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Nikam S, Vedi J, Chandankhede V, Ekhar V, Shelkar R. Comparative Study of Various Techniques of Mastoid Obliteration following Canal Wall Down Mastoidectomy. Indian J Otolaryngol Head Neck Surg 2023; 75:3457-3460. [PMID: 37974683 PMCID: PMC10645946 DOI: 10.1007/s12070-023-04018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/23/2023] [Indexed: 11/19/2023] Open
Abstract
The primary objective of mastoid obliteration is the eradication of the disease and prevention of its recurrence. We intend to evaluate the impact of mastoid obliteration using autologous materials on the achievement of a dry mastoid bowl and frequency of maintenance care and hearing outcome of the operated ear. This was a hospital-based, non - randomized, prospective study. The study was performed over a period of 2 years. The study was performed in the Department of ENT of a tertiary care teaching hospital. Patients of chronic otitis media - squamosal type underwent canal wall down mastoidectomy and patients were divided into 2 groups of obliterated and non-obliterated. The canal wall obliterated patients were further compared in 3 groups based on the technique of mastoid obliteration used - bone dust, musculo-periosteal flap and cartilage graft. 6 months post-operative mastoid cavity epithelisation based on oto-microscopy and hearing outcome based on pure tone audiometry findings were compared. Majority of patients at 6-months follow-up found that epithelization was most common status of mastoid cavity with musculoperiosteal flap and discharge was commonest with cartilage graft. Mastoid obliteration with autologous materials is a safe and effective method to achieve a dry, safe and useful ear. In this study, musculo-periosteal flap being significantly better in terms of a well epithelized cavity and hearing outcome.
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Affiliation(s)
- Surabhi Nikam
- Indira Gandhi Medical College and Hospital, Nagpur, Maharashtra 440001 India
| | - Jeevan Vedi
- Indira Gandhi Medical College and Hospital, Nagpur, Maharashtra 440001 India
| | | | - Vipin Ekhar
- Indira Gandhi Medical College and Hospital, Nagpur, Maharashtra 440001 India
| | - Ritesh Shelkar
- Indira Gandhi Medical College and Hospital, Nagpur, Maharashtra 440001 India
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Pontillo V, Ciprelli S, Grillo R, Quaranta N. Quality of life after revision mastoidectomy with mastoid obliteration. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2023; 74:352-358. [PMID: 37331626 DOI: 10.1016/j.otoeng.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/14/2023] [Indexed: 06/20/2023]
Abstract
AIMS To evaluate the postoperative quality of life (QoL) after revision canal wall down mastoidectomy with mastoid obliteration (rCWD). MATERIAL AND METHODS A retrospective analysis was conducted on patients treated by rCWD for cholesteatoma between 2016 and 2019. A control group including all patients treated by primary canal wall down with mastoid obliteration (pCWD) for cholesteatoma between 2009 and 2014 was used for the comparison of the postoperative QoL, assessed by the COMQ-12. RESULTS The rCWD and pCWD groups respectively counted 38 and 78 patients with an average follow-up of 30 and 62 months respectively. No significant difference was found in terms of QoL between the two groups. An intra-group analysis among rCWD patients, showed that patients treated by canal wall down (CWD) at the primary surgery had a significantly worse post-revision QoL compared to those initially treated by canal wall up (CWU), specifically in the hearing and balance domains of the questionnaire. CONCLUSIONS Revision mastoid obliteration leads to similar QoL results to those obtained after primary CWD with obliteration. Patients who had undergone a CWD as primary surgery complain worse hearing and balance problems compared to those primarily submitted to CWU, even after revision surgery.
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Affiliation(s)
- Vito Pontillo
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Sabino Ciprelli
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Rossella Grillo
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Nicola Quaranta
- Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Karamitsou P, Poutoglidis A, Tsetsos N, Gougousis S, Karamitsou A, Fountarlis AL, Skalias A. Quality of life after mastoid surgery. Is there a real benefit to preserving the posterior wall of the external auditory canal? A systematic review and meta-analysis. Auris Nasus Larynx 2023:S0385-8146(23)00028-7. [PMID: 36746693 DOI: 10.1016/j.anl.2023.01.008] [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: 11/06/2022] [Revised: 12/25/2022] [Accepted: 01/24/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Canal wall up (CWU) and canal wall down (CWD) mastoidectomies represent the most common cholesteatoma surgical techniques. In this meta-analysis, we compare the postoperative quality of life (QoL) in patients treated with either CWU or CWD mastoidectomy. METHODS A literature search was conducted in the following three electronic databases: Medline/PubMed, ScienceDirect, and Google Scholar. Articles were assessed for eligibility in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and data were extracted independently by two authors. Biases assessment was conducted for each study according to the Methodological Items for Non-Randomized Studies (MINORS) tool. Meta-analysis was performed for postoperative QoL following CWU versus CWD mastoidectomy. RESULTS Our systematic review included four studies that met the inclusion criteria, three prospective cohort studies, and one retrospective cohort study. The meta-analysis did not favor treatment with one of the two surgical techniques. Postoperative QoL did not show a statistically significant difference between CWU and CWD mastoidectomies (p>0.05). CONCLUSION Our systematic review and meta-analysis results indicate that QoL is not statistically significantly better among patients who underwent CWU mastoidectomies when compared with CWD. The trend of selecting CWU over CWD mastoidectomies in selected cases - for QoL purposes - is not always based on evidence-based data. The statistically insignificant difference between the two surgical techniques suggests that an initial more radical approach might prevent patients from further surgeries, without affecting postoperative QoL.
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Affiliation(s)
- Paraskevi Karamitsou
- Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Papanikolaou' General Hospital, Leoforos Papanikolaou 57010, Thessaloniki, Greece.
| | - Alexandros Poutoglidis
- Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Papanikolaou' General Hospital, Leoforos Papanikolaou 57010, Thessaloniki, Greece
| | - Nikolaos Tsetsos
- Department of Otorhinolaryngology-Head and Neck Surgery, 424 General Military Training Hospital, Periferiaki Odos N. Efkarpia 56429, Thessaloniki, Greece
| | - Spyridon Gougousis
- Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Papanikolaou' General Hospital, Leoforos Papanikolaou 57010, Thessaloniki, Greece
| | - Aikaterini Karamitsou
- Fourth Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, 'G. Papanikolaou' General Hospital, Leoforos Papanikolaou 57010, Thessaloniki, Greece
| | - Athanasios Luca Fountarlis
- Department of Otorhinolaryngology-Head and Neck Surgery, University General Hospital of Larisa, Larisa 41110, Greece
| | - Antonios Skalias
- Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Papanikolaou' General Hospital, Leoforos Papanikolaou 57010, Thessaloniki, Greece
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Liao PS, Chiu CC, Fu YH, Hsia CC, Yang YC, Lee KF, Hsieh SL, Kuo SJ. Incidence of Hip Fractures among Patients with Chronic Otitis Media: The Real-World Data. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081138. [PMID: 36013605 PMCID: PMC9416011 DOI: 10.3390/medicina58081138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022]
Abstract
Chronic otitis media (COM) has been considered as a localized disease, and its systemic impact is poorly understood. Whether COM-induced inflammation could be associated with systemic bone loss and hip fracture is unknown at present. Our study tried to determine the risk of hip fracture among COM patients. We selected the comparison individuals without the COM coding and paired the controls with COM patients by gender, age, and comorbidities (including osteoporosis) by about a one-to-two ratio. Our study showed that the incidence of hip fracture was 4.48 and 3.92 per 1000 person-years for comparison and COM cohorts respectively. The cumulative incidence of hip fracture is higher in the COM cohort (p < 0.001). After adjustment for gender, age, and comorbidities, the COM patients had a 1.11-fold (aHR = 1.11; 95% CI = 1.05−1.17) risk of hip fracture than the control subjects. Among COM patients, a history of hearing loss is associated with higher (aHR = 1.21; 95% CI = 1.20−1.42) fracture risk. Our study showed that COM patients, especially those with hearing loss, are susceptible to a higher risk for hip fracture.
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Affiliation(s)
- Pei-Shao Liao
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 404327, Taiwan
| | - Ching-Chih Chiu
- Department of Education, China Medical University Hospital, Taichung 404327, Taiwan
| | - Yi-Hsiu Fu
- Department of Education, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Chia-Chun Hsia
- Department of Education, China Medical University Hospital, Taichung 404327, Taiwan
| | - Yu-Cih Yang
- Management Office for Health Data, China Medical University Hospital, Taichung 404327, Taiwan
| | - Kun-Feng Lee
- Department of Education, China Medical University Hospital, Taichung 404327, Taiwan
| | - Shang-Lin Hsieh
- School of Medicine, China Medical University, Taichung 404328, Taiwan
- Correspondence: (S.-L.H.); (S.-J.K.)
| | - Shu-Jui Kuo
- School of Medicine, China Medical University, Taichung 404328, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404327, Taiwan
- Correspondence: (S.-L.H.); (S.-J.K.)
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高 竞, 刘 卓, 阮 标, 李 书, 江 超, 杨 晶, 陆 涛, 龙 瑞. [Evaluation of cross-sectional area and morphological value of external auditory meatus in concha plasty with I shaped incision]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:289-292. [PMID: 35511622 PMCID: PMC10128188 DOI: 10.13201/j.issn.2096-7993.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Indexed: 06/14/2023]
Abstract
Objective:To evaluate the preliminary value of the cross-sectional area and morphological changes of the external ear canal opening after the two-flap auriculoplasty through the I shaped posterior incision. Methods:One hundred and thirty-seven patients(a total of 155 ears) who received open radical mastoidectomy in the department of otolaryngology in the First Affiliated Hospital of Kunming Medical University were treated with I shaped incision and two-flap auriculoplasty. Vertical diameter(D1) and horizontal diameter(D2) of the external ear canal were measured at the completion of surgery, 1 month and 6 months post-operation, respectively. The cross-sectional area(S=1/4πD1×D2) of the external ear canal was calculated according to the two diameters. The dry ear time and intraoperative lumen epithelialization time were observed after operation. At 6 months after operation, the morphology of the external ear canal opening was analyzed. Results:The postoperative dry ear duration was 18-61 days(27.32±7.52) days. The time to complete epithelialization of the operative cavity was 24-70 days(32.18±10.36) days. Six months after the operation, the morphological classification of 155 outer ear meatal openings was as follows: 117 ears( 75.48%) were round(the difference between vertical diameter and horizontal diameter was within 2 mm); Oval(oval appearance, difference between vertical diameter and horizontal diameter greater than 2 mm) 35 ears(22.58%), triangle 3 ears(1.94%); Irregular ear canal orifice was not observed in all cases. During the operation, and at 1 month and 6 months after the operation, the cross-sectional area of the external ear canal was(2.51±0.48) cm², (2.45±0.35) cm², (2.41±0.43) cm², respectively. And no significant differences were observed. (P>0.05). Conclusion:The I shaped posterior auricular incision and two-flap auricular lumenoplasty is not compex and easy to perform. The morphology of the external ear opening is regular after the operation, which can effectively match the ventilation of the operative cavity.
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Affiliation(s)
- 竞逾 高
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 卓慧 刘
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 标 阮
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 书聆 李
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 超武 江
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 晶 杨
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 涛 陆
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 瑞清 龙
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
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Arabic Cross-Cultural Adaptation and Validation of Health-Related Quality of Life Measures for Chronic Otitis Media (COMQ-12). Otol Neurotol 2021; 42:e709-e715. [PMID: 33661241 DOI: 10.1097/mao.0000000000003098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our study aimed to translate the chronic otitis media questionnaire-12 (COMQ-12) into the Arabic language, evaluate the internal consistency of the test and test-retest reliability, and validate the adaptation for further use in Arabic studies. STUDY DESIGN A prospective observation monocenter cohort study. SETTINGS This study was done at Kafrelsheikh University Hospital, Egypt. PATIENTS One hundred twenty five ear pathology-free patients were asked to complete the questionnaire forming group A. One hundred twenty five patients with different forms of COM completed the questionnaire 2 weeks before the planned ear surgery and the same day of the operation, forming group B. Those patients who underwent the ear surgery, completed the questionnaire again 6 months after the operation forming group C. INTERVENTION We did an Arabic forward and backward translation of the original COMQ-12. The patients in group B underwent ear surgery (tympanoplasty with or without mastoidectomy). After fulfilling the questionnaire in different groups, we assessed the psychometric properties of the Arabic version of COMQ-12: internal consistency, reliability, reproducibility, validity, and responsiveness. MAIN OUTCOME MEASURES Cronbach's α was 0.973. The Spearman's rank correlation coefficient was 0.981, while the Intraclass correlation coefficient was 0.973. RESULTS A statistically significant difference was present between group A (average total score 2.38 ± 1.543) and group B (average total score 35.86 ± 5.98). Also, there was a statistically significant difference between group B and group C (average total score 7.46 ± 8.294). The calculated cut-off point of the total score was more than or equal to eight. CONCLUSION The cross-culturally Arabic adaptation of COMQ-12 was reliable, valid with strong internal consistency and responsiveness. It can detect the significant effect of COM on the quality of life of Arabic patients. This effect would be improved obviously after surgical management that markedly enhanced the preoperative hearing problem.
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Correlation of pre-operative computed tomography, intra-operative findings and surgical outcomes in revision tympanomastoidectomy. The Journal of Laryngology & Otology 2021; 134:1096-1102. [PMID: 33407963 DOI: 10.1017/s0022215120002698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To correlate pre-operative computed tomography findings, intra-operative details and surgical outcomes with cholesteatoma recurrence in revision tympanomastoidectomy. METHODS This retrospective, non-randomised, single-institution cohort study included 42 patients who underwent pre-operative computed tomography imaging and revision surgery for recurrent chronic otitis media. Twelve disease localisations noted during revision surgery were correlated with pre-operative temporal bone computed tomography scans. A matched pair analysis was performed on patients with similar intra-operative findings, but without pre-operative computed tomography scans. RESULTS Pre-operative computed tomography identified 25 out of 31 cholesteatoma recurrences. Computed tomography findings correlated with: recurrent cholesteatoma when attic opacification and ossicular chain involvement were present; and revision surgery type. Sinodural angle disease, posterior canal wall erosion and dehiscent dura were identified as predictors of canal wall down tympanomastoidectomy. Patients with pre-operative computed tomography scans had a higher rate of cholesteatoma recurrence, younger age at diagnosis of recurrent disease, more revision surgical procedures and less time between previous and revision surgical procedures (all p < 0.05). CONCLUSION Pre-operative imaging and intra-operative findings have important clinical implications in revision surgery for chronic otitis media. Performing pre-operative computed tomography increases diagnosis accuracy and reduces the time required to diagnose recurrent disease.
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Conway RM, Sioshansi PC, Howard AL, Babu SC. Perioperative cost evaluation of canal wall down mastoidectomy. Am J Otolaryngol 2020; 41:102733. [PMID: 32971408 DOI: 10.1016/j.amjoto.2020.102733] [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: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION To evaluate perioperative costs of canal wall-down (CWD) mastoidectomy as an initial surgery compared to revision surgery following initial canal wall-up (CWU) mastoidectomy. METHODS This study is a retrospective chart review of adult patients who underwent CWD mastoidectomy for chronic otitis media with or without cholesteatoma at a tertiary referral center. Patients were divided into groups that had previous CWU surgery and were undergoing revision CWD and those that were having an initial CWD mastoidectomy. Cost variables including previous surgeries, imaging costs, audiometric testing, and post-operative visits were compared between the two groups using t-test analysis. RESULTS There was no significant difference with regards to the cost of post-operative visits, peri-operative imaging, or revision surgeries between the two groups. Hearing outcomes based on mean speech reception threshold (SRT) were not statistically different between the two groups (p = 0.087). There was a significant difference in total cost with the revision group having a higher mean cost by $6967.84, most of which was accounted for by the difference in the cost of the previous surgeries of $6488.53. CONCLUSIONS The revision CWD surgery group had increased total cost that could be attributed to the cost of previous surgery. Increased peri-operative cost was not noted with the initial CWD surgery group for any individual variables examined. Initial CWD mastoidectomy should be considered in the proper patient population to help decrease healthcare costs.
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Affiliation(s)
- Robert M Conway
- Ascension Macomb-Oakland Hospital, Otolaryngology - Head & Neck Surgery, Madison Heights, MI, United States of America.
| | | | - Anthony L Howard
- Ascension Macomb-Oakland Hospital, Otolaryngology - Head & Neck Surgery, Madison Heights, MI, United States of America
| | - Seilesh C Babu
- Michigan Ear Institute, Farmington Hills, MI, United States of America
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Celis-Aguilar E, Medina-Cabrera CA, Torrontegui-Zazueta LA, Núñez-Millán BX, García-Valle CG, Ochoa-Miranda CA. Adaptation and validation of the chronic otitis media questionnaire 12 (COMQ-12) in the Mexican Spanish language (COMQ-12-Mx). Acta Otolaryngol 2020; 140:450-455. [PMID: 32125212 DOI: 10.1080/00016489.2020.1730438] [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] [Indexed: 02/02/2023]
Abstract
Background: Chronic otitis media (COM) questionnaire 12 (COMQ-12) is a specific-disease tool that evaluates COM patients.Objective: To validate COMQ-12 in the Mexican Spanish language (COMQ-12-Mx).Materials and methods: Mexican Spanish-speaking healthy volunteers and COM patients who attended a Secondary Care Center from May 2019 to October 2019. The COMQ-12 in Mexican Spanish was obtained by translation and back translation from an English-Spanish translator. All participants completed the COMQ-12-Mx questionnaire. COM patients were included regardless of their COM status. Control group completed the questionnaire twice. Participants were categorized into three groups: group 1 (COM), group 2 (volunteers first test) and group 3 (volunteers retest). Cronbach's alpha was used for internal consistency, Spearman's rank correlation coefficient was used for test-retest reliability and Mann-Whitney U test compared groups.Results: We included 78 Mexican Spanish-speaking participants (COM n = 37, healthy volunteers n = 41), 51 females and 27 males, mean age was 39.67 years (SD ± 18.32). Group 1 COMQ-12-Mx score was 22.108 ± 11.79, group 2 score was 3.561 ± 4.399 (p ≤ .001) and group 3 score was 3.683 ± 4.435. Cronbach's alpha was 0.828 and test-retest reliability achieved a 0.928 outcome.Conclusions: COMQ-12-Mx is a valid and reliable tool to evaluate quality life in Mexican Spanish-speaking patients with COM.
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Affiliation(s)
- Erika Celis-Aguilar
- Department of Otolaryngology and Neurotology, Center of Research and Teaching in Health Sciences, Civil Hospital of Culiacán, Autonomous University of Sinaloa, Sinaloa, Mexico
| | - Cindy Anahí Medina-Cabrera
- Department of Otolaryngology and Neurotology, Center of Research and Teaching in Health Sciences, Civil Hospital of Culiacán, Autonomous University of Sinaloa, Sinaloa, Mexico
| | - Luis Alejandro Torrontegui-Zazueta
- Department of Otolaryngology and Neurotology, Center of Research and Teaching in Health Sciences, Civil Hospital of Culiacán, Autonomous University of Sinaloa, Sinaloa, Mexico
| | - Blanca Xóchitl Núñez-Millán
- Resident of Otolaryngology, Center of Research and Teaching in Health Sciences. Civil Hospital of Culiacán, Autonomous University of Sinaloa, Sinaloa, Mexico
| | - César Guillermo García-Valle
- Department of Otolaryngology and Neurotology, Center of Research and Teaching in Health Sciences, Civil Hospital of Culiacán, Autonomous University of Sinaloa, Sinaloa, Mexico
| | - Carlos Andrey Ochoa-Miranda
- Department of Otolaryngology and Neurotology, Center of Research and Teaching in Health Sciences, Civil Hospital of Culiacán, Autonomous University of Sinaloa, Sinaloa, Mexico
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Hurley R, Iyer A. Cavity obliteration in revision mastoidectomy leads to dry ear and improved quality of life: Our experience in 29 patients. Clin Otolaryngol 2020; 45:604-607. [PMID: 32219983 DOI: 10.1111/coa.13532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 11/05/2019] [Accepted: 03/14/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Rhona Hurley
- Department of Otolaryngology and Head and Neck Surgery, University Hospital Monklands, Airdrie, UK
| | - Arunachalam Iyer
- Department of Otolaryngology and Head and Neck Surgery, University Hospital Monklands, Airdrie, UK
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Aljehani M, Alhussini R. The Correlation Between Preoperative Findings of High-Resolution Computed Tomography (HRCT) and Intraoperative Findings of Chronic Otitis Media (COM). CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550619870471. [PMID: 31452605 PMCID: PMC6700852 DOI: 10.1177/1179550619870471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/27/2019] [Indexed: 02/02/2023]
Abstract
Objectives: The aim of this study was to investigate the correlation between the preoperative findings of high-resolution computed tomography (HRCT) of temporal bone in chronic otitis media (COM) and the intraoperative findings. Methods: This retrospective study was conducted in the ORL-HNS Unit at Ohud Hospital, Medina, Saudi Arabia, during the period from January to September 2018. We included all patients with COM, and an informed consent was obtained from all participants. The HRCT images were studied in comparison with the intraoperative findings. The parameters of comparison were tympanic membrane, middle ear structures, and the status of cholesteatoma. Results: A total of 39 patients were included in the analysis: 14 male and 25 female patients. The age range was 9 to 50 years. As a result of the comparison between HRCT findings and intraoperative observations, we found that incus erosion through computed tomography (CT) was the same as during surgical observation in 12 cases (30.8%). Malleus appeared eroded on CT in 1 case (2.6%); however, 5 cases were seen with that observation during operation (12.8%). Cholesteatoma was similarly seen in the CT scan and during surgery with a significant relation between intraoperative cholesteatoma extending and HRCT findings of the disease (95% confidence level, P-value = 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value were 100% for detecting sigmoid plate erosion, dura exposure, incus erosion, stapes erosion, and malleus-incus joint discontinuity through preoperative CT. Conclusions: Intraoperative findings and HRCT have shown better results with good correlation of diagnostic value regarding the comparisons between recorded observations, especially in detecting sigmoidal plate erosion, dural exposure, incus and stapes erosion, and malleus-incus joint discontinuity. Preoperative CT scan is beneficial and contributory in the decision of indicating surgery to patients.
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Affiliation(s)
- Mariam Aljehani
- Department of Otorhinolaryngology, Head and Neck surgery, Ohud Hospital, Madinah, Saudi Arabia
| | - Rayan Alhussini
- Department of Otology , Neurotology and Skull base surgery ,Ohud Hospital,Madinah,Saudi Arabia
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Fonseca ACO, Ramos P, Balsalobre FA, Freitas EL, Phillips JS, Yung MW, Bento RF. Validation of a Portuguese version of the health-related quality of life measure for active chronic otitis media (COMQ-12). Braz J Otorhinolaryngol 2018; 84:708-712. [PMID: 28918976 PMCID: PMC9442823 DOI: 10.1016/j.bjorl.2017.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/04/2017] [Accepted: 08/12/2017] [Indexed: 02/02/2023] Open
Abstract
Introduction Objective Methods Results Conclusion
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Affiliation(s)
| | - Pedro Ramos
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil
| | - Fernando A Balsalobre
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Edson L Freitas
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - John S Phillips
- Norfolk & Norwich University Hospital, Department of Otolaryngology-Head and Neck Surgery, Norwich, United Kingdom
| | - Matthew W Yung
- Ipswich Hospital, Department of Otolaryngology-Head and Neck Surgery, Ipswich, United Kingdom
| | - Ricardo F Bento
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
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Sood D, Rana L, Chauhan R, Shukla R, Nandolia K. Superior semicircular canal dehiscence: A new perspective. Eur J Radiol Open 2017; 4:144-146. [PMID: 29234688 PMCID: PMC5717502 DOI: 10.1016/j.ejro.2017.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/22/2017] [Accepted: 10/30/2017] [Indexed: 02/02/2023] Open
Abstract
Objective To determine the use of multi-detector computed tomography (MDCT) in the diagnostic interpretation of superior semicircular canal dehiscence (SSCD) or thinning and its association with ear pathologies and to find whether it is an acquired condition and its association with increase in age. Materials and methods study was performed in a tertiary care institute present in a village, following approval of the institutional ethical committee. Retrospective review of temporal bone CT examinations performed between September 2016 and March 2017 was done. 1 mm interval axial images with sagittal and coronal reformatted images were reviewed for the presence of canal dehiscence and thinning by investigators. We characterised the Superior semicircular canal status as normal, frank dehiscence or thinning. Frank dehiscence was further classified anatomically as anterior limb, apex and posterior limb dehiscence.The patient list was then subcategorized into 5 age groups, and the prevalence of SSCD was calculated for each group. Results Retrospective review yielded 80 positive cases which included SSC dehiscence (N = 39) and thinning (N = 41). 80 normal scans were selected as control group retrospectively. Statistical analysis was performed to assess for differences between the groups studied. Pearson chi-square test applied. there was a significant association of SSC pathologies prevalence with increasing age (p = < 0.001). No significant relationship was found between SSCD and presence of either CSOM or Cholesteatoma (p = 0.285). Vertigo rather than Tullio phenomenon was the statistically significant complaint (p = <0.001). which brought the patient to the hospital. Conclusions The SSCD and thinning belong to the same spectrum and are acquired conditions. Increasing prevalence in old age suggests it to be an acquired condition rather than a congenital one. No significant association of these condition was seen with CSOM and cholesteatoma. Vertigo is the predominat symptom bringing the patient to hospital along with Tullio phenomenon.
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Affiliation(s)
- Dinesh Sood
- Department of Radiodiagnosis DRPGMC, Tanda, Kangra, H.P., India
| | - Lokesh Rana
- Department of Radiodiagnosis DRPGMC, Tanda, Kangra, H.P., India
| | - Raman Chauhan
- Department of PSM, DRPGMC, Tanda, Kangra, H.P., India
| | - Roshni Shukla
- Department of Radiodiagnosis DRPGMC, Tanda, Kangra, H.P., India
| | - Khanak Nandolia
- Department of Radiodiagnosis DRPGMC, Tanda, Kangra, H.P., India
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Vos J, de Vey Mestdagh P, Colnot D, Borggreven P, Orelio C, Quak J. Bioactive glass obliteration of the mastoid significantly improves surgical outcome in non-cholesteatomatous chronic otitis media patients. Eur Arch Otorhinolaryngol 2017; 274:4121-4126. [PMID: 28956143 DOI: 10.1007/s00405-017-4757-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 09/21/2017] [Indexed: 11/28/2022]
Abstract
This retrospective follow-up study evaluates the efficacy and safety of bioactive glass (BAG) S53P4 when applied as filler material in mastoid obliteration surgery performed on non-cholesteatomatous chronic otitis media (NC-COM) patients with chronically discharging ears despite conservative therapy. 94 Patients (96 ears) were included. Patients underwent either intact canal wall (ICW) or canal wall down (CWD) mastoid surgery between 2005 and 2015. The intervention group comprised 23 patients (23 ears) who were treated with additional mastoid obliteration using BAG S53P4; the remaining 71 patients (73 ears) were considered controls. All patients underwent preoperative CT scanning of the mastoid. Primary functional outcome, as defined by control of suppuration, was assessed using Merchant's scale. Hearing results as measured by air-bone gap and the incidence of adverse events were assessed as secondary outcomes. Thirty-two ears (44%) in the control group (n = 73) achieved complete control of infection at the most recent postoperative clinic visit vs 17 (74%) in the S53P4 obliteration group (n = 23). Comparing these outcomes yielded an odds ratio (OR) of 3.6 (p = 0.012, 95% CI 1.3-10.3). Complete failure to manage infection significantly differed (p = 0.048) between the control group (11 ears; 15%) and the S53P4 obliteration group (0 ears). No adverse events were observed in either group. Pre- and postoperative ABG results did not differ significantly between groups. Obliteration of the mastoid cavity using BAG S53P4 along with mastoidectomy in patients with chronically discharging NC-COM significantly improves the achievement of a dry and safe ear as compared to mastoidectomy alone. Importantly, no adverse events were observed with S53P4 BAG obliteration.
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Affiliation(s)
- Joris Vos
- Department of Otorhinolaryngology and Head and Neck Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Pieter de Vey Mestdagh
- Department of Otorhinolaryngology and Head and Neck Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - David Colnot
- Department of Otorhinolaryngology and Head and Neck Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Pepijn Borggreven
- Department of Otorhinolaryngology and Head and Neck Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Claudia Orelio
- Diakademie Research Support, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Jasper Quak
- Department of Otorhinolaryngology and Head and Neck Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
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Kanzara T, Virk JS, Owa AO. Meatoplasty: A novel technique and minireview. World J Otorhinolaryngol 2016; 6:50-53. [DOI: 10.5319/wjo.v6.i3.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/29/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
We describe a modified aural meatoplasty technique. The technique has been mainly used for mastoid surgery but it may also be used to address other causes of meatal stenosis. It involves removing most of the cartilage in the conchal bowl and soft tissue in the external auditory meatus. Cartilage from the helical root may also be sacrificed as part of this procedure. Our technique produces an excellent cosmetic result and an adequate meatoplasty which is easy to monitor in the outpatient setting.
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Abstract
OBJECTIVE To evaluate the impact of mastoid obliteration on the achievement of a dry mastoid bowl and frequency of maintenance care. STUDY DESIGN Retrospective chart review. SETTING Academic medical center. PATIENTS There were 63 canal-wall-down mastoidectomies for chronic otitis media with or without cholesteatoma between 2007 and 2014 with follow-up of at least 6 months. Eighteen mastoids were nonobliterated and 45 were obliterated. Thirteen underwent secondary obliteration of existing mastoid bowls with chronic drainage, whereas 32 underwent primary obliteration at the original canal-wall-down procedure. INTERVENTION Mastoid obliteration. MAIN OUTCOME MEASURES Achievement of a dry healed mastoid cavity and frequency of outpatient visits. RESULTS In more than 80% of the cases, a dry ear was achieved, with no significant difference between the obliterated and nonobliterated cases (p = 0.786). Eleven of the 13 secondary cases experienced cessation of otorrhea, achieving dry ears at rates similar to that of the primary and nonobliterated cases. The secondary obliteration population was also significantly younger than the primary group (22.1 versus 43.5 years, p = 0.002). Multivariable-mixed effects analysis demonstrated a reduction in 0.1 visits per 6-month period following surgery overtime (p < 0.001). CONCLUSIONS Mastoid obliteration may be valuable in the management of the well-developed and chronically wet mastoid cavity, particularly when the drainage emanates from mucosal disease or cell tracts in a deep sinodural angle. Younger patients may require secondary obliteration because of continued craniofacial maturation several years following canal-wall-down surgery.
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Li S, Meng J, Zhang F, Li X, Qin Z. Revision surgery for canal wall down mastoidectomy: intra-operative findings and results. Acta Otolaryngol 2015; 136:18-22. [PMID: 26406779 DOI: 10.3109/00016489.2015.1092170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
CONCLUSION Canal wall down mastoid surgery following multiple earlier surgical failures can be revised by a well-trained experienced surgeon. A dry and safe ear is obtainable in most patients, and hearing preservation is also possible. OBJECTIVES To analyze the intra-operative findings in revision surgery for canal wall down (CWD) mastoidectomy and to ascertain the prognosis. METHODS A total of 76 revision mastoidectomies with tympanoplasties performed from March 2008 to May 2014 at the First Affiliated Hospital of Zhengzhou University in China were reviewed. The pre-operative, intra-operative, and post-operative data was recorded and analyzed. RESULTS The possible reason of previous surgical failures were confirmed by the operative findings, which included inadequate mastoidectomy or persistent air-cell disease (66/76 [86.8%]), recurrent or persistent cholesteatoma (44/76 [57.9%]), excessive opened cavity combined with complications (9/76 [11.8%]), and infected cavities (68/76 [89.5%]). In this study, disease control was achieved in 70 (92.1%) patients. Complications following previous surgery were modified by revision surgery. Hearing was significantly improved in the 54 cases with ossicular replacement prosthesis. After a mean follow-up of 22 months, the group of revision surgery with ossiculoplasty as a whole experienced a statistically significant hearing gain of 16.57 ± 11.96 dB (p < 0.05) at air conduction pure tone average (PTA).
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Affiliation(s)
- Sujuan Li
- a Department of Otology , the First Affiliated Hospital of Zhengzhou University , Zhengzhou , Henan , PR China
| | - Juan Meng
- a Department of Otology , the First Affiliated Hospital of Zhengzhou University , Zhengzhou , Henan , PR China
| | - Fan Zhang
- a Department of Otology , the First Affiliated Hospital of Zhengzhou University , Zhengzhou , Henan , PR China
| | - Xiaohua Li
- a Department of Otology , the First Affiliated Hospital of Zhengzhou University , Zhengzhou , Henan , PR China
| | - Zhaobing Qin
- a Department of Otology , the First Affiliated Hospital of Zhengzhou University , Zhengzhou , Henan , PR China
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Shape of the Osseous External Auditory Canal and Its Relationship to Troublesome Cavities. Laryngoscope 2015; 126:693-8. [DOI: 10.1002/lary.25474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 02/02/2023]
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Park M, Lee JS, Lee JH, Oh SH, Park MK. Prevalence and risk factors of chronic otitis media: the Korean National Health and Nutrition Examination Survey 2010-2012. PLoS One 2015; 10:e0125905. [PMID: 25978376 PMCID: PMC4433353 DOI: 10.1371/journal.pone.0125905] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/21/2015] [Indexed: 02/02/2023] Open
Abstract
Background The performance of nationwide studies of chronic otitis media (COM) in adults has been insufficient in Korea. We evaluated the prevalence and risk factors of COM in Korea. Methods This study was conducted using data from the fifth Korean National Health and Nutrition Examination Survey (n = 23,621). After excluding the subjects under 20 year old and suffered from cancers, 16,063 patients were evaluated for COM. Participants underwent a medical interview, physical examination, endoscopic examination, and blood and urine test. COM was diagnosed by trained residents in the Department of Otorhinolaryngology using an ear, nose, and throat questionnaire and otoendoscopy findings. Data on the presence and absence of COM were collected. Multivariate logistic regression analyses were performed to identify its risk factors. Results Of the 16,063 participants aged above 20 year old, the weighted prevalence of COM was 3.8%. In the multivariate analyses, the following factors showed high odds ratios (ORs) for COM: pulmonary tuberculosis (adjusted OR, 1.78; 95% confidence interval [CI], 1.06-3.01), chronic rhinosinusitis (adjusted OR, 1.87; 95% CI, 1.17-2.98), mild hearing impairment (adjusted OR, 1.95; 95% CI, 1.34-2.85), moderate hearing impairment (adjusted OR, 4.00; 95% CI, 2.21-7.22), tinnitus (adjusted OR, 1.82; 95% CI, 1.34-2.49), increased hearing thresholds in pure tone audiometry in the right ear (adjusted OR, 1.02; 95% CI, 1.01-1.03), and left ear (adjusted OR, 1.03; 95% CI, 1.02-1.04). The following factors showed low odds ratios for COM: hepatitis B (adjusted OR, 0.28; 95% CI, 0.08-0.94) and rhinitis (adjusted OR, 0.60; 95% CI, 0.42-0.88). In addition, high levels of vitamin D, lead, and cadmium, EQ-5D index; and low red blood cell counts were associated with development of COM (Student’s t-test, P < 0.01). Conclusions Our population-based study showed that COM is not rare in Korea, and its development may be associated with various host and environmental factors. Further research on its relationships and the pathogenesis are needed.
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Affiliation(s)
- Mina Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
- * E-mail:
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The one-cut meatoplasty: novel surgical technique and outcomes. Am J Otolaryngol 2015; 36:130-5. [PMID: 25456511 DOI: 10.1016/j.amjoto.2014.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/04/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE To present the surgical technique and clinical outcomes of a novel modification to conventional meatoplasty. MATERIALS AND METHODS All consecutive patients undergoing canal wall down tympanomastoidectomy incorporating the one-cut meatoplasty technique between January 2009 and February 2013 were evaluated. Primary outcome measures included meatal stenosis requiring revision surgery, frequency of drainage beyond 2months postoperatively and results of a composite patient questionnaire incorporating the Chronic Ear Survey. RESULTS Twenty-eight of 36 (78%) eligible patients completed a questionnaire and were included. All ears underwent canal wall down tympanomastoidectomy utilizing the one-cut meatoplasty technique. At a mean follow-up of 38.0months, the average Chronic Ear Survey score was 78.6±2.6 points. There was only one case of postoperative meatal stenosis. Intermittent otorrhea developed in 14.3% of cases but was remedied by conservative measures including in-office cleaning, ototopical therapy and water precautions. Eighty-nine percent of patients denied any self-consciousness about the aesthetic appearance of the ear. CONCLUSIONS The one-cut meatoplasty is an effective alternative to traditional techniques that is simple to perform. The results of the Chronic Ear Survey indicate that the one-cut meatoplasty supports a stable and healthy, open cavity with functional results that compare favorably to other series evaluating canal wall down tympanomastoidectomy with traditional meatoplasty. Additionally, patients report high satisfaction with the appearance of their ear, and all hearing aid users could continue to utilize a hearing aid without feedback, pain, or other difficulties related to poor fitting.
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Radiographic features of superior semicircular canal dehiscence in the setting of chronic ear disease. Otol Neurotol 2014; 35:91-6. [PMID: 24136312 DOI: 10.1097/mao.0b013e3182a03522] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if radiologic chronic otitis media (COM), both with and without cholesteatoma, is associated with superior semicircular canal dehiscence (SSCD). STUDY DESIGN Retrospective review of consecutive high-resolution computed tomography (HRCT) scans of the temporal bone. SETTING Tertiary care medical center. PATIENTS Two hundred consecutive patients undergoing HRCT of the temporal bone beginning January 1, 2012. INTERVENTION Imaging was evaluated by 3 reviewers (2 neuroradiologists and 1 neurotologist). All scans were assessed for the presence of SSCD, cholesteatoma, chronic otomastoiditis, tegmen dehiscence, and for abnormalities of the cochlea, vestibule, facial nerve, and temporal bone vasculature. MAIN OUTCOME MEASURE Ears with COM associated with chronic otomastoiditis or cholesteatoma were compared with those without COM with respect to the presence of SSCD or other temporal bone abnormalities. Statistical analysis was performed to assess for differences between the groups studied. RESULTS One-hundred ninety-four patients (388 ears) were included. Cholesteatoma was identified in 48 ears (12.4%) and chronic otomastoiditis in 62 ears (16%). Ten ears with cholesteatoma had ipsilateral SSCD, and 8 ears with chronic otomastoiditis had ipsilateral SSCD. In 340 ears without either cholesteatoma or chronic otomastoiditis, SSCD was found in 18 (5.3%). SSCD was found to occur significantly more often in patients with ipsilateral radiologic cholesteatoma. No cases of SSCD were associated with cochlear, facial nerve, or vascular abnormalities. CONCLUSION Our findings suggest that COM with cholesteatoma is associated with the presence of SSCD, although the nature of this association is unclear.
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Sarin J, Grénman R, Aitasalo K, Pulkkinen J. Bioactive Glass S53P4 in Mastoid Obliteration Surgery for Chronic Otitis Media and Cerebrospinal Fluid Leakage. Ann Otol Rhinol Laryngol 2012; 121:563-9. [DOI: 10.1177/000348941212100901] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objectives: We evaluated the results of cases of chronic otitis media treated with mastoid obliteration surgery using bioactive glass S53P4. Methods: Twenty-five patients with chronic otitis media and 1 patient with cerebrospinal fluid leakage without chronic infection were treated with bioactive glass S53P4. Twenty patients had had previous surgery because of chronic otitis media with or without cholesteatoma. A mastoid obliteration was performed with bioactive glass S53P4 granules and a musculoperiosteal flap with or without bone paté. In 2 patients with a bony dehiscence at the middle cranial fossa, a bioactive glass plate was used to support the protruding dura. In addition, in 3 patients, occlusion of a dural fistula was needed. The median follow-up period was 34.5 months (range, 1 to 182 months). Results: Excluding the 2 patients with only 1 month of follow-up at our department, 96% of the patients had a dry, safe ear or only intermittent otorrhea. In 92% of the patients, the objective of achieving a smaller or nonexistent cavity was achieved. Conclusions: Bioactive glass S53P4 is a noteworthy material in mastoid obliteration surgery.
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Galectin-7 as a marker of cholesteatoma residue and its detection during surgery by an immunofluorescent method--a preliminary study. Otol Neurotol 2012; 33:396-9. [PMID: 22377647 DOI: 10.1097/mao.0b013e3182488021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To visualize the distribution of galectin-7 in middle ear cholesteatomas using an immunofluorescent method and to establish whether galectin-7 can be used as a marker of cholesteatoma residue at the time of operation. METHODS Middle ear cholesteatomas were obtained at surgery from 30 patients. Samples were frozen and preserved in a freezer until histological study. After serial sectioning with a cryostat, 2 of the specimens were processed with primary antibody and Zenon rabbit immunoglobulin G labeling kits. After sufficient reaction time, the samples were observed using a confocal laser microscope. In the remaining 28 specimens, the cholesteatoma was treated as 1 block and stained with the same solution. It was then observed using a fluorescent stereomicroscope. RESULTS Confocal microscopic analyses showed that galectin-7 was distributed in the cholesteatoma matrix. Because this area strongly stained green, it was easily recognized using a confocal laser microscope. In the stereomicroscopic study using the 1-block specimen in which the cholesteatoma was processed together with the surrounding granulation and mucosal tissue, only the matrix and overlying debris was yellow-green in response to excitation by light; the surrounding granulation and mucosal tissues did not respond in 7 specimens. In the remaining 21 specimens, the whole sample was composed of cholesteatoma and responded well to excitation by light. These findings suggest that galectin-7 might be a useful marker of cholesteatoma residue that can be visualized using this immunofluorescent method. CONCLUSION Because residual cholesteatoma matrix is considered to be one of the main causes of cholesteatoma recurrence, staining with galectin-7 at the time of operation would be a promising way to facilitate complete removal of the residue.
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Stankovic KM, Juliano AF, Hasserjian RP. Case records of the Massachusetts General Hospital. Case 36-2010. A 50-year-old woman with pain and loss of hearing in the left ear. N Engl J Med 2010; 363:2146-56. [PMID: 21105797 DOI: 10.1056/nejmcpc1000967] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Salami A, Mora R, Dellepiane M, Crippa B, Guastini L. Results of revision mastoidectomy with Piezosurgery(®). Acta Otolaryngol 2010; 130:1119-24. [PMID: 20377507 DOI: 10.3109/00016481003716536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
CONCLUSION For otologic revision surgery, the advantage of the piezoelectric device appears real because it is possible to perform a 'blind' cutting of bone with fewer precautions necessary for soft tissues such as the facial nerve, lateral sinus, and dura mater. OBJECTIVES The aim of this study was to determine the efficiency of the piezoelectric device in revision surgery for chronic otitis media. METHODS A total of 30 patients had revision mastoidectomy with previous canal wall up mastoidectomy. The piezoelectric device was used in all intraoperative steps. Before surgery and 1 month and 1 year after surgery, all the patients underwent the following instrumental examinations: pure-tone audiometry, tympanometry, transient-evoked otoacoustic emissions, distortion product otoacoustic emissions, auditory brainstem response, and electronystamographic recording. RESULTS The piezoelectric device provided effective cutting, with excellent control and without side effects on the adjacent structures of the middle and inner ear (lateral sinus, facial nerve, and/or dura mater). Postoperatively, all patients had an uneventful recovery with no evidence of audiovestibular deficit or side effects. Among 30 cases followed for 1 year, 29 (97%) maintained a dry and safe ear. Intermittent otorrhea with perforation of the tympanic membrane occurred in one patient (3%).
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Berçin >S, Kutluhan A, Bozdemir K, Yalçiner G, Sari N, Karameşe Ö. Results of revision mastoidectomy. Acta Otolaryngol 2009; 129:138-41. [PMID: 18607914 DOI: 10.1080/00016480802140893] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
CONCLUSIONS Successful canal wall down (CWD) mastoidectomy requires removal of all diseased air cells, lowering of the facial ridge to the mastoid segment of the facial nerve, complete removal of the lateral epitympanic wall, and amputation of the mastoid tip. Additionally, the inferior canal wall should be lowered to adequately expose the hypotympanum, which allows a smooth transition into the mastoid cavity. An adequate meatoplasty is also necessary. Closed supratubal recess should be opened, anulus and tympanic membrane remnant should be removed in CWD cases. Revision mastoidectomy has a high success rate in obtaining a dry and epithelialized ear. OBJECTIVE This study reports revision mastoidectomy results and indicates factors that must receive attention in chronic otitis media surgery to produce less revision surgery. PATIENTS AND METHODS Thirty-five patients who underwent revision mastoidectomy with or without cholesteatoma between 2005 and 2008 were analyzed retrospectively. Patients who had revision mastoidectomy with previous intact canal wall (ICW) or CWD mastoidectomies were included in the study. RESULTS Patients were aged 32-69 years (mean 57.4). There were 22 female and 13 male patients. Revision mastoidectomies were applied to 14 previous ICW and 21 prior CWD mastoidectomies. Of the 35 patients, 24 patients had cholesteatoma and 11 of them did not. Of the patients who had revision surgery, 10 had ICW mastoidectomy and 25 had CWD mastoidectomy. After revision mastoidectomy, at 3-25 months follow-up (mean 16.7 months), 29 patients had been successfully treated; they had dry well epithelialized cavity, with no findings of persistent, recurrent discharge or granulation tissue and cholesteatoma. In 21 patients in whom revision CWD mastoidectomy was performed, causes of failure of previous ear surgery in order of frequency were recurrent or persistent cholesteatoma and narrow meatoplasty (80.9%), persistent sinodural angle air cells and close supratubal recess (71.4%), high facial ridge and inadequate canalplasty (66.7%), persistent tegmental air cells and tympanic membrane remnant (57.1%), persistent mastoid apex air cells and open eustachian orifice (52.4%). Causes of failure after our revision ICW mastoidectomy in order of frequency were persistent or recurrent cholesteatoma (78.6%), closed supratubal recess (64.3%), persistent sinodural angle air cells, inadequate canalplasty and persistent mastoid apex air cells (57.1%), persistent tegmental air cells (42.9%).
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