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Erfurt C, Westerhout SF, Straatman LV, Smit AL, Stokroos RJ, Thomeer HGXM. Canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes. Front Surg 2024; 11:1381481. [PMID: 38650663 PMCID: PMC11033303 DOI: 10.3389/fsurg.2024.1381481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
Objectives The primary objective was to determine whether obliteration of the epitympanic area and mastoid cavity during canal wall up (CWU) cholesteatoma surgery reduces the rate of recurrent and residual cholesteatoma compared to not obliterating the same area. The secondary objective was to compare postoperative hearing outcomes between both techniques. Methods A retrospective cohort study was conducted in a tertiary referral center. One-hundred-fourty-three ears were included of patients (≥18y) who underwent a CWU tympanomastoidectomy for cholesteatoma with or without bony obliteration between January 2015 and March 2020 in the University Medical Center Utrecht. The median follow-up was respectively 1.4 (IQR 1.1-2.2) vs. 2.0 years (IQR 1.2-3.1) (p = 0.013). Interventions All patients underwent CWU tympanomastoidectomy for cholesteatoma. For 73 ears bone dust, Bonalive® or a combination was used for obliteration of the mastoid and epitympanic area, the rest of the ears (n = 70) were not obliterated. In accordance with the Dutch protocol, included patients are planned to undergo an MRI scan with diffusion-weighted imaging (DWI) one, three and five years after surgery to detect recurrent or residual cholesteatoma. Main outcome measures The primary outcome measure was recurrent and residual cholesteatoma as evaluated by MRI-DWI and/or micro-otoscopy and confirmed by micro-otoscopy and/or revision surgery. The secondary outcome measure was the postoperative hearing. Results In this cohort, the group treated with canal wall up tympanomastoidectomy with subsequent bony obliteration (73 ears, 51.0%) had significantly lower recurrent (4.1%) and residual (6.8%) cholesteatoma rates than the group without obliteration (70 ears, 25.7% and 20.0%, respectively; p < 0.001). There was no significant difference between both groups in postoperative bone conduction thresholds (mean difference 2.7 dB, p = 0.221) as well as the mean air-bone gap closure 6 weeks after surgery (2.3 dB in the non-obliteration and 1.5 dB in the obliteration group, p = 0.903). Conclusions Based on our results, a canal wall up tympanomastoidectomy with bony obliteration is the treatment of choice, since the recurrent and residual disease rate is lower compared to the group without obliteration. The bony obliteration technique does not seem to affect the perceptive or conductive hearing results, as these are similar between both groups.
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Affiliation(s)
- Chiara Erfurt
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sanne F. Westerhout
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Louise V. Straatman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Adriana L. Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Robert J. Stokroos
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hans G. X. M. Thomeer
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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Li QC, Wang SQ, Cao ZZ, Zhou SH. Enhanced Mitophagy in Cholesteatoma Epithelial Cells. Otol Neurotol 2023; 44:e688-e694. [PMID: 37590884 DOI: 10.1097/mao.0000000000003986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
HYPOTHESIS Mitophagy may have a potential role in the pathogenesis of acquired cholesteatoma. BACKGROUND Enhanced mitophagy has been proven to be involved in various cancers. However, its role in the pathogenesis of cholesteatoma, which shares some common features with cancer, is controversial. This study investigated mitophagy in cholesteatoma epithelial cells. METHODS The autophagy protein markers LC3-II and p62 and mitophagy proteins BNIP3, Parkin, and PINK1 were analyzed in cholesteatoma epithelial cells and external auditory canal epithelium cells by immunoblotting. The results were confirmed by immunohistochemistry. Adenovirus Ad-mCherry-GFP-LC3B and Ad-GFP-LC3B were used to evaluate autophagic activity. Transmission electron microscopy was used to observe and analyze autophagosomes. RESULTS LC3-II expression was increased in cholesteatoma cells, whereas soluble and insoluble p62 levels were decreased. The expressions of BNIP3, Parkin, and PINK1 were higher in total protein and mitochondrial protein of cholesteatoma cells compared with normal external auditory canal epithelium cells. Autophagic activity was increased in cholesteatoma cells compared with normal external auditory canal epithelium cells. CONCLUSION Mitophagy was enhanced in cholesteatoma epithelial cells and may have a potential role in the pathogenesis of acquired cholesteatoma.
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Affiliation(s)
- Quan-Cheng Li
- Department of Otolaryngology-Head and Neck Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Iannella G, Pace A, Greco A, Polimeni A, Maniaci A, Mucchino A, Lechien JR, Saibene AM, Mat Q, Gargula S, Fakhry N, Simone F, Gioacchini FM, Re M, Magliulo G. Endaural microscopic approach versus endoscopic transcanal approach in treatment of attic cholesteatomas. Am J Otolaryngol 2023; 44:103860. [PMID: 36996516 DOI: 10.1016/j.amjoto.2023.103860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Compare the audiological results and postoperative outcomes of the endoscopic approach versus the endaural microscopic approach for treatment of attic cholesteatomas, using a randomized prospective model. MATERIALS AND METHODS Eighty patients were consecutively enrolled in the study and randomized into two groups of treatment of 40 patients: Group A -tympanoplasty with a microscopic endaural approach; Group B -tympanoplasty with an exclusive trans-meatal endoscopic approach. Preoperative, intraoperative and postoperative outcomes were evaluated. Hearing was assessed preoperatively and at 1 month, 3 months and 6 months after surgery in both groups. RESULTS There were no differences in the parameters analyzed (CT findings, patient age, disease duration, intraoperative cholesteatoma characteristics,) between the group A and B patients. No statistical difference between the two groups regarding hearing improvement, abnormal taste sensation, dizziness, post-operative pain and healing times emerged. Graft success rate was 94.5 % and 92.1 % for MES and ESS respectively. CONCLUSION Both microscopic and exclusively endoscopic endaural approaches offer similar and excellent results in the surgical treatment of attic cholesteatomas.
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Bovi C, Luchena A, Bivona R, Borsetto D, Creber N, Danesi G. Recurrence in cholesteatoma surgery: what have we learnt and where are we going? A narrative review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S48-S55. [PMID: 37698100 PMCID: PMC10159641 DOI: 10.14639/0392-100x-suppl.1-43-2023-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 09/13/2023]
Abstract
Treatment of cholesteatoma is surgical and has historically encompassed two main techniques: canal wall up (CWU) and canal wall down (CWD) tympanoplasty. Follow-up for cholesteatoma is still debated and can be either radiological or with second-look surgery. MRI with diffusion weighted sequences has proved to have high sensitivity and specificity in detecting recurrent or residual disease. Specifically, non-echo planar imaging DWI (non-EPI DWI) has been shown to be superior to other imaging techniques, allowing, in some cases, to avoid second-look surgery. Both residual and recurrence rates are higher in CWU compared to CWD procedures. Endoscopic ear surgery (EES) has become popular with the advantage of “looking around corners”. The endoscope is used in addition to a microscope or exclusively to reduce cholesteatoma recurrence. In addition, it has been demonstrated that mastoid obliteration and the use of potassium titanyl phosphate laser (KTP) can reduce cholesteatoma recurrence, with better functional outcomes. A synthetic sulphur compound (MESNA) may have an interesting role in the overall improvement in recurrence and residual cholesteatoma disease. This narrative review critically appraises the factors associated with the risk of recurrent cholesteatoma.
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Affiliation(s)
- Chiara Bovi
- Otolaryngology Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alberto Luchena
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - Rachele Bivona
- Department of Neurosciences, Section of Otorhinolaryngology and Skull Base Microsurgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Daniele Borsetto
- Department of ENT Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nathan Creber
- Otolaryngology, Department of Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Giovanni Danesi
- Department of Neurosciences, Section of Otorhinolaryngology and Skull Base Microsurgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Li J, Jufas N, Forer M, Patel N. Incidence and trends of middle ear cholesteatoma surgery and mastoidectomy in Australia-A national hospital morbidity database analysis. Laryngoscope Investig Otolaryngol 2022; 7:210-218. [PMID: 35155800 PMCID: PMC8823164 DOI: 10.1002/lio2.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/07/2021] [Accepted: 11/26/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To investigate the incidence of middle ear cholesteatoma surgery and assess trends in mastoidectomy procedures in Australia. STUDY DESIGN Cross-sectional population-based study using data from the National Hospital Morbidity Database. METHODS Admitted care episodes containing the principal diagnosis of middle ear cholesteatoma were analyzed for two 12-month periods of 2007-2008 and 2017-2018. Surgical admissions involving mastoidectomy were identified by procedure codes. Incidence rate per 100,000 person-years were compared between study periods. RESULTS Of the 3855 middle ear cholesteatoma admissions, 3558 (92.3%) involved surgery, with the incidence rate for cholesteatoma surgical admissions estimated at 8.6 per 100,000 (95% CI: 8.2-9.0) and 8.1 per 100,000 (95% CI: 7.7-8.5) for 2017-2018 and 2007-2008, respectively. Population aged 10-19 years had the highest age-specific incidence rate at 12.5 per 100,000 (95% CI: 11.3-13.9) for 2017-2018. The 60 years and over age groups had the highest decennial percentage increase. Mastoidectomy procedures were consistently used in over half of all surgical admissions. An increase in the rate of canal wall up (CWU) mastoidectomy procedure related admissions was observed (rate ratio of 1.62 [95%CI: 1.41-1.86], P <.001) and was offset by a decreased rate of canal wall down (CWD) procedure associated admissions (0.69 [95% CI: 0.61-0.78], P <.001]). CONCLUSIONS The incidence rate of cholesteatoma surgery in Australia is estimated at 8.6 per 100,000. Mastoidectomy continues to play an essential role in cholesteatoma surgery with a trend favoring CWU over CWD mastoidectomy. Level of evidence: 4.
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Affiliation(s)
- Jonathan Li
- Division of Otolaryngology Head & Neck SurgeryRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Nicholas Jufas
- Division of Otolaryngology Head & Neck SurgeryRoyal North Shore HospitalSydneyNew South WalesAustralia
- Discipline of Surgery, Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
- Department of Otolaryngology – Head & Neck Surgery, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Kolling Deafness Research Centre, Royal North Shore HospitalMacquarie University and University of SydneySydneyNew South WalesAustralia
| | - Martin Forer
- Division of Otolaryngology Head & Neck SurgeryRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Nirmal Patel
- Division of Otolaryngology Head & Neck SurgeryRoyal North Shore HospitalSydneyNew South WalesAustralia
- Discipline of Surgery, Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
- Department of Otolaryngology – Head & Neck Surgery, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Kolling Deafness Research Centre, Royal North Shore HospitalMacquarie University and University of SydneySydneyNew South WalesAustralia
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Lan WC, Wang CY, Tsai MH, Lin CD. Long-term follow-up of applying autologous bone grafts for reconstructing tympanomastoid defects in functional cholesteatoma surgery. PeerJ 2021; 9:e12522. [PMID: 34900435 PMCID: PMC8621709 DOI: 10.7717/peerj.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives This study investigated the long-term surgical outcomes of functional cholesteatoma surgery with canal wall reconstruction using autologous bone grafts as the primary material in patients with acquired cholesteatoma. Subjects and Methods Medical charts were retrospectively reviewed for all patients admitted to one institution for surgical intervention between 2010 and 2018. We analyzed 66 patients (66 ears) who underwent functional tympanomastoidectomy involving the use of autologous bone grafts for canal wall defect reconstruction. Surgical outcomes were evaluated by comparing preoperative audiometric results with follow-up data (at least 36 months after surgery). Logistic regression analyses were performed to determine prognostic factors related to long-term hearing success. These factors included classification and stage of cholesteatoma, stapes condition, ossicular chain damage, active infection of the middle ear, state of the contralateral ear, preoperative hearing thresholds, gender, and age. Results The mean follow-up period was 49.2 months. The recidivism rate was 6% (four of 66 ears). The pure-tone average significantly improved from 50.78 ± 19.98 to 40.81 ± 21.22 dB hearing level (HL; p < 0.001). Air–bone gaps significantly improved from 26.26 ± 10.53 to 17.58 ± 8.21 dB HL (p < 0.001). In multivariate logistic regression analysis, early-stage disease (p = 0.021) and pars flaccida cholesteatoma (p = 0.036) exhibited statistically significant correlations with successful hearing preservation. Conclusion Functional cholesteatoma surgery with autologous bone grafts reconstruction is an effective approach to significantly improve hearing with low recidivism rates. Localized disease and pars flaccida cholesteatoma were two independent predictors of successful hearing preservation.
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Affiliation(s)
- Wei-Che Lan
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Yuan Wang
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Hsui Tsai
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Der Lin
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
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Tames HLVC, Padula M, Sarpi MO, Gomes RLE, Toyama C, Murakoshi RW, Olivetti BC, Gebrim EMMS. Postoperative Imaging of the Temporal Bone. Radiographics 2021; 41:858-875. [PMID: 33739892 DOI: 10.1148/rg.2021200126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The anatomy of the temporal bone is complex, and postoperative imaging evaluation of this bone can be challenging. Surgical approaches to the temporal bone can be categorized didactically into tympanoplasty and ossicular reconstruction, mastoidectomy, and approaches to the cerebellopontine angle and internal auditory canal (IAC). In clinical practice, different approaches can be combined for greater surgical exposure. Postoperative imaging may be required for follow-up of neoplastic lesions and to evaluate unexpected outcomes or complications of surgery. CT is the preferred modality for assessing the continuity of the reconstructed conductive mechanism, from the tympanic membrane to the oval window, with use of grafts or prostheses. It is also used to evaluate aeration of the tympanic and mastoid surgical cavities, as well as the integrity of the labyrinth, ossicular chain, and tegmen. MRI is excellent for evaluation of soft tissue. Use of a contrast-enhanced fat-suppressed MRI sequence is optimal for follow-up after IAC procedures. Non-echo-planar diffusion-weighted imaging is optimal for detection of residual or recurrent cholesteatoma. The expected imaging findings and complications of the most commonly performed surgeries involving the temporal bone are summarized in this review. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Hugo L V C Tames
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Mario Padula
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Maíra O Sarpi
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Regina L E Gomes
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Carlos Toyama
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Rodrigo W Murakoshi
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Bruno C Olivetti
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
| | - Eloísa M M S Gebrim
- From the Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 75, São Paulo, SP 05403-000, Brazil
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Król B, Cywka KB, Skarżyńska MB, Skarżyński PH. Mastoid obliteration with S53P4 bioactive glass after canal wall down mastoidectomy: Preliminary results. Am J Otolaryngol 2021; 42:102895. [PMID: 33429176 DOI: 10.1016/j.amjoto.2020.102895] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bioactive glass (S53P4), abbreviated BG, currently seems to be the best material for reconstructing the posterior wall of the auditory canal and obliterating the postoperative cavity. PURPOSE The aim of the study was to report preliminary results of otosurgery involving obliteration of the mastoid cavity after canal wall down mastoidectomy. METHODS 11 adult patients who had had a history of chronic otitis media with cholesteatoma in one or both ears and previous canal wall down mastoidectomy. The duration of the follow-up was 6 months, with routine visits after 7 days, then 1, 3, and 6 months after surgery. The patient's medical history, noting other diseases potentially affecting the healing process, was analyzed. Healing, audiometric results, reduction of the volume of the cavity after surgery, and reduction of bacterial flora growth were assessed. RESULTS There was not worsening in the audiological evaluation. Healing period was uneventful. There was a reduction in volume of the postoperative cavity, no development of pathological flora, and no recurrence of cholesteatoma. CONCLUSION Obliteration of the mastoid process with S53P4 bioactive glass is a safe and effective method of treatment. Such a procedure should be considered as a treatment for patients after canal wall down surgery (CWD).
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Affiliation(s)
- B Król
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland; Oto-Rhino-Laryngology Surgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - K B Cywka
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - M B Skarżyńska
- Institute of Sensory Organs, Kajetany, Poland; World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland; Center of Hearing and Speech Medincus, Kajetany, Poland
| | - P H Skarżyński
- Institute of Sensory Organs, Kajetany, Poland; World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland; Heart Failure and Cardiac Rehabilitation Department, 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland; Center of Hearing and Speech Medincus, Kajetany, Poland.
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Verma B, Dabholkar YG. Role of endoscopy in surgical management of cholesteatoma: A systematic review. J Otol 2020; 15:166-170. [PMID: 33293919 PMCID: PMC7691841 DOI: 10.1016/j.joto.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/28/2020] [Indexed: 01/03/2023] Open
Abstract
Endoscopes are increasingly being used in cholesteatoma surgeries either as an adjunct to microscopes or sometimes exclusively. Their role at present is more as adjunct to microscope which still remains the work-horse for mastoidectomy. However, as endoscopy and endoscopic instruments are increasingly getting refined, role of endoscopy in management of cholesteatoma is continuously being appraised with progressively newer studies. This review aims to assess outcomes of several studies in which endoscopic techniques were used in cholesteatoma surgery and recognize common trends. An extensive review of literature on this theme was performed. Sixteen studies comprising of 1685 patients treated endoscopically either exclusively or in combination with microscope were included. Intra-operatively, in 267 (15.82%) cases, residual cholesteatoma was identified by endoscope in hidden areas after completion of surgery with microscope. On follow-up, recidivism was identified in 108 cases (6.4%) in second look procedures. Common sites of recurrence were hidden areas like sinus tympani. This review while acknowledging the value of microscope, highlights the merit of endoscope usage in cholesteatoma surgery and its role in reducing recurrence.
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Affiliation(s)
- Bhavika Verma
- Department of ENT, School of Medicine, D.Y. Patil University, Navi Mumbai, India
| | - Yogesh G Dabholkar
- Department of ENT, School of Medicine, D.Y. Patil University, Navi Mumbai, India
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Lee CH, Kim MK, Kim HM, Won C, Shin TH, Kim SY. Endaural Laser-Assisted Single-Stage Inside-Out Cholesteatoma Surgery (LASIC) to Treat Advanced Congenital Cholesteatoma. Otol Neurotol 2020; 40:927-935. [PMID: 31295203 DOI: 10.1097/mao.0000000000002299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Investigation of endaural laser-assisted single-stage inside-out cholesteatoma surgery (LASIC) to treat advanced congenital cholesteatoma (ACC) by a modified staging system based on ossicle status. STUDY DESIGN A retrospective case review. SETTING A university hospital otology referral clinic. PATIENTS Two hundred consecutive pediatric patients with ACC were enrolled. INTERVENTIONS Endaural LASIC and postoperative temporal bone computed tomography (CT). MAIN OUTCOME MEASURES Residual or recurrent CC and audiological outcomes. RESULTS LASIC was feasible in 98.0% of patients. Single-stage ossiculoplasty was performed in 95.5% of patients. Hearing preservation to less than 20 dB was 59.2% and to the preoperative hearing level was 84.5%. Mastoid invasion did not result in worse recidivism or hearing loss (HL) but further invasion of the stapes superstructure (stage IV) significantly elevated both the recidivism (16.7%) and the risk for HL (to 84.8%) (p = 0.001). Ossicle preservation LASIC was frequently possible in stage III posterior type (75.6%), whereas it was rarely possibly (15.4%) in the anterior type. Incudostapedial joint (ISJ) invasion in the absence of cochleariform process (CP) invasion (III-posterior) did not increase the incidence of HL (6.1%) or recidivism (2.4%). However, simultaneous invasion of the CP and ISJ (III-anterior) elevated the risk of HL by 46.2% by ossicle removal, although recidivism was not increased (3.8%). CONCLUSIONS Endaural LASIC for ACC achieved satisfactory recidivism (overall 7.5%, 16.7% in stage IV) comparable to early CC (17.2%). An ossicle status-based staging system was more efficient for correlation with audiologic and surgical outcomes of CC than that of mastoid invasion.
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Affiliation(s)
- Chang Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA University College of Medicine, Seongnam, Gyeonggi-do, Republic of Korea
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Pareschi R, Lepera D, Nucci R. Canal wall down approach for tympano-mastoid cholesteatoma: long-term results and prognostic factors. ACTA ACUST UNITED AC 2019; 39:122-129. [PMID: 31097831 PMCID: PMC6522862 DOI: 10.14639/0392-100x-2237] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
Abstract
The aim of this study is to analyse the long-term anatomical and functional outcomes and prognostic factors of the canal wall down (CWD) tympanoplasty for the treatment of tympano-mastoid cholesteatoma. A total of 895 patients treated for tympano-mastoid cholesteatoma with follow-up longer than 10 years were included. Recidivism (recurrent and residual) cholesteatoma rates and functional results were analysed. The rate of recidivism was 7.7% (6.7% persistence and 1% recurrent disease). Recidivism was higher in paediatric patients (10.1% versus 5.0% of adults). Pathological middle ear mucosa and pars tensa was associated with increased rates of recidivism. Postoperatively, air pure-tone-average (aPTA) ≤ 30 dB was achieved in 36.4% of patients. Of 895 patients, a revision CWD tympanoplasty for chronic otorrhoea was performed in 14 cases (1.5%) with complete recovery in all cases. Nine of those patients had a recurrence of cholesteatoma and five had cavity problems related to granulation, de-epithelisation or recurrent infection. Paediatric patients and absence of stapes superstructure were associated with the worst auditory outcomes. Six-month results were always better than long-term results. A CWD approach was demonstrated to be effective, achieving the goals of cholesteatoma treatment.
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Affiliation(s)
- R Pareschi
- Department of Otorhinolaryngology, Ospedale Nuovo di Legnano, Milan, Italy
| | - D Lepera
- Department of Otorhinolaryngology, Ospedale Nuovo di Legnano, Milan, Italy
| | - R Nucci
- Department of Otorhinolaryngology, Ospedale Nuovo di Legnano, Milan, Italy
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Abdul-Aziz D, Kozin ED, Lin BM, Wong K, Shah PV, Remenschneider AK, Landegger LD, Juliano AF, Cohen MS, Lee DJ. Temporal bone computed tomography findings associated with feasibility of endoscopic ear surgery. Am J Otolaryngol 2017; 38:698-703. [PMID: 28711236 DOI: 10.1016/j.amjoto.2017.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/10/2017] [Accepted: 06/13/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE There are no formal radiologic criteria to stratify patients for transcanal (TEES) or transmastoid endoscopic ear surgery for resection of cholesteatoma. We aim to determine 1) whether standard preoperative computed tomography (CT) findings are associated with the need for conversion to a transmastoid approach and 2) the amount of time added for conversion from TEES to transmastoid techniques. MATERIALS AND METHODS Retrospective chart review of consecutive pediatric and adult cases of TEES for primary cholesteatoma from 2013 through 2015 (n=52). TEES cases were defined as endoscope-only procedures that did not require a transmastoid approach (n=33). Conversion cases were defined as procedures that began as TEES however, required conversion to a transmastoid approach due to the inability to complete cholesteatoma removal (n=19). Preoperative CT findings and total operating room (OR) times of TEES and conversion cases were compared. RESULTS Preoperative CT scan characteristics that were associated with conversion included tegmen erosion (p=0.026), malleus erosion (p<0.001), incus erosion (p=0.009), mastoid opacification (p=0.009), soft tissue opacification extending into the aditus ad antrum (p=0.009) and into antrum (p=0.006). Total OR time for TEES cases was significantly shorter than conversion cases (median 143min versus 217min, p<0.001). CONCLUSIONS Preoperative CT findings, notably extension of soft tissue in the aditus ad antrum, antrum and mastoid, are associated with need for conversion to transmastoid technique to achieve removal of cholesteatoma. Endoscope-only cases were significantly faster than cases that required conversion to a transmastoid approach.
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Affiliation(s)
- Dunia Abdul-Aziz
- Department of Otology and Laryngology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
| | - Elliott D Kozin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
| | - Brian M Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
| | - Kevin Wong
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
| | - Parth V Shah
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
| | - Aaron K Remenschneider
- Department of Otology and Laryngology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
| | - Lukas D Landegger
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
| | - Michael S Cohen
- Department of Otology and Laryngology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
| | - Daniel J Lee
- Department of Otology and Laryngology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
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Sajjadi H. Endoscopic transcanal modified canal-wall-down mastoidectomy for cholesteatoma. World J Otorhinolaryngol Head Neck Surg 2017. [PMID: 29516060 PMCID: PMC5829304 DOI: 10.1016/j.wjorl.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Attic cholesteatoma with antral extension in tight sclerotic mastoid cavities is a common presentation that creates difficult decision-making intraoperatively. Drilling through a sclerotic and small mastoid cavity, keeping the canal wall intactis often difficult and increases the risk of serious injury. Consequently, a canal-wall-down mastoidectomy is often performed. The endoscopic transcanal modified canal-wall-down mastoidectomy approach allows the benefits of an open cavity for cholesteatoma resection and the benefits of a closed cavity for better long-term care and a more normal ear canal and middle ear reconstruction.
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Affiliation(s)
- Hamed Sajjadi
- Stanford University School of Medicine, Department of Otolaryngology-HNS, USA
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Kuo CL, Shiao AS, Chen CH, Lien CF. Multidimensional staging system for pediatric acquired cholesteatoma: A 30-year verification data. Auris Nasus Larynx 2015; 43:387-94. [PMID: 26443626 DOI: 10.1016/j.anl.2015.09.007] [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: 05/19/2015] [Revised: 08/04/2015] [Accepted: 09/08/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This article presents a points-based prognostic prediction model for pediatric acquired cholesteatoma, incorporating the multidimensional factors that contribute to surgical failure. METHODS This study included 132 ears with acquired cholesteatoma from 128 children (≤18 years) identified between 1982 and 2012. Each case was scored for the extent of the cholesteatoma, history of grommet insertion, age of the patient, ossicular destruction, and otorrhea. The patients were classified as stage I, II, or III. We compared differences between stages regarding the cumulative rates of recidivism and linear trends in these rates. RESULTS Among stage I cases, the rate of cumulative recidivism was 0%; however, among stage 2 cases, this increased with time, eventually leveling off at 15.7% after 18 years of follow-up. The same was observed among stage III cases, which leveled off at 34.1% after 17 years of follow-up. In the second half of the cohort and the entire cohort, differences in the cumulative recidivism curves reached statistical significance, as did the linear trends (all p<0.05). CONCLUSIONS Our findings demonstrate the efficacy of the proposed multidimensional staging system in linking the severity of cholesteatoma to outcomes, thereby enabling the stratification of patients according to prognosis in order to identify children at risk of recidivism.
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Affiliation(s)
- Chin-Lung Kuo
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Otolaryngology, Hsinchu Armed Force Hospital, Hsinchu, Taiwan, ROC; Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, ROC.
| | - An-Suey Shiao
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chien-Hao Chen
- ESTAT Statistical Consulting Center, Taipei, Taiwan, ROC
| | - Chiang-Feng Lien
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
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Abstract
OBJECTIVE To compare cholesteatoma recidivism rates after exclusive transcanal technique (ETC), combined transcanal and mastoidal technique (TCM, both subsets of intact canal wall technique, ICW), and canal wall down surgery (CWD). STUDY DESIGN Retrospective case review and clinical case study SETTING Tertiary referral center. PATIENTS 406 cholesteatoma surgeries (2007-2009), 116 ears in clinical re-examination at least 1 year postoperatively. INTERVENTION Sequential cholesteatoma surgery with ETC, TCM, or CWD. MAIN OUTCOME MEASURES Cholesteatoma recidivism, residual and recurrent disease, localization of recidivism, validity of clinical findings. RESULTS Out of 406 patients, ETC was performed in 227 (56%), TCM in 122 (30%), and CWD in 57 (14%) cases. Recidivism rates after ICW (15%) and CWD (16%) were almost similar. Recidivism was more frequent after ETC (11%) than after TCM (25%). Residuals were observed in 2% after ETC, 6.5% after TCM, and 7% after CWD. Incidence of recurrent disease was 9% for ETC, 18% for TCM, and 9% for CWD. Preferred localization of recidivism was the tympanic cavity after ETC (92%) and CWD (56%) and the mastoid cavity after TCM (53%). The clinical re-examination showed no further recidivistic disease. CONCLUSIONS Sequential surgery is an effective and successful strategy in cholesteatoma eradication, providing a similar recidivism rate compared to following cholesteatoma retrograde and resection of the posterior canal wall. Lower recidivism after ETC was observed as a consequence of limited disease and the postoperative middle ear status determined the higher rate of recurrence after TCM. Therefore, the restricted visualization of the middle ear during ICW surgery does not increase the rate of recidivism, compared with CWD, as described in other studies. Cholesteatoma recidivism is mainly attributed to the surgeon's experience that outweighs the chosen strategy.
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Updates and knowledge gaps in cholesteatoma research. BIOMED RESEARCH INTERNATIONAL 2015; 2015:854024. [PMID: 25866816 PMCID: PMC4381684 DOI: 10.1155/2015/854024] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 12/15/2022]
Abstract
The existence of acquired cholesteatoma has been recognized for more than three centuries; however, the nature of the disorder has yet to be determined. Without timely detection and intervention, cholesteatomas can become dangerously large and invade intratemporal structures, resulting in numerous intra- and extracranial complications. Due to its aggressive growth, invasive nature, and the potentially fatal consequences of intracranial complications, acquired cholesteatoma remains a cause of morbidity and death for those who lack access to advanced medical care. Currently, no viable nonsurgical therapies are available. Developing an effective management strategy for this disorder will require a comprehensive understanding of past progress and recent advances. This paper presents a brief review of background issues related to acquired middle ear cholesteatoma and deals with practical considerations regarding the history and etymology of the disorder. We also consider issues related to the classification, epidemiology, histopathology, clinical presentation, and complications of acquired cholesteatoma and examine current diagnosis and management strategies in detail.
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Marchioni D, Soloperto D, Rubini A, Villari D, Genovese E, Artioli F, Presutti L. Endoscopic exclusive transcanal approach to the tympanic cavity cholesteatoma in pediatric patients: our experience. Int J Pediatr Otorhinolaryngol 2015; 79:316-22. [PMID: 25631934 DOI: 10.1016/j.ijporl.2014.12.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the present study is to describe our experience in the management of tympanic cavity cholesteatoma in pediatric patients, treated with endoscopic exclusive transcanal approach. METHODS A chart review of clinical data and videos from the operations of 54 pediatric patients, undergoing surgery between January 2007 and December 2013, was made. Patients presenting with cholesteatoma involving the tympanic cavity (mesotympanum, epitympanum, protympanum and/or hypotympanum), with no mastoid involvement, were included in the first group and underwent an exclusive transcanalar endoscopic approach (TEA). In case of mastoid extension of the pathology, patients were included in the control group and underwent a canal wall up microscopic technique (CWU). RESULTS In this study, 34 males and 20 females, including 5 bilateral cases, giving a total of 59 ears, were reviewed. Median age was 9.6 years (range 4-16 years). 31 cholesteatomas underwent a TEA approach, while 28 underwent a CWU approach, based on inclusion criteria. No differences from congenital vs acquired form was made, due to the difficult to correctly distinguish always the two forms. The ossicular chain was preserved in 26.6% of patients (16 ears): 42% of patients (13 ears) undergoing a transcanal endoscopic approach and 10% of patients undergoing a canal wall up microscopic approach (3 ears) (P=0.006). Second look surgery was executed in 41.6% of patients (25 ears). In partial ossicular prosthesis reconstructions, the mean preoperative pure-tone average was 29.4dB, while the mean postoperative pure-tone average was 27.1dB, with a mean increase of 2.3dB. In total ossicular prosthesis reconstructions, the mean preoperative pure-tone average was 47.8dB, while the mean postoperative pure-tone average was 26.5dB, with a mean increase of 21.3dB. Recurrence rate was 12.9% (4 ears) for the transcanal endoscopic approach group and 17.2% (5 ears) for the canal wall up microscopic approach. Residual disease was present in 26.6%: 19.3% (6 ears) for the transcanal endoscopic approach group and 34.4% (10 ears) for the canal wall up microscopic approach. The mean follow up was 36 months (range 8-88). Kaplan-Meier analysis at 36 months showed a lower recurrence risk for the transcanal endoscopic approach compared with the canal wall up microscopic approach, but this data was not statistically significant (P=0.58). CONCLUSION The transcanal endoscopic approach represents a feasible, minimally invasive and conservative technique for the management of pediatric middle ear cholesteatoma.
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Affiliation(s)
- Daniele Marchioni
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Davide Soloperto
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy.
| | - Alessia Rubini
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Domenico Villari
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Elisabetta Genovese
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Franca Artioli
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Livio Presutti
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
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Kuo CL, Lien CF, Shiao AS. Mastoid Obliteration for Pediatric Suppurative Cholesteatoma: Long-Term Safety and Sustained Effectiveness after 30 Years' Experience with Cartilage Obliteration. Audiol Neurootol 2014; 19:358-69. [DOI: 10.1159/000363685] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/15/2014] [Indexed: 11/19/2022] Open
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A review of current progress in acquired cholesteatoma management. Eur Arch Otorhinolaryngol 2014; 272:3601-9. [PMID: 25227761 DOI: 10.1007/s00405-014-3291-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/10/2014] [Indexed: 02/03/2023]
Abstract
The aim of this study was to review recent advances in the management of acquired cholesteatoma. All papers referring to acquired cholesteatoma management were identified in Medline via OVID (1948 to December 2013), PubMed (to December 2013), and Cochrane Library (to December 2013). A total of 86 papers were included in the review. Cholesteatoma surgery can be approached using either a canal wall up (CWU) or canal wall down (CWD) mastoidectomy with or without reconstruction of the middle ear cleft. In recent decades, a variety of surgical modifications have been developed including various "synthesis" techniques that combine the merits of CWU and CWD. The application of transcanal endoscopy has also recently gained popularity; however, difficulties associated with this approach remain, such as the need for one-handed surgery, the inability to provide continuous irrigation/suction, and limitations regarding endoscopic accessibility to the mastoid cavity. Additionally, several recent studies have reported successes in the application of laser-assisted cholesteatoma surgery, which overcomes the conflicting goals of eradicating disease and the preservation of hearing. Nevertheless, the risk of residual disease remains a challenge. Each of the techniques examined in this study presents pros and cons regarding final outcomes, such that any pronouncements regarding the superiority of one technique over another cannot yet be made. Flexibility in the selection of surgical methods according to the context of individual cases is essential in optimizing the outcomes.
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Kanegaonkar RG, Whittaker M, Najuko-Mafemera A. Hearing outcomes following primary malleostapedial rotation ossiculoplasty in patients undergoing modified radical mastoidectomy. Ann R Coll Surg Engl 2014; 96:458-61. [PMID: 25198979 DOI: 10.1308/003588414x13946184902163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Treatment of cholesteatoma consists of either excision or exteriorisation of disease. Approaches have traditionally included a radical or modified radical mastoidectomy and combined approach tympanoplasty. Hearing thresholds following a modified radical mastoidectomy alone have been reported as poor. We assessed hearing outcomes in patients undergoing a primary malleostapedial reconstruction combined with their open cavity surgery. METHODS All patients undergoing open cavity mastoidectomy with primary malleostapedial rotation ossiculoplasty between 2009 and 2013 were identified. Case notes were reviewed, and demographic data, recurrence rate and audiometry were recorded. RESULTS Twenty-one patients were identified. The age range was 10-65 years. There was no evidence of recurrence of cholesteatoma. The mean postoperative air-bone gap was 20dBHL, 23dBHL, 10dBHL and 27dBHL at 0.5kHz, 1kHz, 2kHz and 4kHz respectively. Excluding cases consistent with a postoperative ossicular discontinuity (n=3), the mean postoperative air-bone gap was 15dBHL, 19dBHL, 8dBHL and 26dBHL at 0.5kHz, 1kHz, 2kHz and 4kHz respectively. CONCLUSIONS The improvement in hearing thresholds demonstrated in this cohort of patients supports the use of this form of ossiculoplasty in those undergoing open cavity procedures. This would also suggest that the subsequent use of hearing aids in these patients would require less amplification and therefore provide superior hearing outcomes. As hearing loss remains a significant concern following modified radical mastoidectomy, we suggest an open cavity with primary malleostapedial rotation ossiculoplasty as a viable alternative to modified radical mastoidectomy alone, in selected cases.
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Alvo A, Garrido C, Salas Á, Miranda G, Stott CE, Delano PH. Use of non-echo-planar diffusion-weighted MR imaging for the detection of cholesteatomas in high-risk tympanic retraction pockets. AJNR Am J Neuroradiol 2014; 35:1820-4. [PMID: 24812017 DOI: 10.3174/ajnr.a3952] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Non-echo-planar DWI MR imaging (including the HASTE sequence) has been shown to be highly sensitive and specific for large cholesteatomas. The purpose of this study was to determine the diagnostic accuracy of HASTE DWI for the detection of incipient cholesteatoma in high-risk retraction pockets. MATERIALS AND METHODS This was a prospective study of 16 patients who underwent MR imaging with HASTE DWI before surgery. Surgeons were not informed of the results, and intraoperative findings were compared against the radiologic diagnosis. Sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS Among the 16 retraction pockets, 10 cholesteatomas were diagnosed intraoperatively (62.5%). HASTE showed 90% sensitivity, 100% specificity, 100% positive predictive value, and 85.7% negative predictive value in this group of patients. We found only 1 false-negative finding in an infected cholesteatoma. CONCLUSIONS We demonstrate a high correlation between HASTE and surgical findings, suggesting that this technique could be useful for the early detection of primary acquired cholesteatomas arising from retraction pockets and could help to avoid unnecessary surgery.
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Affiliation(s)
- A Alvo
- From the Departments of Otorhinolaryngology (A.A., C.E.S., P.H.D.)
| | - C Garrido
- Radiology (C.G., A.S., G.M.), Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Á Salas
- Radiology (C.G., A.S., G.M.), Hospital Clínico Universidad de Chile, Santiago, Chile
| | - G Miranda
- Radiology (C.G., A.S., G.M.), Hospital Clínico Universidad de Chile, Santiago, Chile
| | - C E Stott
- From the Departments of Otorhinolaryngology (A.A., C.E.S., P.H.D.)
| | - P H Delano
- From the Departments of Otorhinolaryngology (A.A., C.E.S., P.H.D.)
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Rehl RM, Oliaei S, Ziai K, Mahboubi H, Djalilian HR. Tympanomastoidectomy with otoendoscopy. EAR, NOSE & THROAT JOURNAL 2013; 91:527-32. [PMID: 23288818 DOI: 10.1177/014556131209101208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A cadaveric study was performed to test the hypothesis that intact-canal-wall mastoidectomy (ICWM) with otoendoscopy allows for equal or better visualization of the middle ear cavity structures when compared with canal-wall-down mastoidectomy (CWDM) with microscopy. Ten temporal bones were prepared with a reversible canal-wall-down tympanomastoidectomy technique. Five anatomic sites in each middle ear cavity (lateral epitympanum, posterior crus of the stapes, the sinus tympani, eustachian tube orifice, and round window niche) were marked with paint. Two otolaryngologists blinded to the purpose of the study viewed the temporal bones with the microscope. Following replacement of the posterior canal walls, the bones were then viewed with a 30° and a 70° otoendoscope. All visualized paint marks for each viewing were recorded and compared. We found that ICWM with 30° or 70° otoendoscopy provided significantly better visualization of the sinus tympani than did CWDM (p ≤ 0.001). There was no significant difference among the three methods in visualization of the lateral epitympanum, posterior crus of the stapes, and round window niche. With respect to the eustachian tube orifice, one of the observers reported significantly better visualization with CWDM (p = 0.036). With adjunctive otoendoscopy, it is not necessary to remove the posterior canal wall to adequately visualize or remove disease from various areas of the middle ear cleft. The use of otoendoscopy during cholesteatoma surgery may allow for more frequent preservation of the posterior canal wall and reduced rates of residual cholesteatoma, given the equal or better visualization of the middle ear cavity.
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Affiliation(s)
- Ryan M Rehl
- California Sinus Institute, East Palo Alto, CA, USA
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Tsilis NS, Vlastarakos PV, Chalkiadakis VF, Kotzampasakis DS, Nikolopoulos TP. Chronic otitis media in children: an evidence-based guide for diagnosis and management. Clin Pediatr (Phila) 2013; 52:795-802. [PMID: 23539681 DOI: 10.1177/0009922813482041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To provide an easy-to-follow evidence-based diagnostic and therapeutic algorithm for the management of chronic otitis media (COM) in children. MATERIALS/METHODS Literature review and critical analysis of the available evidence in Medline and other scientific database sources. DATA SYNTHESIS Otorrhea and hearing loss are the cardinal symptoms of COM, while oto-microscopy and imaging techniques can confirm the diagnosis. Conservative treatment is acceptable to some extent (i.e. mild cases of COM without cholesteatoma). It involves topical drops (quinolones as first choice drugs- strength of recommendation B), as well as performing aural toilet (strength of recommendation B), and avoiding water ingress. Tympanoplasty without mastoidectomy is expected to improve hearing in cases of non-cholesteatomatous COM (strength of recommendation C), and positively affect the children's quality of life (strength of recommendation B). Less experienced surgeons and inflamed, wet middle ear mucosa represent the two most important factors, which could lead to reperforations (strength of recommendation C). The surgical management of COM with cholesteatoma tends to employ the least invasive surgical technique, in order to obtain a small self-cleaning mastoid cavity, as well as good hearing results (strength of recommendation C). CONCLUSION The treatment of choice in most cases of pediatric COM is surgery. Figure 1 proposes a detailed and easy-to-follow evidence-based algorithm with regard to the diagnosis and management of COM in children.
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Tomlin J, Chang D, McCutcheon B, Harris J. Surgical Technique and Recurrence in Cholesteatoma: A Meta-Analysis. ACTA ACUST UNITED AC 2013; 18:135-42. [DOI: 10.1159/000346140] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 11/27/2012] [Indexed: 11/19/2022]
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Cholesteatoma surgery in children: 10-year retrospective review. The Journal of Laryngology & Otology 2012; 126:450-3. [PMID: 22310087 DOI: 10.1017/s0022215111003483] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To review outcomes following paediatric cholesteatoma surgery performed between 1999 and 2009 in a tertiary paediatric ENT unit. STUDY DESIGN Retrospective case note review. RESULTS A total of 137 mastoid procedures were recorded. Fifty-four per cent of children were observed to have disease involving the entire middle-ear cleft and mastoid complex. The revision rate was 25 per cent. Time to recurrence was one to three years in 17 patients, three to six years in five patients, and six to nine years in three cases. Eight of 25 revision cases demonstrated spontaneous improvement in air conduction thresholds following primary surgery. A high facial ridge and inadequate meatoplasty correlated highly with disease recurrence. CONCLUSION Children tend to present with aggressive disease. Disease extent and ossicular chain involvement are associated with a higher risk of recurrent disease. Spontaneous improvement in hearing thresholds following cholesteatoma surgery should alert the clinician to recurrent disease.
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Posttraumatic Cholesteatoma Complicated by a Facial Paralysis: A Case Report. Case Rep Otolaryngol 2012; 2012:262958. [PMID: 22953104 PMCID: PMC3420452 DOI: 10.1155/2012/262958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 11/14/2011] [Indexed: 11/18/2022] Open
Abstract
The posttraumatic cholesteatoma is a rare complication of different types of the temporal bone damage. Its diagnosis is often done after several years of evolution, sometimes even at the stage of complications. A case of posttraumatic cholesteatoma is presented that was revealed by a facial nerve paralysis 23 years after a crash of the external auditory canal underlining the importance of the otoscopic and radiological regular monitoring of the patients with a traumatism of the temporal bone.
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Kuo CL, Shiao AS, Liao WH, Ho CY, Lien CF. Can Long-Term Hearing Preservation be Expected in Children following Cholesteatoma Surgery? Results from a 14-Year-Long Study of Atticotomy-Limited Mastoidectomy with Cartilage Reconstruction. ACTA ACUST UNITED AC 2012; 17:386-94. [DOI: 10.1159/000341985] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/19/2012] [Indexed: 02/06/2023]
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Bergeron M, Saliba I. Canal wall window mastoidectomy for extensive labyrinthine cholesteatoma: total dissection and hearing preservation. Int J Pediatr Otorhinolaryngol 2011; 75:976-9. [PMID: 21605917 DOI: 10.1016/j.ijporl.2011.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Revised: 04/20/2011] [Accepted: 04/22/2011] [Indexed: 11/27/2022]
Abstract
This case report highlights outcomes of a 6-year-old patient who preserved functional hearing after complete dissection of an extensive labyrinthine cholesteatoma causing two semicircular canals fistulas with endolymph leak, tympanic and labyrinthine fallopian canal erosion of the facial nerve and internal auditory canal invasion with cerebrospinal fluid leak. The patient preserved 40 dB average of bone conduction threshold and 92% of speech discrimination score at 26 months postoperatively. This article reveals that canal wall window mastoidectomy might be an option even in cases of extensive cholesteatomatous labyrinthine fistula therefore avoiding hearing loss and long life cleaning of a canal wall down mastoid cavity.
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Affiliation(s)
- M Bergeron
- Montreal University, Montreal, Quebec, Canada
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