1
|
Kaya E, Kaya F, Kaya Mİ, Çaklı H, İncesulu ŞA. A study on the efficacy of combined surgery in advanced-stage congenital cholesteatoma with canal-wall-up surgery. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08820-9. [PMID: 39025976 DOI: 10.1007/s00405-024-08820-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE This study aimed to compare the outcomes of patients with advanced congenital cholesteatoma who underwent microscopic or endoscope-combined Canal Wall Up Tympanomastoidectomy (CWUT) in our clinic and to determine the contribution of endoscope use in reducing recurrence/residual rates. METHODS In this retrospective study, the data of individuals who underwent microscopic or combined endoscopic surgery between 2008 and 2022 in our clinic were scanned from the database. Demographic data, preoperative computed tomography (CT) findings, preoperative and postoperative hearing results, operation and intraoperative status of the ossicles, duration of surgery, postoperative follow-up period, recurrence and residual disease status during follow-up were investigated. RESULTS The data of 37 pediatric cases operated in our clinic were included in the study. All of the included cases were Potsic Stage 4 patients who underwent CWUT. The mean age of the operated individuals was 8.7 years (5-12 years) and the mean follow-up period was 47.3 months (12-112 months). 19 cases were performed microscopically only, 2 recurrences and 5 residuals were detected. 18 cases were performed combined and 1 recurrence and 1 residual was found. CONCLUSION In this study, it was determined that using an endoscope together with a microscope in congenital cholesteatoma cases, decreased the rate of recurrence and residual disease by protecting the external auditory canal in patients with advanced mastoid invasion.
Collapse
Affiliation(s)
- Ercan Kaya
- Department of Otorhinolaryngology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Furkan Kaya
- Department of Otorhinolaryngology, Yunus Emre State Hospital, Eskişehir, Türkiye.
| | - Melike İtgin Kaya
- Department of Otorhinolaryngology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Hamdi Çaklı
- Department of Otorhinolaryngology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | | |
Collapse
|
2
|
Xue P, Wang Z, Chai Y, Si M, Hu L. Treatment of congenital middle ear cholesteatoma in children using endoscopic and microscopic ear surgeries: a case series. Front Pediatr 2024; 12:1336183. [PMID: 38853779 PMCID: PMC11157046 DOI: 10.3389/fped.2024.1336183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Surgical removal is widely employed in children with congenital middle ear cholesteatoma (CMEC). Here, we report the surgical outcomes of CMEC removal via endoscopic ear surgery (EES) and microscopic ear surgery (MES) in children. Methods Children with CMEC who underwent preoperative medical history inquiry, hearing test, endoscopic evaluation, and radiology imaging before receiving EES or MES were included. Postoperative audiological outcomes and recurrence rates were collected. Results Seventeen children (20 ears) with stage II-IV CMEC were included. Of those, 11 ears (55.0%) underwent EES, and 9 ears (45.0%) underwent MES. The follow-up time was 35 ± 13.5 months. One child in the EES group with stage III CMEC had a recurrence during the follow-up period. In the EES group, the average minimum diameter of the external auditory canal on the affected side was 5.8 mm (4.3-8.0 mm). No linear association was found between age and the minimum diameter of the external auditory canal. Discussion EES is a promising treatment option for children with early-stage CMEC because of its low recurrence rate and minimally invasive nature. The minimum diameter of the external auditory canal on the affected side should be meticulously examined when performing EES in children.
Collapse
Affiliation(s)
- Po Xue
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Zhaoyan Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Yongchuan Chai
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Mingjue Si
- Department of Radiology, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingxiang Hu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| |
Collapse
|
3
|
Leahy J, Wong K, Govindan A, Powers A, Perez ER, Wanna GB, Cosetti MK. Long-term outcomes following pediatric endoscopic titanium ossiculoplasty: A single-institution experience. Int J Pediatr Otorhinolaryngol 2024; 179:111938. [PMID: 38579403 DOI: 10.1016/j.ijporl.2024.111938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/11/2024] [Accepted: 03/31/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION Endoscopic ossicular chain reconstruction (OCR) in adults has demonstrated equivalent outcomes to the traditional microscopic approach. Less data exist on endoscopic OCR outcomes in children, who have unique considerations including a smaller transcanal corridor and variable pathology. The purpose of this study was to investigate surgical and audiometric outcomes in children undergoing fully endoscopic and endoscopic-assisted OCR in both the short and long-term. METHODS Retrospective review of all children (<17 years) who underwent endoscopic OCR at one tertiary care center between 2017 and 2021. Children undergoing primary and revision endoscopic OCR with either partial (PORP) and total ossicular reconstruction prostheses (TORP) were included. Children undergoing surgery for juvenile otosclerosis or congenital stapes fixation, or any child receiving a stapes prosthesis were excluded. Primary outcome measures were post-operative change in 4 frequency (500 Hz, 1, 2, 4 KHz) air conduction pure tone average (AC PTA) and change in air-bone gap (ABG). Secondary measures included need for readmission and/or revision surgery, complication rate, and surgery duration. RESULTS Seventeen patients met inclusion criteria. Average age was 11.3 years (range, 5-17 years); 14 were male. A variety of fixed length, titanium total and partial prostheses were used. The most common prosthesis length was 2 mm (range 2-5 mm), and there were no intra- or perioperative complications. Mean long-term follow-up was 2.6 years. Most common pathology was congenital cholesteatoma (11/17, 64%), followed by chronic otitis media with tympanic membrane perforation (5/17, 29.4%), and extruded prosthesis (1/17, 5.9%). Intraoperatively, the most common finding was incus erosion (10/17, 58.8%), followed by malleus erosion (6/17, 35.3%), stapes erosion (4/17, 23.5%), and stapes absence (4/17, 23.5%). Eight children (47%) were reconstructed with PORPs, and 9 children (52.9%) were reconstructed with TORPs. Average ABG improved from 36.8 dB preoperatively to 19.9 dB postoperatively in the short-term and remained stable at 19.5 dB in the long-term. Average short-term ABG improvement was 4.2 dB for PORPs and 18 dB for TORPs. In the long-term, average ABG improved by 2.3 dB in PORPs and 13.4 dB in TORPs. PORPs had higher rates of ABG closure and lower AC PTAs than TORPs in the long-term. DISCUSSION Endoscopic ossiculoplasty is a viable option in children presenting with ossicular erosion from various causes. Audiometric improvement following endoscopic partial and total ossicular reconstruction remains stable over time, with a preference towards partial in the long-term, and mirrors published outcomes for microscopic surgery.
Collapse
Affiliation(s)
- Jasmine Leahy
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Kevin Wong
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aparna Govindan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann Powers
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Enrique R Perez
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maura K Cosetti
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
4
|
Kallyadan A, Sarkar S, Pradhan P, Karakkandy V, Parida PK, Chappity P, Samal DK, Sharma P, Adhikari A, Shah A, Nayak S. Endoscopic Tympanoplasty as an Alternative to Microscopic Tympanoplasty: A Comparative Study on Surgical Outcomes and patient satisfaction. Indian J Otolaryngol Head Neck Surg 2024; 76:469-476. [PMID: 38440479 PMCID: PMC10908901 DOI: 10.1007/s12070-023-04184-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/24/2023] [Indexed: 03/06/2024] Open
Abstract
Background Chronic otitis media treatment has evolved, with microscopic surgeries as the gold standard and endoscopic surgeries as a newer addition. Materials and Methods This retrospective study includes 209 patients who underwent type 1 tympanoplasty, utilizing both endoscopic and microscopic techniques, between January 2019 and December 2022 at a tertiary care institute in India. The study aims to compare hearing outcomes, graft uptake, hospital stay, postoperative pain, and cosmesis between the two groups. Results Mean AB gap closure was 17.09 + 5.98 dB in the endoscopic group and 16.74 + 5.05 dB in the microscopic group (P = 0.687). The duration of surgery was 79.26 ± 17.37 min in the Endoscopic group and 91.92 ± 15.35 min in the Microscopic group. (P = < 0.00001). The Endoscopic group experienced less post-operative pain, shorter hospital stay (P = < 0.00001, P = 0.0008), and exhibited better cosmetic outcomes (P = 0.00001) compared to the microscopic group. Conclusion Endoscopic tympanoplasty is a better alternative to microscopic tympanoplasty, delivering comparable hearing outcomes, shorter surgical duration, improved pain scores, and better cosmesis. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04184-4.
Collapse
Affiliation(s)
- Aswathi Kallyadan
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Saurav Sarkar
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pradeep Pradhan
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vinusree Karakkandy
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pradipta Kumar Parida
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Preetam Chappity
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Dillip Kumar Samal
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prity Sharma
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Asutosh Adhikari
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anwer Shah
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Saurav Nayak
- Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, India
| |
Collapse
|
5
|
Flockerzi V, Schick B, Bozzato A. [Experiences with endoscopic ear surgery of a German tertiary hospital for otolaryngology]. HNO 2023; 71:787-794. [PMID: 37599311 PMCID: PMC10663200 DOI: 10.1007/s00106-023-01348-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND The aim of this article is to report on the integration of endoscopic ear surgery (EES) into daily clinical practice. MATERIAL AND METHODS In a monocentric prospective study, the endoscopy unit was set up during even weeks over a period of 10 months and the procedure was primarily started endoscopically via a transmeatal approach. In odd weeks, the endoscopy was omitted. A total of 60 procedures in 59 patients were evaluated. Points of comparison were intraoperative vision, incision-suture time, postoperative hearing outcome, and postoperative otoscopic findings. RESULTS With the exception of the facial nerve (p = 0.15 Mann-Whitney U‑test), the EES showed significantly improved visualization of all areas in the middle ear. The incision-suture times were similar in both methods. If bimanual placement of an ossicular prosthesis was necessary, the incision-suture time increased disproportionately (MES: 57.18 ± 9.7 min, EES: 76.83 ± 24.99 min; p = 0.019, *). There were no statistically significant changes related to hearing outcomes when comparing EES with the microscopic technique. There were no postoperative complications in the EES surgery group. CONCLUSION Integration of EES proved to be successful and advantageous in a real patient collective at this location.
Collapse
Affiliation(s)
- Veronika Flockerzi
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes, 66421, Homburg, Deutschland.
| | - Bernhard Schick
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes, 66421, Homburg, Deutschland
| | - Alessandro Bozzato
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes, 66421, Homburg, Deutschland
| |
Collapse
|
6
|
Hamela MAA, Abd-Elnaseer O, El-Dars MM, El-Antably A. Comparison of the outcomes of endoscopic versus microscopic approach in cholesteatoma surgery: a randomized clinical study. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2023; 39:128. [DOI: 10.1186/s43163-023-00492-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/04/2023] [Indexed: 09/02/2023]
Abstract
Abstract
Background
Endoscopic ear surgery is a new, less invasive otologic procedure. Since 1990s, it has been grown in prominence because of anatomical and physiological theories. It offers a view of hidden places, avoids mastoidectomies and endaural vertical and postauricular incisions, and has many other benefits over microscopic surgery. The purpose of this study was to distinguish the difference between the outcomes of microscopic and endoscopic cholesteatoma surgery.
Methods
Eighty individuals who were diagnosed with cholesteatoma participated in this randomized clinical research. Patients were randomly allocated into two equivalent treatment groups. One group submitted to tympanoplasty via microscopic ear surgery and the other group had exclusive trans-canal endoscopic ear surgery. All patients had preoperative otomicroscopic and radiologic assessment to ensure cholesteatoma diagnosis. Audiological evaluations were also obtained.
Results
There was no discernible difference in the tested groups’ operational times, air-bone gaps, or air conduction. The endoscopic surgery group healed significantly more quickly than the microscopic surgery group (5.4 0.5 vs 7.7 0.5 weeks, p > 0.001). The frequency of residual lesions (5.0% vs 22.5%, p = 0.023) and recurrence (7.5% vs 27.5%, p = 0.019) was significantly lower in the endoscopic group of patients.
Conclusions
When comparing healing times, rates of residual disease and rates of recurrence, endoscopic surgery clearly outperforms microscopic surgery. The endoscope encourages visualization and magnification of anatomy while being less invasive thanks to its improved picture quality, lighting, and capacity to “see around the corner.” Additionally, a significant portion of viable mastoid tissues and healthy mucosa were preserved.
Collapse
|
7
|
Wong K, Gorthey S, Arrighi-Allisan AE, Fan CJ, Barber SR, Schwam ZG, Wanna GB, Cosetti MK. Defining the Learning Curve for Endoscopic Ear Skills Using a Modular Trainer: A Multi-Institutional Study. Otol Neurotol 2023; 44:346-352. [PMID: 36805421 DOI: 10.1097/mao.0000000000003826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Quantify the learning curve for endoscopic ear skills acquisition in otolaryngology residents using a simulator. The secondary objective was to determine if demographic factors or previous endoscopic experience influenced skill development. STUDY DESIGN Prospective, multicenter study. Resident participants each completed 10 amassed trials using a validated endoscopic ear skill trainer. SETTING Two academic teaching hospitals. SUBJECTS Otolaryngology residents. MAIN OUTCOME MEASURES Trial completion times; rate of improvement over time. RESULTS Thirty-eight residents completed the study, 26 from program A and 12 from program B. Fifteen participants were women and 23 were men. Mean age was 30 years old (range 26 to 34 years). Previous experience with otoendoscopy (B = -16.7, p = 0.005) and sinus endoscopy (B = -23.4, p = 0.001) independently correlated with lower overall trial times. Age, gender, postgraduate year, handedness, interest in otology, and video gaming were not associated with trial times. On multivariate logistic regression, resident completion times improved with trial number, and residents without previous endoscopy experience improved at a faster rate than those with experience ( p < 0.001). CONCLUSIONS Novice surgeons may acquire basic endoscopic ear experience with self-directed simulation training. The learning curve for transcanal endoscopic ear surgery is comparable to those demonstrated for other otologic surgeries, and specific task competencies can be achieved within 10 trials, suggesting that previous experiences, or lack thereof, may not dictate the ability to acquire new skills. There may be a translational value to previous endoscopic sinus experience on learning transcanal endoscopic ear surgery.
Collapse
Affiliation(s)
| | - Scott Gorthey
- Department of Otolaryngology, Albert Einstein College of Medicine, New York, NY
| | | | | | - Samuel R Barber
- Department of Otolaryngology, University of Arizona College of Medicine, Tucson, AZ
| | | | | | | |
Collapse
|
8
|
Srinivasan T, Cherches A, Seguya A, Salano V, Patterson RH, Xu MJ, Alkire BC, Okerosi SN, Tamir SO. Essential equipment and services for otolaryngology care: a proposal by the Global Otolaryngology-Head and Neck Surgery Initiative. Curr Opin Otolaryngol Head Neck Surg 2023; 31:194-201. [PMID: 36942853 PMCID: PMC10155687 DOI: 10.1097/moo.0000000000000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW To highlight the need for comprehensive resource lists to provide baseline care of otolaryngologic conditions; to present a proposed list of essential equipment and services that may be applied toward surgical systems research, policymaking, and charitable efforts in global otolaryngology-head and neck surgery. RECENT FINDINGS To provide effective and high-quality surgical care across care settings, there must be a global standard for equipment and ancillary services necessary to provide baseline care. Though there have been efforts to devise resource standards via equipment lists and appraisal tools, these have been limited in scope to general surgery, emergency care, and a few other subspecialty surgical contexts. Recent efforts have brought attention to the significant burden imposed by otolaryngologic conditions such as hearing loss, otitis media, head and neck cancer, head and neck trauma, and upper airway foreign bodies. Yet, there has not been a comprehensive list of resources necessary to provide baseline care for common otolaryngologic conditions. SUMMARY Through an internal survey of its members, the Global Otolaryngology-Head and Neck Surgery Initiative has compiled a list of essential equipment and services to provide baseline care of otolaryngologic conditions. Our efforts aimed to address common otolaryngologic conditions that have been previously identified as high-priority with respect to prevalence and burden of disease. This expert-driven list of essential resources functions as an initial framework to be adapted for internal quality assessment, implementation research, health policy development, and economic priority-setting.
Collapse
Affiliation(s)
- Tarika Srinivasan
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Harvard Medical School, Boston, Massachusetts
| | - Alexander Cherches
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Amina Seguya
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Mulago National Referral Hospital, Kampala, Uganda
| | - Valerie Salano
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Nyahururu County Hospital, Laikipia County, Kenya
| | - Rolvix H Patterson
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Mary Jue Xu
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Blake C Alkire
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical Schoo
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Samuel N Okerosi
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Kenyatta National Hospital, Nairobi, Kenya
| | - Sharon Ovnat Tamir
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Department of Otolaryngology/Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| |
Collapse
|
9
|
Kawale M, Landge S, Garg D, Kanani K. Endoscopic Versus Microscopic Type 1 Tympanoplasty (Myringoplasty) in a Rural Tertiary Care Hospital in India: A Retrospective Comparative Study. Cureus 2023; 15:e36109. [PMID: 37065312 PMCID: PMC10101192 DOI: 10.7759/cureus.36109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/13/2023] [Indexed: 03/15/2023] Open
Abstract
Background Chronic suppurative otitis media (CSOM) is described as middle ear cleft inflammation that results in long-term alterations to the tympanic membrane and/or the middle ear structures. In cases of CSOM, type 1 tympanoplasty, also known as myringoplasty, is a successful procedure for repairing the tympanic membrane and can even help restore hearing loss. This study aims to compare functional and clinical outcomes of type 1 tympanoplasty performed using transcanal endoscopic ear surgery (TEES) versus those performed via microscopic ear surgery (MES) for perforation in the tympanic membrane in the safe type of CSOM. Methodology Between January 2018 and January 2022, a retrospective analysis of 100 patients (47 men and 53 women) operated for the safe type of CSOM with a perforated tympanic membrane was conducted in our department. Based on the surgical methods, cases were randomly divided into two groups. There were 50 people in group 1 who underwent endoscopic tympanoplasty and 50 in group 2 who underwent microscopic tympanoplasty. The following factors were assessed: patient demographics; tympanic membrane perforation size at the time of surgery; operating room time; hearing outcomes, that is, closure of air-bone gap (ABG); graft uptake success rate; postoperative hospital stay; and medical resource usage. Patients were followed up for 12 weeks. Results Both groups shared similar epidemiological profiles, preoperative hearing status, and perforation sizes. In both groups, the rate of graft uptake was comparable. The average ABG closure was also quite comparable. In the case of endoscopic surgeries, the mean operative time was shorter; which was statistically significant, and complications were significantly lower in group 1. Conclusions Compared to its microscopic counterpart, endoscopic tympanoplasty has a similar graft uptake success rate and a comparable hearing outcome; however, it requires less operative time and hospital stay, has early recovery, and makes lesser use of medical resources, and it is cosmetically better.
Collapse
|
10
|
Hu X, Chen M, Dai W, Zhang C, Li S. Efficiency of intraoperative endoscopic inspection in reducing residuals in canal-wall-up surgery for pediatric cholesteatoma involving the mastoid. Eur Arch Otorhinolaryngol 2023:10.1007/s00405-023-07857-6. [PMID: 36700981 DOI: 10.1007/s00405-023-07857-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/20/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To investigate the efficiency of additional intraoperative endoscopic inspection in reducing residual cholesteatoma in pediatric cholesteatoma involving the mastoid treated with classic canal-wall-up mastoidectomy and tympanoplasty. MATERIALS AND METHODS 32 cases of pediatric cholesteatoma involving the mastoid were enrolled in this perspective study and treated with classic canal-wall-up mastoidectomy and tympanoplasty. Transmastoid posterior tympanotomy, atticotomy and transecting tendon of tympani tensor were conducted to achieve adequate visualization of hidden spaces in the middle ear. After complete removal of cholesteatoma, endoscopic inspection was additionally performed to check residual cholesteatoma. All cases had at least a 2-year follow-up by routine otoscopy examination, CT scan or MR imaging. Residual rates of both intraoperative and follow-up findings were used to evaluate the efficiency of the endoscopic inspection in reducing residual cholesteatoma and compared with published reports. RESULTS The additional intraoperative endoscopic inspection did not find any residual in this case series. In the 2-year follow-up, 2 cases (2/32, 6.3%) with residual cholesteatoma and 3 cases with recurrence (3/32, 9.4%) were found. The mean duration of endoscopic inspection and microscopic procedure were 17.9 min and 93.6 min, respectively. CONCLUSIONS This study suggested that the additional intraoperative endoscopic inspection in microscopic CWU surgery for pediatric cholesteatoma involving the mastoid had no obvious value in reducing residual cholesteatoma but took extra time.
Collapse
Affiliation(s)
- Xuerui Hu
- Department of Otolaryngology and Head-Neck Surgery, ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Min Chen
- Department of Otolaryngology and Head-Neck Surgery, ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Wenjia Dai
- Department of Otolaryngology and Head-Neck Surgery, ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Chen Zhang
- Department of Otolaryngology and Head-Neck Surgery, ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Shufeng Li
- Department of Otolaryngology and Head-Neck Surgery, ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China.
| |
Collapse
|
11
|
Comparison between endoscopic and microscopic butterfly cartilage graft inlay tympanoplasty: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:151-158. [PMID: 35748934 DOI: 10.1007/s00405-022-07477-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/30/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to compare the effectiveness of endoscopic and microscopic approaches for butterfly cartilage graft inlay tympanoplasty regarding anatomical and hearing outcomes through a systematic review and meta-analysis. METHODS A search of PubMed, Embase, MEDLINE, and Virtual Health Library was performed from inception to July 3rd, 2021, using keywords, such as tympanoplasty, cartilage graft, and inlay technique. Data from articles that met inclusion criteria were extracted by two authors independently. The PRISMA statement was followed. RoB-2 and ROBINS-I tools were used to assess risk of bias. The primary outcome was tympanic membrane closure rate. The secondary outcome was improvement of the air-bone gap. RESULTS Five studies were included, one randomized clinical trial and four retrospective cohorts, in which a total of 318 patients were included. Graft take rate was 91.3% in the endoscopic group and 93.6% in the microscopic group (RR 0.98; 95% CI 0.93-1.03; I2 0%; P = 0.68). Four studies provided data about the secondary outcome, all showing significant reductions in air-bone gap, ranging from 5.7 to 11.0 in the endoscope group and from 5.8 to 11.6 in the microscope group, with a mean difference between groups of 0.85 (95% CI - 0.79 to 2.48). CONCLUSION Although the overall evidence of the included studies was low, endoscopic and microscopic butterfly cartilage graft inlay tympanoplasties have similar results on anatomical and hearing outcomes, making the selection between such approaches an individual choice for the surgeon.
Collapse
|
12
|
Takahashi M, Motegi M, Yamamoto K, Yamamoto Y, Kojima H. Endoscopic tympanoplasty type I using interlay technique. JOURNAL OF OTOLARYNGOLOGY - HEAD & NECK SURGERY 2022; 51:45. [PMCID: PMC9670569 DOI: 10.1186/s40463-022-00597-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 09/19/2022] [Indexed: 11/18/2022]
Abstract
Abstract
Background
Tympanoplasty using the interlay technique has rarely been reported in transcanal endoscopic ear surgery, unlike the underlay technique. This is because many surgeons find it challenging to detach the epithelial layer of the tympanic membrane using only one hand. However, the epithelial layer can be easily detached from the inferior part of the tympanic membrane. Another key point is to actively improve anteroinferior visibility even if the overhang is slight because most perforations and postoperative reperforations are found in the anteroinferior quadrant of the tympanic membrane. We report the application of the interlay technique in endoscopic tympanoplasty type I for tympanic perforations.
Methods
We retrospectively reviewed the medical records of 51 patients who had undergone tympanoplasty using the interlay technique without ossiculoplasty between 2017 and 2020. We then compared the data with those of patients who underwent microscopic surgery (MS) using the underlay technique between 1998 and 2009 (n = 104). No other technique was used in each group during this period. Repair of tympanic membrane perforation and hearing outcomes were assessed for > 1 year postoperatively.
Results
The perforation sites were limited to the anterior, posterior, and anterior–posterior quadrants in 23, 1, and 27 ears, respectively. Perforations were closed in 50 of the 51 ears (98.0%), and the postoperative hearing was good (average air-bone [A-B] gap was 6.8 ± 5.8 dB). The surgical success rate for the repair of tympanic membrane perforation was not significantly different from the MS group (93.3%, P = 0.15). The average postoperative average A-B gap in the group that underwent the interlay technique was significantly different from that in the MS group (10.1 ± 6.6 dB, P < 0.01).
Conclusion
The interlay technique should be considered as one of the treatment methods in endoscopic surgery for tympanic perforations. Further study of the postoperative outcomes of this procedure should be conducted to establish the optimal surgical procedure for tympanic perforations.
Trial registration: This study was retrospectively approved by the Institutional Review Board of the Jikei University, Tokyo, Japan (approval number: 32-205 10286).
Video abstract
Collapse
|
13
|
Stramiello JA, Wong SJ, Good R, Tor A, Ryan J, Carvalho D. Validation of a three-dimensional printed pediatric middle ear model for endoscopic surgery training. Laryngoscope Investig Otolaryngol 2022; 7:2133-2138. [PMID: 36544939 PMCID: PMC9764782 DOI: 10.1002/lio2.945] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 12/24/2022] Open
Abstract
Objective The purpose of this study is to assess the anatomical appropriateness of a three-dimensional (3D) printed pediatric middle ear model with a replaceable middle ear unit as an endoscopic ear surgery (EES) simulator. Methods Single-blinded, prospective, proof-of-concept study conducted in a simulation operative suite. A simulator was developed through segmentation of source images and multi-material 3D printing. Subjects were asked to point to seven anatomical sites before and after a short anatomy presentation of a human middle ear photograph. They also filled out a survey about the feasibility of the model. Outcome variables included survey scores, pre-anatomy lesson (PreAL) and post-anatomy lesson (PostAL) quiz scores. Results There were 24 participants (19 residents, 1 fellow, and 4 attendings), none with self-reported proficiency in EES. The PreAL mean score was 4.42 and PostAL quiz mean score was 5.32 (average improvement of 43% [CI = 17%-70%]; p = .003). The higher the level of training, the higher the PreAL scores (0.55 points per year of training; p = .004). The subspecialty (otology, other, in-training) was also associated with the PreAL scores (p = .004). Total survey score means were 22.8 (out of 30). Conclusion The results of our study suggest that our model has adequate anatomical high fidelity to mimic a real, pediatric temporal bone for EES. As 3D printing technologies continue to advance, the quality of ear models has the potential to provide improved surgical training for pediatric EES. Level of Evidence 4.
Collapse
Affiliation(s)
- Joshua Anthony Stramiello
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Stephanie J. Wong
- Division of Pediatric OtolaryngologyRady Children's Hospital – San DiegoSan DiegoCaliforniaUSA,Department of Otolaryngology‐Head and Neck SurgeryVirginia Commonwealth University Medical CenterRichmondVirginiaUSA
| | - Raquel Good
- Division of Pediatric OtolaryngologyRady Children's Hospital – San DiegoSan DiegoCaliforniaUSA
| | - Alice Tor
- Jacobs School of EngineeringUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Justin Ryan
- Division of Pediatric OtolaryngologyRady Children's Hospital – San DiegoSan DiegoCaliforniaUSA,3D Innovations LabRady Children's Hospital, San DiegoSan DiegoCaliforniaUSA
| | - Daniela Carvalho
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California, San DiegoSan DiegoCaliforniaUSA,Division of Pediatric OtolaryngologyRady Children's Hospital – San DiegoSan DiegoCaliforniaUSA
| |
Collapse
|
14
|
Yang Q, Wang B, Zhang J, Liu H, Xu M, Zhang W. Comparison of endoscopic and microscopic tympanoplasty in patients with chronic otitis media. Eur Arch Otorhinolaryngol 2022; 279:4801-4807. [PMID: 35122510 PMCID: PMC9474537 DOI: 10.1007/s00405-022-07273-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND To compare the results between type I tympanoplasty performed with transcanal endoscopic ear surgery (TEES) and microscopic ear surgery (MES) for treatment of chronic otitis media in a homogenous group of patients. METHODS A retrospective study was performed in our department between January 2011 and January 2016 to review primary type I tympanoplasty cases with a subtotal perforation, an intact ossicular chain, a dry ear for at least 1 month, normal middle ear mucosa, and a follow-up period of at least 6 months post surgery. The adoption of TEES or MES was divided temporally (before and since 2013). TEES was undertaken in 224 patients (224 ears) and MES in 121 patients (121 ears). RESULTS The successful graft take rate was 94.64% (212/224) in the TEES group and 90.91% (110/121) in the MES group (P = 0.239). The improvements in the air conduction levels between the 2 groups were not statistically different at 1, 3, or 6 (> 6) months (P > 0.05) after surgery. The improvements in the air-bone gaps were not significantly different between the 2 groups (P > 0.05). The average hearing gains in the TEES group 6 (and > 6) months post surgery were 11.85 ± 5.47 dB, which was better than 10.48 ± 5.18 dB in the MES group (P = 0.031). The use of medical resources was lower in the TEES group than in the MES group regarding the average operating time (49.22 ± 8.24 min vs 81.22 ± 14.73 min, respectively; P < 0.0001). Patients receiving MES had a significant higher incidence of the wound problems (ear pain, numbness around the ears, and wet ear; P < 0.05). CONCLUSION TEES for type I tympanoplasty seems to achieve a shorter operative time and ideal tympanic membrane healing rate and hearing results in patients with chronic otitis media.
Collapse
Affiliation(s)
- Qimei Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Bing Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Jin Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Hui Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Min Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Wen Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China.
| |
Collapse
|
15
|
Comparative Analysis of Recidivism After Endoscopic and Microscopic-Based Cholesteatoma Resection. Otol Neurotol 2022; 43:466-471. [DOI: 10.1097/mao.0000000000003476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Comparing two different techniques to repair pediatric anterior tympanic membrane perforations. Int J Pediatr Otorhinolaryngol 2021; 150:110903. [PMID: 34479059 DOI: 10.1016/j.ijporl.2021.110903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/16/2021] [Accepted: 08/28/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Compare outcomes between a microscopic and endoscopic technique for anterior tympanic membrane (TM) perforation. METHODS Results of microscopic overlay (MT) and endoscopic tympanoplasty (ET) for management of anterior TM perforations from a single surgeon. RESULTS There were 28 patients in the MT group and 35 in the ET group. The mean age was 7.1 years and 10.9 years (p < 0.001) MT and ET groups respectively. There was no statistical differences in perforation location (p = 0.1), etiology (p = 0.52) or size (p = 0.1) between both groups. Mean operating time was 119.0 min and 131.0 min in the MT and ET groups respectively (p = 0.23). Follow up was 30.9 months and 9.0 months (p = 0.001) MT and ET respectively. The perforation was successfully closed in 29 patients at 6 weeks in the ET (82.9%) and 25 in the MT (89.3%), p = 0.47. Adjusting for age revealed no significant difference between groups. Long term follow up, resulted in 10 failures (28.6%) and 7 patients (25.0%) in the ET and MT groups respectively, p = 0.75. Adjusting for the follow-up period or age, there was no significant difference between groups. The change in ABG and PTA measures were not statistically different between groups. CONCLUSIONS An anteriorly based ET is a novel technique for management of anterior TM perforations. Results from this pilot study indicate that this ET approach may be an appropriate alternative to MT for difficult to repair anterior perforations. A longer follow-up will be necessary to determine its role in these perforations.
Collapse
|
18
|
Curran JF, Coleman H, Tikka T, Iyer A. Comparison of outcomes of endoscopic ear surgery with microsurgery for cholesteatoma: A prospective study of 91 cases with three-year follow-up. Clin Otolaryngol 2021; 47:197-202. [PMID: 34490718 DOI: 10.1111/coa.13856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/21/2021] [Indexed: 01/14/2023]
Affiliation(s)
| | - Holli Coleman
- Department of ENT, University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| | - Theofano Tikka
- Department of ENT, University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| | - Arunachalam Iyer
- Department of ENT, University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| |
Collapse
|
19
|
A Novel Instrument for Endoscopic Ear Surgery With a Steerable Flexible Tip: A Pediatric Anatomical Validation Study. Otol Neurotol 2021; 42:e1683-e1690. [PMID: 34238900 DOI: 10.1097/mao.0000000000003237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS This study compares the reaching ability of two classes of transcanal endoscopic ear surgery (TEES) instruments when operating on difficult to access anatomical targets; two novel instruments with steerable flexible tips (SFT-A and SFT-B) and suction capability are compared with standard commercially available tools. BACKGROUND TEES surgeons identified the need for a new surgical instrument that can enable accessibility of all areas visualized by the endoscope. This motivated the development of the two instrument prototypes. METHODS Six temporal bone models were 3D printed based on CT data from five cholesteatoma patients. Four anatomical targets were marked on each model. Using these targets, the reaching ability while using four standard TEES instruments were compared with the SFT-A and SFT-B prototypes by five surgeon participants. Results were analysed to compare success rates of contacting each target using each tool by fitting four Firth's logistic regression models. This calculated the statistically significant differences (p < 0.05) in tool success rate. RESULTS Using SFT-A to contact the sinus tympani (100%) was significantly more successful than the Panetti suction dissector for atticus (PAT) (77%) and to contact the sinodural angle (0%) was less successful than the PAT (10%) and SFT-B (93%). Using SFT-B to contact the lateral semicircular canal (90%) was significantly more successful than all current tools and to contact the sinodural angle (93%) was significantly more successful than all tools. CONCLUSION Using SFT-B enables enhanced accessibility of anatomical structures during TEES which may lead to less extensive bone removal to facilitate minimally invasive TEES.
Collapse
|
20
|
Masalski M, Wąż A, Błauciak P, Zatoński T, Morawski K. Handheld laser-fiber vibrometry probe for assessing auditory ossicles displacement. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210077RR. [PMID: 34291616 PMCID: PMC8292735 DOI: 10.1117/1.jbo.26.7.077001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
SIGNIFICANCE Measurements of auditory ossicles displacement are commonly carried out by means of laser-Doppler vibrometry (LDV), which is considered to be a gold standard. The limitation of the LDV method, especially for in vivo measurements, is the necessity to expose an object in a straight line to a laser beam operating from a distance. An alternative to this approach is the use of a handheld laser-fiber vibrometry probe (HLFVP) with a curved tip. AIM We evaluate the feasibility of an HLFVP with a curved tip for measuring sound-induced displacement of the auditory ossicles. APPROACH A handheld vibrometer probe guiding the laser beam with a fiber-optic cable was used for displacement measurements of the incus body and the posterior crus of the stapes. Tonal stimuli at frequencies of 0.5, 1, 2, and 4 kHz were presented by means of an insert earphone positioned in the outer ear canal. The probe was fixed at the measurement site using a tripod or hand-held by one of the two surgeons. RESULTS The measurements were carried out on six fresh temporal bones. Multivariate analysis of variance showed statistically significant differences for stimulus frequency (F3,143 = 29.37, p < 0.001, and η2 = 0.35), bone (F5,143 = 4.61, p = 0.001, and η2 = 0.01), and measurement site (F1,143 = 4.74, p = 0.03, and η2 = 0.02) in the absence of statistically significant differences for the probe fixation method (F2,143 = 0.15, p = 0.862, and η2 = 0.001). Standard deviations of the means were 6.9, 2.6, 1.9, and 0.6 nm / Pa for frequency, bone, site, and fixation, respectively. Ear transfer functions were found to be consistent with literature data. CONCLUSIONS The feasibility of applying HLFVP to measure the displacement of auditory ossicles has been confirmed. HLFVP offers the possibility of carrying out measurements at various angles; however, this needs to be standardized taking into account anatomical limitations and surgical convenience.
Collapse
Affiliation(s)
- Marcin Masalski
- Wroclaw Medical University, Department of Otolaryngology Head and Neck Surgery, Wroclaw, Poland
- Wroclaw University of Science and Technology, Department of Biomedical Engineering, Wroclaw, Poland
| | - Adam Wąż
- Wroclaw University of Science and Technology, Department of Field Theory, Electronic Circuits, and Optoelectronics, Wroclaw, Poland
| | | | - Tomasz Zatoński
- Wroclaw Medical University, Department of Otolaryngology Head and Neck Surgery, Wroclaw, Poland
| | | |
Collapse
|
21
|
Ranguis SC, Leonard CG, James AL. Prospective Comparison of Pediatric Endoscopic Lateral Graft and Interlay Tympanoplasty. Otol Neurotol 2021; 42:867-875. [PMID: 34111050 DOI: 10.1097/mao.0000000000003053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare outcomes and complications of endoscopic lateral graft (LGT) and interlay (IT) tympanoplasty. STUDY DESIGN Prospective observational cohort study of totally endoscopic ear surgery (TEES) tympanoplasty. SETTING Pediatric tertiary referral center. PATIENTS One hundred fourteen surgeries for children with tympanic membrane perforation without cholesteatoma. INTERVENTION Porcine-derived collagen graft tympanoplasty using either LGT or IT. MAIN OUTCOME MEASURES Closure rates of perforation, hearing outcomes (four-tone average air conduction [AC] and air bone gap), and complications that required further surgery were assessed 12 months postoperatively. RESULTS Perforation closure rates did not differ between LGT (52/59 (88%)) and IT (45/51 (88%)), (Fisher's exact p = 1.00) (four ears lost to follow-up). AC thresholds (p = 0.32) and air bone gap (p = 0.88) improved similarly after surgery with LGT (median 8.8 dB) and IT (median 7.5 dB). The proportion of ears with serviceably normal hearing (AC ≤ 30 dB HL) postoperatively was similar (LGT 40/49 (82%), IT 36/46 (78%), Fisher's exact p = 0.80). Following IT, three (6%) ears developed inclusion cholesteatoma requiring revision surgery. One (2%) LGT ear developed blunting after myringitis. CONCLUSIONS IT and LGT provide similar perforation closure rates and hearing outcomes. When choosing between these two techniques to repair pediatric tympanic membrane perforations, LGT would seem to be preferable than IT due to the risk of inclusion cholesteatoma after IT. There is a small risk of anterior blunting after LGT.
Collapse
Affiliation(s)
- Sebastian C Ranguis
- Department of Otolaryngology, Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | |
Collapse
|
22
|
The Influence of Ciprofloxacin-Dexamethasone Ear Drops on Perforation Closure Rates After Endoscopic Tympanoplasty. Otol Neurotol 2021; 42:e1644-e1647. [PMID: 34172656 DOI: 10.1097/mao.0000000000003236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Topical ciprofloxacin and dexamethasone have both been shown to disrupt healing of tympanic membrane perforations in animal models. There have been no clinical studies evaluating the effect of ciprofloxacin-dexamethasone (CD) ear drops on success of tympanoplasty. We compare perforation closure rates in pediatric endoscopic tympanoplasty with and without use of postoperative CD. STUDY DESIGN Retrospective comparative cohort study. SETTING Tertiary referral centre. PATIENTS One hundred sixty-two totally endoscopic tympanoplasties with porcine-derived collagen graft in children, mean age 12.0 years (range 2.3-17.9 yrs). INTERVENTION Prescription of CD versus no ear drops in the immediate postoperative period. MAIN OUTCOME MEASURE Perforation closure rate 2 months after totally endoscopic tympanoplasty. RESULTS Postoperative CD was given to 65 (40%) ears and no drops given to the remainder. Overall, successful closure of tympanic membrane perforation was achieved in 140 (86%) of ears. The closure rate was not significantly different in those ears given CD postoperatively than those not given CD (54/65 [83%] vs 86/97 [89%], Fisher's p = 0.35). Multiple logistical regression revealed no confounding effect of other variables on outcome including age, revision surgery, graft position, or type of postoperative packing material. CONCLUSIONS Our results reveal no harm or benefit with prescription of drops containing ciprofloxacin and dexamethasone on success of perforation closure after tympanoplasty. Allocation to treatment in this retrospective study was nonrandomized and was predominantly based on a change in practice. No other variables are known to have influenced this finding but a randomized prospective study could be justified for more reliable evidence.
Collapse
|
23
|
Bozzato A, Flockerzi V. [Endoscopically guided reconstruction of the ossicular chain-an introduction]. HNO 2021; 69:797-802. [PMID: 34125235 DOI: 10.1007/s00106-021-01062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
The term "endoscopic ossiculoplasty" refers to surgical methods with the intention to reconstruct the ossicular chain using endoscopic vision. Apart from malformations and injuries, inflammatory processes cause the majority of indications for ossicular reconstruction. This article offers a commented overview of current literature and preliminary personal experience.
Collapse
Affiliation(s)
- Alessandro Bozzato
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Straße, Gebäude 6, 66421, Homburg/Saar, Deutschland.
| | - Veronika Flockerzi
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Straße, Gebäude 6, 66421, Homburg/Saar, Deutschland
| |
Collapse
|
24
|
Preyer S. [Incision-suture times in endoscopic ear surgery]. HNO 2021; 69:811-816. [PMID: 34125238 PMCID: PMC8476474 DOI: 10.1007/s00106-021-01066-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
Hintergrund Endoskopische Ohrchirurgie („endoscopic ear surgery“, EES) wird international immer häufiger anstelle der mikroskopischen Ohrchirurgie („microscopic ear surgery“, MES) eingesetzt, hat sich in Deutschland aber als Routineverfahren noch nicht etabliert. Fragestellung Untersucht wurden die Schnitt-Naht-Zeiten bei der EES und die Praktikabilität der Methode im deutschen Klinik-Setting. Material und Methoden In einer retrospektiven Studie wurden 60 konsekutive mikroskopisch operierte Patienten (MES) von 2015 mit 60 konsekutiven endoskopisch operierten Patienten aus dem Jahr 2018 verglichen. Verglichen wurden Hörergebnisse, Trommelfellbefund und Schnitt-Naht-Zeiten nach 3 Wochen. Ergebnisse Bei endoskopisch geführten Ohroperationen war der Zugang meistens transmeatal und musste seltener als bei mikroskopisch durchgeführten Operationen die Gehörgangsvorderwand zurückgeschliffen werden. Die Operationszeiten unterschieden sich in den 2 Gruppen statistisch nicht signifikant. Ein Trommelfellverschluss gelang bei 57/60 Patienten in der mikroskopischen Gruppe und bei 59/60 in der endoskopischen Gruppe. Eine Hörverbesserung wurde in beiden Gruppen erreicht. Die Hörverbesserung war in den 2 Gruppen statistisch signifikant nicht unterschiedlich. Schlussfolgerungen Endoskopische Ohrchirurgie ist eine zeitökonomische und minimal-invasive Methode und stellt bei vergleichbaren Ergebnissen eine praktikable Alternative zur mikroskopischen Ohrchirurgie dar.
Collapse
Affiliation(s)
- S Preyer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie und plastische Gesichtschirurgie, ViDia-Kliniken Karlsruhe, Steinhäuserstraße 18, 76133, Karlsruhe, Deutschland.
| |
Collapse
|
25
|
Ito T, Furukawa T, Ohshima S, Takahashi K, Takata Y, Furukawa M, Hiraumi H, Yamauchi D, Yuasa Y, Goto S, Sasaki A, Koizumi K, Otsuki K, Imaizumi M. Multicenter Study of Congenital Middle Ear Anomalies. Report on 246 Ears. Laryngoscope 2021; 131:E2323-E2328. [PMID: 33645732 DOI: 10.1002/lary.29482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS Congenital middle ear anomalies represent a relatively rare condition. This study aimed to describe the characteristics and the surgical outcomes for patients with middle ear anomalies. METHODS A multicenter study was conducted of consecutive patients with congenital middle ear anomalies who underwent primary surgical treatment between January 2008 and December 2017. Demographics, surgical procedures, and audiometric data were registered into the institutional database. Hearing changes and postoperative air-bone gap (ABG) were evaluated 1 year after surgery. RESULTS A total of 246 patients (246 ears) (median age: 14 years, range: 4-75 years old) were included in this study. Anomalies were subdivided using the Teunissen and Cremers classification: 53 ears (22%) were categorized as class I, comprising only stapes ankylosis; 35 ears (14%) as class II, having ossicular chain anomalies with stapes ankylosis; 139 ears (57%) as class III, having ossicular chain anomalies with a mobile stapes-footplate; and 19 ears (8%) as class IV, with aplasia of the oval window. Evaluation of hearing outcomes for 198 ears with more than 1 year of follow-up revealed that good postoperative ABG (≤20 dB) was achieved in 82% of class I, 68% of class II, 74% of class III, and 23% of class IV anomalies. The postoperative ABG in class IV was significantly worse than in class I (P < .001) or class III (P < .01). CONCLUSIONS This study demonstrated that class III anomalies comprised the majority of middle ear anomalies and surgical outcomes for class IV anomalies are unfavorable. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2323-E2328, 2021.
Collapse
Affiliation(s)
- Tsukasa Ito
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takatoshi Furukawa
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Shinsuke Ohshima
- Department of Otolaryngology Head and Neck Surgery, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kuniyuki Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yusuke Takata
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masayuki Furukawa
- Department of Otorhinolaryngology, Juntendo Urayasu Hospital, Chiba, Japan
| | - Harukazu Hiraumi
- Department of Otolaryngology, Head and Neck Surgery, Iwate Medical University, School of Medicine, Shiwa, Japan
| | - Daisuke Yamauchi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Yuasa
- Sendai Ear Surgicenter, Sendai, Japan
| | - Shinichi Goto
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Akira Sasaki
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Koh Koizumi
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Akita University, Akita, Japan
| | - Koshi Otsuki
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
26
|
Ridge SE, Shetty KR, Lee DJ. Current trends and applications in endoscopy for otology and neurotology. World J Otorhinolaryngol Head Neck Surg 2021; 7:101-108. [PMID: 33997719 PMCID: PMC8103526 DOI: 10.1016/j.wjorl.2020.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/28/2020] [Indexed: 01/03/2023] Open
Abstract
There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade. In this review paper, we discuss the current trends and applications of the endoscope in the field of otology and neurotology. Advantages of the endoscope include excellent ergonomics, compatibility with pediatric anatomy, and improved access to the middle ear through the external auditory canal. Transcanal endoscopic ear surgery has demonstrated comparable outcomes in the management of cholesteatoma, tympanic membrane perforations, and otosclerosis as compared to microscopic approaches, while utilizing less invasive surgical corridors and reducing the need for postauricular incisions. When a postauricular approach is required, the endoscopic-assisted transmastoid approach can avoid a canal wall down mastoidectomy in cases of cholesteatoma. The endoscope also has utility in treatment of superior canal dehiscence and various skull base lesions including glomus tumors, meningiomas, and vestibular schwannomas. Outside of the operating room, the endoscope can be used during examination of the outer and middle ear and for debridement of complex mastoid cavities. For these reasons, the endoscope is currently poised to transform the field of otology and neurotology.
Collapse
Affiliation(s)
- Sarah E Ridge
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Kunal R Shetty
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Daniel J Lee
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
27
|
Ridge SE, Shetty KR, Lee DJ. Heads-up Surgery: Endoscopes and Exoscopes for Otology and Neurotology in the Era of the COVID-19 Pandemic. Otolaryngol Clin North Am 2021; 54:11-23. [PMID: 33243372 PMCID: PMC7522672 DOI: 10.1016/j.otc.2020.09.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A new era of surgical visualization and magnification is poised to disrupt the field of otology and neurotology. The once revolutionary benefits of the binocular microscope now are shared with rigid endoscopes and exoscopes. These 2 modalities are complementary. The endoscope improves visualization of the hidden recesses through the external auditory canal or canal-up mastoidectomy. The exoscope provides an immersive visual experience and superior ergonomics compared with binocular microscopy. Endoscopes and exoscopes are poised to disrupt the standard of care for surgical visualization and magnification in otology and neurotology.
Collapse
|
28
|
Kim DJ, Lee HM, Choi SW, Oh SJ, Kong SK, Lee IW. Comparative study of endoscopic and microscopic tympanoplasty performed by a single experienced surgeon. Am J Otolaryngol 2021; 42:102788. [PMID: 33171411 DOI: 10.1016/j.amjoto.2020.102788] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/13/2020] [Accepted: 10/17/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE The use of endoscopes in otologic procedures has been increasing worldwide. This study aimed to compare the efficacy of microscopic tympanoplasty (MT) and endoscopic tympanoplasty (ET) for tympanic membrane and middle ear surgery. MATERIALS AND METHODS We retrospectively analyzed 81 patients who underwent MT (n = 44) and ET (n = 37) for chronic otitis media with tympanic membrane perforation performed by a single surgeon between January 2013 and September 2019. The hearing outcomes, graft success rate, complications, operation time and hospital stay, and cost-effectiveness were recorded and compared between groups. Hearing outcomes were determined by pure tone audiometry. Cost-effectiveness was determined by the operation cost and total cost. RESULTS There was no significant difference between the MT and ET groups regarding demographic characteristics, with the exception of the male:female ratio. There was no significant difference in the pre- and postoperative air conduction, bone conduction thresholds, and air-bone gap values between the two groups, but a significant audiologic improvement was observed in both groups (p < 0.05). In terms of recurrence of tympanic membrane perforation, postoperative otorrhea, and discomfort symptoms, there was no significant difference between groups (p > 0.05). The operation time and hospital stay were shorter in the ET group than in the MT group (p < 0.05). There were no significant differences in operation cost between the two groups (p > 0.05), but the total cost was significantly lower in the ET group than the MT group (p < 0.05). CONCLUSION ET is as safe and medically efficacious as conventional MT, shortens the operation time and hospital stay, and is cost-effective.
Collapse
Affiliation(s)
- Dong Jo Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyun Min Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sung-Won Choi
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Se-Joon Oh
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Il-Woo Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
| |
Collapse
|
29
|
|
30
|
Abstract
Pediatric chronic ear disease and its sequelae often necessitate surgical intervention, such as ear tube insertion, ossiculoplasty, tympanoplasty, and cholesteatoma removal. Although these procedures have traditionally been performed with the microscope, use of rigid endoscopes provides an alternative method for visualization. The endoscope offers improved visualization of the middle ear space and adjacent structures and can either be used alone to perform surgery through the ear canal or together with the microscope if mastoidectomy is required. Endoscopic ear surgery can reduce the need for a postauricular incision or mastoidectomy while resulting in equivalent hearing outcomes compared with those performed with the microscope. In addition, use of the endoscope is associated with lower rates of residual disease following primary cholesteatoma procedures.
Collapse
Affiliation(s)
- Evette Ronner
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - Michael S Cohen
- Department of Otolaryngology, Massachusetts Eye and Ear and Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
| |
Collapse
|
31
|
Chen CK, Hsieh LC. Clinical outcome of exclusive endoscopic tympanoplasty with porcine small intestine submucosa in 72 patients. Clin Otolaryngol 2020; 45:938-943. [PMID: 32657525 DOI: 10.1111/coa.13607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/05/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Chin-Kuo Chen
- Department of Otolaryngology-Head and Neck Surgery and Communication Enhancement Center, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan
| | - Li-Chun Hsieh
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Audiology and Speech Language Pathology, Mackay Medical College, Taipei, Taiwan
| |
Collapse
|
32
|
Lucidi D, Fernandez IJ, Botti C, Amorosa L, Alicandri-Ciufelli M, Villari D, Presutti L. Does microscopic experience influence learning curve in endoscopic ear surgery? A multicentric study. Auris Nasus Larynx 2020; 48:50-56. [PMID: 32680599 DOI: 10.1016/j.anl.2020.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of the present study was to illustrate the learning curve of endoscopic type-1 tympanoplasty comparing experts in microscopic otology versus neophyte surgeons. METHODS Eight ear surgeons, from tertiary referral centers, who had performed at least 30 endoscopic type 1 tympanoplasties were included in the study. Demographic data and medical records regarding the first 30 endoscopic type-1 tympanoplasties were retrospectively collected by each surgeon. A 14-questions survey focused on subjective aspects of the learning curve was administered. Surgeons were divided in two groups: one with previous experience in microscopic ear surgery (group 1) and one with no previous experience in ear surgery (group 2). The learning curve of endoscopic type 1 tympanoplasty was compared between the groups. RESULTS Mean surgical time was 89.2 min in group 1 vs. 79.5 min in group 2 (p < 0.01). When divided in 5 surgeries-steps, the only significant difference was appreciated in the first 5 surgeries with a longer mean time in group 1 vs. group 2 (+28.4 min; p < 0.05). CONCLUSIONS Surgeon's previous experience may influence the EES learning curve. Our results show that the first 5 surgical procedures are more challenging for surgeons experienced in microscopic surgery, subsequently the curve progression improves sharply and appears reversing the initial trend by the end of the 30 surgeries.
Collapse
Affiliation(s)
- Daniela Lucidi
- Department of Otolaryngology - Head and Neck Surgery, University of Modena and Reggio Emilia, University Hospital of Modena, Via del Pozzo 71, Modena, Italy
| | - Ignacio Javier Fernandez
- Department of Otolaryngology - Head and Neck Surgery, University of Modena and Reggio Emilia, University Hospital of Modena, Via del Pozzo 71, Modena, Italy.
| | - Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 80, Reggio Emilia, Italy
| | - Luca Amorosa
- Department of Otolaryngology Head and Neck Surgery, Ospedale Maggiore, Largo Nigrisoli 2, Bologna, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otolaryngology - Head and Neck Surgery, University of Modena and Reggio Emilia, University Hospital of Modena, Via del Pozzo 71, Modena, Italy
| | - Domenico Villari
- Department of Otolaryngology - Head and Neck Surgery, University of Modena and Reggio Emilia, University Hospital of Modena, Via del Pozzo 71, Modena, Italy
| | - Livio Presutti
- Department of Otolaryngology - Head and Neck Surgery, University of Modena and Reggio Emilia, University Hospital of Modena, Via del Pozzo 71, Modena, Italy
| |
Collapse
|
33
|
Hu Y, Teh BM, Hurtado G, Yao X, Huang J, Shen Y. Can endoscopic ear surgery replace microscopic surgery in the treatment of acquired cholesteatoma? A contemporary review. Int J Pediatr Otorhinolaryngol 2020; 131:109872. [PMID: 31945733 DOI: 10.1016/j.ijporl.2020.109872] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 11/30/2022]
Abstract
Acquired cholesteatoma leads to significant morbidities while current surgical options remain a challenge. The principles of surgery include complete removal of disease, prevention of recurrence, and restoration of hearing function when possible. Traditionally, this has been performed using microscopes; however, a novel technique using endoscopes offers a new perspective on our understanding of anatomy, pathogenesis and surgical approaches. In recent years, various studies have demonstrated good outcomes with transcanal endoscopic ear surgery (EES) in cholesteatoma surgery. Nevertheless, the use of EES is not universal and remains controversial due to the efficacy of microscopes, specific limitations of endoscopes and the need to learn new skills. This review focuses on recent advances in EES for the treatment of acquired cholesteatoma, benefits, current challenges, and a discussion on the indications and contraindications of EES.
Collapse
Affiliation(s)
- Yi Hu
- Department of Otolaryngology Head and Neck Surgery, Ningbo Medical Center (Ningbo Lihuili Hospital), The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China; School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Bing Mei Teh
- Department of Ear Nose and Throat, Head and Neck Surgery, Eastern Health, Box Hill, Victoria, Australia; Department of Otolaryngology, Head and Neck Surgery, Monash Health, Clayton, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Guillermo Hurtado
- Department of Otolaryngology, Head and Neck Surgery, Monash Health, Clayton, Victoria, Australia
| | - Xu Yao
- Department of Otolaryngology Head and Neck Surgery, Ningbo Medical Center (Ningbo Lihuili Hospital), The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China; School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Juntao Huang
- Department of Otolaryngology Head and Neck Surgery, Ningbo Medical Center (Ningbo Lihuili Hospital), The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China; School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yi Shen
- Department of Otolaryngology Head and Neck Surgery, Ningbo Medical Center (Ningbo Lihuili Hospital), The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China; School of Medicine, Ningbo University, Ningbo, Zhejiang, China.
| |
Collapse
|
34
|
Dursun E, Demir E, Terzi S, Erdivanlı ÖÇ, Coşkun ZÖ, Balaban GA, Çeliker M. Endoscopic type 1 cartilage tympanoplasty in children. Int J Pediatr Otorhinolaryngol 2020; 131:109854. [PMID: 31918245 DOI: 10.1016/j.ijporl.2019.109854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/23/2019] [Accepted: 12/25/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Endoscopic type 1 tympanoplasty using cartilage grafts for repair of chronic tympanic membrane perforation is increasing. The aim of this study was to evaluate the results of endoscopic type 1 cartilage tympanoplasty in children. MATERIALS AND METHODS Patients under 18 years of age who underwent type 1 cartilage tympanoplasty between January 2013 and February 2019 were retrospectively evaluated. Anatomic success rate was calculated according to the intact status of the graft. Air conduction (AC), bone conduction (BC), air-bone gap (ABG) and hearing gain were calculated using pure tone audiometry tests at pre-operative, and 6th month postoperative period. Patients with postoperative ABG ≤20 dB were considered as functionally successful. RESULTS The study included 56 patients (6 bilateral) and 62 ears. The anatomic success rate of our study was 91.9% (57/62). Preoperative AC was 36.4 ± 6.5 (21-50) dB, BC was 7.8 ± 3.7 (5-25) dB, and ABG was 28.6 ± 6.9 (10-41) dB. Postoperative AC was 24.5 ± 8.8 (7-45) dB, BC was 7.6 ± 3.4 (5-19) dB, and ABG was 16.9 ± 7.4 (2-32) dB. There was no change in postoperative BC (p: 0.683), whereas AC, and ABG significantly decreased (p < 0.001). Mean hearing gain was 12.1 ± 6.2 (3-26) dB and the functional success rate was 72.5% (45/62). CONCLUSION Endoscopic type 1 cartilage tympanoplasty, a minimally invasive surgical procedure, provided successful functional and anatomical results at the pediatric population.
Collapse
Affiliation(s)
- Engin Dursun
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Emine Demir
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey.
| | - Suat Terzi
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Özlem Çelebi Erdivanlı
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Zerrin Özergin Coşkun
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Gökçe Aydın Balaban
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Metin Çeliker
- Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| |
Collapse
|
35
|
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]
|
36
|
Malic M, Milicic B, Gjuric M. Endoscopic Removal of Medially Migrated Tympanostomy Tube. EAR, NOSE & THROAT JOURNAL 2019; 100:NP191-NP192. [PMID: 31565990 DOI: 10.1177/0145561319869606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mislav Malic
- Department of ENT and H&N Surgery, 162072University Hospital Centre Zagreb, Zagreb, Croatia
| | - Borna Milicic
- Department of ENT and H&N Surgery, 162072University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mislav Gjuric
- Department of ENT and H&N Surgery, 162072University Hospital Centre Zagreb, Zagreb, Croatia
| |
Collapse
|