1
|
Erfurt C, Westerhout SF, Straatman LV, Smit AL, Stokroos RJ, Thomeer HGXM. Canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes. Front Surg 2024; 11:1381481. [PMID: 38650663 PMCID: PMC11033303 DOI: 10.3389/fsurg.2024.1381481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
Objectives The primary objective was to determine whether obliteration of the epitympanic area and mastoid cavity during canal wall up (CWU) cholesteatoma surgery reduces the rate of recurrent and residual cholesteatoma compared to not obliterating the same area. The secondary objective was to compare postoperative hearing outcomes between both techniques. Methods A retrospective cohort study was conducted in a tertiary referral center. One-hundred-fourty-three ears were included of patients (≥18y) who underwent a CWU tympanomastoidectomy for cholesteatoma with or without bony obliteration between January 2015 and March 2020 in the University Medical Center Utrecht. The median follow-up was respectively 1.4 (IQR 1.1-2.2) vs. 2.0 years (IQR 1.2-3.1) (p = 0.013). Interventions All patients underwent CWU tympanomastoidectomy for cholesteatoma. For 73 ears bone dust, Bonalive® or a combination was used for obliteration of the mastoid and epitympanic area, the rest of the ears (n = 70) were not obliterated. In accordance with the Dutch protocol, included patients are planned to undergo an MRI scan with diffusion-weighted imaging (DWI) one, three and five years after surgery to detect recurrent or residual cholesteatoma. Main outcome measures The primary outcome measure was recurrent and residual cholesteatoma as evaluated by MRI-DWI and/or micro-otoscopy and confirmed by micro-otoscopy and/or revision surgery. The secondary outcome measure was the postoperative hearing. Results In this cohort, the group treated with canal wall up tympanomastoidectomy with subsequent bony obliteration (73 ears, 51.0%) had significantly lower recurrent (4.1%) and residual (6.8%) cholesteatoma rates than the group without obliteration (70 ears, 25.7% and 20.0%, respectively; p < 0.001). There was no significant difference between both groups in postoperative bone conduction thresholds (mean difference 2.7 dB, p = 0.221) as well as the mean air-bone gap closure 6 weeks after surgery (2.3 dB in the non-obliteration and 1.5 dB in the obliteration group, p = 0.903). Conclusions Based on our results, a canal wall up tympanomastoidectomy with bony obliteration is the treatment of choice, since the recurrent and residual disease rate is lower compared to the group without obliteration. The bony obliteration technique does not seem to affect the perceptive or conductive hearing results, as these are similar between both groups.
Collapse
Affiliation(s)
- Chiara Erfurt
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sanne F. Westerhout
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Louise V. Straatman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Adriana L. Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Robert J. Stokroos
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hans G. X. M. Thomeer
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
2
|
Kemps G, Geven L, Kunst H, Mylanus E, Mulder J, Lanting C, Pennings R. Surgical Treatment for Troublesome Mastoid Cavities: Canal Wall Reconstruction With Bony Obliteration Versus Subtotal Petrosectomy. Otol Neurotol 2024; 45:273-280. [PMID: 38270225 DOI: 10.1097/mao.0000000000004109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
INTRODUCTION A chronically discharging modified radical mastoid cavity may require surgical intervention. We aim to explore two techniques. OBJECTIVE To compare outcomes of subtotal petrosectomy (STP) and canal wall reconstruction with bony obliteration technique (CWR-BOT). STUDY DESIGN Retrospective cohort study. SETTING A tertiary referral center. PATIENTS All patients with a chronically discharging mastoid cavity surgically treated at the Radboud University Medical Center by STP or CWR-BOT in 2015 to 2020, excluding patients with preoperative cholesteatoma. MAIN OUTCOME MEASURES Dry ear rate, audiometry, and rehabilitation. SECONDARY OUTCOME MEASURES Healing time, number of postoperative visits, complications, cholesteatoma, and need for revision surgeries. RESULTS Thirty-four (58%) patients underwent STP, and 25 (42%) CWR-BOT. A dry ear was established in 100% of patients (STP) and 87% (CWR-BOT). The air-bone gap (ABG) increased by 12 dB in STP, and decreased by 11 dB in CWR-BOT. Postoperative ABG of CWR-BOT patients was better when preoperative computed tomography imaging showed aerated middle ear aeration. ABG improvement was higher when ossicular chain reconstruction took place. Mean follow-up time was 32.5 months (STP) versus 40.5 months (CWR-BOT). Healing time was 1.2 months (STP) versus 4.1 months (CWR-BOT). The number of postoperative visits was 2.5 (STP) versus 5 (CWR-BOT). Cholesteatoma was found in 15% (STP) versus 4% (CWR-BOT) of patients. Complication rate was 18% (STP) and 24% (CWR-BOT) with a need for revision in 21% (STP) and 8% (CWR-BOT), including revisions for cholesteatoma. CONCLUSION STP and CWR-BOT are excellent treatment options for obtaining a dry ear in patients with a chronically discharging mastoid cavity. This article outlines essential contributing factors in counseling patients when opting for one or the other. Magnetic resonance imaging with diffusion-weighted imaging follow-up should be conducted at 3 and 5 years postoperatively.
Collapse
Affiliation(s)
- Glen Kemps
- Department of Otorhinolaryngology, Isala Hospital, Zwolle
| | | | | | | | - Jef Mulder
- Department of Otorhinolaryngology, Radboudumc, Nijmegen
| | - Cris Lanting
- Department of Otorhinolaryngology, Radboudumc, Nijmegen
| | | |
Collapse
|
3
|
Schouwenaar EMM, Hellingman CA, Waterval JJ. Health-related quality of life after otologic surgical treatment for chronic otitis media: systematic review. Front Neurol 2023; 14:1268785. [PMID: 38020592 PMCID: PMC10654635 DOI: 10.3389/fneur.2023.1268785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This systematic review aims to describe the impact of otologic surgery as a treatment for chronic otitis media (COM) on the Health-Related Quality of Life (HRQoL) of adult patients. Methods A literature search was performed in PubMed, Scopus, Embase, and Web of Science until May 2023. Prospective studies including adult patients with COM (cholesteatoma) who underwent canal wall up mastoidectomy, canal wall down mastoidectomy, or tympanoplasty without mastoidectomy, with pre- and postoperative HRQoL measurements, were considered eligible. Questionnaire validation studies were excluded. The risk of bias and study quality were evaluated with a Quality Assessment Tool (for before-after studies with no control group). To assess the change in HRQoL, pre- and postoperative HRQoL values and absolute changes were extracted, synthesized, and presented in tables. Standardized mean differences (SMD) were calculated to enhance comparisons. Results Of the 720 studies identified, 16 met the inclusion criteria of this review. Different questionnaires were used throughout the studies. The CES and COMOT-15 were used in five studies and the ZCMEI-21 and COMQ-12 in three studies. All studies indicated statistically significant improvement in HRQoL from pre- to postoperative, measured with disease-specific HRQoL questionnaires. General HRQoL questionnaires did not show significant improvement. Calculated SMDs ranged from 0.24 to 6.99. Discussion and conclusion Included studies had low (n = 10) to high (n = 6) risk of bias and poor (n = 4), fair (n = 7) or good (n = 5) study quality. Surgical treatment positively impacts the HRQoL of adult COM patients with and without cholesteatoma. However, the clinical relevance of the reported changes is unknown due to the lack of minimal clinically important differences (MCID) or cut-off values in each questionnaire. Therefore, further research regarding the MCIDs of each questionnaire is needed. Future research should also report preoperative chief symptoms and indications for surgery to improve individual patient counseling.
Collapse
Affiliation(s)
- Esther M. M. Schouwenaar
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Catharine A. Hellingman
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jérôme J. Waterval
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| |
Collapse
|
4
|
Pontillo V, Ciprelli S, Grillo R, Quaranta N. Quality of life after revision mastoidectomy with mastoid obliteration. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2023; 74:352-358. [PMID: 37331626 DOI: 10.1016/j.otoeng.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/14/2023] [Indexed: 06/20/2023]
Abstract
AIMS To evaluate the postoperative quality of life (QoL) after revision canal wall down mastoidectomy with mastoid obliteration (rCWD). MATERIAL AND METHODS A retrospective analysis was conducted on patients treated by rCWD for cholesteatoma between 2016 and 2019. A control group including all patients treated by primary canal wall down with mastoid obliteration (pCWD) for cholesteatoma between 2009 and 2014 was used for the comparison of the postoperative QoL, assessed by the COMQ-12. RESULTS The rCWD and pCWD groups respectively counted 38 and 78 patients with an average follow-up of 30 and 62 months respectively. No significant difference was found in terms of QoL between the two groups. An intra-group analysis among rCWD patients, showed that patients treated by canal wall down (CWD) at the primary surgery had a significantly worse post-revision QoL compared to those initially treated by canal wall up (CWU), specifically in the hearing and balance domains of the questionnaire. CONCLUSIONS Revision mastoid obliteration leads to similar QoL results to those obtained after primary CWD with obliteration. Patients who had undergone a CWD as primary surgery complain worse hearing and balance problems compared to those primarily submitted to CWU, even after revision surgery.
Collapse
Affiliation(s)
- Vito Pontillo
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Sabino Ciprelli
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Rossella Grillo
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Nicola Quaranta
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| |
Collapse
|
5
|
Fieux M, Tournegros R, Hermann R, Tringali S. Allograft bone vs. bioactive glass in rehabilitation of canal wall-down surgery. Sci Rep 2023; 13:17945. [PMID: 37864103 PMCID: PMC10589328 DOI: 10.1038/s41598-023-44901-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 10/13/2023] [Indexed: 10/22/2023] Open
Abstract
Canal wall-down (CWD) mastoidectomy creates a radical cavity that modifies the anatomy and physiology of the middle ear, thus preventing it from being self-cleaning and causing epidermal stagnation in the posterior cavities. Canal wall-down tympanomastoidectomy with reconstruction (CWDTwR) can obliterate such radical cavities. The main objective of this study was to compare postoperative results after CWDTwR by using either bone allografts or 45S5 bioactive glass as a filling tissue with an 18-month follow-up. This was a single-center observational trial including all patients undergoing CWDTwR. Patients were divided into two groups according to the filling material used: allograft bone (AB group) or 45S5 bioactive glass (BG group). Clinical monitoring was performed regularly, with control imaging performed at 18 months (CT scan and DW MRI). The two groups were compared with the t test for quantitative variables and the chi square test for qualitative variables (no revision surgery, audiometric results, complications, mastoid obliteration volume). Thirty-two patients underwent CWDTwR between October 2015 and 2018. The mean age was 48 years, and 71.9% (23/32) were men. A total of 46.9% (15/32) of the patients had undergone at least 3 middle-ear surgeries prior to CWDTwR. The most frequent preoperative symptom was otorrhea (100.0%, 32/32), and only 12.5% (4/32) experienced dizziness. Fifteen and 17 patients underwent surgery with bone allografts and 45S5 bioactive glass, respectively. At 18 months post-operation, 53.3% of the patients (8/15) in the AB group presented with recurrent otorrhea versus 5.9% (1/17) of patients in the BG group (p = 0.005). Seventy-eight percent (7/9) of symptomatic patients had undergone revision surgery at 18 months postoperation: 40.0% (6/15) in the AB group and 5.9% (1/17) in the BG group (p = 0.033). One patient's surgery was cancelled due to the COVID-19 pandemic, and one patient refused surgery. The effects of CWDTwR with bone allografts are disappointing in early follow-up, with significant resorption leading to a 40.0% revision surgery rate. 45S5 BG is a simple solution, with preliminary results that are superior to those of AB. However, prospective controlled studies with longer follow-up times are needed to evaluate the value of BG versus other synthetic materials (such as hydroxyapatite) in surgical management of CWDTwR.Trial registration: retrospectively registered.
Collapse
Affiliation(s)
- Maxime Fieux
- Service d'ORLd'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite Cedex, France.
- Université de Lyon, Université Lyon 1, 69003, Lyon, France.
- UMR 5305, Laboratoire de Biologie Tissulaire et d'Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS/Université Claude Bernard Lyon 1, 7 Passage du Vercors, 69367, Lyon Cedex 07, France.
| | - Romain Tournegros
- Service d'ORLd'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite Cedex, France
| | - Ruben Hermann
- Université de Lyon, Université Lyon 1, 69003, Lyon, France
- Service d'ORL et de chirurgie cervico-faciale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003, Lyon, France
| | - Stéphane Tringali
- Service d'ORLd'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite Cedex, France
- Université de Lyon, Université Lyon 1, 69003, Lyon, France
- UMR 5305, Laboratoire de Biologie Tissulaire et d'Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS/Université Claude Bernard Lyon 1, 7 Passage du Vercors, 69367, Lyon Cedex 07, France
| |
Collapse
|
6
|
Kroon VJ, Mes SW, Borggreven PA, van de Langenberg R, Colnot DR, Quak JJ. Efficacy of S53P4 Bioactive Glass for the Secondary Obliteration of Chronically Discharging Radical Cavities. OTO Open 2023; 7:e96. [PMID: 38034064 PMCID: PMC10685330 DOI: 10.1002/oto2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/27/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023] Open
Abstract
Objective Present the results of the secondary obliteration of chronically discharging radical cavities using S53P4 bioactive glass (BAG). Study Design Retrospective cohort study. Setting Single-center study. Methods A single-center retrospective cohort study was conducted of all patients that underwent secondary obliteration of persistently draining radical cavities using S53P4 BAG between 2011 and 2022. Patients with middle ear cholesteatoma were excluded. The main outcome was postoperative otorrhea, as indicated by Merchant grading. Results In total, 97 patients were included. The median postoperative follow-up time was 3.9 years (range 0.5-10.4). Average time between the original canal wall down surgery and the secondary obliteration was 25.3 years (SD 11.7, range 2-66). At the most recent follow-up visit, a Merchant grade of 0 to 1 was observed in 95% of the cases. There were no cases of sensorineural hearing loss or facial palsy, one case developed a retro auricular skin defect and 1 patient developed CSF leakage. Minor complications were seen in 10 patients (10%). Ossicular chain reconstruction with a titanium prosthesis was performed in 42 cases, resulting in a median improvement of 11.2 dB in air conduction thresholds. In 9/42 cases (21%), closure of the postoperative air-bone gap to ≤20 dB was achieved. Twenty-five percent of cases could be discharged from out-patient visits. Conclusion Revision of persistently draining radical cavities with BAG obliteration is feasible and results in a dry and safe ear in 95% of the patients, thereby enabling wearing of a conventional hearing aid. Out-patient visits could be ceased in 25% of the cases.
Collapse
Affiliation(s)
- Victor J. Kroon
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
- Amsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Steven W. Mes
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
- Department of OtolaryngologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Pepijn A. Borggreven
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
| | - Rick van de Langenberg
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
| | - David R. Colnot
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
| | - Jasper J. Quak
- Department of Otolaryngology and Head and Neck SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
- Amsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| |
Collapse
|
7
|
Bächinger D, Neudert M, Dazert S, Röösli C, Huber A, Mlynski R, Weiss NM. [Health-related quality of life in chronic otitis media-measurement methods and their application in surgical therapy]. HNO 2023; 71:556-565. [PMID: 37422596 DOI: 10.1007/s00106-023-01324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Chronic otitis media (COM) can lead to significant impairment of health-related quality of life (HRQoL) due to symptoms such as otorrhea, pain, hearing loss, tinnitus, or dizziness. A systematic assessment of HRQoL in COM is becoming increasingly important as it complements (semi-)objective outcome parameters in clinical practice and research. HRQoL is measured by means of patient-reported outcome measures (PROMs). There are two disease-specific validated PROMs available for COM in German-the Chronic Otitis Media Outcome Test (COMOT-15) and the Zurich Chronic Middle Ear Inventory (ZCMEI-21)-which have become increasingly popular in recent years. OBJECTIVE The purpose of this narrative review is to present the current state of research on measuring HRQoL in COM before and after surgical procedures. RESULTS AND CONCLUSION Hearing is the most important factor influencing HRQoL in COM. Surgical procedures usually result in a clinically relevant improvement in HRQoL in COM with or without cholesteatoma. However, if cholesteatoma is present, its extent does not correlate with HRQoL. While HRQoL plays a secondary role in establishment of the indication for surgical therapy in COM with cholesteatoma, it plays an important role in terms of relative surgical indications, e.g., a symptomatic open mastoid cavity after resection of the posterior canal wall. We encourage the regular use of disease-specific PROMs preoperatively as well as during follow-up to assess HRQoL in COM in individual patients, in research, and in the context of quality monitoring.
Collapse
Affiliation(s)
- David Bächinger
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, St. Elisabeth-Hospital, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Marcus Neudert
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum "Carl Gustav Carus", Dresden, Deutschland
| | - Stefan Dazert
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, St. Elisabeth-Hospital, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Christof Röösli
- Klinik für Ohren‑, Nasen‑, Hals und Gesichtschirurgie, Universitätsspital Zürich, Zürich, Schweiz
- Universität Zürich, Zürich, Schweiz
| | - Alexander Huber
- Klinik für Ohren‑, Nasen‑, Hals und Gesichtschirurgie, Universitätsspital Zürich, Zürich, Schweiz
- Universität Zürich, Zürich, Schweiz
| | - Robert Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Rostock, Deutschland
| | - Nora M Weiss
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, St. Elisabeth-Hospital, Ruhr-Universität Bochum, Bochum, Deutschland.
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, St. Elisabeth Hospital, Klinikum der Ruhr-Universität Bochum, Bleichstraße 15, 44787, Bochum, Deutschland.
| |
Collapse
|
8
|
Kara H, Sen C, Sonmez S, Celik M, Polat B. The effect of bony obliteration on quality of life after tympano-mastoidectomy surgery: A prospective observational controlled cohort study. Laryngoscope Investig Otolaryngol 2023; 8:1052-1060. [PMID: 37621278 PMCID: PMC10446264 DOI: 10.1002/lio2.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/17/2023] [Accepted: 06/04/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives The study's primary objective was to compare the quality of life (QoL) and external auditory canal (EAC) hygiene among patients who underwent bony mastoid obliteration or meatoplasty after canal wall down (CWD) mastoidectomy. Methods A prospective, observational, controlled cohort study was conducted at our tertiary referral university hospital. Twenty-eight patients older than 16 years of age with chronic otitis media who underwent CWD mastoidectomy were included. Two cohorts were followed: CWD mastoidectomy followed by mastoid obliteration (Group 1, n = 14) and CWD mastoidectomy followed by meatoplasty (Group 2, n = 14). The main outcome measures of total COMBI score (postoperative 6-month QoL) and EAC hygiene were compared between the groups. Results The average age of the patients was 36.14 (12. 22) years; 15 (53.6%) were female and 13 (46.4%) were male. There were no differences in demographic variables, preoperative findings, or COMQ-12 (preoperative QoL) scores between groups. The average COMBI score of Group 1 (49.0 [8.66]) was not significantly different from Group 2 (46.79 [7.76]) (p = .482). Poor EAC hygiene was observed in eight (57.1%) patients in Group 2 and three (21.4%) patients in Group 1 (p = .06). In Group 1, no resorption of graft material was observed in 10 (71.4%) patients, minor resorption was observed in three (21.4%) patients, and significant resorption was observed in one (7.1%) patient. There were no significant differences in audiological findings between groups (p > .05). Conclusion There were no significant differences regarding short-term postoperative QoL, EAC hygiene, or hearing outcomes between patients who underwent bony mastoid obliteration or meatoplasty after CWD mastoidectomy. Level of Evidence 1b (individual prospective cohort study).
Collapse
Affiliation(s)
- Hakan Kara
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| | - Comert Sen
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| | - Said Sonmez
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| | - Mehmet Celik
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| | - Beldan Polat
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| |
Collapse
|
9
|
Li L, Gong S, Xie J, Wang C. Clinical outcomes of revision radical mastoidectomy surgeries to dry ears: A retrospective study. Medicine (Baltimore) 2023; 102:e32787. [PMID: 36749232 PMCID: PMC9901945 DOI: 10.1097/md.0000000000032787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This study retrospectively investigated the reasons for failure to dry the ear after primary radical mastoidectomy for chronic otitis media. In this retrospective study, we analyzed the main causes of dry ear failure in 43 patients (46 ears) who underwent radical mastoidectomy. We found that inadequate exposure of the mastoid cavity, incomplete removal of pathological tissues, and poor drainage of the surgical cavity were the main reasons for failure of radical mastoidectomy. Lesions in the tympanic ostium of the eustachian tube and incorrect selection of surgical techniques could also cause dry ear failure. Revision surgery based on preoperative temporal bone computed tomography and intraoperative surgical findings could achieve dry ear in 100% of cases and no complications were observed. In patients who underwent tympanoplasty, there was a significant postoperative decrease in the decibel hearing level for the air conduction threshold and air-bone gap ( P < .05). Based on the reasons for failure, the corresponding treatment was undertaken to achieve dry ears during revision surgery.
Collapse
Affiliation(s)
- Ly Li
- Department of Otorhinolaryngology, Shunyi Hospital, Beijing, China
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital Affiliated to Captial University of Medical Sciences, Beijing, China
| | - Shusheng Gong
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital Affiliated to Captial University of Medical Sciences, Beijing, China
| | - Jing Xie
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital Affiliated to Captial University of Medical Sciences, Beijing, China
| | - Chaoshan Wang
- Department of Otorhinolaryngology, Shunyi Hospital, Beijing, China
- * Correspondence: Chaoshan Wang, Department of Otorhinolaryngology, Shunyi Hospital, Beijing 101300, China (e-mail: )
| |
Collapse
|
10
|
Bartel R, Cruellas F, Gonzalez-Compta X, Hamdan M, Huguet G, Mesalles M, Cisa E, Nogues J. Mastoid obliteration and canal wall reconstruction with posterior auricular artery (PAA) fascia-periosteum flap. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2023; 74:1-7. [PMID: 36858782 DOI: 10.1016/j.otoeng.2021.07.006] [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: 03/25/2021] [Accepted: 07/24/2021] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Unstable cavities are defined as cavities with cerumen accumulation that need frequent cavity cleaning in the out-patient clinic, cavities that are intolerant to water due to risk of infection or that are subject to frequent infection and otorrhoea. The objective of this study is to address the problem of troublesome mastoid cavities, with the performance of secondary mastoid obliteration and canal wall reconstruction, using a novel posterior auricular artery (PAA) fascia-periosteum flap. MATERIALS AND METHODS A prospective study was designed, only secondary obliterations were included. Unstable mastoid cavities were defined as Merchant grade 2 or 3 and were included for surgery. RESULTS At 12 months of follow up, a complete external auditory canal (EAC) and a self-cleaning ear were achieved in all 23 patients. Completely dry ears were achieved in 21 patients (91.3%). An air-bone gap improvement of 5dB was achieved. CONCLUSION Mastoid obliteration and EAC reconstruction are effective procedures to treat troublesome post canal wall down mastoid cavities. They improve quality of life and enable patients to overcome ear discharge. A standard EAC size enables the utilization of conventional hearing aids, it also reduces the need for constant mastoid cleaning and decreases healthcare expenses. The PAA flap seems to be an effective procedure to achieve all these features, as it is used to obliterate the mastoid and becomes a structural component of the neo-EAC.
Collapse
Affiliation(s)
- Ricardo Bartel
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain; Otology Research Group of Young Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France; Otology Commission of the Catalan Society of Otorhinolaryngology (SCORL), Barcelona, Spain.
| | - Francesc Cruellas
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Xavier Gonzalez-Compta
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Miriam Hamdan
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Gabriel Huguet
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Marta Mesalles
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Enric Cisa
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Julio Nogues
- Otolaryngology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| |
Collapse
|
11
|
Cavaliere M, Di Lullo AM, Capriglione P, Motta G, Cantone E. Quality of Life Assessment of Chronic Otitis Media Patients Following Surgery. J Pers Med 2022; 13:jpm13010074. [PMID: 36675735 PMCID: PMC9861684 DOI: 10.3390/jpm13010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/16/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Chronic otitis media (COM) is a persistent inflammation of the middle ear. COM often requires surgical management and represents one of the most disabling pathologies in the field of otolaryngology, not only due to hearing loss but also because recurrent otorrhea seriously affects the quality of life (QoL) of patients. The COMOT-15 questionnaire is a reliable, valid and sensitive tool for measuring the QoL of patients with COM. The aim of this study was to evaluate QoL by using the Italian version of the COMOT-15 in COM patients undergoing surgery based on age and different operation techniques. This observational retrospective study involved fifty-two consecutive patients undergoing surgical treatment for COM according to Nadol criteria. Preoperatively (T0) and 12 months after surgery (T1) patients underwent clinical examination, imaging, the Italian version of the COMOT-15 and pure tone audiometry. After surgery, we observed an improvement of QoL in 84.6% of the population. The COMOT-15 overall score, ear symptoms and hearing subscores showed significantly better ratings after surgery in the whole analyzed group. However, the separate analysis of patients operated with open techniques and closed techniques showed a significant improvement in ear symptoms subscore in both groups and a significant improvement in hearing subscore and mental health subscore only in patients operated on with closed techniques. Moreover, we observed a positive correlation between age and Δ-COMOT. This study shows the crucial role of a reliable and suitable questionnaire such as the COMOT-15 in evaluating COM patients, including clinical symptoms, functional and psychological impairments and highlighting a positive correlation between age and COMOT-15 results.
Collapse
Affiliation(s)
- Michele Cavaliere
- ENT Section, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples, Federico II. Pansini Street n.5, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-3334797200
| | - Antonella Miriam Di Lullo
- ENT Section, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples, Federico II. Pansini Street n.5, 80131 Naples, Italy
| | - Pasquale Capriglione
- ENT Section, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples, Federico II. Pansini Street n.5, 80131 Naples, Italy
| | - Gaetano Motta
- Otorhinolaryngology, Head and Neck Surgery Unit, Department of Mental and Physical Health and Preventive, Medicine, Università Degli Studi Della Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Elena Cantone
- ENT Section, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples, Federico II. Pansini Street n.5, 80131 Naples, Italy
| |
Collapse
|
12
|
Quality of Life after Surgical Treatment for Chronic Otitis Media: A Systematic Review of the Literature. J Pers Med 2022; 12:jpm12121959. [PMID: 36556180 PMCID: PMC9783172 DOI: 10.3390/jpm12121959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
This systematic review aims to (a) define what instruments are available to measure quality of life (QoL) in patients undergoing tympanoplasty for chronic otitis media (COM) and what is the most commonly selected timing to do so; (b) compare outcomes from different surgical techniques; and (c) describe any reported correlation between subjective and functional results. This review was conducted following the PRISMA statement recommendations. Of the 151 articles screened, 24 were included. Most studies had a prospective design. The mean age at surgery was 44.5 years. A microscopic retroauricular approach was the most common surgical technique. Most articles included both primary and revision surgeries. The most commonly used questionnaire was the Glasgow Benefit Inventory (GBI), followed by the Chronic Ear Survey (CES), the Chronic Otitis Media Outcome Test 15 (COMOT-15) and the Zurich Chronic Middle Ear Inventory (ZCMEI-21). Questionnaires were administered about 12 months after surgery in most studies. Ten studies reported possible associations between hearing results and QoL. QoL assessment after COM surgery variably relies on disease-specific and non-specific questionnaires. Patients are usually evaluated 12 months after surgery, and this appears to be a suitable timing to contrast the possible bias effect of different tympanoplasty techniques associated with different healing times. A comparison between QoL outcomes in different surgical approaches cannot be made, as several influencing factors have not been detailed in the included studies. Few studies have investigated the correlation between subjective and objective outcomes of tympanoplasty for COM so far.
Collapse
|
13
|
Skoloudik L, Chrobok V, Laco J, Dedkova J, Diaz Garcia D, Filip S. An Effect of Cyclosporin A in a Treatment of Temporal Bone Defect Using hBM-MSCs. Biomedicines 2022; 10:biomedicines10112918. [PMID: 36428486 PMCID: PMC9687466 DOI: 10.3390/biomedicines10112918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background. The treatment of middle ear cholesteatoma requires surgical treatment and the reconstruction of the temporal bone, which represents an ongoing problem. Otologists have focused on the research of materials allowing an airy middle ear and the preservation of hearing function to reconstruct the temporal bone. Methods. This study evaluated the effect of cyclosporin A (CsA) and a combined biomaterial in the healing process of postoperative temporal bone defects in an animal model. Cultured human Bone Marrow Mesenchymal Stromal Cells (hBM-MSCs) were mixed with hydroxyapatite (Cem-Ostetic®), and subsequently applied as a bone substitute after middle ear surgery, showing that the therapeutic potential of hBM-MSCs associated with bone regeneration and replacement is directly influenced by CsA, confirming that it promotes the survival of MSCs in vivo. Results. The therapeutic efficacy of the combination of MSCs with CsA is greater than the sole application of MSCs in a hydroxyapatite carrier. Conclusion. The reconstruction of a temporal bone defect using hBM-MSCs requires an immunosuppressant to improve the results of treatment.
Collapse
Affiliation(s)
- Lukas Skoloudik
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Králové, Czech Republic
| | - Viktor Chrobok
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Králové, Czech Republic
| | - Jan Laco
- The Fingerland Department of Pathology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Králové, Czech Republic
| | - Jana Dedkova
- Department of Radiology, University Hospital Hradec Kralove, 500 05 Hradec Králové, Czech Republic
| | - Daniel Diaz Garcia
- Department of Pharmacology, Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Králové, Czech Republic
| | - Stanislav Filip
- Department of Oncology and Radiotherapy, Faculty of Medicine Hradec Kralove, Charles University, 500 03 Hradec Králové, Czech Republic
- Correspondence: ; Tel.: +420-495-834-618
| |
Collapse
|
14
|
Mastoid obliteration and external auditory canal reconstruction using 3D printed bioactive glass S53P4 /polycaprolactone scaffold loaded with bone morphogenetic protein-2: A simulation clinical study in rabbits. Regen Ther 2022; 21:469-476. [PMID: 36313396 PMCID: PMC9588957 DOI: 10.1016/j.reth.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The lack of good prosthetic materials and objective standards has limited the promotion of mastoid obliteration and external auditory canal reconstruction, and the quality of the surgery varies. In this study, bioactive glass S53P4 (S53P4), the most popular artificial prosthetic material, was modified and combined with polycaprolactone (PCL) and bone morphogenetic protein-2 (BMP-2) to produce an individualized biological scaffold using 3D printing technology to explore a better material and method for mastoid obliteration and external auditory canal reconstruction. METHODS 3D-printed S53P4/PCL scaffolds were fabricated from 3D reconstruction data of bone defect areas in New Zealand rabbits simulating "Canal Wall Down Mastoidectomy". The water absorption, swelling rate, porosity, and Young's modulus of the scaffold were measured, and the morphology and pore size of the scaffold were observed using scanning electron microscopy. The cytotoxicity of the S53P4/PCL scaffolds was detected using the CCK8 assay, and the in vitro antibacterial activity of the S53P4/PCL scaffolds was detected using the inhibition circle method. The BMP-2-loaded S53P4/PCL scaffolds were prepared using the drop-in lyophilization method and implanted into animal models. The biocompatibility, osteogenic activity, and external auditory canal repair of the scaffolds were observed using endoscopy, micro-CT, and histological examination. RESULTS The S53P4/PCL scaffold was highly compatible with the defective area of the animal model, and its physicochemical properties met the requirements of bone tissue engineering. In vitro experiments showed that the S53P4/PCL scaffold was non-cytotoxic and exhibited better antibacterial activity than the same volume of the S53P4 powder. In vivo experiments showed that the S53P4/PCL scaffold had good biocompatibility and osteogenic activity, and could effectively repair bone defects and reconstruct the normal morphology of the external auditory canal in animal models. Furthermore, its osteogenic activity and repair ability were significantly improved after loading with BMP-2. CONCLUSIONS The 3D printed S53P4/PCL scaffold has great potential for clinical mastoid obliteration and external auditory canal reconstruction.
Collapse
|
15
|
Skarzynski PH, Krol B, Skarzynski H, Cywka KB. Implantation of two generations of Bonebridge after mastoid obliteration with bioactive glass S53P4. Am J Otolaryngol 2022; 43:103601. [PMID: 35981433 DOI: 10.1016/j.amjoto.2022.103601] [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: 12/08/2021] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE After radical surgery for chronic cholesteatoma (CWD mastoidectomy), patients have the option to have the posterior wall of their external auditory canal surgically reconstructed with S53P4 bioactive glass. The procedure eliminates some of the restrictions related to having a postoperative cavity and extends the options for a hearing prosthesis. If classic reconstruction is not possible and a hearing aid is not used, we suggest use of a Bonebridge implant. METHODS This study describes, over 18 months of follow-up, 16 patients after a two-stage surgical procedure: obliteration of the mastoid cavity with bioactive glass followed by Bonebridge implantation. There were 7 patients who received the first generation implant (BCI 601) and 9 who used the second (BCI 602). Before and after implantation, pure tone audiometry, sound field thresholds, and free-field audiometry were performed. Speech reception thresholds in noise were assessed using the Polish Sentence Matrix Test. Subjective assessment of benefits was done using the APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire. RESULTS During the observation period, no serious complications were found. The study demonstrated the safety and validity of the procedures and confirmed the safety of using S53P4 bioactive glass in otosurgery (antibacterial effect, nonrecurrence of cholesteatoma, and no effect on the inner ear). The audiological benefits expected from using the Bonebridge implant processor were also confirmed. CONCLUSION It is concluded that, after reconstructing the posterior wall of the external auditory canal with bioactive glass, two-stage implantation of a Bonebridge implant in a typical site is a safe solution for patients who have difficult anatomical conditions following their CWD mastoidectomy.
Collapse
Affiliation(s)
- Piotr H Skarzynski
- Teleaudiology and Screening Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland; Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland; Institute of Sensory Organs, Kajetany, Warsaw, Poland.
| | - Bartlomiej Krol
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland
| | - Henryk Skarzynski
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland
| | - Katarzyna B Cywka
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland
| |
Collapse
|
16
|
Cherdantseva DD, Vakhrushev SG, Toropova LA. [Mastoid obliteration during last 5 years]. Vestn Otorinolaringol 2022; 87:55-60. [PMID: 36580510 DOI: 10.17116/otorino20228706155] [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: 12/30/2022]
Abstract
The article presents modern approaches to mastoid obliteration in cases of chronic purulent otitis media with cholesteatoma, published in peer-reviewed russian and foreign journals from 2017 to 2021. The review tells us about effect of mastoid cavity obliteration on reducing the recurrence of cholesteatoma, improving the quality of life of patients according to the results of international questionnaires and the effect of surgery on hearing in the long-term postoperative period. An analysis of the use of autologous and biocompatible materials in middle ear surgery is presented. Their safety and ease of use during surgical intervention were evaluated.
Collapse
Affiliation(s)
- D D Cherdantseva
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - S G Vakhrushev
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - L A Toropova
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| |
Collapse
|
17
|
Mastoid obliteration and canal wall reconstruction with posterior auricular artery (PAA) fascia-periosteum flap. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otorri.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
18
|
Faramarzi M, Kaboodkhani R, Faramarzi A, Roosta S, Erfanizadeh M, Hosseinialhashemi M. Mastoid obliteration and external auditory canal reconstruction with silicone block in canal wall down mastoidectomy. Laryngoscope Investig Otolaryngol 2021; 6:1188-1195. [PMID: 34693003 PMCID: PMC8513454 DOI: 10.1002/lio2.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/19/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To prevent cavity problems in canal wall down mastoidectomy, silicone block for mastoid obliteration was used. METHODS In this retrospective cohort study, 39 patients (21 males and 18 females) underwent canal wall down mastoidectomy and mastoid obliteration using silicone block. We evaluated the postoperative outcome, the time until epithelialization of the cavity, graft success rate, and the hearing outcome. RESULTS The time until complete epithelialization of the mastoid cavity was 35.5 ± 5.4 days. We had a graft success rate of 100% during the follow-ups. The postoperative evaluation revealed 36 dry ears (92.3%) patients without any cavity problems. However, one ear developed granulation tissue, and two ears had partially exposed silicone block, which required revision mastoidectomy. Regarding hearing outcomes, a complication such as deaf ear was not reported. CONCLUSION Silicone block is safe and suitable for mastoid obliteration and external auditory canal reconstruction in canal wall down mastoidectomy. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Mohammad Faramarzi
- Department of Otorhinolaryngology – Head & Neck surgeryShiraz University of Medical SciencesShirazIran
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Reza Kaboodkhani
- Department of Otorhinolaryngology – Head & Neck surgeryShiraz University of Medical SciencesShirazIran
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Ali Faramarzi
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Sareh Roosta
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Mohammadjavad Erfanizadeh
- Department of Otorhinolaryngology – Head & Neck surgeryShiraz University of Medical SciencesShirazIran
| | - Milad Hosseinialhashemi
- Department of Otorhinolaryngology – Head & Neck surgeryShiraz University of Medical SciencesShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| |
Collapse
|
19
|
Fieux M, Tournegros R, Zaouche S, Tringali S. Bioactive glass in canal wall reconstruction tympanoplasty. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 139:293-296. [PMID: 34535425 DOI: 10.1016/j.anorl.2021.09.001] [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: 11/16/2022]
Abstract
The purpose of this Technical Note is to describe the surgical technique to transform canal wall down tympanoplasty into canal wall up tympanoplasty, that is, to rehabilitate a recess cavity by filling the mastoid and epitympanic cavities with synthetic tissue (bioactive glass) and recreating a normal-caliber external auditory canal. Mastoid cavity obliteration leads to a clinically significant improvement in health-related quality of life without increasing risk of recurrent or residual cholesteatoma, conditional upon technically impeccable surgery.
Collapse
Affiliation(s)
- M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France.
| | - R Tournegros
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France
| | - S Zaouche
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France
| | - S Tringali
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France
| |
Collapse
|
20
|
Bächinger D, Großmann W, Mlynski R, Weiss NM. Characteristics of health-related quality of life in different types of chronic middle ear disease. Eur Arch Otorhinolaryngol 2020; 278:3795-3800. [PMID: 33242111 DOI: 10.1007/s00405-020-06487-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Different types of chronic middle ear disease (CMED) present with differing severity of single symptoms, such as discharge, vertigo or hearing loss, which impair health-related quality of life (HRQoL). Here, we aimed to (i) investigate characteristics of HRQoL and (ii) evaluate the association between HRQoL and hearing among different types of CMED. METHODS In this prospective longitudinal cohort study, we included adult patients undergoing surgical treatment for CMED. Primary outcomes included HRQoL assessed by the Zurich Chronic Middle Ear Inventory (ZCMEI-21) and hearing assessed by pure-tone audiometry. RESULTS In the included 108 patients (51% females), CMED were chronic otitis media (COM) with (n = 46) or without (n = 22) cholesteatoma, persistent mastoid cavity (with [n = 15] or without [n = 10] recurrent cholesteatoma), revision ossiculoplasty for hearing restoration (n = 14), and postinflammatory meatal fibrosis (n = 1). Preoperatively, the mean ZCMEI-21 score showed statistically significant differences among different types of CMED (p = 0.007) with persistent mastoid cavity without cholesteatoma exhibiting the highest score (34.1, SD 7.7) indicating poor HRQoL. At a mean follow-up period of 183 days, no statistically significant differences in the ZCMEI-21 scores among different types of CMED were observed (p = 0.67). CONCLUSION This study objectifies differences in HRQoL among different types of CMED. In patients with indication for functional surgery only, e.g., persistent mastoid cavity without cholesteatoma, the worst HRQoL was observed. Yet, in these types of CMED, HRQoL guides decision for treatment. Moreover, differences in HRQoL among different types of CMED were not closely associated with hearing, but largely depended on other symptoms, such as discharge or vertigo.
Collapse
Affiliation(s)
- David Bächinger
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Wilma Großmann
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", University Medical Centre, Doberaner Strasse 137-139, 18057, Rostock, Germany
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", University Medical Centre, Doberaner Strasse 137-139, 18057, Rostock, Germany
| | - Nora M Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", University Medical Centre, Doberaner Strasse 137-139, 18057, Rostock, Germany.
| |
Collapse
|
21
|
Impact of depressive disorders on quality of life after middle ear surgery in patients with chronic otitis media. Eur Arch Otorhinolaryngol 2020; 278:3217-3225. [PMID: 33011956 PMCID: PMC8328900 DOI: 10.1007/s00405-020-06397-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/23/2020] [Indexed: 01/31/2023]
Abstract
Purpose The aim of this study was to determine whether preoperative depressive symptoms influence health-related quality of life (HRQOL) after middle ear surgery in patients with chronic otitis media (COM). Methods This prospective clinical case study was conducted at a tertiary referral center. All 102 patients who had undergone middle ear surgery for COM were assessed clinically and by audiometric testing (pure tone audiometry) in pre- and postoperative settings. Disease-specific HRQOL was assessed by the validated chronic otitis media outcome test 15 (COMOT-15) and the Zurich chronic middle ear inventory (ZCMEI-21). General HRQOL was measured using the short form 36 (SF-36). Depressive symptoms were assessed using the patient health questionnaire (PHQ-D). The Charlson comorbidity index (CCI) was used to classify comorbidities. The middle ear status was determined using the ossiculoplasty outcome parameter staging (OOPS) index. Results After middle ear surgery, the total COMOT-15 and ZCMEI-21 scores improved significantly (p < 0.001). General HRQOL (total SF-36 score) was unaffected by surgery (p < 0.05). Patients without elevated depressive symptoms had significantly better total scores for the COMOT-15 (p < 0.01), ZCMEI-21 (p < 0.001), and for SF-36 (p < 0.001) postoperatively. The results of the multiple regression analyses show that, after adjusting for the OOPS, CCI, and hearing improvement, preoperative depressiveness was significantly associated with worse postoperative COMOT-15 and ZCMEI-21 outcome scores (β = 0.425 and β = 0.362, p < 0.001). Conclusion Preoperative depressiveness was an essential predictive factor for HRQOL in patients with COM. This should be considered during patient selection to provide more suitable preoperative counseling.
Collapse
|
22
|
Weiss NM, Bächinger D, Rrahmani A, Bernd HE, Huber A, Mlynski R, Röösli C. Mapping the ChOLE classification to hearing outcomes and disease-specific health-related quality of life. Eur Arch Otorhinolaryngol 2020; 277:2729-2738. [PMID: 32372258 PMCID: PMC7496049 DOI: 10.1007/s00405-020-06002-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/20/2020] [Indexed: 11/25/2022]
Abstract
Objectives To investigate the association between the “ChOLE” classification, hearing outcomes and disease-specific health-related quality of life (HRQoL). Methods In two tertiary referral centers, patients requiring primary or revision surgery for cholesteatoma were assessed for eligibility. Audiometric assessment was performed pre- and postoperatively. The ChOLE classification was determined intraoperatively and via the preoperative CT scan. HRQoL was assessed pre- and postoperatively using the Zurich Chronic Middle Ear Inventory (ZCMEI-21). Results A total of 87 patients (mean age 45.2 years, SD 16.2) were included in this study. ChOLE stage I cholesteatoma was found in 8 (9%), stage II cholesteatoma was found in 65 (75%), and stage III cholesteatoma was found in 14 (16%) patients. Postoperatively, the mean air–bone gap (0.5, 1, 2, 3 kHz) was significantly smaller than before surgery (14.3 dB vs. 23.0 dB; p = 0.0007). The mean ZCMEI-21 total score significantly decreased after surgery (26.8 vs. 20.7, p = 0.004). No correlation between the ZCMEI-21 total score and both the ChOLE stage and the extent of the cholesteatoma (ChOLE subdivision “Ch”) was found. A trend towards worse HRQoL associated with a poorer status of the ossicular chain (ChOLE subdivision “O”) was observed. The audiometric outcomes were not associated with the extent of the cholesteatoma. The ChOLE subdivision describing the ossicular status showed a strong association with the pre- and postoperative air conduction (AC) thresholds. Further, the ZCMEI-21 total score and its hearing subscore correlated with the AC thresholds. Conclusion The ChOLE classification does not show a clear association with HRQoL measured by the ZCMEI-21. The HRQoL neither seems to be associated with the extent of the disease nor with the ossicular chain status. Yet, surgical therapy significantly improved HRQoL by means of reduced ZCMEI-21 total scores, which were strongly associated with the AC thresholds. Intraoperative assessment of a cholesteatoma using the ChOLE classification and HRQoL complement each other and provide useful information.
Collapse
Affiliation(s)
- Nora M Weiss
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery "Otto Körner", Rostock University Medical Center, Doberaner Strasse 137-139, 18057, Rostock, Germany.
| | - David Bächinger
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | | | - Hans E Bernd
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery "Otto Körner", Rostock University Medical Center, Doberaner Strasse 137-139, 18057, Rostock, Germany
| | - Alexander Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Robert Mlynski
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery "Otto Körner", Rostock University Medical Center, Doberaner Strasse 137-139, 18057, Rostock, Germany
| | - Christof Röösli
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| |
Collapse
|