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Simon F, Remangeon F, Loundon N, Leboulanger N, Couloigner V, Garabédian N, Denoyelle F. Pediatric Cholesteatoma Follow-Up: Residual and Recurrence in 239 Cases with Over 5-Year Hindsight. Laryngoscope 2024; 134:4789-4798. [PMID: 38855882 DOI: 10.1002/lary.31567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/29/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Pediatric cholesteatoma is an aggressive disease which requires long-term evaluation to assess management strategies. The objective was to determine optimal follow-up duration in pediatric cholesteatoma to detect residual and recurrent diseases. METHODS This cohort study was set in a tertiary referral center. All consecutive patients with a minimum 5-year follow-up were included. Medical history, initial extension, surgical procedures, and follow-up were collected. The main outcome measure were Kaplan-Meier survival curves of residual and recurrence cumulative incidence. RESULTS Totally 239 ears with the first tympanoplasty between 2008 and 2014 were studied including 25% congenital. At first surgery (S1), mean age was 8.4 years and mean follow-up time 7.9 years. Mastoidectomy was performed in 69% and stapes was absent in 38% of cases. Notably, 83% (199 ears) had a second procedure (S2) of which 186 were planned. After S1, maximum cumulated incidence of residual was 45% [95%CI, 38%; 52%] at 74 months, with probability of residual of 39% at 3 years. After S2 (n = 199), maximum cumulated residual incidence was 21% [95%CI, 12%; 32%] at 62 months and 16% at 3 years. Concerning recurrence, maximum cumulated incidence after S1 (n = 239) was reached at 98 months with 21% [95%CI, 12%; 32%], 13% at 3 years and 16% at 5 years. Congenital disease had significantly less residuals after S1 (p = 0.02), but similar recurrence rate (p = 0.66) compared with acquired. CONCLUSIONS AND RELEVANCE We recommend MRI follow-up of at least 5 years after the last surgery for residual disease and clinical follow-up of at least 10 years to detect recurrence. LEVEL OF EVIDENCE 4 Laryngoscope, 134:4789-4798, 2024.
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Affiliation(s)
- François Simon
- Université Paris Cité, Paris, France
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Françoise Remangeon
- Université Paris Cité, Paris, France
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Natalie Loundon
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboulanger
- Université Paris Cité, Paris, France
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Université Paris Cité, Paris, France
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Noel Garabédian
- Université Paris Cité, Paris, France
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Françoise Denoyelle
- Université Paris Cité, Paris, France
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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Nishimura R, Miuchi S, Ikehata M, Sakagami M, Tsuzuki K. Change in chorda tympani nerve function after two-stage tympanoplasty for cholesteatoma. Laryngoscope Investig Otolaryngol 2022; 7:2035-2042. [PMID: 36544921 PMCID: PMC9764802 DOI: 10.1002/lio2.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/25/2022] [Accepted: 09/21/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Chorda tympani nerve (CTN) function may be damaged more by two-stage than by one-stage surgery for middle ear cholesteatoma. However, few studies have reported the relationship between two-stage cholesteatoma surgery and CTN function. This study aimed to investigate CTN function after two-stage surgery for cholesteatoma. Methods In this prospective study, 35 patients underwent two-stage canal wall up tympanoplasty (CWUT). Perioperative CTN function was assessed using questionnaires and electrogustometry (EGM). Participants were categorized into minor, major, and section groups, based on the degree of CTN manipulation during surgery. Results In the first-stage surgery, posterior tympanotomy with an intact canal wall reduced the degree of CTN manipulation. The incidence of taste disorder after the first-stage surgery was 71.4%. Postoperative taste disorder and the EGM threshold improved early in the minor manipulation group. In the second-stage surgery, no new CTN damage occurred, even if this surgery involved removal of residual cholesteatoma. The incidence of taste disorder after second-stage surgery was less than that after first-stage surgery, independent of CTN preservation. However, the recovery rate of the EGM threshold after second-stage surgery was significantly lower in the section group than in those with CTN preservation. Conclusion CTN function, including symptoms and EGM threshold, can be preserved during two-stage cholesteatoma surgery if care is taken to preserve the CTN in both the first- and second-stage surgeries. A two-stage CWUT, ensuring an intact bony annulus, may be effective to facilitate CTN preservation. Level of Evidence 2b.
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Affiliation(s)
- Riu Nishimura
- Department of Otorhinolaryngology – Head and Neck SurgeryHyogo Medical UniversityHyogoJapan
| | - Shinya Miuchi
- Department of Otorhinolaryngology – Head and Neck SurgeryHyogo Medical UniversityHyogoJapan
| | - Miki Ikehata
- Department of OtolaryngologyAmagasaki Chuo HospitalHyogoJapan
| | - Masafumi Sakagami
- Department of Otorhinolaryngology – Head and Neck SurgeryHyogo Medical UniversityHyogoJapan
| | - Kenzo Tsuzuki
- Department of Otorhinolaryngology – Head and Neck SurgeryHyogo Medical UniversityHyogoJapan
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Cancer diagnosis and anosmia recovery in the pandemic update, cholesteatoma diagnosis, otosclerosis in pregnancy, and no renaissance of maxillary sinus irrigation. The Journal of Laryngology & Otology 2022; 136:189-190. [DOI: 10.1017/s0022215122000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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van der Toom HFE, van Dinther JJS, Zarowski A, Baazil AHA, De Foer B, Bernaerts A, Casselman JW, Offeciers E. Radiological Follow-up After the Bony Obliteration Tympanoplasty in Detecting Residual Cholesteatoma: Towards an Optimal Postoperative MR Imaging Protocol. Otol Neurotol 2022; 43:e79-e87. [PMID: 34607996 DOI: 10.1097/mao.0000000000003348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIM There is no consensus in literature on the most optimal follow-up imaging protocol for non-echoplanar diffusion-weighted magnetic resonance imaging (non-EP DW MRI) after the canal wall-up bony obliteration tympanoplasty. Clearly, no residual cholesteatoma should be missed but on the other hand, unnecessary MR controls should be avoided. The aim of this study is to evaluate the postoperative results of non-EP DW MRI after canal wall-up bony obliteration tympanoplasty surgery at our Institute and to propose an optimal postoperative MR imaging scheme based on our data. MATERIAL AND METHODS Retrospective cohort study; all 271 patients who underwent the bony obliteration tympanoplasty between January 2010 and January 2016 with follow-up at our Institute were included. A postoperative MR imaging was systematically performed at 1 year after surgery and repeated at either 5 or both 3 and 5 years after surgery, based on the preferences of the surgeon. Variables of interest were retrieved from electronic patient records. RESULTS The median follow-up time was 60 months (inter-quartile range 56-62 mo). Two hundred seventy-one patients (100%) received a 1-year MRI, 107 (39%) a 3-year MRI, and 216 (79.7%%) a 5-year MRI. Residual cholesteatoma was found in nine cases (3.3%), corresponding with an estimated residual rate at 5 years follow-up of 3.7% when using Kaplan-Meier analysis. Of these nine cases, six cases of residual cholesteatoma (66.7%) were detected at the 1-year MRI (12-14 mo postsurgery), two cases (22.2%) at the 3-year MRI (35-39 mo postsurgery), and one case (11.1%) at the 5-year MRI (51 mo postsurgery, in this patient no 3-year MRI was performed). An uncertain MRI result was found in 15 cases, presenting as relatively hyperintense lesions. However, subsequent follow-up scans did not show persistent evidence for residual disease in 14 of these 15 cases. CONCLUSIONS A postoperative MRI scan after 1 and 5 years is essential to detect early and late residual cholesteatoma. In our cohort, 22.2% of residual cases were detected at the 3-year MRI. However, this percentage could potentially have been higher when all patients would have received a 3-year MRI. Therefore, in order to detect residual disease as soon as possible, we propose to perform an MRI scan at 1, 3, and 5 years after the bony obliteration tympanoplasty. In cases with an unclear MR result, we suggest a repeat MRI after 12 months.
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Affiliation(s)
- Hylke F E van der Toom
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustinus, GZA Hospital, Antwerp, Belgium
| | - Joost J S van Dinther
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustinus, GZA Hospital, Antwerp, Belgium
| | - Andrzej Zarowski
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustinus, GZA Hospital, Antwerp, Belgium
| | - Adrianus H A Baazil
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustinus, GZA Hospital, Antwerp, Belgium
| | - Bert De Foer
- Department of Radiology, Sint-Augustinus, GZA Hospital, Antwerp
| | - Anja Bernaerts
- Department of Radiology, Sint-Augustinus, GZA Hospital, Antwerp
| | - Jan W Casselman
- Department of Radiology, Sint-Augustinus, GZA Hospital, Antwerp
- Department of Radiology, AZ Sint-Jan Brugge-Oostende av, Campus Brugge, Bruges, Belgium
| | - Erwin Offeciers
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustinus, GZA Hospital, Antwerp, Belgium
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Piras G, Sykopetrites V, Taibah A, Russo A, Caruso A, Grinblat G, Sanna M. Long term outcomes of canal wall up and canal wall down tympanomastoidectomies in pediatric cholesteatoma. Int J Pediatr Otorhinolaryngol 2021; 150:110887. [PMID: 34425355 DOI: 10.1016/j.ijporl.2021.110887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/02/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
UNLABELLED Cholesteatomas in children have a more aggressive growth pattern compared to adults, which leads to a higher incidence of both residual and recurrent disease. A staged canal wall-up or a canal wall-down tympanomastoidectomy (CWUT and CWDT, respectively) is selected depending on the extent of the disease and condition of the middle ear (ME) cleft and mastoid. Endoscopic ear surgery (EES) has been recently introduced as an adjuvant tool for the treatment of this pathology even in the pediatric population. OBJECTIVES To analyze long term outcomes of CWUT and CWDT in the pediatric population, focusing on residual and recurrence rates of cholesteatoma and hearing results. A literature review including cases treated with EES were discussed. MATERIAL AND METHODS Pediatric patients treated for cholesteatoma involving both the ME and mastoid with a follow-up (FU) of at least 4 years were retrospectively analyzed in a quaternary referral center for otology and lateral skull base surgery. Patients were grouped according to the surgical technique (CWUT versus CWDT). Rates of residual and recurrent cholesteatoma after each surgical technique were reported and compared. Mean Air-Bone Gap (ABG) of 0.5-1-2-4 KHz was measured and reported before the first surgery and at the last post-operative FU. RESULTS Two-hundred and thirty-six cases fulfilled our inclusion criteria. The mean FU was 100.4 ± 44.2 months (median 89 months). One-hundred and five (44.5%) cases underwent a CWUT, whereas 131 (55.5%) a CWDT. A second stage surgery was performed in 73.5% of CWUT and 58.7% of CWDT. Among the CWUT group, residual cholesteatoma occurred in 22 (21%) ears and recurrence in 24 (22.9%). Patients undergoing CWDT showed lower rates of both residual and recurrent cholesteatoma (7.6% and 2.3%, respectively). ABG improvement was noted for both groups, even though CWUT showed better post-operative hearing results. CONCLUSIONS The CWDT technique offers a definite surgical therapy, with minimal residual and recurrence rates and audiological results comparable to the CWUT technique. EES must still prove its added benefit or equivalence to pure microscopic approaches.
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Affiliation(s)
- Gianluca Piras
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Piacenza-Rome, Italy; Casa di Cura "Piacenza" S.P.A, Piacenza, Italy.
| | - Vittoria Sykopetrites
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Piacenza-Rome, Italy; Casa di Cura "Piacenza" S.P.A, Piacenza, Italy
| | - Abdelkader Taibah
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Piacenza-Rome, Italy; Casa di Cura "Piacenza" S.P.A, Piacenza, Italy
| | - Alessandra Russo
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Piacenza-Rome, Italy; Casa di Cura "Piacenza" S.P.A, Piacenza, Italy
| | - Antonio Caruso
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Piacenza-Rome, Italy; Casa di Cura "Piacenza" S.P.A, Piacenza, Italy
| | - Golda Grinblat
- Hillel Yaffe Medical Center, Affiliated to Technion University, Haifa, Israel
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Piacenza-Rome, Italy; Casa di Cura "Piacenza" S.P.A, Piacenza, Italy
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Hu Y, Qian X. Hsa_circ_0074491 regulates the malignance of cholesteatoma keratinocytes by modulating the PI3K/Akt pathway by binding to miR-22-3p and miR-125a-5p: An observational study. Medicine (Baltimore) 2021; 100:e27122. [PMID: 34664835 PMCID: PMC8447995 DOI: 10.1097/md.0000000000027122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022] Open
Abstract
Cholesteatoma is a benign cystic lesion that can continue to grow like a tumor. Circular ribonucleic acid (RNA) hsa_circ_0074491 (circ_0074491) has been reported to be down-regulated in cholesteatoma tissues. However, the role and regulatory mechanism of circ_0074491 in the growth of cholesteatoma are unclear.The expression of circ_0074491, microRNA (miR)-22-3p, and miR-125a-5p in cholesteatoma tissues was detected by quantitative real-time polymerase chain reaction. The proliferation, cell cycle, apoptosis, migration, and invasion of cholesteatoma keratinocytes were evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, plate clone, flow cytometry, or transwell assays. Several protein levels were examined by western blotting. The targeting relationship between miR-22-3p or miR-125a-5p and circ_0074491 was verified via dual-luciferase reporter and RNA pull-down assays.We observed the downregulation of circ_0074491 in cholesteatoma tissues. Furthermore, circ_0074491 knockdown facilitated cell proliferation, migration, invasion, and repressed cell apoptosis in cholesteatoma keratinocytes. Circ_0074491 was verified as a decoy for miR-22-3p and miR-125a-5p in cholesteatoma keratinocytes. Both miR-22-3p and miR-125a-5p silencing reversed the impacts of circ_0074491 silencing on proliferation, apoptosis, migration, and invasion of cholesteatoma keratinocytes. Also, circ_0074491 knockdown activated the PI3K/Akt pathway in cholesteatoma keratinocytes via miR-22-3p and miR-125a-5p.Circ_0074491 played a suppressive role in cholesteatoma through inactivating the PI3K/Akt pathway via binding to miR-22-3p and miR-125a-5p, which provided a novel evidence for the involvement of circRNA in the development of cholesteatoma.
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Magnetic resonance non-echo planar diffusion-weighted imaging accuracy in detecting cholesteatoma in comparison with clinical and surgical findings. The Journal of Laryngology & Otology 2021; 136:208-214. [PMID: 34405776 DOI: 10.1017/s0022215121002188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gafford J, Freeman M, Fichera L, Noble J, Labadie R, Webster RJ. Eyes in Ears: A Miniature Steerable Digital Endoscope for Trans-Nasal Diagnosis of Middle Ear Disease. Ann Biomed Eng 2021; 49:219-232. [PMID: 32458223 PMCID: PMC7688494 DOI: 10.1007/s10439-020-02518-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/24/2020] [Indexed: 01/17/2023]
Abstract
The aim of this work is to design, fabricate and experimentally validate a miniature steerable digital endoscope that can provide comprehensive, high-resolution imaging of the middle ear using a trans-nasal approach. The motivation for this work comes from the high incidence of middle ear diseases, and the current reliance on invasive surgery to diagnose and survey these diseases which typically consists of the eardrum being lifted surgically to directly visualize the middle ear using a trans-canal approach. To enable less-invasive diagnosis and surveillance of middle ear disease, we propose an endoscope that is small enough to pass into the middle ear through the Eustachian tube, with a steerable tip that carries a 1 Megapixel image sensor and fiber-optic illumination to provide high-resolution visualization of critical middle ear structures. The proposed endoscope would enable physicians to diagnose middle ear disease using a non-surgical trans-nasal approach instead, enabling such procedures to be performed in an office setting and greatly reducing invasiveness for the patient. In this work, the computational design of the steerable tip based on computed tomography models of real human middle ear anatomy is presented, and these results informed the fabrication of a clinical-scale steerable endoscope prototype. The prototype was used in a pilot study in three cadaveric temporal bone specimens, where high-quality middle ear visualization was achieved as determined by an unbiased cohort of otolaryngologists. This is the first paper to demonstrate cadaveric validation of a digital, steerable, clinical-scale endoscope for middle ear disease diagnosis, and the experimental results illustrate that the endoscope enables the visualization of critical middle ear structures (such as the epitympanum or sinus tympani) that were seldom or never visualized in prior published trans-Eustachian tube endoscopy feasibility studies.
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Affiliation(s)
- Joshua Gafford
- Vanderbilt University Engineering Department, Nashville, TN, USA.
| | | | | | - Jack Noble
- Vanderbilt University Engineering Department, Nashville, TN, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
| | - Robert Labadie
- Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
| | - Robert J Webster
- Vanderbilt University Engineering Department, Nashville, TN, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
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Chiluisa AJ, Van Rossum FJ, Gafford JB, Labadie RF, Webster RJ, Fichera L. Computational Optimization of Notch Spacing for a Transnasal Ear Endoscopy Continuum Robot. ... INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS. INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS 2020; 2020:188-194. [PMID: 36844884 PMCID: PMC9948123 DOI: 10.1109/ismr48331.2020.9312937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper presents a computational framework to optimize the visual coverage attainable by a notched-tube continuum robotic endoscope inside the middle ear cavity. Our framework combines anatomically-accurate geometric (mesh) models of the middle ear with a sampling-based motion planning algorithm (RRT) and a ray-casting procedure to quantify what regions of the middle ear can be accessed and visualized by the endoscope. To demonstrate the use of this framework, we run computer simulations to investigate the effect of varying the distance between each pair of consecutive flexure elements (i.e., notches) in our robotic endoscope.
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Affiliation(s)
- Alex J Chiluisa
- Robotics Engineering Program, Worcester Polytechnic Institute, Worcester, MA 01609, USA
| | - Floris J Van Rossum
- Robotics Engineering Program, Worcester Polytechnic Institute, Worcester, MA 01609, USA
| | - Joshua B Gafford
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Robert F Labadie
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Loris Fichera
- Robotics Engineering Program, Worcester Polytechnic Institute, Worcester, MA 01609, USA
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Conway RM, Sioshansi PC, Howard AL, Babu SC. Perioperative cost evaluation of canal wall down mastoidectomy. Am J Otolaryngol 2020; 41:102733. [PMID: 32971408 DOI: 10.1016/j.amjoto.2020.102733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION To evaluate perioperative costs of canal wall-down (CWD) mastoidectomy as an initial surgery compared to revision surgery following initial canal wall-up (CWU) mastoidectomy. METHODS This study is a retrospective chart review of adult patients who underwent CWD mastoidectomy for chronic otitis media with or without cholesteatoma at a tertiary referral center. Patients were divided into groups that had previous CWU surgery and were undergoing revision CWD and those that were having an initial CWD mastoidectomy. Cost variables including previous surgeries, imaging costs, audiometric testing, and post-operative visits were compared between the two groups using t-test analysis. RESULTS There was no significant difference with regards to the cost of post-operative visits, peri-operative imaging, or revision surgeries between the two groups. Hearing outcomes based on mean speech reception threshold (SRT) were not statistically different between the two groups (p = 0.087). There was a significant difference in total cost with the revision group having a higher mean cost by $6967.84, most of which was accounted for by the difference in the cost of the previous surgeries of $6488.53. CONCLUSIONS The revision CWD surgery group had increased total cost that could be attributed to the cost of previous surgery. Increased peri-operative cost was not noted with the initial CWD surgery group for any individual variables examined. Initial CWD mastoidectomy should be considered in the proper patient population to help decrease healthcare costs.
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Affiliation(s)
- Robert M Conway
- Ascension Macomb-Oakland Hospital, Otolaryngology - Head & Neck Surgery, Madison Heights, MI, United States of America.
| | | | - Anthony L Howard
- Ascension Macomb-Oakland Hospital, Otolaryngology - Head & Neck Surgery, Madison Heights, MI, United States of America
| | - Seilesh C Babu
- Michigan Ear Institute, Farmington Hills, MI, United States of America
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A Novel Surgery Classification for Endoscopic Approaches to Middle Ear Cholesteatoma. Curr Med Sci 2020; 40:9-17. [PMID: 32166660 DOI: 10.1007/s11596-020-2141-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/10/2019] [Indexed: 10/24/2022]
Abstract
This study aimed to develop a novel surgery classification for an endoscopic approach to middle ear cholesteatoma. We retrospectively analyzed the surgical approaches and outcomes of patients with middle ear cholesteatoma. Middle ear cholesteatoma surgeries were divided into four types and two special types as follows: type I, attic retraction pocket, which only requires tympanostomy tube placement or retraction pocket resection and cartilage reconstruction; type II, cholesteatoma which is limited to the attic or in which endoscopy can confirm complete removal of mastoid cholesteatoma lesions, including type II a, requiring only use of a curette, and type II b, requiring use of an electric drill or chisel; type III, cholesteatoma not limited to the attic, in which endoscopy cannot confirm complete removal of mastoid cholesteatoma lesions, requiring the combined use of endoscope and microscope to perform endoscopic tympanoplasty and "Canal Wall Up" mastoidectomy; type IV, extensive involvement of mastoid cavity cholesteatoma lesions and/or cases with a potential risk of complications, removal of which can only be performed under a microscope for "Canal Wall Down" mastoidectomy. In addition, there were two special types: "difficult external auditory canal" and congenital cholesteatoma in children. In our system, type I and type II middle ear cholesteatoma surgery was completely performed under an endoscope alone. However, estimating the extent of the lesions, determining the choice of mastoid opening and reestablishing ventilation are the key points for an endoscopic approach to middle ear cholesteatoma. The classification of endoscopic middle ear cholesteatoma surgery may benefit the selection of surgical indications.
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Muhonen EG, Mahboubi H, Moshtaghi O, Sahyouni R, Ghavami Y, Maducdoc M, Lin HW, Djalilian HR. False-Positive Cholesteatomas on Non-Echoplanar Diffusion-Weighted Magnetic Resonance Imaging. Otol Neurotol 2020; 41:e588-e592. [DOI: 10.1097/mao.0000000000002606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Luu K, Chi D, Kiyosaki KK, Chang KW. Updates in Pediatric Cholesteatoma. Otolaryngol Clin North Am 2019; 52:813-823. [DOI: 10.1016/j.otc.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Felici F, Scemama U, Bendahan D, Lavieille JP, Moulin G, Chagnaud C, Montava M, Varoquaux A. Improved Assessment of Middle Ear Recurrent Cholesteatomas Using a Fusion of Conventional CT and Non-EPI-DWI MRI. AJNR Am J Neuroradiol 2019; 40:1546-1551. [PMID: 31413008 DOI: 10.3174/ajnr.a6141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/17/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Recurrent middle ear cholesteatomas are commonly preoperatively assessed using MR imaging (non-EPI-DWI) and CT. Both modalities are used with the aim of distinguishing scar tissue from cholesteatoma and determining the extent of bone erosions. Inflammation and scar tissue associated with the lesions might hamper a proper delineation of the corresponding extensions on CT images. Using surgical findings as the criterion standard, we assessed the recurrent middle ear cholesteatoma extent using either uncoregistered or fused CT-MR imaging datasets and determined the corresponding accuracy and repeatability. MATERIALS AND METHODS Twenty consecutive patients with suspected recurrent middle ear cholesteatoma and preoperative CT-MR imaging datasets were prospectively included. A double-blind assessment and coregistration of the recurrent middle ear cholesteatoma extent and manual delineation of 18 presumed recurrent middle ear cholesteatomas were performed by 2 radiologists and compared with the criterion standard. "Reliability score" was defined to qualify radiologists' confidence. For each volume, segmentation repeatability was assessed on the basis of intraclass correlation coefficient and overlap indices. RESULTS For the whole set of patients, recurrent middle ear cholesteatoma was further supported by surgical results. Two lesions were excluded from the analysis, given that MR imaging did not show a restricted diffusion. Lesions were accurately localized using the fused datasets, whereas significantly fewer lesions (85%) were correctly localized using uncoregistered images. Reliability scores were larger for fused datasets. Segmentation repeatability showed an almost perfect intraclass correlation coefficient regarding volumes, while overlaps were significantly lower in uncoregistered (52%) compared with fused (60%, P < .001) datasets. CONCLUSIONS The use of coregistered CT-MR images significantly improved the assessment of recurrent middle ear cholesteatoma with a greater accuracy and better reliability and repeatability.
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Affiliation(s)
- F Felici
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.)
| | - U Scemama
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.)
| | - D Bendahan
- North Hospital, and CNRS, CRMBM-CEMEREM UMR 7339, 13385 (D.B., A.V.)
| | - J-P Lavieille
- La Conception University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery (J.-P.L., M.M.).,UMRT 24 IFSTTAR (J.-P.L., M.M.), Aix-Marseille University, Marseille, France
| | - G Moulin
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.)
| | - C Chagnaud
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.)
| | - M Montava
- La Conception University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery (J.-P.L., M.M.).,UMRT 24 IFSTTAR (J.-P.L., M.M.), Aix-Marseille University, Marseille, France
| | - A Varoquaux
- From the Department of Medical Imaging (F.F., U.S., G.M., C.C., A.V.) .,North Hospital, and CNRS, CRMBM-CEMEREM UMR 7339, 13385 (D.B., A.V.)
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15
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Titanium ossicular chain reconstruction in single stage canal wall down tympanoplasty for chronic otitis media with mucosa defect. Am J Otolaryngol 2019; 40:205-208. [PMID: 30553603 DOI: 10.1016/j.amjoto.2018.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate surgical outcomes for chronic otitis media with mucosa defect underwent titanium ossicular chain reconstruction (OCR) in single stage canal wall down tympanoplasty (CWD). METHODS A clinical retrospective study was performed on 83 cases of the chronic otitis media with mucosa defect and 123 ears with mucosa integrity according to intraoperative findings that underwent synchronous titanium OCR in single stage CWD form January 2012 to January 2018. Pre- and postoperative air conduction threshold (AC), air-bone gap (ABG) and ABG closure at 0.5, 1, 2, and 4 kHz were investigated. RESULTS The overall mean AC threshold of 53.4 ± 16.5 dB was lowered to 41.2 ± 15.9 dB postoperatively (p < 0.01). The mean pre- and postoperative ABG of all patients were 27.9 ± 9.9 dB and 17.2 ± 9.3 dB (p < 0.01), respectively, with a mean ABG closure of 10.7 ± 8.4 dB. The total rate of success, postoperative ABG ≤ 20 dB was achieved in 71.4%. In the mucosa defect group underwent TORP, the mean pre- and postoperative ABG were 28.1 ± 9.8 dB and 20.1 ± 9.0 dB (p < 0.01), respectively, with the ABG closure was 8.0 ± 7.9 dB. In the mucosa defect group underwent PORP, the mean pre- and postoperative ABG were 27.9 ± 10.1 dB and 16.5 ± 9.1 dB (p < 0.01), respectively, with the ABG closure was 11.4 ± 8.6 dB. Furthermore, in the mucosa defect group, there was significant difference in success rate of achieved postoperative ABG ≤ 20 dB between the TORP (48.9%) and PORP (77.5%) (p < 0.05). CONCLUSION It is revealed PORP in single stage CWD tympanoplasty for the patients suffered from chronic otitis media with mucosa defect is favored.
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16
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Gao J, Tang Q, Zhu X, Wang S, Zhang Y, Liu W, Gao Z, Yang H. Long noncoding RNAs show differential expression profiles and display ceRNA potential in cholesteatoma pathogenesis. Oncol Rep 2018; 39:2091-2100. [PMID: 29565455 PMCID: PMC5928766 DOI: 10.3892/or.2018.6320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/16/2018] [Indexed: 11/05/2022] Open
Abstract
Cholesteatoma is a pathologically benign but clinically destructive middle ear disease, which is caused by excessive epidermal migration and uncontrolled hyperproliferation of keratinocytes of squamous epithelium, leading to various clinical manifestations and serious complications, such as hearing loss, dizziness, facial paralysis, meningitis, and hydrocephalus. However, the pathogenesis of cholesteatoma is still not fully understood. Herein, we performed microarray analysis to identify the differentially expressed patterns of lncRNAs in cholesteatoma for the first time. Our data indicated that compared with matched normal skin tissue, lncRNA expression profiles were significantly altered in cholesteatoma. A total of 787 lncRNAs were identified (fold change ≥2.0, P<0.05), consisting of 181 upregulated and 606 downregulated lncRNAs. Furthermore, by constructing an lncRNA/miRNA/mRNA competing endogenous RNA (ceRNA) network, we found that lncRNAs, such as lncRNA‑uc001kfc.1, had ceRNA potential in cholesteatoma formation. In conclusion, lncRNAs were aberrantly expressed in cholesteatoma compared with normal skin tissues and may play important roles in cholesteatoma formation. Our findings shed novel light on the molecular mechanism of cholesteatoma pathogenesis and suggest that lncRNAs may be potential therapeutic targets for cholesteatoma.
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Affiliation(s)
- Juanjuan Gao
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Qi Tang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Xiaohui Zhu
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Shihua Wang
- Center of Excellence in Tissue Engineering, Key Laboratory of Beijing, Institute of Basic Medical Sciences and School of Basic Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Yongli Zhang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Wenbin Liu
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Zhiqiang Gao
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Hua Yang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
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17
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Shapiro S, Bennett D, Wetmore S, Cassis A. Complete Malleus Removal for Cholesteatoma: A Multivariate Analysis of Ossiculoplasty Success and Residual Disease. Ann Otol Rhinol Laryngol 2017; 127:33-38. [PMID: 29171281 DOI: 10.1177/0003489417743519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Scott Shapiro
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Donald Bennett
- West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Stephen Wetmore
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Adam Cassis
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
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18
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Schwam ZG, Michaelides E, Schwam JR, Kuo P, Hajek MA, Judson BL, Schutt C. Comparing 30-Day Morbidity and Mortality in Pediatric and Adult Otologic Surgery. Otolaryngol Head Neck Surg 2017; 157:830-836. [DOI: 10.1177/0194599817704376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective To determine differences in timing and rate of postoperative adverse events among pediatric and adult populations undergoing specific otologic procedures. Study Design Administrative database study. Setting Multi-institutional database. Subjects and Methods The National Surgical Quality Improvement Program (NSQIP) and NSQIP-Pediatric (NSQIP-P) were used to extract data from 819 adults (years 2005-2010) and 7020 children (years 2012-2014) undergoing tympanoplasty and (tympano)mastoidectomy, respectively. Simple summary statistics, χ2, and multivariable logistic regression analyses were performed. Results There were no significant differences in overall adverse event rates between adults (2.9%) and children (2.3%) ( P = .233). Adults experienced infectious complications more frequently than did children (0.4% vs 0.0%, P = .002). Postdischarge complications accounted for 83.7% of all complications. Children treated by pediatric otolaryngologists had higher readmission rates (odds ratio [OR], 2.80; 95% confidence interval [CI], 1.20-3.60; P = .002). Tympanomastoidectomy was associated with higher odds of reoperation (OR, 1.02; 95% CI, 1.01-1.03; P < .001), as was undergoing a concurrent procedure that did not include myringotomy (OR, 3.38; 95% CI, 1.47-7.79; P = .004). Conclusion Both adult and pediatric otologic surgery are safe, with patients experiencing similarly low complication rates. Most adverse events occur after discharge.
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Affiliation(s)
| | - Elias Michaelides
- Yale School of Medicine, Department of Surgery, Section of Otolaryngology, New Haven, Connecticut, USA
| | | | - Phoebe Kuo
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Benjamin L. Judson
- Yale School of Medicine, Department of Surgery, Section of Otolaryngology, New Haven, Connecticut, USA
| | - Christopher Schutt
- Yale School of Medicine, Department of Surgery, Section of Otolaryngology, New Haven, Connecticut, USA
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19
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Fichera L, Dillon NP, Zhang D, Godage IS, Siebold MA, Hartley BI, Noble JH, Russell PT, Labadie RF, Webster RJ. Through the Eustachian Tube and Beyond: A New Miniature Robotic Endoscope to See Into The Middle Ear. IEEE Robot Autom Lett 2017; 2:1488-1494. [PMID: 29202035 DOI: 10.1109/lra.2017.2668468] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper presents a novel miniature robotic endoscope that is small enough to pass through the Eustachian tube and provide visualization of the middle ear (ME). The device features a miniature bending tip previously conceived of as a small-scale robotic wrist that has been adapted to carry and aim a small chip-tip camera and fiber optic light sources. The motivation for trans-Eustachian tube ME inspection is to provide a natural-orifice-based route to the ME that does not require cutting or lifting the eardrum, as is currently required. In this paper, we first perform an analysis of the ME anatomy and use a computational design optimization platform to derive the kinematic requirements for endoscopic inspection of the ME through the Eustachian tube. Based on these requirements, we fabricate the proposed device and use it to demonstrate the feasibility of ME inspection in an anthropomorphic model, i.e. a 3D-printed ME phantom generated from patient image data. We show that our prototype provides > 74% visibility coverage of the sinus tympani, a region of the ME crucial for diagnosis, compared to an average of only 6.9% using a straight, non-articulated endoscope through the Eustachian Tube.
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Affiliation(s)
- Loris Fichera
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235 USA
| | - Neal P Dillon
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235 USA
| | - Dongqing Zhang
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235 USA
| | - Isuru S Godage
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235 USA
| | - Michael A Siebold
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235 USA
| | - Bryan I Hartley
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Jack H Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235 USA
| | - Paul T Russell
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Robert F Labadie
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235 USA
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