1
|
Sooriyamoorthy T, Salau E, Ghunaim M, Vijendren A. The VITOM-3D exoscope as an alternative to the operating microscope for major ear surgery: A retrospective case-controlled study. Clin Otolaryngol 2024; 49:353-358. [PMID: 38375991 DOI: 10.1111/coa.14147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/27/2023] [Accepted: 02/03/2024] [Indexed: 02/21/2024]
Affiliation(s)
| | - Eniola Salau
- ENT Department, Lister Hospital, East and North Herts NHS Trust, Stevenage, Hertfordshire, UK
| | - Mohammad Ghunaim
- ENT Department, Lister Hospital, East and North Herts NHS Trust, Stevenage, Hertfordshire, UK
| | - Ananth Vijendren
- ENT Department, Lister Hospital, East and North Herts NHS Trust, Stevenage, Hertfordshire, UK
| |
Collapse
|
2
|
Patel TA, Ettyreddy A, Cheng T, Smith K, Sridharan SS, McCall AA. Cost-Effectiveness of Diffusion Weighted MRI Versus Planned Second-Look Surgery for Cholesteatoma. Ann Otol Rhinol Laryngol 2024:34894241250253. [PMID: 38676449 DOI: 10.1177/00034894241250253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To compare the cost-effectiveness of serial non-echo planar diffusion weighted MRI (non-EP DW MRI) versus planned second look surgery following initial canal wall up tympanomastoidectomy for the treatment of cholesteatoma. METHODS A decision-analytic model was developed. Model inputs including residual cholesteatoma rates, rates of non-EP DW MRI positivity after surgery, and health utility scores were abstracted from published literature. Cost data were derived from the 2022 Centers for Medicare and Medicaid Services fee rates. Efficacy was defined as increase in quality-adjusted life year (QALY). One- and 2-way sensitivity analyses were performed on variables of interest to probe the model. Total time horizon was 50 years with a willingness to pay (WTP) threshold set at $50 000/QALY. RESULTS Base case analysis revealed that planned second-look surgery ($11 537, 17.30 QALY) and imaging surveillance with non-EP DWMRI ($10 439, 17.26 QALY) were both cost effective options. Incremental cost effectiveness ratio was $27 298/QALY, which is below the WTP threhshold. One-way sensitivity analyses showed that non-EP DW MRI was more cost effective than planned second-look surgery if the rate of residual disease after surgery increased to 48.3% or if the rate of positive MRI was below 45.9%. A probabilistic sensitivity analysis at WTP of $50 000/QALY found that second-look surgery was more cost-effective in 56.7% of iterations. CONCLUSION Non-EP DW MRI surveillance is a cost-effect alternative to planned second-look surgery following primary canal wall up tympanomastoidectomy for cholesteatoma. Cholesteatoma surveillance decisions after initial canal wall up tympanomastoidectomy should be individualized. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- Terral A Patel
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Abhinav Ettyreddy
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tracy Cheng
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kenneth Smith
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Shaum S Sridharan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrew A McCall
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
3
|
Nishiike S, Michiba T, Ito R, Ashida N, Kato H, Kuki A, Ogawa K, Tamura K, Uetsuka S. Quantitative measurement of airborne particles during endoscopic and microscopic ear surgery in the operating room. J Laryngol Otol 2024; 138:405-409. [PMID: 37646247 DOI: 10.1017/s0022215123001433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVE This study aimed to quantitatively investigate airborne particle load in the operating room during endoscopic or microscopic epitympanectomy or mastoidectomy. METHOD In the transcanal endoscopic ear surgery group, drilling was performed underwater. A particle counter was used to measure the particle load before, during and after drilling during transcanal endoscopic ear surgery or microscopic ear surgery. The device counted the numbers of airborne particles of 0.3, 0.5 or 1.0 μm in diameter. RESULTS The particle load during drilling was significantly higher in the microscopic ear surgery group (n = 5) than in the transcanal endoscopic ear surgery group (n = 11) for all particle sizes (p < 0.01). In the transcanal endoscopic ear surgery group, no significant differences among the particle load observed before, during and after drilling were seen for any of the particle sizes. CONCLUSION Bone dissection carries a lower risk of airborne infection if it is performed using the endoscopic underwater drilling technique.
Collapse
Affiliation(s)
- S Nishiike
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - T Michiba
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - R Ito
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - N Ashida
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - H Kato
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - A Kuki
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - K Ogawa
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - K Tamura
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - S Uetsuka
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| |
Collapse
|
4
|
Oh MS, Vettikattu NT, Baddour HM, Gross JH, Boyce BJ, Patel MR, Schmitt NC, Arturo Solares C, Vuncannon JR, Kaka AS. Submental Island Flaps for Lateral Reconstruction: Technical Refinements for Optimal Outcomes and Resource Efficiency. OTO Open 2024; 8:e131. [PMID: 38618288 PMCID: PMC11015144 DOI: 10.1002/oto2.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/02/2024] [Accepted: 02/05/2024] [Indexed: 04/16/2024] Open
Abstract
Objective To describe our modifications to the submental island flap (SMIF) in a case series that demonstrates improved reproducibility, shortened length of stay (LOS), and reduced utilization of hospital resources. Study Design This retrospective case series with chart review included adult patients who underwent resection of malignant or benign tumors resulting in lateral facial, parotid, or temporal bone defects, which were reconstructed with SMIF. Setting A tertiary-care academic referral center. Methods Retrospective case series included all adult patients who underwent SMIF reconstruction between March 2020 and August 2021. Patient demographic and clinical data were collected. Primary outcomes were measures of hospital utilization including duration of surgery, LOS, and postoperative outcomes. Results Twenty-eight patients were included with a mean age of 71.7 years. Eighty percent were male. All patients underwent parotidectomy, and the mean operative time was 347 minutes. The median LOS was 2.5 days (range 0-16 days). Seventy-five percent of the flaps drained into the internal jugular vein, and 25% drained into the external jugular vein. No patients required reoperation or readmission. All flaps survived. Conclusion SMIFs are a safe and effective option for reconstruction of lateral facial, parotid, and temporal bone defects. Compared to free flap reconstruction, SMIFs offer reduced length of surgery, decreased use of health care resources, and lower rate of reoperation. As health care resource allocation is increasingly important, the SMIF offers an excellent alternative to free flap reconstruction of lateral defects.
Collapse
Affiliation(s)
- Melissa S. Oh
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Nikhil T. Vettikattu
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Harry Michael Baddour
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jennifer H. Gross
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Brian J. Boyce
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Mihir R. Patel
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Nicole C. Schmitt
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Clementino Arturo Solares
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jackson R. Vuncannon
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| | - Azeem S. Kaka
- Department of Otolaryngology–Head and Neck Surgery, Division of Head and Neck Oncology and ReconstructionEmory University School of MedicineAtlantaGeorgiaUSA
| |
Collapse
|
5
|
Bolton L, Young K, Ray J, Chawdhary G. Virtual temporal bone simulators and their use in surgical training: a narrative review. J Laryngol Otol 2024; 138:356-360. [PMID: 37973532 DOI: 10.1017/s0022215123002025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Temporal bone dissection is a difficult skill to acquire, and the challenge has recently been further compounded by a reduction in conventional surgical training opportunities during the coronavirus disease 2019 pandemic. Consequently, there has been renewed interest in ear simulation as an adjunct to surgical training for trainees. We review the state-of-the-art virtual temporal bone simulators for surgical training. MATERIALS AND METHODS A narrative review of the current literature was performed following a Medline search using a pre-determined search strategy. RESULTS AND ANALYSIS Sixty-one studies were included. There are five validated temporal bone simulators: Voxel-Man, CardinalSim, Ohio State University Simulator, Melbourne University's Virtual Reality Surgical Simulation and Visible Ear Simulator. The merits of each have been reviewed, alongside their role in surgical training. CONCLUSION Temporal bone simulators have been demonstrated to be useful adjuncts to conventional surgical training methods and are likely to play an increasing role in the future.
Collapse
Affiliation(s)
- Lauren Bolton
- ENT Offices, York Hospital, York and Scarborough Teaching Hospitals NHS Foundation Trust, York UK
| | - Kenneth Young
- ENT, Castle Hill Hospital, Hull University Teaching Hospital, Hull, UK
| | - Jaydip Ray
- ENT, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gaurav Chawdhary
- ENT, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
6
|
Noy R, Livneh I, Zohar Y, Abergel E, Vaisbuch Y. Intraoperative hybrid technique for excision of temporal bone paraganglioma: A case report. Head Neck 2024; 46:E44-E48. [PMID: 38334158 DOI: 10.1002/hed.27672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Temporal bone paragangliomas are vascularized neoplasms. Although preoperative angioembolization serves as a valuable approach to reduce intraoperative blood loss, it comes with an elevated risk of cranial neuropathies, offers no assurance of complete hemostasis, and precludes real-time adjustments during surgery. METHODS A 74-year-old patient presented with recurrent episodes of ear bleeding. On examination, a vascular lesion obstructed her external auditory canal. It had the clinical and radiological characteristics of a paraganglioma. Angiography revealed that it had three feeding vessels. RESULTS The patient was successfully scheduled for hybrid, intraoperative angiography and temporary balloon occlusion of the feeding vessels supplying the lesion instead of preoperative angioembolization. CONCLUSIONS Utilizing hybrid intraoperative angiography with temporary balloon occlusion during the surgical removal of temporal bone paragangliomas represents an innovative technique that reduces the risk of permanent cranial neuropathies while providing the capacity for real-time adjustments and improved hemostasis.
Collapse
Affiliation(s)
- Roee Noy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
- The Rappaport Faculty of Medicine and Integrated Cancer Center, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ido Livneh
- The Rappaport Faculty of Medicine and Integrated Cancer Center, Technion-Israel Institute of Technology, Haifa, Israel
- Institute of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Yaniv Zohar
- The Rappaport Faculty of Medicine and Integrated Cancer Center, Technion-Israel Institute of Technology, Haifa, Israel
- Institute of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Eitan Abergel
- The Rappaport Faculty of Medicine and Integrated Cancer Center, Technion-Israel Institute of Technology, Haifa, Israel
- Endovascular Neuro-Intervention Unit, Rambam Health Care Campus, Haifa, Israel
| | - Yona Vaisbuch
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
- The Rappaport Faculty of Medicine and Integrated Cancer Center, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
7
|
Raymond MJ, Biswal B, Pipaliya RM, Rowley MA, Meyer TA. Convolutional Neural Network-Based Deep Learning Engine for Mastoidectomy Instrument Recognition and Movement Tracking. Otolaryngol Head Neck Surg 2024. [PMID: 38520201 DOI: 10.1002/ohn.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To develop a convolutional neural network-based computer vision model to recognize and track 2 mastoidectomy surgical instruments-the drill and the suction-irrigator-from intraoperative video recordings of mastoidectomies. STUDY DESIGN Technological development and model validation. SETTING Academic center. METHODS Ten 1-minute videos of mastoidectomies done for cochlear implantation by varying levels of resident surgeons were collected. For each video, containing 900 frames, an open-access computer vision annotation tool was used to annotate the drill and suction-irrigator class images with bounding boxes. A mastoidectomy instrument tracking module, which extracts the center coordinates of bounding boxes, was developed using a feature pyramid network and layered with DETECTRON, an open-access faster-region-based convolutional neural network. Eight videos were used to train the model, and 2 videos were used for testing. Outcome measures included Intersection over Union (IoU) ratio, accuracy, and average precision. RESULTS For an IoU of 0.5, the mean average precision for the drill was 99% and 86% for the suction-irrigator. The model proved capable of generating maps of drill and suction-irrigator stroke direction and distance for the entirety of each video. CONCLUSIONS This computer vision model can identify and track the drill and suction-irrigator from videos of intraoperative mastoidectomies performed by residents with excellent precision. It can now be employed to retrospectively study objective mastoidectomy measures of expert and resident surgeons, such as drill and suction-irrigator stroke concentration, economy of motion, speed, and coordination, setting the stage for characterization of objective expectations for safe and efficient mastoidectomies.
Collapse
Affiliation(s)
- Mallory J Raymond
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Jacksonville, USA
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Biswajit Biswal
- Computer Science and Mathematics, South Carolina State University, Orangeburg, South Carolina, USA
| | - Royal M Pipaliya
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Jacksonville, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona, USA
| | - Mark A Rowley
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Jacksonville, USA
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Jacksonville, USA
| |
Collapse
|
8
|
Andersen SAW, Hittle B, Värendh M, Lee J, Varadarajan V, Powell KA, Wiet GJ. Further Validity Evidence for Patient-Specific Virtual Reality Temporal Bone Surgical Simulation. Laryngoscope 2024; 134:1403-1409. [PMID: 37650640 DOI: 10.1002/lary.31016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/21/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Patient-specific virtual reality (VR) simulation of cochlear implant (CI) surgery potentially enables preoperative rehearsal and planning. We aim to gather supporting validity evidence for patient-specific simulation through the analysis of virtual performance and comparison with postoperative imaging. METHODS Prospective, multi-institutional study. Pre- and postoperative cone-beam CT scans of CI surgical patients were obtained and processed for patient-specific VR simulation. The virtual performances of five trainees and four attendings were recorded and (1) compared with volumes removed during actual surgery as determined in postoperative imaging, and (2) assessed using the Copenhagen Cochlear Implant Surgery Assessment Tool (CISAT) by two blinded raters. The volumes compared were cortical mastoidectomy, facial recess, and round window (RW) cochleostomy as well as violation of the facial nerve and chorda. RESULTS Trainees drilled more volume in the cortical mastoidectomy and facial recess, whereas attendings drilled more volume for the RW cochleostomy and made more violations. Except for the cochleostomy, attendings removed volumes closer to that determined in postoperative imaging. Trainees achieved a higher CISAT performance score compared with attendings (22.0 vs. 18.4 points) most likely due to lack of certain visual cues. CONCLUSION We found that there were differences in performance of trainees and attendings in patient-specific VR simulation of CI surgery as assessed by raters and in comparison with actual drilled volumes. The presented approach of volume comparison is novel and might be used for further validation of patient-specific VR simulation before clinical implementation for preoperative rehearsal in temporal bone surgery. LEVEL OF EVIDENCE n/a Laryngoscope, 134:1403-1409, 2024.
Collapse
Affiliation(s)
- Steven Arild Wuyts Andersen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology, Rigshospitalet, Copenhagen, Denmark
| | - Brad Hittle
- Department of Biomedical Informatics, Ohio State University, Columbus, Ohio, U.S.A
| | - Maria Värendh
- Department of Otorhinolaryngology, Örebro University Hospital, Örebro University, Örebro, Sweden
- Department of Otorhinolaryngology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Julian Lee
- Department of Otorhinolaryngology, The Ohio State University, Columbus, Ohio, U.S.A
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | | | - Kimerly A Powell
- Department of Biomedical Informatics, Ohio State University, Columbus, Ohio, U.S.A
| | - Gregory J Wiet
- Department of Otorhinolaryngology, The Ohio State University, Columbus, Ohio, U.S.A
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| |
Collapse
|
9
|
Benchetrit L, Shave S, Garcia A, Chung JJ, Suresh K, Lee DJ. Predictors of non-primary auditory and vestibular symptom persistence following surgical repair of superior canal dehiscence syndrome. Front Neurol 2024; 15:1336627. [PMID: 38469592 PMCID: PMC10925929 DOI: 10.3389/fneur.2024.1336627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024] Open
Abstract
Objective Patients with superior canal dehiscence syndrome (SCDS) can present with a plethora of auditory and/or vestibular symptoms associated with a bony defect of the superior semicircular canal. While surgical repair is a reasonable option for patients with significant localizing symptoms, the degree of clinical improvement will vary among patients and poses challenges in outcome prediction. This study aims to assess the relationship between preoperative and postoperative symptoms and identify predictors of symptom persistence following repair. Study design Retrospective chart review. Setting Tertiary neurotology single-institution care center. Main outcome measures The primary outcome was to determine the proportion of resolved and persistent primary (most bothersome) and non-primary audiologic and vestibular symptoms following SCD repair. Secondary outcomes included comparison of patient, operative and radiologic characteristics between patients with resolved vs. persistent symptoms. Standardized patient questionnaires including 11 auditory and 8 vestibular symptoms were administered to patients at their preoperative and follow-up visits. Patient pre- vs. postoperative survey results, demographic and clinical characteristics, operative characteristics, audiometric data and cervical vestibular evoked myogenic potential (cVEMP) thresholds were compared via univariate χ2 and multivariate binary logistic regression analyses between those patients reporting full postoperative resolution of symptoms and persistence of one or more symptoms. Radiologic computed tomography (CT) measurements of superior canal dehiscence (SCD) defect size, location, and laterality were also compared between these two groups. Results Of 126 patients (132 ears) included in our study, 119 patients (90.2%) reported postoperative resolution (n = 82, 62.1%) or improvement (n = 37, 28.0%) of primary (most bothersome) symptoms, while 13 patients (9.8%) reported persistence of primary symptoms. The median (interquartile range) and range between surgery and questionnaire completion were 9 (4-28), 1-124 months, respectively. Analyzing all symptoms (primary and non-primary) 69 (52.3%) and 68 (51.1%) patients reported complete postoperative auditory and vestibular symptom resolution, respectively. The most likely persistent symptoms included imbalance (33/65/67, 50.8%), positional dizziness (7/20, 35.0%) and oscillopsia (44/15, 26.7%). Factors associated with persistent auditory symptoms included history of seizures (0% vs. 7.6%, p = 0.023), auditory chief complaint (50.0% vs. 70.5%), higher PTA (mean 19.6 vs. 25.1 dB, p = 0.043) and higher cervical vestibular evoked myogenic potential (cVEMP) thresholds at 1000 Hz (mean 66.5 vs. 71.4, p = 0.033). A migraine diagnosis (14.0% vs. 41.9% p < 0.010), bilateral radiologic SCD (17.5% vs. 38.1%, p = 0.034) and revision cases (0.0% vs. 14.0%, p = 0.002) were associated with persistent vestibular symptoms. Neither SCD defect size nor location were significantly associated with symptom persistence (P > 0.05). Conclusions Surgical repair for SCDS offers meaningful reduction in the majority of auditory and vestibular symptoms. However, the persistence of certain, mostly non-primary, symptoms and the identification of potential associated factors including migraines, PTA thresholds, cVEMP threshold, bilateral SCD, and revision cases emphasize the importance of individualized patient counseling and management strategies.
Collapse
Affiliation(s)
- Liliya Benchetrit
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
- Department of Otolaryngology-Head, and Neck Surgery, Boston University, Boston, MA, United States
| | - Samantha Shave
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Alejandro Garcia
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
- Department of Otolaryngology-Head, and Neck Surgery, University of Iowa, Iowa City, IA, United States
| | - Janice J Chung
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
| | - Krish Suresh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
| |
Collapse
|
10
|
Maccarrone F, Molinari G, Fermi M, Alicandri-Ciufelli M, Presutti L, Tassi S, Villari D, Negri M. Surgical anatomy of posterior tympanotomy: influence of the retrotympanum on round window exposure. J Laryngol Otol 2024; 138:142-147. [PMID: 37246511 DOI: 10.1017/s0022215123000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To describe how the retrotympanic structures could influence the visibility of the round window niche and the round window membrane during cochlear implant surgery, and to investigate if a round window approach is possible even in cases with unfavourable anatomy. METHODS Video recordings from 37 patients who underwent cochlear implantation were reviewed. The visibility of the round window niche and round window membrane at different timepoints was assessed according to a modified version of the Saint Thomas Hospital classification. The structures that concealed the round window niche and round window membrane were evaluated. RESULTS After posterior tympanotomy, 54 per cent of cases had limited exposure (classes IIa, IIb and III) of the round window niche. After remodelling the retrotympanum, round window niche visibility significantly increased, with 100 per cent class I and IIa cases. Following remodelling of the round window niche, visibility of more than 50 per cent of the round window membrane surface was achieved in 100 per cent of cases. CONCLUSION Remodelling the retrotympanum and the round window niche significantly increased exposure of the round window niche and round window membrane respectively, allowing round window insertion in all cases.
Collapse
Affiliation(s)
- Francesco Maccarrone
- Department of Otolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
- Department of Otolaryngology Head and Neck Surgery, Azienda USL di Modena, Ospedale 'Ramazzini' di Carpi, Carpi (MO), Italy
| | - Giulia Molinari
- Department of Otorhinolaryngology and Audiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - Matteo Fermi
- Department of Otorhinolaryngology and Audiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology and Audiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - Sauro Tassi
- Department of Otolaryngology Head and Neck Surgery, Azienda USL di Modena, Ospedale 'Ramazzini' di Carpi, Carpi (MO), Italy
| | - Domenico Villari
- Department of Otolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Maurizio Negri
- Department of Otolaryngology Head and Neck Surgery, Azienda USL di Modena, Ospedale 'Ramazzini' di Carpi, Carpi (MO), Italy
| |
Collapse
|
11
|
Freiser ME, Magnetta M, Ghodadra A, Castaño JE, Jabbour N. The 3-Dimensional Temporal Bone Dissection Manual: Operable Stepwise Models for Teaching Otologic Surgery. OTO Open 2024; 8:e110. [PMID: 38333549 PMCID: PMC10851023 DOI: 10.1002/oto2.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/01/2023] [Accepted: 12/31/2023] [Indexed: 02/10/2024] Open
Abstract
Deconstructing surgeries into steps and providing instructions with illustrations has been the staple of surgical textbooks for decades. However, it may be difficult for the novice surgeon to interpret 2-dimensional (2D) illustrations into 3D surgeries. The objective of this study is to create operable models that demonstrate the progression of surgery in 3D and allow for mastering the final steps of the operation first. Mastoidectomy was performed in a stepwise fashion to different end points on 5 identical 3D-printed temporal bone models to represent 5 major steps of the operation. The drilled models were computed tomography scanned and the subsequent images were used to create 3D model copies of each step. This is the first study to demonstrate that it is possible to create, scan, and copy stepwise, operable, patient-specific 3D-printed models, which the trainee can both reference as a 3D dissection guide and can operate on repeatedly and in any order.
Collapse
Affiliation(s)
- Monika E. Freiser
- Department of OtolaryngologyChildren's Hospital of Pittsburgh of University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
- Present address:
Department of OtolaryngologyWest Virginia UniversityMorgantownWVUSA
| | - Michael Magnetta
- Department of RadiologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
- Present address:
NorthShore University Health SystemChicagoILUSA
| | - Anish Ghodadra
- Department of RadiologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Johnathan E. Castaño
- Department of OtolaryngologyChildren's Hospital of Pittsburgh of University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
- Present address:
Department of OtolaryngologyWest Virginia UniversityMorgantownWVUSA
| | - Noel Jabbour
- Department of OtolaryngologyChildren's Hospital of Pittsburgh of University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| |
Collapse
|
12
|
Al-Alawneh M, Al-Ashqar R, Al-Omari I, Odat H. Attic reconstruction techniques in cholesteatoma surgery: a comparative analysis of cartilage versus bone pate. Acta Otolaryngol 2023; 143:936-939. [PMID: 38127425 DOI: 10.1080/00016489.2023.2293227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Cholesteatoma surgery involves canal wall down (CWD) and canal wall up (CWU) mastoidectomy. CWU is associated with higher cholesteatoma recurrence, often linked to attic retraction pockets. Attic reconstruction with cartilage or bone pate lacks comparative evidence. AIMS/OBJECTIVES To compare the effectiveness of cartilage and bone pate in attic reconstruction during CWU mastoidectomy for cholesteatoma. MATERIAL AND METHODS We conducted a retrospective study at King Abdullah University Hospital (KAUH) in Jordan, analyzing surgeries performed from 2011 to 2021. Patients who underwent CWU mastoidectomy with attic reconstruction using tragal cartilage with perichondrium or bone pate were included. RESULTS Of 48 patients analyzed, 26 had cartilage graft attic reconstruction, and 22 received bone pate. Recurrent cholesteatoma occurred in 19.23% of the cartilage group but none in the bone pate group (p = .001). Ear discharge was observed in 19.23% of the cartilage group and 18.18% of the bone pate group, while tympanic membrane perforations and external auditory canal cholesteatoma were more prevalent in the cartilage group. CONCLUSIONS AND SIGNIFICANCE Our study indicates that bone pate results in significantly lower cholesteatoma recurrence than cartilage grafting in CWU mastoidectomy attic reconstruction. Bone pate offers stability and favorable long-term outcomes for outer attic wall repair.
Collapse
Affiliation(s)
- Mohammad Al-Alawneh
- Department of Special Surgery, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ra'ed Al-Ashqar
- Department of Special Surgery, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Isra Al-Omari
- Department of Special Surgery, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Haitham Odat
- Department of Special Surgery, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
13
|
McKenna D, Reddy E. Congenital mastoid-isolated cholesteatoma in a 14-year-old boy. Clin Case Rep 2023; 11:e8182. [PMID: 38028056 PMCID: PMC10654462 DOI: 10.1002/ccr3.8182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/01/2023] [Accepted: 09/15/2023] [Indexed: 12/01/2023] Open
Abstract
Congenital mastoid confined cholesteatoma is a very rare entity with only 30 reported cases worldwide. We describe the presentation and treatment of this condition in a 14-year-old boy, with maintenance of normal hearing and ear canal function.
Collapse
Affiliation(s)
- Dominic McKenna
- Craigavon Area Hospital (Southern Health and Social Care Trust)PortadownUK
| | - Ekambar Reddy
- Craigavon Area Hospital (Southern Health and Social Care Trust)PortadownUK
| |
Collapse
|
14
|
Jones JW, Ballard DP, Hillman TA, Chen DA. Outcomes of Mastoidectomy With Antibiotic Catheter Irrigation for Patients With Draining Ventilation Tubes. Ear Nose Throat J 2023; 102:673-679. [PMID: 34130511 DOI: 10.1177/01455613211025742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of mastoidectomy with antibiotic catheter irrigation in patients with chronic tympanostomy tube otorrhea. METHODS A chart review of adult and pediatric patients with persistent tympanostomy tube otorrhea who had failed outpatient medical management and underwent mastoidectomy with placement of a temporary indwelling catheter for antibiotic instillation was performed. Patients were retrospectively followed for recurrent drainage after 2 months and outcomes were categorized as resolution (0-1 episodes of otorrhea or otitis media with effusion during follow-up), improvement (2-3 episodes), or continued episodic (>3 episodes). RESULTS There were 22 patients and 23 operated ears. Median age was 46 years (interquartile range, IQR = 29-65). The median duration of otorrhea from referral was 5.5 months (IQR = 2.8-12). Following surgery, 14 ears had resolution of drainage, 6 had improvement, and 3 had episodic. The observed percentage of resolved/improved ears (87%) was significant (P = .0005, 95% CI = 67.9%-95.5%). Median follow-up time was 25 months (IQR = 12-59). Pre and postoperative pure tone averages improved (difference of medians = -3.3 dB, P = .02) with no significant difference in word recognition scores (P = .68). Methicillin-resistant Staphylococcus aureus was the most common isolated microbe while no growth was most frequently noted on intraoperative cultures. CONCLUSIONS Mastoidectomy with antibiotic catheter irrigation may be an effective surgical strategy, and single stage alternative to intravenous antibiotics, for select patients with persistent tube otorrhea who have failed topical and oral antibiotics.
Collapse
Affiliation(s)
- Joel W Jones
- Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA
- Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Daniel P Ballard
- Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Todd A Hillman
- Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Douglas A Chen
- Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA
| |
Collapse
|
15
|
Mokhatrish M. Auricular Protrusion After the Postauricular Approach: A Review of the Current Literature. Cureus 2023; 15:e46509. [PMID: 37808593 PMCID: PMC10551775 DOI: 10.7759/cureus.46509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/10/2023] Open
Abstract
The postauricular approach is a widely adopted surgical technique for the ear due to its unique access to the middle ear, mastoid, and other internal structures, while adeptly concealing the surgical incision for aesthetic superiority. Despite its advantages, concerns have emerged regarding the potential for auricular protrusion following the procedure. While the exact mechanisms underlying this phenomenon remain under debate, it is worth noting that comprehensive literature on this topic is scant. Nevertheless, available studies predominantly indicate no association between the postauricular approach and lasting auricular protrusion. In the few reports that do note its occurrence, the protrusion appears transient, resolving over time. These findings suggest that surgeons should continue using the postauricular approach without concerns regarding auricular protrusion. Nonetheless, it is recommended to take all precautionary measures, including appropriate patient selection, engagement of an experienced surgeon, and meticulous postoperative dressing.
Collapse
Affiliation(s)
- Mohammad Mokhatrish
- Depratment of Surgery, Prince Sattam bin Abdulaziz University, Al-Kharj, SAU
- Department of Otorhinolaryngology and Head and Neck Surgery, Prince Sattam bin Abdulaziz University, Al-Kharj, SAU
| |
Collapse
|
16
|
Wu X, Zhang Q, Huang Y, Wang X, Feng G. Predictors of Functional Outcomes and Recovery Time Following Tympanoplasty. Ear Nose Throat J 2023:1455613231194748. [PMID: 37605434 DOI: 10.1177/01455613231194748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
Objectives: To identify the predictors of tympanoplasty success including graft success, hearing outcomes, and recovery time. Methods: Patients who underwent a tympanoplasty between January 2019 and July 2022 were enrolled. Hearing outcomes were measured by air-bone gap from pure tone. Demographic data of the patient, surgical parameters, and Ossiculoplasty Outcome Parameter Staging (OOPS) were reviewed and evaluated to predict the success of tympanoplasty using univariate and multivariate logistic or Cox regression analyzes. Results: Of 138 patients, 151 procedures were studied. At the 6-month follow-up visit, the overall graft success was 90.7% and the overall hearing success was 40.4%. There was a correlation between the OOPS index and postoperative hearing success (Spearman r = 0.322). Blood loss > 10 ml and OOPS ≥ 4 were independent predictors of hearing failure. Blocked aditus ad antrum and blood loss > 10 ml were independent predictors of prolonged recovery time. Conclusions: The OOPS index exhibits a strong predictive influence on hearing outcomes after tympanoplasty. A predictive model that combines the amount of blood loss and blockage of aditus ad antrum can serve as a useful tool in predicting postoperative recovery time.
Collapse
Affiliation(s)
- Xuan Wu
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Qing Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yu Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xi Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Guodong Feng
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
17
|
Yang X, Man D, Yang Y, Li X. Feasibility of an endoscope-dominated side-to-end hypoglossal-facial anastomosis: an anatomical study. Front Surg 2023; 10:1251527. [PMID: 37671034 PMCID: PMC10475590 DOI: 10.3389/fsurg.2023.1251527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/25/2023] [Indexed: 09/07/2023] Open
Abstract
Objective A surgical simulation of an endoscope-dominated side-to-end hypoglossal-facial anastomosis was performed to evaluate the feasibility. Methods Eight anatomical cadaver heads (16 sides) were recruited. The steps in conventional procedures were abbreviated or omitted. A facial nerve was first harvested near its external genu and was used for a side-to-end hypoglossal-facial anastomosis. The stump of the used facial nerve was truncated and recycled immediately caudal to the facial recess in another anastomosis and then recycled again at the stylomastoid foramen. As a recycled stump becomes too short to ensure a side-to-end anastomosis, the hypoglossal nerve was transected in situ, and an endoscopic end-to-end hypoglossal-facial anastomosis was attempted. Surgical simulation and quantitative measurement methods were used to analyze the anastomosis effects of different harvested sites of the facial nerve. Results Several steps in the conventional procedures provide little benefit in endoscopic surgery. A facial nerve stump recycled at the stylomastoid foramen is too short to ensure a tensionless side-to-end anastomosis. An endoscopic end-to-end hypoglossal-facial anastomosis was feasible, although it required more time than the classical microsurgical anastomosis. The greater agility of an endoscope enables the conventional surgical steps to be overlapped or interweaved into the procedure. Conclusions The multiple surgical fields and ability to manipulate the viewpoint provided by an endoscope have brought about breakthroughs in classical surgical paradigms. In addition, it is best to choose the sites of the facial nerve harvested near the external genu. If unavailable, an alternative section site could be selected immediately caudal to the facial recess, but cannot be distal to the stylomastoid foramen. The length of the stump should be individualized and preferably optimized with a nerve stimulator.
Collapse
Affiliation(s)
- Xiaobing Yang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Dulegeqi Man
- Department of Neurosurgery, International Mongolia Hospital of Inner Mongolia, Hohhot, China
| | - Yang Yang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Xingang Li
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| |
Collapse
|
18
|
Kara H, Sen C, Sonmez S, Celik M, Polat B. The effect of bony obliteration on quality of life after tympano- mastoidectomy surgery: A prospective observational controlled cohort study. Laryngoscope Investig Otolaryngol 2023; 8:1052-1060. [PMID: 37621278 PMCID: PMC10446264 DOI: 10.1002/lio2.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/17/2023] [Accepted: 06/04/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives The study's primary objective was to compare the quality of life (QoL) and external auditory canal (EAC) hygiene among patients who underwent bony mastoid obliteration or meatoplasty after canal wall down (CWD) mastoidectomy. Methods A prospective, observational, controlled cohort study was conducted at our tertiary referral university hospital. Twenty-eight patients older than 16 years of age with chronic otitis media who underwent CWD mastoidectomy were included. Two cohorts were followed: CWD mastoidectomy followed by mastoid obliteration (Group 1, n = 14) and CWD mastoidectomy followed by meatoplasty (Group 2, n = 14). The main outcome measures of total COMBI score (postoperative 6-month QoL) and EAC hygiene were compared between the groups. Results The average age of the patients was 36.14 (12. 22) years; 15 (53.6%) were female and 13 (46.4%) were male. There were no differences in demographic variables, preoperative findings, or COMQ-12 (preoperative QoL) scores between groups. The average COMBI score of Group 1 (49.0 [8.66]) was not significantly different from Group 2 (46.79 [7.76]) (p = .482). Poor EAC hygiene was observed in eight (57.1%) patients in Group 2 and three (21.4%) patients in Group 1 (p = .06). In Group 1, no resorption of graft material was observed in 10 (71.4%) patients, minor resorption was observed in three (21.4%) patients, and significant resorption was observed in one (7.1%) patient. There were no significant differences in audiological findings between groups (p > .05). Conclusion There were no significant differences regarding short-term postoperative QoL, EAC hygiene, or hearing outcomes between patients who underwent bony mastoid obliteration or meatoplasty after CWD mastoidectomy. Level of Evidence 1b (individual prospective cohort study).
Collapse
Affiliation(s)
- Hakan Kara
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| | - Comert Sen
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| | - Said Sonmez
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| | - Mehmet Celik
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| | - Beldan Polat
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| |
Collapse
|
19
|
Lee SC, Jung JW, Choi SR, Chung CJ, Lee TY, Park SY. Comparison of Postoperative Nausea and Vomiting Incidence between Remimazolam and Sevoflurane in Tympanoplasty with Mastoidectomy: A Single-Center, Double-Blind, Randomized Controlled Trial. Medicina (Kaunas) 2023; 59:1197. [PMID: 37512009 PMCID: PMC10383232 DOI: 10.3390/medicina59071197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/13/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Postoperative nausea and vomiting (PONV) is a common adverse effect of general anesthesia, especially in middle ear surgery. Remimazolam is a newer benzodiazepine recently approved for use in general anesthesia. This study aimed to compare the incidence rate of PONV after tympanoplasty with mastoidectomy between using remimazolam and sevoflurane. Materials and Methods: This study included 80 patients undergoing elective tympanoplasty with mastoidectomy. The patients were randomly assigned to either the remimazolam or sevoflurane group. The primary outcome was the incidence rate of PONV 12 h after surgery. The secondary outcomes were the incidence rate of PONV 12-24 and 24-48 h after surgery, severity of PONV, incidence rate of vomiting, administration of rescue antiemetics, hemodynamic stability, and recovery profiles. Results: The incidence rate of PONV 0-12 h after tympanoplasty with mastoidectomy was significantly lower in the remimazolam group compared with that in the sevoflurane group (28.9 vs. 57.9%; p = 0.011). However, the incidence rate of delayed PONV did not differ between the two groups. PONV severity in the early periods after the surgery was significantly lower in the remimazolam group than in the sevoflurane group. The incidence rate of adverse hemodynamic events was lower in the remimazolam group than in the sevoflurane group, but there was no difference in the overall trends of hemodynamic data between the two groups. There was no difference in recovery profiles between the two groups. Conclusions: Remimazolam can significantly reduce the incidence rate of early PONV after tympanoplasty with mastoidectomy under general anesthesia.
Collapse
Affiliation(s)
- Seung Cheol Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Republic of Korea
| | - Ji Wook Jung
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Republic of Korea
| | - So Ron Choi
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Republic of Korea
| | - Chan Jong Chung
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Republic of Korea
| | - Tae Young Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Republic of Korea
| | - Sang Yoong Park
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Republic of Korea
| |
Collapse
|
20
|
Khanna O, D'Souza G, Hattar-Medina E, Karsy M, Chiffer RC, Willcox TO, Farrell CJ, Evans JJ. A Comparison of Outcomes Using Combined Intra- and Extradural versus Extradural-Only Repair of Tegmen Defects. J Neurol Surg B Skull Base 2023; 84:136-142. [PMID: 36895816 PMCID: PMC9991520 DOI: 10.1055/a-1757-0328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022] Open
Abstract
Objective Tegmen tympani or tegmen mastoideum defects involve dehiscence of the temporal bone that can be a source of cerebrospinal fluid (CSF) otorrhea. Herein, we compare a combined intra-/extradural repair strategy with an extradural-only repair as it pertains to surgical and clinical outcomes. Design A retrospective review from our institution was performed of patients with tegmen defects requiring surgical intervention. Participants Patients with tegmen defects who underwent surgery (combined transmastoid and middle fossa craniotomy) for repair of tegmen defects between 2010 and 2020 were inclined in this study. Results A total of 60 patients with 40 intra-/extradural (mean follow-up time: 1,060 ± 1,103 days) and 20 extradural-only (mean follow-up time: 519 ± 369 days) repairs were identified. No major differences in demographic factors or presenting symptoms were identified between the two cohorts. There was no difference in hospital length of stay between the two patient cohorts (mean: 4.15 vs. 4.35 days, p = 0.8). In the extradural-only repair technique, synthetic bone cement was more frequently used (100 vs. 7.5%, p < 0.01), whereas in the combined intra-/extradural repair, synthetic dural substitute was used more often (80 vs. 35%, p < 0.01), with similar successful surgical outcomes achieved. Despite disparities in the techniques and materials used for repair, there were no differences in complication rates (wound infection, seizures, and ossicular fixation), 30-day readmission rates, or persistent CSF leak between the two treatment cohorts. Conclusion The results of this study suggest no difference in clinical outcomes between combined intra-/extradural versus extradural-only repair of tegmen defects. A simplified extradural-only repair strategy can be effective, and may reduce the morbidity of intradural reconstruction (seizures, stroke, and intraparenchymal hemorrhage).
Collapse
Affiliation(s)
- Omaditya Khanna
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Glen D'Souza
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Ellina Hattar-Medina
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Michael Karsy
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Rebecca C Chiffer
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Thomas O Willcox
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Christopher J Farrell
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - James J Evans
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| |
Collapse
|
21
|
Raymond M, Studer M, Al-Mulki K. Supplementing Intraoperative Mastoidectomy Teaching With Video-Based Coaching. Ann Otol Rhinol Laryngol 2023; 132:440-448. [PMID: 35658718 DOI: 10.1177/00034894221098804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Video-based coaching might complement general surgery education, but little is known of its applicability for otologic microsurgical teaching. Our purpose was thus to evaluate the content and resident-perceived benefit of video-based coaching for mastoidectomy education. METHODS In this mixed-methods pilot design, mastoidectomies were recorded from operative microscopes and reviewed during 30-minute video-based coaching sessions at 2 tertiary care centers. Eight residents and 3 attendings participated. Ten-point Likert-type questionnaires on the extent to which attendings taught 12 topics through 8 techniques were completed by residents after surgical and coaching sessions. Coaching sessions and structured interviews with residents were audio-recorded, transcribed and iteratively coded. RESULTS Seven audio-recordings were available for coaching sessions, during which a mean of 2.22 ± 0.5 topics per minute were discussed. Of the 12 teaching topics, technique was discussed most frequently (32%, 0.71 ± 0.2 topics/min), followed by anatomy (16%, 0.31 ± 0.16 topics/min). Of all 8 ratings between coaching and operative sessions, residents indicated a greater extent of discussion of anatomy (median difference, [95% confidence interval (CI)] of 3 [1-4]), progress (2.25 [95% CI, 0.5-4]), technique (3.5 [95% CI, 1.5-5.5]), pitfalls (2.5 [95% CI, 1-3.5]), and summarizing (3 [95% CI, 1-5]). In structured interviews, residents reported improved self-confidence and global perspective. CONCLUSIONS Video-based coaching is educationally dense and characterized by perceived richer teaching and promotion of a deeper surgical understanding. It requires no additional resources, can be completed in a short period of time and can be implemented programmatically for any otolaryngologic subspecialty utilizing video-recording capable equipment.
Collapse
Affiliation(s)
- Mallory Raymond
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew Studer
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Kareem Al-Mulki
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
22
|
Dalğıç A, Aksoy Yıldırım G, Zorlu ME, Delice O, Aysel A. Total Transcanal Endoscopic Ear Surgery for Cholesteatoma. Turk Arch Otorhinolaryngol 2023; 61:1-7. [PMID: 37583974 PMCID: PMC10424586 DOI: 10.4274/tao.2023.2022-11-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/12/2023] [Indexed: 08/17/2023] Open
Abstract
Objective This study aimed to evaluate the outcomes of total transcanal endoscopic cholesteatoma surgery. Methods Twenty-seven cholesteatoma patients that had undergone transcanal endoscopic ear surgery (TEES) were included in the study. Age, sex, operation date of patients, operated side, need for ossiculoplasty, graft material, and surgical technique were recorded. All patients were evaluated through otoscopic, endoscopic, and audiological examinations and followed up for at least five months after surgery. All patients were staged using the European Academy of Otology and Neurotology/Japan Otological Society (EAONO/JOS) Staging System on Middle Ear Cholesteatoma. Results Mean age of the patients was 36.4 years (range, 4-67 years). According to the EAONO/JOS Staging System, 11 patients were stage 1, while 11 were stage 2, and five were stage 3. Two had lateral semicircular canal defect, one had facial canal dehiscence, and one had oval window defect. The average follow-up period was 19 months (range, 5-41 months), during which two patients experienced retraction pocket and hearing loss and one patient had perforation. One patient underwent revision surgery during follow-up and no recurrence or residual cholesteatoma was observed. The preoperative and postoperative air-bone gaps were 25.14±13.93 dB and 22.22±12.64 dB with no significant difference. Conclusion TEES is a minimally invasive and safe procedure with low complication and recurrence rates. As with all surgical procedures, experience is essential, and as experience increases, the capability to perform endoscopic otologic surgery on more complex cases may become possible.
Collapse
Affiliation(s)
- Abdullah Dalğıç
- Department of Otolaryngology and Head & Neck Surgery, İzmir Bozyaka Training and Research Hospital, University of Health Sciences Turkey, İzmir, Turkey
| | - Gökçe Aksoy Yıldırım
- Department of Otolaryngology and Head & Neck Surgery, İzmir Bozyaka Training and Research Hospital, University of Health Sciences Turkey, İzmir, Turkey
| | - Mehmet Ekrem Zorlu
- Department of Otolaryngology and Head & Neck Surgery, İzmir Bozyaka Training and Research Hospital, University of Health Sciences Turkey, İzmir, Turkey
| | - Orçun Delice
- Department of Otolaryngology and Head & Neck Surgery, İzmir Bozyaka Training and Research Hospital, University of Health Sciences Turkey, İzmir, Turkey
| | - Abdulhalim Aysel
- Department of Otolaryngology and Head & Neck Surgery, İzmir Bozyaka Training and Research Hospital, University of Health Sciences Turkey, İzmir, Turkey
| |
Collapse
|
23
|
Friesen TL, Hall M, Ramchandar N, Berry JG, Jiang W. Evolving Management of Acute Mastoiditis: Analysis of the Pediatric Health Information System Database. Otolaryngol Head Neck Surg 2023. [PMID: 36939424 DOI: 10.1002/ohn.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/20/2022] [Accepted: 01/12/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The optimal management of acute mastoiditis remains controversial. Most existing studies are retrospective single-institutional experiences with small cohorts. Our objectives were to analyze the treatment of acute mastoiditis by pediatric centers across the United States and changes in management over time. STUDY DESIGN Retrospective analysis. SETTING Administrative database study using Pediatric Health Information System. METHODS Patients ≤18 years of age who were admitted with a principal diagnosis of acute mastoiditis from January 1, 2010 to December 31, 2019 were included. Trends were assessed by Cochran-Armitage Trend Test. χ2 and Wilcoxon rank sum tests were used to compare outcomes between the surgical and nonsurgical groups. RESULTS A total of 2170 patients met the inclusion criteria, with 1248 (57.5%) requiring surgical management. The rate of surgical procedures decreased significantly over time. The rate of myringotomy decreased from 64% in 2010 to 47% in 2019 (p < .001), and mastoidectomy decreased from 22% in 2010 to 10% in 2019 (p < .001). On admission, 29% of the cohort presented with mastoiditis-related complications. Patients treated surgically were younger (p < .001), more likely to present with complications (37.5% vs 17.5%, p < .001), required longer length of stay (3.7 vs 2.3 days, p < .001), and had higher intensive care unit utilization (8.6% vs 2.2%, p < .001). However, the rate of 30-day readmission, emergency department return, and in-hospital mortality were all similar. CONCLUSION Acute mastoiditis has been successfully treated with declining rates of a surgery over time. Younger patients who present with complications are more likely to be managed surgically, and the overall outcomes remain excellent.
Collapse
Affiliation(s)
- Tzyynong L Friesen
- Department of Otolaryngology, University of California San Diego, San Diego, California, USA.,Division of Otolaryngology, Rady Children's Hospital, San Diego, California, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Nanda Ramchandar
- Department of Pediatrics, Naval Medical Center, San Diego, California, USA
| | - Jay G Berry
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Wen Jiang
- Department of Otolaryngology, University of California San Diego, San Diego, California, USA.,Division of Otolaryngology, Rady Children's Hospital, San Diego, California, USA
| |
Collapse
|
24
|
Psillas G, Constantinidis J. Facial Palsy Secondary to Cholesteatoma: A Case-Series of 14 Patients. Audiol Res 2023; 13:86-93. [PMID: 36648929 DOI: 10.3390/audiolres13010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To evaluate patients with middle ear cholesteatoma presenting with facial palsy (FP). MATERIAL-METHODS A total of 14 subjects (10 males and 4 females), with a mean age of 42.5 years, were included in our study. The majority of patients presented with incomplete FP (House-Brackmann HB II-IV, 11 cases) and the remaining 3 patients had complete facial paralysis (HB V-VI). A canal wall down mastoidectomy was performed in all the patients, followed by partial facial nerve decompression. RESULTS At the one-year follow-up, eleven (78.5%) patients demonstrated satisfactory recovery to HB I-II. Facial function recovered to HB grade I-II in 9 (100%) patients who were surgically treated within one month, and in 2 (40%) patients who underwent surgery after one month. The tympanic segment of facial nerve was the most common site of involvement (8 patients). The multiple regression analysis showed that a higher preoperative HB grade combined with a gradual than sudden onset of FP more likely resulted in worse postoperative HB grade. CONCLUSION Early surgical removal of cholesteatoma associated with FP is more likely to result in good facial nerve recovery (78.5% of cases), when it is performed within one month from the onset of FP. According to the literature, the tympanic segment of the facial nerve was more frequently damaged (77.7%), followed by the mastoid segment (22.9%), labyrinthine segment (11.1%), and geniculate ganglion (11.1%). Labyrinthine fistula, mainly of the lateral semicircular canal, can be expected in cases of facial nerve dehiscence. The canal wall down mastoidectomy combined with partial decompression surgery was the most preferred surgical treatment for the FP secondary to cholesteatoma.
Collapse
|
25
|
Gelbart M, Bilavsky E, Scheurman O, Chodick G, Gelbart M, Ashkenazi-Hoffnung L. Characteristics of pediatric recurrent acute mastoiditis: A case-control study. Pediatr Int 2023; 65:e15545. [PMID: 37249329 DOI: 10.1111/ped.15545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Data on pediatric recurrent acute mastoiditis are lacking, despite its morbidity and clinical significance. Our aim was to describe the incidence, characteristics, and associated factors of recurrent mastoiditis in hospitalized children. METHODS Using a case-control design, analyzing electronic data of hospitalized children with acute mastoiditis between June 2011 and December 2018, children with recurrent mastoiditis were compared to children with a single episode at the time of hospitalization. Recurrent episodes of mastoiditis were compared to the first episodes. Recurrent acute mastoiditis was defined as recurring mastoiditis ≥4-weeks after a completely resolved event. RESULTS Of 347 children hospitalized with acute mastoiditis, 22 (6.3%) had recurrent mastoiditis; the median interval between episodes was 3 months (range: 1-36). The mean ± SD age was 2.3 ± 2.25 years. A comparison of first episodes in recurring cases to single episodes by univariate and multivariate analysis, showed no differences in the pre-admission management or in the isolated pathogens; however, a history of atopic dermatitis and percutaneous abscess drainage were more frequent in first episodes of recurring cases (27.3% vs. 1.2%, p < 0.001, and 27.3% vs. 10.0%, p = 0.026, respectively). The second episode of acute mastoiditis was characterized by a milder clinical course and shorter durations from symptoms to hospitalization, intravenous antibiotic therapy, and length of hospital stay. Linear regression showed that an increased interval from symptoms to hospitalization significantly increased length of hospital stay (regression coefficient of 0.215 [95% CI: 0.114-0.317], p < 0.001). CONCLUSIONS Recurrent episodes of mastoiditis were clinically milder, with shorter length of hospital stay compared to first episodes, possibly because of early admission.
Collapse
Affiliation(s)
- Miri Gelbart
- Departments of Pediatrics A, B, C and Department of Day Hospitalization, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Pediatric Neurology and Child Development Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Efraim Bilavsky
- Departments of Pediatrics A, B, C and Department of Day Hospitalization, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheurman
- Departments of Pediatrics A, B, C and Department of Day Hospitalization, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Chodick
- Epidemiology & Database Research, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Maoz Gelbart
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Liat Ashkenazi-Hoffnung
- Departments of Pediatrics A, B, C and Department of Day Hospitalization, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
26
|
Sarno LD, Cammisa I, Curatola A, Pansini V, Eftimiadi G, Gatto A, Chiaretti A. A scoping review of the management of acute mastoiditis in children: What is the best approach? Turk J Pediatr 2023; 65:906-918. [PMID: 38204305 DOI: 10.24953/turkjped.2023.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Acute mastoiditis (AM) is a severe infection of the mastoid air cells that occurs in cases of acute, sub-acute, or chronic middle ear infections. No definitive consensus regarding the management of AM has been identified. The current guidelines include a conservative approach (parenteral antibiotics alone, antibiotics plus minor surgical procedures such as myringotomy with a ventilation tube inserted or drainage of the subperiosteal abscess through retro-auricolar incision or needle aspiration) or surgical treatment (mastoidectomy). The main aim of this review was to evaluate and summarize the current knowledge about the management of pediatric AM by analyzing the current evidence in the literature. METHODS We examined the following bibliographic electronic databases: Pubmed and the Cochrane Library, from the inception date until February 2023. The search was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISM). The key words used for the search across electronic databases were: `mastoiditis` and `management`; `mastoiditis` and `surgery`; `mastoiditis` and `conservative`; `mastoiditis` and `antibiotics`; `mastoiditis` and `myringotomy`; `mastoiditis` and `grommet`; `mastoiditis` and `drainage`; and `mastoiditis` and `mastoidectomy`. RESULTS We selected 12 articles involving 1124 episodes of mastoiditis. Some of these studies considered medical therapy alone as a valid first step, whereas others considered a minor surgical intervention as an initial approach along with antibiotic therapy. Considering the studies that evaluated medical therapy as the initial sole treatment option, the success rate of antibiotics alone was 24.6%. Overall, the success rate of minor surgical procedures, excluding mastoidectomy, was 87.7%, whereas the mastoidectomy success rate was 97%. CONCLUSIONS Overall, there is no shared consensus on the diagnostic or therapeutic approach to mastoiditis. Conservative therapy has gained considerable ground in recent times, quite limiting the predominant role of mastoidectomy. Further studies will be necessary to definitely develop standardized protocols shared in the scientific community.
Collapse
Affiliation(s)
- Lorenzo Di Sarno
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ignazio Cammisa
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonietta Curatola
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valeria Pansini
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gemma Eftimiadi
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Chiaretti
- Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
27
|
Iljin A, Antoszewski B, Durko M, Zieliński T, Stabryła P, Pietruszewska W. External ear carcinoma: evaluation of surgical and reconstructive management with postauricular island flap. Postepy Dermatol Alergol 2022; 39:1134-40. [PMID: 36686011 DOI: 10.5114/ada.2022.122608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/13/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Cancers of the auricle and the external auditory canal (EAC) remain a relevant oncological problem. Aim Presentation of the results after resections of conchal bowl and EAC carcinoma (with or without radical mastoid surgery) and after reconstructions (postauricular island flap - PIF). Material and methods We analysed results of 37 patients with cancers of the auricular conchal bowl and EAC after tumour resection and reconstruction (2000-2017). Results The cancers were completely excised in all patients, with no recurrences within at least 5 years after surgery. We noted venous congestion in 22 (59.4%) cases, pinning of the operated ear in 18 (48.6%), prominent earlobe in 14 (37.8%), and EAC constriction in 6 (16.2%) cases treated without radical mastoid surgery. Conclusions Retroauricular approach in cancer of the auricular concha and EAC allowed for accurate evaluation of the tumour extent and proper surgical access, which facilitated complete removal of the tumour. Use of radical mastoid operation with conchal bowl resection and PIF reconstruction in patients with aquamous cell carcinoma or infiltrating basal cell carcinoma of auricular concha and osseous EAC resulted in cancer extirpation and good aesthetic outcomes, despite minor functional consequences. In these cancers mastoidectomy offered a wider access to determine the radicality of oncological resection.
Collapse
|
28
|
Mejzlik J, Chrobok V, Homolac M, Valenta T, Svejdova A, Cerny M, Striteska M, Krtickova J, Skoloudik L. The Relationship between Bone Conduction Hearing Threshold Shifts after Surgery for Chronic Otitis Media with Cholesteatoma According to STAM, EAONO/JOS, and SAMEO-ATO Classifications. J Clin Med 2022; 11:jcm11154481. [PMID: 35956098 PMCID: PMC9369348 DOI: 10.3390/jcm11154481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/26/2022] [Accepted: 07/30/2022] [Indexed: 11/26/2022] Open
Abstract
Background: This study focuses on the hearing threshold for bone conduction (BC) after middle-ear surgery. Methods: A total of 92 patients (120 ears) were treated for newly diagnosed chronic otitis media with cholesteatoma (2013−2018). BC was examined at frequencies of 0.5, 1, 2, and 4 kHz prior to and 1 year after surgery. STAM classification for cholesteatoma location, EAONO/JOS for stage, and surgery according to SAMEO-ATO classification were applied. The bone conduction threshold was compared for individual frequencies in patients with occurrence/absence of cholesteatoma in different locations. Results: For the occurrence of cholesteatoma in the attic (A), a statistically significant difference was found at 4 kHz (p < 0.001), in the supratubal recess (S1) at 4 kHz (p = 0.003), and for the mastoid (M) at 0.5 kHz (p = 0.024), at 1 kHz (p = 0.032), and at 2 kHz (p = 0.039). Conclusions: Cholesteatoma location can influence the post-operative hearing threshold for bone conduction.
Collapse
Affiliation(s)
- Jan Mejzlik
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic; (V.C.); (M.H.); (T.V.); (M.C.); (M.S.); (J.K.); (L.S.)
- Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic
- Correspondence: (J.M.); (A.S.)
| | - Viktor Chrobok
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic; (V.C.); (M.H.); (T.V.); (M.C.); (M.S.); (J.K.); (L.S.)
- Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic
| | - Michal Homolac
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic; (V.C.); (M.H.); (T.V.); (M.C.); (M.S.); (J.K.); (L.S.)
- Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic
| | - Tomas Valenta
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic; (V.C.); (M.H.); (T.V.); (M.C.); (M.S.); (J.K.); (L.S.)
- Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic
| | - Anna Svejdova
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic; (V.C.); (M.H.); (T.V.); (M.C.); (M.S.); (J.K.); (L.S.)
- Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic
- Correspondence: (J.M.); (A.S.)
| | - Michal Cerny
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic; (V.C.); (M.H.); (T.V.); (M.C.); (M.S.); (J.K.); (L.S.)
- Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic
| | - Maja Striteska
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic; (V.C.); (M.H.); (T.V.); (M.C.); (M.S.); (J.K.); (L.S.)
- Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic
| | - Jana Krtickova
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic; (V.C.); (M.H.); (T.V.); (M.C.); (M.S.); (J.K.); (L.S.)
- Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic
| | - Lukas Skoloudik
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic; (V.C.); (M.H.); (T.V.); (M.C.); (M.S.); (J.K.); (L.S.)
- Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic
| |
Collapse
|
29
|
Jang JH, Choo OS, Kim H, Park HY, Choung YH. Comparison of surgical results between 'atticosinuplasty' and canal wall up mastoidectomy for early-stage cholesteatoma. Acta Otolaryngol 2022; 142:259-264. [PMID: 35297742 DOI: 10.1080/00016489.2022.2046290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND We devised a surgical technique called 'atticosinuplasty' (AS) for the treatment of early-stage cholesteatoma. OBJECTIVE This study analyzed the adequacy and applicability of AS compared to canal wall-up mastoidectomy (CWU) in patients treated for early-stage cholesteatoma. MATERIALS AND METHODS A total of 187 patients with either AS (n = 89) or CWU (n = 98) were compared in terms of postoperative hearing outcome, recurrence and re-operation rate, and radiologic outcome. RESULTS Hearing gain was significant in the AS group (p < 0.001) but not in the CWU group. Air conduction change, air-bone gap (ABG) change, and ABG closure did not significantly differ between the two groups. The frequencies of cholesteatoma recurrence and revision ossiculoplasty were also similar. Of the 32 patients in the AS group with only attic/sinus involvement preoperatively, 20 (62.5%) showed no haziness and 6 (18.8%) had haziness extending to the mastoid postoperatively. Among the 67 patients in the CWU group who had haziness extending to the mastoid preoperatively, in 54 (80.6%) there was no change postoperatively. CONCLUSIONS AND SIGNIFICANCE AS is a surgical technique worth trying in patients with early stage of attic/sinus cholesteatoma in terms of the rate of recurrence and hearing improvement.
Collapse
Affiliation(s)
- Jeong Hun Jang
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Oak-Sung Choo
- Department of Otolaryngology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Hantai Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hun Yi Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yun-Hoon Choung
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
- Bk21 Plus Research Center for Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| |
Collapse
|
30
|
Park SH, Kim H, Lee YY, Kim YJ, Jang JH, Choo OS, Choung YH. Development of Intracorporeal Differentiation of Stem Cells to Induce One-Step Mastoid Bone Reconstruction during Otitis Media Surgeries. Polymers (Basel) 2022; 14:877. [PMID: 35267699 DOI: 10.3390/polym14050877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/20/2022] [Accepted: 02/20/2022] [Indexed: 11/21/2022] Open
Abstract
Mastoidectomy is a surgical procedure for the treatment of chronic otitis media. This study investigated the ability of rat stromal vascular fraction cells (rSVF) in combination with polycaprolactone (PCL) scaffolds and osteogenic differentiation-enhancing blood products to promote the regeneration of mastoid bone defect. Twenty male Sprague Dawley rats were randomly divided according to obliteration materials: (1) control, (2) PCL scaffold only, (3) rSVFs + PCL, (4) rSVFs + PCL + platelet-rich plasma, and (5) rSVFs + PCL + whole plasma (WP). At 7 months after transplantation, the rSVFs + PCL + WP group showed remarkable new bone formation in the mastoid. These results indicate that SVFs, PCL scaffolds, and blood products accelerate bone regeneration for mastoid reconstruction. Autologous SVF cells with PCL scaffolds and autologous blood products are promising composites for mastoid reconstruction which can be easily harvested after mastoidectomy. With this approach, the reconstruction of mastoid bone defects can be performed right after mastoidectomy as a one-step procedure which can offer efficiency in the clinical field.
Collapse
|
31
|
Bu DD, Schwam ZG, Kaul VF, Wong K, Fan C, Wanna GB, Cosetti MK, Perez E. Cost-effectiveness of Canal Wall-Up vs Canal Wall-Down Mastoidectomy: A Modeling Study. Otolaryngol Head Neck Surg 2022; 167:552-559. [PMID: 35133895 DOI: 10.1177/01945998221076051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the relative lifetime costs, benefits, and cost-effectiveness between the 2 approaches, canal wall-up (CWU) and canal wall-down (CWD) tympanomastoidectomy, used in the treatment of cholesteatomas. STUDY DESIGN Markov state transition model. SETTING Tertiary academic health system. METHODS A Markov state transition model was used to simulate outcomes across the patient lifetime. Outcome and complication probabilities were obtained from the existing literature. Costs were calculated from the payer perspective, with procedure, hospital, clinic, and physician cost derived from Medicare reimbursement. Quality-adjusted life years (QALYs) were used to represent effectiveness and utility. One-way and probability sensitivity analyses (PSAs) were conducted. RESULTS The base case analysis, assuming a 40-year-old patient, yielded a lifetime cost of $14,214 for a patient treated with the CWU approach assuming second-look surgery and $22,290 with a CWD approach. CWU and CWD generated a benefit of 17.11 and 17.30 QALYs, respectively. The incremental cost-effectiveness ratio for CWU was $43,237 per QALY. The Monte Carlo PSA validated the base case scenario. Using a standard $50,000 willingness-to-pay threshold, CWD was the more cost-effective approach and was selected 54.8% of the time by the simulation. CONCLUSION Both CWU and CWD were found to be cost-effective, with CWD being cost-effective 54.8% of the time at a WTP threshold of $50,000. The assumptions used in the analysis were validated by the results of 1-way and PSA.
Collapse
Affiliation(s)
- Daniel D Bu
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Zachary G Schwam
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Vivian F Kaul
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Kevin Wong
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Caleb Fan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - George B Wanna
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Maura K Cosetti
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Enrique Perez
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| |
Collapse
|
32
|
Li J, Jufas N, Forer M, Patel N. Incidence and trends of middle ear cholesteatoma surgery and mastoidectomy in Australia-A national hospital morbidity database analysis. Laryngoscope Investig Otolaryngol 2022; 7:210-218. [PMID: 35155800 PMCID: PMC8823164 DOI: 10.1002/lio2.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/07/2021] [Accepted: 11/26/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To investigate the incidence of middle ear cholesteatoma surgery and assess trends in mastoidectomy procedures in Australia. STUDY DESIGN Cross-sectional population-based study using data from the National Hospital Morbidity Database. METHODS Admitted care episodes containing the principal diagnosis of middle ear cholesteatoma were analyzed for two 12-month periods of 2007-2008 and 2017-2018. Surgical admissions involving mastoidectomy were identified by procedure codes. Incidence rate per 100,000 person-years were compared between study periods. RESULTS Of the 3855 middle ear cholesteatoma admissions, 3558 (92.3%) involved surgery, with the incidence rate for cholesteatoma surgical admissions estimated at 8.6 per 100,000 (95% CI: 8.2-9.0) and 8.1 per 100,000 (95% CI: 7.7-8.5) for 2017-2018 and 2007-2008, respectively. Population aged 10-19 years had the highest age-specific incidence rate at 12.5 per 100,000 (95% CI: 11.3-13.9) for 2017-2018. The 60 years and over age groups had the highest decennial percentage increase. Mastoidectomy procedures were consistently used in over half of all surgical admissions. An increase in the rate of canal wall up (CWU) mastoidectomy procedure related admissions was observed (rate ratio of 1.62 [95%CI: 1.41-1.86], P <.001) and was offset by a decreased rate of canal wall down (CWD) procedure associated admissions (0.69 [95% CI: 0.61-0.78], P <.001]). CONCLUSIONS The incidence rate of cholesteatoma surgery in Australia is estimated at 8.6 per 100,000. Mastoidectomy continues to play an essential role in cholesteatoma surgery with a trend favoring CWU over CWD mastoidectomy. Level of evidence: 4.
Collapse
Affiliation(s)
- Jonathan Li
- Division of Otolaryngology Head & Neck SurgeryRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Nicholas Jufas
- Division of Otolaryngology Head & Neck SurgeryRoyal North Shore HospitalSydneyNew South WalesAustralia
- Discipline of Surgery, Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
- Department of Otolaryngology – Head & Neck Surgery, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Kolling Deafness Research Centre, Royal North Shore HospitalMacquarie University and University of SydneySydneyNew South WalesAustralia
| | - Martin Forer
- Division of Otolaryngology Head & Neck SurgeryRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Nirmal Patel
- Division of Otolaryngology Head & Neck SurgeryRoyal North Shore HospitalSydneyNew South WalesAustralia
- Discipline of Surgery, Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
- Department of Otolaryngology – Head & Neck Surgery, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Kolling Deafness Research Centre, Royal North Shore HospitalMacquarie University and University of SydneySydneyNew South WalesAustralia
| |
Collapse
|
33
|
Pan DW, Voelker CCJ. Congenital duplicated incus in the mastoid cavity. Clin Case Rep 2022; 10:e05279. [PMID: 35070305 PMCID: PMC8762576 DOI: 10.1002/ccr3.5279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/12/2022] Open
Abstract
Many congenital ossicular chain malformations exist, usually involving ossicular deformities, fixation, absence, or discontinuity. Duplication of ossicles has not been reported, much less a duplicated ossicle located in the mastoid. We present a case of a patient who had a duplicated incus in the mastoid antrum.
Collapse
Affiliation(s)
- Dorothy W. Pan
- Caruso Department of Otolaryngology – Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Courtney C. J. Voelker
- Caruso Department of Otolaryngology – Head and Neck SurgeryKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| |
Collapse
|
34
|
Frithioff A, Frendø M, Weiss K, Foghsgaard S, Pedersen DB, Sørensen MS, Wuyts Andersen SA. Effect of 3D-Printed Models on Cadaveric Dissection in Temporal Bone Training. OTO Open 2021; 5:2473974X211065012. [PMID: 34926973 PMCID: PMC8671684 DOI: 10.1177/2473974x211065012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Mastoidectomy is a cornerstone in the surgical management of middle and inner ear diseases. Unfortunately, training is challenged by insufficient access to human cadavers. Three-dimensional (3D) printing of temporal bones could alleviate this problem, but evidence on their educational effectiveness is lacking. It is largely unknown whether training on 3D-printed temporal bones improves mastoidectomy performance, including on cadavers, and how this training compares with virtual reality (VR) simulation. To address this knowledge gap, this study investigated whether training on 3D-printed temporal bones improves cadaveric dissection performance, and it compared this training with the already-established VR simulation. Study Design Prospective cohort study of an educational intervention. Setting Tertiary university hospital, cadaver dissection laboratory, and simulation center in Copenhagen, Denmark. Methods Eighteen otorhinolaryngology residents (intervention) attending the national temporal bone dissection course received 3 hours of mastoidectomy training on 3D-printed temporal bones. Posttraining cadaver mastoidectomy performances were rated by 3 experts using a validated assessment tool and compared with those of 66 previous course participants (control) who had received time-equivalent VR training prior to dissection. Results The intervention cohort outperformed the controls during cadaver dissection by 29% (P < .001); their performances were largely similar across training modalities but remained at a modest level (~50% of the maximum score). Conclusion Mastoidectomy skills improved from training on 3D-printed temporal bone and seemingly more so than on time-equivalent VR simulation. Importantly, these skills transferred to cadaveric dissection. Training on 3D-printed temporal bones can effectively supplement cadaver training when learning mastoidectomy.
Collapse
Affiliation(s)
- Andreas Frithioff
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark
| | - Martin Frendø
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark.,Department of Plastic and Reconstructive Surgery, Herlev Hospital, Copenhagen, Denmark
| | - Kenneth Weiss
- Department of Mechanical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Søren Foghsgaard
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - David Bue Pedersen
- Department of Mechanical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Mads Sølvsten Sørensen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark
| |
Collapse
|
35
|
Fyrmpas G, Tsetsos N, Poutoglidis A, Alghoj A, Vlachtsis K. What is the impact of mastoid surgery on swimming? Clin Otolaryngol 2021; 47:375-379. [PMID: 34931451 DOI: 10.1111/coa.13905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/10/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Georgios Fyrmpas
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Tsetsos
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Alexandros Poutoglidis
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Ahmad Alghoj
- 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
| |
Collapse
|
36
|
Ozturk M, Topdag DO, Mutlu A, Bayraktar H, Erdogan S, Iseri M. Postoperative Radiologic Assessment and Long-Term Clinical Results of Tegmen Mastoideum Defects. Medeni Med J 2021; 36:249-256. [PMID: 34915684 PMCID: PMC8565584 DOI: 10.5222/mmj.2021.96393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/21/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Tegmen defects occur mainly due to cholesteatoma and iatrogenic trauma, and the intervention for the related defects is still a debate. In this study, we aimed to discuss our clinical experience on the management of the tegmen defects which were revealed during the mastoidectomy surgeries. Methods This study was designed as a retrospective chart review study and patients who were operated between 2007-2017 were included. The causes of the defects, repair technics, and results of the long-term follow up were evaluated. The perioperative and postoperative defect sizes which were obtained from the radiological studies were analyzed. Results Total number of 62 patients had tegmen defects, and their etiologic factors were cholesteatoma in 31 (50%), iatrogenic factors in 29 (46.7%), and chronic infection in 2 (3.3%) patients. The number of the tegmen defects was higher in intact canal wall technic. All of the tegmen defects were repaired with different materials, and no complication was detected. The obtained data from the postoperative radiological images revealed that the related perioperative defects were significantly decreased (p<0.001). Conclusion The perioperative bone defects were observedly decreased significantly in postoperative period. Early detection of the defect and appropriate interventions may help to manage this problem without any complication in the long term.
Collapse
Affiliation(s)
- Murat Ozturk
- Kocaeli University Faculty of Medicine, Department of Otorhinolaryngology, Kocaeli, Turkey
| | | | - Ahmet Mutlu
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Prof.Dr. Suleyman Yalcin City Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Hakan Bayraktar
- Health Sciences University Derince Research and Training Hospital, Department of Otorhinolaryngology, Kocaeli, Turkey
| | | | | |
Collapse
|
37
|
Favre NM, McIntyre KM, Kuo CC, Carr MM. Mitigation of Particle Spread During Mastoidectomy: A Systematic Review. Cureus 2021; 13:e19040. [PMID: 34853757 PMCID: PMC8608671 DOI: 10.7759/cureus.19040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 11/05/2022] Open
Abstract
Our objective is to analyze the risk of particle spread through mastoidectomy during the COVID-19 pandemic with an aim to assess the tools used to mitigate the spread. A systematic review was conducted using PRISMA guidelines. Our search terms included: MASTOIDECTOMY + COVID-19 or MASTOIDECTOMY + SAR- CoV-2 or MASTOIDECTOMY + CORONAVIRUS. Studies consistent with the inclusion and exclusion criteria were included in the review. Of the 20 articles identified in the initial search, six met the inclusion criteria. The included articles were all experimental studies, with five studies using cadaver subjects and one study using live human subjects. Three studies measured droplet spread and three studies measured aerosolized particle spread. The maximum distance of particle spread ranged from 30 cm to 208 cm. Four studies assessed the use of a barrier system, with two using the OtoTent and two using a barrier drape. Two studies defined the microscope alone as a possible mitigatory tool. One study compared burr type and size to determine the effects on particle spread. During the coronavirus disease 2019 (COVID-19) pandemic, evaluation of tools to mitigate particle spread is imperative for the safety of the surgical team and the healthcare system at large. Barrier drapes, OtoTents and microscopes all have proven to mitigate particle spread; however, further research needs to be performed to compare their efficacy and develop a standard of safety.
Collapse
Affiliation(s)
- Nicole M Favre
- Otolaryngology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Kelcy M McIntyre
- Otolaryngology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Cathleen C Kuo
- Otolaryngology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Michele M Carr
- Otolaryngology, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| |
Collapse
|
38
|
Ding AS, Capostagno S, Razavi CR, Li Z, Taylor RH, Carey JP, Creighton FX. Volumetric Accuracy Analysis of Virtual Safety Barriers for Cooperative-Control Robotic Mastoidectomy. Otol Neurotol 2021; 42:e1513-e1517. [PMID: 34325455 PMCID: PMC8595530 DOI: 10.1097/mao.0000000000003309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS Virtual fixtures can be enforced in cooperative-control robotic mastoidectomies with submillimeter accuracy. BACKGROUND Otologic procedures are well-suited for robotic assistance due to consistent osseous landmarks. We have previously demonstrated the feasibility of cooperative-control robots (CCRs) for mastoidectomy. CCRs manipulate instruments simultaneously with the surgeon, allowing the surgeon to control instruments with robotic augmentation of motion. CCRs can also enforce virtual fixtures, which are safety barriers that prevent motion into undesired locations. Previous studies have validated the ability of CCRs to allow a novice surgeon to safely complete a cortical mastoidectomy. This study provides objective accuracy data for CCR-imposed safety barriers in cortical mastoidectomies. METHODS Temporal bone phantoms were registered to a CCR using preoperative computed tomography (CT) imaging. Virtual fixtures were created using 3D Slicer, with 2D planes placed along the external auditory canal, tegmen, and sigmoid, converging on the antrum. Five mastoidectomies were performed by a novice surgeon, moving the drill to the limit of the barriers. Postoperative CT scans were obtained, and Dice coefficients and Hausdorff distances were calculated. RESULTS The average modified Hausdorff distance between drilled bone and the preplanned volume was 0.351 ± 0.093 mm. Compared with the preplanned volume of 0.947 cm3, the mean volume of bone removed was 1.045 cm3 (difference of 0.0982 cm3 or 10.36%), with an average Dice coefficient of 0.741 (range, 0.665-0.802). CONCLUSIONS CCR virtual fixtures can be enforced with a high degree of accuracy. Future studies will focus on improving accuracy and developing 3D fixtures around relevant surgical anatomy.
Collapse
Affiliation(s)
- Andy S. Ding
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Sarah Capostagno
- Department of Biomedical Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Christopher R. Razavi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zhaoshuo Li
- Department of Computer Science, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Russell H. Taylor
- Department of Computer Science, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - John P. Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Francis X. Creighton
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
39
|
Abstract
Significance Statement: Primary middle ear inverted papilloma is an exceedingly rare finding posing a diagnostic challenge, as symptomatology often mimics common clinical entities like serous otitis media. Clinical and radiological findings are not specific, whilst high recurrence rates, local destruction, and potential malignant transformation constitute an overall demanding surgical challenge, requiring aggressive procedures. We report the case of a primary inverted papilloma of the middle ear, discussing diagnostic and therapeutic issues.
Collapse
Affiliation(s)
- Sarantis Blioskas
- 2nd Department of Otorhinolaryngology - Head and Neck Surgery, 37794Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Iordanis Konstantinidis
- 2nd Department of Otorhinolaryngology - Head and Neck Surgery, 37794Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Ioannis Antoniadis
- 2nd Department of Otorhinolaryngology - Head and Neck Surgery, 37794Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Anastasia Kypriotou
- 2nd Department of Otorhinolaryngology - Head and Neck Surgery, 37794Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Prodromos Hytiroglou
- Department of Pathology, 37788Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Markou
- 2nd Department of Otorhinolaryngology - Head and Neck Surgery, 37794Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| |
Collapse
|
40
|
Deepika V, Ahuja V, Thapa D, Gombar S, Gupta N. Evaluation of analgesic efficacy of superficial cervical plexus block in patients undergoing modified radical mastoidectomy: A randomised controlled trial. Indian J Anaesth 2021; 65:S115-S120. [PMID: 34703056 PMCID: PMC8500200 DOI: 10.4103/ija.ija_339_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/26/2021] [Accepted: 07/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: Intravenous analgesics and local infiltration are used for postoperative analgesia in patients undergoing mastoidectomy. No randomised controlled trial (RCT) has so far determined response rates of pain reduction after ultrasound-guided superficial cervical plexus block (SCPB) in adult patients undergoing modified radical mastoidectomy. Methods: This double-blind RCT was conducted in 30 adult patients of the American Society of Anesthesiologists (ASA) grade I/II undergoing modified radical mastoidectomy. The primary outcome was a reduction in the visual analogue scale (VAS) score. Secondary outcomes were postoperative diclofenac consumption, haemodynamics, and occurrence of any adverse events. All patients received general anaesthesia. At the end of the surgery, patients were randomised to either Group ‘Block’ (n = 15) ultrasound guided SCPB with 5 mL ropivacaine 0.5% or Group ‘No block’ (n = 15). All patients received intravenous (IV) paracetamol 1 g every 6 hourly and rescue analgesic IV diclofenac 75 mg if VAS score >4. Results: Patients in Group ‘Block’ reported lower VAS score at rest versus Group ‘No block’ at 1 h postoperatively (P = 0.012). VAS score on movement was lower in patients of Group ‘Block’ compared to Group ‘No block’ at 1 h (P = 0.010), 4 h (P = 0.035), 8 h (P = 0.027), and 12 h (*P = 0.003) postoperatively. Diclofenac consumption was lower in patients of Group ‘Block’ (P = 0.041). No adverse effects were reported. Conclusion: Postoperative ultrasound-guided SCPB produced higher response rates in terms of reduction in VAS score in patients undergoing modified radical mastoidectomy.
Collapse
Affiliation(s)
- Vijaya Deepika
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Vanita Ahuja
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Deepak Thapa
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Satinder Gombar
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Nitin Gupta
- Department of Otolaryngology, Government Medical College and Hospital, Chandigarh, India
| |
Collapse
|
41
|
Mocanu H, Mocanu AI, Bonciu A, Coadă G, Schipor MA, Rădulescu M. Analysis of long-term functional results of radical mastoidectomy. Exp Ther Med 2021; 22:1216. [PMID: 34584561 PMCID: PMC8422386 DOI: 10.3892/etm.2021.10650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022] Open
Abstract
We performed a long-term, retrospective, non-controlled study on the functional results of mastoidectomy (both radical and modified radical) and defined the relevant statistical factors that may influence the hearing outcome. In a cohort of 200 patients, we performed both radical and modified radical mastoidectomy (MRM) and followed them clinically for a period of 8.12 years. The functional results were defined by the analytical function of the severity and the period of evolution of the disease. These parameters were defined by assessing the pre-operative absolute hearing threshold (AHT), bone conduction threshold (BCT) and age of the patient at the moment of the operation. The two parameters evolved inversely proportional to the functional results and represented a complete and precise analytical tool. The global average hearing gain ratio was 32% and the ratio for unmodified pre-operative hearing (status quo ante) was 61%. With favorable prognostic factors, the average gain rate was 56% and the hearing-loss rate was 5% (1-dB SPL nominal value). The maximum ratio for gain was 81% and for hearing loss this was 0%.
Collapse
Affiliation(s)
- Horia Mocanu
- Department of ENT & HNS, Faculty of Medicine, 'Titu Maiorescu' University, 031593 Bucharest, Romania
| | - Adela-Ioana Mocanu
- Department of ENT & HNS, Polimed Medical Center, 040067 Bucharest, Romania
| | - Alexandru Bonciu
- Department of ENT & HNS, 'Dr. Carol Davila' Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Gabriella Coadă
- Department of ENT & HNS, 'Sf. Maria' Clinical Hospital, 011172 Bucharest, Romania
| | - Mihai-Adrian Schipor
- Technical University of Munich, Institute of Astronomical and Physical Geodesy, D-80333 Munich, Germany
| | - Marian Rădulescu
- Department of ENT & HNS, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| |
Collapse
|
42
|
Spini R, Arias E, Bianchi F, Cohen D. [Complicated cholesteatoma in a child with Down syndrome: a case report]. ARCH ARGENT PEDIATR 2021; 119:e504-e507. [PMID: 34569751 DOI: 10.5546/aap.2021.e504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
El colesteatoma adquirido en niños es una enfermedad agresiva debido a su rápido crecimiento y la alta tasa de recurrencia. Las complicaciones se dividen en dos grandes grupos: las relacionadas con el hueso temporal (dentro o fuera de él) y las complicaciones intracraneales. El absceso subperióstico es la complicación extratemporal más común y es más frecuente en los niños más pequeños. Los pacientes que padecen síndrome de Down tienen una prevalencia elevada (superior al 80 %) de otitis media con efusión, que puede estar determinada anatómicamente por la hipoplasia mediofacial con una nasofaringe estrecha y adenoides hipertrófica, junto a trastornos funcionales y mecánicos de la trompa auditiva. Se presenta un niño de 8 años con síndrome de Down que desarrolló un absceso subperióstico como complicación de un colesteatoma que requirió abordaje quirúrgico inmediato para su resolución.
Collapse
Affiliation(s)
- Roxana Spini
- División de Otorrinolaringología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Elena Arias
- División de Otorrinolaringología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
| | - Florencia Bianchi
- División de Otorrinolaringología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
| | - Daniela Cohen
- División de Otorrinolaringología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
43
|
Vozel D, Božič D, Jeran M, Jan Z, Pajnič M, Pađen L, Steiner N, Kralj-Iglič V, Battelino S. Autologous Platelet- and Extracellular Vesicle-Rich Plasma Is an Effective Treatment Modality for Chronic Postoperative Temporal Bone Cavity Inflammation: Randomized Controlled Clinical Trial. Front Bioeng Biotechnol 2021; 9:677541. [PMID: 34307321 PMCID: PMC8294456 DOI: 10.3389/fbioe.2021.677541] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/10/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To determine the efficacy of autologous platelet- and extracellular vesicle-rich plasma (PVRP) to treat chronic postoperative temporal bone cavity inflammation (CPTBCI) after exhausting surgical and standard conservative therapies. Materials and Methods Patients were randomly allocated to treatment with PVRP (PVRP group) or standard conservative methods (control group) in a setting of four once-monthly checkups and subsequent follow-up. The treatment outcome was measured with the Chronic Otitis Media Questionnaire-12 (COMQ-12), CPTBCI focus surface area, and CPTBCI symptom-free time after the fourth checkup. Results Eleven patients from each group completed the trial; 95% of patients suffered from chronically discharging mastoid cavity (the type of CPTBCI). Within four checkups, the COMQ-12 score decreased statistically significantly in the PVRP group (p < 0.001) but not in the control group (p = 0.339). The CPTBCI foci surface area decreased statistically significantly between the first and second checkups (p < 0.0005) but not between other checkups (p > 0.05) in the PVRP group. No statistically significant differences in CPTBCI foci surface area were detected between checkups in the control group (p = 0.152). Nine patients from the PVRP group and three patients from the control group were CPTBCI symptom-free at the fourth checkup. The median symptom-free time was 9.2 months (95% CI [7.4, 11.9]) in the PVRP group. Cumulatively, 49% of patients in the PVRP group remained CPTBCI symptom-free for 12.7 months after the fourth checkup. Conclusion Autologous PVRP represents a novel additional and successful treatment modality for a chronically discharging radical mastoid cavity when the surgical and standard conservative treatment methods have been exhausted. Trial Number https://clinicaltrials.gov (NCT04281901).
Collapse
Affiliation(s)
- Domen Vozel
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Darja Božič
- Laboratory of Clinical Biophysics, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia.,Laboratory of Physics, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Marko Jeran
- Laboratory of Clinical Biophysics, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia.,Laboratory of Physics, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Zala Jan
- Laboratory of Clinical Biophysics, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Manca Pajnič
- Laboratory of Clinical Biophysics, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Ljubiša Pađen
- Laboratory of Clinical Biophysics, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Nejc Steiner
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Veronika Kralj-Iglič
- Laboratory of Clinical Biophysics, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia.,Extracellular Vesicles and Mass Spectrometry Laboratory, Institute of Biosciences and BioResources, National Research Council of Italy, Naples, Italy
| | - Saba Battelino
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
44
|
Annalisa P, Giannicola I, Valeria R, Daniela M, Irene Claudia V, Roberta P, Alessandro M, Giuseppe M. Isolated Congenital Mastoid Cholesteatoma with no Involvement of Aditus Ad Antrum and Middle Ear. Clin Med Insights Case Rep 2021; 14:11795476211014032. [PMID: 34025126 PMCID: PMC8120602 DOI: 10.1177/11795476211014032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/07/2021] [Indexed: 11/15/2022]
Abstract
Cholesteatoma is a non-neoplastic, keratinized squamous epithelial lesion that affects the temporal bone. The middle ear is the most frequent, while the isolated cholesteatoma of the mastoid is rare. The aim of this study was to describe a rare case of isolated mastoid cholesteatoma with no involvement of aditus ad antrum and middle ear including a literature review of the topic. This case report describes the case of a 58 years old female with a cholesteatoma isolated in the mastoid region, evidenced by imaging (computer tomography and magnetic resonance). A mastoidectomy was performed: mastoid process was completely involved, but antrum was not reached. Moreover, it reached the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. In the literature few articles described cases of cholesteatoma isolated in the mastoid region. Research was conducted using PubMed and reference list and there were considered only reports about cholesteatoma exclusively located in the mastoid process without involvement of antrum or middle ear. Fourteen articles were included in this review, with a total number of 23 cases of cholesteatoma isolated in the mastoid region. All papers analyzed reported the cases of isolated mastoid cholesteatoma that presented a congenital origin. Its diagnosis is difficult, therefore, imaging evaluation is mandatory and surgery is the treatment of choice. Mastoid cholesteatomas without involvement of aditus ad antrum and middle ear are rare and only 23 cases are reported in literature. Our case is in line with all clinical and diagnostic features of this rare disease, but it is the only one that evidenced an exposure of the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. The treatment of choice was the surgical one, avoiding damaging of important anatomo-functional structure.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Magliulo Giuseppe
- Magliulo Giuseppe, Organi di Senso Department University, Sapienza University of Rome, Via Gregorio VII n.80, Rome 00165, Italy.
| |
Collapse
|
45
|
Abstract
OBJECTIVES To evaluate the feasibility, morphological, and functional outcomes of endoscopic retrograde transcanal mastoidectomy. STUDY DESIGN Prospective study. SETTINGS Tertiary Referral Hospital. MATERIALS AND METHODS We analyzed 31 patients with a diagnosis of chronic otitis media with cholesteatoma that extended to the mastoid cavity who underwent endoscopic transcanal retrograde canal wall down mastoidectomy under general anesthesia. The tympanic membrane and posterior canal wall reconstruction were done using the tragal cartilage palisade technique reinforced with perichondrium. Morphological and functional results were reported in the follow-up of a minimum of 1 year. The graft uptake was also compared with the presence of granulations and discharge status. RESULTS Graft uptake and disease-free conditions were achieved in 21 of 24 patients, that is, 87.5%, and 3 patients required revision surgery. The graft uptake rate was not affected by the presence of granulation tissues and discharge. The hearing was improved after the surgery, which was statistically significant. CONCLUSION Endoscopic retrograde mastoidectomy is a new technique to deal with cholesteatoma with excellent results. It is more functional, ideal for sclerotic mastoid, allows faster wound healing, has excellent outcomes, and is a minimally invasive procedure that avoids postauricular incision and tissue dissection. Because the set up for the surgery costs less, it holds a promising future for the developing countries.
Collapse
Affiliation(s)
- Dipesh Shakya
- Department of Otorhinolaryngology, 533641Civil Service Hospital, Minbhawan, Kathmandu, Nepal
| | - Ajit Nepal
- Department of Otorhinolaryngology, 475268Patan Academy of Health Sciences, School of Medicine, Lagankhel, Lalitpur, Nepal
| |
Collapse
|
46
|
Freiser ME, Dharmarajan H, Sri Kavya Boorgu DS, Sim ES, Corcoran TE, Jabbour N, Chi DH. Droplet and Aerosol Generation With Mastoidectomy During the COVID-19 Pandemic: Assessment of Baseline Risk and Mitigation Measures With a High-performance Cascade Impactor. Otol Neurotol 2021; 42:614-622. [PMID: 33710998 PMCID: PMC7968968 DOI: 10.1097/mao.0000000000002987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS Aerosols are generated during mastoidectomy and mitigation strategies may effectively reduce aerosol spread. BACKGROUND An objective understanding of aerosol generation and the effectiveness of mitigation strategies can inform interventions to reduce aerosol risk from mastoidectomy and other open surgeries involving drilling. METHODS Cadaveric and fluorescent three-dimensional printed temporal bone models were drilled under variable conditions and mitigation methods. Aerosol production was measured with a cascade impactor set to detect particle sizes under 14.1 μm. Field contamination was determined with examination under UV light. RESULTS Drilling of cadaveric bones and three-dimensional models resulted in strongly positive aerosol production, measuring positive in all eight impactor stages for the cadaver trials. This occurred regardless of using coarse or cutting burs, irrigation, a handheld suction, or an additional parked suction. The only mitigation factor that led to a completely negative aerosol result in all eight stages was placing an additional microscope drape to surround the field. Bone dust was scattered in all directions from the drill, including on the microscope, the surgeon, and visually suspended in the air for all but the drape trial. CONCLUSIONS Aerosols are generated with drilling the mastoid. Using an additional microscope drape to cover the surgical field was an effective mitigation strategy to prevent fine aerosol dispersion while drilling.
Collapse
Affiliation(s)
- Monika E. Freiser
- Department of Otolaryngology, University of Pittsburgh Medical Center
| | | | | | - Edward S. Sim
- University of Pittsburgh School of Medicine, University of Pittsburgh
| | | | - Noel Jabbour
- Department of Otolaryngology, University of Pittsburgh Medical Center
- Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - David H. Chi
- Department of Otolaryngology, University of Pittsburgh Medical Center
- Children's Hospital of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
47
|
Muniz CR, Pena CFO, da Fonseca MRS, de Freitas MR. Barrier for Particle Dispersion Control During Mastoidectomy. Int Arch Otorhinolaryngol 2021; 25:e296-e300. [PMID: 33968236 PMCID: PMC8096509 DOI: 10.1055/s-0040-1718960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/26/2020] [Indexed: 10/26/2022] Open
Abstract
Introduction The China Health Authority alerted the World Health Organization (WHO) of several cases of pneumonia, and the WHO has declared the novel coronavirus (COVID-19) a global pandemic. Mastoidectomy is a high-risk aerosol generating procedure with the potential to expose the surgeon to infectious particles. Objective Aim to develop a low-cost prototype for a barrier device that can be used during mastoidectomy. Methods Describe the steps involved during otological emergency, requiring immediate surgical procedure, in untested patients. The Otorhinolaryngology Surgical Team of Walter Cantídio Hospital developed the barrier for particle dispersion presented here. Results During surgery, the prototype did not compromise visualization of the surgical field and instrumentation. Microscope repositioning was not compromised or limited by tent Instrumentation and instrument pouch under the Microscope-Tent (MT) performed surgery. After surgery, the plastic sheet was removed simply, without requiring strength. Bone dust and irrigation droplets were collected on the tent. Conclusion Our team developed and practiced, in an otologic emergency, a low-cost and reproducible barrier device that can be used in mastoidectomy in COVID-19 patients. Further tests on efficacy may be necessary.
Collapse
Affiliation(s)
- Camila Rêgo Muniz
- Discipline of Otorhinolaryngology, Hospital Walter Cantídio, Universidade Federal do Ceará, CE, Brazil
| | | | | | - Marcos Rabelo de Freitas
- Discipline of Otorhinolaryngology, Hospital Walter Cantídio, Universidade Federal do Ceará, CE, Brazil
| |
Collapse
|
48
|
Fernández LV, Arias E, Cohen D, Spini R. [Actinomycosis in temporal bone. A pediatric case report]. ARCH ARGENT PEDIATR 2021; 119:e153-e157. [PMID: 33749207 DOI: 10.5546/aap.2021.e153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/30/2020] [Indexed: 11/12/2022]
Abstract
Actinomycosis is an infection caused by a Gram-positive, filamentous anaerobic bacillus. Mainly belonging to the human commensal flora of the oropharynx, it normally colonizes the human digestive and genital tracts and the bronchial tree. It is slightly frequent in the temporal bone. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. Patients with actinomycosis require prolonged (6- to 12-month) high doses of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened in patients in whom optimal surgical resection of infected tissues has been performed. A pediatric patient with actinomycosis in temporal bone who needed surgery resolution is reported.
Collapse
Affiliation(s)
- Lucía V Fernández
- Residencia de Otorrinolaringología Infantil, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Elena Arias
- División de Otorrinolaringología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
| | - Daniela Cohen
- División de Otorrinolaringología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
| | - Roxana Spini
- División de Otorrinolaringología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
49
|
Markey AL, Leong SC, Vaughan C. Droplet and bone dust contamination from high-speed drilling during mastoidectomy. Clin Otolaryngol 2021; 46:614-618. [PMID: 33533176 DOI: 10.1111/coa.13725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/05/2021] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to examine contamination from otolaryngologic procedures involving high-speed drilling, specifically mastoid surgery, and to assess the adequacy of PPE in such procedures. DESIGN AND SETTING Mastoid surgery was simulated in a dry laboratory using a plastic temporal bone, microscope and handheld drill with irrigation and suction. Comparisons of distance of droplet and bone dust contamination and surgeon contamination were made under differing conditions. Irrigation speed, use of microscope and drill burr size and type were compared. MAIN OUTCOME MEASURES Measurement of the distance of field contamination while performing simulated mastoidectomy and location of surgeon contamination. RESULTS There was a greater distance field contamination and surgeon contamination without the use of the microscope. Contamination was reduced by using a smaller drill burr and by using a diamond burr when compared to a cutting burr. The use of goggles and a face mask provided good protection for the surgeon. However, the microscope alone may provide sufficient protection to negate the need for goggles. CONCLUSIONS While the risks of performing mastoid surgery during the coronavirus pandemic cannot be completely removed, they can be mitigated. Such factors include using the microscope for all drilling, using smaller size drill burrs and creating a safe zone around the operating table.
Collapse
Affiliation(s)
- Anne L Markey
- Liverpool Head and Neck Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Samuel C Leong
- Liverpool Head and Neck Centre, Aintree University Hospital, Liverpool University Hospitals Foundation Trust, Liverpool, UK.,Department of Clinical Sciences, Liverpool School of tropical Medicine, Liverpool, UK
| | - Casey Vaughan
- Liverpool Head and Neck Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| |
Collapse
|
50
|
Freiser ME, Ghodadra A, McCall AA, Shaffer AD, Magnetta M, Jabbour N. Operable, Low-Cost, High-Resolution, Patient-Specific 3D Printed Temporal Bones for Surgical Simulation and Evaluation. Ann Otol Rhinol Laryngol 2021; 130:1044-1051. [PMID: 33554632 DOI: 10.1177/0003489421993733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Three-dimensional printed models created on a consumer level printer can be used to practice mastoidectomy and to discern mastoidectomy experience level. Current models in the literature for mastoidectomy are limited by expense or operability. The aims of this study were (1) to investigate the utility of an inexpensive model for mastoidectomy and (2) to assess whether the model can be used as an evaluation tool to discern the experience level of the surgeon performing mastoidectomy. METHODS Three-dimensional printed temporal bone models from the CT scan of a 7-year old patient were created using a consumer-level stereolithography 3D printer for a raw material cost of $10 each. Mastoidectomy with facial recess approach was performed by 4 PGY-2 residents, 4 PGY-5 residents, and 4 attending surgeons on the models who then filled out an evaluation. The drilled models were collected and then graded in a blinded fashion by 6 attending otolaryngologists. RESULTS Both residents and faculty felt the model was useful for training (mean score 4.7 out of 5; range: 4-5) and case preparation (mean score: 4.3; range: 3-5). Grading of the drilled models revealed significant differences between junior resident, senior resident, and attending surgeon scores (P = .012) with moderate to excellent interrater agreement (ICC = 0.882). CONCLUSION The described operable model that is patient-specific was rated favorably for pediatric mastoidectomy case preparation and training by residents and faculty. The model may be used to differentiate between experience levels and has promise for use in formative and summative evaluations.
Collapse
Affiliation(s)
- Monika E Freiser
- Department of Otolaryngology, University of Pittsburgh Medical Center, PA, USA
| | - Anish Ghodadra
- Department of Radiology, University of Pittsburgh Medical Center, PA, USA
| | - Andrew A McCall
- Department of Otolaryngology, University of Pittsburgh Medical Center, PA, USA
| | | | | | - Noel Jabbour
- Department of Otolaryngology, University of Pittsburgh Medical Center, PA, USA.,Children's Hospital of Pittsburgh, PA, USA
| |
Collapse
|