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Fieux M, Tournegros R, Hermann R, Tringali S. Allograft bone vs. bioactive glass in rehabilitation of canal wall-down surgery. Sci Rep 2023; 13:17945. [PMID: 37864103 PMCID: PMC10589328 DOI: 10.1038/s41598-023-44901-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 10/13/2023] [Indexed: 10/22/2023] Open
Abstract
Canal wall-down (CWD) mastoidectomy creates a radical cavity that modifies the anatomy and physiology of the middle ear, thus preventing it from being self-cleaning and causing epidermal stagnation in the posterior cavities. Canal wall-down tympanomastoidectomy with reconstruction (CWDTwR) can obliterate such radical cavities. The main objective of this study was to compare postoperative results after CWDTwR by using either bone allografts or 45S5 bioactive glass as a filling tissue with an 18-month follow-up. This was a single-center observational trial including all patients undergoing CWDTwR. Patients were divided into two groups according to the filling material used: allograft bone (AB group) or 45S5 bioactive glass (BG group). Clinical monitoring was performed regularly, with control imaging performed at 18 months (CT scan and DW MRI). The two groups were compared with the t test for quantitative variables and the chi square test for qualitative variables (no revision surgery, audiometric results, complications, mastoid obliteration volume). Thirty-two patients underwent CWDTwR between October 2015 and 2018. The mean age was 48 years, and 71.9% (23/32) were men. A total of 46.9% (15/32) of the patients had undergone at least 3 middle-ear surgeries prior to CWDTwR. The most frequent preoperative symptom was otorrhea (100.0%, 32/32), and only 12.5% (4/32) experienced dizziness. Fifteen and 17 patients underwent surgery with bone allografts and 45S5 bioactive glass, respectively. At 18 months post-operation, 53.3% of the patients (8/15) in the AB group presented with recurrent otorrhea versus 5.9% (1/17) of patients in the BG group (p = 0.005). Seventy-eight percent (7/9) of symptomatic patients had undergone revision surgery at 18 months postoperation: 40.0% (6/15) in the AB group and 5.9% (1/17) in the BG group (p = 0.033). One patient's surgery was cancelled due to the COVID-19 pandemic, and one patient refused surgery. The effects of CWDTwR with bone allografts are disappointing in early follow-up, with significant resorption leading to a 40.0% revision surgery rate. 45S5 BG is a simple solution, with preliminary results that are superior to those of AB. However, prospective controlled studies with longer follow-up times are needed to evaluate the value of BG versus other synthetic materials (such as hydroxyapatite) in surgical management of CWDTwR.Trial registration: retrospectively registered.
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Affiliation(s)
- Maxime Fieux
- Service d'ORLd'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite Cedex, France.
- Université de Lyon, Université Lyon 1, 69003, Lyon, France.
- UMR 5305, Laboratoire de Biologie Tissulaire et d'Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS/Université Claude Bernard Lyon 1, 7 Passage du Vercors, 69367, Lyon Cedex 07, France.
| | - Romain Tournegros
- Service d'ORLd'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite Cedex, France
| | - Ruben Hermann
- Université de Lyon, Université Lyon 1, 69003, Lyon, France
- Service d'ORL et de chirurgie cervico-faciale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003, Lyon, France
| | - Stéphane Tringali
- Service d'ORLd'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre Bénite Cedex, France
- Université de Lyon, Université Lyon 1, 69003, Lyon, France
- UMR 5305, Laboratoire de Biologie Tissulaire et d'Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS/Université Claude Bernard Lyon 1, 7 Passage du Vercors, 69367, Lyon Cedex 07, France
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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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Illés K, Meznerics FA, Dembrovszky F, Fehérvári P, Bánvölgyi A, Csupor D, Hegyi P, Horváth T. Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta-analysis. Laryngoscope 2022; 133:1297-1305. [PMID: 36169349 DOI: 10.1002/lary.30413] [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: 05/04/2022] [Revised: 08/18/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Our study aims to evaluate the effectiveness of mastoid obliteration compared to the canal wall up (CWU) technique in cholesteatoma surgery based on the systematic review of the literature and the meta-analysis of the data. METHODS The systematic search was performed in four major databases (MEDLINE, Web of Science, Embase, and CENTRAL) on October 14, 2021. Studies comparing the CWU technique and mastoid obliteration were included. The exclusion criteria were less than 12 months follow-up, congenital cholesteatoma, indefinite description of the surgical method, and animal studies. The protocol was registered on Prospero (registration number: CRD42021282485). The risk of bias was evaluated with the ROBINS-I tool. Residual and recurrent disease proportions as primary outcomes, quality of life, ear discharge, infection rates, hearing results, and operation time as secondary outcomes were analyzed. In the quantitative synthesis, the random effect model was used, and heterogeneity was identified. RESULTS A total of 11 articles with 2077 operations' data were found eligible. All the identified studies were retrospective cohorts. The odds of pooled residual and recurrent disease proportion were significantly lower in the obliteration group compared to CWU (OR = 0.45, CI:0.28;0.80, p = 0.014). However, when separated, the proportion of ears with recurrent (OR = 0.41, CI:0.11;1.57, p = 0.140) or residual (OR = 0.59, CI:0.23, 1.50, p = 0.207) disease did not show a significant difference, even though the odds were quite similar. The qualitative synthesis identified no significant difference in the secondary outcomes, but obliteration elongated the operation time. CONCLUSION Mastoid obliteration significantly decreased the proportion of residual and recurrent cholesteatoma in pooled analyses compared to the CWU technique with low-quality of data. LEVEL OF EVIDENCE NA Laryngoscope, 2022.
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Affiliation(s)
- Kata Illés
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Fanni Adél Meznerics
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Fanni Dembrovszky
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Fehérvári
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Biomathematics and Informatics, University of Veterinary Medicine, Budapest, Hungary
| | - András Bánvölgyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Dezső Csupor
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tamás Horváth
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
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Cherdantseva DD, Vakhrushev SG, Toropova LA. [Mastoid obliteration during last 5 years]. Vestn Otorinolaringol 2022; 87:55-60. [PMID: 36580510 DOI: 10.17116/otorino20228706155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The article presents modern approaches to mastoid obliteration in cases of chronic purulent otitis media with cholesteatoma, published in peer-reviewed russian and foreign journals from 2017 to 2021. The review tells us about effect of mastoid cavity obliteration on reducing the recurrence of cholesteatoma, improving the quality of life of patients according to the results of international questionnaires and the effect of surgery on hearing in the long-term postoperative period. An analysis of the use of autologous and biocompatible materials in middle ear surgery is presented. Their safety and ease of use during surgical intervention were evaluated.
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Affiliation(s)
- D D Cherdantseva
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - S G Vakhrushev
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - L A Toropova
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
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Fieux M, Tournegros R, Zaouche S, Tringali S. Bioactive glass in canal wall reconstruction tympanoplasty. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 139:293-296. [PMID: 34535425 DOI: 10.1016/j.anorl.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this Technical Note is to describe the surgical technique to transform canal wall down tympanoplasty into canal wall up tympanoplasty, that is, to rehabilitate a recess cavity by filling the mastoid and epitympanic cavities with synthetic tissue (bioactive glass) and recreating a normal-caliber external auditory canal. Mastoid cavity obliteration leads to a clinically significant improvement in health-related quality of life without increasing risk of recurrent or residual cholesteatoma, conditional upon technically impeccable surgery.
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Affiliation(s)
- M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France.
| | - R Tournegros
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France
| | - S Zaouche
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France
| | - S Tringali
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France
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