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Tang Y, Gao M, Zhang T, Zhang M, Tu X, Wang H, Yang H. A retrospective study of audiological outcomes after endoscopic tympanoplasty and tympanomastoidectomy in patients with cholesteatoma. Asian J Surg 2023; 46:3496-3504. [PMID: 36853866 DOI: 10.1016/j.asjsur.2022.09.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/05/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigated whether endoscopic tympanoplasty and tympanomastoidectomy could present satisfying audiological outcomes for cholesteatoma patients. METHODS This was a retrospective study of 83 patients with cholesteatoma who underwent endoscopic tympanoplasty and tympanomastoidectomy between 2019 and 2021. The preoperative and postoperative audiological evaluations were performed. The evaluation methods included air conduction (AC), bone conduction (BC), and air-bone gap (ABG) procedures. RESULTS Eighty-three patients were included in the study, all of whom underwent endoscopic tympanoplasty and tympanomastoidectomy. Forty-seven patients presented postoperative ABG≤20 dB (59.49%). The frequencies tested included low-frequency (LF), middle-frequency (MF), high-frequency (HF), and pure-tone average (PTA). All three audiological parameters significantly decreased after surgery (P < 0.05) at every frequency, except for BC-LF (P > 0.05). There were also significant differences between the preoperative and postoperative proportions of degree of hearing (P < 0.05). Additionally, shifts in AC, BC, and ABG were linearly related to preoperative AC, BC, and ABG. Lastly, postoperative ABG-PTA presented differently depending on preoperative stapes superstructure conditions (present: 15.81 ± 11.23 dB, absent: 22.94 ± 12.20 dB, P = 0.009). CONCLUSIONS Our study of endoscopic tympanoplasty and tympanomastoidectomy presented complete audiological outcomes for cholesteatoma patients. It had a positive surgery success rate and improved AC, BC, and ABG at every frequency except BC-LF. Additionally, AC-LF and AC-MF improved to a greater degree than AC-HF due to these procedures. Moreover, the linear regression analyses demonstrated that preoperative ABG-PTA was the most efficient audiological indicator for surgery. Likewise, the preoperative condition of the stapes superstructure was proved to be the most efficient anatomical indicator for hearing outcomes.
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Affiliation(s)
- Yiyang Tang
- Department of Otolaryngology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Minqian Gao
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Tao Zhang
- Department of Otolaryngology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China.
| | - Mingyan Zhang
- Department of Otolaryngology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China.
| | - Xinfeng Tu
- Department of Otolaryngology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China.
| | - HaiYan Wang
- Department of Otolaryngology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China.
| | - Haidi Yang
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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Harshvardhan R, Prakash C, Meena RL, Kumbhat P. Hearing Outcome After Incudo-stapedial Joint Reconstruction Using Conchal Cartilage Interposition Graft. Indian J Otolaryngol Head Neck Surg 2023; 75:1694-1698. [PMID: 37636698 PMCID: PMC10447325 DOI: 10.1007/s12070-023-03649-w] [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: 06/25/2022] [Accepted: 02/26/2023] [Indexed: 08/29/2023] Open
Abstract
Ossicular chain defects secondary to Chronic otitis media most frequently involves the incudo-stapedial joint. This study observes the effect of incudo-stapedial joint reconstruction using conchal cartilage interposition graft on hearing of the patient. Fifty-three patients with chronic otitis media of inactive mucosal type with incudostapedial necrosis of less than half of long process of incus were posted for tympanoplasty with incudostapedial joint reconstruction using autologus conchal cartilage. Their hearing outcome was analysed by comparing the pre-operative and 12 weeks post-operative Pure Tone Audiogram. A statistically significant improvement is seen in air conduction by 14.66 dB after incudo-stapedial joint reconstruction using conchal cartilage (p value 0.0001), whereas improvement seen in bone conduction was statistically insignificant. 52 (98.1%) patients had ≤ 40 dB post-op AC and 1 (1.9%) had > 40 dB.. Conchal cartilage is an easy-to-harvest, biocompatible and cost effective graft material. It gives hearing results comparable to other materials.
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Affiliation(s)
- Rekha Harshvardhan
- Department of Otorhinolaryngology and Head and Neck Surgery, S.M.S. Medical College, Jaipur, Rajasthan India
| | - Chandra Prakash
- Department of Otorhinolaryngology and Head and Neck Surgery, S.M.S. Medical College, Jaipur, Rajasthan India
| | - Ram Lakhan Meena
- Department of Otorhinolaryngology and Head and Neck Surgery, S.M.S. Medical College, Jaipur, Rajasthan India
| | - Payal Kumbhat
- Department of Otorhinolaryngology and Head and Neck Surgery, S.M.S. Medical College, Jaipur, Rajasthan India
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Kálmán J, Horváth T, Dános K, Tamás L, Polony G. Primary ossiculoplasties provide better hearing results than revisions: a retrospective cohort study. Eur Arch Otorhinolaryngol 2023; 280:3177-3185. [PMID: 36806910 DOI: 10.1007/s00405-023-07835-y] [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: 11/01/2022] [Accepted: 01/11/2023] [Indexed: 02/20/2023]
Abstract
PURPOSE To evaluate the efficacy of ossicular chain reconstruction (OCR) in primary and revision surgeries, and to investigate the impact of the number of previous surgeries on hearing outcomes. METHODS Retrospective analysis of cases with OCR due to chronic otitis in a tertiary center between January 2018 and September 2021. RESULTS Altogether, 147 cases of ossicle involvement were assessed. In 91.83% (n = 135) OCR was performed, 96.26% of them with titanium TORP/PORP (n = 130), two cases with autologous prosthesis and three with piston. Mean follow-up was 8.8 months. The ABG significantly improved in the total group (TORP/PORP) from a mean (SD) of 30.94 (15.55) to 19.76 (13.36) dB (p < 0.0001) with 60.86% success. The best results were achieved in primary OCR with PORP implantation without cholesteatoma (89.47%). Primary cases have a significantly higher success rate in contrary to revision surgeries (72.27%, vs. 52.00%, p = 0.032). The only relevant predictive factor proved to be the fact of revision (p = 0.029). A statistically significant correlation between the number of previous surgeries and hearing results could not be proved. There was no difference in hearing outcomes between patients with only one or more than one previous surgeries in the revision groups. Neither the presence of cholesteatoma, nor the type of OCR (TOPR/PORP) and the indication of revision had an impact on postoperative ABG. CONCLUSIONS Titanium prostheses are effective in OCR both in primary and revision cases. It is not the number of previous surgeries, but the fact of revision that influences postoperative hearing results.
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Affiliation(s)
- Judit Kálmán
- Department of Otorhinolaryngology-Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Út 89-91., Budapest, 1106, Hungary
| | - Tamás Horváth
- Department of Otorhinolaryngology-Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Út 89-91., Budapest, 1106, Hungary
| | - Kornél Dános
- Department of Otorhinolaryngology-Head and Neck Surgery, Semmelweis University, Szigony Utca 36., Budapest, 1083, Hungary
| | - László Tamás
- Department of Otorhinolaryngology-Head and Neck Surgery, Semmelweis University, Szigony Utca 36., Budapest, 1083, Hungary
| | - Gábor Polony
- Department of Otorhinolaryngology-Head and Neck Surgery, Semmelweis University, Szigony Utca 36., Budapest, 1083, Hungary.
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Karamitsou P, Poutoglidis A, Tsetsos N, Gougousis S, Karamitsou A, Fountarlis AL, Skalias A. Quality of life after mastoid surgery. Is there a real benefit to preserving the posterior wall of the external auditory canal? A systematic review and meta-analysis. Auris Nasus Larynx 2023:S0385-8146(23)00028-7. [PMID: 36746693 DOI: 10.1016/j.anl.2023.01.008] [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: 11/06/2022] [Revised: 12/25/2022] [Accepted: 01/24/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Canal wall up (CWU) and canal wall down (CWD) mastoidectomies represent the most common cholesteatoma surgical techniques. In this meta-analysis, we compare the postoperative quality of life (QoL) in patients treated with either CWU or CWD mastoidectomy. METHODS A literature search was conducted in the following three electronic databases: Medline/PubMed, ScienceDirect, and Google Scholar. Articles were assessed for eligibility in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and data were extracted independently by two authors. Biases assessment was conducted for each study according to the Methodological Items for Non-Randomized Studies (MINORS) tool. Meta-analysis was performed for postoperative QoL following CWU versus CWD mastoidectomy. RESULTS Our systematic review included four studies that met the inclusion criteria, three prospective cohort studies, and one retrospective cohort study. The meta-analysis did not favor treatment with one of the two surgical techniques. Postoperative QoL did not show a statistically significant difference between CWU and CWD mastoidectomies (p>0.05). CONCLUSION Our systematic review and meta-analysis results indicate that QoL is not statistically significantly better among patients who underwent CWU mastoidectomies when compared with CWD. The trend of selecting CWU over CWD mastoidectomies in selected cases - for QoL purposes - is not always based on evidence-based data. The statistically insignificant difference between the two surgical techniques suggests that an initial more radical approach might prevent patients from further surgeries, without affecting postoperative QoL.
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Affiliation(s)
- Paraskevi Karamitsou
- Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Papanikolaou' General Hospital, Leoforos Papanikolaou 57010, Thessaloniki, Greece.
| | - Alexandros Poutoglidis
- Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Papanikolaou' General Hospital, Leoforos Papanikolaou 57010, Thessaloniki, Greece
| | - Nikolaos Tsetsos
- Department of Otorhinolaryngology-Head and Neck Surgery, 424 General Military Training Hospital, Periferiaki Odos N. Efkarpia 56429, Thessaloniki, Greece
| | - Spyridon Gougousis
- Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Papanikolaou' General Hospital, Leoforos Papanikolaou 57010, Thessaloniki, Greece
| | - Aikaterini Karamitsou
- Fourth Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, 'G. Papanikolaou' General Hospital, Leoforos Papanikolaou 57010, Thessaloniki, Greece
| | - Athanasios Luca Fountarlis
- Department of Otorhinolaryngology-Head and Neck Surgery, University General Hospital of Larisa, Larisa 41110, Greece
| | - Antonios Skalias
- Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Papanikolaou' General Hospital, Leoforos Papanikolaou 57010, Thessaloniki, Greece
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Alam M, Chandra K. Ears with Cholesteatoma: Outcomes of Canal Wall Up and Down Tympano-Mastoidectomies—A Comparative Prospective Study. Indian J Otolaryngol Head Neck Surg 2022; 74:730-736. [PMID: 36032825 PMCID: PMC9411471 DOI: 10.1007/s12070-021-02549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022] Open
Abstract
This prospective study has been carried out to observe the outcomes of canal wall up (CWU) and canal wall down (CWD) Tympano-mastoidectomies in ears with cholesteatoma. Outcomes of the procedures have been done in terms of recurrence of cholesteatoma, complications, graft uptake rates and post-operative hearing gain. This study was carried out in the Department of Otorhinolaryngology of a reputed tertiary teaching hospital of North India from January 2016 to June 2020, with a mean follow-up of 32 months. The study included 100 patients of otitis media with cholesteatoma. In Canal Wall Up Tympano-mastoidectomy (CWUT) group, the number of males and females were 22 each. On the other hand, 36 males and 20 females underwent Canal Wall Down Tympano-mastoidectomy (CWDT). Each surgery was done as a single-staged and at the end of the surgical procedure angled oto-endoscopes were used for ensuring complete removal of the disease. Though there is no statistically significant difference in recurrence of cholesteatoma and complications rate in CWU and CWD Tympano-mastoidectomy techniques, but CWUT is superior to CWDT in terms of better graft uptake (p = 0.0156), and better average audiological gain (8.56 ± 0.93 dB) with p value = 0.0315. A diligent post-operative follow-up is must for assessing the outcomes of different types of mastoidectomies. This study shows no statistical difference in the disease recurrence and complication rates between Canal Wall Up and Down Tympano-mastoidectomies, though the anatomical changes and creation of the mastoid cavity in canal wall down procedure may affect the graft uptake and post-operative hearing gain. Use of Oto-endoscopes in cholesteatoma surgery helps in improving the outcomes of both techniques and thus recommended if the facility for the same is available.
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Review of Transcanal Endoscopic Ear Surgery (TEES) and Bioengineering for Pediatric Otologic Surgery. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00417-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ali E, Tawalbeh M, Khreesha L, Al Nsour A, Shatnawi J, Al-Shudifat A. Comparison between autologous and artificial graft ossiculoplasty in canal wall down tympanomastoidectomy: A 10 year's personal experience. INDIAN JOURNAL OF OTOLOGY 2022. [DOI: 10.4103/indianjotol.indianjotol_219_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Contreras A, García Ibáñez L, Parilli D. How I do it video: Canal wall-down tympanoplasty in a case of advanced middle ear cholesteatoma with large fallopian canal and lateral semicircular canal dehiscences. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 3:79-83. [PMID: 34373224 DOI: 10.1016/j.anorl.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- A Contreras
- Garcia Ibañez Otology Institute, 91st Dr. Roux Street, 08017 Barcelona, Spain.
| | - L García Ibáñez
- Garcia Ibañez Otology Institute, 91st Dr. Roux Street, 08017 Barcelona, Spain
| | - D Parilli
- Garcia Ibañez Otology Institute, 91st Dr. Roux Street, 08017 Barcelona, Spain
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Diab KM, Daikhes NA, Pashchinina OA, Zukhba AG, Kondratchikov DS, Panina OS. [Anatomical and functional results of ossiculoplasty with adjustable length titanium prostheses with and without hydroxyapatite]. Vestn Otorinolaringol 2021; 86:14-19. [PMID: 34269018 DOI: 10.17116/otorino20218603114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the anatomical and functional results of the ossicular chain reconstruction with classic titanium adjustable prostheses and titanium adjustable prostheses with hydroxyapatite cap. MATERIAL AND METHODS The 300 patients (360 cases) with chronic suppurative otitis media were examined and operated. The patients are divided into 2 groups. Group A included patients who received an ossicular prosthesis with a hydroxyapatite cap (90 cases with a partial prosthesis and 90 with a full one). Group B included patients who received prostheses without hydroxyapatitis (90 cases with a partial prosthesis and 90 with a complete one). The patients who received a prosthesis with a hydroxyapatite cap were divided into two subgroups, depending on the autotissue, which was placed between the prosthesis cap and the nontympanic membrane: this is an autocartilage plate or perichondrium/fascial graft. The follow-up period after surgery was 38.5±14.4 months (from 12 to 48 months). In the long-term postoperative period, the subjects were assessed the values of the bone-air gap (BAG), the consistency of the nontympanic membrane, and the presence of signs of extrusion of the prosthesis cap. Comparison of anatomical and functional results between patients with full and partial ossicular prostheses was performed separately. RESULTS A good result in the form of a 20 dB or more dB BAG reduction was achieved in 82.2% of patients who received a partial prosthesis (85 patients in group A and 63 in group B), and in 57.8% of patients who received a complete prosthesis (45 patients in group A and 59 in group B). The BAG values in the long-term period after surgery did not statistically significantly differ between patients who received a prosthesis with a hydroxyapatite cap or a fully titanium one (p=0.939 for patients with full prostheses and p=0.745 for patients with partial prostheses). The placement of cartilage or perichondrium/fascial graft between the hydroxyapatite prosthesis cap and the nontympanic membrane also did not affect the functional outcome (with full prostheses - p=0.651, with partial prostheses - p=0.142). CONCLUSION It is possible to use ossicular prostheses with a hydroxyapatite cap without placing an autocartilaginous plate between the nontympanic membrane and the cap of the prosthesis. In the long term period, functional and anatomical results with hydroxyapatite cap prostheses do not differ statistically significantly from those with all-titanium prostheses.
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Affiliation(s)
- Kh M Diab
- National Medical Research Center of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - N A Daikhes
- National Medical Research Center of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - O A Pashchinina
- National Medical Research Center of Otorhinolaryngology, Moscow, Russia
| | - A G Zukhba
- National Medical Research Center of Otorhinolaryngology, Moscow, Russia
| | - D S Kondratchikov
- National Medical Research Center of Otorhinolaryngology, Moscow, Russia
| | - O S Panina
- National Medical Research Center of Otorhinolaryngology, Moscow, Russia
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Faramarzi M, Tale M, Khosravaniardakani S, Roosta S, Faramarzi A. Comparison of Titanium versus Polycel as Partial Ossicular Replacement Prosthesis: A Randomized Clinical Trial. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2021; 33:143-149. [PMID: 34222105 PMCID: PMC8231300 DOI: 10.22038/ijorl.2021.52321.2775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Each type of prosthesis for ossiculoplasty has its advantages and disadvantages, and the choice of the best material has been a matter of various studies. The present study aimed to make a comparison between the hearing outcomes of partial ossicular replacement prosthesis (PORP) using titanium versus Polycel prosthesis. MATERIAL AND METHODS A total of 106 patients undergoing PORP as a second stage ossiculoplasty were analyzed in this study. Following that, they were randomly assigned to two groups of titanium (n=54) and Polycel (n=52) prosthesis. Subsequently, pre-and post-operative audiometric data were assessed based on the aim of the study. RESULTS In general, the post-operative air-bone gap within 20 dB was given to 63.5% and 55.6% of all ears in the Polycel and titanium groups, respectively, indicating a non-significant difference (P=0.407). Finally, no SNHL was observed in the groups. CONCLUSION Overall, the hearing outcomes and the success rate of PORP are comparable between titanium and Polycel prostheses. Therefore, the selection of these prostheses could be based on the surgeons' preferences, availability, and cost.
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Affiliation(s)
- Mohammad Faramarzi
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiraz University of Medical sciences, Shiraz, Iran
- Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masih Tale
- Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Sareh Roosta
- Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Faramarzi
- Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Shakya D, Nepal A. Transcanal Endoscopic Retrograde Mastoidectomy for Cholesteatoma: A Prospective Study. EAR, NOSE & THROAT JOURNAL 2021; 102:NP269-NP276. [PMID: 33848200 DOI: 10.1177/01455613211009439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility, morphological, and functional outcomes of endoscopic retrograde transcanal mastoidectomy. STUDY DESIGN Prospective study. SETTINGS Tertiary Referral Hospital. MATERIALS AND METHODS We analyzed 31 patients with a diagnosis of chronic otitis media with cholesteatoma that extended to the mastoid cavity who underwent endoscopic transcanal retrograde canal wall down mastoidectomy under general anesthesia. The tympanic membrane and posterior canal wall reconstruction were done using the tragal cartilage palisade technique reinforced with perichondrium. Morphological and functional results were reported in the follow-up of a minimum of 1 year. The graft uptake was also compared with the presence of granulations and discharge status. RESULTS Graft uptake and disease-free conditions were achieved in 21 of 24 patients, that is, 87.5%, and 3 patients required revision surgery. The graft uptake rate was not affected by the presence of granulation tissues and discharge. The hearing was improved after the surgery, which was statistically significant. CONCLUSION Endoscopic retrograde mastoidectomy is a new technique to deal with cholesteatoma with excellent results. It is more functional, ideal for sclerotic mastoid, allows faster wound healing, has excellent outcomes, and is a minimally invasive procedure that avoids postauricular incision and tissue dissection. Because the set up for the surgery costs less, it holds a promising future for the developing countries.
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Affiliation(s)
- Dipesh Shakya
- Department of Otorhinolaryngology, 533641Civil Service Hospital, Minbhawan, Kathmandu, Nepal
| | - Ajit Nepal
- Department of Otorhinolaryngology, 475268Patan Academy of Health Sciences, School of Medicine, Lagankhel, Lalitpur, Nepal
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Kálmán J, Horváth T, Liktor B, Dános K, Tamás L, Gődény M, Polony G. Limitations of non-echo planar diffusion weighted magnetic resonance imaging (non-EPI MRI) in cholesteatoma surveillance after ossicular chain reconstruction. A prospective study. Auris Nasus Larynx 2020; 48:630-635. [PMID: 33303286 DOI: 10.1016/j.anl.2020.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Non-echo planar diffusion weighted magnetic resonance imaging is a reliable surveillance tool of residual cholesteatoma nowadays. It is not known whether the material of the ossicular chain prosthesis modifies the sensitivity and specificity of MRI in these cases. The aim of the study was to compare the sensitivity, specificity and a localization-specific accuracy of non-EPI DW MRI sequences for residual cholesteatoma in the following 3 subgroups: patients with titanium ossicular prosthesis (group T), with autologous cortical bone columella (group A) or without any reconstruction (group WR) of hearing bones. METHODS This prospective study covered 28 cases with cholesteatoma of the middle ear undergone second-look surgery, who had preoperative PROPELLER DW-MRI. Surgical findings were compared to the results of the DWI-MRI. RESULTS The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were: 0.76-0.8-0.76-0.8. Group T, group A and group WR sensitivity was 0.83-0.6-1, specificity: 0.75-0.75-0.85, PPV: 0.83-0.75-0.66, NPV: 0.75-0.6-1. Overall accuracy was 0.78. Size of missed cholesteatoma was 2-4 mm (mean: 2.66±1.15). CONCLUSIONS Various materials are suitable for ossicular chain reconstruction. The poor detectability of residual or recurrent cholesteatoma in the middle ears reconstructed with autologous bony prosthesis may still claim second-look surgery instead of the usage of non- EPI DWI sequences independently in these patients.
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Affiliation(s)
- Judit Kálmán
- Department of Otorhinolaryngology - Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Tamás Horváth
- Department of Otorhinolaryngology - Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Bálint Liktor
- Department of Otorhinolaryngology - Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Kornél Dános
- Department of Otorhinolaryngology - Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - László Tamás
- Department of Otorhinolaryngology - Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Mária Gődény
- Department of Diagnostic Radiology, National Institute of Oncology, Budapest, Hungary
| | - Gábor Polony
- Department of Otorhinolaryngology - Head and Neck Surgery, Semmelweis University, Budapest, Hungary.
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Polanik MD, Trakimas DR, Castillo‐Bustamante M, Cheng JT, Kozin ED, Remenschneider AK. Do high-frequency air-bone gaps persist after ossiculoplasty? Laryngoscope Investig Otolaryngol 2020; 5:734-742. [PMID: 32864446 PMCID: PMC7444777 DOI: 10.1002/lio2.418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/29/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Conventional reporting of postoperative hearing outcomes utilizes a pure-tone averaged air-bone gap (ABG) that is biased toward low frequencies. Consequently, a high-frequency ABG after otologic surgery may go unnoticed. In this study, we evaluate changes in low- and high-frequency ABG following ossiculoplasty. STUDY DESIGN Retrospective review. SUBJECTS AND SETTING Consecutive series of patients who underwent ossiculoplasty at a single tertiary care center. Patients with pre- and postoperative audiograms were included. METHODS Low-frequency ABG was calculated as the mean ABG at 250, 500, and 1000 Hz. High-frequency ABG was calculated at 4 kHz. Pre- and postoperative ABGs were compared. RESULTS Thirty-seven consecutive patients were included. Mean age at surgery was 38 years (range, 7-77 years). Reconstruction materials included: cartilage (N = 4), hydroxyapatite cement (N = 5), and partial or total ossicular replacement prostheses (N = 20 and N = 8, respectively). Postoperatively, the mean low-frequency ABG improved by 11.9 ± 15.1 dB (P < .0001) and the mean high-frequency ABG improved by 5.9 ± 16.0 dB (P = .030). Low-frequency ABG closure was significantly larger than high-frequency ABG closure (P = .007). Mean postoperative persistent high-frequency ABG was 22.0 ± 13.8 dB. CONCLUSION In this series, ossiculoplasty improved ABG across all frequencies, but greater improvements were observed at low frequencies when compared to high frequency. Current reporting standards may not identify persistent high-frequency ABG. Additional study of the mechanisms of high-frequency sound conduction in reconstructed middle ears is needed to improve high-frequency hearing outcomes in ossiculoplasty. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Marc D. Polanik
- Eaton‐Peabody LaboratoriesMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyUMass Memorial Medical CenterWorcesterMassachusettsUSA
- University of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Danielle R. Trakimas
- Department of Otolaryngology‐Head & Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | | | - Jeffrey T. Cheng
- Eaton‐Peabody LaboratoriesMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology‐Head & Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Elliott D. Kozin
- Eaton‐Peabody LaboratoriesMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology‐Head & Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Aaron K. Remenschneider
- Eaton‐Peabody LaboratoriesMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyUMass Memorial Medical CenterWorcesterMassachusettsUSA
- University of Massachusetts Medical SchoolWorcesterMassachusettsUSA
- Department of Otolaryngology‐Head & Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
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14
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Elaprolu S, Alexander A, Ganesan S, Manu CB. Effect of a boomerang-shaped Conchal cartilage graft for Type three Tympanoplasty on Hearing. Int Arch Otorhinolaryngol 2020; 25:e289-e295. [PMID: 33968235 PMCID: PMC8096510 DOI: 10.1055/s-0040-1712934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 04/13/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction
Chronic suppurative otitis media atticoantral disease (CSOM-AAD) is often associated with ossicular erosion resulting in significant hearing loss. Absence of the stapes suprastructure is a poor prognostic indicator of hearing outcome, which necessitates an effective reconstruction technique for ossicular continuity and restoration of middle ear volume. In the present study, we used a boomerang-shaped conchal cartilage graft.
Objective
To evaluate the improvement in hearing using a boomerang-shaped conchal cartilage graft for Type III tympanoplasty in cases of CSOM-AAD in which the stapes suprastructure was absent and to study the incidence of intraoperative/postoperative complications of this procedure.
Method
A total of 21 patients with CSOM-AAD who were found to have absent stapes suprastructure intraoperatively were included. A boomerang-shaped conchal cartilage graft was placed over the stapes footplate for reconstruction following canal wall down mastoidectomy. Pure tone audiogram (500, 1,000, 2,000 and 4,000 Hz) was done preoperatively and at 12 weeks postoperatively. Hearing outcome and incidence of complications were noted.
Results
There was a statistically significant reduction in the hearing loss for air conduction and air-bone gap (ABG) of 6.1 dB and 6.9 dB respectively (
p
< 0.05). Air-bone gap < 30 dB could be achieved in 71.4% of the patients as compared with 23.8% preoperatively. No significant difference was noted in the bone conduction threshold (p > 0.05). A better hearing outcome was observed at higher frequencies (2,000, 4,000 Hz). No major complications were encountered.
Conclusion
A boomerang-shaped conchal cartilage graft is effective when used for Type III tympanoplasty, especially at higher (2,000, 4,000 Hz) frequencies, and is comparable to newer materials such as titanium total ossicular reconstruction prosthesis (TORP). No major intraoperative/postoperative complications were noted.
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Affiliation(s)
- Snigdha Elaprolu
- Department of Ear, Nose and Throat, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Arun Alexander
- Department of Ear, Nose and Throat, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Sivaraman Ganesan
- Department of Ear, Nose and Throat, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Coimbatore Balakrishnan Manu
- Department of Ear, Nose and Throat, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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15
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Pareschi R, Lepera D, Nucci R. Canal wall down approach for tympano-mastoid cholesteatoma: long-term results and prognostic factors. ACTA ACUST UNITED AC 2019; 39:122-129. [PMID: 31097831 PMCID: PMC6522862 DOI: 10.14639/0392-100x-2237] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
Abstract
The aim of this study is to analyse the long-term anatomical and functional outcomes and prognostic factors of the canal wall down (CWD) tympanoplasty for the treatment of tympano-mastoid cholesteatoma. A total of 895 patients treated for tympano-mastoid cholesteatoma with follow-up longer than 10 years were included. Recidivism (recurrent and residual) cholesteatoma rates and functional results were analysed. The rate of recidivism was 7.7% (6.7% persistence and 1% recurrent disease). Recidivism was higher in paediatric patients (10.1% versus 5.0% of adults). Pathological middle ear mucosa and pars tensa was associated with increased rates of recidivism. Postoperatively, air pure-tone-average (aPTA) ≤ 30 dB was achieved in 36.4% of patients. Of 895 patients, a revision CWD tympanoplasty for chronic otorrhoea was performed in 14 cases (1.5%) with complete recovery in all cases. Nine of those patients had a recurrence of cholesteatoma and five had cavity problems related to granulation, de-epithelisation or recurrent infection. Paediatric patients and absence of stapes superstructure were associated with the worst auditory outcomes. Six-month results were always better than long-term results. A CWD approach was demonstrated to be effective, achieving the goals of cholesteatoma treatment.
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Affiliation(s)
- R Pareschi
- Department of Otorhinolaryngology, Ospedale Nuovo di Legnano, Milan, Italy
| | - D Lepera
- Department of Otorhinolaryngology, Ospedale Nuovo di Legnano, Milan, Italy
| | - R Nucci
- Department of Otorhinolaryngology, Ospedale Nuovo di Legnano, Milan, Italy
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16
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Karamert R, Eravcı FC, Cebeci S, Düzlü M, Zorlu ME, Gülhan N, Tutar H, Uğur MB, İriz A, Bayazıt YA. Canal wall down versus canal wall up surgeries in the treatment of middle ear cholesteatoma. Turk J Med Sci 2019; 49:1426-1432. [PMID: 31651106 PMCID: PMC7018256 DOI: 10.3906/sag-1904-109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/17/2019] [Indexed: 11/23/2022] Open
Abstract
Background/aim To compare outcomes of canal wall up (CWU) and canal wall down (CWD) techniques in the treatment of middle ear cholesteatoma. Materials and methods Medical records of 76 patients who had a primary surgery due to middle ear cholesteatoma between July 2015 and November 2017 were reviewed retrospectively. Hearing thresholds, speech discrimination scores (SDS), recurrences, and revision surgeries of CWU and CWD surgeries were compared. Results Of 76 cholesteatoma cases, 40 (52.6%) had a CWU and 36 (47.4%) had a CWD operation. Postoperatively, the mean air conduction thresholds were significantly better in CWU compared to CWD surgeries (P = 0.016). The presence of the stapes and the type of reconstruction material used did not have a significant effect on auditory success rates (P = 0.342 and P = 0.905, respectively). Auditory success was affected by the status of the middle ear mucosa as well. The recurrence and revision rates did not differ between the surgical techniques (P > 0.05). Conclusion Status of the middle ear mucosa and external auditory canal are important factors affecting the outcomes in cholesteatoma. Instead of a CWD surgery, a CWU surgery seems applicable in cases of cholesteatoma when the bone in the external auditory canal is not eroded by the disease.
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Affiliation(s)
- Recep Karamert
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Fakih Cihat Eravcı
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Süleyman Cebeci
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Düzlü
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Ekrem Zorlu
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Nagihan Gülhan
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hakan Tutar
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Birol Uğur
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayşe İriz
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
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17
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Singh GB, Solo M, Rana N, Kumar S. Evaluation of Type III Tympanoplasty Using Cartilage Ossiculoplasty in Cholesteatoma Ear Surgery. EAR, NOSE & THROAT JOURNAL 2019; 99:22-26. [PMID: 30974998 DOI: 10.1177/0145561319840546] [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: 11/15/2022] Open
Abstract
This prospective observational study evaluates the role of tympanoplasty type III in cholesteatoma ear disease during same sitting with mastoid surgery using cartilage ossiculoplasty. Forty patients of chronic suppurative otitis media-cholesteatoma disease were recruited in the study. All the patients had extensive cholesteatoma and underwent canal wall down mastoid surgery. Tympanoplasty type III, that is, stapes columella, minor columella, or major columella, was done in each case along with mastoid surgery depending upon the remnant ossicular status. Conchal cartilage graft was used for ossiculoplasty along with temporalis fascia graft. Hearing and graft uptake results were evaluated at the end of 6 months postoperatively. Of the 40 cases, 3 cases failed tympanoplasty. In the remaining 37 cases, a statistically significant hearing improvement (air-bone gap of 33 dB) was observed postoperatively. Seven cases underwent stapes columella, 13 cases underwent minor columella, and 17 cases underwent major columella tympanoplasty type III. Although a hearing improvement was recorded in all these subgroups, a statistically significant hearing gain was present only in tympanoplasty type III minor columella cases thereby underlying the importance of intact stapes. However, it is difficult to discern the type of tympanoplasty type III that the patient would undergo prior to the ear surgery.
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Affiliation(s)
- Gautam Bir Singh
- Department of Otorhinolaryngology-Head & Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, India
| | - Medozhanuo Solo
- Department of Otorhinolaryngology-Head & Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, India
| | - Nishant Rana
- Department of Otorhinolaryngology-Head & Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, India
| | - Sunil Kumar
- Department of Otorhinolaryngology-Head & Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, India
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18
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Zwierz A, Haber K, Sinkiewicz A, Kalińczak-Górna P, Tyra J, Mierzwiński J. The significance of selected prognostic factors in pediatric tympanoplasty. Eur Arch Otorhinolaryngol 2018; 276:323-333. [PMID: 30483940 DOI: 10.1007/s00405-018-5193-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this study was to determine the importance of selected prognostic factors on outcomes of tympanoplasty in children. MATERIALS AND METHODS 241 children classified into three age groups (3-7, 8-12 and 13-18), had undergone tympanoplasty between 2001 and 2007 and were subsequently observed for at least 2 years. Prognostic factors were assessed with regard to their impact on the functional and anatomical outcome of the tympanoplasty defined, respectively, as postoperative air-bone gap and state of the middle ear. RESULTS In 85% of children, a tympanic membrane reconstruction was performed. An unchanged TM was achieved in 85% of the patients in early results and in 76% in later results. Air-bone gap closure was observed in 66% of cases. The earlier preventive retraction pocket tympanoplasty was performed, the better anatomical results were obtained-ranging from 91% in the 3-7 age group versus 75-70% in 8-12 and 13-18 age groups. The results of total or subtotal perforation reconstructions were worse than for small perforation with closure rates of 76.5% vs 94.5%, respectively. CONCLUSION Age is not a factor determining the success rate in pediatric tympanoplasty. A better surgical outcome can be achieved in children with a dry ear, and better middle ear condition, because of previously performed surgeries. Preventive tympanoplasty is also advantageous. The hearing results in type 2 and 3 tympanoplasty are similar, but type 1 tympanoplasty has superior efficacy to the former two types.
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Affiliation(s)
- Aleksander Zwierz
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Bydgoszcz, Poland.,Department of Otolaryngology, Audiology and Phoniatrics, University Hospital of Bydgoszcz, Bydgoszcz, Poland
| | - Karolina Haber
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Bydgoszcz, Poland
| | - Anna Sinkiewicz
- Department of Otolaryngology, Audiology and Phoniatrics, University Hospital of Bydgoszcz, Bydgoszcz, Poland
| | - Paulina Kalińczak-Górna
- Department of Otolaryngology, Audiology and Phoniatrics, University Hospital of Bydgoszcz, Bydgoszcz, Poland.
| | - Justyna Tyra
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Bydgoszcz, Poland
| | - Józef Mierzwiński
- Department of Otolaryngology, Audiology and Phoniatrics, Children's Hospital of Bydgoszcz, Bydgoszcz, Poland
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