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Hosoya M, Kurihara S, Koyama H, Komune N. Recent advances in Otology: Current landscape and future direction. Auris Nasus Larynx 2024; 51:605-616. [PMID: 38552424 DOI: 10.1016/j.anl.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/24/2023] [Accepted: 02/21/2024] [Indexed: 05/12/2024]
Abstract
Hearing is an essential sensation, and its deterioration leads to a significant decrease in the quality of life. Thus, great efforts have been made by otologists to preserve and recover hearing. Our knowledge regarding the field of otology has progressed with advances in technology, and otologists have sought to develop novel approaches in the field of otologic surgery to achieve higher hearing recovery or preservation rates. This requires knowledge regarding the anatomy of the temporal bone and the physiology of hearing. Basic research in the field of otology has progressed with advances in molecular biology and genetics. This review summarizes the current views and recent advances in the field of otology and otologic surgery, especially from the viewpoint of young Japanese clinician-scientists, and presents the perspectives and future directions for several topics in the field of otology. This review will aid next-generation researchers in understanding the recent advances and future challenges in the field of otology.
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Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Sho Kurihara
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi Minato-ku, Tokyo, 105-8471, Japan
| | - Hajime Koyama
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8654, Japan
| | - Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1Maidashi Higashi-ku, Fukuoka 812-8582, Japan
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Sacchetto L, Raguso G, Confuorto G, Arietti V, Torroni L, Marchioni D, Nocini R. A comparison between endoscopic and microscopic approaches for stapes surgery: experience of a tertiary referral center. Eur Arch Otorhinolaryngol 2024; 281:2959-2965. [PMID: 38158420 DOI: 10.1007/s00405-023-08411-0] [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: 10/03/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Otosclerosis is a common ear disease causing ankylosis of the stapedio-vestibular joint and conductive hearing loss. Stapedoplasty is the most advisable surgical solution. The restoration of hearing depends on the condition of the patient and the surgery itself. The aim of our work was to compare the surgical and audiological results of stapedoplasty performed with endoscopic versus microscopic technique. METHODS This is a retrospective study of 254 patients treated with stapedoplasty with a microscopic approach (91/254) or with an endoscopic approach (163/254) between 2014 and 2021 at our tertiary referral center. Statistical significance of differences between the two methods was determined using the Mann-Whitney test for quantitative variables and the Wilcoxon matched-pairs signed-rank test for repeated measures. Categorical variables were assessed with Fisher's exact test. RESULTS Both techniques improved the hearing status of patients, with no statistically significant difference between them. There was also no statistically significant difference in reported complications between the two techniques. There is a statistical difference (p < 0.001) in operating time between the two techniques: the endoscopic technique had a mean operating time of 39 min versus 45 min for the microscopic technique. CONCLUSIONS The two techniques are comparable in terms of results and the choice depends on the surgeon's preferences and experience.
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Affiliation(s)
- L Sacchetto
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy
| | - G Raguso
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy
| | - G Confuorto
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy
| | - V Arietti
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy.
| | - L Torroni
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - D Marchioni
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - R Nocini
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy
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Uğurlu BN, Aktar Uğurlu G. Exploring trends and developments in cholesteatoma research: a bibliometric analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08749-z. [PMID: 38809268 DOI: 10.1007/s00405-024-08749-z] [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: 02/26/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Examination of the scientific literature on cholesteatoma from past to present using bibliometric methods. METHODS A total of 2353 articles on cholesteatoma between 1980 and 2023 were obtained from the Web of Science database and statistically analysed using bibliometric techniques. RESULTS The journals with the highest number of contributions to the literature were Otology & Neurotology (n = 192), Acta Oto-Laryngologica (156) and Laryngoscope (149). The most impactful journals based on h-index and total citation (TC) counts were Laryngoscope (h:36, TC: 4241), Otology & Neurotology (29, 3141), and American Journal of Otology (26, 2071) respectively. The most prolific author was Kojima H. (n = 49). According to the findings of the Reference Publication Year Spectroscopy (RPYS) analysis, there has been a significant increase in academic interest in Cholesteatoma since its first description in 1959, particularly following the expansion of its definition in 1977. Subsequently, the trend of increased interest has risen rapidly in later years, with notable peaks in research intensity observed in 1989, 2006, and 2011. The highest academic trend occurred in 2006. In recent years, trending topics have included innovative approaches such as diagnostic and imaging methods particularly alongside technological developments, endoscopic surgery, recurrence and complications, prognosis and quality of life, artificial intelligence, and obliteration. CONCLUSION In conclusion, the evolution of cholesteatoma and its research priorities reveal temporal shifts and emerging areas of interest over time. Primarily, diagnosis, treatment, and surgical approaches remain central. Additionally, research has expanded to encompass developments in surgical techniques, imaging modalities, cellular biology, pathology, and molecular mechanisms.
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Affiliation(s)
- Burak Numan Uğurlu
- Private Practitioner, Otolaryngology, Çorum, Turkey.
- Department of Otorhinolaryngology, Faculty of Medicine , Hitit University, Çorum, Turkey.
| | - Gülay Aktar Uğurlu
- Department of Otorhinolaryngology, Faculty of Medicine , Hitit University, Çorum, Turkey
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Fontana V, Sinosi FA, Marchioni D, Masotto B. Transcanal transpromontorial approach for vestibular schwannoma: experience of a single center. Eur Arch Otorhinolaryngol 2024; 281:2679-2690. [PMID: 38519593 DOI: 10.1007/s00405-024-08565-5] [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: 09/08/2023] [Accepted: 02/16/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The expanded transpromontorial transcanal approach (ExpTTA) represents a recent addition to the surgical approaches available for the treatment of vestibular schwannoma. An initial purely endoscopic version has been complemented by the use of the microscope and it is now one of the possible surgical options for small to medium-sized vestibular schwannomas with a predominantly intracanalar development. METHODS This is a series of 54 patients who underwent microsurgical resection of sporadic, unilateral vestibular schwannoma, mainly Koos I-II with non-serviceable hearing, between January 2016 and January 2023 using the expanded transcanal transpromontorial approach. We describe the surgical technique, focusing on anatomical landmarks, and analyzing its advantages and shortcomings. Retrospective analysis of clinical outcomes is presented, including early and late complications. The mean follow-up was 46.7 months. RESULTS We achieved gross total resection of the lesion in all cases, confirmed on the first follow-up MRI at least 6 months after each procedure. We did not record any intraoperative complication nor disease recurrence. We recorded two postoperative severe facial nerve palsies, one of which was permanent. No cases of disabling vertigo or imbalance were reported, and all patients reported full recovery of autonomy in daily activities. Three cases of otoliquorrhea were managed conservatively successfully. CONCLUSIONS The transcanal transpromontorial approach combines the advantages of endoscopy with the possibilities provided by microsurgery. Our experience confirms its safety in terms of surgical complications and facial nerve outcome. This approach is amongst the treatment options for small-medium schwannomas in patients with impaired hearing, especially in young patients, ensuring radical resection, disease control, and minimal morbidity.
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Affiliation(s)
- Vincenzo Fontana
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy, Ospedale Civile Maggiore Verona, Verona, Italy.
| | - F A Sinosi
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy, Ospedale Civile Maggiore Verona, Verona, Italy
| | - D Marchioni
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - B Masotto
- Posterior Cranial Fossa Unit, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Civile Maggiore Verona, Verona, Italy
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Phanbuh DS, Meher R, Singh I, Taneja HC, Wadhwa V, Kumar J. Endoscopic Assessment of Cholesteatoma Following Microscope Assisted Tympano: Mastoidectomy: Study design: a cross section descriptive study. Indian J Otolaryngol Head Neck Surg 2024; 76:726-733. [PMID: 38440500 PMCID: PMC10908918 DOI: 10.1007/s12070-023-04263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/04/2023] [Indexed: 03/06/2024] Open
Abstract
Complete surgical removal of cholesteatoma has been traditionally performed by microscopic approaches. In recent years, use of endoscopes in middle ear surgery is gaining increasing importance. The wide field view offered by the endoscopes in comparison to the narrow field of view of the binocular microscope enables a surgeon to see and dissect around corners, thereby exposing 'hidden recesses' of the middle ear which can be useful during cholesteatoma surgery. To identify remnant cholesteatoma in difficult access sites of the middle ear cleft using endoscopes following a microscope assisted mastoidectomy. A cross sectional study was conducted in patients who were clinically diagnosed with cholesteatoma. Patients were subjected to High Resolution Computed Tomography of the temporal bone and pre-operative audiological tests. Mastoid exploration was performed microscopically followed by endoscopic evaluation and clearance of disease in the same setting. Patients were then followed up post-operative and endoscopically evaluated to look for any remnant disease. A total of 45 patients were included, all of which underwent microscopic assisted mastoidectomy. Remnant cholesteatoma was discovered in 15 out of 45 cases (33%) distributed in the hidden areas; in the region of sinus tympani 9(60%), anterior epitympanum 4(27%), hypotympanum 1(7%) and tip Cells 1(7%). It can be concluded that endoscopes have a definite role in evaluation and complete surgical clearance of cholesteatoma particularly from the hidden areas of middle ear cleft which would have otherwise been missed by the straight line view of a microscope thereby grossly reducing the rate of remnant disease. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04263-6.
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Affiliation(s)
- Daphylla Shisha Phanbuh
- Department of Otorhinolaryngology, Maulana Azad Medical College and Lok Nayak Hospital, LNJP Colony, New Delhi, Delhi 110002 India
| | - Ravi Meher
- Department of Otorhinolaryngology, Maulana Azad Medical College and Lok Nayak Hospital, LNJP Colony, New Delhi, Delhi 110002 India
| | - Ishwar Singh
- Department of Otorhinolaryngology, Maulana Azad Medical College and Lok Nayak Hospital, LNJP Colony, New Delhi, Delhi 110002 India
| | - Harish Chandra Taneja
- Department of Otorhinolaryngology, Maulana Azad Medical College and Lok Nayak Hospital, LNJP Colony, New Delhi, Delhi 110002 India
| | - Vikram Wadhwa
- Department of Otorhinolaryngology, Maulana Azad Medical College and Lok Nayak Hospital, LNJP Colony, New Delhi, Delhi 110002 India
| | - Jyoti Kumar
- Department of Radiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Gopal A. Evaluation of Medial Retrotympanum by High-Resolution Computed Tomography and Endoscopy - A Descriptive Study. Indian J Otolaryngol Head Neck Surg 2024; 76:477-484. [PMID: 38440614 PMCID: PMC10908987 DOI: 10.1007/s12070-023-04187-1] [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: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 03/06/2024] Open
Abstract
The aim of this study was to determine and compare the capability of the High-Resolution Computed Tomography (HRCT) and endoscope in detecting hidden areas of medial retrotympanum in cases with chronic otitis media (COM). Per-operative endoscopic evaluation of structures in medial retrotympanum was done in 74 patients suffering from COM and was compared with pre-operative HRCT of the temporal bone in 50 patients. HRCT revealed type-A Sinus Tympani (ST) in 61.2%, type-B in 34.7%, and type-C in 4.1% of the patients; endoscope could reveal type-A in 71.6%, type-B in 25.7% and type-C in 1.4% of the patients. Ponticulus was discovered in 84.1%, subiculum in 100%, finiculus in 97.3% and sinus subtympanicus (SST) in 100% of the cases using endoscope. HRCT could detect ponticulus in 38.6% and subiculum in 4.0% of the cases. HRCT could not very clearly detect finiculus and SST. HRCT could not differentiate the content of the ST as compared with endoscopy. HRCT is a useful diagnostic tool in predicting the presence and type of ST, but its accuracy in detecting SST, finer bony ridges of ponticulus, subiculum, and finiculus and the contents is poorer than endoscope.
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Affiliation(s)
- Aarthi Gopal
- Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203 Uttarakhand India
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Beckmann S, Hool SL, Yacoub A, Hakim A, Caversaccio M, Wagner F, Anschuetz L. Accuracy of High-Resolution Computed Tomography Compared to High-Definition Ear Endoscopy to Assess Cholesteatoma Extension. Otolaryngol Head Neck Surg 2023; 169:1276-1281. [PMID: 37418100 DOI: 10.1002/ohn.413] [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: 03/05/2023] [Revised: 05/10/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To correlate radiographic evidence of cholesteatoma in the retrotympanum with intraoperative endoscopic findings in cholesteatoma patients and to evaluate the clinical relevance of radiographic evidence of cholesteatoma in the retrotympanum. STUDY DESIGN Case series with chart review. SETTING Tertiary referral center. METHODS Seventy-six consecutive cases undergoing surgical cholesteatoma removal with preoperative high-resolution computed tomography (HRCT) were enrolled in this study. A retrospective analysis of the medical records was conducted. The extension of cholesteatoma regarding different middle ear subspaces, into the antrum and mastoid were reviewed radiologically in preoperative HRCT and endoscopically from surgical videos. Additionally, facial nerve canal dehiscence, infiltration of the middle cranial fossa, and inner ear involvement were documented. RESULTS Comparison of radiological and endoscopic cholesteatoma extension revealed statistically highly significant overestimation of radiological cholesteatoma extension for all retrotympanic regions (sinus tympani 61.8% vs 19.7%, facial recess 69.7% vs 43.4%, subtympanic sinus 59.2% vs 7.9%, and posterior sinus 72.4% vs 4.0%) and statistically significant overestimation for mesotympanum (82.9% vs 56.6%), hypotympanum (39.5% vs 9.2%), and protympanum (23.7% vs 6.6%). No statistically significant differences were found for epitympanum (98.7% vs 90.8%), antrum (64.5% vs 52.6%), and mastoid (26.3% vs 32.9%). Statistically significant radiological overestimation of facial nerve canal dehiscence (54.0% vs 25.0%) and invasion of tegmen tympani (39.5% vs 19.7%) is reported. CONCLUSION Radiologic cholesteatoma extension in different middle ear subspaces is overestimated compared to the intraoperative extension. The preoperative relevance of radiological retrotympanic extension might be limited in the choice of approach and transcanal endoscopic approach is always recommended first.
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Affiliation(s)
- Sven Beckmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sara-Lynn Hool
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Abraam Yacoub
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Arsany Hakim
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bianchini AJ, Berlitz VG, Mocelin AG, Ribeiro JF, Keruk JG, Hamerschmidt R. Endoscopic or Microscopic Tympanoplasty Advantages and Disadvantages: A Theory Domain Systematic Review. Int Arch Otorhinolaryngol 2023; 27:e528-e535. [PMID: 37564466 PMCID: PMC10411212 DOI: 10.1055/s-0042-1748808] [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: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 10/17/2022] Open
Abstract
Introduction Tympanoplasty is a reparative surgery that has multiple indications. The aid of a microscope or an endoscope is necessary to carry out the procedure. The classic method utilizes the microscope; however, in the recent decades, the endoscope has been popular. Although many articles try to compare these two techniques, there is still no robust evidence that confirms the superiority of either technique. In the present work, we seek to perform a systematic review contribute with this. Objectives The present systematic review attempted to compare endoscopic and microscopic surgery techniques and to discover whether there would be superiority in the results of any of them, based on data currently available in the literature. Data Synthesis The objectives of the present review were organized according to the PICO planning and strategy adapted for systematic reviews. The inclusion and exclusion criteria were established aiming to select only select primary data. The main medical databases were searched using an optimized search string with appropriate descriptors. The searched databases were MEDLINE, LILACS, SciELO, and EMBASE. A total of 99 studies were selected and 38 were fully assessed after the inclusion criteria were applied. All included articles were reviewed by all authors and their results were discussed and summarized. Conclusion The endoscopic technique was shown to be a safer technique comparable in effectiveness to the use of microscopy. In addition, it provides possible advantages such as shortening the surgical time and better postoperative pain outcomes.
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Affiliation(s)
- Ana Júlia Bianchini
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - Vitória Gabriela Berlitz
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - Aurenzo Gonçalves Mocelin
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - Juliana Ferraz Ribeiro
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - João Gabriel Keruk
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - Rogério Hamerschmidt
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
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Stefan I, Stefanescu CD, Vlad AM, Zainea V, Hainarosie R. Postoperative Outcomes of Endoscopic versus Microscopic Myringoplasty in Patients with Chronic Otitis Media-A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1074. [PMID: 37374278 DOI: 10.3390/medicina59061074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
Endoscopes are increasingly being used in middle ear surgery as an adjunct to or replacement for the operative microscope. The superior visualization of hidden areas and a minimally invasive transcanal approach to the pathology are some of the endoscope's advantages. The aim of this review is to compare the surgical outcomes of a totally endoscopic transcanal approach with a conventional microscopic approach for type 1 tympanoplasty in patients with chronic otitis media (COM) in order to establish if endoscopic myringoplasty (EM) could be a better alternative to microscopic myringoplasty (MM). A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. The selected articles were identified by searching PubMed Central, PubMed, MEDLINE and Embase databases for the relevant publications. Only studies where the same surgeon in the department performed both endoscopic and microscopic myringoplasty have been included in the review. The results suggest that with an endoscopic approach, minimally invasive myringoplasty can be achieved with a similar graft success rate and postoperative air-bone gap (ABG) improvement, a shorter operative time and less postoperative complications compared to a microscopic approach.
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Affiliation(s)
- Iemima Stefan
- Medical Center of Special Telecommunications Service, 060044 Bucharest, Romania
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
| | - Cristian Dragos Stefanescu
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Ana Maria Vlad
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Viorel Zainea
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Răzvan Hainarosie
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
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Khan MM, Parab SR, Rana AK, Kumar S. Portable Gas Spring with Rachet and Pinion System as a Third Arm for Holding Endoscope in Two Handed Endoscopic ENT Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:73-78. [PMID: 37206714 PMCID: PMC10188770 DOI: 10.1007/s12070-022-03246-3] [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: 09/03/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
The role of endoscope has been changing from that being an adjuvant during microear surgery to the exclusive endoscopic middle ear surgery. However the only disadvantage of endoscopic ear surgery is its single handed technique as the non-dominant hand is used to hold the endoscope. We propose the concept and design of our portable endoscope holder for two handed endoscopic ear surgery. It is based on the gas spring action and rack and pinion system which act as a third arm to hold the endoscope. The novel portable endoscope holder bears the potential to provide benefits for various two handed endoscopic ear nose and throat surgeries. Level of evidence: Level V. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03246-3.
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Affiliation(s)
- Mubarak Muhamed Khan
- Sushrut ENT Hospital and Dr. Khan’s Research Center, Talegaon Dabhade, India
- Department of Otolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | | | - Amit Kumar Rana
- Shri Ram Murti Smarak Institute of Medical Sciences (SRMS IMS), Bareilly, India
| | - Shivesh Kumar
- ENT Career Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh India
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11
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Svistushkin VM, Mukhamedov IT, Varosyan EG, Eremeeva KV, Mokoyan ZT. [Anatomical factors of temporal bone residual cholesteatoma: our experience]. Vestn Otorinolaringol 2023; 88:80-85. [PMID: 37184559 DOI: 10.17116/otorino20228802180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The article describes clinical cases of invasive cholesteatoma of the temporal bone pyramid, leading to a massive destruction of the surrounding structures. Paying attention to the importance of knowing the microsurgical anatomy of critical structures of temporal bone (the anterior bony plate (cog), the tensor tympani fold and the tendon, the tympanic orifice of the eustachian tube, the pretympanic recess, tympanic sinuses) bearing a significance and helping to improve the removal of the invasive cholesteatoma.
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Affiliation(s)
- V M Svistushkin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - I T Mukhamedov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E G Varosyan
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - K V Eremeeva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Zh T Mokoyan
- Sechenov First Moscow State Medical University, Moscow, Russia
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12
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Variability of the retrotympanum and its association with mastoid pneumatization in cholesteatoma patients. Eur Arch Otorhinolaryngol 2023; 280:131-136. [PMID: 35695918 DOI: 10.1007/s00405-022-07465-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE This study aimed to investigate the variability of the retrotympanum in patients undergoing surgical treatment for cholesteatoma. METHODS We included 59 ears of patients undergoing middle ear surgery for cholesteatoma who had preoperative computed tomography scans. A retrospective analysis of the medical records was conducted. The sinus tympani (ST), subtympanic sinus (STS) and facial recess (FR) were classified into types A-C based on the relationship of their extension to the facial nerve. The mastoid and petrous apex were assessed and categorized as normal pneumatized or sclerotic. RESULTS Type A extension was the most frequently found in all sinuses (ST 64%, FR 77%, STS 69%), Type B extension was found more often in ST (34%) and STS (24%) than in FR (15%). A very deep extension was found only rarely (ST 2%, FR 8%, STS 7%). A sclerotic mastoid was found in 67% of cases. Those cases showed a statistically significant difference regarding retrotympanum pneumatization when compared with normal mastoid. CONCLUSION The most frequent variant of retrotympanic pneumatization in relation to the facial nerve was type A in all subsites in cholesteatoma patients. The variability among patients with cholesteatoma is different to previously published results in healthy subjects. Moreover, the pneumatization of the retrotympanum is associated with mastoid pneumatization.
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Tu LJ, Fina M, Golub JS, Kazahaya K, Quesnel AM, Tawfik KO, Cohen MS. Current Trends in Endoscopic Ear Surgery. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e023. [PMID: 38516579 PMCID: PMC10950159 DOI: 10.1097/ono.0000000000000023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/21/2022] [Indexed: 03/23/2024]
Affiliation(s)
- Leona J. Tu
- Drexel University College of Medicine, Philadelphia, PA
| | - Manuela Fina
- Department of Otolaryngology—Head and Neck Surgery, University of Minnesota, Minneapolis, MN
| | - Justin S. Golub
- Department of Otolaryngology—Head and Neck Surgery, Valegos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Ken Kazahaya
- Division of Pediatric Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Alicia M. Quesnel
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Kareem O. Tawfik
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael S. Cohen
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
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Nair S, Aishwarya JG, Vasu PK, Karthikeyan A, Shalini M. Outcomes of Totally Endoscopic Versus Microscopic Techniques in Middle Ear Cholesteatoma: A Systematic Review and Meta-Analysis. Indian J Otolaryngol Head Neck Surg 2022; 74:4200-4211. [PMID: 36742509 PMCID: PMC9895727 DOI: 10.1007/s12070-021-02869-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023] Open
Abstract
Endoscopes have revolutionized the field of otology for the past two decades due to its minimally invasive technique and improved visualization. The advantage of endoscope during surgery for middle ear cholesteatoma both for diagnosing and aiding in removal of residual disease from the hidden areas and the resulting lower recurrence rates have been proven in the past by many authors. But the feasibility of totally endoscopic ear surgery and its surgical and patient related outcomes are yet to be explored in detail. We conducted this systematic review and meta-analysis to compare the surgical and patient related outcomes between totally endoscopic and microscopic technique in cases of acquired middle ear cholesteatoma. This meta-analysis has been conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Search engines used to identify the eligible articles were Pubmed, Web of Science, Cochrane Library, Virtual Health Library databases. The studies that compared the outcomes of microscopic and endoscopic techniques in case of acquired middle ear cholesteatoma and with more than 10 patients were included. Outcomes like recurrence, residual disease, graft uptake rate, audiological outcome, conversion rate, pain score, surgery duration, complications and quality of life outcomes were compared.The quality of the included studies was assessed by Methodological Index for Non-randomized studies criteria in case of non-randomized studies and by means of Cochrane Risk of Bias Tool in case of randomized controlled studies. A random effects model was used to calculate pooled estimates. The ODDS ratio and 95% confidence interval were calculated. The heterogeneity among the studies was represented by the Q statistic and Higgins I2 statistic. The test for overall effect was calculated by Z test and a p value of < 0.05 was considered as statistically significant. 11 studies were included in this meta-analysis. Out of 11 included studies, 4 were prospectively designed and 7 were retrospective studies. The overall effect showed recurrence rate (Z:2.69, P:0.007) was lower among endoscopic technique. Post-operative pain was less among the endoscopic technique and there was no difference between the groups with respect to surgical duration. Although endoscopic technique showed lower residual rate and post-operative vertigo with better graft success rate among the individual studies, the overall analysis showed that the difference was not statistically significant. Endoscope has been an invaluable tool in the cholesteatoma surgery over the past 20 years due to its excellent optics and minimally invasive technique. Evaluation of the present data available in the literature reveals that both the techniques have similar outcomes except for a definite advantage of endoscopic technique in reducing the recurrence and post-operative discomfort.
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Affiliation(s)
- Satish Nair
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | - J. G. Aishwarya
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | - Pooja K. Vasu
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | | | - Martina Shalini
- Department of Community Health, Bangalore Baptist Hospital, Bangalore, Karnataka India
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Learning Curve of Two Handed Endoscopic Ear Surgery on Sheep Temporal Bone: A Fellow’s Perspective. Indian J Otolaryngol Head Neck Surg 2022; 74:550-558. [PMID: 36032876 PMCID: PMC9411402 DOI: 10.1007/s12070-021-02388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 11/26/2022] Open
Abstract
The study puts forth the learning curve of two handed endoscopic middle ear dissection on a sheep temporal bone. It also highlights the usage of sheep temporal bone as an effective simulation technique for two-handed cadaveric temporal bone dissection. 6 sheep temporal bone models were dissected in a period of 15 days. Harvesting of cartilage graft, endoscopic myringotomy and grommet insertion, cartilage butterfly tympanoplasty, ossiculoplasty, stapes surgery and facial nerve decompression, using the Endohold®, were conducted on each bone. There was a remarkable decrease in the time required for subsequent temporal bone dissections, with significant improvement in efficiency, accuracy and neatness of dissection. Practice and experience resulted in upliftment in the level of confidence of the fellow. Striking similarities were noticed between sheep and human temporal bones. Availability of both the hands with a clear endoscopic view made it easier and more convenient to perform various procedures. Two handed endoscopic technique provides an excellent approach for ear surgeries. Availability of both the hands for the delicate surgery along with the spectacular endoscopic view contributes to increase in efficiency and surgery outcome. Cadaveric dissection of sheep temporal bones provides a great learning experience for a trainee to practice these delicate and skilful two-handed endoscopic middle ear surgical exercises. Its easy availability and striking similarity of the anatomy makes it a boon for the beginners. It gives ample opportunity to the trainee to explore and learn the complex anatomy, try new skills and develop an expertise in this field. The efficiency and accuracy increases significantly with each dissection, smoothening out the steep learning curve, that is, for such fine and intricate surgical skills.
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Audiometric Outcomes Comparing Endoscopic Versus Microscopic Ossiculoplasty. Otol Neurotol 2022; 43:820-826. [PMID: 35802898 DOI: 10.1097/mao.0000000000003577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess endoscopic and microscopic ossiculoplasty audiometric outcomes. STUDY DESIGN Retrospective review. SETTING Tertiary academic center. PATIENTS Adult patients who underwent ossiculoplasty with either partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP) from 2010 to 2019 with at least 1 year of audiometric follow-up were included. INTERVENTIONS Endoscopic or microscopic ossiculoplasty. MAIN OUTCOME MEASURES Postoperative air-bone gap (ABG) after at least 1 year. RESULTS A total of 198 patients, 53.5% female, and a median age of 47.5 years, met inclusion criteria. 64.1% of patients were reconstructed with a PORP, and 31.8% were reconstructed using an endoscopic approach. The median audiometric follow-up was 27 months. The median postoperative ABG was 16.9 dB overall, 15.6 dB for PORP reconstruction, and 19.4 dB for TORP reconstruction (PORP versus TORP, p = 0.002). For TORP reconstructions, the median ABG for both endoscopic and microscopic TORP was 19.4 dB (p = 0.92). For PORP reconstructions, the median ABG for endoscopic PORP was 12.3 dB compared with 16.3 dB for microscopic PORP (p = 0.02). Using multivariate linear regression to predict postoperative PORP ABG, and controlling for age, prior ossiculoplasty, middle ear mucosal disease (granulation, fibrosis, polyposis), middle ear atelectasis, myringitis, contralateral middle ear disease, and use of byte prostheses, endoscopic PORP reconstruction was associated with improvement in ABG over the microscopic approach by 4.4 dB (p = 0.04). CONCLUSIONS For PORP ossiculoplasty procedures, endoscopic ossiculoplasty is associated with improved postoperative ABG compared with microscopic ossiculoplasty.
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Topographic Anatomy of the Medial Labyrinthine Wall: Implications for the Transcanal Endoscopic Approach to the Internal Auditory Canal. Otol Neurotol 2022; 43:e671-e678. [PMID: 35761464 DOI: 10.1097/mao.0000000000003530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
HYPOTHESIS To characterize transcanal endoscopic landmarks of the medial labyrinthine wall and correlate these with anatomical features of the fundus of the internal auditory canal (IAC). BACKGROUND The transcanal transpromontorial approach (TTA) enables minimally invasive access to the IAC. The establishment of a landmark-based dissection technique for the approach is crucial to avoid injury to the facial nerve. METHODS Twenty temporal bones were dissected endoscopically through the TTA. Furthermore, high-resolution computed tomography (CT) scans from ten adult normal temporal bones were analyzed and three-dimensionally reconstructed. RESULTS A stepwise dissection technique for the TTA was demonstrated depending on a newly described landmark used in the identification of the facial nerve. The proposed landmark, which was named the intervestibulocochlear crest (IVCC), is an integrated part of the otic capsule. It can be differentiated after the excision of the lateral labyrinthine wall as a laterally based bony pyramid between the cochlea and the vestibule. Its medially directed apex blends with the central part of the falcifrom crest and points to the distal part of the meatal facial nerve. The IVCC is best detected on axial CT images at the level of the tympanic facial nerve. The union between the IVCC and the falciform crest appears radiologically as a short stem or mini-martini glass. CONCLUSION The proposed IVCC is a novel landmark with a consistent relationship to the IAC fundus and the facial nerve. It may be utilized in conjunction with the falciform crest to identify the facial nerve during minimally invasive transcanal surgeries.
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Celik O, Ulkumen B. Endoscopic versus microscopic ossiculoplasty: Does the functional outcome vary according to the type of osciculoplasty? Braz J Otorhinolaryngol 2022; 89:213-221. [PMID: 35428604 PMCID: PMC10071538 DOI: 10.1016/j.bjorl.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 12/05/2021] [Accepted: 02/14/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare functional outcome of microscopic and endoscopic approach regarding type of ossiculoplasty. METHODS In this retrospective study, cases who had undergone type-II and type-III tympanoplasty between February 2007 to September 2019 were divided into two groups according to the type of approach as microscopic and endoscopic. In cases with type-II reconstruction; Partial Ossicular chain Replacement Prosthesis (PORP), incus interposition and bone cement were used in order of frequency. Whereas in cases with type-III reconstruction, only Total Ossicular chain Replacement Prosthesis (TORP) was used. The average Air Bone Gap (ABG) was determined pre- and post-operatively for the calculation of Air Conductance Gain (ACG). The ACG, pre- and post-operative ABG values of each group were compared with regard to the type of ossiculoplasty. RESULTS A total of 79 cases consisting of 32 females and 47 males who had undergone type-II and type-III tympanoplasty were enrolled. No statistically significant difference between microscopic and endoscopic approach was found in terms of ACG (p = 0.42), pre-(p = 0.23) and postoperative ABG (p = 0.99). We did not find any significant difference in terms of ACG, pre- and postoperative ABG between two approaches for type-II and type-III reconstructions (p > 0.05). CONCLUSIONS According to the current study, endoscopic approach in type-II and type-III reconstruction is at least reliable as microscopic approach regarding functional outcome. Since both techniques have similar functional results, other factors (anatomic characteristics, habitude of the surgeon and duration of the surgery) should be considered when choosing the technique. LEVEL OF EVIDENCE In the current paper we present a retrospective comparative study of two different approaches of a particular type of otologic surgery. Level of evidence corresponds to level III.
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Affiliation(s)
- Onur Celik
- Manisa Celal Bayar University, Department of Otorhinolaryngology, Manisa, Turkey
| | - Burak Ulkumen
- Manisa Celal Bayar University, Department of Otorhinolaryngology, Manisa, Turkey.
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Suda S, Kitamura M, Kawaida M, Fujioka M, Ozawa H. A Case Report of a Middle Ear Mass Originated From Cartilage-like Tissue Treated With Transcanal Endoscopic Ear Surgery. EAR, NOSE & THROAT JOURNAL 2021:1455613211065510. [PMID: 34904447 DOI: 10.1177/01455613211065510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Middle ear tumors are relatively rare, and among them, the diagnoses of middle ear lesions originating from cartilage-like tissue are even rarer. Use of transcanal endoscopic ear surgery (TEES) has increased in recent years because of its advantages, such as clear visual field and minimally invasive procedure. Here, we report a middle ear mass originating from cartilage-like tissue treated with TEES. A 62-year-old woman presented with progressive right-sided hearing loss. A white mass was revealed through the tympanic membrane, and pure-tone audiometry detected a mean 50.0 dB conductive hearing loss. Computed tomography showed a mass in the tympanic cavity. TEES was performed for diagnosis and treatment. A white translucent tumor was observed intraoperatively, and it was completely resected. Histopathological examination confirmed the diagnosis of a mass originating from degenerated cartilage-like tissue. To the best of our knowledge, this is the first study of a middle ear mass originating from cartilage-like tissue treated with TEES. TEES with its clear visual field and precise techniques was beneficial in treating the middle ear lesions circumscribed in the tympanic cavity.
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Affiliation(s)
- Satoshi Suda
- Department of Otorhinolaryngology, Head and Neck Surgery, 12869Keio University School of Medicine, Tokyo, Japan
- Department of Otorhinolaryngology, 37013Sano Kosei General Hospital, Sano-shi, Japan
| | - Mitsuru Kitamura
- Department of Otorhinolaryngology, Head and Neck Surgery, 12869Keio University School of Medicine, Tokyo, Japan
- Department of Otorhinolaryngology, 84175Saiseikai Yokohamashi Tobu Hospital, Yokohama-shi, Japan
| | - Miho Kawaida
- Department of Pathology, 12869Keio University School of Medicine, Tokyo, Japan
| | - Masato Fujioka
- Department of Otorhinolaryngology, Head and Neck Surgery, 12869Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology, Head and Neck Surgery, 12869Keio University School of Medicine, Tokyo, Japan
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Veleur M, Lahlou G, Torres R, Daoudi H, Mosnier I, Ferrary E, Sterkers O, Nguyen Y. Robot-Assisted Middle Ear Endoscopic Surgery: Preliminary Results on 37 Patients. Front Surg 2021; 8:740935. [PMID: 34692763 PMCID: PMC8527038 DOI: 10.3389/fsurg.2021.740935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Endoscopy during middle ear surgery is advantageous for better exploration of middle ear structures. However, using an endoscope has some weaknesses as surgical gestures are performed with one hand. This may trouble surgeons accustomed to using two-handed surgery, and may affect accuracy. A robot-based holder may combine the benefits from endoscopic exposure with a two-handed technique. The purpose of this study was to assess the safety and value of an endoscope held by a teleoperated system. Patients and Methods: A case series of 37 consecutive patients operated using endoscopic exposure with robot-based assistance was analyzed retrospectively. The RobOtol® system (Collin, France) was teleoperated as an endoscope holder in combination with a microscope. The following data were collected: patient characteristics, etiology, procedure type, complications, mean air and bone conduction thresholds, and speech performance at 3 months postoperatively. Patients had type I (myringoplasty), II (partial ossiculoplasty), and III (total ossiculoplasty) tympanoplasties in 15, 14, and 4 cases, respectively. Three patients had partial petrosectomies for cholesteatomas extending to the petrous apex. Finally, one case underwent resection of a tympanic paraganglioma. Ambulatory procedures were performed in 25 of the 37 patients (68%). Results: Complete healing with no perforation of the tympanic membrane was noted postoperatively in all patients. No complications relating to robotic manipulation occurred during surgery or postoperatively. The mean air conduction gain was 3.8 ± 12.6 dB for type I (n = 15), 7.9 ± 11.4 dB for type II (n = 14), and −0.9 ± 10.8 for type III tympanoplasties (n = 4), and the postoperative air-bone conduction gap was 13.8 ± 13.3 dB for type I, 19.7 ± 11.7 dB for type II and 31.6 ± 13.0 dB for type III tympanoplasty. They was no relapse of cholesteatoma or paraganglioma during the short follow-up period (<1 year). Conclusion: This study indicates that robot-assisted endoscopy is a safe and trustworthy tool for several categories of middle ear procedures. It combines the benefits of endoscopic exposure with a two-handed technique in middle ear surgery. It can be used as a standalone tool for pathology limited to the middle ear cleft or in combination with a microscope in lesions extending to the mastoid or petrous apex.
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Affiliation(s)
- Marine Veleur
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France
| | - Ghizlene Lahlou
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France.,Inserm/Pasteur UMR 1120 "Innovative Technologies and Translational Therapeutics for Deafness", Hearing Institute Paris, Paris, France
| | - Renato Torres
- Inserm/Pasteur UMR 1120 "Innovative Technologies and Translational Therapeutics for Deafness", Hearing Institute Paris, Paris, France
| | - Hannah Daoudi
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France
| | - Isabelle Mosnier
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France.,Inserm/Pasteur UMR 1120 "Innovative Technologies and Translational Therapeutics for Deafness", Hearing Institute Paris, Paris, France
| | - Evelyne Ferrary
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France.,Inserm/Pasteur UMR 1120 "Innovative Technologies and Translational Therapeutics for Deafness", Hearing Institute Paris, Paris, France
| | - Olivier Sterkers
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France.,Inserm/Pasteur UMR 1120 "Innovative Technologies and Translational Therapeutics for Deafness", Hearing Institute Paris, Paris, France
| | - Yann Nguyen
- ENT Department, Sorbonne University, AP-HP, GHU Pitié-Salpêtrière, GRC Robot and Surgery's Innovation, Paris, France.,Inserm/Pasteur UMR 1120 "Innovative Technologies and Translational Therapeutics for Deafness", Hearing Institute Paris, Paris, France
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A Novel Three-Dimensional Robot Arm Steered Camera for Ear Surgery. J Craniofac Surg 2021; 32:e672-e676. [PMID: 34705372 DOI: 10.1097/scs.0000000000007858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Ear surgery requires magnified imaging of anatomical structures from its beginning to achieve safe and successful surgical outcomes. The historical evolution of magnification in otology has developed from monocular to binocular, and to three-dimensional and even to digital in modern times. Current technological advancements pursue high-quality visualization for the best surgical outcomes but also ergonomic for surgeons. Here, we evaluated the usability of such new technology in common otological surgeries like cochlear implantation and stapedectomy for the first time in patients. A three-dimensional camera mounted to a robot arm has hands-free control by goggles worn by the surgeon on a head mount. The camera at a distance of the patients but can also be draped in a sterile way that it forms a barrier tent between patient and surgical personnel in the theatre. The main reason to evaluate the feasibility of this new exoscope was driven by COVID-19 obligate measures for elective surgery such as hearing restoration. This new technology can be considered an important advantage for the surgeons working in microsurgery to perform their elective operations without aerosolization of the drill rinsing water possibly containing contaminated tissue. From a subjective point of view, the image quality is equivalent to conventional microscopes to provide safe otologic surgery.
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Abstract
Because endoscopic technology has matured over the past several decades, ear surgeons have increasingly used endoscopy to address some of the limitations of operative microscopy. The wide field of view and high-resolution images provided by endoscopes allow for improved visualization of the tympanic cavity using minimally invasive surgical portals compared with the standard operative binocular microscope. The endoscope is becoming an essential tool in the otologist's armamentarium. In this article, the authors discuss rationale for endoscopic ear surgery, terminology and classification, surgical indications, essential equipment, surgical ergonomics, and practical steps to incorporate endoscopic ear surgery into practice.
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Isaacson B, Killeen DE, Bianconi L, Marchioni D. Endoscopic Assisted Lateral Skull Base Surgery. Otolaryngol Clin North Am 2021; 54:163-173. [PMID: 33243373 DOI: 10.1016/j.otc.2020.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pathology of the lateral skull base poses a unique challenge for the surgeon. An intimate knowledge of the anatomy and the various approaches used for accessing pathology of the lateral skull base is critical. Three novel, minimally invasive, transcanal approaches for the management of lateral skull base pathology are described herein along with their respective indications, advantages, and disadvantages.
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Affiliation(s)
- Brandon Isaacson
- Department of Otolaryngology, UT Southwestern Medical Center, 2001 Inwood Road, Dallas, TX 75390-9035, USA.
| | - Daniel E Killeen
- Department of Otolaryngology, UT Southwestern Medical Center, 2001 Inwood Road, Dallas, TX 75390-9035, USA
| | - Luca Bianconi
- ENT Department, University Hospital of Verona, Piazzale Aristide Stefani, 1, Verona 37126, Italy
| | - Daniele Marchioni
- ENT Department, University Hospital of Verona, Piazzale Aristide Stefani, 1, Verona 37126, Italy
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Abstract
The introduction of the microscope to ear surgery by Wullstein has been a transformative event in ear surgery. The ability to visualize disease and anatomy has resulted in more effective surgery and better functional outcomes. Many surgical disciplines have adapted the endoscope as the instrument of choice to access and correct internal pathology without disruption of overlying tissue. Multiple discussions and attempts at using the endoscope in ear surgery over the years have culminated in the development of transcanal endoscopic ear surgery. This article discusses the integration of the endoscope into the practice of otologic surgery.
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Affiliation(s)
- Muaaz Tarabichi
- Tarabichi Stammberger Ear and Sinus Institute, PO Box 73101, 143 Umm Suqiem Road, Dubai, United Arab Emirates.
| | - Zainab Arsiwala
- Department of Otolaryngology, American Hospital Dubai, PO Box 5566, Oud Metha, Dubai, United Arab Emirates
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Correlation between functional outcome and the SAMEO-ATO framework. Eur Arch Otorhinolaryngol 2021; 279:2881-2888. [PMID: 34309753 PMCID: PMC9072504 DOI: 10.1007/s00405-021-07000-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/13/2021] [Indexed: 11/08/2022]
Abstract
Purpose To evaluate the recently proposed SAMEO-ATO framework for middle ear and mastoid surgery, by correlating it with the functional outcome in a large cohort of patients operated for middle ear and mastoid cholesteatoma in a tertiary referral center. Methods We retrospectively included all surgeries for middle ear and mastoid cholesteatoma undergone in our Department between January 2009 and December 2014, by excluding revision surgeries, congenital and petrous bone cholesteatoma. All surgeries were classified according to the SAMEO-ATO framework. The post-operative air bone gap (ABG) was calculated and chosen as benchmark parameter for the correlation analysis. Results 282 consecutive surgeries for middle ear and mastoid cholesteatoma were released in the study period on a total of 273 patients, with a mean age of 41.2 years. All patients were followed for an average period of 55.3 months. 54% of patients underwent M2c mastoidectomy (Canal Wall Down, CWD), while the remaining underwent Canal Wall Up (CWU) procedures, being M1b2a mastoidectomy the most common one (33%). Mean pre-operative and post-operative ABGs were 29.2 and 23.5 dB, with a significant improvement (p < 0.0001). ‘Mastoidectomy’ and ‘Ossicular reconstruction’ parameters of SAMEO-ATO showed significant association with postoperative ABG, with smaller residual gaps for the classes Mx and On, and worse hearing results for M3a and Ox. Conclusion Our results show the utility of SAMEO-ATO framework, and in particular of ‘M’ (Mastoidectomy) and ‘O’ (Ossicular reconstruction) parameters, in predicting the hearing outcome.
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A Novel Instrument for Endoscopic Ear Surgery With a Steerable Flexible Tip: A Pediatric Anatomical Validation Study. Otol Neurotol 2021; 42:e1683-e1690. [PMID: 34238900 DOI: 10.1097/mao.0000000000003237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS This study compares the reaching ability of two classes of transcanal endoscopic ear surgery (TEES) instruments when operating on difficult to access anatomical targets; two novel instruments with steerable flexible tips (SFT-A and SFT-B) and suction capability are compared with standard commercially available tools. BACKGROUND TEES surgeons identified the need for a new surgical instrument that can enable accessibility of all areas visualized by the endoscope. This motivated the development of the two instrument prototypes. METHODS Six temporal bone models were 3D printed based on CT data from five cholesteatoma patients. Four anatomical targets were marked on each model. Using these targets, the reaching ability while using four standard TEES instruments were compared with the SFT-A and SFT-B prototypes by five surgeon participants. Results were analysed to compare success rates of contacting each target using each tool by fitting four Firth's logistic regression models. This calculated the statistically significant differences (p < 0.05) in tool success rate. RESULTS Using SFT-A to contact the sinus tympani (100%) was significantly more successful than the Panetti suction dissector for atticus (PAT) (77%) and to contact the sinodural angle (0%) was less successful than the PAT (10%) and SFT-B (93%). Using SFT-B to contact the lateral semicircular canal (90%) was significantly more successful than all current tools and to contact the sinodural angle (93%) was significantly more successful than all tools. CONCLUSION Using SFT-B enables enhanced accessibility of anatomical structures during TEES which may lead to less extensive bone removal to facilitate minimally invasive TEES.
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Preyer S. [Incision-suture times in endoscopic ear surgery]. HNO 2021; 69:811-816. [PMID: 34125238 PMCID: PMC8476474 DOI: 10.1007/s00106-021-01066-5] [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] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
Hintergrund Endoskopische Ohrchirurgie („endoscopic ear surgery“, EES) wird international immer häufiger anstelle der mikroskopischen Ohrchirurgie („microscopic ear surgery“, MES) eingesetzt, hat sich in Deutschland aber als Routineverfahren noch nicht etabliert. Fragestellung Untersucht wurden die Schnitt-Naht-Zeiten bei der EES und die Praktikabilität der Methode im deutschen Klinik-Setting. Material und Methoden In einer retrospektiven Studie wurden 60 konsekutive mikroskopisch operierte Patienten (MES) von 2015 mit 60 konsekutiven endoskopisch operierten Patienten aus dem Jahr 2018 verglichen. Verglichen wurden Hörergebnisse, Trommelfellbefund und Schnitt-Naht-Zeiten nach 3 Wochen. Ergebnisse Bei endoskopisch geführten Ohroperationen war der Zugang meistens transmeatal und musste seltener als bei mikroskopisch durchgeführten Operationen die Gehörgangsvorderwand zurückgeschliffen werden. Die Operationszeiten unterschieden sich in den 2 Gruppen statistisch nicht signifikant. Ein Trommelfellverschluss gelang bei 57/60 Patienten in der mikroskopischen Gruppe und bei 59/60 in der endoskopischen Gruppe. Eine Hörverbesserung wurde in beiden Gruppen erreicht. Die Hörverbesserung war in den 2 Gruppen statistisch signifikant nicht unterschiedlich. Schlussfolgerungen Endoskopische Ohrchirurgie ist eine zeitökonomische und minimal-invasive Methode und stellt bei vergleichbaren Ergebnissen eine praktikable Alternative zur mikroskopischen Ohrchirurgie dar.
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Affiliation(s)
- S Preyer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie und plastische Gesichtschirurgie, ViDia-Kliniken Karlsruhe, Steinhäuserstraße 18, 76133, Karlsruhe, Deutschland.
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Vilain J. Complication in endoscopic ear surgery: A case of dura mater injury. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
OBJECTIVE The aim of this study was to report a multicentric surgical experience in the exclusive endoscopic management of glomus tympanicum (GT). STUDY DESIGN Retrospective case series review at two institutions. SETTING Tertiary referral centers. PATIENTS The study included 30 patients who underwent exclusive transcanal excision of GT between 2010 and 2017 at the two referral centers. INTERVENTIONS Exclusive endoscopic transcanal excision of GT type A1, A2, and B1 (modified Fisch-Mattox classification). All surgical procedures were performed by two senior surgeons (L.P.; M.B.). MAIN OUTCOME MEASURES For each procedure, intraoperative features of the disease, postoperative complications, and functional outcomes were evaluated. Recurrent or residual diseases were clinically and radiologically assessed during the follow-up period. RESULTS None of the patients treated with transcanal endoscopic approach (TEA) experienced intraoperative complications, nor required conversion to microscopic approach. Gross total resection (GTR) was obtained in 90% of the cases, while a near total resection was advocated when the residual pathology had a close relationship with the internal carotid artery. Mean hospitalization time was 1.6 (±0.8 SD) days and no postoperative complications were reported. No recurrences were reported in the GTR group after a mean follow-up period of 38.1 (±28.7 SD) months. CONCLUSIONS Middle ear paragangliomas with no mastoid involvement (Class A1, A2, and B1) can be safely managed by means of a transcanal endoscopic approach. Low rate of postoperative complications, short hospitalization, and high rate of gross total resection demonstrate that TEA is a safe and effective procedure.
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Correlation of Radiologic Versus Endoscopic Visualization of the Middle Ear: Implications for Endoscopic Ear Surgery. Otol Neurotol 2021; 41:e1122-e1127. [PMID: 32925849 DOI: 10.1097/mao.0000000000002787] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the limits of visualization during transcanal endoscopic ear surgery (EES) by correlating the relationship between radiologic and endoscopic anatomy using angled optics. METHODS Radiology and endoscopic visualization of tensor fold, protympanum, facial sinus (FS), sinus tympani (ST), subtympanic sinus (STS), hypotympanum, and aditus ad antrum were analyzed using a transcanal approach in 30 human temporal bones specimens with different angled endoscopes (0 degree, 45 degrees, 70 degrees) to check for the full visualization of these regions. High-resolution computed tomography (CT) was performed prior to dissection to classify retrotympanic anatomy. According to previously published descriptions, FS, ST, and STS were classified into types A, B, and C depending on their morphology relative to the mastoid segment of the facial nerve. These radiologic findings were compared to endoscopic visualization of these same structures using a Chi-squared test. RESULTS Visualization of the posterior wall of three different retrotympanic areas was significantly associated (FS p < 0.01; ST p < 0.01; STS p = 0.02) with the radiologic classification and endoscopic optical angle. Angled endoscopy improved visual access to the other subsites, especially the aditus ad antrum and the tensor fold (>70% with 45 degrees and 70 degrees). CONCLUSION Complete visual access to the hidden recesses of the middle ear can be achieved using angled endoscopes (45 degrees and 70 degrees). We observed a statistically significant association of endoscopic visualization to radiologic description of the retrotympanum on CT and the optical angle used. The prediction of the endoscopic exposure of the retrotympanum from the preoperative CT is possible. Even with the use of 70 degrees lens, retrotympanum is not fully visualized on transcanal endoscopy if a type C retrotympanic recesses (posterior and medial to the facial nerve) is present. This represents a technical limit of exclusive transcanal EES.
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Bogomilsky MR, Polunin MM, Soldatsky YL, Minasyan VS, Ivanenko AM, Kulmakov SA. [Transcanal endoscopic middle ear surgery in children with chronic suppurative otitis media]. Vestn Otorinolaringol 2021; 86:25-29. [PMID: 33720647 DOI: 10.17116/otorino20218601125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Otomicroscopic surgery remains the gold standard in the surgical treatment of patients with CHS. Endoscopic ear surgery is gaining more and more importance as an adjunct to microsurgery. Recently, thanks to the resolution of the endoscopic technique, endoscopic surgery can be used as an independent method. This article presents the results of endoscopic tympanoplasty, endoscopic removal of the tympanic cholesteatoma, performed on the basis of the otorhinolaryngology department of the Morozov Children's City Clinical Hospital. Research has shown that transcanal endoscopic surgery is an effective alternative to traditional otomicroscopic surgery. Advantage in minimal impact and improved visualization of all quadrants of the tympanic membrane, the anterior tympanomeatal angle of the NSP, and structures of the middle ear.
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Affiliation(s)
- M R Bogomilsky
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia
| | - M M Polunin
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia.,Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - Yu L Soldatsky
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia.,Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - V S Minasyan
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia
| | - A M Ivanenko
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - S A Kulmakov
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia.,Morozovskaya Children's City Clinical Hospital, Moscow, Russia
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The outcomes of endoscopic approach for attic cholesteatoma: underwater continuous drilling versus traditional intermittent drilling. The Journal of Laryngology & Otology 2021; 135:310-314. [PMID: 33726879 DOI: 10.1017/s0022215121000633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to analyse the differences between underwater continuous drilling and traditional intermittent drilling for attic cholesteatoma. METHODS The clinical data of 61 patients with attic cholesteatoma who underwent an endoscopic approach procedure were analysed. Forty patients underwent underwater continuous drilling (group A), and 21 patients underwent traditional intermittent drilling (group B). RESULTS The operation time was 64.61 ± 12.90 minutes in group A and 79.60 ± 16.81 minutes in group B (p < 0.05). The anaesthesia time was 102.69 ± 17.93 minutes in group A and 119.82 ± 19.28 minutes in group B (p < 0.05). The dry ear time, the hearing improvement rate and the post-operative complications were no different in the two groups. CONCLUSION Group A and group B had no differences in surgical outcome or hearing recovery. However, treatment in the former group resulted in a significantly shortened operation and anaesthesia time.
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Li B, Zhou L, Wang M, Wang Y, Zou J. Endoscopic versus microscopic surgery for treatment of middle ear cholesteatoma: A systematic review and meta-analysis. Am J Otolaryngol 2021; 42:102451. [PMID: 33360773 DOI: 10.1016/j.amjoto.2020.102451] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/27/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Endoscopic ear surgery (EES) is minimally invasive and increasingly used to treat middle ear disease. In this meta-analysis, we compared the efficacies of EES and microscopic ear surgery (MES) in patients with middle ear cholesteatoma. METHODS The PubMed, Embase, Cochrane Library, and Web of Science databases were searched for studies that reported the comparative surgical outcomes of EES and MES in patients with middle ear cholesteatoma. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. All included studies involved ≥1 of the following outcomes: recurrence of or residual disease, graft intake success rate, audiological performance, and operation time. We calculated the pooled relative risk (RR) or weighted mean difference with 95% confidence intervals (CIs) by using STATA software. RESULTS Thirteen studies were included in the quantitative meta-analysis. The pooled recurrence and residual rates of cholesteatoma were significantly lower in the EES group than in the MES group [RR: 0.51, 95%CI: 0.31-0.84, heterogeneity (I2) = 4.7%; P = .394; RR: 0.68; 95%CI: 0.47-0.99; I2 = 0.0%; P = .878; respectively]. There were no significant differences in other parameters, such as graft intake success rates, audiological performance, and operation times, between the 2 groups. CONCLUSION The pooled results showed that EES reduced the residual lesion rate and postoperative recurrence risk in patients with middle ear cholesteatoma. However, there was insufficient evidence to prove that EES was advantageous in graft intake success rate auditory performance, and operation time.
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Salzman R, Bakaj T, Starek I. Postoperative pain and analgesic consumption after endoscopic and microscopic ear procedures. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:46-50. [PMID: 33542539 DOI: 10.5507/bp.2021.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Endoscopic ear surgery (EES) is considered a minimally invasive technique. It is hypothesized that patients after endoscopic procedures experience less pain and require fewer painkillers. Our aim was to compare patients' postoperative pain and need for analgesics in patients undergoing microscopic and endoscopic ear surgeries. METHODS a single-institution, prospective study included 92 patients undergoing ear procedures (48 cholesteatoma and 44 reconstructive);(43 endoscopic and 49 microscopic) during 1/2016-1/2018. The postoperative pain (visual analogue scale (VAS) 0-10) and painkillers consumption were recorded and compared in each subgroup. RESULTS VAS (P=0.02) and analgesics consumption (P=0.06) were lower after endoscopic ear surgeries. In the cholesteatoma group, 94% of endoscopic patients reported VAS 0-2 in contrast to 58 % of microscopic patients on day 1 (P=0.04). Similar tendencies were revealed in reconstructive cases, i.e. 92% compared to 73% (P>0.05). On day 1, 92% of endoscopic, and 77% of microscopic reconstruction patients received no painkillers group (P=0.06). In the cholesteatoma patients, 88% of endoscopic patients, 43% of microscopic patients using endaural approach, and 75% of microscopic patients using retroauricular approach, required no painkillers on the postoperative day 1 (P>0.05). CONCLUSIONS Our study revealed that the EES is associated with less postoperative pain than the conventional microscopic ear surgery. It seems that it is rather the transmeatal approach, and not the endoscope itself that reduces postoperative pain. The removal of the same size cholesteatoma using endoscope (rather than using microscope) leads to less intensive postoperative pain. Consequently, it was not surprising that patients after endoscopic ear surgery very rarely took painkillers.
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Affiliation(s)
- Richard Salzman
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Tomas Bakaj
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Ivo Starek
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
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Jianqing C, Yongchuan C, Zhihua Z, Huan J, Zhaoyan W, Hao W. A microscope-assisted endoscopic transcanal transpromontorial approach for vestibular schwannoma resection: a preliminary report. Eur Arch Otorhinolaryngol 2021; 279:75-82. [PMID: 33523282 DOI: 10.1007/s00405-021-06612-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the feasibility of a microscope-assisted endoscopic transcanal transpromontorial approach (METTA) for the removal of small vestibular schwannomas (VS) limited to the internal auditory canal (IAC), and introduce a modification without external auditory canal (EAC) closure. METHODS Between August 2018 and February 2019, seven patients with intrameatal VS underwent surgery in our center, endoscopic transcanal transpromontorial approach was applied in the first 2 patients and the rest 5 patients were operated via METTA. Treatment outcomes including efficacy of tumor resection, facial nerve outcome, operation time and post-operative course were recorded and analyzed. RESULTS All seven patients were pathologically confirmed to have intrameatal VS. Total tumor removal was achieved in all cases. Two patients experienced cerebrospinal fluid leakage which resolved spontaneously within 5 days. The average operation time was 161.41 ± 18.42 min. All patients presented normal facial nerve function 1 month after surgery. CONCLUSION The METTA was effective in the removal of intrameatal VS. It can be an alternative surgical option for intrameatal VS with no serviceable hearing.
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Affiliation(s)
- Chen Jianqing
- Department of Otolaryngology-Head and Neck Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.,Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Chai Yongchuan
- Department of Otolaryngology-Head and Neck Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.,Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Zhang Zhihua
- Department of Otolaryngology-Head and Neck Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.,Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jia Huan
- Department of Otolaryngology-Head and Neck Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.,Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Wang Zhaoyan
- Department of Otolaryngology-Head and Neck Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China. .,Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China. .,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China.
| | - Wu Hao
- Department of Otolaryngology-Head and Neck Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China. .,Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China. .,Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China.
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Dixon PR, James AL. Evaluation of Residual Disease Following Transcanal Totally Endoscopic vs Postauricular Surgery Among Children With Middle Ear and Attic Cholesteatoma. JAMA Otolaryngol Head Neck Surg 2021; 146:408-413. [PMID: 32134439 DOI: 10.1001/jamaoto.2020.0001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Transcanal totally endoscopic ear surgery (TEES) improves tympanic cavity visibility during cholesteatoma resection but does not readily permit 2-handed surgery, which is possible with a postauricular approach and use of an operating microscope. Improved visibility and 2-handed access may reduce rates of incomplete surgical clearance and residual cholesteatoma. Objective To compare rates of residual cholesteatoma after TEES vs those after open surgery with a postauricular approach for initial disease limited to the middle ear and/or attic. Design, Setting, and Participants This propensity score-matched cohort study considered a consecutive sample of 209 pediatric cases of cholesteatomas resected at a tertiary referral center between January 1, 2005, and December 31, 2017, by either TEES or postauricular approach. The 177 cases (84.7%) in 172 patients that were eligible for inclusion in the study had undergone at least 1 of the following assessments: second-look tympanoplasty, diffusion-weighted magnetic resonance imaging, or in-clinic follow-up examination at least 2 years after the operation. Ears were matched on the basis of the propensity score, a function of age, sex, comorbid diagnoses, etiology, disease extent, ossicular chain condition, presence or absence of tympanic membrane perforation, and otorrhea status at the time of surgery. Exposures Transcanal totally endoscopic ear surgery was defined as a transcanal approach with surgeon-reported use of an endoscope for resection of cholesteatoma. Use of an operating microscope was permitted in the TEES group for graft placement during tympanoplasty. The postauricular approach was characterized by a postauricular incision and use of an operative microscope with or without adjunct use of an endoscope. Main Outcomes and Measures Residual cholesteatoma. Results Of 177 cases included in the study, the unmatched cohort consisted of 65 ears that had undergone TEES (mean [SD] age, 9.9 [3.6] years; 33 [50.8%] female) and 112 ears of patients who had undergone surgery with a postauricular approach (mean [SD] age, 9.9 [3.5] years; 72 [64.3%] male). Propensity score matching was accomplished for a total of 128 cases, with 64 in each group. After matching, standardized differences between TEES and postauricular approaches were less than 0.20 for all measured baseline characteristics, indicating balanced groups. The TEES group had a residual disease incidence of 4 of 64 (6.3%) compared with 7 of 64 (10.9%) in the propensity score-matched postauricular approach group (absolute risk difference, -4.7%; 95% CI, -14.8% to 5.4%). Conclusions and Relevance This study's findings suggest that there was no apparent advantage of the 2-handed postauricular microscopic approach with respect to surgical clearance of cholesteatoma limited to the middle ear and/or attic. Transcanal totally endoscopic ear surgery may be an effective alternative to a postauricular approach for removal of limited cholesteatoma in children.
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Affiliation(s)
- Peter R Dixon
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Adrian L James
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Ridge SE, Shetty KR, Lee DJ. Heads-up Surgery: Endoscopes and Exoscopes for Otology and Neurotology in the Era of the COVID-19 Pandemic. Otolaryngol Clin North Am 2021; 54:11-23. [PMID: 33243372 PMCID: PMC7522672 DOI: 10.1016/j.otc.2020.09.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A new era of surgical visualization and magnification is poised to disrupt the field of otology and neurotology. The once revolutionary benefits of the binocular microscope now are shared with rigid endoscopes and exoscopes. These 2 modalities are complementary. The endoscope improves visualization of the hidden recesses through the external auditory canal or canal-up mastoidectomy. The exoscope provides an immersive visual experience and superior ergonomics compared with binocular microscopy. Endoscopes and exoscopes are poised to disrupt the standard of care for surgical visualization and magnification in otology and neurotology.
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Rusetsky YY, Meitel IY, Krasivicheva OV, Arutyunyan SK, Sotnikova LS. [Basis of endoscopic dissection of the ear with analysis of endoscopic anatomy. Part 2.]. Vestn Otorinolaringol 2021; 85:116-118. [PMID: 33474929 DOI: 10.17116/otorino202085061116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nowadays, endoscopic transcanal otosurgery with confident steps is becoming a practice. Obviously, any new method of intervention needs to be repeatedly tested by the surgeon before it is used on the patient. This is why dissection work is so important and popular. Working on biomaterial sets itself several tasks: training manual skills of working with an endoscope and an instrument in the middle ear cavities, stage-by-stage training for performing specific interventions, detailed analysis and repetition of anatomy and topography of structures. This article presents a step-by-step dissection algorithm with an analysis of the anatomical landmarks of each area, such as the prototype. The proposed training protocol allows practicing such interventions as endaural atticotomy, types of ossiculoplasty, stapedoplasty, decompression of the facial nerve to the geniculate ganglion area, infracochlear and transpromontorial approaches to the internal auditory canal. Keywords: endoscopic otosurgery, transcanal otosurgery, chronic otitis media, otitis media, otitis media in children, otodissection, endoscopic otodissection.
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Affiliation(s)
- Yu Yu Rusetsky
- National Medical Research Center of Children's Health of the Ministry of Health of Russia, Moscow, Russia
| | - I Yu Meitel
- National Medical Research Center of Children's Health of the Ministry of Health of Russia, Moscow, Russia
| | - O V Krasivicheva
- National Medical Research Center of Children's Health of the Ministry of Health of Russia, Moscow, Russia
| | - S K Arutyunyan
- National Medical Research Center of Children's Health of the Ministry of Health of Russia, Moscow, Russia
| | - L S Sotnikova
- National Medical Research Center of Children's Health of the Ministry of Health of Russia, Moscow, Russia
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Jena D, Rout K, Sahoo P, Zacharias G. Endoscopic management of stage-2 attic cholesteatoma: An institutional study. INDIAN JOURNAL OF OTOLOGY 2021. [DOI: 10.4103/indianjotol.indianjotol_172_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rusetsky YY, Meitel IY, Krasivicheva OV, Arutyunyan SK, Sotnikova LS. [Basis of endoscopic dissection of the ear with analysis of endoscopic anatomy. Part 1]. Vestn Otorinolaringol 2020; 85:106-108. [PMID: 33140946 DOI: 10.17116/otorino202085051106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Today, endoscopic transcanal ear surgery with confident steps is becoming a practice. It will be used by the patient in repeated practice by the surgeon before being used in the patient. It is so important and popular in connection with this dissection work. Working on biomaterial sets itself several tasks: training manual skills to work with an endoscope and an instrument in the middle ear, stage-by-stage training for performing specific interventions, detailed analysis and understanding of structures anatomy and topography. This article presents a step-by-step dissection algorithm with an analysis of the each area anatomical landmarks, like a prototype. Moreover, the course of dissection allows you to work out the performance of type I tympanoplasty.
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Affiliation(s)
- Yu Yu Rusetsky
- National Medical Research Center for Children's Health Federal State Autonomous Institution of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - I Yu Meitel
- National Medical Research Center for Children's Health Federal State Autonomous Institution of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - O V Krasivicheva
- National Medical Research Center for Children's Health Federal State Autonomous Institution of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - S K Arutyunyan
- National Medical Research Center for Children's Health Federal State Autonomous Institution of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - L S Sotnikova
- National Medical Research Center for Children's Health Federal State Autonomous Institution of the Ministry of Health of the Russian Federation, Moscow, Russia
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Nogueira JF, de Sousa Lobo Ferreira Querido R, Gonçalves da Silva Leite J, Cabral da Costa T. Future of Endoscopic Ear Surgery. Otolaryngol Clin North Am 2020; 54:221-231. [PMID: 33153734 DOI: 10.1016/j.otc.2020.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endoscopic ear surgery has gained popularity in recent years, becoming standard practice in otology centers around the world as an adjunct to conventional microscopic surgery and as a sole tool for limited disease. During the last years, technical improvements and growing expertise in the handling of the endoscope allowed introducing an exclusive endoscopic approach to the middle ear, lateral skull base, middle cranial fossa, and posterior fossa/cerebellopontine angle pathologies. Endoscopic instrumentation, techniques, and knowledge have improved during the last few years, and in the future, endoscopic surgical techniques will gain even more importance in otologic surgery.
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Affiliation(s)
- Joao Flavio Nogueira
- Medicine Faculty, State University of Ceará, Dr. Silas Munguba Av., 1700, Fortaleza 60741-000, Brazil.
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Pradhan S, Chappity P, Nayak A, Pradhan P, Parida PK. Exclusive endoscopic transcanal approach to lateral skull base lesions: Institutional experience of 3 cases. J Otol 2020; 16:55-60. [PMID: 33505451 PMCID: PMC7814085 DOI: 10.1016/j.joto.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 10/29/2022] Open
Abstract
Introduction Majority of petrous bone and lateral skull base pathologies are benign in nature. The complex anatomy usually warrants an extensive approach with associated morbidity. Case summary Two cases of petrous bone cholesteatoma (1 congenital cholesteatoma with facial palsy and 1 acquired cholesteatoma) and a case of glomus tympanicum were treated with exclusive endoscopic transcanal approach. The cases of petrous cholesteatoma were addressed with trans-promontorial and infra-cochlear approaches. The mean operative time was approximately 140 min. No CSF otorrhoea was noticed in the post-operative period. The average period of hospital stay was 3.7 days. Conclusion In the subset of cases with limited benign disease an endoscopic trans-canal approach is a better alternative to an external approach. It decreases operative time, blood loss, chance of meningitis, morbidity and hospital stay. The lack of depth perception is a major hurdle which can be come over by experience in endoscopic middle ear surgery. This approach can create direct access to cochlea/petrous apex/internal auditory canal (IAC)/Supra-geniculate ganglion region.
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Affiliation(s)
- Sidharth Pradhan
- All India Institute of Medical Sciences, Bhubaneswar Department of Otorhinolaryngology and Head & Neck Surgery, 1 floor, AIIMS, Bhubaneswar, Sijua, Bhubaneswar, Odisha, 751019, India
| | - Preetam Chappity
- All India Institute of Medical Sciences, Bhubaneswar Department of Otorhinolaryngology and Head & Neck Surgery, 1 floor, AIIMS, Bhubaneswar, Sijua, Bhubaneswar, Odisha, 751019, India
| | - Anindya Nayak
- All India Institute of Medical Sciences, Bhubaneswar Department of Otorhinolaryngology and Head & Neck Surgery, 1 floor, AIIMS, Bhubaneswar, Sijua, Bhubaneswar, Odisha, 751019, India
| | - Pradeep Pradhan
- All India Institute of Medical Sciences, Bhubaneswar Department of Otorhinolaryngology and Head & Neck Surgery, 1 floor, AIIMS, Bhubaneswar, Sijua, Bhubaneswar, Odisha, 751019, India
| | - Pradipta K Parida
- All India Institute of Medical Sciences, Bhubaneswar Department of Otorhinolaryngology and Head & Neck Surgery, 1 floor, AIIMS, Bhubaneswar, Sijua, Bhubaneswar, Odisha, 751019, India
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Ayache S, Kutz W, Isaacson B, Badr-El-Dine M, Nogueira JF, Marchioni D, Presutti L. COVID-19 and ear endoscopy in otologic practices. Eur Arch Otorhinolaryngol 2020; 278:2133-2135. [PMID: 32876726 PMCID: PMC7466917 DOI: 10.1007/s00405-020-06309-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
Purpose Otolaryngologists have had to postpone the majority of surgical procedures in the current COVID-19 pandemic. Airborne transmission, beyond the projection of droplets from upper airways, expose healthcare workers to a risk of viral infection. Aerosol generating procedures (AGP) increase the risk of viral transmission to staff within the operating room. Methods Surgery of middle ear and mastoid is also considered an AGP, particularly mastoidectomy performed using a high-speed drill. The authors report their experience in endoscopic ear surgery as an alternative technique to reduce AGP in otologic procedures. Results Transcanal endoscopic ear surgery is a reliable technique used to manage many otologic conditions. Conclusion The endoscopic approach may reduce the risk of viral transmission to operating room staff by reducing the need for mastoidectomy.
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Affiliation(s)
- Stephane Ayache
- Otology and Neurotology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Centre Simone Veil, Cannes, France.
| | - Walter Kutz
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brandon Isaacson
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mohamed Badr-El-Dine
- Department of Otolaryngology, University Hospital of Alexandria, Alexandria, Egypt
| | - Joao Flavio Nogueira
- Department of Otolaryngology-Head and Neck Surgery, Estedualda Ceara University, Sinus and Oto Centro, Fortaleza, Brazil
| | - Daniele Marchioni
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Livio Presutti
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
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Tsetsos N, Vlachtsis K, Stavrakas M, Fyrmpas G. Endoscopic versus microscopic ossiculoplasty in chronic otitis media: a systematic review of the literature. Eur Arch Otorhinolaryngol 2020; 278:917-923. [PMID: 32632614 DOI: 10.1007/s00405-020-06182-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare the endoscopic and microscopic ossiculoplasty in patients with chronic otitis media. METHODS MEDLINE, ScienceDirect, and the Cochrane Library databases as well as other sources were searched by two independent reviewers. Controlled studies comparing endoscopic and microscopic ossiculoplasty in patients with chronic otitis media were included. Mean air-bone gap closure was the primary outcome. Secondary outcomes were operation time and complications. RESULTS Three studies met the inclusion criteria. No statistically significant differences in audiometric outcomes between endoscopic and microscopic groups in all three included studies were reported. Although endoscopic technique was related to a fewer number of postoperative complications and a shorter operation time, these outcomes did not reach statistical significance. CONCLUSION Endoscopic ossiculoplasty is associated with similar postoperative hearing results compared to the traditional microscopic approach. A trend towards a shorter operative time and reduced morbidity for the endoscopic approach has been observed, but well-designed randomized controlled trials are warranted to confirm this finding.
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Affiliation(s)
- Nikolaos Tsetsos
- Department of Otorhinolaryngology, Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, Greece.
| | - Konstantinos Vlachtsis
- Department of Otorhinolaryngology, Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Marios Stavrakas
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Georgios Fyrmpas
- Department of Otorhinolaryngology, Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
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Robot-based assistance in middle ear surgery and cochlear implantation: first clinical report. Eur Arch Otorhinolaryngol 2020; 278:77-85. [PMID: 32458123 DOI: 10.1007/s00405-020-06070-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Middle ear surgery may benefit from robot-based assistance to hold micro-instruments or an endoscope. However, the surgical gesture performed by one hand may perturb surgeons accustomed to two-handed surgery. A robot-based holder may combine the benefits from endoscopic exposure and a two-handed technique. Furthermore, tremor suppression and accurate tool control might help the surgeon during critical surgical steps. The goal of this work was to study the safety of an otological robot-based assistant under clinical conditions in a limited series of patients. METHODS The RobOtol system has been used as an endoscope or a micro instrument holder for this series. Eleven cases were operated on with the robot as an endoscope holder for chronic otitis. Twenty-one cases were operated on with the robot as a micro-instrument holder for otosclerosis (9 cases), transtympanic tube placement (2 cases), or cochlear implantation (10 cases). RESULTS No complications related to the robot manipulation occurred during surgery nor in postoperative. In the chronic otitis group, all perforations were sealed and 3-month postoperative pure-tone average air-bone gap (PTA ABG) was 15 ± 2.6 dB. In the otosclerosis group, 1-month post-op PTA ABG was 10 ± 1 dB. For cochlear implantation cases, a scala tympani insertion, a vestibular scala translocation occurred and a full scala vestibuli insertion was observed in 7, 2 and 1 case, respectively. CONCLUSION The RobOtol system has reached the clinical stage. It could be used safely and with accurate control as an endoscope holder or a micro instrument holder in 32 cases.
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Grachev NS, Polev GA, Morozov II, Samarin AE, Vorozhtsov IN, Shcherbakov DA. [Our first experience with endoscopic ear surgery]. Vestn Otorinolaringol 2020; 85:88-93. [PMID: 32241997 DOI: 10.17116/otorino20208501188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION For the last decades endoscopic ear surgery has become a common practice. Advantages of the endoscopic technique in middle ear surgery are high definition and magnification of the endoscope with a modern camera and the ability to 'look around the corner' with the angled scope. MATERIAL AND METHODS From March 2017 to November 2019 in NSRC PHOI named after Dmitry Rogachev in the Department of Oncology and Pediatric Surgery 53 patients (81 surgeries) have undergone endoscopic-assisted ear surgery: 3 biopsies for middle ear neoplasm with the transcanal endoscopic approach, 1 endoscopic tympanoplasty for attic retraction pocket with cholesteatoma, 2 endoscopic removal of middle ear tumors (including 1 combined approach) and 32 endoscopic myringoplasties, 22 canal wall down mastoidectomies for extensive middle ear and mastoid cholesteatoma, 21 second-look surgery with ossiculoplasty with overall good outcome. Age of the patients varied from 2 months to 16 years. Follow up period varied from 1 month to 3 years. RESULTS Two cases of middle ear tumor removal via endoscopic transcanal approach are described. In one case endoscopic transmeatal approach was used as an addition to the middle fossa approach for removal of facial nerve neurinoma located on the upper surface of petrous bone with expansion to the middle ear cavity. In the second case endoscopic transmeatal approach was used alone for removal of benign tumor (salivary gland choristoma) of middle ear cavity with extension to pneumatic system of petrous bone. In both cases endoscopic approach allowed to biopsy the tumor first and then to remove the tumor in a less invasive way, which lead to faster patient recovery. CONCLUSION In the majority of cases endoscopic technique is a method of assistance in otologic surgery, but sometimes could be a used a single method in middle ear surgery, allowing less traumatic approach and the implementation of high-definition camera for more precise disease control. In our preliminary experience endoscopic technique could be used in pediatric practice independently of the patient's age.
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Affiliation(s)
- N S Grachev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Health of Russia, Moscow, Russia, 117997; Institute of Medical and Social Technologies, Department of Otorhinolaryngology, Moscow State University of Food Production, Moscow, Russia, 125080
| | - G A Polev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Health of Russia, Moscow, Russia, 117997
| | - I I Morozov
- Head Clinical Hospital of Ministry of Internal Affairs, Moscow, Russia, 123060
| | - A E Samarin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Health of Russia, Moscow, Russia, 117997
| | - I N Vorozhtsov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Health of Russia, Moscow, Russia, 117997
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Use of the KTP laser in totally endoscopic cholesteatoma surgery. The Journal of Laryngology & Otology 2020; 134:362-365. [PMID: 32122410 DOI: 10.1017/s0022215120000420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This paper reviews our experience of potassium titanyl phosphate (KTP) laser in transcanal totally endoscopic cholesteatoma surgery. METHODS A prospective cohort study was conducted in a tertiary referral centre, involving a consecutive series of children with cholesteatoma who underwent totally endoscopic cholesteatoma surgery with a KTP laser. RESULTS The patients' mean age was 10.5 years (range, 1.8-18 years). A KTP laser was used in 70 of the 83 cases (84 per cent). The laser was not used in 13 'clean' cases, in which disease was removed more easily. Residual disease was detected in five cases (6 per cent), of which the KTP laser had been used in four (5 per cent). No complications were associated with KTP laser use. CONCLUSION The combination of KTP laser use with endoscopic visualisation is effective for minimising the risk of residual disease using a minimally invasive surgical approach. The thin, semi-flexible fibre carrier of the KTP laser is ideally suited to work alongside the endoscope within the narrow confines of the ear canal.
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Bekci T, Hizli O, Ozturk M, Yildirim G. Quantitative three-dimensional computed tomography analysis of sinus tympani volume in temporal bones with petrous apex pneumatization. Auris Nasus Larynx 2020; 47:587-592. [PMID: 32057525 DOI: 10.1016/j.anl.2020.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/14/2020] [Accepted: 01/28/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the association between sinus tympani volume and petrous apex pneumatization in this retrospective-archival temporal bone computed tomography study. METHODS We included 46 temporal bones with pneumatized petrous apex from 26 patients and 52 temporal bones without petrous apex pneumatization from 26 other patients. Using OsiriX software for MacOS (version 3.8.1, Pixmeo), we measured the volumes from three-dimensional sinus tympani models and compared the sinus tympani volumes and depths between the temporal bones with and without pneumatized petrous apex. RESULTS Among 150 patients totally reviewed, 26 (17.3%) had petrous apex pneumatization. The median sinus tympani volume was 16.05 (5.6-59.7) mm3 in temporal bones with pneumatized petrous apex and 8.7 (1.76-59.7) mm3in temporal bones without. The sinus tympani volume was significantly greater in temporal bones with pneumatized petrous apex compared to those without (p < 0.001). Additionally, temporal bones with pneumatized petrous apex had a significantly deeper sinus tympani [median depth = 2.17 (0-3.04) mm] compared to the temporal bones without [median depth = 1.69 (0-3.73) mm] (p = 0.045). We found that petrous apex pneumatization was associated with deeper and larger sinus tympani. CONCLUSION Patients with pneumatized petrous apex had a greater sinus tympani volume associated with the increased risk of residual cholesteatoma.
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Affiliation(s)
- Tumay Bekci
- Department of Radiology, Giresun University, Giresun, Turkey.
| | - Omer Hizli
- Department of ENT, Giresun University, Giresun, Turkey
| | - Mesut Ozturk
- Department of Radiology, Ondokuz Mayis University, Samsun, Turkey
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The Management of Tympanic Membrane Perforation With Endoscopic Type I Tympanoplasty. Otol Neurotol 2020; 41:214-221. [DOI: 10.1097/mao.0000000000002465] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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