1
|
Molinari G, Reale M, Albera A, Russo FY, Di Lullo AM, Gaffuri M, Ralli M, Turri-Zanoni M, Simon F, Anschuetz L, Trecca EMC. Follow-up strategies in pediatric cholesteatoma: a systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08875-8. [PMID: 39097857 DOI: 10.1007/s00405-024-08875-8] [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: 05/02/2024] [Accepted: 07/25/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE The aim of this article was to systematically review the literature on the pediatric population surgically treated for cholesteatoma and describe the applied post-operative follow-up strategies. METHODS A systematic review was conducted following the Primary Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement recommendations. After running the selected search string in PubMed, Scopus and Google Scholar, studies in English, reporting on surgically treated pediatric cholesteatoma patients (age younger or equal to 18 year-old) were retrieved. Both primary and revision cholesteatoma surgeries were included. Articles lacking specific data on post-surgical follow-up and case series with less than 10 patients were excluded. RESULTS Nineteen papers, published between 2000 and 2023, were included for final analysis. Fourteen studies were retrospective and five prospective, for a total of 1319 patients and 1349 operated ears. Male to female ratio was 1.8:1, with a mean age at surgery of 10.4 years (range 1-18). The mean length of the follow-up after surgery was 4.4 ± 1.7 years (range 1-6.9). Clinical follow-up was detailed in 9 studies (47%) with otomicroscopy being the most common evaluation. In most articles (n = 8, 50%), MRI alone was utilized for radiological follow-up, while in 3 studies (19%), CT scans were employed exclusively. In 5 studies (31%), MRI was combined with CT scans. The timing of radiological investigations varied widely (ranging from 6 months to 3 years). A second-look strategy was reported in 14 studies (74%). CONCLUSION This systematic review highlights the heterogeneity of the follow-up strategies applied to pediatric patients after cholesteatoma surgery, both in terms of timing and types of investigations.
Collapse
Affiliation(s)
- Giulia Molinari
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Marella Reale
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy.
- Department of Otorhinolaryngology, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Andrea Albera
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesca Yoshie Russo
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Antonella Miriam Di Lullo
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Otorhinolaryngology - Head and Neck Surgery Unit, Department of Mental and Physical Health and Preventive, Medicine, University of Campania Luigi Vanvitelli, 80131, Naples, Italy
- CEINGE- Advanced Biotechnology, Salvatore G. Street N.486, 80131, Naples, Italy
| | - Michele Gaffuri
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Massimo Ralli
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Mario Turri-Zanoni
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100, Varese, Italy
- Department of Otolaryngology Head and Neck Surgery, Department of Biotechnology and Life Sciences, ASST Lariana, Ospedale Sant'Anna, University of Insubria, San Fermo Della Battaglia, 22042, Como, Italy
| | - Francois Simon
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, 75015, Paris, France
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland
| | - Eleonora M C Trecca
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery (GOS), Rome, Italy
- Department of Otorhinolaryngology and Maxillofacial Surgery, IRCCS Research Hospital Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| |
Collapse
|
2
|
Middle ear status in cholesteatoma: Associations among preoperative computed tomography scans, audiological assessments, and intraoperative endoscopic findings. Am J Otolaryngol 2022; 43:103198. [PMID: 34509081 DOI: 10.1016/j.amjoto.2021.103198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/03/2021] [Accepted: 08/26/2021] [Indexed: 11/23/2022]
|
3
|
Does Pregnancy Have an Influence on Otosclerosis? The Journal of Laryngology & Otology 2021; 136:191-196. [PMID: 34819176 DOI: 10.1017/s0022215121003601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
4
|
ALADA Dose Optimization in the Computed Tomography of the Temporal Bone: The Diagnostic Potential of Different Low-Dose CT Protocols. Diagnostics (Basel) 2021; 11:diagnostics11101894. [PMID: 34679601 PMCID: PMC8534882 DOI: 10.3390/diagnostics11101894] [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: 09/02/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Repeated computed tomography (CT) is essential for diagnosis, surgical planning and follow-up in patients with middle and inner ear pathology. Dose reduction to “as low as diagnostically acceptable” (ALADA) is preferable but challenging. We aimed to compare the diagnostic quality of images of subtle temporal bone structures produced with low doses (LD) and reference protocols (RP). Methods: Two formalin-fixed human cadaver heads were scanned using a 64-slice CT scanner and cone-beam CT (CBCT). The protocols were: RP (120 kV, 250 mA, CTDIvol 83.72 mGy), LD1 (100 kV, 80 mA, CTDIvol 26.79 mGy), LD2 (100 kV, 35 mA, CTDIvol 7.66 mGy), LD3 (80 kV, 40 mA, CTDIvol 4.82 mGy), and CBCT standard protocol. Temporal bone structures were assessed using a 5-point scale. Results: A median score of ≥2 was achieved with protocols such as the tendons of m. tensor tympani (RP/LD1/LD2/CBCT) and m. stapedius (CBCT), the incudostapedial joint (RP/LD1/CBCT), the incudomalleolar joint (RP/LD1/LD2/CBCT), the stapes feet (RP/LD1/CBCT), the stapes head (RP/LD1/LD2/CBCT), the tympanic membrane (RP/LD1/LD2/CBCT), the lamina spiralis ossea (none), the chorda tympani (RP/LD1/CBCT), and the modiolus (RP/LD1/LD2/CBCT). Adaptive statistical iterative reconstructions did not show advantages over the filtered back projection. Conclusions: LD protocols using a CTDIvol of 7.66 mGy may be sufficient for the identification of temporal bone structures.
Collapse
|
5
|
Deep Learning in Automated Region Proposal and Diagnosis of Chronic Otitis Media Based on Computed Tomography. Ear Hear 2021; 41:669-677. [PMID: 31567561 DOI: 10.1097/aud.0000000000000794] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The purpose of this study was to develop a deep-learning framework for the diagnosis of chronic otitis media (COM) based on temporal bone computed tomography (CT) scans. DESIGN A total of 562 COM patients with 672 temporal bone CT scans of both ears were included. The final dataset consisted of 1147 ears, and each of them was assigned with a ground truth label from one of the 3 conditions: normal, chronic suppurative otitis media, and cholesteatoma. A random selection of 85% dataset (n = 975) was used for training and validation. The framework contained two deep-learning networks with distinct functions: a region proposal network for extracting regions of interest from 2-dimensional CT slices; and a classification network for diagnosis of COM based on the extracted regions. The performance of this framework was evaluated on the remaining 15% dataset (n = 172) and compared with that of 6 clinical experts who read the same CT images only. The panel included 2 otologists, 3 otolaryngologists, and 1 radiologist. RESULTS The area under the receiver operating characteristic curve of the artificial intelligence model in classifying COM versus normal was 0.92, with sensitivity (83.3%) and specificity (91.4%) exceeding the averages of clinical experts (81.1% and 88.8%, respectively). In a 3-class classification task, this network had higher overall accuracy (76.7% versus 73.8%), higher recall rates in identifying chronic suppurative otitis media (75% versus 70%) and cholesteatoma (76% versus 53%) cases, and superior consistency in duplicated cases (100% versus 81%) compared with clinical experts. CONCLUSIONS This article presented a deep-learning framework that automatically extracted the region of interest from two-dimensional temporal bone CT slices and made diagnosis of COM. The performance of this model was comparable and, in some cases, superior to that of clinical experts. These results implied a promising prospect for clinical application of artificial intelligence in the diagnosis of COM based on CT images.
Collapse
|
6
|
Maccarrone F, Molinari G, Alberici MP, Cesinaro AM, Villari D, Alicandri-Ciufelli M, Tassi S, Negri M. The Tensor Tympani Tendon: A Hypothetical Site of Origin of Congenital Cholesteatoma. Head Neck Pathol 2021; 16:224-228. [PMID: 34106408 PMCID: PMC9018919 DOI: 10.1007/s12105-021-01342-4] [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: 04/13/2021] [Accepted: 05/31/2021] [Indexed: 12/30/2022]
Abstract
Multiple theories have been discussed about the etiopathogenesis of congenital middle ear cholesteatoma (CMEC) and its specific site of origin. The intraoperative identification of the precise location of the keratinous mass is important to guarantee its complete removal, in order to reduce the risk of recurrence. This study proposes the tensor tympani tendon (TTT) as a possible site of origin of CMEC. All CMECs treated between 2013 and 2019 were reviewed. Only Potsic stage I lesions were included. Preoperative radiologic images were compared to intraoperative findings. Three removed TTT were sent for histologic evaluation. Seven patients were included (M:F = 3:4). Preoperative CT images were classified as type A in 2 cases (28.6%) and type B in 5 cases (71.4%). At intraoperative evaluation all CMEC sacs were found pedunculated on the TTT. The histologic examinations confirmed the connection between the cholesteatomatous sac and the TTT. According to the correlation of imaging, intraoperative findings and histology, we proposed that the TTT could be the primary site from which CMEC originates.
Collapse
Affiliation(s)
- Francesco Maccarrone
- Department of Otolaryngology-Head and Neck Surgery, “B. Ramazzini” Hospital of Carpi, Carpi, Italy ,Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Giulia Molinari
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Maria Paola Alberici
- Department of Otolaryngology-Head and Neck Surgery, “B. Ramazzini” Hospital of Carpi, Carpi, Italy
| | | | - Domenico Villari
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | | | - Sauro Tassi
- Department of Otolaryngology-Head and Neck Surgery, “B. Ramazzini” Hospital of Carpi, Carpi, Italy
| | - Maurizio Negri
- Department of Otolaryngology-Head and Neck Surgery, “B. Ramazzini” Hospital of Carpi, Carpi, Italy
| |
Collapse
|
7
|
Cavaliere M, Di Lullo AM, Russo C, Mesolella M, Cantone E, Di Lorenzo G, Motta G, Elefante A. Computed-Tomography-Structured Reporting in Middle Ear Opacification: Surgical Results and Clinical Considerations From a Large Retrospective Analysis. Front Neurol 2021; 12:615356. [PMID: 33716923 PMCID: PMC7943916 DOI: 10.3389/fneur.2021.615356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/14/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose: The aim of the study is to compare the accuracy of unstructured preoperative Computed Tomography (CT) reports from non-tertiary diagnostic centers with intraoperative findings in a large cohort of patients with Chronic Otitis Media (COM) undergone surgery. Methods: From 2012 to 2019, a total number of 301 patients were considered for our purposes. All patients with clinical evidence of COM had preoperative non-contrast high resolution CT scan of the temporal bone in non-tertiary diagnostic centers, performed within 3 months before surgery. Results: The accuracy of CT reports was analyzed in terms of nature, anatomical site, disease extension, bony erosion, vascular structures abnormalities relevant to surgical planning, and Eustachian tube patency. Compared to post-surgical findings, CT reporting critical analysis revealed a tendency to overestimation of bony erosion, coupled to underestimated description of facial canal/lateral semi-circular canal, vascular structures, and Eustachian tube. Conclusion: Discrepancies between CT reports and surgical findings in middle ear opacification can be at least in part due to limited expertise of general radiologists in ENT neuroimaging. To limit this lack of information and the limited accuracy of middle ear structures depiction, here we propose a structured checklist to adopt in the case of a temporal bone CT scan for COM, in order to optimize the communication with surgeons and provide all the crucial information for an accurate surgical planning.
Collapse
Affiliation(s)
- Michele Cavaliere
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy
| | - Antonella Miriam Di Lullo
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy.,CEINGE-Centro di Ingegneria Genetica e Biotecnologie Avanzate, Naples, Italy
| | - Camilla Russo
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Massimo Mesolella
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy
| | - Elena Cantone
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Di Lorenzo
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II", Naples, Italy
| | - Gaetano Motta
- Head and Neck Surgery Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Elefante
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| |
Collapse
|
8
|
Singh P, Singh R, Rai R, Sethi S, Ahluwalia AS, Choudhary G. High-resolution computed tomography (HRCT) in pediatric and adult patients with unsafe chronic suppurative otitis media (CSOM) and its surgical correlation. J Family Med Prim Care 2020; 9:4067-4073. [PMID: 33110811 PMCID: PMC7586635 DOI: 10.4103/jfmpc.jfmpc_455_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/25/2020] [Accepted: 06/19/2020] [Indexed: 11/21/2022] Open
Abstract
Background and Aim: Atticoantral, alias unsafe type of CSOM affects the posterosuperior part of the middle ear cleft and is frequently coupled with complications and bony erosions. This study aimed to correlate the high-resolution computed tomography (HRCT) temporal bone and intraoperative findings in the patients with the unsafe type of CSOM. Methods: This prospective study included 50 patients (28 males: 22 females; mean age 24 ± 14 years) who presented with clinically suspected unsafe CSOM. All patients underwent HRCT of the temporal bone and subsequent surgical procedure. The intraoperative and histopathological findings were compared with HRCT findings. Descriptive statistics, sensitivity, specificity, and positive and negative predictive value for HRCT were calculated. Student's t-test and Chi-square test were performed. Results: Out of 50 patients, left, right, and bilateral ear involvement were seen in 42% (21/50), 38% (19/50), and 20% (10/50) patients, respectively. Ear discharge was the most common symptom (100%) followed by earache (66%), vertigo (16%), and tinnitus (14%), respectively. Cholesteatoma was reported in 82% (49/60) of ears on HRCT while histopathological and intraoperative evaluation confirmed the diagnosis in 40 out of 49 ears. In 18% (11/60) ears, the cholesteatoma was not diagnosed on HRCT evaluation; however, the intraoperative and histopathological assessment revealed cholesteatoma in six patients while the rest had granulation tissue. For detection of ossicular erosions, tegmen erosions, erosions of facial nerve canal, erosions of sigmoid sinus plate, and erosions of lateral/posterior semicircular canals; HRCT had high sensitivity (86.44%–100%) and specificity (93.33%–100%). Conclusion: HRCT has a superb correlation with intraoperative findings and is a valuable tool for preoperative assessment of temporal bone pathologies.
Collapse
|