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Touska P, Connor SEJ. ESR Essentials: imaging of middle ear cholesteatoma-practice recommendations by the European Society of Head and Neck Radiology. Eur Radiol 2024:10.1007/s00330-024-11021-x. [PMID: 39186104 DOI: 10.1007/s00330-024-11021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 06/28/2024] [Accepted: 07/10/2024] [Indexed: 08/27/2024]
Abstract
Although non-malignant, middle ear cholesteatoma can result in significant complications due to local bone erosion and infection. The treatment of cholesteatoma is surgical, but residual disease is common and may be clinically occult, particularly when the canal wall is preserved or reconstructive techniques are employed. Imaging plays a pivotal role in the management of patients with middle ear cholesteatoma-aiding clinical diagnosis, identifying complications, planning surgery, and detecting residual disease at follow-up. Computed tomography is the primary imaging tool in the preoperative setting since it can provide both a surgical roadmap and detect erosive complications of cholesteatoma. The ability of magnetic resonance imaging with non-echoplanar diffusion-weighted sequences to accurately detect residual disease has led to a shift in the diagnostic paradigm for post-surgical follow-up of cholesteatoma, such that routine "second-look" surgery is no longer required. The following practice recommendations are aimed at helping the radiologist choose appropriate imaging approaches and understand the key diagnostic considerations for the evaluation of pre- and post-surgical middle ear cholesteatoma. KEY POINTS: In the preoperative setting, CT is the first-line imaging modality and MRI is reserved for rare clinical scenarios (low evidence). Non-echoplanar imaging (EPI) DWI is the optimal MRI sequence for the detection of residual cholesteatoma (moderate evidence). Non-EPI DWI plays an important role in the postoperative surveillance of cholesteatoma (moderate evidence).
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Affiliation(s)
- Philip Touska
- Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Steve E J Connor
- Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom.
- Department of Neuroradiology, Kings College Hospital NHS Trust, Denmark Hill, London, SE5 9RS, United Kingdom.
- School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's College London, London, United Kingdom.
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Iannella G, Pace A, Greco A, De Virgilio A, Croce E, Maniaci A, Lechien JR, Gioacchini FM, Re M, Cammaroto G, Perrone T, Cocuzza S, Magliulo G. Endoscopic ear surgery in the treatment of chronic otitis media with atelectasis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08845-0. [PMID: 39126509 DOI: 10.1007/s00405-024-08845-0] [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: 04/22/2024] [Accepted: 07/12/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE Atelectasis otitis media (AtOM) is a chronic condition where the tympanic membrane (TM) becomes retracted towards the middle ear and the ossicular chain. Surgical treatment for this condition could be indicated based on stage of atelectasis, patient's clinical condition and hearing loss. Over the years, AtOM has been treated with various types of tympanoplasty under microscopic view. The aim of this study is to present the results of endoscopic ear surgery in AtOM. METHODS Forty-five patients who underwent endoscopic trans-canal tympanoplasty were included in the study. Preoperative features, intraoperative findings and postoperative outcomes were collected. RESULTS Preoperatively, none of the study's patients were classified with a Sadè Grade I, whereas grades II, III and IV were 3 (6.6%), 23 (32.1%) and 19 (67.8%) respectively. The 3 patients with Sadè grade II showed a conductive hearing loss higher than 20 dB and a continuous ear fullness, therefore they were surgically treated. The postoperative graft success rate was estimated at 95.5%. During follow-up, 2 patients showed a TM perforation (at 6 and 12 months after surgery) whereas 1 patient experienced a recurrence of atelectasis in the TM (16 months after surgery). The overall success rate at the final follow-up was calculated at 88.8%. The average preoperative air-conduction threshold was 51.1 ± 21.5, which reduced to 34.6 ± 22.1 (p = 0.04) at follow-up. The preoperative air-bone gap decreased from 28 ± 7.2 to 11.8 ± 10 (p = 0.002) after surgery. CONCLUSION Atelectasis otitis media might be suitable for exclusive endoscopic surgical treatment, as it appears to exhibit a low recurrence rate and promising audiological outcomes.
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Affiliation(s)
- Giannicola Iannella
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00183, Rome, Italy.
| | - Annalisa Pace
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00183, Rome, Italy
| | - Antonio Greco
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00183, Rome, Italy
| | - Armando De Virgilio
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00183, Rome, Italy
| | - Enrica Croce
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00183, Rome, Italy
| | | | - Jerome R Lechien
- Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons, Belgium
| | - Francesco Maria Gioacchini
- Department of Clinical and Molecular Sciences, ENT Unit, Polytechnic University of Marche, Ancona, Italy
| | - Massimo Re
- Department of Clinical and Molecular Sciences, ENT Unit, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, OtolaryngologyForlì, Italy
| | | | - Salvatore Cocuzza
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Giuseppe Magliulo
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00183, Rome, Italy
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Sacchetto L, Raguso G, Confuorto G, Arietti V, Torroni L, Marchioni D, Nocini R. A comparison between endoscopic and microscopic approaches for stapes surgery: experience of a tertiary referral center. Eur Arch Otorhinolaryngol 2024; 281:2959-2965. [PMID: 38158420 DOI: 10.1007/s00405-023-08411-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Otosclerosis is a common ear disease causing ankylosis of the stapedio-vestibular joint and conductive hearing loss. Stapedoplasty is the most advisable surgical solution. The restoration of hearing depends on the condition of the patient and the surgery itself. The aim of our work was to compare the surgical and audiological results of stapedoplasty performed with endoscopic versus microscopic technique. METHODS This is a retrospective study of 254 patients treated with stapedoplasty with a microscopic approach (91/254) or with an endoscopic approach (163/254) between 2014 and 2021 at our tertiary referral center. Statistical significance of differences between the two methods was determined using the Mann-Whitney test for quantitative variables and the Wilcoxon matched-pairs signed-rank test for repeated measures. Categorical variables were assessed with Fisher's exact test. RESULTS Both techniques improved the hearing status of patients, with no statistically significant difference between them. There was also no statistically significant difference in reported complications between the two techniques. There is a statistical difference (p < 0.001) in operating time between the two techniques: the endoscopic technique had a mean operating time of 39 min versus 45 min for the microscopic technique. CONCLUSIONS The two techniques are comparable in terms of results and the choice depends on the surgeon's preferences and experience.
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Affiliation(s)
- L Sacchetto
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy
| | - G Raguso
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy
| | - G Confuorto
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy
| | - V Arietti
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy.
| | - L Torroni
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - D Marchioni
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - R Nocini
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy
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Kostadinov F, Schlegel-Wagner C, Linder T. A tailored approach in cholesteatoma surgery. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08748-0. [PMID: 38809267 DOI: 10.1007/s00405-024-08748-0] [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: 03/25/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE In recent years, new techniques have been added to cholesteatoma surgery, and established microsurgical approaches are being reconsidered. This study aims to present the importance of individualized decision-making for the selection of an intact canal wall (CWU) or canal wall down (CWD) surgical procedure for each patient. METHODS Using the "ChOLE" classification we categorized 264 operations retrospectively. 162 CWU and 102 CWD surgeries were performed. We focus to determine why a CWD procedure was chosen quite frequently despite some low-stage cases. Furthermore, we evaluated recidivism and hearing outcomes. RESULTS Smaller cholesteatomas (Ch-stage 1a, 1b & 2a) were found in 182 patients (70%), ossicular chain status feasible for straightforward reconstruction (O-stage 0, 1 & 2) was present in 186 patients (70%), minor complications due to the cholesteatoma (L-stage 1) were infrequent with 28 cases (11%) and a well-pneumatized mastoid was found in 144 cases (55%). Recidivism rates were low (7%) without any difference in both groups and a mean follow-up time of 4 years and 8 months. In primary surgeries there was a significant difference (p < 0.05) in postoperative mean air-bone gap (ABG) between CWU (17dB) and CWD (27dB). CONCLUSION The main goals of cholesteatoma surgery remain the avoidance of recidivism and optimal hearing rehabilitation. We recommend a tailored approach in the treatment of cholesteatomas and not a dogmatic one. Surgeons should not hesitate to perform a CWD procedure if required. Performed correctly it results in a dry ear and CWD surgery should remain in the skill set of the otologic surgeon.
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Affiliation(s)
- Filip Kostadinov
- Department of Otorhinolaryngology/Head and Neck Surgery, Luzerner Kantonsspital, Spitalstrasse 16, Luzern, 6000, Switzerland.
| | - Christoph Schlegel-Wagner
- Department of Otorhinolaryngology/Head and Neck Surgery, Luzerner Kantonsspital, Spitalstrasse 16, Luzern, 6000, Switzerland
| | - Thomas Linder
- Department of Otorhinolaryngology/Head and Neck Surgery, Luzerner Kantonsspital, Spitalstrasse 16, Luzern, 6000, Switzerland
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Kobayashi T, Kuzume M, Ito H, Komori M, Hyodo M. Surgical results of 29 ears with congenital middle ear anomalies; Microscopic vs. endoscopic ear surgery. Auris Nasus Larynx 2024; 51:412-416. [PMID: 37648585 DOI: 10.1016/j.anl.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Although congenital middle ear anomalies include various types of ossicular anomalies, all of these can be treated by ossiculoplasty or stapes surgery. Transcanal endoscopic ear surgery (TEES) is a minimally invasive surgical method for middle ear disease with an excellent surgical view that has been widely adopted worldwide. To determine the efficacy of TEES for middle ear anomalies, we describe the surgical results and compare the hearing outcomes between patients treated by TEES and microscopic ear surgery (MES). METHODS A total of 39 ears with congenital middle ear anomalies were treated surgically at the University Hospital of Kochi Medical School between January 2011 and December 2021. In total, 29 ears of 23 patients were included in the study. Demographics, type of anomaly, surgical methods, pre- and postoperative hearing thresholds, and surgical complications were investigated by retrospective chart review. RESULTS Of the 29 ears, 11 were treated by MES and 18 were treated by TEES. There were no differences in sex, age, preoperative hearing thresholds, or rate of stapes surgery between the two groups. The mean air-bone gap improvement was 20.6 dB in the MES group and 28.8 dB in the TEES group; these values were not significantly different. The median operation time was not significantly different between the MES and TEES groups (125 and 130 min, respectively). The improvements of air conduction in class 1 and 2 (stapes surgery) and class 3 (ossiculoplasty) cases were also not different between the groups. CONCLUSIONS TEES achieved comparable hearing outcomes to MES without postauricular or endaural incisions. Further, class 1 and 2 anomalies demonstrated hearing improvement similar to class 3 without major complications. Since the surgical field limited around the ossicular chain, coupled with the fact that the middle ear anomaly itself does not exhibit inflammation leading to unfavorable bleeding, TEES is a feasible surgical procedure for all types of congenital ossicular anomalies.
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Affiliation(s)
- Taisuke Kobayashi
- Department of Otolaryngology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, JAPAN.
| | - Mayu Kuzume
- Department of Otolaryngology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, JAPAN
| | - Hiroaki Ito
- Department of Otolaryngology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, JAPAN
| | - Masahiro Komori
- Department of Otolaryngology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, JAPAN
| | - Masamitsu Hyodo
- Department of Otolaryngology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, JAPAN
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Pietraszek M, Bartochowska A, Wierzbicka M, Gawęcki W. The assesment of intraoperative use of mesna in canal wall-up cholesteatoma surgery - preliminary report. OTOLARYNGOLOGIA POLSKA 2023; 77:1-6. [PMID: 37772375 DOI: 10.5604/01.3001.0016.3415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
<b>Introduction:</b> Surgery is still the method of choice in chronic otitis media with cholesteatoma. Except for some specific clinical situations, classic canal wall up technique (CWU), remains a gold standard as a primary treatment in most departments. Unfortunately, the risk of recurrence in such an approach is estimated at 9 to even 70%. This fact prompts researchers to look for ways to reduce those unfavourable statistics. One of the recognized methods supporting the removal of cholesteatoma is the intraoperative use of mesna (sodium 2-mercaptoethanesulfonate). This synthetic sulphur compound disrupts disulfide bridges in polypeptide chains, thanks to which it facilitates matrix preparation.</br></br> <b>Aim:</b> To evaluate the effect of intraoperative use of mesna on the treatment outcomes in patients with chronic otitis media with cholesteatoma operated on by means of the canal wall up technique (CWU).</br></br> <b>Material and methods:</b> 459 surgical reports of patients with middle ear cholesteatoma were analyzed. In total, 52 adult patients with no history of previous ear surgery operated on by means of the CWU technique by the same experienced otosurgeon with all follow-up data available were included in the study. Twenty-six were operated on with the use of mesna (mesna group) and 26 by means of the classic CWU technique (control / no-mesna group). There were 28 women and 24 men with a mean age of 41 years.</br></br> <b>Main Outcome Measure(s):</b> Postoperative hearing results and cholesteatoma recidivism rate.</br></br> <b>Results:</b> Overall recidivism rate was 21.15 %. It was higher in the no-mesna (26.9%) than in the mesna group (15.4%) - although the outcomes were better in the mesna group, the difference was not statistically significant (P = 0.49715). Hearing gain was better in the mesna than in the no-mesna group (10 dB vs 7 dB), but the difference was not statistically significant (P = 0.20089).</br></br> <b>Conclusions:</b> Our preliminary results show that mesna reduces recidivism rates in patients with cholesteatoma. Further study with the analysis of a larger group of patients is needed to prove it statistically.
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Affiliation(s)
- Marta Pietraszek
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Anna Bartochowska
- Department of Otolaryngology and Laryngological Oncology, Medical University of Poznan, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Gawęcki
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
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Iannella G, Pace A, Greco A, Polimeni A, Maniaci A, Mucchino A, Lechien JR, Saibene AM, Mat Q, Gargula S, Fakhry N, Simone F, Gioacchini FM, Re M, Magliulo G. Endaural microscopic approach versus endoscopic transcanal approach in treatment of attic cholesteatomas. Am J Otolaryngol 2023; 44:103860. [PMID: 36996516 DOI: 10.1016/j.amjoto.2023.103860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Compare the audiological results and postoperative outcomes of the endoscopic approach versus the endaural microscopic approach for treatment of attic cholesteatomas, using a randomized prospective model. MATERIALS AND METHODS Eighty patients were consecutively enrolled in the study and randomized into two groups of treatment of 40 patients: Group A -tympanoplasty with a microscopic endaural approach; Group B -tympanoplasty with an exclusive trans-meatal endoscopic approach. Preoperative, intraoperative and postoperative outcomes were evaluated. Hearing was assessed preoperatively and at 1 month, 3 months and 6 months after surgery in both groups. RESULTS There were no differences in the parameters analyzed (CT findings, patient age, disease duration, intraoperative cholesteatoma characteristics,) between the group A and B patients. No statistical difference between the two groups regarding hearing improvement, abnormal taste sensation, dizziness, post-operative pain and healing times emerged. Graft success rate was 94.5 % and 92.1 % for MES and ESS respectively. CONCLUSION Both microscopic and exclusively endoscopic endaural approaches offer similar and excellent results in the surgical treatment of attic cholesteatomas.
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Wong K, Gorthey S, Arrighi-Allisan AE, Fan CJ, Barber SR, Schwam ZG, Wanna GB, Cosetti MK. Defining the Learning Curve for Endoscopic Ear Skills Using a Modular Trainer: A Multi-Institutional Study. Otol Neurotol 2023; 44:346-352. [PMID: 36805421 DOI: 10.1097/mao.0000000000003826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Quantify the learning curve for endoscopic ear skills acquisition in otolaryngology residents using a simulator. The secondary objective was to determine if demographic factors or previous endoscopic experience influenced skill development. STUDY DESIGN Prospective, multicenter study. Resident participants each completed 10 amassed trials using a validated endoscopic ear skill trainer. SETTING Two academic teaching hospitals. SUBJECTS Otolaryngology residents. MAIN OUTCOME MEASURES Trial completion times; rate of improvement over time. RESULTS Thirty-eight residents completed the study, 26 from program A and 12 from program B. Fifteen participants were women and 23 were men. Mean age was 30 years old (range 26 to 34 years). Previous experience with otoendoscopy (B = -16.7, p = 0.005) and sinus endoscopy (B = -23.4, p = 0.001) independently correlated with lower overall trial times. Age, gender, postgraduate year, handedness, interest in otology, and video gaming were not associated with trial times. On multivariate logistic regression, resident completion times improved with trial number, and residents without previous endoscopy experience improved at a faster rate than those with experience ( p < 0.001). CONCLUSIONS Novice surgeons may acquire basic endoscopic ear experience with self-directed simulation training. The learning curve for transcanal endoscopic ear surgery is comparable to those demonstrated for other otologic surgeries, and specific task competencies can be achieved within 10 trials, suggesting that previous experiences, or lack thereof, may not dictate the ability to acquire new skills. There may be a translational value to previous endoscopic sinus experience on learning transcanal endoscopic ear surgery.
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Affiliation(s)
| | - Scott Gorthey
- Department of Otolaryngology, Albert Einstein College of Medicine, New York, NY
| | | | | | - Samuel R Barber
- Department of Otolaryngology, University of Arizona College of Medicine, Tucson, AZ
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Fermi M, Bassano E, Villari D, Capriotti V, Calvaruso F, Bonali M, Alicandri-Ciufelli M, Marchioni D, Presutti L. Prognostic role of EAONO/JOS, STAMCO, and ChOLE Staging for Exclusive Endoscopic and Endoscopic-Microscopic Tympanoplasty. Otolaryngol Head Neck Surg 2023; 168:829-838. [PMID: 36939615 DOI: 10.1002/ohn.171] [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: 07/25/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate cholesteatoma's surgical outcomes in patients treated with endoscopic ear surgery (EES) or a combined endoscopic-microscopic approach (cEMA) according to STAM, STAMCO, ChOLE, and EAONO/JOS system (EJS) classifications and staging. STUDY DESIGN Retrospective study. SETTING Monocentric study in a tertiary referral center. METHODS One-hundred sixty-eight patients who underwent EES or cEMA for cholesteatoma between 2010 and 2018 were classified according to the abovementioned classification and staging. Data on cholesteatoma's recurrence and residual rates were collected. Inferential statistical analysis was performed to evaluate surgical outcomes and the prognostic value of classifications and staging. RESULTS The recurrence rate was significantly lower in cholesteatomas classified in EJS stage 1 (2.6%) and STAM stage 1 (0%). A comparison of the different stages of the disease showed a significantly lower recurrence only for stage 1 versus the superior stages of both classifications. Involvement of mastoid bone was associated with a higher risk of recurrence (odds ratio [OR]: 4.12; p = .031). Attical involvement was associated with a higher risk of residual cholesteatoma (OR: 1.165; p = .046). CONCLUSION EES or cEMA represents an effective treatment for middle ear cholesteatoma. The STAM classification and the EJS have shown a prognostic value, with STAM 1 and EAONO-JOS 1 stages associated with a better prognosis. Mastoid involvement represents a risk factor for recurrence. Attic localization is associated with residual disease. Localization at difficult access sites did not implicate a higher risk for recurrence or residual. ChOLE classification, Ossicular chain status, and complication status did not provide prognostic information regarding recurrence or residual cholesteatoma.
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Affiliation(s)
- Matteo Fermi
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Edoardo Bassano
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Domenico Villari
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Vincenzo Capriotti
- Otorhinolaryngology and Head and Neck Surgery Unit, ASST Bergamo Ovest, Treviglio-Caravaggio Hospital, Treviglio, Italy
| | - Federico Calvaruso
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Marco Bonali
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | | | - Daniele Marchioni
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
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Ragonesi T, Niederhauser L, Fernandez IJ, Molinari G, Caversaccio M, Presutti L, Anschuetz L. Digital image enhancement may improve sensitivity of cholesteatoma detection during endoscopic ear surgery. Clin Otolaryngol 2023. [PMID: 36939045 DOI: 10.1111/coa.14049] [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: 04/11/2022] [Revised: 02/22/2023] [Accepted: 03/05/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVES This study investigates the possible benefits and limitations of the digital image enhancement systems provided by Storz Professional Image Enhancement System (SPIES) during endoscopic ear surgery (EES) for cholesteatoma. An increased detection of cholesteatoma residuals during the final steps of endoscopic surgery using DIE technology was hypothesized. DESIGN Cross-sectional study. SETTING Tertiary referral hospital. METHODS A total of 10 questionnaires of 18 intraoperative pictures with equal numbers of cholesteatoma and non-cholesteatoma images, each presented in three different image-enhancing modalities (Clara, Spectra A, Spectra B), were generated. Fifty-one experienced ear surgeons participated to the survey and were randomly assigned to a questionnaire and completed it at two time points. The experts were asked to rate for each picture whether cholesteatoma was present or not. The answers were compared with the histopathological reports. RESULTS Clara showed the highest accuracy in cholesteatoma detection, followed by Spectra A and lastly Spectra B. In contrast, Spectra B showed the highest sensitivity and Clara the highest specificity, while Spectra A was placed in the middle for both values. Using the Spectra B modality, most responses agreed across the two time points. Ear surgeons assessed the usefulness, as well as preference among image modalities for cholesteatoma surgery, in the following order: Clara, Spectra B, Spectra A. CONCLUSION Digital enhancement technologies are applicable to EES. After complete cholesteatoma removal, Spectra B showed the highest sensitivity in the detection of cholesteatoma residuals as compared with Clara and Spectra A. Thus, Spectra B may be recommended to avoid missing any cholesteatoma residuals during EES.
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Affiliation(s)
- Talisa Ragonesi
- Department of Otolaryngology - Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | | | - Ignacio Javier Fernandez
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giulia Molinari
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marco Caversaccio
- Department of Otolaryngology - Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Livio Presutti
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Lukas Anschuetz
- Department of Otolaryngology - Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Nair S, Aishwarya JG, Vasu PK, Karthikeyan A, Shalini M. Outcomes of Totally Endoscopic Versus Microscopic Techniques in Middle Ear Cholesteatoma: A Systematic Review and Meta-Analysis. Indian J Otolaryngol Head Neck Surg 2022; 74:4200-4211. [PMID: 36742509 PMCID: PMC9895727 DOI: 10.1007/s12070-021-02869-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023] Open
Abstract
Endoscopes have revolutionized the field of otology for the past two decades due to its minimally invasive technique and improved visualization. The advantage of endoscope during surgery for middle ear cholesteatoma both for diagnosing and aiding in removal of residual disease from the hidden areas and the resulting lower recurrence rates have been proven in the past by many authors. But the feasibility of totally endoscopic ear surgery and its surgical and patient related outcomes are yet to be explored in detail. We conducted this systematic review and meta-analysis to compare the surgical and patient related outcomes between totally endoscopic and microscopic technique in cases of acquired middle ear cholesteatoma. This meta-analysis has been conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Search engines used to identify the eligible articles were Pubmed, Web of Science, Cochrane Library, Virtual Health Library databases. The studies that compared the outcomes of microscopic and endoscopic techniques in case of acquired middle ear cholesteatoma and with more than 10 patients were included. Outcomes like recurrence, residual disease, graft uptake rate, audiological outcome, conversion rate, pain score, surgery duration, complications and quality of life outcomes were compared.The quality of the included studies was assessed by Methodological Index for Non-randomized studies criteria in case of non-randomized studies and by means of Cochrane Risk of Bias Tool in case of randomized controlled studies. A random effects model was used to calculate pooled estimates. The ODDS ratio and 95% confidence interval were calculated. The heterogeneity among the studies was represented by the Q statistic and Higgins I2 statistic. The test for overall effect was calculated by Z test and a p value of < 0.05 was considered as statistically significant. 11 studies were included in this meta-analysis. Out of 11 included studies, 4 were prospectively designed and 7 were retrospective studies. The overall effect showed recurrence rate (Z:2.69, P:0.007) was lower among endoscopic technique. Post-operative pain was less among the endoscopic technique and there was no difference between the groups with respect to surgical duration. Although endoscopic technique showed lower residual rate and post-operative vertigo with better graft success rate among the individual studies, the overall analysis showed that the difference was not statistically significant. Endoscope has been an invaluable tool in the cholesteatoma surgery over the past 20 years due to its excellent optics and minimally invasive technique. Evaluation of the present data available in the literature reveals that both the techniques have similar outcomes except for a definite advantage of endoscopic technique in reducing the recurrence and post-operative discomfort.
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Affiliation(s)
- Satish Nair
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | - J. G. Aishwarya
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | - Pooja K. Vasu
- Department of ENT-HNS, Apollo Hospitals, Bannerghatta Road, Bangalore, Karnataka 560076 India
| | | | - Martina Shalini
- Department of Community Health, Bangalore Baptist Hospital, Bangalore, Karnataka India
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Early S, Saad MA, Mallidi S, Mansour A, Seist R, Hasan T, Stankovic KM. A fluorescent photoimmunoconjugate for imaging of cholesteatoma. Sci Rep 2022; 12:19905. [PMID: 36402793 PMCID: PMC9675863 DOI: 10.1038/s41598-022-22072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/10/2022] [Indexed: 11/21/2022] Open
Abstract
Cholesteatoma is a potentially serious complication of chronic ear infections and requires surgical intervention for definitive management. Long-term complications include a frequent need for repeat surgical intervention for disease recurrence, and techniques to improve efficacy of single-stage surgery are an important area of continued research. This study investigates a novel application of the photosensitizer immune conjugate (PIC) cetuximab-benzoporphyrin derivative (Cet-BPD) for in vitro localization of human cholesteatoma tissue, coupled with an in vivo safety study for middle ear application of Cet-BPD in a murine model. In fresh human cholesteatoma tissues, Cet-BPD demonstrates selective localization to the hyperplastic squamous cell tissue associated with cholesteatoma, without localizing to other tissues such as middle ear mucosa. Applied to the murine middle ear, Cet-BPD does not demonstrate any deleterious effect on murine hearing when assessed by any of auditory brainstem response (ABR) thresholds, distortion product otoacoustic emission thresholds, or ABR wave I amplitudes. These findings demonstrate the technical promise and encouraging safety profile for the use of PICs for intraoperative localization and treatment of cholesteatoma.
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Affiliation(s)
- Samuel Early
- grid.39479.300000 0000 8800 3003Department of Otolaryngology – Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, MA USA ,grid.413086.80000 0004 0435 1668Department of Otolaryngology – Head and Neck Surgery, University of California San Diego Medical Center, San Diego, CA USA
| | - M. Ahsan Saad
- grid.32224.350000 0004 0386 9924Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA USA
| | - Srivalleesha Mallidi
- grid.32224.350000 0004 0386 9924Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA USA ,grid.429997.80000 0004 1936 7531Department of Biomedical Engineering, Tufts University, Medford, MA USA
| | - Amer Mansour
- grid.39479.300000 0000 8800 3003Department of Otolaryngology – Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA USA
| | - Richard Seist
- grid.39479.300000 0000 8800 3003Department of Otolaryngology – Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, MA USA ,grid.168010.e0000000419368956Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA USA
| | - Tayyaba Hasan
- grid.32224.350000 0004 0386 9924Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA USA
| | - Konstantina M. Stankovic
- grid.39479.300000 0000 8800 3003Department of Otolaryngology – Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, MA USA ,grid.168010.e0000000419368956Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA USA
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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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A Step towards Achieving Sustainable Otologic Surgery in Low-Resource Settings: A Cost Comparison between Shipping an Otologic versus Microscopic Surgical Setup. Audiol Res 2022; 12:388-392. [PMID: 35892665 PMCID: PMC9326652 DOI: 10.3390/audiolres12040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The advancement of otologic surgery in low-resource settings has been limited by the cost and transport of surgical equipment. This study compared the transportation costs of an otologic microscopic surgical setup (MSS) versus an endoscopic surgical setup (ESS) in low- and low to middle-income countries (LMICs) for surgical teaching. Methods: Dimensions of microscopes, endoscopes and associated surgical instruments were used to calculate shipping costs from Minneapolis, MN, USA to Kenya, Haiti and Sri Lanka. Results: The average cost of internationally shipping the ESS is less than the MSS in Kenya (ESS: USD 1344.03; MSS: USD 20,947.00; p = 0.370), Haiti (ESS: USD 549.11; MSS: USD 1679.00; p < 0.05) and Sri Lanka (ESS: USD 945.38; MSS: USD 8490.57; p = 0.377). Freight shipping was required for the MSS while the ESS can be packed into an international checked bag for USD 35.00 USD. Discussion: The ESS has fewer logistical barriers than the MSS, making the endoscope a feasible option for surgical teaching in LMICs.
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Postoperative pain after transcanal endoscopic ear surgery: A systematic literature review. Am J Otolaryngol 2022; 43:103355. [PMID: 34999349 DOI: 10.1016/j.amjoto.2021.103355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Transcanal endoscopic ear surgery is hypothesized to result in less postoperative pain when compared to nonendoscopic techniques due to its minimally invasive nature. In this systematic literature review, we aim to summarize and evaluate the evidence surrounding postoperative pain control and analgesic utilization after transcanal endoscopic ear surgery. DATABASES REVIEWED PubMed, EMBASE, and Cochrane. METHODS A systematic literature search was performed using standardized methodology. Computerized and manual searches were performed to identify studies that evaluated postoperative pain outcomes following endoscopic ear surgery. Only studies that met predetermined criteria were selected and evaluated for quality and bias. Extracted data included demographics, pain scores, analgesic administered as well as the diagnosis and type of surgery undertaken. Exclusion criteria included letters/commentaries and reviews, lack of pain outcome data and studies not concerning endoscopic ear surgery. RESULTS The systematic literature review included 24 studies. Seven were RCTs, 10 were prospective and 7 were retrospective observational studies. A total of 1859 patients were evaluated for surgical approach and postoperative pain levels and analgesic use. Due to the lack of sufficient reporting of the data, a meta-analysis was not applicable. In the qualitative synthesis for the primary outcome, weighted pooled analysis showed that there was a slight reduction in postoperative pain after transcanal endoscopic ear surgery. Based on the Cochrane risk of bias tool, the quality for the finding is low. CONCLUSION There is a small reduction in postoperative pain after transcanal endoscopic ear surgery when compared to nonendoscopic approaches, however, the clinical significance of this reduction is unclear. The evidence was from studies of only low to moderate quality.
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Zhang Z, Li JB, Li X, Zhu CY, Ren L, Huang XJ, Wu J, Ji J, Xu ZK. Janus membranes with asymmetric cellular adhesion behaviors for regenerating eardrum perforation. J Mater Chem B 2022; 10:2719-2727. [PMID: 35138320 DOI: 10.1039/d1tb02418c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The tympanic membrane plays an important role in the human hearing system, which is easily perforated under unfavorable conditions, leading to loss of hearing and otitis media. Many autologous materials and artificial materials have been used to repair a perforated tympanic membrane, but these materials sometimes can cause severe hearing loss because of their adhesion to the ossicle during the healing process and the postoperative process. Herein, we report Janus membranes with asymmetric cellular adhesion behaviors for regenerating the eardrum. These Janus membranes are constructed by co-depositing a tannic acid (TA)/3-aminopropyltriethoxysilane (APTES) coating on one surface of the polypropylene microfiltration membrane. Cellular experiments indicate that the Janus membranes have good biocompatibility and asymmetric cellular adhesion properties. The repair of the tympanic membrane perforation experiment and laser Doppler vibrometer (LDV) measurements prove that the hydrophilic surface of Janus membranes repairs perforated eardrums, and meanwhile the hydrophobic surface can avoid adhering to the inner ear tissue for reducing hearing loss. The Janus membranes have good prospects in the treatment of tympanic membrane perforation.
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Affiliation(s)
- Zhili Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The first affiliated hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jin-Bo Li
- Department of Chemistry, Zhejiang University, Hangzhou 310027, China.
| | - Xu Li
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, and Key Laboratory of Adsorption and Separation Materials & Technologies of Zhejiang Province, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
| | - Cheng-Ye Zhu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, and Key Laboratory of Adsorption and Separation Materials & Technologies of Zhejiang Province, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
| | - Liujie Ren
- Department of FPRS, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.
| | - Xiao-Jun Huang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, and Key Laboratory of Adsorption and Separation Materials & Technologies of Zhejiang Province, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
| | - Jian Wu
- Department of Chemistry, Zhejiang University, Hangzhou 310027, China.
| | - Jian Ji
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, and Key Laboratory of Adsorption and Separation Materials & Technologies of Zhejiang Province, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
| | - Zhi-Kang Xu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, and Key Laboratory of Adsorption and Separation Materials & Technologies of Zhejiang Province, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
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Jenks CM, Purcell PL, Federici G, Villari D, Presutti L, James AL, Hoff SR. Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma: A Multi-institutional Series. Otolaryngol Head Neck Surg 2021; 167:537-544. [PMID: 34932403 DOI: 10.1177/01945998211067502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess outcomes of transcanal endoscopic ear surgery (TEES) for congenital cholesteatoma. STUDY DESIGN Case series with chart review of children who underwent TEES for congenital cholesteatoma over a 10-year period. SETTING Three tertiary referral centers. METHODS Cholesteatoma extent was classified according to Potsic stage; cases with mastoid extension (Potsic IV) were excluded. Disease characteristics, surgical approach, and outcomes were compared among stages. Outcomes measures included residual or recurrent cholesteatoma and audiometric data. RESULTS Sixty-five cases of congenital cholesteatoma were included. The mean age was 6.5 years (range, 1.2-16), and the mean follow-up was 3.9 years (range, 0.75-9.1). There were 19 cases (29%) of Potsic stage I disease, 10 (15%) stage II, and 36 (55%) stage III. Overall, 24 (37%) patients underwent a second-stage procedure, including 1 with Potsic stage II disease (10%) and 21 (58%) with Potsic stage III disease. Eight cases (12%) of residual cholesteatoma occurred. One patient (2%) developed retraction-type ("recurrent") cholesteatoma. Recidivism occurred only among Potsic stage III cases. Postoperative air conduction hearing thresholds were normal (<25 dB HL) in 93% of Potsic stage I, 88% of stage II, and 36% of stage III cases. CONCLUSION TEES is feasible and effective for removal of congenital cholesteatoma not extending into the mastoid. Recidivism rates were lower with the TEES approach in this large series than in previously reported studies. Advanced-stage disease was the primary risk factor for recidivism and worse hearing result. As minimally invasive TEES is possible in the youngest cases, children benefit from early identification and intervention.
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Affiliation(s)
- Carolyn M Jenks
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patricia L Purcell
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Gaia Federici
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Domenico Villari
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Otolaryngology-Head and Neck Surgery, University Hospital of Bologna, Bologna, Italy
| | - Adrian L James
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Stephen R Hoff
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Division of Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Curran JF, Coleman H, Tikka T, Iyer A. Comparison of outcomes of endoscopic ear surgery with microsurgery for cholesteatoma: A prospective study of 91 cases with three-year follow-up. Clin Otolaryngol 2021; 47:197-202. [PMID: 34490718 DOI: 10.1111/coa.13856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/21/2021] [Indexed: 01/14/2023]
Affiliation(s)
| | - Holli Coleman
- Department of ENT, University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| | - Theofano Tikka
- Department of ENT, University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| | - Arunachalam Iyer
- Department of ENT, University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
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