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Abraham L, Philip A, Lepcha A, Augustine AM, Mathews SS, Paul RR, Mammen MD. A Comparative Study of Outcomes and Quality of Life in Canal Wall up Mastoidectomies and Canal Wall down Mastoidectomies. Indian J Otolaryngol Head Neck Surg 2022; 74:600-607. [PMID: 36032861 PMCID: PMC9411485 DOI: 10.1007/s12070-021-02424-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022] Open
Abstract
Abstract Chronic Otitis Media (COM) of the squamosal type was primarily managed by performing a canal wall down mastoidectomy; however, the latter era otolaryngologist envisioned benefits in preserving the posterior canal wall. Our primary objective was to assess the disease specific quality of life following canal wall up (CWU) mastoidectomy and canal wall down (CWD) mastoidectomy surgery after a 6 month post-operative period. A prospective observational study was done from September 2017 to August 2018 where the charts of 380 patients from Christian Medical College, Vellore were reviewed. Details of patients above 18 years who had undergone the above surgeries for COM active squamosal disease from the period of January 2014 to December 2016; and had their post-operative follow up (average of 16 months) during the period of study were looked at. The CWU group had a significantly better disease-specific quality of life in the symptoms subscale than the CWD group (p value < 0.01). The CWU group showed a significant air-bone gap closure to 23.3 dB as compared to 27.7 dB in CWD (p value = 0.005). The recurrence rates were 4.5% (9 cases) in the CWU group and 3.9% (7 cases) in the CWD group, which was not statistically significant. Both CWU and CWD methods of mastoidectomy for COM squamosal type give comparable outcomes in terms of recurrence with the CWU group having a better disease-specific quality of life after surgery. Level of Evidence 2a.
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Yang J, Lyu J, Wang Y, Chen B, Xu J, Ren D. Comparison of Endoscopic Cartilage Myringoplasty in Dry and Wet Ears With Chronic Suppurative Otitis Media. EAR, NOSE & THROAT JOURNAL 2021; 102:NP177-NP182. [PMID: 33719601 DOI: 10.1177/0145561321999263] [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: 11/15/2022] Open
Abstract
OBJECTIVES This study compared the rate of graft success, as well as hearing improvement and dry ear time between dry ears and wet ears with otomycosis or without otomycosis in patients with chronic suppurative otitis media (CSOM) after endoscopic cartilage myringoplasty. METHODS This retrospective study was conducted in a tertiary hospital in Shanghai. In total, 83 patients with CSOM (43 with dry ears and 40 with wet ears) were included. Among the 40 patients with CSOM and wet ears, 25 exhibited otomycosis. All patients underwent endoscopic myringoplasty, and perforations were repaired using tragal cartilage with a single-sided perichondrium. Patients were followed up for at least 6 months. Pure-tone hearing was examined preoperatively and at 3 months postoperatively. The graft uptake rate, hearing improvement, and dry ear time were compared between the groups. RESULTS The graft success rate did not differ significantly between the dry-ear and wet-ear groups (95.35% and 90.00%, respectively). Furthermore, the graft success rate also did not differ significantly between patients with wet ears and otomycosis and those with wet ears without otomycosis (92.00% and 86.67%, respectively). Hearing gain did not differ significantly between the dry-ear and wet-ear groups. No significant difference in hearing gain was also found in patients with wet ears with or without otomycosis. However, the time to dry ear was significantly longer in the wet-ear group than in the dry-ear group. CONCLUSION Patients with CSOM and wet ears required more time to achieve a completely healthy status. However, the graft success rate and hearing improvement were not affected by a wet middle ear and otomycosis. Thus, endoscopic myringoplasty using tragus cartilage is an effective treatment for refractory CSOM in patients with wet ears and otomycosis.
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Affiliation(s)
- Juanmei Yang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, People's Republic of China
| | - Jihan Lyu
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, People's Republic of China
| | - Yanmei Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, People's Republic of China
| | - Binjun Chen
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, People's Republic of China
| | - Jianghong Xu
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, People's Republic of China
| | - Dongdong Ren
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, People's Republic of China
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The myringoplasty of the perforation with otomycosis. Am J Otolaryngol 2020; 41:102732. [PMID: 32981763 DOI: 10.1016/j.amjoto.2020.102732] [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: 09/12/2020] [Accepted: 09/13/2020] [Indexed: 11/21/2022]
Abstract
In consideration of the American Journal of Otolaryngology's reviewing and editing my submission, the author(s) undersigned transfers, assigns and otherwise conveys all copyright ownership to Elsevier Inc. in the event that such work is published in the American Journal of Otolaryngology.
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Tiwari R, Singhal P, Verma N, Sehra R, Yadav R, Agarwal S, Prasad B. Is It Wise to Wait for Ear to Become Dry in Indian Scenario? Indian J Otolaryngol Head Neck Surg 2020; 72:448-452. [PMID: 33088773 DOI: 10.1007/s12070-020-01896-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/04/2020] [Indexed: 11/26/2022] Open
Abstract
Tympanoplasty is the standard and well-established procedure for closure of tympanic membrane perforations. Tympanoplasty in wet ear is still a topic of debate among ENT surgeons. This study discusses the balance between wait and watch policy and early intervention in wet ear. It also compares the rate of graft uptake and hearing improvement in Type I tympanoplasty in dry and wet ears. This is a hospital based, observational, descriptive and comparative study. Total 246 patients enrolled in the study. Two groups were created with 123 patients in each group. One included dry ears and another included wet ears. All patients had mucosal type of chronic otitis media. They all underwent Type I tympanoplasty. Graft uptake rate and hearing was compared between both groups. The overall success rate (graft uptake) was 91.06% (224). The success rate in dry ear group was 93.50% (115) and in wet ear group it was 88.62% (109). This study concluded that there is no added advantage of drying the ear rather the delay in treatment increases morbidity and drop outs in Indian scenario.
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Affiliation(s)
| | - Pawan Singhal
- Department of Otorhinolaryngology, SMS Medical College, 78 A, Lipi Clinics, Vishnupuri, Durgapura, Jaipur, Rajasthan 302018 India
| | - Namita Verma
- Department of Otorhinolaryngology, SMS Medical College, 78 A, Lipi Clinics, Vishnupuri, Durgapura, Jaipur, Rajasthan 302018 India
| | - Ritu Sehra
- Department of Otorhinolaryngology, SMS Medical College, 78 A, Lipi Clinics, Vishnupuri, Durgapura, Jaipur, Rajasthan 302018 India
| | - Rajeev Yadav
- Department of Otorhinolaryngology, SMS Medical College, 78 A, Lipi Clinics, Vishnupuri, Durgapura, Jaipur, Rajasthan 302018 India
- Department of Preventive and Social Medicine, SMS Medical College, Jaipur, Rajasthan India
| | - Sunita Agarwal
- Department of Otorhinolaryngology, SMS Medical College, 78 A, Lipi Clinics, Vishnupuri, Durgapura, Jaipur, Rajasthan 302018 India
| | - Beni Prasad
- Department of Otorhinolaryngology, SMS Medical College, 78 A, Lipi Clinics, Vishnupuri, Durgapura, Jaipur, Rajasthan 302018 India
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Lou Z, Li X. A comparative study of endoscopic cartilage myringoplasty used to treat wet and dry ears with mucosal-type chronic otitis media. J Laryngol Otol 2020; 134:1-6. [PMID: 32753085 DOI: 10.1017/s0022215120001486] [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: 11/06/2022]
Abstract
OBJECTIVE The outcomes of dry and wet ears were compared following endoscopic cartilage myringoplasty performed to treat chronic tympanic membrane perforations in patients with mucosal chronic otitis media. METHODS Patients with chronic perforations, and with mucosal chronic otitis media with or without discharge, were recruited; all underwent endoscopic cartilage myringoplasty. The graft success rate and hearing gain were evaluated at six months post-operatively. RESULTS The graft success rates were 85.9 per cent (67 out of 78) in dry ears and 86.2 per cent (25 out of 29) in wet ears; the difference was not significant (p = 0.583). Among the 29 wet ears, the graft success rates were 100 per cent in 11 ears with mucoid discharge and 77.8 per cent in the 18 patients with mucopurulent otorrhoea. CONCLUSION The wet or dry status of ears in patients with chronic perforations with mucosal chronic otitis media did not affect graft success rate or hearing gain after endoscopic cartilage myringoplasty. However, ears with mucopurulent discharge were associated with increased failure rates and graft collapse, whereas ears with mucoid discharge were associated with higher graft success rates.
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Affiliation(s)
- Z Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, China
| | - X Li
- Department of Otolaryngology, Jining No. 1 People's Hospital, China
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Cavel O, Ungar OJ, Oron Y, Ben Ami R, Dekel M, Handzel O. Outcome of surgery for chronic suppurative otitis media with resistant Pseudomonas aeruginosa. Eur Arch Otorhinolaryngol 2020; 278:959-964. [PMID: 32583180 DOI: 10.1007/s00405-020-06152-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the effectiveness of surgical treatment of active chronic suppurative otitis media (CSOM) with ciprofloxacin-resistant Pseudomonas aeruginosa (P. aeruginosa) that failed comprehensive local and systemic treatment. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Eleven patients with ciprofloxacin-resistant P. aeruginosa CSOM that remained active despite comprehensive local and systemic treatment. All patients were operated by a single surgeon between February 2016 and July 2019 INTERVENTION(S): Tympanoplasty alone was performed in seven cases and accompanied by mastoidectomy in the other four cases. MAIN OUTCOME MEASURE(S) Resolution of infection and tympanic graft take on otoscopy. The secondary outcome measure is hearing. RESULTS Tympanic graft take was successful and the infectious process was resolved in 8 out of the 11 cases, yielding a success rate of 73%. The average follow-up was 20 months. No surgical complications occurred. CONCLUSIONS Tympanoplasty, with or without mastoidectomy, is safe and yields acceptable anatomical and functional success rates when intensive local and systemic treatment fails to stop the purulent discharge.
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Affiliation(s)
- O Cavel
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel.
| | - O J Ungar
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel
| | - Y Oron
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel
| | - R Ben Ami
- Department of Infectious Diseases, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M Dekel
- Department of Infectious Diseases, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - O Handzel
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel
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Author's response to letter to the editor: "Fungal otitis externa and wet ear with mucopurulent should be a influencing factors on tympanic membrane closure". Eur Arch Otorhinolaryngol 2020; 277:2147. [PMID: 32206872 DOI: 10.1007/s00405-020-05917-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
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Lou Z. Fungal otitis externa and wet ear with mucopurulent should be influencing factors on tympanic membrane closure. Eur Arch Otorhinolaryngol 2020; 277:1557-1558. [DOI: 10.1007/s00405-020-05815-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 11/30/2022]
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