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Peng Q, Liu K, Wang M, Zhou C, Zhang S, Liu Y, Xie B. Post-operative vestibular and equilibrium evaluation in patients with cholesteatoma-induced labyrinthine fistulas. J Laryngol Otol 2024; 138:16-21. [PMID: 37650309 DOI: 10.1017/s0022215123000671] [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] [Indexed: 09/01/2023]
Abstract
OBJECTIVE This study aimed to compare the pre- and post-operative vestibular and equilibrium functions of patients with cholesteatoma-induced labyrinthine fistulas who underwent different management methods. METHODS Data from 49 patients with cholesteatoma-induced labyrinthine fistulas who underwent one of three surgical procedures were retrospectively analysed. The three management options were fistula repair, obliteration and canal occlusion. RESULTS Patients underwent fistula repair (n = 8), canal occlusion (n = 18) or obliteration procedures (n = 23). Patients in the fistula repair and canal occlusion groups suffered from post-operative vertigo and imbalance, which persisted for longer than in those in the obliteration group. Despite receiving different management strategies, all patients achieved complete recovery of equilibrium functions through persistent efforts in rehabilitation exercises. CONCLUSION Complete removal of the cholesteatoma matrix overlying the fistula is reliable for preventing iatrogenic hearing deterioration due to unremitting labyrinthitis. Thus, among the three fistula treatments, obliteration is the optimal method for preserving post-operative vestibular functions.
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Affiliation(s)
- Q Peng
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, China
| | - K Liu
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, China
| | - M Wang
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, China
| | - C Zhou
- Department of Otolaryngology, Shangrao Municipal Hospital, Shangrao, China
| | - S Zhang
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, China
| | - Y Liu
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, China
| | - B Xie
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, China
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Aw NMY, Thong JF, Tan BYB, Tan VYJ. Managing cholesteatomas with labyrinthine fistula. Singapore Med J 2023:384049. [PMID: 37675676 DOI: 10.4103/singaporemedj.smj-2021-377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Introduction A retrospective study (2011 to 2018) was conducted to evaluate the management of cholesteatomas with labyrinthine fistulae (LFs), clinical characteristics and postoperative hearing outcomes in a hospital. Methods Demographic data of patients with primary middle ear mastoidectomies for cholesteatoma were extracted. Preoperative high-resolution computed tomography (HRCT) temporal bone and intraoperative findings, and hearing levels preoperatively and postoperatively were evaluated. Results Of the middle ear cholesteatomas, 15.6% (n = 14) of ears were complicated by LF. HRCT scans showed 92.9% sensitivity and 94.7% specificity in the identification of LFs. Intraoperative findings of LFs include stapes erosion (78.6%), malleus erosion (78.6%), incus erosion (92.9%), dehiscence of tegmen tympani (28.6%) and tympanic facial canal (64.3%). Compared to the non-LF group, the LF group showed significantly higher incidence of stapes erosion (P < 0.001), tegmen tympani dehiscence (P = 0.016) and semicircular canal dehiscence (P < 0.001). Matrix was removed completely in 85.7% (n = 12) and was left behind in 14.3% (n = 2) of ears. Also, 21.5% (n = 3) had preoperative dead ears. Postoperative hearing results had a mean follow-up time of 2.1 (standard deviation 1.5, range 0.14-4.84) years. In the matrix removal group (n = 9), 77.9% had unchanged hearing levels, 11.1% showed improvement and 11.1% showed decrease in hearing levels. The matrix preservation group (n = 2) had deteriorated hearing levels. Conclusion Preservation of hearing in LFs is possible with cautious matrix removal. Despite matrix preservation to preserve hearing in large LFs, our patients' hearing deteriorated postoperatively. Longer follow-up of hearing with matrix preservation may show poorer hearing outcomes.
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Affiliation(s)
| | - Jiun Fong Thong
- Department of Otorhinolaryngology - Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Barrie Yau Boon Tan
- Department of Otorhinolaryngology - Head and Neck Surgery, Singapore General Hospital; Barrie Tan ENT Head and Neck Surgery, Gleneagles Hospital, Singapore
| | - Vanessa Yee Jueen Tan
- Department of Otorhinolaryngology - Head and Neck Surgery, Singapore General Hospital, Singapore
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Kryukov AI, Garov EV, Moseikina LA, Kurilenkov GV, Chugunova MA, Pryakhina MA, Saydulaev VA. [A case of hearing preservation during surgical treatment of distributed fistula labyrinth in a patient with chronic purulent means otitis and cholesteatoma]. Vestn Otorinolaringol 2022; 87:99-106. [PMID: 35818953 DOI: 10.17116/otorino20228703199] [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] [Indexed: 06/15/2023]
Abstract
The article provides a brief overview of the epidemiology, diagnosis, clinical manifestations and surgical methods of treatment of labyrinthine fistulas (LF) in patients with chronic suppurative otitis media (CSOM) with cholesteatoma. The efficacy of various LF treatment techniques, their complications, and the principles of prevention of cochleovestibular disorders during surgical treatment are described. The prognostic criteria for the deterioration of bone conduction thresholds during LF surgery, which include a large LF size, the opening of the membranous labyrinth, and the extent of damage to the structures of the inner ear, are presented. A clinical case of surgical treatment of widespread LF in CSOM with cholesteatoma is presented, which proves the possibility of preserving the auditory and vestibular functions while observing the stages of sanitation, manipulations on the LF and obliteration of semicircular canals defects with auto tissues. Combined surgery of such a plan must certainly be accompanied by local instillation of solutions of hormonal preparations in case of a deficiency of perilymphatic fluid in the labyrinth and postoperative antibacterial and hormonal therapy.
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Affiliation(s)
- A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E V Garov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - L A Moseikina
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - G V Kurilenkov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Chugunova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Pryakhina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - V A Saydulaev
- National medical reserch center of Otorhinolaryngology Moscow, Moscow, Russia
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Cavaliere M, Di Lullo AM, Russo C, Mesolella M, Cantone E, Di Lorenzo G, Motta G, Elefante A. Computed-Tomography-Structured Reporting in Middle Ear Opacification: Surgical Results and Clinical Considerations From a Large Retrospective Analysis. Front Neurol 2021; 12:615356. [PMID: 33716923 PMCID: PMC7943916 DOI: 10.3389/fneur.2021.615356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/14/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose: The aim of the study is to compare the accuracy of unstructured preoperative Computed Tomography (CT) reports from non-tertiary diagnostic centers with intraoperative findings in a large cohort of patients with Chronic Otitis Media (COM) undergone surgery. Methods: From 2012 to 2019, a total number of 301 patients were considered for our purposes. All patients with clinical evidence of COM had preoperative non-contrast high resolution CT scan of the temporal bone in non-tertiary diagnostic centers, performed within 3 months before surgery. Results: The accuracy of CT reports was analyzed in terms of nature, anatomical site, disease extension, bony erosion, vascular structures abnormalities relevant to surgical planning, and Eustachian tube patency. Compared to post-surgical findings, CT reporting critical analysis revealed a tendency to overestimation of bony erosion, coupled to underestimated description of facial canal/lateral semi-circular canal, vascular structures, and Eustachian tube. Conclusion: Discrepancies between CT reports and surgical findings in middle ear opacification can be at least in part due to limited expertise of general radiologists in ENT neuroimaging. To limit this lack of information and the limited accuracy of middle ear structures depiction, here we propose a structured checklist to adopt in the case of a temporal bone CT scan for COM, in order to optimize the communication with surgeons and provide all the crucial information for an accurate surgical planning.
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Affiliation(s)
- Michele Cavaliere
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy
| | - Antonella Miriam Di Lullo
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy.,CEINGE-Centro di Ingegneria Genetica e Biotecnologie Avanzate, Naples, Italy
| | - Camilla Russo
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Massimo Mesolella
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy
| | - Elena Cantone
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Di Lorenzo
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy
| | - Gaetano Motta
- Head and Neck Surgery Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Elefante
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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Kryukov AI, Kynelskaya NL, Garov EV, Zelikovich EI, Baybakova EV, Zelenkova VN, Garova EE, Martirosyan TG. [Variants of treatment of the head direction at the festulars of the labi-rint of inflammatory genesis]. Vestn Otorinolaringol 2019; 84:20-25. [PMID: 31793522 DOI: 10.17116/otorino20198405120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To analyze the effectiveness of various methods of treating dizziness with fistulas of the labyrinth (FL) of inflammatory genesis. An analysis of the surgical treatment of 216 patients with chronic suppurative otitis media (CSOM) with cholesteatoma complicated by FL using a variety of FL treatment methods is presented. All patients underwent a debridement operation on the middle ear or revision of the postoperative cavity: in 48 patients with a matrix of cholesteatoma in situ on the fistula, in 109 patients with matrix removal followed by plastic repair or FL filling with various autotissues, in 59 patients with matrix conservation, plastic removal or filling FL and SLD labyrinth. In the last two groups, filling of a semicircular canal (SC) defect was performed in 33 patients, and mastoidoplasty - in 47. CONCLUSION All used FL treatment techniques are effective in the treatment of peripheral vestibular disorders. Careful treatment of SC fistula after removal of all pathological conditions in the absence of active inflammation and the appointment of hormone therapy in the postoperative period are the main factors in preserving the functions of the labyrinth in any surgical technique. Filling of the lumen of the SC and mastoidoplasty in patients with CSOM with FL can eliminate peripheral dizziness.
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Affiliation(s)
- A I Kryukov
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - N L Kynelskaya
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - E V Garov
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - E I Zelikovich
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - E V Baybakova
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - V N Zelenkova
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - E E Garova
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - T G Martirosyan
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
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Bernardeschi D, Law-Ye B, Bielle F, Hochet B, Sterkers O, Dormont D, Pyatigorskaya N. Bioactive glass granules for mastoid and epitympanic surgical obliteration: CT and MRI appearance. Eur Radiol 2019; 29:5617-5626. [PMID: 30888487 DOI: 10.1007/s00330-019-06120-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/07/2019] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the appearance of mastoid and epitympanic obliteration using S53P4 bioactive glass (BG) granules in high-resolution computed tomography (HRCT) and MRI. MATERIALS AND METHODS Patients undergoing mastoid and epitympanic obliteration between May 2013 and December 2015 were prospectively included in an uncontrolled clinical study. All patients underwent a temporal HRCT scan 1 year after surgery, aimed at evaluating the attenuation, homogeneity, and osseointegration of the BG granules, as well as the ventilation of the middle ear and the volume of the obliterated paratympanic spaces. If a cholesteatoma was found during surgery, additional MRI, including at least pre- and post-contrast T1-weighted, T2-weighted, and axial non-echo-planar diffusion-weighted (DW) sequences, was performed 1 year after surgery, to study the normal signal of the BG granules and the presence of residual cholesteatoma and/or other temporal bone pathologies. RESULTS Seventy cases were included. On 1-year HRCT, the mean attenuation of the BG granules was 888.34 ± 166.10 HU. The obliteration was found to be mostly homogeneous with partial osseointegration. The appearance of the BG granules having a low-intensity signal in T2-weighted imaging and DW MRI was always different from the appearance of cholesteatoma. A longer follow-up has shown no attenuation or signal modification of the BG granules compared with the 1-year imaging. CONCLUSION Radiological follow-up of patients operated on with mastoid and epitympanic obliteration using BG granules is effective using both HRCT and MRI. A cholesteatoma and/or other potential complications could easily be detected due to the specific radiological appearance of the BG granules. KEY POINTS • The appearance of mastoid and epitympanic obliteration by S53P4 bioactive glass (BG) granules on high-resolution computed tomography (HRCT) scans was homogeneous with an attenuation significantly higher than the attenuation of cholesteatoma and lower than mastoid bone attenuation. • The granules have a low-intensity signal on non-echo-planar diffusion-weighted sequences and on T2-weighted images and present contrast enhancement allowing the differential diagnosis with cholesteatoma and effective for the detection of other underlying temporal bone pathologies. • The volume and radiological appearance of the obliteration appear to be stable with time.
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Affiliation(s)
- Daniele Bernardeschi
- AP-HP, Otology, Auditory Implants and Skull Base Surgery Department, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, 75013, Paris, France.,Inserm UMR_S 1159, "Réhabilitation chirurgicale mini-invasive et robotisée de l'audition", F-75018, Paris, France
| | - Bruno Law-Ye
- AP-HP, Neuroradiology department, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, 75013, Paris, France
| | - Franck Bielle
- AP-HP, Neuropathology Department, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, 75013, Paris, France
| | - Baptiste Hochet
- AP-HP, Otology, Auditory Implants and Skull Base Surgery Department, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, 75013, Paris, France.,Inserm UMR_S 1159, "Réhabilitation chirurgicale mini-invasive et robotisée de l'audition", F-75018, Paris, France
| | - Olivier Sterkers
- AP-HP, Otology, Auditory Implants and Skull Base Surgery Department, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, 75013, Paris, France.,Inserm UMR_S 1159, "Réhabilitation chirurgicale mini-invasive et robotisée de l'audition", F-75018, Paris, France
| | - Didier Dormont
- AP-HP, Neuroradiology department, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, 75013, Paris, France
| | - Nadya Pyatigorskaya
- AP-HP, Neuroradiology department, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, 75013, Paris, France. .,UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Sorbonne Universités, F-75013, Paris, France. .,Neuroradiology Department, Pitié-Salpetriere Hospital, 75013, Paris, France.
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