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Iannella G, Pace A, Greco A, De Virgilio A, Croce E, Maniaci A, Lechien JR, Gioacchini FM, Re M, Cammaroto G, Perrone T, Cocuzza S, Magliulo G. Endoscopic ear surgery in the treatment of chronic otitis media with atelectasis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08845-0. [PMID: 39126509 DOI: 10.1007/s00405-024-08845-0] [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: 04/22/2024] [Accepted: 07/12/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE Atelectasis otitis media (AtOM) is a chronic condition where the tympanic membrane (TM) becomes retracted towards the middle ear and the ossicular chain. Surgical treatment for this condition could be indicated based on stage of atelectasis, patient's clinical condition and hearing loss. Over the years, AtOM has been treated with various types of tympanoplasty under microscopic view. The aim of this study is to present the results of endoscopic ear surgery in AtOM. METHODS Forty-five patients who underwent endoscopic trans-canal tympanoplasty were included in the study. Preoperative features, intraoperative findings and postoperative outcomes were collected. RESULTS Preoperatively, none of the study's patients were classified with a Sadè Grade I, whereas grades II, III and IV were 3 (6.6%), 23 (32.1%) and 19 (67.8%) respectively. The 3 patients with Sadè grade II showed a conductive hearing loss higher than 20 dB and a continuous ear fullness, therefore they were surgically treated. The postoperative graft success rate was estimated at 95.5%. During follow-up, 2 patients showed a TM perforation (at 6 and 12 months after surgery) whereas 1 patient experienced a recurrence of atelectasis in the TM (16 months after surgery). The overall success rate at the final follow-up was calculated at 88.8%. The average preoperative air-conduction threshold was 51.1 ± 21.5, which reduced to 34.6 ± 22.1 (p = 0.04) at follow-up. The preoperative air-bone gap decreased from 28 ± 7.2 to 11.8 ± 10 (p = 0.002) after surgery. CONCLUSION Atelectasis otitis media might be suitable for exclusive endoscopic surgical treatment, as it appears to exhibit a low recurrence rate and promising audiological outcomes.
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Affiliation(s)
- Giannicola Iannella
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00183, Rome, Italy.
| | - Annalisa Pace
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00183, Rome, Italy
| | - Antonio Greco
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00183, Rome, Italy
| | - Armando De Virgilio
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00183, Rome, Italy
| | - Enrica Croce
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00183, Rome, Italy
| | | | - Jerome R Lechien
- Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons, Belgium
| | - Federico Maria Gioacchini
- Department of Clinical and Molecular Sciences, ENT Unit, Polytechnic University of Marche, Ancona, Italy
| | - Massimo Re
- Department of Clinical and Molecular Sciences, ENT Unit, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, OtolaryngologyForlì, Italy
| | | | - Salvatore Cocuzza
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Giuseppe Magliulo
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00183, Rome, Italy
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Bhutta MF, Leach AJ, Brennan-Jones CG. Chronic suppurative otitis media. Lancet 2024; 403:2339-2348. [PMID: 38621397 DOI: 10.1016/s0140-6736(24)00259-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/12/2023] [Accepted: 02/08/2024] [Indexed: 04/17/2024]
Abstract
Chronic suppurative otitis media (CSOM) is a leading global cause of potentially preventable hearing loss in children and adults, associated with socioeconomic deprivation. There is an absence of consensus on the definition of CSOM, which complicates efforts for prevention, treatment, and monitoring. CSOM occurs when perforation of the tympanic membrane is associated with severe or persistent inflammation in the middle ear, leading to hearing loss and recurrent or persistent ear discharge (otorrhoea). Cholesteatoma, caused by the inward growth of the squamous epithelium of the tympanic membrane into the middle ear, can also occur. The optimal treatment of discharge in CSOM is topical antibiotics. In resource-limited settings where topical antibiotics might not be available, topical antiseptics are an alternative. For persistent disease, surgery to repair the tympanic membrane or remove cholesteatoma might offer long-term resolution of otorrhoea and potential improvement to hearing. Recent developments in self-fitted air-conduction and bone-conduction hearing aids offer promise as new options for rehabilitation.
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Affiliation(s)
- Mahmood F Bhutta
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, UK; Department of ENT, Royal Sussex County Hospital, Brighton, UK.
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Darwin, NT, Australia
| | - Christopher G Brennan-Jones
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Ear Health Group, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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Ishibashi N, Motegi M, Yamamoto Y, Nakazawa T, Hirabayashi M, Kurihara S, Takahashi M, Yamamoto K, Sakurai Y, Kojima H. Radiological and audiological predictors of stapes destruction in adherent pars tensa. Eur Arch Otorhinolaryngol 2023:10.1007/s00405-023-07873-6. [PMID: 36774407 DOI: 10.1007/s00405-023-07873-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/07/2023] [Indexed: 02/13/2023]
Abstract
PURPOSE Progressive adherent pars tensa occasionally induces ossicular erosion. Specifically, stapes discontinuity adversely affects postoperative hearing. However, this irretrievable sequela is challenging to prove preoperatively, partly because perimatrix inflammation on the pars tensa can obscure the visibility of the ossicles or the partial volume effect of computed tomography (CT) imaging can hamper detailed ossicular visualization. Therefore, there is no consensus regarding the ideal timing for switching from a wait-and-see approach to a surgical one. Herein, we aimed to explore the potential predictors of stapes superstructure destruction in adherent pars tensa. METHODS This retrospective cohort study enrolled consecutive patients who underwent primary tympanoplasty for adherent pars tensa categorized as grade IV on Sadé's grading scale between April 2016 and September 2021. The impact of features on otoscopy and CT and air-bone gap (ABG) on stapes superstructure destruction was assessed using uni- and multivariable logistic regression analyses. RESULTS Sixty-four ears were included. Multivariate analysis revealed the presence of debris on the adherent pars tensa (odds ratio [OR] [95% confidence interval {CI}]): 4.799 [1.063-21.668], p = 0.0415), presence of soft-tissue density occupying the oval window (OR [95% CI]: 13.876 [3.084-62.437], p = 0.0006), and a ≥ 20-dB preoperative ABG at 3 kHz (OR [95% CI]: 7.595 [1.596-36.132], p = 0.0108) as independent predictors for stapes superstructure destruction. CONCLUSION High preoperative awareness of the possibility of destruction of the stapes superstructure would enable the surgeon to make a timely decision to provide surgical intervention before progression to severe stapes destruction, thereby maintaining long-term satisfactory hearing.
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Affiliation(s)
- Naoki Ishibashi
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masaomi Motegi
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Yutaka Yamamoto
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takara Nakazawa
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Motoki Hirabayashi
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Sho Kurihara
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masahiro Takahashi
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kazuhisa Yamamoto
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yuika Sakurai
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Kassem F, Dagan O, Biadsee A, Masalha M, Nachmani A, Nageris B, Lee DJ, Ungar OJ, Handzel O. Possible clinical implications of the structural variations between the tympanic membrane quadrants. Laryngoscope Investig Otolaryngol 2022; 7:1164-1170. [PMID: 36000041 PMCID: PMC9392409 DOI: 10.1002/lio2.861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/17/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Retraction pockets and marginal perforations of the pars tensa of the tympanic membrane (TM) are most commonly found at superior posterior quadrant (SPQ). The patulous Eustachian tube tends to manifest in the same quadrant. Variation in the structure of the TM may explain these observations. Material and Methods A line defined by the manubrium was used to divide the pars tensa into anterior and posterior portions. A transverse line centered on the umbo divides the pars tensa into superior and inferior parts, resulting in four quadrants. Surface areas of each of the TM quadrants were measured in a sample of 23 human adult formalin-fixed temporal bones. The TMs were completely excised, faced medially, and placed against graph paper to maintain scale measurements, photoed, and measured.TM thickness was measured on a different set of 20 human temporal bones (TB) preparations with normal external and middle ears. Four random loci were chosen from each pars tensa's TM quadrant. The thickness was measured using high-magnification power microscopy. Results The SPQ was the largest and thinnest of the four quadrants. It occupies 31% of the pars tensa area. It is 69 μm as compared to approximately 85 μm in the other quadrants. The radial lines between the umbo and the annulus are in descending order from superior posterior toward the anterior-superior radials. Conclusion The SPQ has the largest vibratory area and is the thinnest of the four TM quadrants. Variation in the thickness of the middle, fibrous layer accounts for the variation in the thickness of the TM. These findings may explain the tendency of pathologies related to Eustachian tube dysfunction to preferentially manifest in or originate from the SPQ. Level of evidence 5
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Affiliation(s)
- Firas Kassem
- Department of Otolaryngology‐Head and Neck SurgeryMeir Medical CenterKfar SabaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Or Dagan
- Department of DermatologySoroka Medical Center, Ben‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Ameen Biadsee
- Department of Otolaryngology‐Head and Neck SurgeryMeir Medical CenterKfar SabaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Department of Otolaryngology‐Head & Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Muhamed Masalha
- Department of Otolaryngology‐Head and Neck SurgeryEmek Medical CenterAfulaIsrael
- The Ruth and Bruce Rappaport Faculty of Medicinethe Technion Institute of TechnologyHaifaIsrael
| | - Ariela Nachmani
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Communication Disorders FacultyHadassah Academic CollegeJerusalemIsrael
| | - Ben Nageris
- Department of Otolaryngology‐Head and Neck SurgeryMeir Medical CenterKfar SabaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Department of communication DisordersSackler faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Daniel J. Lee
- Department of Otolaryngology, Massachusetts Eye and Ear InfirmaryHarvard Medical SchoolBostonMassachusettsUSA
| | - Omer J. Ungar
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Department of Otolaryngology, Head, Neck and Maxillofacial SurgeryTel‐Aviv Sourasky Medical CenterTel‐AvivIsrael
| | - Ophir Handzel
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Department of Otolaryngology, Head, Neck and Maxillofacial SurgeryTel‐Aviv Sourasky Medical CenterTel‐AvivIsrael
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