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El-Anwar MW, Fouad YA, Elgohary AF, Saber S, Mobasher MA. External Auditory Canal: Computed Tomography Analysis and Classification. Int Arch Otorhinolaryngol 2023; 27:e565-e570. [PMID: 37876695 PMCID: PMC10593536 DOI: 10.1055/s-0042-1758213] [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: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Computed tomography (CT) details of the external auditory canal (EAC) are not fully covered in the literature, so building up base for the CT evaluation and description is important. Preoperative details of the EAC are mandatory before any approach or procedure involving the canal. Objective To determine the different dimensions, measurements, and grading of the EAC by CT scan that were not previously published. Methods The CT scans of 100 temporal bones (200 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. Results At the EAC entry, the mean vertical length (height) was 7.75 ± 1 mm, and its mean horizontal length (width) was 6.1 ± 0.8. At the bony cartilaginous junction of the EAC, the mean vertical length was 7.88 ± 1 mm, and its mean horizontal length was 6.22 ± 0.9. At the EAC isthmus, the mean vertical length was 6.8 ± 0.97 mm, and its mean horizontal length was 5.2 ± 0.76. At the medial end of the EAC, the mean vertical length was 7.1 ± 0.9 mm, and its mean horizontal length was 5.4 ± 0.85. There were no reported significant differences between right and left sides in all dimensions. Males showed significantly longer vertical and horizontal dimensions of the EAC entry, vertical dimension of the isthmus, and vertical dimension of the medial end of the EAC than females. Conclusion This study improves otologists and radiologists' awareness of EAC variations in the ear field and can be of help to residents in training.
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Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Yasser Ahmed Fouad
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Fouad Elgohary
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh Saber
- Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Adel Mobasher
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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2
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Martinez JC, Hwee GZ, Yap L, De Chua KW, Kamath S, Chung CKR, Teo WYB, Tan CKL, Dritsas S, Simpson RE. Lexicon for classifying ear-canal shapes. Sci Rep 2023; 13:11866. [PMID: 37481591 PMCID: PMC10363131 DOI: 10.1038/s41598-023-38570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023] Open
Abstract
The ear canal is usually described as an S-shaped funnel. In attempting to classify ear-canal shapes obtained from point clouds digitized from molds of 300 ears, the problem of designing criteria for distinguishing and organizing the canal shapes arose. In this work, we extracted features inspired by the S-shape characteristic (critical point, maximum, minimum, twist, writhe, translation, rotation) and, through them, introduced 14 types of ear-canal shapes. This classification allowed comparison of ears within a type and of ears between different types. It expanded our range of descriptors of canal shapes and unlocked perspectives for applications.
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Affiliation(s)
- J C Martinez
- Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore.
| | - Goh Zhi Hwee
- Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore
| | - Luis Yap
- University of Sydney, Sydney, NSW, 2006, Australia
| | - Kenneth Wei De Chua
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore, Singapore
| | - Savitha Kamath
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore, Singapore
| | - Conrad Kang Rui Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore, Singapore
| | - Wendy Yu Bing Teo
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore, Singapore
| | - Charmaine Kai Ling Tan
- Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore
| | - Stylianos Dritsas
- Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore
| | - Robert E Simpson
- School of Engineering, University of Birmingham, Birmingham, B15 2TT, UK
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3
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Mammarella F, Loperfido A, Cianciulli M, Fionda B, Stasolla A, Bellocchi G. External Auditory Canal Cholesteatoma after Radiation Therapy for Nasopharyngeal Cancer: Case Series and Systematic Review. J Clin Med 2023; 12:jcm12051977. [PMID: 36902764 PMCID: PMC10004166 DOI: 10.3390/jcm12051977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/20/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
The authors performed a systematic review, in accordance with the PRISMA guidelines, across multiple databases, including all original studies published until November 2022, focusing on External auditory canal cholesteatoma (EACC) after radiation therapy (RT) for nasopharyngeal cancer (NC). Inclusion criteria were original articles reporting on secondary EACC after RT for NC. Articles were critically appraised to assess level of evidence using the Oxford Center for Evidence-Based Medicine criteria. Overall, 138 papers were identified and after duplicate removal (34 papers) and excluding papers not in English, 93 papers were assessed for eligibility; finally, only five papers were included and summarized with the three cases coming from our institution. These mainly involved the anterior and the inferior part of the EAC. The mean time of diagnosis after RT was the largest series of 6.5 years (with a range from 0.5 to 15.4 years). Patients undergoing RT for NC have 18 times a higher risk of developing EACC compared to the normal population. EACC is probably one of the most underreported side effects, because patients may present variable clinical findings, which could lead to misdiagnosis. Early diagnosis of RT related EACC is advised to enable conservative treatment.
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Affiliation(s)
- Fulvio Mammarella
- Otolaryngology Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | | | - Michele Cianciulli
- Department of Radiation Oncology, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Bruno Fionda
- U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
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Chen CK, Kuo CL, Weng YT, Hsieh LC. Endoscopic transcanal transtympanic myringoplasty vs. endoscopic transcanal tympanoplasty: 1-year follow-up study. J Chin Med Assoc 2022; 85:1017-1023. [PMID: 35818928 DOI: 10.1097/jcma.0000000000000777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Endoscopic transcanal transtympanic myringoplasty (ETTM) is a relatively easier technique than endoscopic transcanal tympanoplasty (ETT) for repairing tympanic membrane perforations. No studies have compared the outcomes of these two procedures with tragal perichondrium after 1-year. Furthermore, there is no evidence-based stratification according to variations in perforation size in endoscopic ear surgery. Therefore, we compared the 1-year outcomes of ETTM and ETT stratified according to perforation size. METHODS Patients who underwent ETT and ETTM to repair eardrum perforations with a tragal perichondrium graft were identified. Pure-tone audiometric tests and otoscopic examination were performed to assess hearing outcomes and perforation sizes both preoperatively and at least 1 year postoperatively. RESULTS In total, 158 patients (159 ears) were included. ETT was performed on 83 ears, and ETTM was performed on 76 ears. The ETTM procedure time was 10-minutes shorter than that for ETT ( p < 0.001). Perforation size was significantly correlated with graft take-rate. For large perforations, the ETT success rate was significantly higher than that of ETTM (91.7% vs. 78.9%). Success rates for small-medium perforations were comparable for both methods ( p > 0.05). However, for medium perforations, the graft take-rate of ETT reached a plateau after 6 months, while that of ETTM gradually declined during the 12-month follow-up. Both groups had a comparable mean postoperative air-bone gap gain ( p = 0.666). CONCLUSION ETTM is suitable for repairing small perforations, whereas ETT is preferred for large perforations. Both methods, and particularly ETTM, should be employed cautiously for medium perforations.
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Affiliation(s)
- Chin-Kuo Chen
- Department of Otolaryngology-Head and Neck Surgery and Communication Enhancement Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
| | - Chin-Lung Kuo
- Department of Otolaryngology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Ting Weng
- Schcool of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Chun Hsieh
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan, ROC
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5
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Zhang Q, Zhang L, Zeng N, Hu J, Li S, Gao C, Yang Q. Canalplasty using underwater bone drilling in transcanal endoscopic myringoplasty for patients with a narrow external auditory canal. Acta Otolaryngol 2022; 142:543-548. [PMID: 35895385 DOI: 10.1080/00016489.2022.2099014] [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: 11/01/2022]
Abstract
BACKGROUND Canalplasty is important in microscopic ear surgery, but it has rarely been studied in otoendoscopic surgery. OBJECTIVES The aim of this study was to investigate the application of canalplasty due to external auditory canal stenosis caused by bony bulges in endoscopic myringoplasty. MATERIALS AND METHODS The procedures and effects of canalplasties and myringoplasties were analysed. During the canalplasties, depending on the location of the bulges, the meatal skin flaps were elevated in different manners, and the underwater bone drilling technique was adopted to remove the bulges to enlarge the osseous canals. RESULTS Canalplasties were performed in 18.5% (33/178) of myringoplasties. All surgeries were completed exclusively via the transcanal endoscopic approach. No iatrogenic injuries were found. Most of the canalplasties required drilling off bulges on multiple walls. The mean total duration of the canalplasties and myringoplasties was 76.6 ± 4.5 min, and the proportion of time required for the canalplasties was 47.3 ± 2.4%. CONCLUSION Only approximately one in five endoscopic myringoplasties require antecedent canalplasties due to concurrent canal stenosis. With the underwater bone drilling technique, transcanal endoscopic canalplasty can be safely and efficiently conducted.
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Affiliation(s)
- Quanming Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
| | - Lue Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
| | - Nan Zeng
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
| | - Jing Hu
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
| | - Shuo Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
| | - Chunsheng Gao
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
| | - Qiong Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
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6
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Ayache S. Transcanal Endoscopic Ear Surgery for Epitympanic Cholesteatoma With Obliteration Using Bioglass. Laryngoscope 2021; 132:433-435. [PMID: 34184754 DOI: 10.1002/lary.29710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Stephane Ayache
- Department of Otorhinolaryngology - Head & Neck Surgery, Otology & Neurotology Unit, Hospital Centre Simone Veil, Cannes, France
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7
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James AL. Totally endoscopic tympanic membrane repair. HNO 2021; 69:791-796. [PMID: 34041565 DOI: 10.1007/s00106-021-01052-x] [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] [Accepted: 03/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transcanal totally endoscopic ear surgery (TEES) has become increasingly popular internationally; however, for surgeons trained with a two-handed microscope-guided approach, the potential challenges of adopting TEES can appear off-putting. OBJECTIVES This article outlines the pros and cons of TEES for tympanic membrane repair and describes aspects of surgical technique relevant to those who might adopt this approach. MATERIALS AND METHODS Data are provided from the author's experience along with a review of relevant literature, including several meta-analyses of tympanoplasty outcome. RESULTS Meta-analyses show that TEES tympanoplasty is as effective at closing tympanic membrane perforations and improving hearing as microscope-guided surgery. Yet patients benefit from avoidance of a skin incision and faster recovery. CONCLUSION Repair of the tympanic membrane with TEES is feasible and effective. This minimally invasive approach is very appealing to patients.
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Affiliation(s)
- Adrian L James
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada.
- Department of Otolaryngology, Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Canada.
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8
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Chen YC, Huang CY, Kuo YJ, Cheng HL, Cheng YF, Liao WH. Developing a novel meatal areolar tissue autograft for minimally invasive tympanoplasty. J Chin Med Assoc 2020; 83:956-961. [PMID: 32649410 PMCID: PMC7526586 DOI: 10.1097/jcma.0000000000000392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We developed an easy and minimally invasive method of transmeatal tympanoplasty using meatal areolar tissue (MAT) grafts to achieve less postoperative morbidity or surgical scarring. We compared the functional and anatomical results of the developed method with conventional endaural tympanoplasty with a temporalis fascia (TF) graft. METHODS In this retrospective cohort study, 58 patients (59 ears) with simple chronic otitis media who underwent type I tympanoplasty between January 2016 and August 2018 were included. All surgeries were performed in a tertiary referral hospital and by the same senior surgeon. The tympanic membrane (TM) was repaired with either a TF or an MAT graft. RESULTS Healing of the perforated TM and improvement in a hearing test by air-bone gap (ABG) closure were identified. Postoperative wound conditions were also evaluated. Twenty-eight ears were grafted with MAT, and 31 ears were grafted with TF. Graft success was observed in 26 patients (92.9%) in the MAT group and 28 patients (90.3%) in the TF group. Both groups showed functional improvement compared with the preoperative measurements. The postoperative pure tone audiogram (p = 0.737), ABG closure (p = 0.547), and graft success rate (p = 0.726) were not significantly different between the two groups. Neither wound dehiscence nor keloid formation was observed in our patients. CONCLUSION Both MAT and TF grafts revealed satisfactory surgical and functional results. Compared with the conventional endaural approach with TF grafts, the new transmeatal approach method with an MAT graft causes relatively minimal trauma and results in better wound cosmetics. This method represents an easy, minimally invasive surgery and shows comparatively good results.
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Affiliation(s)
- Yen-Chi Chen
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chii-Yuan Huang
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ying-Ju Kuo
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsiu-Lien Cheng
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yen-Fu Cheng
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Address correspondence: Dr. Yen-Fu Cheng and Dr Wen Huei Liao, Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (Y.-F. Cheng); (W.H. Liao)
| | - Wen Huei Liao
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Address correspondence: Dr. Yen-Fu Cheng and Dr Wen Huei Liao, Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (Y.-F. Cheng); (W.H. Liao)
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9
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Ayache S, Kutz W, Isaacson B, Badr-El-Dine M, Nogueira JF, Marchioni D, Presutti L. COVID-19 and ear endoscopy in otologic practices. Eur Arch Otorhinolaryngol 2020; 278:2133-2135. [PMID: 32876726 PMCID: PMC7466917 DOI: 10.1007/s00405-020-06309-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
Purpose Otolaryngologists have had to postpone the majority of surgical procedures in the current COVID-19 pandemic. Airborne transmission, beyond the projection of droplets from upper airways, expose healthcare workers to a risk of viral infection. Aerosol generating procedures (AGP) increase the risk of viral transmission to staff within the operating room. Methods Surgery of middle ear and mastoid is also considered an AGP, particularly mastoidectomy performed using a high-speed drill. The authors report their experience in endoscopic ear surgery as an alternative technique to reduce AGP in otologic procedures. Results Transcanal endoscopic ear surgery is a reliable technique used to manage many otologic conditions. Conclusion The endoscopic approach may reduce the risk of viral transmission to operating room staff by reducing the need for mastoidectomy.
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Affiliation(s)
- Stephane Ayache
- Otology and Neurotology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Centre Simone Veil, Cannes, France.
| | - Walter Kutz
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brandon Isaacson
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mohamed Badr-El-Dine
- Department of Otolaryngology, University Hospital of Alexandria, Alexandria, Egypt
| | - Joao Flavio Nogueira
- Department of Otolaryngology-Head and Neck Surgery, Estedualda Ceara University, Sinus and Oto Centro, Fortaleza, Brazil
| | - Daniele Marchioni
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Livio Presutti
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
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10
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Chen CK, Hsieh LC. Clinical outcome of exclusive endoscopic tympanoplasty with porcine small intestine submucosa in 72 patients. Clin Otolaryngol 2020; 45:938-943. [PMID: 32657525 DOI: 10.1111/coa.13607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/05/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Chin-Kuo Chen
- Department of Otolaryngology-Head and Neck Surgery and Communication Enhancement Center, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan
| | - Li-Chun Hsieh
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Audiology and Speech Language Pathology, Mackay Medical College, Taipei, Taiwan
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11
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Morphometry of the external auditory canal: Radiological study. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.680964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Rusetsky YY, Meitel IY, Anikin AV, Pashkova AE, Arutyunyan SK, Rozmanov EO, Krasivicheva OV. [External ear canal parameters and endoscopic otosurgery in children]. Vestn Otorinolaringol 2020; 85:24-29. [PMID: 32885632 DOI: 10.17116/otorino20208504124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Main difficulties of endoscopic ear surgery in children could be connected with width of external ear canal (EEC) and endoscope diameter discrepancy. OBJECTIVE To investigate EEC parameters in children, to determine cross section and to develop the recommendations whenever possible of endootosurgery performance in children. MATERIAL AND METHODS Research included two stages. First - average values determination of narrowest site EEC in children according to computer tomograms. Second - determination of age of the patient and the amount of acoustical pass at which there are specifications for performance of interventions endoscopic. RESULTS EEC square: 1-3 years - 12.6±1.91 mm2, diameter is 4.01±0.59 mm; 4-7 years - 16.8±1.34 mm2, diameter is 5.34±0.43 mm; 8-11 years - 21.7±1.38 mm2, diameter is 6.9±0.45 mm; 12-18 years - 31.3±4.27 mm2, diameter is 9.96±1.4 mm. The difference between parameters at each of age groups was statistically reliable. Comfortable work endoscopically is possible with EEC square 20.4±3.19 mm2 and more. This corresponds to average value of EEC in 8-18 years. CONCLUSIONS Endoscopic ear surgery is inexpedient in children up to 4 years. It is necessary to expect that intervention will be exigeant and transition to the microscopic equipment is required in case of 4-7 years old patients. Endoscopic ear surgery can be used with success to performance of various manipulations and surgical interventions on a middle ear in patients 8-18 years old.
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Affiliation(s)
- Yu Yu Rusetsky
- National Medical Research Center for Children's Health, Moscow, Russia
| | - I Yu Meitel
- National Medical Research Center for Children's Health, Moscow, Russia
| | - A V Anikin
- National Medical Research Center for Children's Health, Moscow, Russia
| | - A E Pashkova
- National Medical Research Center for Children's Health, Moscow, Russia
| | - S K Arutyunyan
- National Medical Research Center for Children's Health, Moscow, Russia
| | - E O Rozmanov
- National Medical Research Center for Children's Health, Moscow, Russia
| | - O V Krasivicheva
- National Medical Research Center for Children's Health, Moscow, Russia
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13
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Lubner RJ, Barber SR, Knoll RM, Kempfle J, Lee DJ, Reinshagen KL, Remenschneider AK, Kozin ED. Transcanal Computed Tomography Views for Transcanal Endoscopic Lateral Skull Base Surgery: Pilot Cadaveric Study. J Neurol Surg B Skull Base 2019; 82:338-344. [PMID: 34026410 DOI: 10.1055/s-0039-3400219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022] Open
Abstract
Objective Transcanal endoscopic operative approaches provide for a minimally invasive surgical portal to the lateral skull base. Traditional preoperative imaging evaluation involves computed tomography (CT) acquisition in the axial and coronal planes that are not optimized for the transcanal surgical corridor. Herein, we describe a novel CT-based "transcanal view" for preoperative surgical planning and intraoperative navigation. Study Design Present study is a cadaveric imaging study. Methods Cadaveric temporal bones ( n = 6) from three specimens underwent high-resolution CT (0.625 mm slice thickness). Using three-dimensional (3D) Slicer 4.8, reformatted "transcanal" views in the plane of the external auditory canal (EAC) were created. Axial and coronal reformats were used to compare and measure distances between anatomic structures in the plane of the EAC. Results The degree of oblique tilt for transcanal CT reformats was 6.67 ± 1.78 degrees to align the EAC in axial and coronal planes. Anticipated critical landmarks were identified easily using the transcanal view. Mean values were 8.68 ± 0.38 mm for annulus diameter, 9.5 ± 0.93 mm for isthmus diameter, 10.27 ± 0.73 mm for distance between annulus and isthmus, 2.95 ± 0.13 mm for distance between annulus and stapes capitulum, 5.12 ± 0.35 mm for distance between annulus and mastoid facial nerve, and 19.54 ± 1.22 mm for EAC length. Conclusion This study is the first to illustrate a novel "transcanal" CT sequence intended for endoscopic lateral skull base surgery. Future studies may address how incorporation of a transcanal CT reformat may influence surgical decision making.
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Affiliation(s)
- Rory J Lubner
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Samuel R Barber
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, University of Arizona College of Medicine, Tucson, Arizona, United States
| | - Renata M Knoll
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Judith Kempfle
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Daniel J Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Katherine L Reinshagen
- Department of Radiology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Aaron K Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States.,Department of Otolaryngology, University of Massachusetts Medical Center, Worcester, Massachusetts, United States
| | - Elliott D Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
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