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Vangrinsven G, Bernaerts A, Deckers F, van Dinther J, Zarowski A, De Foer B. Beyond the otoscope: an imaging review of congenital cholesteatoma. Insights Imaging 2024; 15:194. [PMID: 39112725 PMCID: PMC11306902 DOI: 10.1186/s13244-024-01761-1] [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: 03/20/2024] [Accepted: 06/22/2024] [Indexed: 08/10/2024] Open
Abstract
Congenital cholesteatoma (CC) is a non-neoplastic lesion of keratin debris lined by epithelium found in the temporal bone. It is the lesser-known sibling of the acquired cholesteatoma and may be classified as congenital middle ear cholesteatoma and congenital petrous bone cholesteatoma. The incidence is rising, probably owing to increased recognition and advances in imaging modalities. Cone beam CT provides detailed anatomical information, highlighting quadrant location, ossicular involvement, and mastoid extension. MRI aids in lesion characterization and detection of complications. The classification systems for congenital middle ear and petrous bone cholesteatoma are helpful in the preoperative workup and have a role in predicting postoperative recurrence rates. Management almost invariably involves surgical intervention aimed at preserving middle and inner ear function. Follow-up of CC is mainly based on MRI together with otoscopic examination. Non-echo planar diffusion-weighted imaging, especially, has proven essential for detecting residual disease. This review article emphasizes the significance of imaging in the timely diagnosis and management of CCs. CLINICAL RELEVANCE STATEMENT: This article underscores the crucial role of imaging for prompt detection, preoperative assessment, and postoperative follow-up of CCs, a condition with rising incidence associated with potentially severe complications. KEY POINTS: Timely diagnosis of CCs is imperative for avoiding complications. Imaging is key in detection, preoperative evaluation, and postoperative management. Cone Beam CT and non-echo planar DWI represent state-of-the-art imaging techniques.
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Affiliation(s)
- Guillaume Vangrinsven
- Departement of Radiology, ZAS Hospitals, Antwerp, Belgium.
- Departement of Radiology, Antwerp University Hospital, Antwerp, Belgium.
| | - Anja Bernaerts
- Departement of Radiology, ZAS Hospitals, Antwerp, Belgium
| | - Filip Deckers
- Departement of Radiology, ZAS Hospitals, Antwerp, Belgium
| | | | | | - Bert De Foer
- Departement of Radiology, ZAS Hospitals, Antwerp, Belgium
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Körmendy KB, Shenker-Horváth K, Shulze Wenning A, Fehérvári P, Harnos A, Hegyi P, Molnár Z, Illés K, Horváth T. Predicting residual cholesteatoma with the Potsic staging system still lacks evidence: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:3557-3568. [PMID: 38351408 PMCID: PMC11211107 DOI: 10.1007/s00405-024-08478-3] [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] [Received: 10/27/2023] [Accepted: 01/12/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE To investigate the rate of residual disease in the Potsic staging system for congenital cholesteatomas. METHODS A protocol registration was published on PROSPERO (CRD42022383932), describing residual disease as a primary outcome and hearing improvement as secondary. A systematic search was performed in four databases (PubMed, Embase, Cochrane Library, Web of Science) on December 14, 2022. Articles were included if cholesteatomas were staged according to the Potsic system and follow-up duration was documented. Risk of bias was evaluated using the Quality In Prognosis Studies (QUIPS) tool. In the statistical synthesis a random effects model was used. Between-study heterogeneity was assessed using I2. RESULTS Thirteen articles were found to be eligible for systematic review and seven were included in the meta-analysis section. All records were retrospective cohort studies with high risk of bias. Regarding the proportions of residual disease, analysis using the χ2 test showed no statistically significant difference between Potsic stages after a follow-up of minimum one year (stage I 0.06 (confidence interval (CI) 0.01-0.33); stage II 0.20 (CI 0.09-0.38); stage III 0.06 (CI 0.00-0.61); stage IV: 0.17 (CI 0.01-0.81)). Postoperative and preoperative hearing outcomes could not be analyzed due to varied reporting. Results on cholesteatoma location and mean age at staging were consistent with those previously published. CONCLUSION No statistically significant difference was found in the proportions of residual disease between Potsic stages, thus the staging system's applicability for outcome prediction could not be proven based on the available data. Targeted studies are needed for a higher level of evidence.
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Affiliation(s)
- Klára Borbála Körmendy
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinkszky Hospital, Budapest, Hungary
| | - Kinga Shenker-Horváth
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Morphology and Physiology, Semmelweis University, Budapest, Hungary
- Center for Sports Nutrition Science, Hungarian University of Sports Science, Budapest, Hungary
| | | | - Péter Fehérvári
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- University of Veterinary Medicine Budapest, Budapest, Hungary
| | - Andrea Harnos
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Zsolt Molnár
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
- Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Kata Illés
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinkszky Hospital, Budapest, Hungary
| | - Tamás Horváth
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinkszky Hospital, Budapest, Hungary.
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Hao Y, Yu X, Wang Y, Hosseini D, Zong S, Sun H, Xiao H. Diagnosis and Management of Unexplained Conductive Hearing Loss With Intact Tympanic Membrane: A Systematic Review. EAR, NOSE & THROAT JOURNAL 2024:1455613241262129. [PMID: 38895947 DOI: 10.1177/01455613241262129] [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: 06/21/2024] Open
Abstract
Objective: To analyze the etiology, diagnosis, and treatment of unexplained conductive hearing loss (UCHL) with intact tympanic membrane. Methods: A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 642 articles were retrieved from databases such as PubMed, Embase, Web of Science, and Cochrane. Fifty-four research articles and 21 case reports were screened out according to the inclusion and exclusion criteria for analysis of the etiology of UCHL. Seven research articles with UCHL who underwent exploratory tympanotomy were selected for data extraction and analysis of clinical characteristics. Results: UCHL is a common manifestation of various diseases, including congenital ossicular anomalies (COA), otosclerosis (OTS), congenital middle ear cholesteatoma (CMEC), oval window atresia, superior semicircular-canal dehiscence, congenital stapedial footplate fixation, middle ear osteoma or adenoma, congenital ossification of stapedial tendon, and so on. A total of 522 patients were included in the 7 articles; among whom OTS showed a tendency to increase with age. The main symptoms were hearing loss, followed by tinnitus, dizziness, ear fullness, ear pain, facial paralysis. A total of 87.5% to 93.0% patients with COA manifested as nonprogressive deafness that occurred since childhood, with tinnitus incidence of 15.6% to 30.2%, and 86.4% to 96.4% patients with OTS presented with progressive hearing loss, with tinnitus incidence of 60.1% to 90.9%. The diagnosis positive rate of high-resolution computed tomography (HRCT) was 33.8% to 87.1%, and CMEC was higher than that of COA (83.3%-100% vs 28.6%-64%). All the articles reported good hearing recovery. The most common surgical complications included taste abnormalities, tinnitus, and dizziness. Conclusion: UCHL presents with similar clinical manifestations and poses challenges in preoperative diagnosis. Exploratory tympanotomy is the primary method for diagnosis and treatment, with good prognosis after removing the lesion and reconstructing hearing during the operation. Children can also safely undergo the surgery.
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Affiliation(s)
- Yuzhe Hao
- Department of Otolaryngology-Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuan Yu
- Department of Otolaryngology-Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Wang
- Department of Otolaryngology-Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Davood Hosseini
- Department of Internal Medicine, Division of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Shimin Zong
- Department of Otolaryngology-Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Haiying Sun
- Department of Otolaryngology-Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hongjun Xiao
- Department of Otolaryngology-Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Kwok HM, Cheung CHL, Ng TF, Lam SY, Wong KHS, Wong HL, Pan NY, Cheng LF, Ma KFJ. Congenital cholesteatoma: what radiologists need to know. Pediatr Radiol 2024; 54:620-634. [PMID: 38393651 DOI: 10.1007/s00247-024-05877-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Congenital cholesteatoma is a rare, non-neoplastic lesion that causes conductive hearing loss in children. It is underrecognized and often diagnosed only when there is an established hearing deficit. In the pediatric population, hearing deficiency is particularly detrimental because it can impede speech and language development and, in turn, the social and academic well-being of affected children. Delayed diagnosis leads to advanced disease that requires more extensive surgery and a greater chance of recurrence. A need to promote awareness and recognition of this condition has been advocated by clinicians and surgeons, but no comprehensive imaging review dedicated to this entity has been performed. This review aims to discuss the diagnostic utility of high-resolution computed tomography and magnetic resonance imaging in preoperative and postoperative settings in congenital cholesteatoma. Detailed emphasis is placed on the essential preoperative computed tomography findings that facilitate individualized surgical management and prognosis in the pediatric population.
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Affiliation(s)
- Hoi Ming Kwok
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong.
| | - Chun Hei Lewey Cheung
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Ting Fung Ng
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Sun Yu Lam
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Ka Hon Stephen Wong
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Ho Lim Wong
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Nin Yuan Pan
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Lik Fai Cheng
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Ka Fai Johnny Ma
- Department of Diagnostic and Interventional Radiology, LG1, Main Block, Princess Margaret Hospital, Kowloon, Hong Kong
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Kadowaki Y, Ide S, Nakamura T, Okuda T, Shigemi H, Hirano T, Takahashi K, Suzuki M. Epidemiology of Congenital Cholesteatoma: Surveys of the Last 17 Years in Japan. J Clin Med 2024; 13:1276. [PMID: 38592124 PMCID: PMC10931836 DOI: 10.3390/jcm13051276] [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: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The incidence of congenital cholesteatoma (CC) has rarely been discussed, particularly from a demographic viewpoint. Therefore, we conducted an epidemiological study of CC using local medical characteristics. (2) Methods: The participants were 100 patients (101 ears) who underwent initial surgical treatment at university hospitals in two rural prefectures between 2006 and 2022. A total of 68% of the patients were males and 32% were females, with a median age of 5 years. We reviewed the medical records for the date of birth, date of surgery, stage of disease, and first symptoms of the disease. (3) Results: The total incidence of CC was calculated to be 26.44 per 100,000 births and tended to increase. No significant difference was found between the incidences in the two prefectures. The number of surgeries performed was higher in the second half of the study period. No difference in the stage of progress was observed based on age. (4) Conclusions: The incidence of CC was estimated to be 26.44 per 100,000 newborn births. The number of patients with CC tended to increase; however, this can be attributed to an increase in the detection rate rather than the incidence.
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Affiliation(s)
- Yoshinori Kadowaki
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan; (Y.K.); (H.S.); (M.S.)
| | - Shinsuke Ide
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Miyazaki University, Miyazaki 889-1601, Japan; (S.I.); (T.N.); (K.T.)
| | - Takeshi Nakamura
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Miyazaki University, Miyazaki 889-1601, Japan; (S.I.); (T.N.); (K.T.)
| | - Takumi Okuda
- Department of Otolaryngology-Head and Neck Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki 880-0017, Japan;
| | - Hideto Shigemi
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan; (Y.K.); (H.S.); (M.S.)
| | - Takashi Hirano
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan; (Y.K.); (H.S.); (M.S.)
| | - Kuniyuki Takahashi
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Miyazaki University, Miyazaki 889-1601, Japan; (S.I.); (T.N.); (K.T.)
| | - Masashi Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan; (Y.K.); (H.S.); (M.S.)
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Delaney DS, Liew LJ, Lye J, Atlas MD, Wong EYM. Overcoming barriers: a review on innovations in drug delivery to the middle and inner ear. Front Pharmacol 2023; 14:1207141. [PMID: 37927600 PMCID: PMC10620978 DOI: 10.3389/fphar.2023.1207141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Despite significant advances in the development of therapeutics for hearing loss, drug delivery to the middle and inner ear remains a challenge. As conventional oral or intravascular administration are ineffective due to poor bioavailability and impermeability of the blood-labyrinth-barrier, localized delivery is becoming a preferable approach for certain drugs. Even then, localized delivery to the ear precludes continual drug delivery due to the invasive and potentially traumatic procedures required to access the middle and inner ear. To address this, the preclinical development of controlled release therapeutics and drug delivery devices have greatly advanced, with some now showing promise clinically. This review will discuss the existing challenges in drug development for treating the most prevalent and damaging hearing disorders, in particular otitis media, perforation of the tympanic membrane, cholesteatoma and sensorineural hearing loss. We will then address novel developments in drug delivery that address these including novel controlled release therapeutics such as hydrogel and nanotechnology and finally, novel device delivery approaches such as microfluidic systems and cochlear prosthesis-mediated delivery. The aim of this review is to investigate how drugs can reach the middle and inner ear more efficiently and how recent innovations could be applied in aiding drug delivery in certain pathologic contexts.
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Affiliation(s)
- Derek S. Delaney
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
- Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Lawrence J. Liew
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
- Centre for Ear Sciences, Medical School, The University of Western Australia, Nedlands, WA, Australia
| | - Joey Lye
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
| | - Marcus D. Atlas
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
- Centre for Ear Sciences, Medical School, The University of Western Australia, Nedlands, WA, Australia
- Faculty of Health Sciences, Curtin Medical School, Curtin University, Bentley, WA, Australia
| | - Elaine Y. M. Wong
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
- Centre for Ear Sciences, Medical School, The University of Western Australia, Nedlands, WA, Australia
- Faculty of Health Sciences, Curtin Medical School, Curtin University, Bentley, WA, Australia
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Botelho CB, Tortoriello R, Koch SN, Lopes NL, Lucas R, Fernandes JI. Middle ear cholesteatoma in two cats diagnosed with the aid of video-otoscopy. JFMS Open Rep 2023; 9:20551169231196528. [PMID: 37781725 PMCID: PMC10540574 DOI: 10.1177/20551169231196528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Case series summary The present report describes middle ear cholesteatoma in two cats and also the use of video-otoscopy and flushing to assist with the diagnosis. CT and video-otoscopic examination and flushing were performed in two cats, a 13-year-old mixed breed spayed female cat and a 1-year-old mixed breed male cat, with middle ear cholesteatomas. During the procedure, keratinous material from the middle ears was collected for histopathological evaluation, demonstrating findings consistent with cholesteatoma, and the middle ears were flushed extensively. Relevance and novel information There is little information about middle ear cholesteatoma in cats, and to the authors' knowledge, there are no reports in cats investigating the use of video-otoscopy to aid in the diagnosis of aural cholesteatoma, and this report demonstrates that it can aid in the diagnosis of this condition in cats. In addition, one of the cats had a concurrent otic polyp, which has not been previously reported in cats with cholesteatoma. Additionally, this is the first report of cholesteatoma in a young cat. The access to the cholesteatoma material was via ventral bulla osteotomy in one cat and via external canal without video-otoscopy in the other. More information regarding cholesteatoma in cats will help identify potential similarities and differences of this condition in cats compared with humans and dogs.
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Affiliation(s)
| | - Rafaella Tortoriello
- Veterinary Institute, Federal Rural University of Rio de Janeiro, Seropedica, Brazil
| | - Sandra Nogueira Koch
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, USA
| | - Natália Lôres Lopes
- Veterinary Institute, Federal Rural University of Rio de Janeiro, Seropedica, Brazil
| | - Ronaldo Lucas
- Veterinary, DSc Dermatoclínica, São Paulo, SP, Brazil
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Cao C, Song J, Su R, Wu X, Wang Z, Hou M. Structure-constrained deep feature fusion for chronic otitis media and cholesteatoma identification. MULTIMEDIA TOOLS AND APPLICATIONS 2023:1-21. [PMID: 37362730 PMCID: PMC10157598 DOI: 10.1007/s11042-023-15425-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/19/2023] [Accepted: 04/18/2023] [Indexed: 06/28/2023]
Abstract
Chronic suppurative otitis media (CSOM) and middle ear cholesteatoma (MEC) were two most common chronic middle ear disease(MED) clinically. Accurate differential diagnosis between these two diseases is of high clinical importance given the difference in etiologies, lesion manifestations and treatments. The high-resolution computed tomography (CT) scanning of the temporal bone presents a better view of auditory structures, which is currently regarded as the first-line diagnostic imaging modality in the case of MED. In this paper, we first used a region-of-interest (ROI) network to find the area of the middle ear in the entire temporal bone CT image and segment it to a size of 100*100 pixels. Then, we used a structure-constrained deep feature fusion algorithm to convert different characteristic features of the middle ear in three groups as suppurative otitis media (CSOM), middle ear cholesteatoma (MEC) and normal patches. To fuse structure information, we introduced a graph isomorphism network that implements a feature vector from neighbourhoods and the coordinate distance between vertices. Finally, we construct a classifier named the "otitis media, cholesteatoma and normal identification classifier" (OMCNIC). The experimental results achieved by the graph isomorphism network revealed a 96.36% accuracy in all CSOM and MEC classifications. The experimental results indicate that our structure-constrained deep feature fusion algorithm can quickly and effectively classify CSOM and MEC. It will help otologist in the selection of the most appropriate treatment, and the complications can also be reduced.
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Affiliation(s)
- Cong Cao
- School of Mathematics and Statistics, Central South University, Changsha, 410083 China
| | - Jian Song
- Department of Otorhinolaryngology of Xiangya Hospital, Central South University, Changsha, 410008 China
- Key Laboratory of Otolaryngology Major Disease Research of Hunan Province, Changsha, 410008 China
- National Clinical Research Centre for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 410008 China
| | - Ri Su
- School of Mathematics and Statistics, Central South University, Changsha, 410083 China
| | - Xuewen Wu
- Department of Otorhinolaryngology of Xiangya Hospital, Central South University, Changsha, 410008 China
- Key Laboratory of Otolaryngology Major Disease Research of Hunan Province, Changsha, 410008 China
- National Clinical Research Centre for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 410008 China
| | - Zheng Wang
- School of Computer Science, Hunan First Normal University, Changsha, 410205 China
| | - Muzhou Hou
- School of Mathematics and Statistics, Central South University, Changsha, 410083 China
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Ji C, Zhang X, Yan X, Cao S, Fu T. Cholesteatoma in chronic otitis media secondary to pars tensa perforation. Acta Otolaryngol 2023; 143:376-381. [PMID: 37082904 DOI: 10.1080/00016489.2023.2200437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Acquired cholesteatoma secondary to pars tensa perforation was rare in clinic. OBJECTIVES In this study, we explored factors related to acquired cholesteatoma in chronic otitis media patients with pars tensa perforation. MATERIAL AND METHODS 262 adults (296 ears) with pars tensa perforation were divided into four groups: anterior perforation group, posterior perforation group, central perforation group, and marginal perforation group. Analysis was carried out in terms of cholesteatoma formation, adhesion of perforation edges, mastoid pneumatization, and the function of eustachian tube. RESULTS Cholesteatoma was found in 34% (18 in 53 ears) in posterior perforation group, 14.3% (14 in 98 ears) in marginal perforation group, and 2.5% (2 in 80 ears) in anterior perforation group. For subjects with adhesion in perforation edges, cholesteatoma was approved in 94% of posterior perforation, 42% of marginal perforation and 25% of anterior perforation groups. The adhesion in perforation edges and function of eustachian tube instead of mastoid pneumatization were statistically significant for cholesteatoma formation. CONCLUSIONS AND SIGNIFICANCE Acquired cholesteatoma was mostly found in patients with posterior and marginal perforation, followed by anterior perforation. Adhesion of perforation edges was another risk factor for cholesteatoma formation. Eustachian tube also functioned by influencing the ventilation of middle ear.
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Affiliation(s)
- Caili Ji
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaowen Zhang
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xudong Yan
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Songli Cao
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tao Fu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Bonnard Å, Engmér Berglin C, Wincent J, Eriksson PO, Westman E, Feychting M, Mogensen H. The Risk of Cholesteatoma in Individuals With First-degree Relatives Surgically Treated for the Disease. JAMA Otolaryngol Head Neck Surg 2023; 149:390-396. [PMID: 36929420 PMCID: PMC10020932 DOI: 10.1001/jamaoto.2023.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Importance Cholesteatoma in the middle ear is not regarded as a hereditary disease, but case reports of familial clustering exist in the literature, as well as observed familial cases in the clinical work. However, the knowledge regarding cholesteatoma as a hereditary disease is lacking in the literature. Objective To assess the risk of cholesteatoma in individuals with a first-degree relative surgically treated for the same disease. Design, Setting, and Participants In this nested case-control study in the Swedish population between 1987 and 2018 of first-time cholesteatoma surgery identified from the Swedish National Patient Register, 2 controls per case were randomly selected from the population register through incidence density sampling, and all first-degree relatives for cases and controls were identified. Data were received in April 2022, and analyses were conducted between April and September 2022. Exposure Cholesteatoma surgery in a first-degree relative. Main Outcomes and Measures The main outcome was first-time cholesteatoma surgery. The association between having a first-degree relative with cholesteatoma and the risk of cholesteatoma surgery in the index persons was estimated by odds ratios (ORs) and 95% CIs through conditional logistic regression analysis. Results Between 1987 and 2018, 10 618 individuals with a first-time cholesteatoma surgery (mean [SD] age at surgery, 35.6 [21.5] years; 6302 [59.4%] men) were identified in the Swedish National Patient Register. The risk of having a cholesteatoma surgery was almost 4 times higher in individuals having a first-degree relative surgically treated for the disease (OR, 3.9; 95% CI, 3.1-4.8), but few cases were exposed overall. Among the 10 105 cases with at least 1 control included in the main analysis, 227 (2.2%) had at least 1 first-degree relative treated for cholesteatoma, while the corresponding numbers for controls were 118 of 19 553 control patients (0.6%). The association was stronger for individuals under the age of 20 years at first surgery (OR, 5.2; 95% CI, 3.6-7.6) and for a surgery involving the atticus and/or mastoid region (OR, 4.8; 95% CI, 3.4-6.2). There was no difference in the prevalence of having a partner with cholesteatoma between cases and controls (10 cases [0.3%] and 16 controls [0.3%]; OR, 0.92; 95% CI, 0.41-2.05), which implies that increased awareness does not explain the association. Conclusions and Relevance In this Swedish case-control study using nationwide register data with high coverage and completeness, the findings suggest that the risk of cholesteatoma in the middle ear is strongly associated with a family history of the condition. Family history was nevertheless quite rare and can therefore only explain a limited number of all cases; these families could be an important source for information regarding the genetic background for cholesteatoma disease.
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Affiliation(s)
- Åsa Bonnard
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Medical Unit of ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden.,Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Engmér Berglin
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Medical Unit of ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
| | - Josephine Wincent
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Per Olof Eriksson
- Medical Unit of ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden.,Department of Surgical Sciences, Otorhinolaryngology, Uppsala University Hospital, Uppsala, Sweden
| | - Eva Westman
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, site Sundsvall, Umeå, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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11
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Jang HB, Lee JM, Kim DJ, Lee SH, Lee IW, Lee HM. Treatment results for congenital cholesteatoma using transcanal endoscopic ear surgery. Am J Otolaryngol 2022; 43:103567. [DOI: 10.1016/j.amjoto.2022.103567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 07/31/2022] [Indexed: 12/01/2022]
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12
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Zeng N, Liang M, Yan S, Zhang L, Li S, Yang Q. Transcanal endoscopic treatment for congenital middle ear cholesteatoma in children. Medicine (Baltimore) 2022; 101:e29631. [PMID: 35866811 PMCID: PMC9302349 DOI: 10.1097/md.0000000000029631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
To investigate the feasibility and efficacy of transcanal endoscopic treatment for congenital middle ear cholesteatoma in children. Eleven children diagnosed with congenital middle ear cholesteatoma, who underwent total ear endoscopic surgery under general anesthesia, were included from the Huazhong University of Science and Technology Union Shenzhen Hospital between January 2016 and December 2020. We retrospectively analyzed their operation process and surgical complications through the surgical video; moreover, we compared the pre- and postoperative hearing outcomes. One child underwent a planned second operation to reconstruct the ossicular chain. At 6 postoperative months, all 11 children underwent reexamination. There was no significant change and a significant decrease in the mean bone and air conduction hearing thresholds, respectively (P > .05 and P < .05); moreover, there was a significant reduction in the air-bone conduction difference (P < .05). Further, the air-bone conduction difference was reduced to >20 dB and >10 dB in 11 and 7 children, respectively. Follow-up of the children did not reveal sensorineural deafness, facial paralysis, and other serious complications; further, there were no cases of recurrence. Transcanal endoscopic treatment for congenital middle ear cholesteatoma in children is feasible, minimally invasive, and functional.
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Affiliation(s)
- Nan Zeng
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
| | - Meng Liang
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, People’s Republic of China
| | - Shang Yan
- Department of Otolaryngology, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Lue Zhang
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
| | - Shuo Li
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
- *Correspondence: Shuo Li, Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, Guangdong, China (e-mail: )
| | - Qiong Yang
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
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13
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Reuven Y, Raveh E, Ulanovski D, Hilly O, Kornreich L, Sokolov M. Congenital cholesteatoma: Clinical features and surgical outcomes. Int J Pediatr Otorhinolaryngol 2022; 156:111098. [PMID: 35255443 DOI: 10.1016/j.ijporl.2022.111098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/17/2022] [Accepted: 03/01/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES A typical presentation of congenital cholesteatoma (CC) is asymmetric conductive hearing loss (CHL). As CHL is usually associated with middle ear effusion, diagnosis of CC is frequently delayed. This study aimed to describe the clinical characteristics, treatment and outcomes of children with CC. METHODS The medical files of children diagnosed with CC at a large tertiary pediatric medical center during 2000-2019 were reviewed. The primary outcome measures were: presenting symptoms, surgical findings, stage of disease, recurrence rate and hearing outcome. Imaging findings and the size of mastoid air cells were assessed in CT scans. RESULTS Thirty-nine children were diagnosed with CC. The presenting symptom was unilateral CHL in 85%, with an average speech reception threshold of 41.5 ± 13.7 dB in the affected ear. The mean time from first symptoms to diagnosis was 1.3 years. The surgical approach was exploratory tympanotomy in 25% and canal wall up mastoidectomy in 69%. Seventy percent of the children presented with Potsic stage III-IV. The mean postoperative speech reception threshold was 26.4 ± 12.2 dB (P = 0.002). Recurrence of cholesteatoma occurred in 38% of the patients, mostly in stage III-IV. Mastoid air cell size was significantly smaller on the affected than the unaffected side. CONCLUSIONS In children with persistent unilateral or asymmetric conductive hearing loss, CC should be suspected. Late diagnosis of CC is associated with a high recurrence rate. This highlights the need to promote awareness to the disease among primary physicians in the community health care system.
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Affiliation(s)
- Yonatan Reuven
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eyal Raveh
- Department of Otorhinolaryngology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Ulanovski
- Department of Otorhinolaryngology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Hilly
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liora Kornreich
- Department of Otorhinolaryngology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meirav Sokolov
- Department of Otorhinolaryngology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Annalisa P, Giannicola I, Valeria R, Daniela M, Irene Claudia V, Roberta P, Alessandro M, Giuseppe M. Isolated Congenital Mastoid Cholesteatoma with no Involvement of Aditus Ad Antrum and Middle Ear. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211014032. [PMID: 34025126 PMCID: PMC8120602 DOI: 10.1177/11795476211014032] [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: 02/25/2021] [Accepted: 04/07/2021] [Indexed: 11/15/2022]
Abstract
Cholesteatoma is a non-neoplastic, keratinized squamous epithelial lesion that affects the temporal bone. The middle ear is the most frequent, while the isolated cholesteatoma of the mastoid is rare. The aim of this study was to describe a rare case of isolated mastoid cholesteatoma with no involvement of aditus ad antrum and middle ear including a literature review of the topic. This case report describes the case of a 58 years old female with a cholesteatoma isolated in the mastoid region, evidenced by imaging (computer tomography and magnetic resonance). A mastoidectomy was performed: mastoid process was completely involved, but antrum was not reached. Moreover, it reached the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. In the literature few articles described cases of cholesteatoma isolated in the mastoid region. Research was conducted using PubMed and reference list and there were considered only reports about cholesteatoma exclusively located in the mastoid process without involvement of antrum or middle ear. Fourteen articles were included in this review, with a total number of 23 cases of cholesteatoma isolated in the mastoid region. All papers analyzed reported the cases of isolated mastoid cholesteatoma that presented a congenital origin. Its diagnosis is difficult, therefore, imaging evaluation is mandatory and surgery is the treatment of choice. Mastoid cholesteatomas without involvement of aditus ad antrum and middle ear are rare and only 23 cases are reported in literature. Our case is in line with all clinical and diagnostic features of this rare disease, but it is the only one that evidenced an exposure of the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. The treatment of choice was the surgical one, avoiding damaging of important anatomo-functional structure.
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Affiliation(s)
- Pace Annalisa
- Organi di Senso Department, Sapienza University of Rome, Rome, Italy
| | | | - Rossetti Valeria
- Organi di Senso Department, Sapienza University of Rome, Rome, Italy
| | - Messineo Daniela
- Organi di Senso Department, Sapienza University of Rome, Rome, Italy
| | | | - Polimeni Roberta
- Organi di Senso Department, Sapienza University of Rome, Rome, Italy
| | - Milani Alessandro
- Organi di Senso Department, Sapienza University of Rome, Rome, Italy
| | - Magliulo Giuseppe
- Organi di Senso Department, Sapienza University of Rome, Rome, Italy
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15
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Benson JC, Carlson ML, Lane JI. Non-EPI versus Multishot EPI DWI in Cholesteatoma Detection: Correlation with Operative Findings. AJNR Am J Neuroradiol 2021; 42:573-577. [PMID: 33334855 DOI: 10.3174/ajnr.a6911] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/29/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Although multishot EPI (readout-segmented EPI) has been touted as a robust DWI sequence for cholesteatoma evaluation, its efficacy in disease detection compared with a non-EPI (eg, HASTE) technique is unknown. This study sought to compare the accuracy of readout-segmented EPI with that of HASTE DWI in cholesteatoma detection. MATERIALS AND METHODS A retrospective review was completed of consecutive patients who underwent MR imaging for the evaluation of suspected primary or recurrent/residual cholesteatomas. Included patients had MR imaging examinations that included both HASTE and readout-segmented EPI sequences and confirmed cholesteatomas on a subsequent operation. Two neuroradiologist reviewers assessed all images, with discrepancies resolved by consensus. The ratio of signal intensity between the cerebellum and any observed lesion was noted. RESULTS Of 23 included patients, 12 (52.2%) were women (average age, 47.8 [SD, 25.2] years). All patients had surgically confirmed cholesteatomas: Six (26.1%) were primary and 17 (73.9%) were recidivistic. HASTE images correctly identified cholesteatomas in 100.0% of patients. On readout-segmented EPI sequences, 16 (69.6%) were positive, 5 (21.7%) were equivocal, and 2 (8.7%) were falsely negative. Excellent interobserver agreement was noted between reviews on both HASTE (κ = 1.0) and readout-segmented EPI (κ = 0.9) sequences. The average signal intensity ratio was significantly higher on HASTE than in readout-segmented EPI, facilitating enhanced detection (mean difference 0.5; 95% CI, 0.3-0.8; P = .003). CONCLUSIONS HASTE outperforms readout-segmented EPI in the detection of primary cholesteatoma and disease recidivism.
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Affiliation(s)
- J C Benson
- Department of Radiology (J.C.B., J.I.L.)
| | - M L Carlson
- Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, Rochester, Minnesota
| | - J I Lane
- Department of Radiology (J.C.B., J.I.L.)
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16
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Kim HC, Yang HC, Cho HH. Endoscopic Surgery of Congenital Cholesteatoma in the Anterior Epitympanic Recess: A Case Report of a Rare Location. EAR, NOSE & THROAT JOURNAL 2020; 101:677-679. [PMID: 33314962 DOI: 10.1177/0145561320969249] [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: 12/20/2022] Open
Abstract
Congenital cholesteatoma is a whitish mass in the middle ear medial to an intact tympanic membrane. It is often without symptoms and therefore incidentally diagnosed. Pediatric congenital cholesteatoma generally starts as a small pearl-like mass in the middle ear cavity that eventually expands to involve the ossicles, epitympanum, and mastoid. The location, size, histopathological type, and extent of the mass must be evaluated to select the appropriate surgical method. Although microscopic ear surgery has traditionally been performed to remove congenital cholesteatoma, a recently introduced alternative is endoscopic surgery, which allows a minimally invasive approach and has better visualization. Here, we report the first known case of a patient with congenital cholesteatoma in the anterior epitympanic recess and discuss the utility of an endoscopic approach in the removal of a congenital cholesteatoma in the hidden area within the middle ear.
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Affiliation(s)
- Hong Chan Kim
- Department of Otolaryngology-Head and Neck Surgery, 65416Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, 65416Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Hyong-Ho Cho
- Department of Otolaryngology-Head and Neck Surgery, 65416Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
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17
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MacDonald B, Bommakanti K, Mallo M, Carvalho D. Isolated Incudostapedial Cholesteatomas: Unique Radiologic and Surgical Features. EAR, NOSE & THROAT JOURNAL 2020; 100:243S-248S. [PMID: 33237827 DOI: 10.1177/0145561320973785] [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] Open
Abstract
OBJECTIVES Congenital cholesteatomas originate from epithelial tissue present within the middle ear in patients with an intact tympanic membrane, no history of otologic surgery, otorrhea, or tympanic membrane perforation. They are diagnosed by a pearl-like lesion on otoscopy and computed tomography (CT) scan showing an expansile soft-tissue mass. We describe a series of patients with no prior otologic history presenting with progressive unilateral conductive hearing loss and normal otoscopy. The CT scans showed ossicular erosion without obvious soft-tissue mass. Surgery confirmed incudostapedial erosion found to be cholesteatoma. In this study, we characterize the clinical course of patients diagnosed with isolated incudostapedial cholesteatoma (IIC) and review possible pathologic mechanisms. METHODS Retrospective review of IIC cases treated by the Department of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, 2014 to 2020. Data included patient demographics, clinical features, imaging, surgical findings, and audiologic data. RESULTS Five patients were diagnosed with IIC (3 [60%] female; mean age at presentation 10.7 years [range 5.5-16.0]). All patients presented with postlingual unilateral conductive hearing loss and normal otoscopy without any past otologic history; delay in diagnosis ranged from 4 months to several years. The CT scans showed ossicular chain erosion with an absent long process of the incus and/or stapes superstructure. All patients underwent middle ear exploration, revealing a thin layer of cholesteatoma in the incudostapedial region, confirmed by histopathology. Mean preoperative speech reception threshold was 55 dB and improved to a mean of 31 dB in the 4 patients who underwent ossicular chain reconstruction. CONCLUSION Isolated incudostapedial cholesteatoma should be included as a possible etiology in pediatric patients with insidious onset of unilateral conductive hearing loss with normal otoscopy, unremarkable otologic history, and a CT scan showing ossicular abnormality/disruption without notable middle ear mass. These patients should be counseled preoperatively regarding the possibility of cholesteatoma and should undergo middle ear exploration with possible ossiculoplasty.
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Affiliation(s)
- Bridget MacDonald
- School of Medicine, 8784University of California at San Diego, La Jolla, CA, USA
| | - Krishna Bommakanti
- School of Medicine, 8784University of California at San Diego, La Jolla, CA, USA
| | - Moises Mallo
- 70904Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Daniela Carvalho
- School of Medicine, 8784University of California at San Diego, La Jolla, CA, USA.,14444Rady Children's Hospital of San Diego, San Diego, CA, USA
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18
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Wisotzky EL, Rosenthal JC, Wege U, Hilsmann A, Eisert P, Uecker FC. Surgical Guidance for Removal of Cholesteatoma Using a Multispectral 3D-Endoscope. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5334. [PMID: 32957675 PMCID: PMC7570528 DOI: 10.3390/s20185334] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023]
Abstract
We develop a stereo-multispectral endoscopic prototype in which a filter-wheel is used for surgical guidance to remove cholesteatoma tissue in the middle ear. Cholesteatoma is a destructive proliferating tissue. The only treatment for this disease is surgery. Removal is a very demanding task, even for experienced surgeons. It is very difficult to distinguish between bone and cholesteatoma. In addition, it can even reoccur if not all tissue particles of the cholesteatoma are removed, which leads to undesirable follow-up operations. Therefore, we propose an image-based method that combines multispectral tissue classification and 3D reconstruction to identify all parts of the removed tissue and determine their metric dimensions intraoperatively. The designed multispectral filter-wheel 3D-endoscope prototype can switch between narrow-band spectral and broad-band white illumination, which is technically evaluated in terms of optical system properties. Further, it is tested and evaluated on three patients. The wavelengths 400 nm and 420 nm are identified as most suitable for the differentiation task. The stereoscopic image acquisition allows accurate 3D surface reconstruction of the enhanced image information. The first results are promising, as the cholesteatoma can be easily highlighted, correctly identified, and visualized as a true-to-scale 3D model showing the patient-specific anatomy.
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Affiliation(s)
- Eric L. Wisotzky
- Department of Computer Vision and Graphics, Fraunhofer Heinrich-Hertz-Institute, 10587 Berlin, Germany; (J.-C.R.); (U.W.); (A.H.); (P.E.)
- Department of Visual Computing, Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Jean-Claude Rosenthal
- Department of Computer Vision and Graphics, Fraunhofer Heinrich-Hertz-Institute, 10587 Berlin, Germany; (J.-C.R.); (U.W.); (A.H.); (P.E.)
| | - Ulla Wege
- Department of Computer Vision and Graphics, Fraunhofer Heinrich-Hertz-Institute, 10587 Berlin, Germany; (J.-C.R.); (U.W.); (A.H.); (P.E.)
| | - Anna Hilsmann
- Department of Computer Vision and Graphics, Fraunhofer Heinrich-Hertz-Institute, 10587 Berlin, Germany; (J.-C.R.); (U.W.); (A.H.); (P.E.)
| | - Peter Eisert
- Department of Computer Vision and Graphics, Fraunhofer Heinrich-Hertz-Institute, 10587 Berlin, Germany; (J.-C.R.); (U.W.); (A.H.); (P.E.)
- Department of Visual Computing, Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Florian C. Uecker
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
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19
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Zhao YY, Liu P, Liu J, Xie J, Wang GP, Guo JY, Gong SS. Suggestion of a Modified Classification for Congenital Middle Ear Cholesteatoma: Based on the Clinical Characteristics and Staging of Fifty-Seven Patients. Cancer Biother Radiopharm 2020; 36:260-267. [PMID: 32735447 DOI: 10.1089/cbr.2020.3786] [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: 11/12/2022] Open
Abstract
Objective: To explore more refined classification methods of congenital middle ear cholesteatoma (CMEC) based on two existing staging systems. Subjects and Methods: This study involved a retrospective data review of 57 patients (61 ears involved) with CMEC requiring the surgical treatment. Patients were classified into different stages according to Nelson, Potsic, and Modified Nelson staging system. Preoperative data and intraoperative findings were recorded. Results: The mean age at operation was 15 ± 15.04 years with a median of 10 years. The main clinical manifestation was hearing loss (72.13%). CMEC mass was mainly located in the posterior portion of the tympanic cavity (65.57%). No patient was classified into Potsic stage II. The erosion of incus happened in all cases. Patients with Nelson type 2 and type 3 had erosions to the structures out of middle ear, such as dura mater, lateral semicircle canal, and facial canal. Postoperative follow-up time was more than 24 months. Recurrence occurred in four patients (6.56%), all of them in Nelson type 2, who had received canal wall down mastoidectomy (three cases) and canal wall up mastoidectomy (one case). Conclusions: Nelson staging system was more suitable for advanced CMEC patients than Potsic staging system. The rare case of Potsic stage II restricted the application of Potsic staging system. Moreover, since both of two staging systems do not distinguish the type of involved ossicles, the authors recommended to subdivide Nelson type 2 into type 2a and type 2b based on the erosion of the ossicular chain, as well as subdivide Nelson type 3 into type 3a and 3b based on the erosion of structures out of middle ear, which was named as Modified Nelson staging system.
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Affiliation(s)
- Yuan-Yuan Zhao
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Otolaryngology, Inner Mongolia People's Hospital, Hohhot, China
| | - Pai Liu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiao Liu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Xie
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guo-Peng Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing-Ying Guo
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shu-Sheng Gong
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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