, clinical, and surgery-related risk factors for residual cholesteatoma. Methods The charts of 108 patients, including children as well as adults, having undergone a second-look or revision surgery after initial cholesteatoma removal at a tertiary referral hospital, were analyzed retrospectively. Results Gender, age, mastoid pneumatization, prior ventilation tube insertion, congenital cholesteatoma, erosion of ossicles, atticotomy, resection of chorda tympani, different reconstruction materials, and postoperative otorrhea did not emerge as statistically significant risk factors for residual disease. However, prior adenoid removal, cholesteatoma growth to the sinus tympani and to the antrum and mastoid, canal-wall-up 2 ways approach, and postoperative retraction and perforation were associated with a statistically higher rate of residual disease. A type A tympanogram as well as canal-wall-down plus reconstruction 2 ways approach for extended epitympanic and for extended epitympanic and mesotympanic cholesteatomas were associated with statistically lower rates of residual disease. A score including the postoperative retraction or perforation of the tympanic membrane, the quality of the postoperative tympanogram and the intraoperative extension of the cholesteatoma to the sinus tympani and/or the antrum was elaborated and proved to be suitable for predicting residual cholesteatoma with acceptable sensitivity and high specificity. Conclusion Cholesteatoma extension to the sinus tympani, antrum and mastoid makes a residual disease more likely. The canal-wall-down plus reconstruction 2 ways approach seems safe with similar rates of residual cholesteatoma and without the known disadvantages of canal-wall-down surgery. The described score can be useful for identifying patients who need a postoperative radiological control and a second-look surgery.
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Affiliation(s)
- Veronika Volgger
- Klinikum der Universität München, Department of Otorhinolaryngology, Head & Neck Surgery, München, Germany.
| | - Göran Lindeskog
- Klinikum der Universität München, Department of Otorhinolaryngology, Head & Neck Surgery, München, Germany
| | - Eike Krause
- Klinikum der Universität München, Department of Otorhinolaryngology, Head & Neck Surgery, München, Germany
| | - Florian Schrötzlmair
- Klinikum der Universität München, Department of Otorhinolaryngology, Head & Neck Surgery, München, Germany
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Treatment of adhesive otitis media by tympanoplasty combined with fascia grafting catheterization. Eur Arch Otorhinolaryngol 2019; 276:2721-2727. [PMID: 31273447 DOI: 10.1007/s00405-019-05514-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The best surgical method for the management of adhesive otitis media is controversial. The aim of the study was to explore the feasibility and effectiveness of tympanoplasty combined with fascia grafting catheterization in the treatment of adhesive otitis media. METHODS This was a retrospective study of patients with adhesive otitis media and who underwent tympanoplasty combined with fascia grafting and catheterization between April 2015 and December 2016 at the Eye-Ear-Nose-Throat Hospital Affiliated to Fudan University. All injured ears were examined by pure tone audiometry at 0.5, 1 and 2 kHz before and at 3 months after operation. RESULTS Thirty-five patients (35 ears) were followed for 12-44 months. The air-conduction pure tone average was 31.7 ± 12.3 dBnHL. Hearing of 28 patients (80%) was improved to a practical level within 40 dBnHL, but 2 patients (6%) had no change in postoperative hearing. Numbers of patients with spontaneous prolapse, artificial removal of tympanic membrane ventilation tube, and unobstructed in place were 15, 12, and 8, respectively. Twenty-seven patients had perforations left after the prolapse and removal of tympanic membrane ventilation tubes, of which 22 (81%) had perforations healing by themselves. All patients had dry ears after operation, without recurrence. Thirty-three patients (94%) had dry ears within 3 months and only 2 patients (6%) for more than 6 months. CONCLUSION Tympanoplasty combined with fascia grafting catheterization is effective in the treatment of adhesive otitis media.
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Seonwoo H, Kim SW, Shin B, Jang KJ, Lee M, Choo OS, Choi MJ, Kim J, Lim KT, Jang JH, Chung JH, Choung YH. Latent stem cell-stimulating therapy for regeneration of chronic tympanic membrane perforations using IGFBP2-releasing chitosan patch scaffolds. J Biomater Appl 2019; 34:198-207. [PMID: 31060420 DOI: 10.1177/0885328219845082] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Hoon Seonwoo
- 1 Department of Industrial Machinery Engineering, College of Life Sciences and Natural Resources, Sunchon National University, Suncheon, Republic of Korea
| | - Seung Won Kim
- 2 Department of Burns and Plastic Surgery, Affiliated Hospital of Yanbian University, Yanji, Jilin, P. R. China
| | - Beomyong Shin
- 3 Department of Biomedical Sciences, BK21 Plus Research Center for Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Kyoung-Je Jang
- 4 Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Myungchul Lee
- 4 Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Oak-Sung Choo
- 5 Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea.,6 Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Mi-Jin Choi
- 3 Department of Biomedical Sciences, BK21 Plus Research Center for Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Jangho Kim
- 7 Department of Rural and Biosystems Engineering, Chonnam National University, Gwangju, Republic of Korea
| | - Ki-Taek Lim
- 8 Department of Biosystems Engineering, College of Agricultural and Life Sciences, Kangwon National University, Chuncheon, Republic of Korea
| | - Jeong Hun Jang
- 5 Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jong Hoon Chung
- 4 Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea.,9 Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul, Republic of Korea
| | - Yun-Hoon Choung
- 3 Department of Biomedical Sciences, BK21 Plus Research Center for Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea.,5 Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea.,6 Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
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Si Y, Chen Y, Xu G, Chen X, He W, Zhang Z. Cartilage tympanoplasty combined with eustachian tube balloon dilatation in the treatment of adhesive otitis media. Laryngoscope 2018; 129:1462-1467. [PMID: 30485447 DOI: 10.1002/lary.27603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Yu Si
- Department of Otolaryngology–Head and Neck Surgery , Sun Yat‐Sen Memorial Hospital, and Institute of Hearing and Speech‐Language ScienceSun Yat‐sen University Guangzhou China
| | - Yubin Chen
- Department of Otolaryngology–Head and Neck SurgeryThird Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Guo Xu
- Department of Otolaryngology–Head and Neck SurgeryShenzhen Children's Hospital Shenzhen China
| | - Ximing Chen
- Department of Otolaryngology–Head and Neck Surgery , Sun Yat‐Sen Memorial Hospital, and Institute of Hearing and Speech‐Language ScienceSun Yat‐sen University Guangzhou China
| | - Wuhui He
- Department of Otolaryngology–Head and Neck Surgery , Sun Yat‐Sen Memorial Hospital, and Institute of Hearing and Speech‐Language ScienceSun Yat‐sen University Guangzhou China
| | - Zhigang Zhang
- Department of Otolaryngology–Head and Neck Surgery , Sun Yat‐Sen Memorial Hospital, and Institute of Hearing and Speech‐Language ScienceSun Yat‐sen University Guangzhou China
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