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Phanbuh DS, Meher R, Singh I, Taneja HC, Wadhwa V, Kumar J. Endoscopic Assessment of Cholesteatoma Following Microscope Assisted Tympano: Mastoidectomy: Study design: a cross section descriptive study. Indian J Otolaryngol Head Neck Surg 2024; 76:726-733. [PMID: 38440500 PMCID: PMC10908918 DOI: 10.1007/s12070-023-04263-6] [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: 06/27/2023] [Accepted: 10/04/2023] [Indexed: 03/06/2024] Open
Abstract
Complete surgical removal of cholesteatoma has been traditionally performed by microscopic approaches. In recent years, use of endoscopes in middle ear surgery is gaining increasing importance. The wide field view offered by the endoscopes in comparison to the narrow field of view of the binocular microscope enables a surgeon to see and dissect around corners, thereby exposing 'hidden recesses' of the middle ear which can be useful during cholesteatoma surgery. To identify remnant cholesteatoma in difficult access sites of the middle ear cleft using endoscopes following a microscope assisted mastoidectomy. A cross sectional study was conducted in patients who were clinically diagnosed with cholesteatoma. Patients were subjected to High Resolution Computed Tomography of the temporal bone and pre-operative audiological tests. Mastoid exploration was performed microscopically followed by endoscopic evaluation and clearance of disease in the same setting. Patients were then followed up post-operative and endoscopically evaluated to look for any remnant disease. A total of 45 patients were included, all of which underwent microscopic assisted mastoidectomy. Remnant cholesteatoma was discovered in 15 out of 45 cases (33%) distributed in the hidden areas; in the region of sinus tympani 9(60%), anterior epitympanum 4(27%), hypotympanum 1(7%) and tip Cells 1(7%). It can be concluded that endoscopes have a definite role in evaluation and complete surgical clearance of cholesteatoma particularly from the hidden areas of middle ear cleft which would have otherwise been missed by the straight line view of a microscope thereby grossly reducing the rate of remnant disease. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04263-6.
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Affiliation(s)
- Daphylla Shisha Phanbuh
- Department of Otorhinolaryngology, Maulana Azad Medical College and Lok Nayak Hospital, LNJP Colony, New Delhi, Delhi 110002 India
| | - Ravi Meher
- Department of Otorhinolaryngology, Maulana Azad Medical College and Lok Nayak Hospital, LNJP Colony, New Delhi, Delhi 110002 India
| | - Ishwar Singh
- Department of Otorhinolaryngology, Maulana Azad Medical College and Lok Nayak Hospital, LNJP Colony, New Delhi, Delhi 110002 India
| | - Harish Chandra Taneja
- Department of Otorhinolaryngology, Maulana Azad Medical College and Lok Nayak Hospital, LNJP Colony, New Delhi, Delhi 110002 India
| | - Vikram Wadhwa
- Department of Otorhinolaryngology, Maulana Azad Medical College and Lok Nayak Hospital, LNJP Colony, New Delhi, Delhi 110002 India
| | - Jyoti Kumar
- Department of Radiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Fermi M, Bassano E, Villari D, Capriotti V, Calvaruso F, Bonali M, Alicandri-Ciufelli M, Marchioni D, Presutti L. Prognostic role of EAONO/JOS, STAMCO, and ChOLE Staging for Exclusive Endoscopic and Endoscopic-Microscopic Tympanoplasty. Otolaryngol Head Neck Surg 2023; 168:829-838. [PMID: 36939615 DOI: 10.1002/ohn.171] [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: 07/25/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate cholesteatoma's surgical outcomes in patients treated with endoscopic ear surgery (EES) or a combined endoscopic-microscopic approach (cEMA) according to STAM, STAMCO, ChOLE, and EAONO/JOS system (EJS) classifications and staging. STUDY DESIGN Retrospective study. SETTING Monocentric study in a tertiary referral center. METHODS One-hundred sixty-eight patients who underwent EES or cEMA for cholesteatoma between 2010 and 2018 were classified according to the abovementioned classification and staging. Data on cholesteatoma's recurrence and residual rates were collected. Inferential statistical analysis was performed to evaluate surgical outcomes and the prognostic value of classifications and staging. RESULTS The recurrence rate was significantly lower in cholesteatomas classified in EJS stage 1 (2.6%) and STAM stage 1 (0%). A comparison of the different stages of the disease showed a significantly lower recurrence only for stage 1 versus the superior stages of both classifications. Involvement of mastoid bone was associated with a higher risk of recurrence (odds ratio [OR]: 4.12; p = .031). Attical involvement was associated with a higher risk of residual cholesteatoma (OR: 1.165; p = .046). CONCLUSION EES or cEMA represents an effective treatment for middle ear cholesteatoma. The STAM classification and the EJS have shown a prognostic value, with STAM 1 and EAONO-JOS 1 stages associated with a better prognosis. Mastoid involvement represents a risk factor for recurrence. Attic localization is associated with residual disease. Localization at difficult access sites did not implicate a higher risk for recurrence or residual. ChOLE classification, Ossicular chain status, and complication status did not provide prognostic information regarding recurrence or residual cholesteatoma.
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Affiliation(s)
- Matteo Fermi
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Edoardo Bassano
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Domenico Villari
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Vincenzo Capriotti
- Otorhinolaryngology and Head and Neck Surgery Unit, ASST Bergamo Ovest, Treviglio-Caravaggio Hospital, Treviglio, Italy
| | - Federico Calvaruso
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Marco Bonali
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | | | - Daniele Marchioni
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
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Samadhiya M, Agarwal H, Vaidya S, Sharma JK. Outcome of Canal Wall Down Mastoidectomy: A Retrospective Review. Indian J Otolaryngol Head Neck Surg 2022; 74:21-25. [PMID: 36032919 PMCID: PMC9411466 DOI: 10.1007/s12070-019-01778-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 12/24/2019] [Indexed: 11/24/2022] Open
Abstract
A canal wall down mastoidectomy (CWDM) is an effective technique for eradication of chronic suppurative otitis media (atticoantral disease) or cholesteatomas. A retrospective study was conducted at R.D. Gardi Medical college between 2015 and 2017 to evaluate the outcome of CWDM for patients with atticoantral type of CSOM. All new cases of MRM/RM which fulfilled the selection criteria were reviewed. The main outcome measures were the hearing outcome and status of dry ear postoperatively. 60 patients of CWDM (32 male, 28 female) were included for analysis. All patients in our study were between 7 and 52 years with mean age 28.38 years. The ossicular chain was eroded in all the cases. Improvement in Air-Bone-Gap was seen in 11 (18.33%), no change in 38 (63.33%) and 11 (18.33%) had deteriorated. In post operative outcome study of our 60 patients, 76.66% of the patients had dry healed cavity and non healed cavity was found to be in 23.33% of the patients. On analysis of data and comparison with other studies it was found that there are three important factors which influence hearing results and the outcome of surgery-status of ossicular chain, presence or absence of cholesteatoma, recurrence or residual disease.
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Baudouin R, Simon F, Levy R, Leboulanger N, Couloigner V, Garabedian EN, Denoyelle F. How Imaging Can Help Surgeons Prepare for Second-Look Cholesteatoma Surgery in Children. JAMA Otolaryngol Head Neck Surg 2022; 148:279-281. [PMID: 35024774 PMCID: PMC8759025 DOI: 10.1001/jamaoto.2021.3785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Robin Baudouin
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
| | - François Simon
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
| | - Raphaël Levy
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
| | - Nicolas Leboulanger
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
| | - Vincent Couloigner
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
| | - Erea-Noël Garabedian
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
| | - Françoise Denoyelle
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, Administration Publique des Hôpitaux de Paris, Centre - Université Paris, F-75015 Paris, France
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Bu DD, Schwam ZG, Kaul VF, Wong K, Fan C, Wanna GB, Cosetti MK, Perez E. Cost-effectiveness of Canal Wall-Up vs Canal Wall-Down Mastoidectomy: A Modeling Study. Otolaryngol Head Neck Surg 2022; 167:552-559. [PMID: 35133895 DOI: 10.1177/01945998221076051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the relative lifetime costs, benefits, and cost-effectiveness between the 2 approaches, canal wall-up (CWU) and canal wall-down (CWD) tympanomastoidectomy, used in the treatment of cholesteatomas. STUDY DESIGN Markov state transition model. SETTING Tertiary academic health system. METHODS A Markov state transition model was used to simulate outcomes across the patient lifetime. Outcome and complication probabilities were obtained from the existing literature. Costs were calculated from the payer perspective, with procedure, hospital, clinic, and physician cost derived from Medicare reimbursement. Quality-adjusted life years (QALYs) were used to represent effectiveness and utility. One-way and probability sensitivity analyses (PSAs) were conducted. RESULTS The base case analysis, assuming a 40-year-old patient, yielded a lifetime cost of $14,214 for a patient treated with the CWU approach assuming second-look surgery and $22,290 with a CWD approach. CWU and CWD generated a benefit of 17.11 and 17.30 QALYs, respectively. The incremental cost-effectiveness ratio for CWU was $43,237 per QALY. The Monte Carlo PSA validated the base case scenario. Using a standard $50,000 willingness-to-pay threshold, CWD was the more cost-effective approach and was selected 54.8% of the time by the simulation. CONCLUSION Both CWU and CWD were found to be cost-effective, with CWD being cost-effective 54.8% of the time at a WTP threshold of $50,000. The assumptions used in the analysis were validated by the results of 1-way and PSA.
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Affiliation(s)
- Daniel D Bu
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Zachary G Schwam
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Vivian F Kaul
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Kevin Wong
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Caleb Fan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - George B Wanna
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Maura K Cosetti
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Enrique Perez
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
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Nguyen DVA, Girerd C, Boyer Q, Rougeot P, Lehmann O, Tavernier L, Szewczyk J, Rabenorosoa K. A Hybrid Concentric Tube Robot for Cholesteatoma Laser Surgery. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2021.3128685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mocanu H, Mocanu AI, Coadă G, Bonciu A, Schipor MA, Rădulescu M. Analysis of long‑term anatomic results of radical mastoidectomy. Exp Ther Med 2021; 23:156. [PMID: 35069837 PMCID: PMC8753967 DOI: 10.3892/etm.2021.11079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
A long-term, retrospective, non-controlled study was performed on the drainage results of mastoidectomy (both radical and modified radical) and the relevant statistical factors that could influence the anatomic outcome were defined. The present study took into consideration the same cohort of 200 patients we have communicated with before in our previous studies concerning the long-term functional results of mastoidectomy and long-term results of ossicular replacement with biovitroceramic prosthesis. The patients were clinically followed for the same period of 8.12 years. The drainage (anatomic) results, similar to previously published functional results, were defined by analytical function of the severity and the period of evolution of disease. The main goal was to define the situations and factors (presence of complications, type of disease, type of tympanic perforation or status of ossicular chain) that influenced the drainage results that could provide us with some type of anatomical prognosis. The follow-up started at the moment of complete epithelization for each cavity as time represents the main study comparison criteria. Drainage failure was assessed by the number of otorrhea episodes. It was concluded that practically and ideally, a maximum of 84% of the mastoid and petrous cells can be cleaned out. The results of 78% drainage success are congruent to this theory. The remaining 16% of cells may contain irreversible lesions.
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Affiliation(s)
- Horia Mocanu
- Department of ENT and HNS, Faculty of Medicine, ‘Titu Maiorescu’ University, 031593 Bucharest, Romania
| | - Adela-Ioana Mocanu
- Department of ENT and HNS, Polimed Medical Center, 040067 Bucharest, Romania
| | - Gabriella Coadă
- Department of ENT and HNS, ‘Sf. Maria’ Clinical Hospital, 011172 Bucharest, Romania
| | - Alexandru Bonciu
- Department of ENT and HNS, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Mihai-Adrian Schipor
- Technical University of Munich, Institute of Astronomical and Physical Geodesy, D-80333 Munich, Germany
| | - Marian Rădulescu
- Department of ENT and HNS, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Pchelenok EV, Tarasova OY, Kosyakov SY. New classification of EAONO/JOS cholesteatoma and SAMEO-ATO middle ear surgery: relevance and clinical significance. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.12.201236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Middle ear cholesteatoma (MEC) is a common problem of modern otology. The European Academy of Otology and Neurootology in cooperation with the Japanese Otological Society (EAONO/JOS) published consensus recommendations on the definition, classification and stages of MEC in 2017. In 2018, the classification of middle ear surgery was presented under the auspices of the International Otology Outcome Group. The leading problem of MEC surgery remains the high recurrence rate, which ranges from 5 to 32% depending on the type of surgical intervention. The main purpose of this article is to describe the new EAONO/JOS classification of MEC and SAMEO-ATO middle ear surgical interventions with an analysis of their possible clinical significance in determining the risk of cholesteatoma recurrence as well as the prognosis for hearing recovery after surgery.
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Fourez AL, Akkari M, Gascou G, Lefevre PH, Duflos C, Kaderbay A, Mondain M, Venail F. Optimal Duration of MRI Follow-up to Safely Identify Middle Ear Residual Cholesteatoma. AJNR Am J Neuroradiol 2021; 42:1313-1319. [PMID: 33858822 DOI: 10.3174/ajnr.a7116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/15/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have demonstrated the usefulness of non-EPI DWI for detection of residual cholesteatoma. However, limited data are available to determine the suitable duration of imaging follow-up after a first MR imaging with normal findings has been obtained. The present study aimed to determine the optimal duration of non-EPI DWI follow-up for residual cholesteatoma. MATERIALS AND METHODS A retrospective, monocentric study was performed between 2013 and 2019 and included all participants followed up after canal wall up tympanoplasty with at least 2 non-EPI DWI examinations performed on the same 1.5T MR imaging scanner. MR images were reviewed independently by 2 radiologists. Sensitivity and specificity values were calculated as a function of time after the operation. Receiver operating characteristic curves were analyzed to determine the optimal follow-up duration. RESULTS We analyzed 47 MRIs from 17 participants. At the end of the individual follow-up period, a residual cholesteatoma had been found in 41.1% of cases. The follow-up duration ranged from 20 to 198 months (mean, 65.9 [SD, 43.9] months). Participants underwent between 2 and 5 non-EPI DWI examinations. Analyses of the receiver operating characteristic curves revealed that the optimal diagnostic value of non-EPI DWI occurred 56 months after the operation when the first MR imaging performed a mean of 17.3 (SD, 6.8) months after the operation had normal findings (sensitivity = 0.71; specificity = 0.7, Youden index = 0.43). CONCLUSIONS Repeat non-EPI DWI is required to detect slow-growing middle ear residual cholesteatomas. We, therefore, recommend performing non-EPI DWI for at least the first 5 years after the initial operation.
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Affiliation(s)
- A-L Fourez
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
| | - M Akkari
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
| | - G Gascou
- Neuroradiology (G.G., P.-H.L.), University Hospital Gui de Chauliac
| | - P-H Lefevre
- Neuroradiology (G.G., P.-H.L.), University Hospital Gui de Chauliac
| | - C Duflos
- Department of Medical Information and Biostatistics (C.D.), University Hospital La Colombière, University of Montpellier, Montpellier, France
| | - A Kaderbay
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
| | - M Mondain
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
| | - F Venail
- From the Departments of ENT and Head and Neck Surgery (A.-L.F., M.A., A.K., M.M., F.V.)
- Institute for Neurosciences de Montpellier (F.V.), Institut National de la Santé et de la Recherche Médicale U1051 and University of Montpellier, Montpellier, France
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New Compartmental Reading Method for MRI Enables Accurate Localization of Cholesteatomas With High Sensitivity and Specificity. Otol Neurotol 2021; 42:431-437. [PMID: 33555752 DOI: 10.1097/mao.0000000000002999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cholesteatoma is an inflammatory disease, frequently observed in childrens and young adults, with a risk of relapse or recurrence. The few studies which analyzed cholesteatoma localization on magnetic resonance imaging (MRI) usually merged CT-MR images or relied on their authors' anatomical knowledge. We propose a compartmental reading method of the compartments of the middle ear cavity for an accurate localization of cholesteatomas on MR images alone. MATERIAL AND METHODS Our method uses easily recognizable anatomical landmarks, seen on both computed tomography (CT) and MRI, to delimit the middle ear compartments (epitympanum, mesotympanum, hypotympanum, retrotympanum, protympanum, antrum-mastoid cavity). We first tested it on 50 patients on non-enhanced temporal bone CT. Then, we evaluated its performances for the localization of cholesteatomas on MRI, compared with surgery on 31 patients (validation cohort). RESULTS The selected anatomical landmarks that delimited the middle ear compartments were applicable in 98 to 100% of the cases. In the validation cohort, we were able to accurately localize the cholesteatoma on MRI in 83% of the cases (n = 26) with high sensitivity (95.7%) and specificity (98.6%). CONCLUSION With our compartmental reading method, based on the recognition of well-known anatomical landmarks to differentiate the compartments of the middle ear cavity on MRI, we were able to accurately localize the cholesteatoma with high (>90%) sensitivity and specificity. Such landmarks are widely applicable and only require limited learning time based on key images. Accurate localization of the cholesteatoma is useful for the choice of surgical approach.
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11
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Müller M, Honegger F, Podvinec M, Metternich F, Gürtler N. Silastic sheeting in staged ear surgery: Is there still a role for this procedure? Eur Arch Otorhinolaryngol 2021; 279:1203-1210. [PMID: 33760955 DOI: 10.1007/s00405-021-06744-2] [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: 08/27/2020] [Accepted: 03/09/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To review long-term outcomes for chronic otitis media with and without cholesteatoma in staged canal-wall-up tympanoplasty with temporary silastic sheeting and to compare hearing and recurrence results with the literature. METHODS Retrospective data analysis of all patients suffering from chronic otitis media with or without cholesteatoma (COMC/COM) and treated by staged canal-wall-up (CWU) technique with silastic insertion between 1992 and 2012. Literature analysis in PubMed 1990-2017. RESULTS 74 cases were included in the analysis. In COMC (n = 47) a total of 2 (4%) recurrent and 14 (30%) residual cholesteatoma were documented. The postoperative hearing test showed a pure-tone-average (PTA) of 36 dB hearing level (HL) and an air-bone-gap (ABG) of 21 dB HL. A significant improvement was only observed for stage I disease (PTA 8 dB HL and ABG 9 dB HL). In COM (n = 27) postoperative PTA and ABG were significantly improved by 33 dB HL and 23 dB HL, respectively. Mean postoperative follow-up was 47 months (12-173) for COMC and 22 months (2-120) for COM. CONCLUSIONS The cholesteatoma recurrence rate in this study reflects contemporary published rates. Assessment of hearing outcome is difficult due to the low number of cases and very high heterogeneity of published data. Still, the staged CWU procedure with temporary silastic sheeting seems to bear some advantages in regard to hearing. The role of additional factors such as Eustachian Tube function to assess outcome should be considered. An internationally agreed upon reporting system should be followed, if various surgical approaches are to be compared. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Martin Müller
- Hals-Nasen-Ohrenklinik Kantonsspital Aarau, Klinik Für Hals- und Gesichtschirurgie, Aarau, Switzerland
| | - Flurin Honegger
- Hals-Nasen-Ohren-Universitätsklinik, University Hospital Basel, University Basel, Basel, Switzerland
| | | | - Frank Metternich
- Hals-Nasen-Ohrenklinik Kantonsspital Aarau, Klinik Für Hals- und Gesichtschirurgie, Aarau, Switzerland
| | - Nicolas Gürtler
- Hals-Nasen-Ohren-Universitätsklinik, University Hospital Basel, University Basel, Basel, Switzerland.
- Hals-Nasen-Ohren-Klinik, Universitätskinderspital Beider Basel, 4031, Basel, Switzerland.
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Hermann R, Blanc J, Fieux M, Desternes G, Coudert A, Truy E. Multi-operated cholesteatoma: when two surgeries are not enough. Eur Arch Otorhinolaryngol 2020; 278:665-673. [PMID: 32535859 DOI: 10.1007/s00405-020-06104-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/03/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Most studies regarding residual and recurrent cholesteatoma focus on single relapse. This study examines patients who had to undergo at least three surgeries for complete eradication of their cholesteatoma, with the aim of bringing to light risk factors and assessing the functional impact of multiple surgeries on hearing. METHOD We include 27 patients who underwent 3 consecutive surgeries for cholesteatoma between 2006 and 2016. This population represented 3.1% of all cholesteatoma operated on during that same period (868 patients). RESULTS Cases of multi-residual and/or recurrent cholesteatoma (RRC) were significantly younger (13.1 years old), than single-RRC or cases with No-RRC (respectively, 28.0 and 38.5 years old) (p < 0.01). Furthermore, there was a significant difference in cholesteatoma location especially for combined attical and mesotympanic location between the three groups (no-RCC 26%; single-RRC 34% and multi-RRC 66%) (p < 0.01). There was also a significant difference in ossicular erosion of the malleus, incus and stapes between the three groups (p < 0.01). In our study, the type of surgery did not influence multi-RRC rates. We did not observe any significant impact on hearing between the first and third surgeries. Mean duration between the first and second surgeries was significantly shorter for multi-RRC (14.5 months SD 8.3) than for single-RRC (23.3 months SD 18.1) (p < 0.05). CONCLUSION Special care should be given in case of combined attical and mesotympanic extension, ossicular erosion and young children. Delaying the realization of MRI, and/or of second-look surgery, could decrease the risk of multi-RRC.
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Affiliation(s)
- Ruben Hermann
- ENT and Cervico-Facial Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France. .,University Claude Bernard Lyon 1, Lyon, France.
| | - Jacques Blanc
- Department of Otolaryngology-Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Maxime Fieux
- University Claude Bernard Lyon 1, Lyon, France.,Department of Otology and Otoneurology, Lyon Sud Hospital, Hospice Civils de Lyon, Lyon, France
| | - Gauvain Desternes
- ENT and Cervico-Facial Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Aurélie Coudert
- ENT and Cervico-Facial Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Eric Truy
- ENT and Cervico-Facial Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,University Claude Bernard Lyon 1, Lyon, France
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Ardıç FN, Mengi E, Tümkaya F, Kara CO, Bir F. Correlation between Surgical Outcome and Stage of Acquired Middle Ear Cholesteatoma: Revalidation of the EAONO/JOS Staging System. J Int Adv Otol 2020; 16:34-39. [PMID: 32401201 PMCID: PMC7224431 DOI: 10.5152/iao.2020.7598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the intraoperative findings, recurrence rate, and hearing outcome of cholesteatoma surgery and correlate them with the newly proposed EAONO/JOS Joint Consensus Statement. MATERIALS AND METHODS The records of 407 patients diagnosed with chronic otitis media and cholesteatoma between 2009 and 2017 were reviewed. After the exclusion of records with unsatisfactory surgical notes and anamnesis, 353 patients were included in the study. The 290 patients who had undergone primary surgery and 63 who had undergone revision surgery were evaluated separately. RESULTS Total 162 of 290 (56%) patients had retraction pocket cholesteatoma and 128 of 290 (44%) patients had non-retraction pocket cholesteatoma. Eighty (28%) patients had stage I, 114 (39%) had stage II, 91 (31%) had stage III, and 5 (2%) had stage VI disease. The recurrence rate was 6.9% (20/290). The average age of these patients at the time of the second operation was 23.31±10.3 years. Twelve patients had (60%) recurrent cholesteatoma, and eight (40%) had residual cholesteatoma. Hearing outcome and surgical technique were significantly associated with the disease stage; however, the recurrence rate showed no such association. CONCLUSION We concluded that the EAONO/JOS staging system is beneficial for estimating the postoperative hearing results and planning the surgical technique. However, there was no significant relationship between the recurrence rate and the EAONO/JOS staging system. We believe that additional factors, such as infection, ossicles, and invasion, predict the recurrence. Widespread use of the EAONO/JOS staging system will enable better evaluation of surgical outcomes and prognosis.
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Affiliation(s)
- Fazıl Necdet Ardıç
- Department of Otolaryngology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Erdem Mengi
- Department of Otolaryngology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Funda Tümkaya
- Department of Otolaryngology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Cüneyt Orhan Kara
- Department of Otolaryngology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Ferda Bir
- Department of Pathology, Pamukkale University School of Medicine, Denizli, Turkey
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El-Anwar MW, Eldib DB, Elmalt A, Khazbak AO. Supratubal recess and sinus tympani: CT analysis of middle ear hidden areas. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0056-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
High-resolution computed tomography (HRCT) magnifies the role of preoperative imaging for detailed middle ear anatomy particularly its hidden area. The purpose of the current study was to assess the sinus tympani (ST) and supratubal recess (STR) by HRCT, to create CT classification of the STR depth, and to study the relationship between ST types and the new STR grades.
Results
In HRCT of non-pathological temporal bones of 100 subjects (200 ears), measurements of the STR and ST were calculated, registered, and analyzed. The depth of the STR was classified into grade 1 with depth less than 3 mm, grade 2 with depth ranged between 3 and 5 mm, and grade 3 with depth more than 5 mm. The mean STR length, width, and height were 4.17 ± 0.86, 3.55 ± 0.65, and 3.64 ± 0.7 mm, respectively, while the ST mean length and width of were 2.52 ± 0.5 and 1.82 ± 0.78 mm, respectively, without significant differences between either sexes or sided. The ST types were found to be type A in 56 ears (28%), type B in 142 ears (71%), and type C in 2 ears (1%). The STR grading was grade 1 in 12 ears (6%), grade 2 in 160 ears (80%), and grade 3 in 28 ears (14%) without significant relationship between ST types and STR grading (P = 0.3).
Conclusion
The current study provided reliable and applicable methods of CT assessment of STR and ST that can help to predict the degree of surgical visibility of the ST and STR during ear surgery.
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Rayneau P, Aussedat C, Trinh TT, Bobillier C, Lescanne E, Robier A, Bakhos D. Influence of surgical technique on residual cholesteatoma location and prevalence. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:13-16. [PMID: 31564619 DOI: 10.1016/j.anorl.2019.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Compared to canal wall up (CWU) tympanoplasty, canal wall reconstruction (CWR) allows better visualization of cholesteatoma extension. The canal wall up approach provides good functional outcomes, but with higher rates of residual cholesteatoma. The aim of this study was to compare residual cholesteatoma prevalence and location between the two approaches. METHOD Subjects were adult patients with residual cholesteatoma following CWU or CWR surgery between January 1, 2010 and December 31, 2015. During this period, 94 patients underwent CWU and 71 CWR; 22 presented with residual cholesteatoma: 16 after CWU (R-CWU group) and 6 after CWR (R-CWR group). RESULTS There was no significant inter-group difference in residual cholesteatoma prevalence: 17% after CWU, 8.4% after CWR. Locations comprised: 13 (81%) in the attic, 9 (56%) in the tympanic cavity and 4 (25%) in the mastoid in the R-CWU group, and 6 (100%) in the attic in the R-CWR group. There were significantly fewer tympanic cavity locations after CWR compared to CWU (P=0.046). CONCLUSION Residual cholesteatoma prevalence did not significantly differ between the CWU and CWR approaches. The most frequent location was the attic; significantly more locations were in the tympanic cavity with the CWU approach. These findings are important for surgeons and neuro-radiologists during follow-up.
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Affiliation(s)
- P Rayneau
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France.
| | - C Aussedat
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France
| | - T T Trinh
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France
| | - C Bobillier
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France
| | - E Lescanne
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France; UMR-S930, université François-Rabelais de Tours, CHRU de Tours, Tours, France
| | - A Robier
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France; UMR-S930, université François-Rabelais de Tours, CHRU de Tours, Tours, France
| | - D Bakhos
- Service ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnelé, 37044 Tours, France; UMR-S930, université François-Rabelais de Tours, CHRU de Tours, Tours, France
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16
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Anatomical and frequencies-specific hearing results of retrograde mastoidectomy. Am J Otolaryngol 2019; 40:372-376. [PMID: 30885447 DOI: 10.1016/j.amjoto.2019.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 01/25/2019] [Accepted: 02/18/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this study was to evaluate the long-term anatomical and frequency-specific hearing results of canal wall down (CWD) and canal wall up (CWU) mastoidectomy by retrograde mastoidectomy (RM) surgical method. MATERIALS AND METHODS Patients underwent CWU and CWD procedures with method of RM, 53 and 59 patients between January 2010 and June 2015 were evaluated retrospectively. The pre- and post-operative pure tone average air-bone gap (ABG) values of these patients were recorded in detail at 0.5, 1, 2 and 4 kHz. Pre and post-operative ABG were evaluated in detail in each group in each frequency. In addition, at least two years follow-up recurrence rates were evaluated. RESULTS In the CWU method, post-operative ABG decreased significantly at low-frequencies compared to pre-operative ABG (p < 0.05), especially at 2 kHz (p < 0.001). But, auditory improvement was not achieved at 4 kHz. In the CWD procedure, auditory improvement was not achieved both 1 kHz and 4 kHz. CWU and CWD recurrence rates were respectively 9.4% and 10.1%. CONCLUSION Postoperative hearing results of both surgical methods provide good auditory outcome at low-frequencies. This improvement is evident in CWU especially at 2 kHz. This may be related to the protection of the external ear canal. In both surgical methods of RM, a satisfactory anatomical success was achieved with recurrence rates of around 10%. RM is a good surgical technique alternative to classical canal wall down procedure with both auditory results and low recurrence rates.
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17
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Shapiro S, Bennett D, Wetmore S, Cassis A. Complete Malleus Removal for Cholesteatoma: A Multivariate Analysis of Ossiculoplasty Success and Residual Disease. Ann Otol Rhinol Laryngol 2017; 127:33-38. [PMID: 29171281 DOI: 10.1177/0003489417743519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Scott Shapiro
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Donald Bennett
- West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Stephen Wetmore
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Adam Cassis
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
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18
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Mobashir MK, Basha WM, Mohamed AES, Elmaghawry ME. Posterior canal wall reposition for management of cholesteatoma: Technique and results. Auris Nasus Larynx 2017; 45:254-260. [PMID: 28736098 DOI: 10.1016/j.anl.2017.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/08/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The main goal of surgery in acquired middle ear cholesteatomas is the complete eradication of the disease with an ear free of discharge. This can be performed either by open or closed techniques with their benefits and drawbacks. We present the technique of reposition of the posterior canal wall for the management of cholesteatoma cases and its results and outcome. PATIENTS AND METHODS This study included 31 patients with primary acquired middle ear cholesteatoma. The surgical technique included complete cortical mastoidectomy, wide posterior tympanotomy, dividing the bony posterior meatal wall with a micro-sagittal saw and its removal, dissection and eradication of cholesteatoma, and repositioning the canal wall segment in its anatomical site. RESULTS No significant intraoperative complication occurred. An injury to the dura occurred in one patient. Damage of the bony posterior canal wall occurred in two patients during saw cutting. Residual cholesteatoma was found in two patients. No dislocation or necrosis of the reconstructed posterior canal wall was noted and the new reconstructed external ear canal appeared to be of near normal size, shape, and contour. CONCLUSION This technique provides optimal surgical exposure and access to areas that are difficult to reach by CWU approach, allows removal of the cholesteatoma without intraoperative complications, decreases the rate of residual cholesteatoma, restores near-normal anatomy of the external auditory canal, and avoids the sequelae of the open mastoid cavity. Therefore, it would be a feasible alternative to the standard CWU and CWD procedures.
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Affiliation(s)
- Mohammad Kamal Mobashir
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Waleed M Basha
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Abd ElRaof Said Mohamed
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Mohammed Elsayed Elmaghawry
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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Intraoperative Bleeding and the Risk of Residual Cholesteatoma: A Multivariate Analysis. Otol Neurotol 2017; 38:529-534. [DOI: 10.1097/mao.0000000000001355] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Endoscopy-Assisted Ear Surgery for Treatment of Chronic Otitis Media With Cholesteatoma, Adhesion, or Retraction Pockets. J Craniofac Surg 2017; 28:1017-1020. [PMID: 28277483 DOI: 10.1097/scs.0000000000003671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The objective of this study was to analyze the results of endoscopy-assisted ear surgery for the treatment of chronic otitis media with cholesteatoma, adhesion, or retraction pockets.Fifty-one patients who underwent oto-endoscopy-assisted canal wall up tympanomastoid surgery and/or limited anterior atticotomy with tympanoplasty for chronic otitis media with cholesteatoma, adhesion, or retraction pocket from 2006 to 2013 have been included in this study. Eradication of the disease from the middle ear and mastoid air cells was achieved by combination of the oto-microscobic and oto-endoscopic approaches. Second look surgery was performed 18 months later from the initial surgery in selected patients. Age, gender, pre-/postoperative otoscopy findings/audiograms, type of the used prostheses, and follow-up time were obtained from the patient's file. Anatomic integrity rates of the tympanic membrane, the mean gains of air bone gap, on pure-tone audiogram at 4 frequencies and existence of the residual disease were reviewed parameters. Functional evaluation was made in patients with intact tympanic membrane.Of the 51 patients, the ratios of the chronic otitis media with cholesteatoma and isolated adhesive otitis or retraction pocket cases were 74.5% (38/51) and 25.5% (13/51), respectively. Ossicular chain reconstruction was made with PORP in 27 patients and TORP in 20 patients, whereas the ossicular chain was intact in 4 patients. Anatomic integrity rates of the tympanic membrane were 90.2% (46/51). The overall (n = 46) pre-/postoperative mean ABG obtained at 4 frequencies were 28.3 ± 12.26 and 9.18 ± 5.68 dB (P < 0.0001) respectively. Residual cholesteatoma rate was 10.5% (34/38) for chronic otitis media with cholesteatoma patients. However, there was no recurrence or new cholesteatoma formation in isolated retraction pockets or adhesive otitis patients.Oto-endoscopic eradication of the cholesteatoma or epithelial tissue from hidden area after the all visible cholesteatoma removal by oto-microscope improves the quality of surgery, significantly decreases the frequency of the canal wall-down procedure and posterior tympanotomy requirements with acceptable residual cholesteatoma rates.
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Elfeky AEM, Khazbzk AO, Nasr WF, Emara TA, Elanwar MW, Amer HS, Fouad YA. Outcomes of Using Otoendoscopy During Surgery for Cholesteatoma. Indian J Otolaryngol Head Neck Surg 2017; 71:1036-1039. [PMID: 31750123 DOI: 10.1007/s12070-017-1084-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 01/25/2017] [Indexed: 10/20/2022] Open
Abstract
To determine the impact of using otoendoscopy at the time of primary surgery of cholesteatoma in identifying hidden "cholesteatoma remnant". Study was prospective study. Setting was University tertiary care hospital. One hundred fifty, patients diagnosed clinically and by CT as having cholesteatoma, have been operated. 64 patients operated by using canal up technique and 86 patients operated by using canal down technique. Once all visible cholesteatoma was removed with standard microscopic techniques, otoendoscopy was utilized in every patient to identify any hidden "cholesteatoma remnant". Despite apparent total microscopic eradication of cholesteatoma of the operated cases, otoendoscopy at time of primary surgery revealed an overall incidence of hidden cholesteatoma remnants of 18%. The incidence of hidden cholesteatoma remnants identified by otoendoscopy was 23% in the canal up group and 14% in the canal down group. Otoendoscopy should be used as an adjunct with standard microscopic technique to identify hidden cholesteatoma remnants during surgery of cholesteatoma.
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Affiliation(s)
- Alaa Eldin M Elfeky
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
| | - Alaa O Khazbzk
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
| | - Wail F Nasr
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
| | - Tarek A Emara
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
| | - Mohamed W Elanwar
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
| | - Hazem S Amer
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
| | - Yasser A Fouad
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
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Alzahrani M, Alhazmi R, Bélair M, Saliba I. Postoperative diffusion weighted MRI and preoperative CT scan fusion for residual cholesteatoma localization. Int J Pediatr Otorhinolaryngol 2016; 90:259-263. [PMID: 27729145 DOI: 10.1016/j.ijporl.2016.09.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/17/2016] [Accepted: 09/25/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the ability of preoperative mastoid high resolution Computerized tomography (CT Scan) fusion with the postoperative diffusion weighted magnetic resonance imaging (Non-EPI DWI) to accurately localize the residual cholesteatoma thus sparing an unnecessary postoperative CT scan radiation. PATIENTS AND METHODS this is a prospective study performed in our tertiary care center. We followed up prospectively a consecutive group of patients presenting with middle ear cholesteatoma using preoperative mastoid CT scans, postoperative mastoid CT scan and mastoid diffusion weighted MRI (DWI) between 2012 and 2013. Postoperative DWI were fused to both: the preoperative and postoperative mastoid CT scans. Fused images were evaluated for their ability to detect accurately the location of residual cholesteatoma if any. Results were correlated to the surgical findings. RESULTS Twenty-eight patients were included in this study. Ten patients showed middle ear opacity on the postoperative CT scans; the remaining negatively patients were excluded. DWI detected residual cholesteatoma in 3 out of the ten patients. Both CT scans; the pre and postoperative were able to precisely localize the residual cholesteatoma when fused to the postoperative DWI. Intra-operatively, three patients had a residual cholesteatoma that corresponded to the fused radiological images while a fourth patient presenting low signal intensity on the Non-EPI DWI had no cholesteatoma. CONCLUSION Diffusion weighted MRI/CT scan fusion combines the advantages of residual cholesteatoma detection and precise localization. Preoperative CT scans performed before the first surgery can be used for the fusion with the Non-EPI DWI in order to spare the patient an unnecessary another CT scan and thus decreasing radiation exposure.
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Affiliation(s)
- Musaed Alzahrani
- Department of Surgery, Division of Otolaryngology, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Rami Alhazmi
- Department of Medical Imaging, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Manon Bélair
- Department of Neuroradiology, Montreal University Hospital Center (CHUM), Quebec, Canada
| | - Issam Saliba
- Department of Surgery, Division of Otorhinolaryngology, Montreal University Hospital Center (CHUM), Quebec, Canada.
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Alicandri-Ciufelli M, Marchioni D, Kakehata S, Presutti L, Villari D. Endoscopic Management of Attic Cholesteatoma. Otolaryngol Clin North Am 2016; 49:1265-70. [DOI: 10.1016/j.otc.2016.05.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ashraf B, Ghonim MR, Eladl HM, Elsisi H. Title: Role of Malleus relocation in cholesteatoma surgery: our experience in 145 patients. Clin Otolaryngol 2016; 42:738-743. [PMID: 27086553 DOI: 10.1111/coa.12658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/27/2022]
Affiliation(s)
- B Ashraf
- Mansoura Faculty of Medicine, Department of ORL (Otology & Neurotology Unit), Mansoura University, Mansoura, Egypt
| | - M R Ghonim
- Mansoura Faculty of Medicine, Department of ORL (Otology & Neurotology Unit), Mansoura University, Mansoura, Egypt
| | - H M Eladl
- Mansoura Faculty of Medicine, Department of ORL (Otology & Neurotology Unit), Mansoura University, Mansoura, Egypt
| | - H Elsisi
- Mansoura Faculty of Medicine, Department of ORL (Otology & Neurotology Unit), Mansoura University, Mansoura, Egypt
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Crowson MG, Ramprasad VH, Chapurin N, Cunningham CD, Kaylie DM. Cost analysis and outcomes of a second-look tympanoplasty-mastoidectomy strategy for cholesteatoma. Laryngoscope 2016; 126:2574-2579. [PMID: 26928951 DOI: 10.1002/lary.25941] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/20/2016] [Accepted: 02/02/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To analyze cost and compare cholesteatoma recidivism and hearing outcomes with single-stage and second-look operative strategies. STUDY DESIGN Retrospective review and cost analysis. METHODS Adult and pediatric patients who underwent a tympanoplasty with mastoidectomy for cholesteatoma with a single-stage or second-look operative strategy were identified. Variables included procedure approach, residual or recurrent cholesteatoma, ossicular chain reconstruction frequency, and operative complications. Audiologic outcomes included pre-/postoperative air bone gap (ABG) and word recognition score (WRS). Cost analysis included charges for consultation and follow-up visits, surgical procedures, computed tomography temporal bone scans, and audiology visits. RESULTS One hundred and six patients had a tympanoplasty with mastoidectomy for cholesteatoma, with 80 canal wall-up procedures (CWU) as initial approach. Of these, 46 (57.5%) CWU patients had a planned second look. Two (4.3%) CWU patients had recurrent cholesteatoma and 20 (43.4%) had residual identified at second look. Four (11.7%) single-stage CWU strategy patients developed recurrent cholesteatoma. There was no significant difference in pre-/postoperative ABG and WRS between second look and single stage (P > 0.05). Compared to second-look patients, single-stage patients had significantly fewer postoperative visits (6.32 vs. 10.4; P = 0.007), and significantly lower overall charges for care ($23,529. vs. $41.411; P < 0.0001). CONCLUSION The goal of cholesteatoma surgery is to produce a safe ear, and a second-look strategy after CWU has historically been used to evaluate for recurrent or residual disease. The cholesteatoma recurrence rate at a second look after a CWU tympanoplasty-mastoidectomy is low. Costs of operative procedures are a significant proportion of healthcare resource expenditures. Considering the low rate of cholesteatoma recurrence and relatively high cost of care, implementation of a second-look strategy should be individually tailored and not universally performed. LEVEL OF EVIDENCE 4. Laryngoscope, 126:2574-2579, 2016.
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Affiliation(s)
- Matthew G Crowson
- Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
| | - Vaibhav H Ramprasad
- Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Nikita Chapurin
- Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Calhoun D Cunningham
- Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - David M Kaylie
- Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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Demographic factors associated with loss to follow up in the management of chronic otitis media: case-control study. The Journal of Laryngology & Otology 2015; 130:166-8. [PMID: 26678651 DOI: 10.1017/s0022215115003266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The likelihood of a patient attending regular follow up can affect decision making when planning and performing tympanomastoid surgery. This study investigated whether demographic factors were associated with loss to follow up. METHODS A database of patients who had been investigated and treated for chronic otitis media was searched. Patients lost to follow up and a matching sample of patients who were formally discharged were identified. The demographic factors of age, sex and postcode were compared between the two groups. The information collected was also used to provide measures of deprivation. RESULTS Fifty patients in each group were identified. Patients lost to follow up were significantly younger than patients formally discharged (p < 0.02), and were more likely to live in an area of education and training deprivation (p < 0.05). CONCLUSION Younger patient age, and living in an area of education and training deprivation, are associated with a higher incidence of loss to follow up.
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27
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Razek AAKA, Ghonim MR, Ashraf B. Computed Tomography Staging of Middle Ear Cholesteatoma. Pol J Radiol 2015; 80:328-33. [PMID: 26171086 PMCID: PMC4485650 DOI: 10.12659/pjr.894155] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/09/2015] [Indexed: 11/24/2022] Open
Abstract
Background To establish computed tomography (CT) staging of middle ear cholesteatoma and assess its impact on the selection of the surgical procedure. Material/Methods Prospective study was conducted on 61 consecutive patients (mean age 26.8 years) with middle ear cholesteatoma. CT scan of the temporal bone and surgery were performed in all patients. CT staging classified cholesteatoma according to its location in the tympanic cavity (T); extension into the mastoid (M); and associated complications (C). Cholesteatoma was staged as stage I (T1, T2), stage II (T3, M1, M2, C1), and stage III (C2). Results The overall sensitivity of CT staging of cholesteatoma compared to surgery was 88% with excellent agreement and correlation between CT findings and intra-operative findings (K=0.863, r=0.86, P=0.001). There was excellent agreement and correlation of CT staging with surgical findings for T location (K=0.811, r=0.89, P=0.001), good for M extension (K=0.734, r=0.88, P=0.001), and excellent for associated C complications (K=1.00, r=1.0, P=0.001). Atticotympanotomy was carried out in stage I (n=14), intact canal wall surgery was performed in stage II (n=38), and canal wall down surgery was done in stage III (n=5) and stage II (n=4). Conclusions We established CT staging of middle ear cholesteatoma that helps surgeons to select an appropriate surgery.
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Affiliation(s)
| | - Mohamed Rashad Ghonim
- Department of Otolaryngology Head and Neck Surgery, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Bassem Ashraf
- Department of Otolaryngology Head and Neck Surgery, Mansoura Faculty of Medicine, Mansoura, Egypt
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Surgical results of retrograde mastoidectomy with primary reconstruction of the ear canal and mastoid cavity. BIOMED RESEARCH INTERNATIONAL 2015; 2015:517035. [PMID: 25861632 PMCID: PMC4377362 DOI: 10.1155/2015/517035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/08/2015] [Accepted: 02/08/2015] [Indexed: 11/18/2022]
Abstract
The aim of this study was to retrospectively review the long-term hearing results and the impact of mastoid exclusion/obliteration in patients with cholesteatoma (102 ears) who underwent retrograde tympanomastoidectomy and in whom bone chips/paté were applied as the sole materials during the procedure. In 79 ears, this was combined with ossiculoplasty in a single-stage procedure. In >71% of ears, the results of audiometric testing were monitored for more than 2 years. The results suggested there was a significant gain in hearing following surgery, with respect to the postoperative change in both air-conduction thresholds and air-bone gaps (P < 0.001). Linear regression analyses of pure-tone averages at different frequencies, before and after surgery, demonstrated that patients benefitted from a postoperative hearing gain at low and middle frequencies, but their hearing often deteriorated at frequencies of 8000 Hz. As for the impact of the type of tympanoplasty on hearing outcomes, type III-interposition markedly increased hearing gain. The overall rate of postoperative adverse events was 8.8%. We conclude that reconstruction of the ear canal and mastoid via mastoid exclusion/obliteration using bone chips/paté can be considered as an alternative procedure following retrograde mastoidectomy. It gives excellent surgical results and has fewer postoperative adverse events.
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Suzuki H, Ikezaki S, Imazato K, Koizumi H, Ohbuchi T, Hohchi N, Hashida K. Partial mastoid obliteration combined with soft-wall reconstruction for middle ear cholesteatoma. Ann Otol Rhinol Laryngol 2014; 123:571-5. [PMID: 24634153 DOI: 10.1177/0003489414525335] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objective was to analyze the surgical outcomes of tympanoplasty with partial mastoid obliteration and soft-wall reconstruction for middle ear cholesteatoma. METHODS Sixty-nine patients (73 ears) with fresh middle ear cholesteatomas, 42 men and 27 women aged 6 to 89 years, were retrospectively analyzed. The cholesteatomas were the pars flaccida and tensa types in 59 and 12 ears, respectively. The patients underwent canal-wall-down tympanoplasty with partial mastoid obliteration and soft-wall reconstruction. Follow-up computed tomography was performed 6 to 12 months after surgery. Hearing outcomes were evaluated by the arithmetic mean of the hearing levels at 500, 1000, and 2000 Hz. RESULTS Residual cholesteatoma occurred in 7 ears (9.6%) and recurrent cholesteatoma in 1 ear (1.4%). No cavity problem was seen. Primary evaluation of postoperative hearing was performed 6 to 12 months after ossiculoplasy. Of the 50 ears with available audiogram in this period, the postoperative air-bone gaps were ≤ 15 dB and ≤ 20 dB in 27 (54.0%) and 37 (74.0%) ears, respectively. The postoperative hearing level was within 30 dB in 22 ears (44.0%). The hearing gain was ≥ 15 dB in 24 ears (48.0%). CONCLUSIONS The surgical outcomes of tympanoplasty with partial mastoid obliteration and soft-wall reconstruction for middle ear cholesteatoma were satisfactory with a low incidence of cholesteatoma recidivism and tolerable postoperative hearing without cavity problems.
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Migirov L, Yakirevitch A, Wolf M. The utility of minimally invasive transcanal endoscopic approach for removal of residual/recurrent cholesteatoma: preliminary results. Eur Arch Otorhinolaryngol 2014; 272:3241-6. [PMID: 25413019 DOI: 10.1007/s00405-014-3402-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/17/2014] [Indexed: 12/28/2022]
Abstract
To investigate the feasibility of applying the transcanal endoscopic approach (TEA) for surgical treatment of residual/recurrent cholesteatoma and present the preliminary results of 17 revision procedures that were carried out with this minimally invasive approach. The records of 17 patients (aged 5-76 years) who underwent transcanal revision procedure using rigid 3-mm diameter, 0°, 30° and 45° endoscopes between 2009 and 2012 were retrospectively reviewed. A wide posterior tympanomeatal flap was elevated via the external auditory canal and then transposed inferiorly in cases of cholesteatoma situated in the middle ear under a tympanic membrane. In certain cases, cholesteatoma was assessed and removed using the endoscopes directly from the radical cavity or from the mastoid cavity remaining after a canal-wall-down procedure. Six patients had originally undergone the canal-wall-up mastoidectomy, 6 patients had a canal-wall-down mastoidectomy and 5 patients had radical mastoid cavities. The interval between the previous and the index surgery ranged between 1 and 6 years. The attic was the most common site involved with cholesteatoma, followed by the tympanic portion of the facial nerve, sinus tympani, mastoid, supratubal recess, promontory, round and oval windows. The size of residual/recurrent lesion varied between 3 and 15 mm. The patients were followed up 26-67 months (mean 52.1 months). The single recurrence (a 4-mm pearl over the tympanic portion of the facial nerve) was eradicated by a transcanal re-revision 1 year following the index surgery. Minimally invasive TEA can be successfully applied in carefully selected patients with endoscopically accessible cholesteatoma subsequent to various types of mastoidectomy.
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Affiliation(s)
- Lela Migirov
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, 5262l, Tel Aviv, Israel.
| | - Arkadi Yakirevitch
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, 5262l, Tel Aviv, Israel
| | - Michael Wolf
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, 5262l, Tel Aviv, Israel
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Canal wall reconstruction in cholesteatoma surgeries: rate of residual. Eur Arch Otorhinolaryngol 2014; 272:2791-7. [PMID: 25227760 DOI: 10.1007/s00405-014-3280-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
Abstract
To evaluate the rates of residual and recurrent cholesteatoma following canal wall reconstruction (CWR) tympano-mastoidectomy with mastoid obliteration, for the treatment of chronic otitis with cholesteatoma. Consecutive cohort study. We included patients following surgical cholesteatoma removal by CWR tympano-mastoidectomy with hydroxyapatite mastoid obliteration from 2008 to 2012. We analyzed audiometric and postoperative radiologic data. We determined the rates of residual disease and recurrence, and evaluated postoperative complications. Thirty-six ears were included in this study. The mean follow-up after surgery was 24 months (range 12.3-51.4 months). The recurrence rate was 3.1% (one case) and the rate of residual disease was 6.2% (two cases including one of iatrogenic cholesteatoma). No canal-wall-down tympanoplasty was required. Local infection was detected in 33% of cases and was successfully treated with appropriate antibiotics. Postoperative audiometry showed no impairment of the cochlear reserve. No postoperative facial palsy or deafness was observed. CWR permits well exposure of the lesion, making complete excision of the cholesteatoma possible. This study showed a decreasing of the rate of residual cholesteatoma and must be confirmed with further studies. CWR makes it possible to use hearing aids for auditory rehabilitation.
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Quérat C, Martin C, Prades JM, Richard C. Canal wall up tympanoplasty for cholesteatoma with intact stapes. Comparison of hearing results between cartilage and PORP on stapes and impact of malleus removal and total reinforcement of the tympanic membrane by cartilage. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:211-6. [DOI: 10.1016/j.anorl.2013.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 03/04/2013] [Accepted: 03/12/2013] [Indexed: 10/25/2022]
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Thiel G, Rutka JA, Pothier DD. The behavior of mastoidectomy cavities following modified radical mastoidectomy. Laryngoscope 2014; 124:2380-5. [PMID: 24459037 DOI: 10.1002/lary.24610] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/05/2014] [Accepted: 01/21/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS An analysis of the frequency and intensity of postoperative aftercare required for modified radical mastoidectomy (MRM) and patterns of healing in the postoperative period. STUDY DESIGN A retrospective review of all primary modified radical mastoidectomies carried out for cholesteatoma under the care of the senior author between the years of 2004 and 2009 with minimum follow-up of 2 years. METHODS The time and number of interventions required to achieve a stable and dry mastoid cavity were collected. Cross-sectional and longitudinal analysis of the behavior of the cavities was carried out. RESULTS Overall, 73 cases (71 patients) were identified. Patients were followed up for a median of 45.7 months (interquartile range, 31.8-70.5). After initial debridement, most cavities settled rapidly, but this was not always predictable, with a large proportion requiring further clinical intervention after the cavity was stable, sometimes for prolonged periods of time. At the time of analysis, 73% had achieved a stable cavity, 17 (23%) still required attention (nine for wax removal and eight for debridement); two were lost to follow-up. No revision surgeries were required. At 6 months, 36% of cavities were settled, 42% at 1 year, 53% at 18 months, and 62% at 2 years. After two standard postoperative visits, a total of 632 visits were made by these patients. CONCLUSIONS Following MRM, the majority of patients achieve a dry, self-cleaning mastoid cavity. This might require periods of intense care interspersed with periods of quiescence. These results allow the benefits of this procedure to be put in the context of the entire patient journey.
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Affiliation(s)
- Gundula Thiel
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Akkari M, Gabrillargues J, Saroul N, Pereira B, Russier M, Mom T, Gilain L. Contribution of magnetic resonance imaging to the diagnosis of middle ear cholesteatoma: Analysis of a series of 97 cases. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:153-8. [DOI: 10.1016/j.anorl.2013.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 07/04/2013] [Accepted: 08/18/2013] [Indexed: 01/06/2023]
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Abstract
OBJECTIVE Estimate the available direct cost of cholesteatoma care in a university practice. STUDY DESIGN Retrospective review of both physician and hospital financial data during a recent 3-year period. SETTING University-based tertiary referral medical system. PATIENTS Adults (≥ 18 yr old) with cholesteatoma. INTERVENTION(S) Financial information associated with both physician and hospital encounters were analyzed in a deidentified manner. MAIN OUTCOME MEASURE(S) Frequency and type of encounter, charges, collections, and payers were tabulated. RESULTS Approximately 949 physician encounters (817 clinic, 130 surgical, and 2 inpatient) among 344 patients resulted in greater than $700, 000 in charges and greater than $211,000 in receipts (≈ 30% rate of collection). The average physician charge per patient per year was approximately $1,600. About 259 hospital encounters among 171 patients resulted in greater than $1.8 million in charges and greater than $520,000 in receipts (≈ 28% collection rate). The average hospital charge per patient per year was ∼$10,000. For physician encounters, managed care (37%) and Medicare (25%) were the most common payers, whereas 17% were uninsured. For hospital encounters, managed care (28%) and Medicare (14%) were the most common payers, whereas 24% were uninsured. CONCLUSION The direct cost of care for patients with cholesteatoma is significant. The current treatment paradigm for this chronic disorder results in repeated health care system access and associated direct (and unmeasured indirect) expenses. Future treatment paradigms should be designed to improve disease-specific quality of life while mitigating this financial impact.
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Van der Gucht K, Van Rompaey V, Vanderveken O, Van de Heyning P, Claes J. Temporary removal of the posterior bony canal wall with reconstruction using microplate osteosynthesis in cholesteatoma surgery: a case series and description of the technique. Eur Arch Otorhinolaryngol 2013; 271:1497-503. [PMID: 23942812 DOI: 10.1007/s00405-013-2601-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 06/10/2013] [Indexed: 01/09/2023]
Abstract
We describe the surgical technique of temporary removal of the posterior auditory canal wall with reconstruction and report the outcome of using this technique as a treatment method for cholesteatoma in a case series. In 32 cases of cholesteatoma surgery a technique of temporary removal of the posterior bony wall was applied. During primary surgery the posterior auditory canal wall was removed using an oscillating saw. For the purpose of reconstruction, the canal wall was repositioned and fixed using two titanium microplates (n = 26). In case the canal wall could not be reconstructed with osteosynthesis, either glass-ionomeric cement (BioCem™) was used for fixation (n = 4) or fibrin glue (Tissucol™) (n = 2) to support the posterior wall. The outcome includes the healing process in the first postoperative month, the absence of residual or recurrent disease and the successful reconstruction of the posterior auditory canal wall as evaluated during second-look surgery. When microplates where used, we saw healing problems of the canal skin in about 4% of patients. Recurrent cholesteatoma was found in 4 cases (14%), residual cholesteatoma in 8 ears (25%). In the osteosynthesis group, successful reconstruction was achieved in 25 patients (96%). In 3 out of 4 patients of the glass-ionomeric cement group (75%) excessive granulation tissue developed with extensive bony lysis. Temporary removal of the posterior auditory canal wall offers potential for the control of cholesteatoma. Our first results suggest that osteosynthesis allows for a good anatomical and functional reconstruction.
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Affiliation(s)
- Karen Van der Gucht
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium,
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Stankovic M. The learning curve in revision cholesteatoma surgery. Am J Otolaryngol 2013; 34:65-71. [PMID: 23102887 DOI: 10.1016/j.amjoto.2012.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 09/04/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To review the results of revision surgery for cholesteatoma. STUDY DESIGN Retrospective review of patient's records. SETTING Tertiary referral center. PATIENTS A retrospective study of patients operated for acquired middle ear cholesteatoma during the period 1990-2002 was performed. A total of 758 patients were divided into two groups according to surgical experience, and followed during short-term and long-term period. The cholesteatoma was divided according to location, age of patients, status of auditory ossicles, and bilaterality of disease. INTERVENTIONS The patients were treated with single canal wall up or wall down, according to the propagation of disease and condition of middle ear. The indications for the reoperations were: recurrent or residual cholesteatoma, resuppuration, and AB gap more than 20 dB. MAIN OUTCOME MEASURES Type of surgical therapy, localization of cholesteatoma, age of patients, revisions, bilaterality of disease, damage of auditory ossicles and learning curve were analyzed. RESULTS The number of revision operations was reduced in the second period (from totally 24.3% to 16.4%). Closed technique gave a significantly lower rate of failure. For attic cholesteatoma, adults, bilateral disease, and ossicular damage the rate of revisions was significantly lower with surgical experience. CONCLUSION Surgical experience was important for reduction of reoperation rate for attic and sinus cholesteatoma, adults, bilateral cholesteatoma, and when closed technique is used.
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Marchioni D, Villari D, Mattioli F, Alicandri-Ciufelli M, Piccinini A, Presutti L. Endoscopic management of attic cholesteatoma: a single-institution experience. Otolaryngol Clin North Am 2012; 46:201-9. [PMID: 23566906 DOI: 10.1016/j.otc.2012.10.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
At present, the main application of endoscopic surgery is in the surgical treatment of middle ear cholesteatoma; however, for definitive validation and acceptance by scientific community, results are needed regarding recurrent and residual rates of the condition. This article analyzes the single-institution experience from results of surgical treatment of attic cholesteatoma.
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Affiliation(s)
- Daniele Marchioni
- Otolaryngology Department, University Hospital of Modena, Modena 41100, Italy.
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